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USER S GUIDE Medical Terminology: An Illustrated Guide, 5 th Edition was created and developed to help you master the language of medicine. The tools and features in the text will help you work through the material presented. Please take a few moments to look through this User’s Guide, which will introduce you to the features that will enhance your learning experience. Chapter Contents, Objectives, and Pretests Chapter Contents & Objectives help you identify learning goals and familiarize yourself with the mate- rial covered in the chapter. Chapter Pretests are a great way to identify your strengths and weaknesses, so you know what to focus on as you work through the chapter content 6 Chapter Six Chapter Contents Objectives Pretest DISEASE Pretest Types of Diseases Infectious Diseases Responses to Disease Neoplasia Word Parts Pertaining to Disease Chapter Review Case Studies 1. List the major categories of diseases. 2. Compare the common types of infectious organisms, and list some diseases caused by each. 3. Describe some common responses to disease. 4. Define and give examples of neoplasia. 5. Identify and use word parts pertaining to diseases. 6. Define the major terms describing types of diseases. 7. List and define the major manifestations of diseases. 8. Analyze the disease terminology in several case studies. 1. Any organism so small that it can only be seen with a microscope is a(n) . 2. A disease that has a sudden and severe onset is described as . 3. Abnormal and uncontrolled growth of tissue is termed . 4. Round bacteria are called . 5. Single-celled animals, as a group, are called . 6. Heat, pain, redness, and swelling are the characteristics signs of . After study of this chapter you should be able to: xi
Transcript
Page 1: USER S GUIDE - Lippincott Williams & Wilkinsdownloads.lww.com/.../samples/sampleUsersGuide.pdfMedical Terminology: An Illustrated Guide, 5th Edition was created and developed to help

USER’S GUIDE

Medical Terminology: An Illustrated Guide, 5th Edition was created and developed to helpyou master the language of medicine. The tools and features in the text will help you workthrough the material presented. Please take a few moments to look through this User’sGuide, which will introduce you to the features that will enhance your learningexperience.

Chapter Contents,Objectives,and Pretests

Chapter Contents & Objectives

help you identify learning goals andfamiliarize yourself with the mate-rial covered in the chapter. ChapterPretests are a great way to identifyyour strengths and weaknesses, soyou know what to focus on as youwork through the chapter content

6

Chapter S ix

Chapter Contents

Objectives

Pretest

DISEASE

PretestTypes of DiseasesInfectious DiseasesResponses to Disease

NeoplasiaWord Parts Pertaining to Disease

Chapter ReviewCase Studies

1. List the major categories of diseases.

2. Compare the common types of infectious organisms,

and list some diseases caused by each.

3. Describe some common responses to disease.

4. Define and give examples of neoplasia.

5. Identify and use word parts pertaining to diseases.

6. Define the major terms describing types of diseases.

7. List and define the major manifestations of diseases.

8. Analyze the disease terminology in several case

studies.1. Any organism so small that it can only be seen

with a microscope is a(n)

.

2. A disease that has a sudden and severe onset is

described as

.3. Abnormal and uncontrolled growth of tissue is

termed .

4. Round bacteria are called

.

5. Single-celled animals, as a group, are called.6. Heat, pain, redness, and swelling are thecharacteristics signs of

.

After study of this chapter you should be able to:

xi

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Detailed Illustrations

Illustrations visually emphasize important terms and concepts

CHAPTER ELEVEN / Th

Upper Respiratory P

Frontal sinus

Nasal cavity

EpiglottisRight lung

Rightbronchus

From pulmonaryarteryAlveolar duct

Alveoli

CapillariesSection of lung

enlarged Pleural space

Right lungSternum

Left lung

Wall ofthorax

Parietalpleura

Visceralpleura

Thoracicvertebra

To pulmonaryvein

Diaphragm

Terminalbronchiole

Mediastinum

Horizontalcross-sectionof lungs

Sphenoidal sinusNasopharynxOropharynxLaryngeal pharynxLarynx and vocal cordsEsophagus

Trachea

Left lung

Pharynx

A

BC

Figure 11-2 The respiratory system. (A) Overview. (B) Enlarged section of lung tissue showing

the relationship between the alveoli (air sacs) and the blood capillaries. (C) A transverse section

through the lungs.

Figure 9-3 The heart’s conduction system. Impulses travel from the sinoatrial (SA) node to the

atrioventricular (AV) node, then to the atrioventricular bundle, bundle branches and Purkinje fibers.

Internodal pathways carry impulses throughout the atria.

Centriole

Golgi apparatus

Nucleolus

Nuclearmembrane

Roughendoplasmicreticulum (ER)

Cytosol

Microvilli

Cilia

Lysosome

Mitochondrion

Peroxisome

Ribosomes

Vesicle

Nucleus

Smooth endoplasmicreticulum (ER) Plasmamembrane

Figure 4-2 Generalized animal cell, sectional view. The main organelles are

Figure 18-9 The eye. The three layers of the eyeball are shown along with other structures

involved in vision.

CHAPTER TW

es from the intestine itself and products from accessory

ins are absorbed into

alled

Villus

Mucosa

Villi

Mucous cells

Connective

tissue

Digestive glands

Mucous glands

in submucosa

A

B

Epithelium

Lacteal

Lumen

Vein

Artery

Capillary

Figure 12-4 Intestinal villi. (A) Microscopic view of the small intestine’s lining showing villi

and glands that secrete mucus and digestive juices. The lumen is the central opening. (B) A villus

of the small intestine. Each villus has blood vessels and a lacteal (lymphatic capillary) for nutrient

absorption.

xii ♦ USER’S GUIDE

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Feature Boxes

Feature boxes call out

important information:

Focus on Words provide historical orother interesting information on selectterms within a chapter

Clinical Perspectives focus onbody processes as well as tech-niques used in clinical settings

Health Professions focus on a variety of health careers, showinghow the knowledge of medical terminology is applied in real-worldjobs

For Your Reference provide sup-plemental information for termswithin a chapter

y ited by either their generic or their trade names. (Box 8-1 has informa-

tion on drug naming.) The generic name is usually a simple version of the chemicalFocus on Words Where Do Drugs Get Their Names?

Drug names are derived in a variety of ways. Some arenamed for their origin. Adrenaline, for example, is

named for its source, the adrenal gland. Even its genericname, epinephrine, informs us that it comes from the glandthat is above (epi-) the kidney (nephr/o). Pitocin, a drugused to induce labor, is named for its source, the pituitarygland, combined with the chemical name of the hormone,oxytocin. Botox, currently injected into the skin for cosmeticremoval of wrinkles, is the toxin from the organism thatcauses botulism, a type of food poisoning. Aspirin (an anti-inflammatory agent), Taxol (an antitumor agent), digitalis(used to treat heart failure), and atropine (a smooth-muscle

relaxant) are all named for the plants they come from. Forexample, aspirin is named for the blossoms of Spiraea, fromwhich it is derived. Taxol comes from a yew (evergreen) ofthe genus Taxus. Digitalis is from purple foxglove, genusDigitalis. Atropine comes from the plant Atropa belladonna.

Some names tell about the drug or its actions. The namefor Humulin, a form of insulin made by genetic engineering,points out that this is human insulin and not a hormonefrom animal sources. Lomotil reduces intestinal motility andis used to treat diarrhea. The name belladonna is from Italianand means “fair lady,” because this drug dilates the pupils ofthe eyes, making women appear more beautiful.

Box 8•1

206 PART THREE / Body Systems

h iitis Obstruction of lymphatic vessels because of surgical excision or

( ee Box 9-3). Any neoplastic disease

h hite

9

Clinical Perspectives

Fluid balance in the body requires appropriate distribu-

tion of fluid among the cardiovascular system, lym-

phatic system, and the tissues. Edema occurs when the

balance is tipped toward excess fluid in the tissues. Often,

edema is due to heart failure. However, blockage of lym-

phatic vessels (with resulting fluid accumulation in the

tissues) can cause another form of edema, called lym-

phedema. The clinical hallmark of lymphedema is chronic

swelling of an arm or leg, whereas heart failure usually

causes swelling of both legs.

Lymphedema may be either primary or secondary. Pri-

mary lymphedema is a rare congenital condition caused by

abnormal development of lymphatic vessels. Secondary

lymphedema, or acquired lymphedema, can develop as a

result of trauma to a limb, surgery, radiation therapy, or

infection of the lymphatic vessels (lymphangitis). One of

the most common causes of lymphedema is the removal of

axillary lymph nodes during mastectomy, which disrupts

lymph flow from the adjacent arm. Lymphedema may also

occur following prostate surgery.

Therapies that encourage the flow of fluid through the

lymphatic vessels are useful in treating lymphedema.

These therapies may include elevation of the affected limb,

manual lymphatic drainage through massage, light exer-

cise, and firm wrapping of the limb to apply compression.

In addition, changes in daily habits can lessen the effects

of lymphedema. For example, further blockage of lymph

drainage can be prevented by wearing loose clothing and

jewelry, carrying a purse or handbag on the unaffected

arm, and not crossing the legs when sitting. Lymphangitis

requires the use of appropriate antibiotics. Prompt treat-

ment is necessary because, in addition to swelling, other

complications include poor wound healing, skin ulcers,

and increased risk of infection.

Box 9•3Lymphedema: When Lymph Stops Flowing

PART THREE / Body Systems

10

The general symptoms of anemia include fatigue sho

tions, pallor, and irritability. There are ma

caused by faulty producti

Health Professions Careers in HematologyHematologists are physicians and other scientists who

specialize in the study of blood and blood diseases. In

medical practice, hematology is often combined with the

study and treatment of blood cancers as the specialty

hematology–oncology.A hematology technician is usually a medical laboratory

technician who specializes in blood studies. He or she may

work in a clinical laboratory, blood banking, industry, or

academic research. The job requires a BS or MS in biologi-

cal science plus training in laboratory procedures, blood

pathology, and testing methods. Hematology technicians

perform a full range of blood studies for diagnosis of infec-

tions, allergies, anemia, leukemia, and other blood dis-

eases. They also run tests to monitor anticoagulant therapy.

They must be able to operate and maintain automated

equipment used to analyze blood. In some cases, they may

also draw blood or administer blood transfusions.

A phlebotomist draws blood for testing, transfusions, or

research. The blood is often drawn from a vein (venipunc-

ture), but may also be drawn from arteries and by skin

puncture. Phlebotomists must be trained in sterile tech-

niques and safety precautions to prevent the spread of

infectious diseases. They must take specimens without

harming the patient or interfering with medical care and

must transport specimens to the proper laboratory. Educa-

tional requirements vary among states. Often, in-house

training with certification by the National Phlebotomy

Association is acceptable. Phlebotomists work in hospitals,

laboratories, private physicians’ offices, clinics, and blood

banks.

Box 10•5

For Your Reference

Box 11•2

Organisms That Infect the Respiratory SystemOrganismDisease

BACTERIAStreptococcus pneumoniae

Most common cause of pneumonia; streptococcal pneumonia

strep-to--KOK-us nu--MO- -ne--e-

Haemophilus influenzaePneumonia, especially in debilitated patients

he--MOF-i-lus in-flu--EN-ze-

Klebsiella pneumoniaePneumonia in elderly and debilitated patients

kleb-se--EL-a nu--MO- -ne--aMycoplasma pneumoniae

Mild pneumonia, usually in young adults and children; “walking pneumonia”

mı--ko--PLAZ-ma nu--MO--ne--e-

Legionella pneumophilaLegionellosis (Legionnaire disease); respiratory disease spread through water

le--ju-NEL-la nu--MO-fi-lasources, such as air conditioners, pools, humidifiers

Chlamydia psittaciPsittacosis (ornithosis); carried by birds

kla-MID-e--a PSI-ta-se-

Streptococcus pyogenes“Strep throat,” scarlet fever

strep-to--KOK-us pı--OJ-e-ne-zMycobacterium tuberculosis

Tuberculosismı--ko--bak-TE-R-e--um tu--ber-ku--LO- -sisBordetella pertussis

Pertussis (whooping cough)

bo-r-de-TEL-a per-TUS-sisCorynebacterium diphtheriae

Diphtheriako--RI

--ne--bak-te-r-e--um dif-THE--re--e-

USER’S GUIDE ♦ xiii

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Word Part TablesDetailed Tables:

Present roots, prefixes, and suffixes covered in each chapter in an easy-to-reference format(with examples of their use in medical terminology).

Word Part Knowledge aids in the learning andunderstanding of common terminology

Exercises

Exercises that aredesigned to test yourknowledge before youmove on to the next learn-ing topic follow each table

CHAPTER TWELVE / The Digestive System

12

Roots Pertaining to Digestion

ROOTMEANING

EXAMPLEDEFINITION OF EXAMPLE

bucc/ocheek

buccoversionturning toward the cheek

buk-ko--VER-zhun

dent/o, dent/itooth, teeth

edentulouswithout teeth

e--DEN-tu--lus

odont/otooth, teeth

periodonticsdental specialty that deals with the study and

per-e--o--DON-tiks treatment of the tissues around the teeth

gingiv/ogum (gingiva)

gingivectomyexcision of gum tissue

jin-ji-VEK-to--me-

gloss/otongue

glossoplegiaparalysis (-plegia) of the tongue

glos-o--PLE--je--a

lingu/otongue

orolingualpertaining to the mouth and tongue

or-o--LING-gwal

gnath/ojaw

prognathoushaving a projecting jaw

PROG-na-thus

labi/o

lip

labium

lip or liplike structure

LA--be--um

or/o

mouth

circumoralaround the mouth

sir-kum-OR-al

stoma, stomat/omouth

xerostomiadryness (xero-) of the mouth

ze--ro--STO

--me--a

palat/opalate

palatinepertaining to the palate (also palatal)

PAL-a-t ı-n

sial/o

saliva, salivary gland,sialogram

radiograph of the salivary glands and ducts

salivary ductsı--AL-o--gram

uvul/ouvula

uvulotomeinstrument (-tome) for incising the uvula

U--vu--lo

--to-m

Roots for the Mouth

Table 12•1

production of immunityim u-ni-ZA-shun

Identify and define the root in the following words:

RootMeaning of Root

1. panmyeloid (pan-MI--e-loyd)

2. prothrombin (pro--THROM-bin)3. preimmunization (pre--im-u--ni-ZA--shun)4. ischemia (is-KE--me--a)

Fill in the blanks:5. Hemorrhage is a profuse flow (-rhage) of

.

6. Erythroclasis (er-i-THROK-la-sis) is the breaking (-clasis) of

.

7. The term thrombocythemia (throm-bo--sı--THE--me--a) refers to an increase in the number of

in the blood.8. Leukopoiesis (lu--ko--poy-E--sis) refers to the production of

.

9. An immunocyte (im-u--no--SI-T) is a cell active in

.

10. A hemocytometer (he--mo--sı--TOM-e-ter) is a device for counting

.

11. Myelofibrosis (mi-e-lo--fı--BRO-sis) is formation of fibrous tissue in

.

12. Lymphokines (LIM-fo--kı-nz) are chemicals active in immunity that are produced by .

Word building. Write a word for the following definitions:13. Immature lymphocyte 14. Tumor of bone marrow 15. Decrease in red blood cells 16. Dissolving (-lysis) of a blood clot 17. Formation (-poiesis) of bone marrow The suffix -osis added to a root for a type of cell means an increase in that type of cell in the blood. Use this suffix to

write a word that means the same as the following:18. Increase in granulocytes in the blood 19. Increase in lymphocytes in the blood

E xerc ise 10-2

myel/obone marrow

granulocytosis

xiv ♦ USER’S GUIDE

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Key Terms include the most commonlyused words

Supplementary Terms list morespecialized words

Key Clinical Terms list medical terms pertinent to the body systemunder discussion

Abbreviations for common terms

CHAPTER TWELVE / The Digestive System 307

12

T E R M I N O L O G Y Key Terms

anus

The distal opening of the digestive tract (root: an/o)

A--nus

appendix

An appendage; usually means the narrow tube of lymphatic tissue attached

a-PEN-diks

to the cecum, the vermiform (wormlike) appendix

bile

The fluid secreted by the liver that emulsified fats and aids in their

bı-l

absorption (roots: chol/e, bili)

cecum

A blind pouch at the beginning of the large intestine (root: cec/o)

SE--kum

colon

The major portion of the large intestine; extends from the cecum to the

KO--lon

rectum and is formed by ascending, transverse, and descending portions

(root: col/o, colon/o)

common bile duct

The duct that carries bile into the duodenum; formed by the union of the

cystic duct and the common hepatic duct (root: choledoch/o)

duodenum

The first portion of the small intestine (root: duoden/o)

du--o--DE--numesophagus

The muscular tube that carries food from the pharynx to the stomach.

e--SOF-a-gusfeces

The waste material eliminated from the intestine (adjective: fecal); stool

FE--se-z

gallbladder

A sac on the undersurface of the liver that stores bile (root: cholecyst/o)

hepatic portal system

A special pathway of the circulation that brings blood directly from the

abdominal organs to the liver for processing (also called simply the portal

system). The vessel that enters the liver is the hepatic portal vein (portal

vein).ileum

The terminal portion of the small intestine (root: ile/o)

IL-e--um

intestine

The portion of the digestive tract between the stomach and the anus. It

in-TES-tin

consists of the small intestine and large intestine. It functions in digestion,

absorption, and elimination of waste (root enter/o). The bowel (BOW-el)

jejunum

The middle portion of the small intestine (root: jejun/o)

je-JU--num

lacteal

A lymphatic capillary in a villus of the small intestine. Lacteals absorb

lak-TE-L

digested fats into the lymph.

large intestine

The terminal portion of the digestive tract, consisting of the cecum, colon,

in-TES-tin

rectum, and anus. It stores and eliminates undigested waste material (feces).

liver

The large gland in the upper right part of the abdomen. In addition to

LIV-er

many other functions, it secretes bile needed for digestion and absorption of

fats (root: hepat/o).

Normal Structure and Function

324 PART THREE / Body Systems

2

T E R M I N O L O G Y Supplementary Terms

Continued

duodenal papilla The raised area where the common bile duct and pancreatic duct enter the

duodenum (see Fig. 12-14); papilla of Vater (FA-ter)

greater omentumA fold of the peritoneum that extends from the stomach over the abdominal

o--MEN-tum

organs

hepatic flexure

The right bend of the colon, forming the junction between the ascending

colon and the transverse colon (see Fig. 12-1)

ileocecal valve

A valvelike structure between the ileum of the small intestine and the

il-e--o--SE--kal

cecum of the large intestine

mesentery

The portion of the peritoneum that folds over and supports the intestine

MES-en-ter-e-

mesocolon

The portion of the peritoneum that folds over and supports the colon

mes-o--KO- -lon

papilla of Vater See duodenal papilla

peritoneum

The serous membrane that lines the abdominal cavity and supports the

per-i-to--NE--um

abdominal organs

rugae

The large folds in the lining of the stomach seen when the stomach is

Ru--je-empty

sphincter of OddiThe ring of muscle at the opening of the common bile duct into the

OD-e-duodenum

splenic flexure

The left bend of the colon, forming the junction between the transverse

colon and the descending colon (see Fig. 12-1)

DISORDERS

achalasia

Failure of a smooth muscle to relax, especially the lower esophageal

ak-a-LA--ze--a

sphincter, so that food is retained in the esophagus

achlorhydria

Lack of hydrochloric acid in the stomach; opposite is hyperchlorhydria

a--klor-H I--dre--a

anorexia

Loss of appetite. Anorexia nervosa is a psychologically induced refusal or

an-o--REK-se--ainability to eat (adjectives: anorectic, anorexic).

aphagia

Refusal or inability to eat; inability to swallow or difficulty in swallowing

a-FA--je--a

aphthous ulcer

A small ulcer in the mucous membrane of the mouth

AF-thus

Barrett syndromeLower esophageal ulcer resulting from chronic esophagitis, often with

constriction caused by mucosal changes; may be premalignant. Also called

Barrett esophagus.

T E R M I N O L O G Y Key Clinical Terms

lymphadenitis Inflammation and enlargement of lymph nodes, usually as a result of lim-fad-e-NI-tis infection

lymphangiitis Inflammation of lymphatic vessels as a result of bacterial infection. Appears lim-fan-je--I

--tis as painful red streaks under the skin. (Also spelled lymphangitis.)

lymphedema Swelling of tissues with lymph caused by obstruction or excision of lim-fe-DE

--ma lymphatic vessels (see Box 9-3)

lymphoma Any neoplastic disease of lymphoid tissuelim-FO

--ma

Lymphatic Disorders

T E R M I N O L O G Y Abbreviations

BEBarium enema (for radiographic study of

the colon)

BMBowel movement

CBD Common bile duct

ERCP Endoscopic retrograde

cholangiopancreatography

FAP Familial adenomatous polyposis

GERD Gastroesophageal reflux disease

GI Gastrointestinal

HAV Hepatitis A virus

HBV Hepatitis B virus

HCV Hepatitis C virus

HDV Hepatitis D virus

HEV Hepatitis E virus

HCl Hydrochloric acid

IBD Inflammatory bowel disease

IBS Irritable bowel syndrome

LES Lower esophageal sphincter

NG Nasogastric (tube)

N & V Nausea and vomiting

N/V/D Nausea, vomiting, and diarrhea

PONV Postoperative nausea and vomiting

PPI Proton-pump inhibitor

TPN Total parenteral nutrition

UGI Upper gastrointestinal (radiograph series)

USER’S GUIDE ♦ xv

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Chapter Review Exercises

Chapter Review Exercises are designed totest your knowledge of the chapter materialand appear at the end of each chapter

CHAPTER TEN / Blood and Im

10

Chapter Review LABELING EXERCISE

Blood Cells

Write the name of each numbered part on the

corresponding line of the answer sheet.

Erythrocyte 1.

Leukocyte 2.

Platelet3.

Leukocytes (white blood cells)

Write the name of each numbered part on the corresponding line of the answer sheet.

1

3

2

1.

Eosinophil 2.

Lymphocyte 3.

Monocyte 4.

Neutrophil 5.

Leukocytes (white blood cells)

12

3

45

Basophil

ody Systems

10

T E R M I N O L O G YMatch the following terms and write the appropriate letter to the left of each number:

1. myelogenica. immature bone marrow cell2. leukopeniab. originating in bone marrow3. leukemiac. malignant overgrowth of white blood cells

4. myeloblastd. formation of white blood cells5. leukopoiesise. deficiency of white blood cells6. calcidiola. pertaining to iron7. hypokalemiab. urinary excretion of nitrogenous compounds

8. ferrousc. hormone involved in the metabolism of calcium

9. siderosisd. decreased potassium in the blood

10. azoturiae. condition involving iron deposits11. thalassemiaa. hives12. petechiaeb. hereditary form of anemia13. urticariac. stoppage of blood flow14. hemophilia

d. hereditary clotting disorder15. hemostasise. pinpoint spots caused by bleeding into the skin

16. pHa. hematocrit17. HIVb. scale for measuring acidity or alkalinity

18. CLLc. hormone that stimulates red blood cell formation

19. PCVd. a form of leukemia20. EPOe. virus that causes an immunodeficiency diseaseSupplementary Terms21. electrophoresis a. separation of blood and use of components

22. heparinb. pigment that comes from hemoglobin

23. apheresisc. anticoagulant24. ELISA

d. method for separating components of a solution25. bilirubin

e. sensitive immunologic testFill in the blanks:

26. The engulfing of foreign material by white cells is called

.

27. The iron-containing pigment in red blood cells that carries oxygen is called

.

28. A substance that separates into ions in solution is a(n)

.

29. The cells fragments active in blood clotting are the

.

30. A substance that induces the formation of antibodies is a(n)

.

31. A hemocytometer is used to count

.

xvi ♦ USER’S GUIDE

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Case Studies and CaseStudy Questions

Case Studies and Case Study Questions inevery chapter present terminology in thecontext of a medical report. These are anexcellent review tool as they test yourcumulative knowledge of medical termi-nology, and put terminology into a real-world context

8

P.L., who has a 4-year history of heart disease, was brought

to the emergency room by ambulance with chest pain that

radiated down her arm, dyspnea, and syncope. Her routine

meds included Lanoxin to slow and strengthen her heart

beat, Inderal to support her heart rhythm, Lipitor to

decrease her cholesterol, Catapres to lower her hyperten-

sion, nitroglycerin prn for chest pain, Hydro DIURIL to

eliminate fluid and decrease the workload of her heart,

Diabinese for her diabetes, and Coumadin to prevent blood

clots. She also took Tagamet for her stomach ulcer and sev-

eral OTC preparations, including an herbal sleeping potion

that she mixed in tea, and Metamucil mixed in orange

juice every morning for her bowels. Shortly after admis-

sion, P.L.'s heart rate deteriorated into full cardiac arrest.

Immediate resuscitation was instituted with cardiopul-

monary resuscitation (CPR), defibrillation, and a bolus of

IV epinephrine. Between shocks she was given a bolus of

lidocaine and a bolus of diltiazem plus repeated doses of

epinephrine every 5 minutes. P.L. did not respond to resus-

citation. On the death certificate, her primary cause of

death was listed as cardiac arrest. Multiple secondary diag-

noses were listed, including polypharmacy.A.E., a 19-year-old college student, was diagnosed at the

age of 13 with Crohn disease, a chronic inflammatory dis-

ease that can affect the entire gastrointestinal tract from

mouth to anus. A.E.’s disease is limited to his large bowel.

During a 9-month period of disease exacerbation, charac-

terized by severe cramping and bloody stools, he took oral

corticosteroids (prednisone) to reduce the inflammatory

response. He experienced many of the drug’s side effects,

but has been in remission for 4 years. Currently, A.E.’s con-

dition is managed on drugs that reduce inflammation by

suppressing the immune response. He takes Pentasa

(mesalamine) 250 mg 4 caps po bid. Pentasa is of the 5-

ASA (acetylsalicylic acid or aspirin) group of antiinflam-

matory agents, which work topically on the inner surface

of the bowel. It has an enteric coating, which dissolves in

the bowel environment. He also takes 6-mercaptopurine

(Purinethol) 75 mg po qd and a therapeutic vitamin with

breakfast. A.E. may take acetaminophen for pain but must

avoid NSAIDs, which will irritate the intestinal mucosa

(inner lining) and cause a flare-up of the disease.

CASE STUDY 8-1: Cardiac Disease and Crisis

CASE STUDY 8-2: Inflammatory Bowel Disease

E.N., a 20-year-old woman with asthma, visited the

preadmission testing unit 1 week before her cosmetic

surgery to meet with the nurse and anesthesiologist. Her

current meds included several bronchodilators, which

she takes by mouth and by inhalation, and a tranquilizer

that she takes when needed for nervousness. She some-

times receives inhalation treatments with Mucomyst, a

mucolytic agent. On E.N.’s preoperative note, the nurse

wrote:

Theo-Dur 1 cap tidFlovent inhaler 1 spray (50 mcg each nostril bid

Ativan (lorazepam) 1 mg po bidAlbuterol-metered dose inhaler 2 puffs (180 mcg) prn

q4-6h for bronchospasm and before exercise

E.N. stated that she has difficulty with her asthma

when she is anxious and when she exercises. She also

admitted to occasional use of marijuana and ecstasy, a hal-

lucinogen and mood-altering illegal recreational drug. The

anesthesiologist wrote an order for lorazepam 4 mg IV 1

hour preop. The plastic surgeon recommended several

herbal products to complement her surgery and her recov-

ery. He ordered a high-potency vitamin 3 tabs with break-

fast and dinner to support tissue health and healing. He

also prescribed Bromelain, an enzyme from pineapple, to

decrease inflammation, 1 po qid 3 days before surgery and

postoperatively for 2 weeks. Arnica Montana was pre-

scribed to decrease discomfort, swelling, and bruising; 3

tabs sublingual tid the evening after surgery and for the fol-

lowing 10 days.

CASE STUDY 8-3: Asthma

Case Study Questions

Multiple choice. Select the best answer and write the letter of your choice to the left of each number:

1. P.L.’s nitroglycerine is ordered: prn SL. This means:

a. as needed, under the tongue

b. at bedtime, under the tongue

c. as needed, on the skin

d. by mouth, on the skin

e. by mouth, under the skin

2. P.L. took several OTC preparations. OTC means:

a. on the cutaneous

b. off the cuff

c. over the counter

d. do not need a prescription

e. c and d

3. P.L.’s herbal sleeping potion was mixed into tea and taken at bedtime. The dissolved mixture is called a(n)

and is taken at

.

a. elixir/QAM

b. emulsion/bid

c. suspension/hs

d. aqueous solution/hs

e. aqueous solution/QAM

4. During P.L.’s resuscitation, epinephrine was given in an IV bolus. This means it was administered:

a. intrathecally in a continuous drip

b. parenterally in a topical solution

c. intravenously in a continuous drip

d. intravenously in a rapid concentrated dose

e. intrathecally in a rapid concentrated dose

5. P.L. had a secondary diagnosis of polypharmacy. This means that she:

a. used more than one drug store

b. had polyps

c. used more prescription than OTC drugs

d. had a toxic dose

e. used many different drugs

6. A.E. takes several drugs to prevent or act against his inflammatory response. These agents are called

drugs.

a. contrainflammatory

b. counterinflammatory

c. antiinflammatory

d. proinflammatory

e. hypoinflammatory

Continued

8

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meaning

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meaning

not

xviii ♦ USER’S GUIDE

in-, -im-, non-, un-

Ch. 3word part

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Ch. 2word part

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