The Gale Encyclopedia of Nursing and Allied Health pdf
The GALE
ENCYCLOPEDIA of
Nursing &
Allied Health
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The GALE
ENCYCLOPEDIA of
Nursing &
Allied Health
VOLUME 1
A-C
Kristine Krapp, Editor
The GALE
ENCYCLOPEDIA of
Nursing &
Allied Health
VOLUME 2
D-H
Kristine Krapp, Editor
The GALE
ENCYCLOPEDIA of
Nursing &
Allied Health
VOLUME 3
I-O
Kristine Krapp, Editor
The GALE
ENCYCLOPEDIA of
Nursing &
Allied Health
VOLUME 4
P-S
Kristine Krapp, Editor
The GALE
ENCYCLOPEDIA of
Nursing &
Allied Health
VOLUME 5
T- Z
Appendix
General Index
Kristine Krapp, Editor
The GALE ENCYCLOPEDIA
of NURSING AND
ALLIED HEALTH
STAFF
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ISBN 0-7876-4934-1 (set)
0-7876-4935-X (Vol. 1)
0-7876-4936-8 (Vol. 2)
0-7876-4937-6 (Vol. 3)
0-7876-4938-4 (Vol. 4)
0-7876-4939-2 (Vol. 5)
Printed in Canada
10 9 8 7 6 5 4 3 2 1
Library of Congress Cataloging-in-Publication Data
The Gale encyclopedia of nursing and allied health / Kristine
Krapp, editor.
p. cm.
Includes bibliographical references and index.
ISBN 0-7876-4934-1 (set : hardcover : alk. paper)
ISBN 0-7876-4935-X (v. 1 : alk. paper) —
ISBN 0-7876-4936-8 (v.2 : alk. paper) —
ISBN 0-7876-4937-6 (v. 3 : alk. paper) —
ISBN0-7876-4938-4 (v. 4 : alk. paper) —
ISBN 0-7876-4939-2 (v. 5 : alk. paper)
1. Nursing Care—Encyclopedias—English. 2. Allied Health
Personnel—Encyclopedias—English.
3. Nursing—Encyclopedias—English. WY 13 G151 2002]
RT21 .G353 2002
610.73'03—dc21
2001040910
CONTENTS
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii
Advisory Board . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix
Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi
Entries
Volume 1: A-C . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Volume 2: D-H . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 641
Volume 3: I-O . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1237
Volume 4: P-S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1797
Volume 5: T-Z . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2383
Appendix of Nursing and Allied Health
Organizations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2663
General Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2669
G A L E E N C Y C L O P E D I A O F N U R S I N G A N D A L L I E D H E A LT H
V
PLEASE READ—IMPORTANT INFORMATION
The Gale Encyclopedia of Nursing and Allied Health
is a medical reference product designed to inform and
educate readers about a wide variety of diseases, treatments, tests and procedures, health issues, human biology, and nursing and allied health professions. 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 warranties of any kind, including without limitation, warranties of merchantability or fitness for
a particular purpose, nor does it guarantee the accuracy,
comprehensiveness, 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 authorities.
INTRODUCTION
The Gale Encyclopedia of Nursing and Allied Health
is a unique and invaluable source of information for the
nursing or allied health student. This collection of over
850 entries provides in-depth coverage of specific diseases and disorders, tests and procedures, equipment and
tools, body systems, nursing and allied health professions, and current health issues. This book is designed to
fill a gap between health information designed for
laypeople and that provided for medical professionals,
which may be too complicated for the beginning student
to understand. The encyclopedia does use medical terminology, but explains it in a way that students can understand.
SCOPE
The Gale Encyclopedia of Nursing and Allied Health
covers a wide variety of topics relevant to the nursing or
allied health student. Subjects covered include those
important to students intending to become biomedical
equipment technologists, dental hygienists, dieteticians,
health care administrators, medical technologists/clinical
laboratory sciencists, registered and licensed practical
nurses, nurse anesthetists, nurse practitioners, nurse midwives, occupational therapists, optometrists, pharmacy
technicians, physical therapists, radiologic technologists,
and speech-language therapists. The encyclopedia also
covers information on related general medical topics,
classes of medication, mental health, public health, and
human biology. Entries follow a standardized format that
provides information at a glance. Rubrics include:
Diseases/Disorders
Definition
Description
Causes and symptoms
Diagnosis
Treatment
Prognosis
Health care team roles
Prevention
Resources
Key terms
Tests/Procedures
Definition
Purpose
Precautions
Description
Preparation
Aftercare
Complications
Results
Health care team roles
Resources
Key terms
Equipment/Tools
Definition
Purpose
Description
Operation
Maintenance
Health care team roles
Training
Resources
Key terms
Human biology/Body systems
Definition
Description
Function
Role in human health
Common diseases and disorders
Resources
Key terms
G A L E E N C Y C L O P E D I A O F N U R S I N G A N D A L L I E D H E A LT H
VII
Introduction
HOW TO USE THIS BOOK
Nursing and allied health professions
The Gale Encyclopedia of Nursing and Allied Health
has been designed with ready reference in mind.
Definition
Description
Work settings
Education and training
Advanced education and training
Future outlook
Resources
Key terms
• Straight alphabetical arrangement of topics allows
users to locate information quickly.
• Bold-faced terms within entries direct the reader to
related articles.
• Cross-references placed throughout the encyclopedia
direct readers from alternate names and related topics
to entries.
Current health issues
• A list of Key terms is provided where appropriate to
define terms or concepts that may be unfamiliar to the
student.
Definition
Description
Viewpoints
Professional implications
Resources
Key terms
• The Resources section directs readers to additional
sources of medical information on a topic.
• Valuable contact information for medical, nursing,
and allied health organizations is included with each
entry. An Appendix of Nursing and Allied Health
organizations in the back matter contains an extensive
list of organizations arranged by subject.
INCLUSION CRITERIA
A preliminary list of topics was compiled from a
wide variety of sources, including nursing and allied
health textbooks, general medical encyclopedias, and
consumer health guides. The advisory board, composed
of advanced practice nurses, allied health professionals,
health educators, and medical doctors, evaluated the topics and made suggestions for inclusion. Final selection of
topics to include was made by the advisory board in conjunction with the Gale editor.
ABOUT THE CONTRIBUTORS
The essays were compiled by experienced medical
writers, including physicians, pharmacists, nurses, and
allied health care professionals. The advisers reviewed
the completed essays to ensure that they are appropriate,
up-to-date, and medically accurate.
VIII
• A comprehensive general index guides readers to significant topics mentioned in the text.
GRAPHICS
The Gale Encyclopedia of Nursing and Allied Health
is enhanced by over 400 black and white photos and illustrations, as well as over 50 tables.
ACKNOWLEDGMENTS
The editor would like to express appreciation to all
of the nursing and allied health professionals who wrote,
reviewed, and copyedited entries for the Gale
Encyclopedia of Nursing and Allied Health.
Cover photos were reproduced by the permission of
Delmar Publishers, Inc., Custom Medical Photos, and the
Gale Group.
G A L E E N C Y C L O P E D I A O F N U R S I N G A N D A L L I E D H E A LT H
ADVISORY BOARD
A number of experts in the nursing and allied health communities provided invaluable assistance in the formulation of this
encyclopedia. The advisory board performed a myriad of duties, from defining the scope of coverage to reviewing individual entries for accuracy and accessibility. The editor would like to express appreciation to them for their time and their expert
contributions.
Dr. Isaac Bankman
Principal Scientist
Imaging and Laser Systems Section
Johns Hopkins Applied Physics Laboratory
Laurel, Maryland
Dr. Gregory M. Karst
Associate Professor
Division of Physical Therapy Education
University of Nebraska Medical Center
Omaha, Nebraska
Martha G. Bountress, M.S., CCC-SLP/A
Clinical Instructor
Speech-Language Pathology and Audiology
Old Dominion University
Norfolk, Virginia
Debra A. Kosko, R.N., M.N., FNP-C
Instructor, Faculty Practice
School of Nursing, Department of Medicine
Johns Hopkins University
Baltimore, Maryland
Michele Leonardi Darby
Eminent Scholar, University Professor
Graduate Program Director
School of Dental Hygiene
Old Dominion University
Norfolk, Virginia
Timothy E. Moore, Ph.D., C Psych
Professor of Psychology
Glendon College
York University
Toronto, Ontario, Canada
Dr. Susan J. Gromacki
Lecturer in Ophthalmology and Visual Sciences
University of Michigan Medical School
Ann Arbor, Michigan
Anne Nichols, C.R.N.P.
Coordinator, Family Nurse Practitioner Program
School of Nursing
Widener University
Chester, Pennsylvania
Dr. John E. Hall
Guyton Professor and Chair
Department of Physiology and Biophysics
University of Mississippi Medical Center
Jackson, Mississippi
Judith B. Paquet, R.N.
Medical Communications Specialist
Paquet Associates
Clementon, New Jersey
Lisa F. Harper, B.S.D.H., M.P.H., R.D., L.D.
Assistant Professor
Baylor College of Dentistry
Dallas, Texas
Lee A. Shratter, M.D.
Radiologist
Healthcare Safety and Medical Consultant
Kentfield, California
Robert Harr, M.S. MT (ASCP)
Associate Professor and Chair
Department of Public and Allied Health
Bowling Green State University
Bowling Green, Ohio
Linda Wheeler, C.N.M., Ed.D.
Associate Professor
School of Nursing
Oregon Health and Science University
Portland, Oregon
G A L E E N C Y C L O P E D I A O F N U R S I N G A N D A L L I E D H E A LT H
IX
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CONTRIBUTORS
Lisa Maria Andres, M.S., C.G.C
San Jose, California
Rachael Tripi Brandt, M.S.
Gettysburg, Pennsylvania
Greg Annussek
New York, New York
Peggy Elaine Browning
Olney, Texas
Maia Appleby
Boynton Beach, Florida
Susan Joanne Cadwallader
Cedarburg, Wisconsin
Bill Asenjo, M.S., C.R.C.
Iowa City, Iowa
Barbara M. Chandler
Sacramento, California
Lori Ann Beck, R.N., M.S.N., F.N.P.-C.
Berkley, Michigan
Linda Chrisman
Oakland, California
Mary Bekker
Willow Grove, Pennsylvania
Rhonda Cloos, R.N.
Austin, Texas
Linda K. Bennington, R.N.C., M.S.N., C.N.S.
Virginia Beach, Virginia
L. Lee Culvert
Alna, Massachusetts
Kenneth J. Berniker, M.D.
El Cerrio, California
Tish Davidson
Fremont, California
Mark A. Best
Cleveland Heights, Ohio
Lori De Milto
Sicklerville, New Jersey
Dean Andrew Bielanowski, R.N., B.Nurs.(QUT)
Rochedale S., Brisbane, Australia
Victoria E. DeMoranville
Lakeville, Massachusetts
Carole Birdsall, R.N. A.N.P. Ed.D.
New York, New York
Janine Diebel, R.N.
Gaylord, Michigan
Bethanne Black
Buford, Georgia
Stéphanie Islane Dionne
Ann Arbor, Michigan
Maggie Boleyn, R.N., B.S.N.
Oak Park, Michigan
J. Paul Dow, Jr.
Kansas City, Missouri
Barbara Boughton
El Cerrito, California
Douglas Dupler
Boulder, Colorado
Patricia L. Bounds, Ph.D.
Zurich, Switzerland
Lorraine K. Ehresman
Northfield, Quebec, Canada
Mary Boyle, Ph.D., C.C.C.-S.L.P., B.C.-N.C.D.
Lincoln Park, New Jersey
L. Fleming Fallon, Jr., M.D., Dr.P.H.
Bowling Green, Ohio
G A L E E N C Y C L O P E D I A O F N U R S I N G A N D A L L I E D H E A LT H
XI
Contributors
Diane Fanucchi-Faulkner, C.M.T., C.C.R.A.
Oceano, California
Paul A. Johnson
San Marcos, California
Janis O. Flores
Sebastopol, Florida
Linda D. Jones, B.A., P.B.T.(A.S.C.P.)
Asheboro, New York
Paula Ford-Martin
Chaplin, Minnesota
Crystal Heather Kaczkowski, M.Sc.
Dorval, Quebec, Canada
Janie F. Franz
Grand Forks, North Dakota
Beth Kapes
Bay Village, Ohio
Sallie Boineau Freeman, Ph.D.
Atlanta, Georgia
Monique Laberge, Ph.D.
Philadelphia, Pennsylvania
Rebecca Frey, Ph.D.
New Haven, Connecticut
Aliene S. Linwood, B.S.N., R.N., D.P.A., F.A.C.H.E.
Athens, Ohio
Lisa M. Gourley
Bowling Green, Ohio
Jennifer Lee Losey, R.N.
Madison Heights, Michigan
Meghan M. Gourley
Germantown, Maryland
Liz Marshall
Columbus, Ohio
Jill Ilene Granger, M.S.
Ann Arbor, Michigan
Mary Elizabeth Martelli, R.N., B.S.
Sebastian, Florida
Elliot Greene, M.A.
Silver Spring, Maryland
Jacqueline N. Martin, M.S.
Albrightsville, Pennsylvania
Stephen John Hage, A.A.A.S., R.T.(R), F.A.H.R.A.
Chatsworth, California
Sally C. McFarlane-Parrott
Mason, Michigan
Clare Hanrahan
Asheville, North Carolina
Beverly G. Miller, M.T.(A.S.C.P.)
Charlotte, North Carolina
Robert Harr
Bowling Green, Ohio
Christine Miner Minderovic, B.S., R.T., R.D.M.S.
Ann Arbor, Michigan
Daniel J. Harvey
Wilmington, Delaware
Mark A. Mitchell, M.D.
Bothell, Washington
Katherine Hauswirth, A.P.R.N.
Deep River, Connecticut
Susan M. Mockus, Ph.D.
Seattle, Washington
David L. Helwig
London, Ontario, Canada
Timothy E. Moore, Ph.D.
Toronto, Ontario, Canada
Lisette Hilton
Boca Raton, Florida
Nancy J. Nordenson
Minneapolis, Minnesota
René A. Jackson, R.N.
Port Charlotte, Florida
Erika J. Norris
Oak Harbor, Washington
Nadine M. Jacobson, R.N.
Takoma Park, Maryland
Debra Novograd, B.S., R.T.(R)(M)
Royal Oak, Michigan
Randi B. Jenkins
New York, New York
Marianne F. O’Connor, M.T., M.P.H.
Farmington Hills, Michigan
Michelle L. Johnson, M.S., J.D.
Portland, Oregon
Carole Osborne-Sheets
Poway, California
XII
G A L E E N C Y C L O P E D I A O F N U R S I N G A N D A L L I E D H E A LT H
Patricia Skinner
Amman, Jordan
Patience Paradox
Bainbridge Island, Washington
Genevieve Slomski
New Britain, Connecticut
Deborah Eileen Parker, R.N.
Lakewood, Washington
Bryan Ronain Smith
Cincinnati, Ohio
Genevieve Pham-Kanter
Chicago, Illinois
Allison Joan Spiwak, B.S., C.C.P.
Gahanna, Ohio
Jane E. Phillips, Ph.D.
Chapel Hill, North Carolina
Lorraine T. Steefel
Morganville, New Jersey
Pamella A. Phillips
Bowling Green, Ohio
Margaret A. Stockley, R.G.N.
Boxborough, Massachusetts
Elaine R. Proseus, M.B.A./T.M., B.S.R.T., R.T.(R)
Farmington Hills, Michigan
Amy Loerch Strumolo
Bloomfield Hills, Michigan
Ann Quigley
New York, New York
Liz Swain
San Diego, California
Esther Csapo Rastegari, R.N., B.S.N., Ed.M.
Holbrook, Massachusetts
Deanna M. Swartout-Corbeil, R.N.
Thompsons Station, Tennessee
Anastasia Marie Raymer, Ph.D.
Norfolk, Virginia
Peggy Campbell Torpey, M.P.T.
Royal Oak, Michigan
Martha S. Reilly, O.D.
Madison, Wisconsin
Mai Tran, Pharm.D.
Troy, Michigan
Linda Richards, R.D., C.H.E.S.
Flagstaff, Arizona
Carol A. Turkington
Lancaster, Pennsylvania
Toni Rizzo
Salt Lake City, Utah
Judith Turner, D.V.M.
Sandy, Utah
Nancy Ross-Flanigan
Belleville, Michigan
Samuel D. Uretsky, Pharm.D.
Wantagh, New York
Mark Damian Rossi, Ph.D, P.T., C.S.C.S.
Pembroke Pines, Florida
Michele R. Webb
Overland Park, Kansas
Kausalya Santhanam
Branford, Connecticut
Ken R. Wells
Laguna Hills, California
Denise L. Schmutte, Ph.D.
Shoreline, Washington
Barbara Wexler, M.P.H.
Chatsworth, California
Joan M. Schonbeck
Marlborough, Massachusetts
Gayle G. Wilkins, R.N., B.S.N., O.C.N.
Willow Park, Texas
Kathleen Scogna
Baltimore, Maryland
Jennifer F. Wilson
Haddonfield, New Jersey
Cathy Hester Seckman, R.D.H.
Calcutta, Ohio
Angela Woodward
Madison, Wisconsin
Jennifer E. Sisk, M.A.
Havertown, Pennsylvania
Jennifer Wurges
Rochester Hills, Michigan
G A L E E N C Y C L O P E D I A O F N U R S I N G A N D A L L I E D H E A LT H
Contributors
Cindy F. Ovard, R.D.A
Spring Valley, California
XIII
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A
Abdominal thrust see Heimlich maneuver
Abdominal ultrasound
Definition
Abdominal ultrasound uses high frequency sound
waves to produce two-dimensional images of the body’s
soft tissues, which are used for a variety of clinical applications, including diagnosis and guidance of treatment
procedures. Ultrasound does not use ionizing radiation
to produce images, and in comparison to other diagnostic imaging modalities, it is low cost, safe, fast, and
versatile.
Purpose
Abdominal ultrasound is used in the hospital radiology department and emergency department, as well as in
physician offices for a number of clinical applications.
Ultrasound has a great advantage over x-ray imaging
technologies in that it does not damage tissues with ionizing radiation. Ultrasound is also generally far better
than plain x-rays at distinguishing the subtle variations of
soft tissue structures, and can be used in any of several
modes, depending on the area of interest.
As an imaging tool, abdominal ultrasound generally
is indicated for patients afflicted with chronic or acute
abdominal pain; abdominal trauma; an obvious or suspected abdominal mass; symptoms of liver disease, pancreatic disease, gallstones, spleen disease, kidney disease
and urinary blockage; or symptoms of an abdominal aortic aneurysm.
Specifically:
• Abdominal pain. Whether acute or chronic, pain can
signal a serious problem—from organ malfunction or
injury to the presence of malignant growths.
Ultrasound scanning can help doctors quickly sort
through potential causes when presented with general
or ambiguous symptoms. All of the major abdominal
organs can be studied for signs of disease that appear as
changes in size, shape, and internal structure.
• Abdominal trauma. After a serious accident, such as a
car crash or a fall, internal bleeding from injured
abdominal organs is often the most serious threat to
survival. Neither the injuries nor the bleeding may be
immediately apparent. Ultrasound is very useful as an
initial scan when abdominal trauma is suspected, and it
can be used to pinpoint the location, cause, and severity of hemorrhaging. In the case of puncture wounds,
from a bullet for example, ultrasound can locate the
foreign object and provide a preliminary survey of
the damage. (CT scans are sometimes used in trauma
settings.)
• Abdominal mass. Abnormal growths—tumors, cysts,
abscesses, scar tissue, and accessory organs—can be
located and tentatively identified with ultrasound. In
particular, potentially malignant solid tumors can be
distinguished from benign fluid-filled cysts. Masses
and malformations in any organ or part of the abdomen
can be found.
• Liver disease. The types and underlying causes of liver
disease are numerous, though jaundice tends to be a
general symptom. Ultrasound can differentiate between
many of the types and causes of liver malfunction, and
is particularly good at identifying obstruction of the
bile ducts and cirrhosis, which is characterized by
abnormal fibrous growths and reduced blood flow.
• Pancreatic disease. Inflammation and malformation of
the pancreas are readily identified by ultrasound, as
are pancreatic stones (calculi), which can disrupt proper functioning.
• Gallstones. Gallstones are an extremely common cause
of hospital admissions. These calculi can cause painful
inflammation of the gallbladder and also obstruct the
bile ducts that carry digestive enzymes from the gall-
G A L E E N C Y C L O P E D I A O F N U R S I N G A N D A L L I E D H E A LT H
1
Abdominal ultrasound
bladder and liver to the intestines. Gallstones are readily identifiable with ultrasound.
• Spleen disease. The spleen is particularly prone to
injury during abdominal trauma. It may also become
painfully inflamed when infected or cancerous.
• Kidney disease. The kidneys are also prone to traumatic injury and are the organs most likely to form calculi,
which can block the flow of urine and cause further
systemic problems. A variety of diseases causing distinct changes in kidney morphology can also lead to
complete kidney failure. Ultrasound imaging has
proven extremely useful in diagnosing kidney disorders, including blockage or obstruction.
• Abdominal aortic aneurysm. This is a bulging weak
spot in the abdominal aorta, which supplies blood
directly from the heart to the entire lower body. A ruptured aortic aneurysm is imminently life-threatening.
However, it can be readily identified and monitored
with ultrasound before acute complications result.
• Appendicitis. Ultrasound is useful in diagnosing
appendicitis, which causes abdominal pain.
Ultrasound technology can also be used for treatment purposes, most frequently as a visual aid during
surgical procedures—such as guiding needle placement
to drain fluid from a cyst, or to guide biopsies.
Precautions
Ultrasound waves of appropriate frequency and
intensity are not known to cause or aggravate any medical condition.
The value of ultrasound imaging as a medical tool,
however, depends greatly on the quality of the equipment
used and the skill of the medical personnel operating it.
More accurate results are obtained when ultrasound is
performed by a clinician skilled in sonography. Basic
ultrasound equipment is relatively inexpensive to obtain,
and any physician with the equipment can perform the
procedure whether specifically trained in ultrasound
scanning and interpretation or not. Patients should not
hesitate to verify the credentials of technologists and
physicians performing ultrasound scanning, as well as
the quality of the equipment used and the benefits of the
proposed procedure.
In cases where ultrasound is used as a treatment tool,
patients should educate themselves about the proposed
procedure with the help of their doctors—as is appropriate before any surgical procedure. Also, any abdominal
ultrasound procedure, diagnostic or therapeutic, may be
hampered by a patient’s body type or other factors, such
as the presence of excessive bowel gas (which is opaque
2
to ultrasound). In particular, very obese people are often
not good candidates for abdominal ultrasound.
Description
Ultrasound includes all sound waves above the frequency of human hearing—about 20 thousand hertz, or
cycles per second. Medical ultrasound generally uses frequencies between one and 10 megahertz (1-10 MHz).
Higher frequency ultrasound waves produce more
detailed images, but are also more readily absorbed and
so cannot penetrate as deeply into the body. Abdominal
ultrasound imaging is generally performed at frequencies
between 2-5 MHz.
An ultrasound scanner consists of two parts: the transducer and the data processing unit. The transducer both
produces the sound waves that penetrate the body and
receives the reflected echoes. Transducers are built around
piezoelectric ceramic chips. (Piezoelectric refers to electricity that is produced when you put pressure on certain
crystals such as quartz.) These ceramic chips react to electric pulses by producing sound waves (they are transmitting waves) and react to sound waves by producing electric pulses (receiving). Bursts of high-frequency electric
pulses supplied to the transducer cause it to produce the
scanning sound waves. The transducer then receives the
returning echoes, translates them back into electric pulses,
and sends them to the data processing unit—a computer
that organizes the data into an image on a television screen.
Because sound waves travel through all the body’s
tissues at nearly the same speed—about 3,400 miles per
hour—the microseconds it takes for each echo to be
received can be plotted on the screen as a distance into
the body. The relative strength of each echo, a function of
the specific tissue or organ boundary that produced it, can
be plotted as a point of varying brightness. In this way,
the echoes are translated into an image.
Four different modes of ultrasound are used in medical imaging:
• A-mode. This is the simplest type of ultrasound in
which a single transducer scans a line through the body
with the echoes plotted on screen as a function of depth.
This method is used to measure distances within the
body and the size of internal organs.
• B-mode. In B-mode ultrasound, a linear array of transducers simultaneously scans a plane through the body that
can be viewed as a two-dimensional image on screen.
• M-Mode. The M stands for motion. A rapid sequence of
B-mode scans whose images follow each other in
sequence on screen enables doctors to see and measure
range of motion, as the organ boundaries that produce
reflections move relative to the probe. M-mode ultra-
G A L E E N C Y C L O P E D I A O F N U R S I N G A N D A L L I E D H E A LT H
Abdominal ultrasound
KEY TERMS
Accessory organ—A lump of tissue adjacent to an
organ that is similar to it, but which serves no
important purpose, if functional at all. While not
necessarily harmful, such organs can cause problems if they grow too large or become cancerous.
Benign—In medical usage, benign is the opposite
of malignant. It describes an abnormal growth
that is stable, treatable, and generally not lifethreatening.
Biopsy—The surgical removal and analysis of a tissue sample for diagnostic purposes. Usually, the
term refers to the collection and analysis of tissue
from a suspected tumor to establish malignancy.
Calculus—Any type of hard concretion (stone) in
the body, but usually found in the gallbladder, pancreas, and kidneys. Calculi (pl.) are formed by the
accumulation of excess mineral salts and other
organic material such as blood or mucous. They
can cause problems by lodging in and obstructing
the proper flow of fluids, such as bile to the intestines or urine to the bladder.
Cirrhosis—A chronic liver disease characterized by
the degeneration of proper functioning—jaundice
is often an accompanying symptom. Causes of cirrhosis include alcoholism, metabolic diseases,
syphilis, and congestive heart disease.
Common bile duct—The branching passage
through which bile—a necessary digestive
enzyme—travels from the liver and gallbladder into
the small intestine. Digestive enzymes from the
pancreas also enter the intestines through the common bile duct.
Computed tomography scan (CT scan)—A specialized type of x-ray imaging that uses highly focused
and relatively low energy radiation to produce
detailed two-dimensional images of soft tissue
structures, particularly the brain. CT scans are the
chief competitor to ultrasound and can yield higher quality images not disrupted by bone or gas.
They are, however, more cumbersome, time consuming and expensive to perform, and they use
ionizing radiation.
sound has been put to particular use in studying heart
motion.
• Doppler mode. Doppler ultrasonography includes the
capability of accurately measuring velocities of moving
Doppler—The Doppler effect refers to the apparent
change in frequency of sound wave echoes returning to a stationary source from a moving target. If
the object is moving toward the source, the frequency increases; if the object is moving away, the
frequency decreases. The size of this frequency
shift can be used to compute the object’s speed—
be it a car on the road or blood in an artery. The
Doppler effect holds true for all types of radiation,
not just sound.
Frequency—Sound, whether traveling through air
or the human body, produces vibrations—molecules bouncing into each other—as the shock wave
travels along. The frequency of a sound is the number of vibrations per second. Within the audible
range, frequency means pitch—the higher the frequency, the higher a sound’s pitch.
Ionizing radiation—Radiation that can damage living tissue by disrupting and destroying individual
cells at the molecular level. All types of nuclear
radiation—x rays, gamma rays and beta rays—are
potentially ionizing. Sound waves physically
vibrate the material through which they pass, but
do not ionize it.
Jaundice—A condition that results in a yellow tint
to the skin, eyes and body fluids. Bile retention in
the liver, gallbladder and pancreas is the immediate
cause, but the underlying cause could be as simple
as obstruction of the common bile duct by a gallstone or as serious as pancreatic cancer. Ultrasound can distinguish between these conditions.
Malignant—The term literally means growing
worse and resisting treatment. It is used as a synonym for cancerous and connotes a harmful condition that generally is life-threatening.
Morphology—Literally, the study of form. In medicine, morphology refers to the size, shape, and
structure rather than the function of a given organ.
As a diagnostic imaging technique, ultrasound
facilitates the recognition of abnormal morphologies as symptoms of underlying conditions.
material, such as blood in arteries and veins. The principle is the same as that used in radar guns that measure
the speed of a car on the highway. Doppler capability is
most often combined with B-mode scanning to produce
G A L E E N C Y C L O P E D I A O F N U R S I N G A N D A L L I E D H E A LT H
3
Abdominal ultrasound
Preparation
A patient undergoing abdominal ultrasound will be
advised by the physician about what to expect and how to
prepare. As mentioned above, preparations generally
include fasting.
Aftercare
In general, no aftercare related to the abdominal
ultrasound procedure itself is required. Discomfort during the procedure is minimal.
Complications
Properly performed, ultrasound imaging is virtually
without risk or side effects. Some patients report feeling
a slight tingling and/or warmth while being scanned, but
most feel nothing at all.
An ultrasound screen shows a patient’s kidney.
(Photograph by Brownie Harris. The Stock Market.
Reproduced by permission.)
images of blood vessels from which blood flow can be
directly measured. This technique is used extensively to
investigate valve defects, arteriosclerosis, and hypertension, particularly in the heart, but also in the abdominal aorta and the portal vein of the liver.
The actual procedure for a patient undergoing an
abdominal ultrasound is relatively simple, regardless of
the type of scan or its purpose. Fasting for at least eight
hours prior to the procedure ensures that the stomach is
empty and as small as possible, and that the intestines
and bowels are relatively inactive. This also helps the
gallbladder become more visible. Prior to scanning, an
acoustic gel is applied to the skin of the patient’s
abdomen to allow the ultrasound probe to glide easily
across the skin and also to better transmit and receive
ultrasonic pulses. The probe is moved around the
abdomen’s surface to obtain different views of the target
areas. The patient will likely be asked to change positions from side to side and to hold the breath as necessary
to obtain the desired views. Usually, a scan will take
from 20 to 45 minutes, depending on the patient’s condition and anatomical area being scanned.
Ultrasound scanners are available in different configurations, with different scanning features. Portable
units, which weigh only a few pounds and can be carried
by hand, are available for bedside use, office use, or use
outside the hospital, such as at sporting events and in
ambulances. Portable scanners range in cost from
$10,000 to $50,000. Mobile ultrasound scanners, which
can be pushed to the patient bedside and between hospital departments, are the most common comfiguration and
range in cost from $100,000 to over $250,000, depending on the scanning features purchased.
4
Results
As a diagnostic imaging technique, a normal abdominal ultrasound is one that indicates the absence of the suspected condition that prompted the scan. For example,
symptoms such as abdominal pain radiating to the back
suggest the possibility of, among other things, an abdominal aortic aneurysm. An ultrasound scan that indicates the
absence of an aneurysm would rule out this life-threatening condition and point to other, less serious causes.
Because abdominal ultrasound imaging is generally
undertaken to confirm a suspected condition, the results
of a scan often will confirm the diagnosis, be it kidney
stones, cirrhosis of the liver, or an aortic aneurysm. At
that point, appropriate medical treatment as prescribed by
a patient’s physician is in order.
Health care team roles
Ultrasound scanning should be performed by a registered and trained ultrasonographer, either a technologist
and/or a physician (radiologist, obstetrician/gynecologist). Ultrasound scanning in the emergency department
may be performed by an emergency medicine physician,
who should have appropriate training and experience in
ultrasonography.
Resources
BOOKS
Dendy, P.P., Heaton, B. Physics for Diagnostic Radiology. 2nd
ed. Philadelphia: Institute of Physics Publishing, 1999.
Hall, Rebecca. The Ultrasonic Handbook: Clinical, etiologic
and pathologic implications of sonographic findings.
Philadelphia: Lippincott, 1993.
G A L E E N C Y C L O P E D I A O F N U R S I N G A N D A L L I E D H E A LT H
PERIODICALS
Freundlich, Naomi. “Ultrasound: What’s Wrong with this
Picture?” Business Week (15 September 1997): 84-85.
Kuhn, M., Bonnin, R.L.L., Davey, M.J., Rowland, J.L.,
Langlois, S. “Emergency Department Ultrasound
Scanning for Abdodminal Aortic Aneurysm: Accessible,
Accurate, Advantageous. Annals of Emergency Medicine.
(September 2000) 36(3):219-223.
Sisk, Jennifer. “Ultrasound in the Emergency Department:
Toward a Standard of Care.” Radiology Today (June 4,
2001) 2(1):8-10.
ORGANIZATIONS
American College of Radiology. 1891 Preston White Drive,
Reston, VA 20191-4397. (800)227-5463.
.
American Institute of Ultrasound in Medicine. 14750 Sweitzer
Lane, Suite 100, Laurel, MD 20707-5906. (301) 4984100. .
American Registry of Diagnostic Medical Sonographers. 600
Jefferson Plaza, Suite 360, Rockville, MD 20852-1150.
(800) 541-9754. .
American Society of Radiologic Technologists (ASRT). 15000
Central Avenue SE, Albuquerque, NM 87123-2778. (800)
444-2778. .
Radiological Society of North America. 820 Jorie Boulevard,
Oak Brook, IL 60523-2251. (630) 571-2670.
.
Society of Diagnostic Medical Sonography. 12770 Coit Road,
Suite 708, Dallas, TX 75251-1319. (972) 239-7367.
.
Jennifer E. Sisk, M.A.
ABO blood typing see Type and screen
Abrasions see Wounds
Abruptio placentae see Placental abruption
Abscess
Definition
An abscess is an enclosed collection of liquefied tissue, known as pus, somewhere in the body. It is the result
of the body’s defensive reaction to foreign material.
Description
There are two types of abscesses, septic and sterile.
Most abscesses are septic, which means that they are the
result of an infection. Septic abscesses can occur anywhere in the body. Only bacteria and the body’s
immune response are required. In response to the invading bacteria, white blood cells gather at the infected site
and begin producing chemicals called enzymes that
attack the bacteria by first marking and then digesting it.
These enzymes kill the bacteria and break them down
into small pieces that can travel in the circulatory system
prior to being eliminated from the body. Unfortunately,
these chemicals also digest body tissues. In most cases,
bacteria produce similar chemicals. The result is a thick,
yellow liquid—pus—containing dead bacteria, digested
tissue, white blood cells, and enzymes.
An abscess is the last stage of a tissue infection that
begins with a process called inflammation. Initially, as
invading bacteria activate the body’s immune system,
several events occur:
• Blood flow to the area increases.
• The temperature of the area increases due to the
increased blood supply.
• The area swells due to the accumulation of water,
blood, and other liquids.
• It turns red.
• It hurts, due to irritation from the swelling and the
chemical activity.
These four signs—heat, swelling, redness, and
pain—characterize inflammation.
As the process progresses, the tissue begins to turn to
liquid, and an abscess forms. It is the nature of an abscess
to spread as the chemical digestion liquefies more and
more tissue. Furthermore, the spreading follows the path
of least resistance, commonly, the tissue that is most easily digested. A good example is an abscess just beneath
the skin. It most easily continues along immediately
beneath the surface rather than traveling up through the
outermost layer or down through deeper structures where
it could drain its toxic contents. The contents of an
abscess can also leak into the general circulation and produce symptoms just like any other infection. These
include chills, fever, aching, and general discomfort.
Sterile abscesses are sometimes a milder form of the
same process caused not by bacteria but by non-living
irritants such as drugs. If an injected drug such as penicillin is not absorbed, it stays where it is injected and may
cause enough irritation to generate a sterile abscess. Such
an abscess is sterile because there is no infection
involved. Sterile abscesses are quite likely to turn into
G A L E E N C Y C L O P E D I A O F N U R S I N G A N D A L L I E D H E A LT H
5
Abscess
Kevles, Bettyann Holtzmann. Naked to the Bone: Medical
imaging in the twentieth century. New Brunswick, New
Jersey: Rutgers University Press, 1997.
Zaret, Barry L., ed. The Patient’s Guide to Medical Tests.
Boston: Houghton Mifflin Company, 1997.
Abscess
Specific types of abscesses
KEY TERMS
Cellulitis—Inflammation
infection.
of
tissue
due
to
Enzyme—Any of a number of protein chemicals
that can initiate chemical reactions at body temperature.
Fallopian tubes—Part of the internal female
anatomy that carries eggs from the ovaries to the
uterus.
Flora—Living inhabitants of a region or area.
Pyogenic—Capable of generating pus. Streptococcus, Staphocococcus, and bowel bacteria
are the primary pyogenic organisms.
Sebaceous glands—Tiny structures in the skin that
produce oil (sebum). If they become plugged,
sebum collects inside and forms a nurturing place
for germs to grow.
Septicemia—The spread of an infectious agent
throughout the body by means of the blood
stream.
Sinus—A tubular channel connecting one body
part with another or with the outside.
hard, solid lumps as they scar, rather than remaining
pockets of pus.
Causes and symptoms
Many different agents cause abscesses. The most
common are the pus-forming (pyogenic) bacteria such as
Staphylococcus aureus, which is a very common cause of
abscesses under the skin. Abscesses near the large bowel,
particularly around the anus, may be caused by any of the
numerous bacteria found within the large bowel. Brain
abscesses and liver abscesses can be caused by any
organism that can travel there through the blood stream.
Bacteria, amoebae, and certain fungi can travel in this
fashion. Abscesses in other parts of the body are caused
by organisms that normally inhabit nearby structures or
that infect them. Some common causes of specific
abscesses are:
• skin abscesses by normal skin flora
• dental and throat abscesses by mouth flora
• lung abscesses by normal airway flora, bacteria that
cause pneumonia or tuberculosis
• abdominal and anal abscesses by normal bowel flora
6
Listed below are some of the more common and
important abscesses.
• Carbuncles and other boils. Skin oil glands (sebaceous
glands) on the back or the back of the neck are the ones
usually infected. The most commonly involved bacteria
is Staphylococcus aureus. Acne is a similar condition
involving sebaceous glands on the face and back.
• Pilonidal cyst. Many people have as a birth defect a tiny
opening in the skin just above the anus. Fecal bacteria
can enter this opening, causing an infection and subsequent abscess.
• Retropharyngeal, parapharyngeal, peritonsillar abscess.
As a result of throat infections such as strep throat and
tonsillitis, bacteria can invade the deeper tissues of the
throat and cause an abscess. These abscesses can compromise swallowing and even breathing.
• Lung abscess. During or after pneumonia, whether it’s
due to bacteria [common pneumonia], tuberculosis,
fungi, parasites, or other bacteria, abscesses can develop as a complication.
• Liver abscess. Bacteria or amoeba from the intestines
can spread through the blood to the liver and cause
abscesses.
• Psoas abscess. Deep in the back of the abdomen, on
either side of the lumbar spine, lie the psoas muscles.
They flex the hips. An abscess can develop in one of
these muscles, usually when it spreads from the appendix, the large bowel, or the fallopian tubes.
Diagnosis
The common findings of inflammation—heat, redness, swelling, and pain—easily identify superficial
abscesses. Abscesses in other places may produce only
generalized symptoms such as fever and discomfort. If
an individual’s symptoms and the results of a physical
examination do not help, a physician may have to resort
to a battery of tests to locate the site of an abscess.
Usually something in the initial evaluation directs the
search. Recent or chronic disease in an organ suggests it
may be the site of an abscess. Dysfunction of an organ or
system, for instance seizures or altered bowel function,
may provide the clue. Pain and tenderness on physical
examination are common findings. Sometimes a deep
abscess will eat a small channel (sinus) to the surface
and begin leaking pus. A sterile abscess may cause only
a painful lump deep in the buttock where a shot was
given.
G A L E E N C Y C L O P E D I A O F N U R S I N G A N D A L L I E D H E A LT H
Abscess
Treatment
Since skin is very resistant to the spread of infection,
it acts as a barrier, often keeping the toxic chemicals of
an abscess from escaping the body on their own. Thus,
the pus must be drained from the abscess by a physician.
The surgeon determines when the abscess is ready for
drainage and opens a path to the outside, allowing the
pus to escape. Ordinarily, the body handles the remaining
infection, sometimes with the help of antibiotics or
other drugs. The surgeon may leave a drain (a piece of
cloth or rubber) in the abscess cavity to prevent it from
closing before all the pus has drained out.
Alternative treatment
If an abscess is directly beneath the skin, it will be
slowly working its way through the skin as it is more rapidly working its way elsewhere. Since chemicals work
faster at higher temperatures, applications of hot compresses to the skin over the abscess will hasten the digestion of the skin and eventually result in its break down
and spontaneous release of pus. This treatment is best
reserved for smaller abscesses in less sensitive areas of
the body such as limbs, trunk, and back of the neck. It is
also useful for all superficial abscesses in their very early
stages. It will “ripen” them.
Contrast hydrotherapy, alternating hot and cold
compresses, can also help assist the body in resorption of
the abscess. There are two homeopathic remedies that
work to rebalance the body in relation to abscess formation, Silica and Hepar sulphuris. In cases of septic
abscesses, bentonite clay packs (bentonite clay and a
small amount of Hydrastis powder) can be used to draw
an infection from the area.
Prognosis
Once an abscess is properly drained, the prognosis is
excellent for the condition itself. The reason for the
abscess (other diseases an individual has) will determine
the overall outcome. If, on the other hand, an abscess
ruptures into neighboring areas or permits the infectious
agent to spill into the bloodstream, serious or fatal consequences are likely. Abscesses in and around the nasal
sinuses, face, ears, and scalp may work their way into the
brain. Abscesses within an abdominal organ such as the
liver may rupture into the abdominal cavity. In either
case, the result is life threatening. Blood poisoning is a
term commonly used to describe an infection that has
spilled into the blood stream and spread throughout the
body from a localized origin. Blood poisoning, known to
physicians as septicemia, is also life threatening.
An amoebic abscess caused by Entameoba histolytica.
(Phototake NYC. Reproduced by permission.)
Of special note, abscesses in the hand are more serious than they might appear. Due to the intricate structure
and the overriding importance of the hand, any hand
infection must be treated promptly and competently.
Health care team roles
First aid providers may unknowingly initiate an
abscess by using inappropriate or incorrect techniques. A
physician, surgeon, physician’s assistant, or nurse practitioner usually diagnoses the presence of an abscess.
Radiologists and laboratory personnel may assist in the
process of establishing a diagnosis. A physician, surgeon,
physician’s assistant, or nurse practitioner usually drains
an abscess. Nurses provide supportive care, dress the
wound, and educate patients about caring for the resulting wound. Occasionally, a physical therapist may be
needed to recover lost function.
Prevention
Infections that are treated early with heat (if superficial) or antibiotics will often resolve without the formation of an abscess. It is even better to avoid infections
altogether by taking prompt care of open injuries, particularly puncture wounds. Bites are the most dangerous of
all, even more so because they often occur on the hand.
Resources
BOOKS
Balistreri, William. “Liver abscess.” In Nelson Textbook of
Pediatrics, 16th ed., edited by Richard E. Behrman et al.,
Philadelphia, Saunders, 2000, 1212.
Chesney, Russell W. “Brain abscess.” In Nelson Textbook of
Pediatrics, 16th ed., edited by Richard E. Behrman et al.,
Philadelphia, Saunders, 2000, 1857-1858.
G A L E E N C Y C L O P E D I A O F N U R S I N G A N D A L L I E D H E A LT H
7
Acid-base balance
Finegold, Sydney M. “Lung abscess.” In Cecil Textbook of
Medicine, 21st ed., edited by Goldman, Lee and Bennett,
J. Claude. Philadelphia: W.B. Saunders, 2000, 439-442.
Herendeen, Neil E and Szilagy, Peter G. “Peritonsillar
abscess.” In Nelson Textbook of Pediatrics, 16th ed., edited by Richard E. Behrman et al., Philadelphia, Saunders,
2000, 1266-1267.
Scheld, W. Michael. “Bacterial meningitis, brain abscess, and
other suppurative intracranial infections.” In Harrison’s
Principles of Internal Medicine, 14th ed., edited by
Anthony S. Fauci, et al. New York: McGraw-Hill, 1998,
2419-2434.
Schwartz, Seymour, Shires, Tom and Spencer, Frank
C.Principles of Surgery, 7th ed. New York, McGraw Hill,
1998.
Stern, Robert C. “Pulmona
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1. Nursing Care—Encyclopedias—English. 2. Allied Health
Personnel—Encyclopedias—English.
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CONTENTS
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii
Advisory Board . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix
Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi
Entries
Volume 1: A-C . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Volume 2: D-H . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 641
Volume 3: I-O . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1237
Volume 4: P-S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1797
Volume 5: T-Z . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2383
Appendix of Nursing and Allied Health
Organizations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2663
General Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2669
G A L E E N C Y C L O P E D I A O F N U R S I N G A N D A L L I E D H E A LT H
V
PLEASE READ—IMPORTANT INFORMATION
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INTRODUCTION
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tools, body systems, nursing and allied health professions, and current health issues. This book is designed to
fill a gap between health information designed for
laypeople and that provided for medical professionals,
which may be too complicated for the beginning student
to understand. The encyclopedia does use medical terminology, but explains it in a way that students can understand.
SCOPE
The Gale Encyclopedia of Nursing and Allied Health
covers a wide variety of topics relevant to the nursing or
allied health student. Subjects covered include those
important to students intending to become biomedical
equipment technologists, dental hygienists, dieteticians,
health care administrators, medical technologists/clinical
laboratory sciencists, registered and licensed practical
nurses, nurse anesthetists, nurse practitioners, nurse midwives, occupational therapists, optometrists, pharmacy
technicians, physical therapists, radiologic technologists,
and speech-language therapists. The encyclopedia also
covers information on related general medical topics,
classes of medication, mental health, public health, and
human biology. Entries follow a standardized format that
provides information at a glance. Rubrics include:
Diseases/Disorders
Definition
Description
Causes and symptoms
Diagnosis
Treatment
Prognosis
Health care team roles
Prevention
Resources
Key terms
Tests/Procedures
Definition
Purpose
Precautions
Description
Preparation
Aftercare
Complications
Results
Health care team roles
Resources
Key terms
Equipment/Tools
Definition
Purpose
Description
Operation
Maintenance
Health care team roles
Training
Resources
Key terms
Human biology/Body systems
Definition
Description
Function
Role in human health
Common diseases and disorders
Resources
Key terms
G A L E E N C Y C L O P E D I A O F N U R S I N G A N D A L L I E D H E A LT H
VII
Introduction
HOW TO USE THIS BOOK
Nursing and allied health professions
The Gale Encyclopedia of Nursing and Allied Health
has been designed with ready reference in mind.
Definition
Description
Work settings
Education and training
Advanced education and training
Future outlook
Resources
Key terms
• Straight alphabetical arrangement of topics allows
users to locate information quickly.
• Bold-faced terms within entries direct the reader to
related articles.
• Cross-references placed throughout the encyclopedia
direct readers from alternate names and related topics
to entries.
Current health issues
• A list of Key terms is provided where appropriate to
define terms or concepts that may be unfamiliar to the
student.
Definition
Description
Viewpoints
Professional implications
Resources
Key terms
• The Resources section directs readers to additional
sources of medical information on a topic.
• Valuable contact information for medical, nursing,
and allied health organizations is included with each
entry. An Appendix of Nursing and Allied Health
organizations in the back matter contains an extensive
list of organizations arranged by subject.
INCLUSION CRITERIA
A preliminary list of topics was compiled from a
wide variety of sources, including nursing and allied
health textbooks, general medical encyclopedias, and
consumer health guides. The advisory board, composed
of advanced practice nurses, allied health professionals,
health educators, and medical doctors, evaluated the topics and made suggestions for inclusion. Final selection of
topics to include was made by the advisory board in conjunction with the Gale editor.
ABOUT THE CONTRIBUTORS
The essays were compiled by experienced medical
writers, including physicians, pharmacists, nurses, and
allied health care professionals. The advisers reviewed
the completed essays to ensure that they are appropriate,
up-to-date, and medically accurate.
VIII
• A comprehensive general index guides readers to significant topics mentioned in the text.
GRAPHICS
The Gale Encyclopedia of Nursing and Allied Health
is enhanced by over 400 black and white photos and illustrations, as well as over 50 tables.
ACKNOWLEDGMENTS
The editor would like to express appreciation to all
of the nursing and allied health professionals who wrote,
reviewed, and copyedited entries for the Gale
Encyclopedia of Nursing and Allied Health.
Cover photos were reproduced by the permission of
Delmar Publishers, Inc., Custom Medical Photos, and the
Gale Group.
G A L E E N C Y C L O P E D I A O F N U R S I N G A N D A L L I E D H E A LT H
ADVISORY BOARD
A number of experts in the nursing and allied health communities provided invaluable assistance in the formulation of this
encyclopedia. The advisory board performed a myriad of duties, from defining the scope of coverage to reviewing individual entries for accuracy and accessibility. The editor would like to express appreciation to them for their time and their expert
contributions.
Dr. Isaac Bankman
Principal Scientist
Imaging and Laser Systems Section
Johns Hopkins Applied Physics Laboratory
Laurel, Maryland
Dr. Gregory M. Karst
Associate Professor
Division of Physical Therapy Education
University of Nebraska Medical Center
Omaha, Nebraska
Martha G. Bountress, M.S., CCC-SLP/A
Clinical Instructor
Speech-Language Pathology and Audiology
Old Dominion University
Norfolk, Virginia
Debra A. Kosko, R.N., M.N., FNP-C
Instructor, Faculty Practice
School of Nursing, Department of Medicine
Johns Hopkins University
Baltimore, Maryland
Michele Leonardi Darby
Eminent Scholar, University Professor
Graduate Program Director
School of Dental Hygiene
Old Dominion University
Norfolk, Virginia
Timothy E. Moore, Ph.D., C Psych
Professor of Psychology
Glendon College
York University
Toronto, Ontario, Canada
Dr. Susan J. Gromacki
Lecturer in Ophthalmology and Visual Sciences
University of Michigan Medical School
Ann Arbor, Michigan
Anne Nichols, C.R.N.P.
Coordinator, Family Nurse Practitioner Program
School of Nursing
Widener University
Chester, Pennsylvania
Dr. John E. Hall
Guyton Professor and Chair
Department of Physiology and Biophysics
University of Mississippi Medical Center
Jackson, Mississippi
Judith B. Paquet, R.N.
Medical Communications Specialist
Paquet Associates
Clementon, New Jersey
Lisa F. Harper, B.S.D.H., M.P.H., R.D., L.D.
Assistant Professor
Baylor College of Dentistry
Dallas, Texas
Lee A. Shratter, M.D.
Radiologist
Healthcare Safety and Medical Consultant
Kentfield, California
Robert Harr, M.S. MT (ASCP)
Associate Professor and Chair
Department of Public and Allied Health
Bowling Green State University
Bowling Green, Ohio
Linda Wheeler, C.N.M., Ed.D.
Associate Professor
School of Nursing
Oregon Health and Science University
Portland, Oregon
G A L E E N C Y C L O P E D I A O F N U R S I N G A N D A L L I E D H E A LT H
IX
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CONTRIBUTORS
Lisa Maria Andres, M.S., C.G.C
San Jose, California
Rachael Tripi Brandt, M.S.
Gettysburg, Pennsylvania
Greg Annussek
New York, New York
Peggy Elaine Browning
Olney, Texas
Maia Appleby
Boynton Beach, Florida
Susan Joanne Cadwallader
Cedarburg, Wisconsin
Bill Asenjo, M.S., C.R.C.
Iowa City, Iowa
Barbara M. Chandler
Sacramento, California
Lori Ann Beck, R.N., M.S.N., F.N.P.-C.
Berkley, Michigan
Linda Chrisman
Oakland, California
Mary Bekker
Willow Grove, Pennsylvania
Rhonda Cloos, R.N.
Austin, Texas
Linda K. Bennington, R.N.C., M.S.N., C.N.S.
Virginia Beach, Virginia
L. Lee Culvert
Alna, Massachusetts
Kenneth J. Berniker, M.D.
El Cerrio, California
Tish Davidson
Fremont, California
Mark A. Best
Cleveland Heights, Ohio
Lori De Milto
Sicklerville, New Jersey
Dean Andrew Bielanowski, R.N., B.Nurs.(QUT)
Rochedale S., Brisbane, Australia
Victoria E. DeMoranville
Lakeville, Massachusetts
Carole Birdsall, R.N. A.N.P. Ed.D.
New York, New York
Janine Diebel, R.N.
Gaylord, Michigan
Bethanne Black
Buford, Georgia
Stéphanie Islane Dionne
Ann Arbor, Michigan
Maggie Boleyn, R.N., B.S.N.
Oak Park, Michigan
J. Paul Dow, Jr.
Kansas City, Missouri
Barbara Boughton
El Cerrito, California
Douglas Dupler
Boulder, Colorado
Patricia L. Bounds, Ph.D.
Zurich, Switzerland
Lorraine K. Ehresman
Northfield, Quebec, Canada
Mary Boyle, Ph.D., C.C.C.-S.L.P., B.C.-N.C.D.
Lincoln Park, New Jersey
L. Fleming Fallon, Jr., M.D., Dr.P.H.
Bowling Green, Ohio
G A L E E N C Y C L O P E D I A O F N U R S I N G A N D A L L I E D H E A LT H
XI
Contributors
Diane Fanucchi-Faulkner, C.M.T., C.C.R.A.
Oceano, California
Paul A. Johnson
San Marcos, California
Janis O. Flores
Sebastopol, Florida
Linda D. Jones, B.A., P.B.T.(A.S.C.P.)
Asheboro, New York
Paula Ford-Martin
Chaplin, Minnesota
Crystal Heather Kaczkowski, M.Sc.
Dorval, Quebec, Canada
Janie F. Franz
Grand Forks, North Dakota
Beth Kapes
Bay Village, Ohio
Sallie Boineau Freeman, Ph.D.
Atlanta, Georgia
Monique Laberge, Ph.D.
Philadelphia, Pennsylvania
Rebecca Frey, Ph.D.
New Haven, Connecticut
Aliene S. Linwood, B.S.N., R.N., D.P.A., F.A.C.H.E.
Athens, Ohio
Lisa M. Gourley
Bowling Green, Ohio
Jennifer Lee Losey, R.N.
Madison Heights, Michigan
Meghan M. Gourley
Germantown, Maryland
Liz Marshall
Columbus, Ohio
Jill Ilene Granger, M.S.
Ann Arbor, Michigan
Mary Elizabeth Martelli, R.N., B.S.
Sebastian, Florida
Elliot Greene, M.A.
Silver Spring, Maryland
Jacqueline N. Martin, M.S.
Albrightsville, Pennsylvania
Stephen John Hage, A.A.A.S., R.T.(R), F.A.H.R.A.
Chatsworth, California
Sally C. McFarlane-Parrott
Mason, Michigan
Clare Hanrahan
Asheville, North Carolina
Beverly G. Miller, M.T.(A.S.C.P.)
Charlotte, North Carolina
Robert Harr
Bowling Green, Ohio
Christine Miner Minderovic, B.S., R.T., R.D.M.S.
Ann Arbor, Michigan
Daniel J. Harvey
Wilmington, Delaware
Mark A. Mitchell, M.D.
Bothell, Washington
Katherine Hauswirth, A.P.R.N.
Deep River, Connecticut
Susan M. Mockus, Ph.D.
Seattle, Washington
David L. Helwig
London, Ontario, Canada
Timothy E. Moore, Ph.D.
Toronto, Ontario, Canada
Lisette Hilton
Boca Raton, Florida
Nancy J. Nordenson
Minneapolis, Minnesota
René A. Jackson, R.N.
Port Charlotte, Florida
Erika J. Norris
Oak Harbor, Washington
Nadine M. Jacobson, R.N.
Takoma Park, Maryland
Debra Novograd, B.S., R.T.(R)(M)
Royal Oak, Michigan
Randi B. Jenkins
New York, New York
Marianne F. O’Connor, M.T., M.P.H.
Farmington Hills, Michigan
Michelle L. Johnson, M.S., J.D.
Portland, Oregon
Carole Osborne-Sheets
Poway, California
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G A L E E N C Y C L O P E D I A O F N U R S I N G A N D A L L I E D H E A LT H
Patricia Skinner
Amman, Jordan
Patience Paradox
Bainbridge Island, Washington
Genevieve Slomski
New Britain, Connecticut
Deborah Eileen Parker, R.N.
Lakewood, Washington
Bryan Ronain Smith
Cincinnati, Ohio
Genevieve Pham-Kanter
Chicago, Illinois
Allison Joan Spiwak, B.S., C.C.P.
Gahanna, Ohio
Jane E. Phillips, Ph.D.
Chapel Hill, North Carolina
Lorraine T. Steefel
Morganville, New Jersey
Pamella A. Phillips
Bowling Green, Ohio
Margaret A. Stockley, R.G.N.
Boxborough, Massachusetts
Elaine R. Proseus, M.B.A./T.M., B.S.R.T., R.T.(R)
Farmington Hills, Michigan
Amy Loerch Strumolo
Bloomfield Hills, Michigan
Ann Quigley
New York, New York
Liz Swain
San Diego, California
Esther Csapo Rastegari, R.N., B.S.N., Ed.M.
Holbrook, Massachusetts
Deanna M. Swartout-Corbeil, R.N.
Thompsons Station, Tennessee
Anastasia Marie Raymer, Ph.D.
Norfolk, Virginia
Peggy Campbell Torpey, M.P.T.
Royal Oak, Michigan
Martha S. Reilly, O.D.
Madison, Wisconsin
Mai Tran, Pharm.D.
Troy, Michigan
Linda Richards, R.D., C.H.E.S.
Flagstaff, Arizona
Carol A. Turkington
Lancaster, Pennsylvania
Toni Rizzo
Salt Lake City, Utah
Judith Turner, D.V.M.
Sandy, Utah
Nancy Ross-Flanigan
Belleville, Michigan
Samuel D. Uretsky, Pharm.D.
Wantagh, New York
Mark Damian Rossi, Ph.D, P.T., C.S.C.S.
Pembroke Pines, Florida
Michele R. Webb
Overland Park, Kansas
Kausalya Santhanam
Branford, Connecticut
Ken R. Wells
Laguna Hills, California
Denise L. Schmutte, Ph.D.
Shoreline, Washington
Barbara Wexler, M.P.H.
Chatsworth, California
Joan M. Schonbeck
Marlborough, Massachusetts
Gayle G. Wilkins, R.N., B.S.N., O.C.N.
Willow Park, Texas
Kathleen Scogna
Baltimore, Maryland
Jennifer F. Wilson
Haddonfield, New Jersey
Cathy Hester Seckman, R.D.H.
Calcutta, Ohio
Angela Woodward
Madison, Wisconsin
Jennifer E. Sisk, M.A.
Havertown, Pennsylvania
Jennifer Wurges
Rochester Hills, Michigan
G A L E E N C Y C L O P E D I A O F N U R S I N G A N D A L L I E D H E A LT H
Contributors
Cindy F. Ovard, R.D.A
Spring Valley, California
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A
Abdominal thrust see Heimlich maneuver
Abdominal ultrasound
Definition
Abdominal ultrasound uses high frequency sound
waves to produce two-dimensional images of the body’s
soft tissues, which are used for a variety of clinical applications, including diagnosis and guidance of treatment
procedures. Ultrasound does not use ionizing radiation
to produce images, and in comparison to other diagnostic imaging modalities, it is low cost, safe, fast, and
versatile.
Purpose
Abdominal ultrasound is used in the hospital radiology department and emergency department, as well as in
physician offices for a number of clinical applications.
Ultrasound has a great advantage over x-ray imaging
technologies in that it does not damage tissues with ionizing radiation. Ultrasound is also generally far better
than plain x-rays at distinguishing the subtle variations of
soft tissue structures, and can be used in any of several
modes, depending on the area of interest.
As an imaging tool, abdominal ultrasound generally
is indicated for patients afflicted with chronic or acute
abdominal pain; abdominal trauma; an obvious or suspected abdominal mass; symptoms of liver disease, pancreatic disease, gallstones, spleen disease, kidney disease
and urinary blockage; or symptoms of an abdominal aortic aneurysm.
Specifically:
• Abdominal pain. Whether acute or chronic, pain can
signal a serious problem—from organ malfunction or
injury to the presence of malignant growths.
Ultrasound scanning can help doctors quickly sort
through potential causes when presented with general
or ambiguous symptoms. All of the major abdominal
organs can be studied for signs of disease that appear as
changes in size, shape, and internal structure.
• Abdominal trauma. After a serious accident, such as a
car crash or a fall, internal bleeding from injured
abdominal organs is often the most serious threat to
survival. Neither the injuries nor the bleeding may be
immediately apparent. Ultrasound is very useful as an
initial scan when abdominal trauma is suspected, and it
can be used to pinpoint the location, cause, and severity of hemorrhaging. In the case of puncture wounds,
from a bullet for example, ultrasound can locate the
foreign object and provide a preliminary survey of
the damage. (CT scans are sometimes used in trauma
settings.)
• Abdominal mass. Abnormal growths—tumors, cysts,
abscesses, scar tissue, and accessory organs—can be
located and tentatively identified with ultrasound. In
particular, potentially malignant solid tumors can be
distinguished from benign fluid-filled cysts. Masses
and malformations in any organ or part of the abdomen
can be found.
• Liver disease. The types and underlying causes of liver
disease are numerous, though jaundice tends to be a
general symptom. Ultrasound can differentiate between
many of the types and causes of liver malfunction, and
is particularly good at identifying obstruction of the
bile ducts and cirrhosis, which is characterized by
abnormal fibrous growths and reduced blood flow.
• Pancreatic disease. Inflammation and malformation of
the pancreas are readily identified by ultrasound, as
are pancreatic stones (calculi), which can disrupt proper functioning.
• Gallstones. Gallstones are an extremely common cause
of hospital admissions. These calculi can cause painful
inflammation of the gallbladder and also obstruct the
bile ducts that carry digestive enzymes from the gall-
G A L E E N C Y C L O P E D I A O F N U R S I N G A N D A L L I E D H E A LT H
1
Abdominal ultrasound
bladder and liver to the intestines. Gallstones are readily identifiable with ultrasound.
• Spleen disease. The spleen is particularly prone to
injury during abdominal trauma. It may also become
painfully inflamed when infected or cancerous.
• Kidney disease. The kidneys are also prone to traumatic injury and are the organs most likely to form calculi,
which can block the flow of urine and cause further
systemic problems. A variety of diseases causing distinct changes in kidney morphology can also lead to
complete kidney failure. Ultrasound imaging has
proven extremely useful in diagnosing kidney disorders, including blockage or obstruction.
• Abdominal aortic aneurysm. This is a bulging weak
spot in the abdominal aorta, which supplies blood
directly from the heart to the entire lower body. A ruptured aortic aneurysm is imminently life-threatening.
However, it can be readily identified and monitored
with ultrasound before acute complications result.
• Appendicitis. Ultrasound is useful in diagnosing
appendicitis, which causes abdominal pain.
Ultrasound technology can also be used for treatment purposes, most frequently as a visual aid during
surgical procedures—such as guiding needle placement
to drain fluid from a cyst, or to guide biopsies.
Precautions
Ultrasound waves of appropriate frequency and
intensity are not known to cause or aggravate any medical condition.
The value of ultrasound imaging as a medical tool,
however, depends greatly on the quality of the equipment
used and the skill of the medical personnel operating it.
More accurate results are obtained when ultrasound is
performed by a clinician skilled in sonography. Basic
ultrasound equipment is relatively inexpensive to obtain,
and any physician with the equipment can perform the
procedure whether specifically trained in ultrasound
scanning and interpretation or not. Patients should not
hesitate to verify the credentials of technologists and
physicians performing ultrasound scanning, as well as
the quality of the equipment used and the benefits of the
proposed procedure.
In cases where ultrasound is used as a treatment tool,
patients should educate themselves about the proposed
procedure with the help of their doctors—as is appropriate before any surgical procedure. Also, any abdominal
ultrasound procedure, diagnostic or therapeutic, may be
hampered by a patient’s body type or other factors, such
as the presence of excessive bowel gas (which is opaque
2
to ultrasound). In particular, very obese people are often
not good candidates for abdominal ultrasound.
Description
Ultrasound includes all sound waves above the frequency of human hearing—about 20 thousand hertz, or
cycles per second. Medical ultrasound generally uses frequencies between one and 10 megahertz (1-10 MHz).
Higher frequency ultrasound waves produce more
detailed images, but are also more readily absorbed and
so cannot penetrate as deeply into the body. Abdominal
ultrasound imaging is generally performed at frequencies
between 2-5 MHz.
An ultrasound scanner consists of two parts: the transducer and the data processing unit. The transducer both
produces the sound waves that penetrate the body and
receives the reflected echoes. Transducers are built around
piezoelectric ceramic chips. (Piezoelectric refers to electricity that is produced when you put pressure on certain
crystals such as quartz.) These ceramic chips react to electric pulses by producing sound waves (they are transmitting waves) and react to sound waves by producing electric pulses (receiving). Bursts of high-frequency electric
pulses supplied to the transducer cause it to produce the
scanning sound waves. The transducer then receives the
returning echoes, translates them back into electric pulses,
and sends them to the data processing unit—a computer
that organizes the data into an image on a television screen.
Because sound waves travel through all the body’s
tissues at nearly the same speed—about 3,400 miles per
hour—the microseconds it takes for each echo to be
received can be plotted on the screen as a distance into
the body. The relative strength of each echo, a function of
the specific tissue or organ boundary that produced it, can
be plotted as a point of varying brightness. In this way,
the echoes are translated into an image.
Four different modes of ultrasound are used in medical imaging:
• A-mode. This is the simplest type of ultrasound in
which a single transducer scans a line through the body
with the echoes plotted on screen as a function of depth.
This method is used to measure distances within the
body and the size of internal organs.
• B-mode. In B-mode ultrasound, a linear array of transducers simultaneously scans a plane through the body that
can be viewed as a two-dimensional image on screen.
• M-Mode. The M stands for motion. A rapid sequence of
B-mode scans whose images follow each other in
sequence on screen enables doctors to see and measure
range of motion, as the organ boundaries that produce
reflections move relative to the probe. M-mode ultra-
G A L E E N C Y C L O P E D I A O F N U R S I N G A N D A L L I E D H E A LT H
Abdominal ultrasound
KEY TERMS
Accessory organ—A lump of tissue adjacent to an
organ that is similar to it, but which serves no
important purpose, if functional at all. While not
necessarily harmful, such organs can cause problems if they grow too large or become cancerous.
Benign—In medical usage, benign is the opposite
of malignant. It describes an abnormal growth
that is stable, treatable, and generally not lifethreatening.
Biopsy—The surgical removal and analysis of a tissue sample for diagnostic purposes. Usually, the
term refers to the collection and analysis of tissue
from a suspected tumor to establish malignancy.
Calculus—Any type of hard concretion (stone) in
the body, but usually found in the gallbladder, pancreas, and kidneys. Calculi (pl.) are formed by the
accumulation of excess mineral salts and other
organic material such as blood or mucous. They
can cause problems by lodging in and obstructing
the proper flow of fluids, such as bile to the intestines or urine to the bladder.
Cirrhosis—A chronic liver disease characterized by
the degeneration of proper functioning—jaundice
is often an accompanying symptom. Causes of cirrhosis include alcoholism, metabolic diseases,
syphilis, and congestive heart disease.
Common bile duct—The branching passage
through which bile—a necessary digestive
enzyme—travels from the liver and gallbladder into
the small intestine. Digestive enzymes from the
pancreas also enter the intestines through the common bile duct.
Computed tomography scan (CT scan)—A specialized type of x-ray imaging that uses highly focused
and relatively low energy radiation to produce
detailed two-dimensional images of soft tissue
structures, particularly the brain. CT scans are the
chief competitor to ultrasound and can yield higher quality images not disrupted by bone or gas.
They are, however, more cumbersome, time consuming and expensive to perform, and they use
ionizing radiation.
sound has been put to particular use in studying heart
motion.
• Doppler mode. Doppler ultrasonography includes the
capability of accurately measuring velocities of moving
Doppler—The Doppler effect refers to the apparent
change in frequency of sound wave echoes returning to a stationary source from a moving target. If
the object is moving toward the source, the frequency increases; if the object is moving away, the
frequency decreases. The size of this frequency
shift can be used to compute the object’s speed—
be it a car on the road or blood in an artery. The
Doppler effect holds true for all types of radiation,
not just sound.
Frequency—Sound, whether traveling through air
or the human body, produces vibrations—molecules bouncing into each other—as the shock wave
travels along. The frequency of a sound is the number of vibrations per second. Within the audible
range, frequency means pitch—the higher the frequency, the higher a sound’s pitch.
Ionizing radiation—Radiation that can damage living tissue by disrupting and destroying individual
cells at the molecular level. All types of nuclear
radiation—x rays, gamma rays and beta rays—are
potentially ionizing. Sound waves physically
vibrate the material through which they pass, but
do not ionize it.
Jaundice—A condition that results in a yellow tint
to the skin, eyes and body fluids. Bile retention in
the liver, gallbladder and pancreas is the immediate
cause, but the underlying cause could be as simple
as obstruction of the common bile duct by a gallstone or as serious as pancreatic cancer. Ultrasound can distinguish between these conditions.
Malignant—The term literally means growing
worse and resisting treatment. It is used as a synonym for cancerous and connotes a harmful condition that generally is life-threatening.
Morphology—Literally, the study of form. In medicine, morphology refers to the size, shape, and
structure rather than the function of a given organ.
As a diagnostic imaging technique, ultrasound
facilitates the recognition of abnormal morphologies as symptoms of underlying conditions.
material, such as blood in arteries and veins. The principle is the same as that used in radar guns that measure
the speed of a car on the highway. Doppler capability is
most often combined with B-mode scanning to produce
G A L E E N C Y C L O P E D I A O F N U R S I N G A N D A L L I E D H E A LT H
3
Abdominal ultrasound
Preparation
A patient undergoing abdominal ultrasound will be
advised by the physician about what to expect and how to
prepare. As mentioned above, preparations generally
include fasting.
Aftercare
In general, no aftercare related to the abdominal
ultrasound procedure itself is required. Discomfort during the procedure is minimal.
Complications
Properly performed, ultrasound imaging is virtually
without risk or side effects. Some patients report feeling
a slight tingling and/or warmth while being scanned, but
most feel nothing at all.
An ultrasound screen shows a patient’s kidney.
(Photograph by Brownie Harris. The Stock Market.
Reproduced by permission.)
images of blood vessels from which blood flow can be
directly measured. This technique is used extensively to
investigate valve defects, arteriosclerosis, and hypertension, particularly in the heart, but also in the abdominal aorta and the portal vein of the liver.
The actual procedure for a patient undergoing an
abdominal ultrasound is relatively simple, regardless of
the type of scan or its purpose. Fasting for at least eight
hours prior to the procedure ensures that the stomach is
empty and as small as possible, and that the intestines
and bowels are relatively inactive. This also helps the
gallbladder become more visible. Prior to scanning, an
acoustic gel is applied to the skin of the patient’s
abdomen to allow the ultrasound probe to glide easily
across the skin and also to better transmit and receive
ultrasonic pulses. The probe is moved around the
abdomen’s surface to obtain different views of the target
areas. The patient will likely be asked to change positions from side to side and to hold the breath as necessary
to obtain the desired views. Usually, a scan will take
from 20 to 45 minutes, depending on the patient’s condition and anatomical area being scanned.
Ultrasound scanners are available in different configurations, with different scanning features. Portable
units, which weigh only a few pounds and can be carried
by hand, are available for bedside use, office use, or use
outside the hospital, such as at sporting events and in
ambulances. Portable scanners range in cost from
$10,000 to $50,000. Mobile ultrasound scanners, which
can be pushed to the patient bedside and between hospital departments, are the most common comfiguration and
range in cost from $100,000 to over $250,000, depending on the scanning features purchased.
4
Results
As a diagnostic imaging technique, a normal abdominal ultrasound is one that indicates the absence of the suspected condition that prompted the scan. For example,
symptoms such as abdominal pain radiating to the back
suggest the possibility of, among other things, an abdominal aortic aneurysm. An ultrasound scan that indicates the
absence of an aneurysm would rule out this life-threatening condition and point to other, less serious causes.
Because abdominal ultrasound imaging is generally
undertaken to confirm a suspected condition, the results
of a scan often will confirm the diagnosis, be it kidney
stones, cirrhosis of the liver, or an aortic aneurysm. At
that point, appropriate medical treatment as prescribed by
a patient’s physician is in order.
Health care team roles
Ultrasound scanning should be performed by a registered and trained ultrasonographer, either a technologist
and/or a physician (radiologist, obstetrician/gynecologist). Ultrasound scanning in the emergency department
may be performed by an emergency medicine physician,
who should have appropriate training and experience in
ultrasonography.
Resources
BOOKS
Dendy, P.P., Heaton, B. Physics for Diagnostic Radiology. 2nd
ed. Philadelphia: Institute of Physics Publishing, 1999.
Hall, Rebecca. The Ultrasonic Handbook: Clinical, etiologic
and pathologic implications of sonographic findings.
Philadelphia: Lippincott, 1993.
G A L E E N C Y C L O P E D I A O F N U R S I N G A N D A L L I E D H E A LT H
PERIODICALS
Freundlich, Naomi. “Ultrasound: What’s Wrong with this
Picture?” Business Week (15 September 1997): 84-85.
Kuhn, M., Bonnin, R.L.L., Davey, M.J., Rowland, J.L.,
Langlois, S. “Emergency Department Ultrasound
Scanning for Abdodminal Aortic Aneurysm: Accessible,
Accurate, Advantageous. Annals of Emergency Medicine.
(September 2000) 36(3):219-223.
Sisk, Jennifer. “Ultrasound in the Emergency Department:
Toward a Standard of Care.” Radiology Today (June 4,
2001) 2(1):8-10.
ORGANIZATIONS
American College of Radiology. 1891 Preston White Drive,
Reston, VA 20191-4397. (800)227-5463.
.
American Institute of Ultrasound in Medicine. 14750 Sweitzer
Lane, Suite 100, Laurel, MD 20707-5906. (301) 4984100. .
American Registry of Diagnostic Medical Sonographers. 600
Jefferson Plaza, Suite 360, Rockville, MD 20852-1150.
(800) 541-9754. .
American Society of Radiologic Technologists (ASRT). 15000
Central Avenue SE, Albuquerque, NM 87123-2778. (800)
444-2778. .
Radiological Society of North America. 820 Jorie Boulevard,
Oak Brook, IL 60523-2251. (630) 571-2670.
.
Society of Diagnostic Medical Sonography. 12770 Coit Road,
Suite 708, Dallas, TX 75251-1319. (972) 239-7367.
.
Jennifer E. Sisk, M.A.
ABO blood typing see Type and screen
Abrasions see Wounds
Abruptio placentae see Placental abruption
Abscess
Definition
An abscess is an enclosed collection of liquefied tissue, known as pus, somewhere in the body. It is the result
of the body’s defensive reaction to foreign material.
Description
There are two types of abscesses, septic and sterile.
Most abscesses are septic, which means that they are the
result of an infection. Septic abscesses can occur anywhere in the body. Only bacteria and the body’s
immune response are required. In response to the invading bacteria, white blood cells gather at the infected site
and begin producing chemicals called enzymes that
attack the bacteria by first marking and then digesting it.
These enzymes kill the bacteria and break them down
into small pieces that can travel in the circulatory system
prior to being eliminated from the body. Unfortunately,
these chemicals also digest body tissues. In most cases,
bacteria produce similar chemicals. The result is a thick,
yellow liquid—pus—containing dead bacteria, digested
tissue, white blood cells, and enzymes.
An abscess is the last stage of a tissue infection that
begins with a process called inflammation. Initially, as
invading bacteria activate the body’s immune system,
several events occur:
• Blood flow to the area increases.
• The temperature of the area increases due to the
increased blood supply.
• The area swells due to the accumulation of water,
blood, and other liquids.
• It turns red.
• It hurts, due to irritation from the swelling and the
chemical activity.
These four signs—heat, swelling, redness, and
pain—characterize inflammation.
As the process progresses, the tissue begins to turn to
liquid, and an abscess forms. It is the nature of an abscess
to spread as the chemical digestion liquefies more and
more tissue. Furthermore, the spreading follows the path
of least resistance, commonly, the tissue that is most easily digested. A good example is an abscess just beneath
the skin. It most easily continues along immediately
beneath the surface rather than traveling up through the
outermost layer or down through deeper structures where
it could drain its toxic contents. The contents of an
abscess can also leak into the general circulation and produce symptoms just like any other infection. These
include chills, fever, aching, and general discomfort.
Sterile abscesses are sometimes a milder form of the
same process caused not by bacteria but by non-living
irritants such as drugs. If an injected drug such as penicillin is not absorbed, it stays where it is injected and may
cause enough irritation to generate a sterile abscess. Such
an abscess is sterile because there is no infection
involved. Sterile abscesses are quite likely to turn into
G A L E E N C Y C L O P E D I A O F N U R S I N G A N D A L L I E D H E A LT H
5
Abscess
Kevles, Bettyann Holtzmann. Naked to the Bone: Medical
imaging in the twentieth century. New Brunswick, New
Jersey: Rutgers University Press, 1997.
Zaret, Barry L., ed. The Patient’s Guide to Medical Tests.
Boston: Houghton Mifflin Company, 1997.
Abscess
Specific types of abscesses
KEY TERMS
Cellulitis—Inflammation
infection.
of
tissue
due
to
Enzyme—Any of a number of protein chemicals
that can initiate chemical reactions at body temperature.
Fallopian tubes—Part of the internal female
anatomy that carries eggs from the ovaries to the
uterus.
Flora—Living inhabitants of a region or area.
Pyogenic—Capable of generating pus. Streptococcus, Staphocococcus, and bowel bacteria
are the primary pyogenic organisms.
Sebaceous glands—Tiny structures in the skin that
produce oil (sebum). If they become plugged,
sebum collects inside and forms a nurturing place
for germs to grow.
Septicemia—The spread of an infectious agent
throughout the body by means of the blood
stream.
Sinus—A tubular channel connecting one body
part with another or with the outside.
hard, solid lumps as they scar, rather than remaining
pockets of pus.
Causes and symptoms
Many different agents cause abscesses. The most
common are the pus-forming (pyogenic) bacteria such as
Staphylococcus aureus, which is a very common cause of
abscesses under the skin. Abscesses near the large bowel,
particularly around the anus, may be caused by any of the
numerous bacteria found within the large bowel. Brain
abscesses and liver abscesses can be caused by any
organism that can travel there through the blood stream.
Bacteria, amoebae, and certain fungi can travel in this
fashion. Abscesses in other parts of the body are caused
by organisms that normally inhabit nearby structures or
that infect them. Some common causes of specific
abscesses are:
• skin abscesses by normal skin flora
• dental and throat abscesses by mouth flora
• lung abscesses by normal airway flora, bacteria that
cause pneumonia or tuberculosis
• abdominal and anal abscesses by normal bowel flora
6
Listed below are some of the more common and
important abscesses.
• Carbuncles and other boils. Skin oil glands (sebaceous
glands) on the back or the back of the neck are the ones
usually infected. The most commonly involved bacteria
is Staphylococcus aureus. Acne is a similar condition
involving sebaceous glands on the face and back.
• Pilonidal cyst. Many people have as a birth defect a tiny
opening in the skin just above the anus. Fecal bacteria
can enter this opening, causing an infection and subsequent abscess.
• Retropharyngeal, parapharyngeal, peritonsillar abscess.
As a result of throat infections such as strep throat and
tonsillitis, bacteria can invade the deeper tissues of the
throat and cause an abscess. These abscesses can compromise swallowing and even breathing.
• Lung abscess. During or after pneumonia, whether it’s
due to bacteria [common pneumonia], tuberculosis,
fungi, parasites, or other bacteria, abscesses can develop as a complication.
• Liver abscess. Bacteria or amoeba from the intestines
can spread through the blood to the liver and cause
abscesses.
• Psoas abscess. Deep in the back of the abdomen, on
either side of the lumbar spine, lie the psoas muscles.
They flex the hips. An abscess can develop in one of
these muscles, usually when it spreads from the appendix, the large bowel, or the fallopian tubes.
Diagnosis
The common findings of inflammation—heat, redness, swelling, and pain—easily identify superficial
abscesses. Abscesses in other places may produce only
generalized symptoms such as fever and discomfort. If
an individual’s symptoms and the results of a physical
examination do not help, a physician may have to resort
to a battery of tests to locate the site of an abscess.
Usually something in the initial evaluation directs the
search. Recent or chronic disease in an organ suggests it
may be the site of an abscess. Dysfunction of an organ or
system, for instance seizures or altered bowel function,
may provide the clue. Pain and tenderness on physical
examination are common findings. Sometimes a deep
abscess will eat a small channel (sinus) to the surface
and begin leaking pus. A sterile abscess may cause only
a painful lump deep in the buttock where a shot was
given.
G A L E E N C Y C L O P E D I A O F N U R S I N G A N D A L L I E D H E A LT H
Abscess
Treatment
Since skin is very resistant to the spread of infection,
it acts as a barrier, often keeping the toxic chemicals of
an abscess from escaping the body on their own. Thus,
the pus must be drained from the abscess by a physician.
The surgeon determines when the abscess is ready for
drainage and opens a path to the outside, allowing the
pus to escape. Ordinarily, the body handles the remaining
infection, sometimes with the help of antibiotics or
other drugs. The surgeon may leave a drain (a piece of
cloth or rubber) in the abscess cavity to prevent it from
closing before all the pus has drained out.
Alternative treatment
If an abscess is directly beneath the skin, it will be
slowly working its way through the skin as it is more rapidly working its way elsewhere. Since chemicals work
faster at higher temperatures, applications of hot compresses to the skin over the abscess will hasten the digestion of the skin and eventually result in its break down
and spontaneous release of pus. This treatment is best
reserved for smaller abscesses in less sensitive areas of
the body such as limbs, trunk, and back of the neck. It is
also useful for all superficial abscesses in their very early
stages. It will “ripen” them.
Contrast hydrotherapy, alternating hot and cold
compresses, can also help assist the body in resorption of
the abscess. There are two homeopathic remedies that
work to rebalance the body in relation to abscess formation, Silica and Hepar sulphuris. In cases of septic
abscesses, bentonite clay packs (bentonite clay and a
small amount of Hydrastis powder) can be used to draw
an infection from the area.
Prognosis
Once an abscess is properly drained, the prognosis is
excellent for the condition itself. The reason for the
abscess (other diseases an individual has) will determine
the overall outcome. If, on the other hand, an abscess
ruptures into neighboring areas or permits the infectious
agent to spill into the bloodstream, serious or fatal consequences are likely. Abscesses in and around the nasal
sinuses, face, ears, and scalp may work their way into the
brain. Abscesses within an abdominal organ such as the
liver may rupture into the abdominal cavity. In either
case, the result is life threatening. Blood poisoning is a
term commonly used to describe an infection that has
spilled into the blood stream and spread throughout the
body from a localized origin. Blood poisoning, known to
physicians as septicemia, is also life threatening.
An amoebic abscess caused by Entameoba histolytica.
(Phototake NYC. Reproduced by permission.)
Of special note, abscesses in the hand are more serious than they might appear. Due to the intricate structure
and the overriding importance of the hand, any hand
infection must be treated promptly and competently.
Health care team roles
First aid providers may unknowingly initiate an
abscess by using inappropriate or incorrect techniques. A
physician, surgeon, physician’s assistant, or nurse practitioner usually diagnoses the presence of an abscess.
Radiologists and laboratory personnel may assist in the
process of establishing a diagnosis. A physician, surgeon,
physician’s assistant, or nurse practitioner usually drains
an abscess. Nurses provide supportive care, dress the
wound, and educate patients about caring for the resulting wound. Occasionally, a physical therapist may be
needed to recover lost function.
Prevention
Infections that are treated early with heat (if superficial) or antibiotics will often resolve without the formation of an abscess. It is even better to avoid infections
altogether by taking prompt care of open injuries, particularly puncture wounds. Bites are the most dangerous of
all, even more so because they often occur on the hand.
Resources
BOOKS
Balistreri, William. “Liver abscess.” In Nelson Textbook of
Pediatrics, 16th ed., edited by Richard E. Behrman et al.,
Philadelphia, Saunders, 2000, 1212.
Chesney, Russell W. “Brain abscess.” In Nelson Textbook of
Pediatrics, 16th ed., edited by Richard E. Behrman et al.,
Philadelphia, Saunders, 2000, 1857-1858.
G A L E E N C Y C L O P E D I A O F N U R S I N G A N D A L L I E D H E A LT H
7
Acid-base balance
Finegold, Sydney M. “Lung abscess.” In Cecil Textbook of
Medicine, 21st ed., edited by Goldman, Lee and Bennett,
J. Claude. Philadelphia: W.B. Saunders, 2000, 439-442.
Herendeen, Neil E and Szilagy, Peter G. “Peritonsillar
abscess.” In Nelson Textbook of Pediatrics, 16th ed., edited by Richard E. Behrman et al., Philadelphia, Saunders,
2000, 1266-1267.
Scheld, W. Michael. “Bacterial meningitis, brain abscess, and
other suppurative intracranial infections.” In Harrison’s
Principles of Internal Medicine, 14th ed., edited by
Anthony S. Fauci, et al. New York: McGraw-Hill, 1998,
2419-2434.
Schwartz, Seymour, Shires, Tom and Spencer, Frank
C.Principles of Surgery, 7th ed. New York, McGraw Hill,
1998.
Stern, Robert C. “Pulmona