Gale Encyclopedia of Surgery Vol 3 pdf

  

The GALE

ENCYCLOPEDIA of

  

S urgery

A G U I D E F O R P A T I E N T S A N D C A R E G I V E R S

  

V O L U M E

P - Z

  

A N T H O N Y J . S E N A G O R E , M . D . , E X E C U T I V E A D V I S O R

C L E V E L A N D C L I N I C F O U N D AT I O N

The GALE

  

ENCYCLOPEDIA of

S urgery

  

A G U I D E F O R P A T I E N T S A N D C A R E G I V E R S

  

3

  

Gale Encyclopedia of Surgery: A Guide for Patients and Caregivers

Anthony J. Senagore MD, Executive Adviser

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LIBRARY OF CONGRESS CATALOGING-IN-PUBLICATION DATA

_{Gale encyclopedia of surgery : a guide for patients and caregivers / Anthony J. Senagore, [editor]. p. cm. Includes bibliographical references and index.}

_{ISBN 0-7876-7721-3 (set : hc) — ISBN 0-7876-7722-1 (v. 1) — ISBN}

0-7876-7723-X (v. 2) — ISBN 0-7876-9123-2 (v. 3) _{Surgery—Encyclopedias. 2. Surgery—Popular works. I. Senagore, Anthony J., 1958- RD17.G34 2003}

_{617’.91’003—dc22 2003015742}

  CONTENTS List of Entries . . . . . . . . . . . . . . . . . . . . . . . . . . vii Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . xv Entries Volume 1: A-F . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Volume 2: G-O . . . . . . . . . . . . . . . . . . . . . . . . 557 Volume 3: P-Z . . . . . . . . . . . . . . . . . . . . . . . . 1079 Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1577 Organizations Appendix . . . . . . . . . . . . . . . . . . 1635 General Index. . . . . . . . . . . . . . . . . . . . . . . . . 1649

LIST OF ENTRIES

  A

  Abdominal ultrasound Abdominal wall defect repair Abdominoplasty Abortion, induced Abscess incision and drainage Acetaminophen Adenoidectomy Admission to the hospital Adrenalectomy Adrenergic drugs Adult day care Ambulatory surgery centers Amniocentesis Amputation Anaerobic bacteria culture Analgesics Analgesics, opioid Anesthesia evaluation Anesthesia, general Anesthesia, local Anesthesiologist’s role Angiography Angioplasty Anterior temporal lobectomy Antianxiety drugs Antibiotics Antibiotics, topical Anticoagulant and antiplatelet drugs Antihypertensive drugs Antinausea drugs Antiseptics Antrectomy Aortic aneurysm repair Aortic valve replacement

  Breast reduction Bronchoscopy Bunionectomy

  C

  Cardiac catheterization Cardiac marker tests Cardiac monitor Cardiopulmonary resuscitation Cardioversion Carotid endarterectomy Carpal tunnel release Catheterization, female Catheterization, male Cephalosporins Cerebral aneurysm repair Cerebrospinal fluid (CSF) analysis Cervical cerclage Cervical cryotherapy Cesarean section Chest tube insertion Chest x ray Cholecystectomy Circumcision Cleft lip repair Club foot repair Cochlear implants Collagen periurethral injection Colonoscopy Colorectal surgery Colostomy Colporrhaphy Colposcopy Colpotomy

  Appendectomy Arteriovenous fistula Arthrography Arthroplasty Arthroscopic surgery Artificial sphincter insertion Aseptic technique Aspirin Autologous blood donation Axillary dissection

  B

  Balloon valvuloplasty Bandages and dressings Bankart procedure Barbiturates Barium enema Bedsores Biliary stenting Bispectral index Bladder augmentation Blepharoplasty Blood donation and registry Blood pressure measurement Blood salvage Bloodless surgery Bone grafting Bone marrow aspiration and biopsy Bone marrow transplantation Bone x rays Bowel resection Breast biopsy Breast implants Breast reconstruction Complete blood count Cone biopsy Corneal transplantation Coronary artery bypass graft surgery Coronary stenting Corpus callosotomy Corticosteroids Craniofacial reconstruction Craniotomy Cricothyroidotomy Cryotherapy Cryotherapy for cataracts CT scans Curettage and electrosurgery Cyclocryotherapy Cystectomy Cystocele repair Cystoscopy

  D

  Death and dying Debridement Deep brain stimulation Defibrillation Dental implants Dermabrasion Dilatation and curettage Discharge from the hospital Disk removal Diuretics Do not resuscitate order (DNR)

  E

  Ear, nose, and throat surgery Echocardiography Elective surgery Electrocardiography Electroencephalography Electrolyte tests Electrophysiology study of the heart Emergency surgery Endolymphatic shunt

  Gastrostomy General surgery Gingivectomy Glossectomy Glucose tests Goniotomy

  H

  Hair transplantation Hammer, claw, and mallet toe surgery Hand surgery Health care proxy Health history Heart surgery for congenital defects Heart transplantation Heart-lung machines Heart-lung transplantation Hemangioma excision Hematocrit Hemispherectomy Hemoglobin test Hemoperfusion Hemorrhoidectomy Hepatectomy Hip osteotomy Hip replacement Hip revision surgery Home care Hospices Hospital services Hospital-acquired infections Human leukocyte antigen test Hydrocelectomy Hypophysectomy Hypospadias repair Hysterectomy Hysteroscopy

  I Ileal conduit surgery

  Ileoanal anastomosis Ileoanal reservoir surgery

  Endoscopic retrograde cholangiopancreatography Endoscopic sinus surgery Endotracheal intubation Endovascular stent surgery Enhanced external counterpulsation Enucleation, eye Epidural therapy Episiotomy Erythromycins Esophageal atresia repair Esophageal function tests Esophageal resection Esophagogastroduodenoscopy Essential surgery Exenteration Exercise Extracapsular cataract extraction Eye muscle surgery

  F

  Face lift Fasciotomy Femoral hernia repair Fetal surgery Fetoscopy Fibrin sealants Finding a surgeon Finger reattachment Fluoroquinolones Forehead lift Fracture repair

  G

  Gallstone removal Ganglion cyst removal Gastrectomy Gastric acid inhibitors Gastric bypass Gastroduodenostomy Gastroenterologic surgery Gastroesophageal reflux scan Gastroesophageal reflux surgery

  List of Entries

  Ileostomy Immunoassay tests Immunologic therapies Immunosuppressant drugs Implantable cardioverter- defibrillator In vitro fertilization Incision care Incisional hernia repair Informed consent Inguinal hernia repair Intensive care unit Intensive care unit equipment Intestinal obstruction repair Intravenous rehydration Intussusception reduction Iridectomy Islet cell transplantation

  K

  Kidney dialysis Kidney function tests Kidney transplantation Knee arthroscopic surgery Knee osteotomy Knee replacement Knee revision surgery Kneecap removal

  L

  Laceration repair Laminectomy Laparoscopy Laparoscopy for endometriosis Laparotomy, exploratory Laryngectomy Laser in-situ keratomileusis (LASIK) Laser iridotomy Laser posterior capsulotomy Laser skin resurfacing Laser surgery Laxatives Leg lengthening/shortening

  N

  Necessary surgery Needle bladder neck suspension Nephrectomy Nephrolithotomy, percutaneous Nephrostomy Neurosurgery Nonsteroidal anti-inflammatory drugs Nursing homes

  O

  Obstetric and gynecologic surgery Omphalocele repair Oophorectomy Open prostatectomy Operating room Ophthalmologic surgery Orchiectomy Orchiopexy Orthopedic surgery Otoplasty Outpatient surgery Oxygen therapy

  P

  Pacemakers Pain management Pallidotomy Pancreas transplantation Pancreatectomy Paracentesis Parathyroidectomy Parotidectomy Patent urachus repair Patient confidentiality Patient rights Patient-controlled analgesia Pectus excavatum repair Pediatric concerns Pediatric surgery

  Limb salvage Lipid tests Liposuction Lithotripsy Liver biopsy Liver function tests Liver transplantation Living will Lobectomy, pulmonary Long-term care insurance Lumpectomy Lung biopsy Lung transplantation Lymphadenectomy

  M

  Magnetic resonance imaging Mammography Managed care plans Mastoidectomy Maze procedure for atrial fibrillation Mechanical circulation support Mechanical ventilation Meckel’s diverticulectomy Mediastinoscopy Medicaid Medical charts Medical errors Medicare Meningocele repair Mentoplasty Microsurgery Minimally invasive heart surgery Mitral valve repair Mitral valve replacement Modified radical mastectomy Mohs surgery Multiple-gated acquisition

  (MUGA) scan Muscle relaxants Myelography Myocardial resection Myomectomy Myringotomy and ear tubes

  List of Entries Pelvic ultrasound Penile prostheses Pericardiocentesis Peripheral endarterectomy Peripheral vascular bypass surgery Peritoneovenous shunt Phacoemulsification for cataracts Pharyngectomy Phlebography Phlebotomy Photocoagulation therapy Photorefractive keratectomy (PRK) Physical examination Planning a hospital stay Plastic, reconstructive, and cosmetic surgery Pneumonectomy Portal vein bypass Positron emission tomography (PET) Post-surgical pain Postoperative care Power of attorney Preoperative care Preparing for surgery Presurgical testing Private insurance plans Prophylaxis, antibiotic Pulse oximeter Pyloroplasty

  Q

  Quadrantectomy

  R

  Radical neck dissection Recovery at home Recovery room Rectal prolapse repair Rectal resection Red blood cell indices Reoperation Retinal cryopexy Retropubic suspension

  Surgical instruments Surgical oncology Surgical team Sympathectomy Syringe and needle

  T

  Talking to the doctor Tarsorrhaphy Telesurgery Tendon repair Tenotomy Tetracyclines Thermometer Thoracic surgery Thoracotomy Thrombolytic therapy Thyroidectomy Tonsillectomy Tooth extraction Tooth replantation Trabeculectomy Tracheotomy Traction Transfusion Transplant surgery Transurethral bladder resection Transurethral resection of the prostate Tubal ligation Tube enterostomy Tube-shunt surgery Tumor marker tests Tumor removal Tympanoplasty Type and screen

  U

  Umbilical hernia repair Upper GI exam Ureteral stenting Ureterosigmoidoscopy Ureterostomy, cutaneous

  Rhinoplasty Rhizotomy Robot-assisted surgery Root canal treatment Rotator cuff repair

  S

  Sacral nerve stimulation Salpingo-oophorectomy Salpingostomy Scar revision surgery Scleral buckling Sclerostomy Sclerotherapy for esophageal varices Sclerotherapy for varicose veins Scopolamine patch Second opinion Second-look surgery Sedation, conscious Segmentectomy Sentinel lymph node biopsy Septoplasty Sex reassignment surgery Shoulder joint replacement Shoulder resection arthroplasty Sigmoidoscopy Simple mastectomy Skin grafting Skull x rays Sling procedure Small bowel resection Smoking cessation Snoring surgery Sphygmomanometer Spinal fusion Spinal instrumentation Spirometry tests Splenectomy Stapedectomy Stereotactic radiosurgery Stethoscope Stitches and staples Stress test Sulfonamides

  List of Entries

  List of Entries

  Urinalysis Vagotomy Vascular surgery

  Urinary anti-infectives

  W

  Vasectomy Urologic surgery

  Webbed finger or toe repair Vasovasostomy

  Uterine stimulants Weight management

  Vein ligation and stripping White blood cell count and

  Venous thrombosis prevention differential Ventricular assist device

  Wound care Ventricular shunt

  V Wound culture

  Vertical banded gastroplasty Vagal nerve stimulation Vital signs Wrist replacement The

  Gale Encyclopedia of Surgery is a medical ref- erence product designed to inform and educate readers about a wide variety of surgeries, tests, drugs, and other medical topics. The Gale Group believes the product to be comprehensive, but not necessarily definitive. While the Gale Group has made substantial efforts to provide information that is accurate, comprehensive, and up-to- date, the Gale Group makes no representations or war- ranties of any kind, including without limitation, war- ranties of merchantability or fitness for a particular pur- pose, nor does it guarantee the accuracy, comprehensive- ness, or timeliness of the information contained in this product. Readers should be aware that the universe of medical knowledge is constantly growing and changing, and that differences of medical opinion exist among au- thorities.

  

PLEASE READ—

IMPORTANT INFORMATION

  

INTRODUCTION

  Surgery

  wherever appropriate to help facilitate discussion with the patient’s physician.

  Questions to ask the doctor is provided

  The Gale Encyclopedia of Surgery has been de- signed with ready reference in mind.

  How to use this book

  The essays were compiled by experienced medical writers, including physicians, pharmacists, nurses, and other health care professionals. The adviser reviewed the completed essays to ensure that they are appropriate, up- to-date, and medically accurate. Illustrations were also reviewed by a medical doctor.

  About the contributors

  was Anthony J. Senagore, MD, MS, FACS, FASCRS. He has published a number of professional ar- ticles and is the Krause/Lieberman Chair in Laparoscop- ic Colorectal Surgery, and Staff Surgeon, Department of Colorectal Surgery at the Cleveland Clinic Foundation in Cleveland, Ohio.

  The Executive Adviser for the Gale Encyclopedia of

  The Gale Encyclopedia of Surgery: A Guide for

  About the Executive Adviser

  A preliminary list of surgeries and related topics was compiled from a wide variety of sources, including professional medical guides and textbooks, as well as consumer guides and encyclopedias. Final selection of topics to include was made by the executive adviser in conjunction with the Gale editor.

  Inclusion criteria

  Entries on surgeries follow a standardized format that provides information at a glance. Rubrics include: Definition Purpose Demographics Description Diagnosis/Preparation Aftercare Risks Normal results Morbidity and mortality rates Alternatives Resources

  This encyclopedia minimizes medical jargon and uses language that laypersons can understand, while still providing detailed coverage that will benefit health sci- ence students.

  is a unique and invaluable source of information for anyone who is considering undergoing a surgical procedure, or has a loved one in that situation. This collection of 465 entries provides in-depth coverage of specific surgeries, diagnostic tests, drugs, and other related entries. The book gives detailed information on 265 surgeries; most include step-by-step illustrations to enhance the reader’s under- standing of the procedure itself. Entries on related top- ics, including anesthesia, second opinions, talking to the doctor, admission to the hospital, and preparing for surgery, give lay readers knowledge of surgery prac- tices in general. Sidebars provide information on who performs the surgery and where, and on questions to ask the doctor.

  Patients and Caregivers

• Straight alphabetical arrangement of topics allows users to locate information quickly.
• Bold-faced terms within entries and See also terms at the end of entries direct the reader to related articles.
• Cross-references placed throughout the encyclopedia direct readers from alternate names and related topics to entries.
• A list of Key terms is provided where appropriate to define unfamiliar terms or concepts.
• A sidebar describing Who performs the procedure and where it is performed is listed with every surgery entry.
• A list of

  Resources section directs readers to additional

• The

  over 160 step-by-step illustrations of surgeries. These il- sources of medical information on a topic. Books, peri- lustrations were specially created for this product to en- odicals, organizations, and internet sources are listed. hance a layperson’s understanding of surgical procedures.

  oduction

• A Glossary of terms used throughout the text is col-

  Intr lected in one easy-to-use section at the back of book.

• A valuable Organizations appendix compiles useful contact information for various medical and surgical organizations.

  Licensing

• A comprehensive General index guides readers to all

  The Gale Encyclopedia of Surgery is available for li- topics mentioned in the text.

  censing. The complete database is provided in a fielded format and is deliverable on such media as disk or CD-

  Graphics

  ROM. For more information, contact Gale’s Business The Gale Encyclopedia of Surgery contains over 230 Development Group at 1-800-877-GALE, or visit our full-color illustrations, photos, and tables. This includes website at www.gale.com/bizdev.

  Laurie Barclay, M.D.

  Austin, TX

  Sr. Research Associate

  Dept. of Pathology University of Michigan Medical

  Center Ann Arbor, MI Laith F. Gulli, M.D.

  M.Sc., M.Sc.(MedSci), M.S.A., Msc.Psych, MRSNZ

  FRSH, FRIPHH, FAIC, FZS DAPA, DABFC, DABCI

  Consultant Psychotherapist in Private Practice

  Lathrup Village, MI

Rosalyn Carson-DeWitt, M.D.

  Medical Writer

  Durham, NC

  Lisa Christenson, PhD Science Writer

  Hamden, CT

  Rhonda Cloos, RN Medical Writer

  Angela Costello Medical writer

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  Cleveland, OH

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  New Haven, CT

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  New York, NY

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  Oklahoma City, OK

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CONTRIBUTORS

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Crystal H. Kaczkowski, MSc.

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  University of Medicine & Dentistry of New Jersey

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  Contributors

  

P

Pacemaker implantation see Pacemakers

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?

  Pacemaker implants are performed by a cardi-

  Pacemakers

  ologist who has completed medical school and an additional internship and residency pro-

  Definition

  gram. Additional training as an electrophysiolo-

  A pacemaker is a surgically implanted electronic de-

  gist may be acquired by the physician during vice that regulates a cardiac arrhythmia. the residency program. Specific training by the

  Pacemakers are most frequently prescribed when

  pacemaker manufacturer may also be ac-

  the heartbeat decreases under 60 beats per minute at rest

  quired. Hospitals performing these procedures

  (severe symptomatic bradycardia). They are also used in

  have access to cardiac catheterization facilities

  some cases to slow a fast heart rate over 120 beats per

  or operating rooms equipped with portable flu- minute at rest (tachycardia). oroscopy units.

  Demographics The population for pacemaker implant is not limited

  The leads are then attached to the pacemaker device,

  by age, sex, or race. Over 100,000 pacemakers are im- which is implanted under the skin of the patient’s chest. planted per year in the United States. The occurrence is

  Patients undergoing surgical pacemaker implanta-

  more frequent in the elderly with over 85% of implants re-

  tion usually stay in the hospital overnight. Once the pro-

  ceived by those over age 65. A history of myocardial in-

  cedure is complete, the patient’s vital signs are moni-

  farction (heart attack), congenital defect, or cardiac trans- tored and a chest x ray is taken to ensure that the pace- plant also increases the likelihood of pacemaker implant. maker and leads are properly positioned.

  Description Modern pacemakers have sophisticated program- ming capabilities and are extremely compact. The small- Approximately 500,000 Americans have an im- est weigh less than 13 grams (under half an ounce) and plantable permanent pacemaker device. A pacemaker im- are the size of two stacked silver dollars. The actual pac- plantation is performed under local anesthesia in a hospi- ing device contains a pulse generator, circuitry pro- tal by a surgeon assisted by a cardiologist. An insulated grammed to monitor heart rate and deliver stimulation, wire called a lead is inserted into an incision above the and a lithium iodide battery. Battery life typically ranges collarbone and guided through a large vein into the cham- from seven to 15 years, depending on the number of leads bers of the heart. Depending on the configuration of the the pacemaker is configured with and how much energy pacemaker and the clinical needs of the patient, as many the pacemaker uses. When a new battery is required, the as three leads may be used in a pacing system. Current unit can be exchanged in a simple outpatient procedure. pacemakers have a double, or bipolar, electrode attached

to the end of each lead. The electrodes deliver an electri- A temporary pacing system is sometimes recom-

cal charge to the heart to regulate heartbeat. They are po- mended for patients who are experiencing irregular

sitioned on the areas of the heart that require stimulation. heartbeats as a result of a recent heart attack or other

  Pacemaker Pacemaker Pacemakers _{Lead Body Connector Pin Lead wire in cephalic vein Mechanism Fixation} Electrode A.

  B.

  Pacemaker Electrode C.

  

To place a pacemaker, a lead wire is inserted into the cephalic vein of the shoulder and fed into the heart chambers (B). An

electrode is implanted in the heart muscle of the lower chamber, and the device is attached (C). (Illustration by Argosy.) acute medical condition. The implantation procedure for electrocardiogram (ECG) or an electrophysiological study the pacemaker leads is similar to that for a permanent or both, to fully evaluate the bradycardia or tachycardia. pacing system, but the actual pacemaker unit housing the pulse generator remains outside the patient’s body. Tem-

  The symptoms of fatigue and lightheadedness that porary pacing systems may be replaced with a perma- are characteristic of bradycardia can also be caused by a nent device at a later date. number of other medical conditions, including anemia. Certain prescription medications can also slow the heart

  Diagnosis/Preparation rate. A doctor should take a complete medical history Patients being considered for pacemaker implantation and perform a full physical work-up to rule out all non- will undergo a full battery of cardiac tests, including an cardiac causes of bradycardia.

  Pacemakers

  Patients are advised to abstain from eating six to eight hours before the surgical procedure. The patient is

  QUESTIONS

  usually given a sedative to help him or her relax for the

  TO ASK THE DOCTOR

  procedure. An intravenous (IV) line will also be inserted into a vein in the patient’s arm before the procedure be-

• How many pacemaker implants has the gins in case medication or blood products are required physician performed? during the insertion.
• What type of pacemaker will be implanted, univentricular or biventricular, and how many of the specific procedure has the physi-

  Aftercare

  cian performed? After an implant without complications the patient

• How long will the expected hospital stay be? can expect a hospital stay of one to five post-procedure
• What precautions should be taken in the days. Pacemaker patients should schedule a follow-up weeks following discharge from the hospital? visit with their cardiologist approximately six weeks after
• What precautions will need to taken in day the surgery. During this visit, the doctor will make any to day activities following pacemaker im- necessary adjustments to the settings of the pacemaker.

  plant? Pacemakers are programmed externally with a handheld electromagnetic device. Pacemaker batteries must be

• When can normal daily, such as driving, ex- checked regularly. Some pacing systems allow patients to

  ercise and work, activities be initiated?

  monitor battery life through a special telephone monitor-

• What will indicate that the pacemaker is fail- ing service that can read pacemaker signals.

  ing and when should emergency care be sought? Patients with cardiac pacemakers should not under- go a magnetic resonance imaging (MRI) procedure.

• How long will the battery function and when Devices that emit electromagnetic waves (including should treatment to replace the device be magnets) may alter pacemaker programming or func- sought? tioning. A 1997 study found that cellular phones often
• Is there special documentation I will need for interfere with pacemaker programming and cause irregu- air travel during security screenings? lar heart rhythm. However, advances in pacemaker de-
• Will there be notification of manufacturer re- sign and materials have greatly reduced the risk of pace- calls? maker interference from electromagnetic fields.

  Risks Normal results

  Because pacemaker implantation is an invasive sur- Pacemakers that are properly implanted and pro- gical procedure, internal bleeding, infection, hemor- grammed can correct a patient’s arrhythmia and resolve rhage, and embolism are all possible complications. In- related symptoms. fection is more common in patients with temporary pac- ing systems. Antibiotic therapy given as a precautionary measure can reduce the risk of pacemaker infection. If

  Morbidity and mortality rates

  infection does occur, the entire pacing system may have to be removed.

  In the United States, patients experience complica- The placing of the leads and electrodes during the tions in 3.3% and 3.8% of cases, with those over 65 implantation procedure also presents certain risks for the years of age demonstrating a slightly higher complica- patient. The lead or electrode could perforate the heart or tion rate of 6.1%. The most common complications in- cause scarring or other damage. The electrodes can also clude lead dislodgement, pneumothorax (collapsed cause involuntary stimulation of nearby skeletal muscles. lung), and cardiac perforation. The risk of death is less then 0.5% throughout the course of the hospital stay.

  A complication known as pacemaker syndrome de- velops in approximately 7% of pacemaker patients with

  Resources

  single-chamber pacing systems. The syndrome is charac- terized by the low blood pressure and dizziness that are BOOKS symptomatic of bradycardia. It can usually be corrected The New Living DeBakey, Michael E. and Antonio Gotto Jr.

  Heart.

  by the implantation of a dual-chamber pacing system. Holbrook, MA: Adams Media Corporation, 1997.

• Ethnic and cultural values. In some cultures, tolerating pain is related to showing strength and endurance. In others, it is considered punishment for misdeeds.
• Age. This refers to the concept that grownups never cry.
• Anxiety and stress. This is related to being in a strange, fearful place such as a hospital, and the fear of the un- known consequences of the pain and the condition causing it, which can all combined to make pain feel more severe. For patients being treated for pain, know- ing the duration of activity of an analgesic leads to anx- iety about the return of pain when the drug wears off. This anxiety can make the pain more severe.
• Fatigue and depression. It is known that pain in itself can actually cause depression. Fatigue from lack of sleep or the illness itself also contribute to depressed feelings.

  Advanced Nursing

  Magnetic resonance imaging (MRI)—An imaging

  foreign material that blocks the flow of blood in an artery. When an embolism blocks the blood supply to a tissue or organ, the tissue the artery feeds dies (infarction). Without immediate and ap- propriate treatment, an embolism can be fatal.

  Embolism—A blood clot, air bubble, or clot of

  electrical activity of the heart in order to diagnose arrhythmia. An electrophysiological study measures electrical signals through a cardiac catheter that is inserted into an artery in the leg and guided up into the atrium and ventricle of the heart.

  Electrophysiological study—A test that monitors the

  electrical activity of the heart. An ECG uses exter- nally attached electrodes to detect the electrical signals of the heart.

  Pain mnagement KEY TERMS Electrocardiogram (ECG)—A recording of the

  evaluated nurses’ perceptions of a se- lect group of white American and Mexican-American women patients’ pain following gallbladder surgery. Ob- jective assessments of each patient’s pain showed little difference between the perceived severities for each group. Yet, the nurses involved in the study consistently rated all patients’ pain as less than the patients reported,

  Health care providers play an important role in under- standing their patients’ pain. All too often, both physi- cians and nurses have been found to incorrectly assess the severity of pain. A study reported in the Journal of

  PERIODICALS Gregoratas, Gabriel, et al. “ACC/AHA Guidelines for Implan- tation of Pacemakers and Antiarrhythmia Devices.” Jour- nal of the American College of Cardiology

  Precautions The perception of pain is an individual experience.

  Yet, the experiencing of pain is a completely unique occurrence for each person, a complex combination of sev- eral factors other than the pain itself. It is influenced by:

  Pain serves to alert a person to potential or actual damage to the body. The definition for damage is quite broad: pain can arise from injury as well as disease. After the message is received and interpreted, further pain can be counterproductive. Pain can have a negative impact on a person’s quality of life and impede recovery from illness or injury, thus contributing to escalating health care costs. Unrelieved pain can become a syn- drome in its own right and cause a downward spiral in a person’s health and outlook. Managing pain properly fa- cilitates recovery, prevents additional health complica- tions, and improves an individual’s quality of life.

  Purpose

  If pain can be defined as a highly unpleasant, indi- vidualized experience of one of the body’s defense mechanisms indicating an injury or problem, pain man- agement encompasses all interventions used to under- stand and ease pain, and, if possible, to alleviate the cause of the pain.

  Packed cell volume see Hematocrit Packed red blood cell volume see Hematocrit Pain management Definition

  Paula Anne Ford-Martin Allison J. Spiwak, MSBME

  ORGANIZATIONS American Heart Association. 7320 Greenville Ave. Dallas, TX 75231. (214) 373-6300. <http://www.americanheart.org>.

  31 (April 1998): 1175–209. Link, Mark S, et al. “Complications of Dual Chamber Pace- maker Implantation in the Elderly.” Journal of Interven- tional Cardiac Electrophysiology 2 (1998): 175–179.

  technique that uses a large circular magnet and radio waves to generate signals from atoms in the body. These signals are used to construct images of internal structures. and with equal consistency, believed that better-educated women born in the United States were suffering more than less-educated Mexican-American women. Nurses from a northern European background were more apt to minimize the severity of pain than nurses from eastern and southern Europe or Africa. The study indicated how health care staff, and especially nursing staff, need to be aware of how their own background and experience con- tributes to how they perceive a person’s pain.

  In a 1990 study reported in the journal Pain, nurses were found to overestimate the severity of pain in patients with severe burns. In most other studies, nurses and physicians ascribe a lower pain severity than do patients.

  Description

  Before considering pain management, a review of pain definitions and mechanisms may be useful. Pain is the means by which the peripheral nervous system (PNS) warns the central nervous system (CNS) of injury or potential injury to the body. The CNS comprises the brain and spinal cord, and the PNS is composed of the nerves that stem from and lead into the CNS. PNS in- cludes all nerves throughout the body, except the brain and spinal cord. Pain is sometimes categorized by its site of origin, either cutaneous (originating in the skin of subcutaneous tissue, such as a shaving nick or paper cut), deep somatic pain (arising from bone, ligaments and tendons, nerves, or veins and arteries), or visceral (appearing as a result of stimulation of pain receptor nerves around organs such as the brain, lungs, or those in the abdomen).

  A pain message is transmitted to the CNS by special PNS nerve cells called nociceptors, which are distributed throughout the body and respond to different stimuli de- pending on their location. For example, nociceptors that extend from the skin are stimulated by sensations such as pressure, temperature, and chemical changes.