Medication definition in nursing. ke/hrxiys/freno-de-escape-hino-300.

e. Here are a few examples of the benefits of preventing medication errors in nursing. 4. Access the link below to determine the nurse’s course of action. Oct 28, 2021 · Medication errors: a positive safety culture is key. We will discuss how indications for drugs are established and the differences between these two categories of indications. Confusion about the definition of care coordination makes studying this topic particularly challenging. in-dico, pp. Page ID. circumvent. The result is 30 mcg/ml. The distribution of a drug throughout the body is dependent on Jul 17, 2020 · 1. Rates can vary depending on the denominator used (e. When preparing and administering medication Critical Thinking Activity 1. ” While this definition does Estimating the prevalence of medication errors is difficult due to the varying definitions and classification systems employed. Literature predominately focuses on Nov 22, 2021 · Medical-surgical nursing is the single largest nursing specialty in the United States and beyond. The American Psychiatric Nurses Association (APNA) Web site provides information about the role of the advanced practice psychiatric nurse organized by topic, workplace setting, and/or specialty. Dispensing: the pharmacist must check for drug–drug interactions and allergies, then release the appropriate quantity of the medication in the correct form. It is important to know which medications need to be monitored and what the signs and symptoms of toxicity are. Usually, drugs of the same therapeutic class are given names with the same stem. May 23, 2024 · Medical and Nursing Terminologies Healthcare professionals, including nurses and doctors, use a specialized set of vocabulary to ensure precise and efficient communication . Introduction. Objective Data in Nursing. This literature covers the extent of the problem of medication errors and adverse drug events, the phases of the medication-use process vulnerable to error, and the threats all of this poses for patients. As such, nonadherence to medication can result in poor health outcomes, including worsening medical conditions, an increase in comorbidities, and death [ 4 ]. As the dose increases, the response of the drug may increase, as well as the potential for toxicity. Over 300 million surgical procedures are performed each year worldwide (6). Prescription Medications, OTCs, Herbals, and Supplements. Administering medication by the parenteral route is defined as medications placed into the tissues and the circulatory system by injection. It includes nurses, doctors, and various specialists. Regulations for Training Programs for Medication Administration by Unlicensed Persons and Immunization Protocol - 2-21-2019. ) Nov 21, 2023 · A drug's indications state the conditions, or symptoms for which the drug is approved. The terms describe how NICE works and how its guidance is produced. Providing free, peer-reviewed, accurate and independent data on more than 24,000 prescription drugs, over-the-counter medicines & natural products. A complete and accurate medication list is the foundation for addressing medication reconciliation Definition. Mosby’s Medical Dictionary. Here is the FAQ. The WHO, in its 2003 report on medication adherence, states that “increasing the effectiveness of adherence interventions may have a far greater impact on the health of the population than any improvement in specific medical treatment” []. Some medications that are monitored There is a large and growing body of research addressing medication safety in health care. As clinicians that blend clinical expertise in diagnosing and treating health conditions with an added emphasis on disease prevention and health management, NPs bring a comprehensive perspective and personal touch to health care. May 20, 2009 · The definition of a medication encompasses not only chemical compounds—drugs, prodrugs (which may themselves have no pharmacological activity), stereoisomers that may have only adverse effects, or compounds that are used for diagnostic purposes (such as contrast media); it also includes cellular elements, such as inactivated or attenuated A Kardex is a desktop file system that gives a brief overview of each patient and is updated every shift. They help determine if a drug is in a toxic range or if the dosage of the medication needs to be increased. " Preventable adverse events are defined as "care that fell below the standard expected of physicians in their community. In addition, 31. " When nurses implement safe nursing practices, including measures to decrease medication errors, patient safety increases. Physician’s orders and/or protocols must be rewritten or reviewed, signed and dated at least yearly, or more often if indicated. Written by medical and nursing specialists, the dictionary provides comprehensive coverage of the ever-expanding vocabulary of the nursing professions. Mr. 55% of the nurses. , patient, prescription or a specific medication). Medication competence is a pivotal priority within the academic settings to prepare nursing students and other healthcare professionals to provide sound knowledge base care and ensure safe medication delivery ( Bourbonnais and Caswell, 2014; Luokkamäki et al. It covers diagnosis, treatment, and prevention of disease, medical research, and many Mar 19, 2018 · Inotropic drugs include digoxin, dobutamine, and milrinone. These terms, often abbreviations or acronyms, are essential for clear documentation and effective patient care . As this body of literature is evaluated, the fact that there are crucial areas about which we know May 4, 2024 · Nursing2023 Drug Handbook delivers evidence-based, nursing-focused drug monographs for nearly 3700 generic, brand-name, and combination drugs. They have a broad knowledge base and are experts in their practice. Board Certified Physicians; the same authors of the Webster's New World™ Medical Dictionary. These five “rights” have been historically incorporated into the nursing curriculum as the standard processes to ensure safe medication administration. Increased Patient Safety: The ethical imperative for all patient safety efforts is, "First, do no harm. Serotonin. Eau Claire (WI): Chippewa Valley Technical College; 2023. The most common types of reported errors were wrong dosage and infusion rate. Parker has been receiving gentamicin 80 mg IV three times daily to treat his infective endocarditis. The NICE glossary provides brief definitions and explanations of terms used on the website. Studies Support Use of Daily Antibiotic to Prevent STDs in High-Risk Groups. Recent national hepatitis C outbreaks DEFINITION OF NURSING. The rights of medication administration help ensure patient safety and consistency in nursing practice. Check Order. Medication reconciliation has received much attention from health care organizations. Medication reconciliation studies have focused on the accuracy of the medication history during various transitions: ambulatory to acute care inpatient setting, skilled nursing facility to acute care inpatient setting, inpatient acute care setting to skilled nursing facility, inpatient acute care setting to discharge, inpatient floor to the intensive care unit (ICU), and ICU Definitions. Additionally, lack of proper lighting, heat/cold, and other environmental factors can cause distractions that lead to errors. Once a drug enters into systemic circulation by absorption or direct administration, it must be distributed into interstitial and intracellular fluids to get to the target cells. All clients must be assessed for any drug Glossary. These drugs are used to treat conditions Nursing implications refer to the responsibilities and actions that nurses take based on their clinical judgment and assessment of a patient’s condition. com is the most popular, comprehensive and up-to-date source of drug information online. Medical-surgical nursing is characterized by caring for a patient before or after surgery, during recovery, or during an acute illness. ISBN-13: 9781957068022 (ebook) ISBN-13: 9781957068039 (print) Mar 26, 2022 · 15. " Based on the review of current data, the use of 5 or more medications is an acceptable AHFS DI from the American Society of Health-System Pharmacists (ASHP) is the most comprehensive source of unbiased and authoritative drug information available to health professionals today. Adherence to medication is a crucial part of patient care and indispensable for reaching clinical goals. Non FDA-approved, also called off-label indications. Oct 30, 2020 · The nurses' integral role in the medication reconciliation process in various transitional points of care has been supported by current international literature. The reported incidence of medication errors in acute hospitals is approximately 6. These implications are an integral part of nursing care plans and guide nurses in providing safe and effective patient care. Circulatory shock leads to cellular and tissue hypoxia resulting in cellular death and dysfunction of vital organs. That requires having access to resources that will help them understand the use, dose, route, and timing of individual medications. If you are studying nursing pharmacology, a great way of understanding and memorizing the use and function of medication is to familiarize yourself with its generic name stem. It is a quasi-original research-review involving law research and medicolegal negligence, admixed with existing clinical nursing data involving adverse events and medication errors. For example, a nurse would perform a PRN dressing change when a dressing is saturated. Medication administration errors are typically thought of as a failure in one of the five “rights” of medication administration (right patient, medication, time, dose, and route). For example, frequency abbreviations in nursing can be used to describe how often a patient needs to take a medication like in the am or pm, q4hr, AC, PC, or BID etc. Lack of knowledge/understanding : Nurses who lack complete knowledge about how a drug works, its various names (generic . Medicine is the field of health and healing. Nov 16, 2018 · Takeaway. Relative contraindication means that caution should be used when two medicines or procedures are used together. Jan 9, 2023 · Nurses should rely on current data for safe medication use in clinical practice. Any unlicensed person, regardless of title, who performs tasks delegated by a nurse. Jul 21, 2016 · Environment : A nurse who is chronically overworked can make medication errors out of exhaustion. Medication is a medicine or a chemical compound used to treat or cure illness. Regulations for Nurse Aide Education Programs - Effective 3-16-2023. PRN is an acronym that’s widely used in medical jargon and documentation. When confronted with these hurdles, having a clear understanding of the proper steps for wasting controlled substances leaves room. The best thing about it is that it’s laminated so you can even use it at work without it getting torn up. 4 days ago · Drug Dictionary-- "technical definitions and synonyms for drugs/agents used to treat patients with cancer or conditions related to cancer. As a result, we aimed in this chapter Feb 12, 2024 · The term polypharmacy was used over one and a half centuries ago to refer to issues related to multiple-drug consumption and excessive use of drugs. Medication-related harm affects 1 out of every 30 patients in health care, with more than a quarter of this harm regarded as severe or life threatening. Oct 11, 2015 · 1. After assessment of the quality of care, quality indicators are used to measure whether improvement actions have the desired result as well as to monitor performance. This book is not intended to be used as a drug reference book, but direct links are provided to DailyMed, which provides trustworthy information about marketed drugs in the United States. Medical-surgical nurses have advanced Distribution is the process by which medication is dispersed throughout the body via the bloodstream. The RxList drug medical dictionary contains definitions and explanations of many medical terms including prescription medication abbreviations. ” 1 Signs are the data that the nurse collects during an assessment, including vital signs, visual May 6, 2021 · Drug diversion is a serious matter. Medical-surgical nurses provide care to adults with a variety of medical issues or who are preparing for/recovering from surgery. One definition refers to preventable adverse events as "avoidable by any means currently available unless that means was not considered standard care. Focusing on the serious consequences for those nurses involved in medication errors not only results in low reporting rates, but can also hamper Electronically and simultaneously display (i. [L. , 2021 ). Medical Dictionary. The scientific application of principles of care related to prevention of illness and care during illness. It is like having a cheat sheet for nurses to reference that is separate from the patient Aug 28, 2022 · Medication compliance is a precursor of patients’ health outcomes. [1] These errors typically involve administering the wrong drug or dose, using the wrong route, administering it incorrectly, or giving medication to the wrong patient. In addition to specific nursing terms, there are many entries in the fields of medicine, anatomy, physiology, psychiatry, nutrition, and pharmacology (including new drugs recently introduced into medical practice). The challenge is compounded by variations in health care system organization and the Dec 22, 2020 · This is a really great idea if you just need something that has the most commonly used terms on it. It explains basic concepts of pharmacology and describes common medication classes. Nursing implications encompass a wide range of activities and Peak and trough levels are drawn to determine a drug's concentration within the system. A wholly independent staff of drug information pharmacists and other professional editorial and analytical staff thoroughly research AHFS DI content. They can also be given in different ways, such as by mouth, by infusion into a vein, or by drops that are put into the ear or eye. Feb 15, 2023 · Nurslings: Student nurses. Apr 1, 2022 · The significance of the concept. A nursing license is a contract between the state and the nurse in which the licensee agrees to provide nursing care according to that state’s Nurse Practice Act. Informed consent, truth-telling, and confidentiality spring from the principle of autonomy, and each of them is discussed. Drug allergy: A drug allergy is the result of an antigen-antibody immunologic response to a medication. In addition, abbreviations can be used when ordered by the physician to tell the nurse how often certain lab levels should be drawn…. -atus, to point out, fr. Abnormal levels of serotonin have been linked to many mental health disorders such as depression, bipolar disorder, and anxiety. , in a single view) the data from at least two list sources in a manner that allows a user to view the data and their attributes, which must include, at a minimum, the source and last modification date. 4 days ago · The Dictionary provides readers with a comprehensive treatment of the ever-expanding vocabulary of the nursing professions. example: troponin levels. (MEH-dih-KAY-shun) A dosage form that contains one or more active and/or inactive ingredients. It is available in granule packets and chewable tablets, as well as regular tablets. Surgical errors. Nurses constantly observe, measure, and document using subjective and objective data. Sep 11, 2023 · Medication errors. They increase or decrease the heart rate by altering the electrical impulses that regulate the heart’s rhythm. However, convincing nurses is challenging because the problem is substantially underestimated, undetected, and underreported, according to Kimberly New, BSN, RN, JD, a specialist in controlled substance security and regulatory compliance at Diversion Specialists in Chicago, Illinois. fr. It’s also an acceptable abbreviation for the Joint Commission. 5. nurses may create workarounds or deviations from best practice with the intention of maintain-. [4] An ADL assessment helps determine whether a patient may require further rehabilitation or assistance at home or if a skilled nursing or long-term help. T he drug is discovered, synthesized, and purified. Ernstmeyer & Christman (Eds. nursing: ( nŭrs'ing ), 1. 1. Contributor Information and Affiliations. Davis's Drug Guide for Nurses includes a High Alert tab in the upper right corner of the monograph header in appropriate medications to alert the nurse to the medication's risk. , smoking). The drug's safety and success rate at various dosages is determined in humans. The scope of practice regarding a nurse’s ability to legally dispense and administer medication is based on each state’s Nurse Practice Act. The Food, Drug, and Cosmetic Act (FDCA) of 1906 was the first federal law to establish the FDA as the main regulatory body for all medications in the United States. The resultant increase in health needs from medication nonadherence often culminates in an increase in the cost of Dose response is the dose of medication required to achieve the desired response to the medication. The measured response and dose are often graphed The SBON governs nursing practice according to that state’s Nurse Practice Act to protect the public through licensure, education, legislation, and discipline. Master today's medical vocabulary. ) Chippewa Valley Technical College via OpenRN. medication administration: [ ad-min″is-tra´shun ] the giving or application of a pharmacologic or other therapeutic agent. In order to use quality indicators to assess care in terms of medication This open access Nursing Pharmacology textbook is designed for entry-level undergraduate nursing students. Effects of shock are reversible in the early stages, and a delay in diagnosis and/or timely initiation of treatment can lead to irreversible changes, including multiorgan failure (MOF) and death. He has his gentamicin level checked one hour after the end of his previous gentamicin infusion was completed. This includes prevention, slowing the progression of a disease, and treatment. Feeding an infant at the breast; tending and caring for a child. Typically PRN is used in the contenxt of medications, but in the hospital it can also be used in other instances such as dressing changes or wound cleaning. Jan 12, 2011 · The Institute for Safe Medication Practices (ISMP) developed these Acute Care Guidelines for Timely Administration of Scheduled Medications after conducting an extensive survey in late-2010 involving almost 18,000 nurses regarding the requirement in the Centers for Medicare & Medicaid Services (CMS) Conditions of P Responsibilities of the RN when Dispensing Medications. Become an informed health-care consumer! Pediatric Nursing: Scope and Standards of Practice is a collaborative effort of the ANA, the Society for Pediatric Nurses (SPN), and NAPNAP. Administration: the correct medication must be supplied to the correct patient at the correct time. Pharmacology and the Nursing Process. Patients in palliative care may receive medical care for their symptoms, or palliative care, along with treatment intended to cure their serious illness. ” “Pro re nata,” depending on the translation, means “as needed,” “as necessary,” or “as the circumstance arises. Early in the process of developing a drug, the drug's Jun 26, 2023 · A provider must address a patient’s general medical condition when determining their level of accomplishing functional capabilities that otherwise ensure independent living and personal care. S. Half of the avoidable harm in health care is related to medications (3). contraindication: [ kon″trah-in″dĭ-ka´shun ] any condition that renders a particular line of treatment improper or undesirable. analgesic administration: intraspinal in the nursing Open Resources for Nursing (Open RN); Editors: Kimberly Ernstmeyer, MSN, RN, CNE, CHSE, APNP-BC and Elizabeth Christman, DNP, RN, CNE. Allergic Reaction: a reaction caused by an unusual hypersensitivity to a medication (allergic reactions can also occur with foods, animals and other environmental substances). Counter Indicative: a condition or factor that increases the risks involved in using a particular drug or engaging in a particular activity (e. Jan 8, 2023 · Subjective vs. The Nursing and Midwifery Council's (NMC) (2018) Code requires nurses to put the interests of people using or needing nursing services first. The challenge is compounded by variations in health care system organization and the Drug diversion is a serious problem and an occupational hazard in nursing. Adverse events may be preventable or nonpreventable. Mar 31, 2021 · The consensus definition states that “Physical restraint is defined as any action or procedure that prevents a person’s free body movement to a position of choice and/or normal access to his/her body by the use of any method, attached or adjacent to a person’s body that he/she cannot control or remove easily. This pamphlet is fantastic for nursing students. in·di·ca·tion. It's important to know the behavioral and patient-care indicators of potential drug diversion. The term "high alert" is used in other parts of the monograph to help the nurse administer these medications safely. Medication administration in hospital is the final stage of the medication process; nurses should be able to recognize errors in this process and prevent these errors from reaching the patient. *Right patient. Nov 10, 2022 · The Council urges medication errors researchers, software developers, and institutions to use this standard definition to identify errors. Regulations for Nursing Education Programs - Revised 2-2-2022. 2. 5 Rights of Medication Administration. As well as nursing-specific terms, there are also many entries in the fields of medicine, anatomy, physiology, ethics, psychiatry, nutrition, statistics, and pharmacology. 3. Nursing Considerations: The medication is safe for children 12 months and older. May 8, 2023 · Medical-surgical nursing typically involves caring for patients in a medical or surgical inpatient unit of a hospital. With a tabbed, alphabetical organization and a “New Drugs” section, NDH2023 makes it easy to check drug facts on the spot. If you cannot find the term you are looking for, please email us so that we can consider adding it to the glossary. This response helps determine the therapeutic index of a drug, or the effective dose range. Medication administration requires good decision-making skills and clinical judgment, and the nurse is responsible for ensuring full understanding of medication administration and its implications for patient safety. Our glossary excludes specific clinical and medical terms. Medication management is a strategy for engaging with patients and caregivers to create a complete and accurate medication list using the brown bag method. According to Encyclopædia Britannica, medication is "a substance used in treating a disease or relieving pain ". Apr 28, 2015 · Generic Drug Name Stems Cheat Sheet. These nurses may also check to see if a surgical wound is healing properly and answer any Indications for drugs can be classified in two categories: FDA-approved, also called labeled indications, and. This role became more complex with the Durham-Humphrey Amendment of 1951 and the Food and Drug Administration Palliative care is specialized medical care for people living with a serious illness, such as cancer or heart failure. There are four basic stages for a medication to go through within the human body: absorption, distribution Apr 17, 2015 · Quality indicators are usually described with a numerator, a denominator, and a performance standard. " Jun 4, 2020 · The 4 main ethical principles, that is beneficence, nonmaleficence, autonomy, and justice, are defined and explained. To use the medical dictionary PRN is an abbreviation of the Latin phrase “pro re nata. dico, to proclaim] NPs are quickly becoming the health partner of choice for millions of Americans. In patient care situations, not infrequently, there are conflicts between ethical principles (especially Results: Medication errors had been made by 64. Without a common definition, it was not feasible to determine what should be included as a care coordination intervention in our review of systematic reviews. The critical care environment is a high-risk area for drug diversion because of the sheer quantity of controlled substances used. Medications administered parenterally are absorbed more quickly compared to oral ingestion, meaning they have a faster onset of action. Because they do not undergo Content last reviewed June 2023. Example: Have patient state their full name and date of birth and compare this information to the patient’s identification band and to the MAR (medication administration record). 5 per 100 admissions. The most common causes were using abbreviations instead of full names of drugs and similar names of drugs. too busy, or the inability to find someone to wit-ness waste. Education and Training. Another way objective and subjective data are described in the nursing context is by “signs” versus “symptoms. 1, 52, 53 Medication reconciliation is defined as an official process in which healthcare providers work with patients to ensure the exact and complete transfer of medication Research Evidence. This paper belongs to a unique category. 2: Basic Concepts of Administering Medications. Contraindication. Throughout the project, experts have underscored the critical need for a consensus definition. Jun 20, 2023 · The Federal Food and Drug Administration (FDA) oversees and manages all medication disbursement in the United States. Drugs are medications or other substances that have a physiological effect when introduced to the body. Confirm you have the right patient for the medication by using at least TWO patient identifiers. Nursing is the diagnosis and treatment of human responses and May 28, 2011 · Safe medication administration and reducing medication errors should be a goal of everyone involved in healthcare. Patient safety is an essential part of nursing care; the ultimate aim is to avert avoidable errors and harm to patients. Pharmacokinetics is the term that describes the four stages of absorption, distribution, metabolism, and excretion of drugs. Medications come in many dosage forms, including tablets, capsules, liquids, creams, and patches. This includes certified nursing aides/assistants (CNAs), patient care assistants (PCAs), patient care technicians (PCTs), state tested nursing assistants (STNA), nursing assistants-registered (NA/Rs) or certified medication aides/assistants (MA-Cs). NAN Alert The National Alert Network (NAN) publishes the alerts from the National Medication Errors Reporting Program. Feb 12, 2024 · Medication errors are the most common and preventable cause of patient injury. There are a variety of drug types and substances patients may utilize for symptom management or to enhance wellness. See the article "Medication Errors: Improving medication. Overview. Search medical terms and abbreviations with the most up-to-date and comprehensive medical dictionary from the reference experts at Merriam-Webster. Each drug entry includes links to check for clinical trials listed in NCI's List of Cancer Clinical Trials. Having an accurate record and knowledge of the different types of substances a patient is taking is important to the patient’s medical and nursing plan of care. Medical terms are from MedTerms™ and are written by pharmacists and U. These stems are mostly placed word-finally (suffix Regulations Governing the Registration of Medication Aides - Effective 2-6-2020. May 21, 2024 · Drug toxicity: Drug toxicity is defined as overdosage of a medication that occurs when the dose that is administered exceeds the client's ability to metabolize and/or excrete the medication. ”. Boxed Warning: Serious mental health side effects, including suicidal ideation. Enable a user to create a single reconciled list of medications, medication allergies, or problems. When performing a fundamental skill on the job, the delegatee is considered to be carrying out an assignment. Chronotropic drugs affect the heart rate. Agency for Healthcare Research and Quality, Rockville, MD. Many psychotropic medications target serotonin. Milk of amnesia: Infusion of propofol, which is a creamy white anesthetic used to induce anesthesia rapidly but is known to have a toxic effect in young children and the elderly. g. Jun 27, 2014 · Medication reconciliation is a process that involves (1) verification of the patient's medication history, (2) clarification that the medications are appropriate for the patient, and (3) reconciliation of any discrepancies. Most clinical practice guidelines and free smartphone applications, such as Epocrates™, provide this information. Verify presence of a current, complete, signed physician’s order in the client record or protocol in the agency. For example, amoxicillin is Estimating the prevalence of medication errors is difficult due to the varying definitions and classification systems employed. A neurotransmitter that modulates multiple neuropsychological processes such as mood, sleep, libido, and temperature regulation. [1] nursing assistants or aides (CNAs), patient care technicians, CMAs, certified medication aids, and home health aides (formerly referred to as ‘‘unlicensed” assistive personnel [UAP]) . Since then, it has evolved with different meanings and situations, including but not limited to "unnecessary drug use" and "medication use without indication. These drugs are used to treat heart failure, cardiogenic shock, and certain arrhythmias. 10a. Nursing integrates the art and science of caring and focuses on the protection, promotion, and optimization of health and human functioning; prevention of illness and injury; facilitation of healing; and alleviation of suffering through compassionate presence. Medication errors have a substantial impact on health care in Canada (Butt, 2010). analgesic administration in the nursing interventions classification , a nursing intervention defined as the use of pharmacologic agents to reduce or eliminate pain. A contraindication is a specific situation in which a medicine, procedure, or surgery should not be used because it may be harmful to the person. Should be avoided for treating mild asthma unless conventional treatment is ineffective. Drugs. DT-ing: delirium tremens; describes a patient who has a rapid onset of confusion triggered by alcohol withdrawal. The drug's therapeutic value is determined in animals. (It is acceptable to do so if the benefits outweigh the risk. 40. 37% of the participants reported medication errors on the verge of occurrence. " Drugs@FDA-- This site is for FDA-approved drugs. There are several reasons why medications may be prescribed via the parenteral route. Sep 20, 2023 · PRN means “as needed. Palliative care is meant to enhance a person's current care by focusing Jul 24, 2023 · Shock is a life-threatening manifestation of circulatory failure. ( in'di-kā'shŭn) The basis or rationale for using a particular treatment or diagnostic test; may be furnished by a knowledge of the cause (causal indication), by the symptoms present (symptomatic indication), or by the nature of the disease (specific indication). Introduction and literature review. The drug's pharmacologic properties are determined in humans, including toxicity. [3] As defined by the National Cancer Institute, dosage forms of medication can include tablets, capsules, liquids, creams, and patches. gu zm se fm vz yw qo jy ai nc