UNTI:1

HUMAN ANOTOMY AND PHYSIOLOGY

1.1. Digestive system:

Definition:

The main purpose of the digestive system is to break down food and absorb
nutrient and eliminate the unused residuals. It is a long, from the mouth to the anus:

Alimentary canal (GI tract)

The alimentary canal (gastrointestinal tract) is 9 meters in length. It consist of the

following parts:

1. Mouth

2. Pharynx

3. Esophagus

4. Stomach

5. Small intestine

6. Large intestine

7. Rectum and

8. Anal canal.

Accessory organs of digestion

The accessory organs of digestion include:

1. Salivary gland

2. Pancreas
1
 3. Liver and

4. Gallbladder

Digestion is described as a process by which food can be changed into substances that
can be absorbed and utilized by the body cells. The digestive system has two major
contributing components: the alimentary canal and the accessory organs. The
alimentary canal starts at the mouth, follows through to the pharynx, esophagus,
stomach, small intestine, large intestine, and finally ends at the anal canal. Foods
undergo three processes in the body: digestion, absorption, and metabolism, utilizing
both mechanical and chemical digestion.

DIGESTIVE SYSTEM

A. Irregular tube called alimentary canal or gastrointestinal (GI) tract

B. Food must first be digested, then absorbed, and later metabolized

WALL OF THE DIGESTIVE TRACT

The wall of the digestive tube is formed by four layers of tissue:

A. Mucosa—mucous epithelium
B. Sub mucosa—connective tissue
C. Muscular is—two or three layers of smooth muscle
D. Siros—serous membrane that covers the outside of abdominal organs; it attaches
the digestive tract to the wall of the abdominopelvic cavity by forming folds called
mesenteries

MOUTH

A. Roof—formed by hard palate (parts of maxillary and palatine bones) and soft
palate, an arch-shaped muscle separating mouth from pharynx; uvula, a downward
projection of soft palate
B. Floor—formed by tongue and its muscles; papillae, small elevations on mucosa of

2
tongue; taste buds, found in many papillae; lingual frenulum, fold of mucous
membrane that helps anchor tongue to floor of mouth

TEETH

A. Names of teeth—incisors, cuspids, bicuspids, and tricuspids

B. Twenty teeth in temporary set; average age for cutting first tooth about 6 months;
set complete at about 2 years of age
C. Thirty-two teeth in permanent set; 6 years about average age for starting to cut first
permanent tooth; set complete usually between ages of 17 and 24 years
D. Structures of a typical tooth—crown, neck, and root

SALIVARY GLANDS

A. Parotid glands
B. Submandibular glands
C. Sublingual glands

PHARYNX

ESOPHAGUS

STOMACH

A. Size—expands after large meal; about size of large sausage when empty
B. Pylorus—lower part of stomach; pyloric sphincter muscle closes opening of
pylorus into duodenum
C. Wall—many smooth muscle fibers; contractions produce churning movements
(peristalsis)
D. Lining—mucous membrane; many microscopic glands that secrete gastric juice
and hydrochloric acid into stomach; mucous membrane lies in folds (rugae) when
stomach is empty

3
SMALL INTESTINE

A. Size—about 7 meters (20 feet) long but only 2 cm or so in diameter

B. Divisions
1. Duodenum
2. Jejunum
3. Ileum
C. Wall—contains smooth muscle fibers that contract to produce peristalsis
D. Lining—mucous membrane; many microscopic glands (intestinal glands) secrete
intestinal juice; villi (microscopic finger-shaped projections from surface of mucosa
into intestinal cavity) contain blood and lymph capillaries

LIVER AND GALLBLADDER

A. Size and location—liver is largest gland; fills upper right section of abdominal
cavity and extends over into left side
B. Liver secretes bile
C. Ducts
1. Hepatic—drains bile from liver
2. Cystic—duct by which bile enters and leaves gallbladder
3. Common bile—formed by union of hepatic and cystic ducts; drains bile from
hepatic or cystic ducts into duodenum
D. Gallbladder
1. Location—undersurface of the liver
2. Function—concentrates and stores bile produced in the liver

PANCREAS

A. Location—behind stomach
B. Functions
1. Pancreatic cells secrete pancreatic juice into pancreatic ducts; main duct empties
into duodenum
2. Pancreatic islets (of Langerhans)—cells not connected with pancreatic ducts;
secrete hormones glucagon and insulin into the blood
4
LARGE INTESTINE

A. Divisions
1. Cecum
2. Colon—ascending, transverse, descending, and sigmoid
3. Rectum
B. Opening to exterior—anus
C. Wall—contains smooth muscle fibers that contract to produce churning,
peristalsis, and defecation
D. Lining—mucous membrane

APPENDIX

Blind tube off cecum; no important digestive functions in humans

PERITONEUM

A. Definitions—peritoneum, serous membrane lining abdominal cavity and

covering abdominal organs; parietal layer of peritoneum lines abdominal
cavity; visceral layer of peritoneum covers abdominal organs; peritoneal space
lies between parietal and visceral layers
B. Extensions—largest ones are the mesentery and greater omentum;
mesentery is extension of parietal peritoneum, which attaches most of small
intestine to posterior abdominal wall; greater omentum, or “lace apron,” hangs
down from lower edge of stomach and transverse colon over intestines

DIGESTION

Meaning:

Changing foods so that they can be absorbed and used by cells

A. Mechanical digestion—chewing, swallowing, and peristalsis break food into tiny
particles, mix them well with digestive juices, and move them along the digestive
tract

5
B. Chemical digestion—breaks up large food molecules into compounds having
smaller molecules; brought about by digestive enzymes

C. Carbohydrate digestion—mainly in small intestine

1. Pancreatic amylase—changes starches to maltose
2. Intestinal juice enzymes
a. Maltase—changes maltose to glucose
b. Sucrase—changes sucrose to glucose
c. Lactase—changes lactose to glucose

D. Protein digestion—starts in stomach; completed in small intestine

1. Gastric juice enzymes, renin and pepsin, partially digest proteins
2. Pancreatic enzyme, trypsin, completes digestion of proteins to amino acids
3. Intestinal enzymes, peptidases, complete digestion of partially digested proteins to
amino acids
E. Fat digestion
1. Bile contains no enzymes but emulsifies fats (breaks fat droplets into very small
droplets)
2. Pancreatic lipase changes emulsified fats to fatty acids and glycerol in small
intestine

ABSORPTION

A. Meaning—digested food moves from intestine into blood or lymph

B. Where absorption occurs—foods and most water from small intestine; some water
also absorbed from large intestine

6
1.2. Respiratory system:

Respiration is defined as the exchange of oxygen and carbon dioxide between the
atmosphere and the body tissues.

Types of respiratory:

Physical or mechanical respiration, which involves the motion of the diaphragm

and rib cage. The musculoskeletal action, which resembles that of a bellows, cause air
to be inhaled or exhaled.

Physiological respiration involves exchange of gases, oxygen and carbon

dioxide, at two sits in the body.

The first is the transfer that occurs in the lungs between the incoming oxygen
and the carbon dioxide present in the capillaries of the lungs(external respiration).
7
 The second transfer occurs when oxygen brought into the body replaces carbon
dioxide in the cellular tissues (internal respiration). Normally, oxygen and carbon
dioxide exchange is in equal volumes: how ever, certain physiological conditions may
throw this balance off. For example, heavy smokers will find that the ability of their
lungs to exchange gases is impaired, leading to shortness of breath and fatigue during
even slight physical exertion.

Functions of respiration:

1. Exchange of oxygen to the tissues and elimination of carbon

dioxide(CO2) from the tissues.

2. It regulates the acid-base balance.

3. Excretion of volatile substance like water vapor and ammonia.

4. It maintain the blood pH level

5. It maintains the temperatures of the body.

RESPIRATORY SYSTEM

Main Function = gas exchange from O2
CO2

Other functions: speech (sounds) regulation of pH of blood.

1. NOSE: This is made of cartilage. Nose jobs involve taking a mallet, breaking
the nasal bone and shaving the cartilages.

8
 a. NASAL CAVITY: This is where the nostrils are. They have hairs
which filter large particles in the respiratory tract. (insects, etc).

The functions of the nasal cavity is for the air you breathe:

1. Warm (cold air can freeze lungs); warmed by superficial veins

2. Clean (dirty air can clog lungs); mucous is sticky, and cilia will
move that dirt down the back of the throat, then it’s swallowed.

3. Humidify (dry lungs can crack). The fluid secreted by glands

makes the moisture, even on windy days the air goes to 100%
humidity by the time it gets to the lungs.

When you have a cold and get extra fluid (edema)
stuffed up or runny nose, and
the pressure can cause sinus headaches.

2. PHARYNX is where the nasal passages join with the oral passages. The
AUDITORY TUBE from the ears is located here.

A. SOFT PALATE: move your tongue along the roof of your mouth,
and going from the front to the back you’ll feel the hard part
turning into a soft part on the roof of your mouth.

B. UVULA: located at the end of the soft palate (seen in cartoons).

9
 The function of the soft palate and uvula is to move upward when swallowing, to
prevent food from going into nasal cavities. When you vomit, they don’t close, and
food and stomach acids go into nasal cavity and cause problems. Can also see tonsils
(lymph nodes) and vocal cords.

3. LARYNX (model)

This is a very complex structure (show overhead). Made up of cartilages

It has two functions:

1. Produce sounds (vocal cords are located in the larynx)

2. Prevent food from entering lungs

A. EPIGLOTTIS closes when you swallow so nothing will go into the trachea and
lungs. When you get hiccoughs, it’s from a sudden movement of air into the lungs,
so the epiglottis closes to prevent more air from going in. It’s unknown why you get
hiccoughs. All the treatments you can try involve interrupting the normal breathing
patterns.

10
B. GLOTTIS is the opening.

C. VOCAL CORDS

Vocal cords are attached to cartilage. If these cartilages move, the vocal cords open.

The type and pitch of sounds you make depend on how far apart the vocal cords are.

Way open = no sound (like when breathing)

Mostly closed = sounds

Men: their thyroid cartilage is larger, so their vocal cords are longer = deeper voice.

LARYNGITIS: inflamed vocal cords (↓ sound production).

Singers can get scar tissue nodules, requires surgery.

The number one sign that a person is lying is voice irregularities.

4. TRACHEA This is a tube that carries air from the larynx to the lungs. (See model)

It’s fairly rigid from about 16 rings of cartilage.

The purpose of the cartilage rings is to keep the trachea open like a hollow tube.
Otherwise, when you inhale, the trachea would collapse like when you suck hard on a
straw. That’s why your vacuum cleaner has rings on the hose.

The trachea is lined with epithelium interspaced with goblet cells, which are the cells
that produce mucous to trap dirt. The epithelial cells also have little hairs on them
called cilia which sweep dirt to larynx
swallowed. In this way, the respiratory
passage is filtered. Therefore, the cilia have several functions: they move the mucus,
remove debris and harmful organisms, and circulate the air.
11
The trachea branches out into smaller tubes called BRONCHI.

Bronchi branch out into smaller tubes called BRONCHIOLES.

Bronchioles branch out into smaller tubes that empty into a sack = ALVEOLI
(overhead picture). This sac is like a balloon surrounded by a capillaries. The alveoli
are where the gas exchange occurs: oxygen goes from the air in the lungs into the red
blood cells passing by there, and carbon dioxide diffuses out of the cells and into the
air in the lungs where it is exhaled. Therefore, inspired air (breathe in) contains
oxygen, and expired air (breathe out) contains more carbon dioxide than oxygen.

By the time these air tubes are this small, they don’t have any more cilia, so any
particle that gets down that far has to be eaten by macrophages or just stay there.
Therefore, within the alveoli are macrophages to eat the foreign object.

A cough can be expelled at 60 mph.

DIAPHRAGM is a muscle on the floor of the chest cavity. It is involved in

breathing.

A. MYTH: Cover your head or catch a cold: Although 90% of the heat
lost from the body is lost from the head, covering your head will not
prevent this heat loss. The heat is lost from the warm air that you
exhale. Respiration: 5 parts:

1. Pulmonary ventilation* = breathing;

2. External respiration* = air into lungs; gas exchange (O2 load/

CO2 unload); air out;
12
 3. Transport of respiratory gases = gases in blood transported
from lungs to body cells and back to lungs;

4. Internal respiration = exchange of gases at body capillaries

(O2 unload/CO2 load).

5. Cellular respiration = use of oxygen by cells to produce

energy (production of CO2).

* Only these two portions are included in the respiratory system.

PHYSIOLOGY OF RESPIRATION

Recall that the function of the respiratory system is to supply cells with oxygen and
remove carbon dioxide. The three basic processes are pulmonary ventilation, external
respiration and internal respiration.

A. Breathing Mechanism (Pulmonary Ventilation)

Breathing involves two actions, inspiration & expiration.

1. Inspiration (inhalation) = breathing air in.

a. Force necessary is atmospheric pressure:

When the diaphragm is at rest (curved upward):

• The air pressure outside the lungs is

equal to the air

pressure inside the lungs (1 atm or 760 mm Hg).

• The thoracic cavity has a given size and

volume.

o During inspiration:

• The diaphragm muscle pushes

downward;
13
 • The size of thoracic cavity increases;

• The pressure in the thoracic cavity

decreases (758 mm Hg) (Boyles' Law);

• The air pressure inside the thoracic

cavity (lungs) is less than the
atmospheric pressure and therefore air
rushes into lungs to equalize the
pressure gradient.

o Pleural Membranes aid in inspiration:

• Serous fluid between membranes

primarily contains water;

• The water in the serous fluid has great

surface tension and therefore,

• Membranes move together:

1. thoracic cage expands;

2. parietal pleura expands;

3. visceral pleura expands;

4. lungs expand.

o Contraction of the external intercostal muscles

also aid inspiration.

PHYSIOLOGY OF RESPIRATION

A. Breathing Mechanism (Pulmonary Ventilation)

2. Expiration = breathing out depends on two factors:

14
 a. the elastic recoil of tissues that were stretched during
inspiration (i.e. tissues bouncing back to shape).

b. the inward pull of surface tension due to the alveolar

fluid.

PHYSIOLOGY OF RESPIRATION

A. Breathing Mechanism (Pulmonary Ventilation)

4. Respiratory Volumes and Capacities

a. are measured by a spirometer;

b. include the following 4 volumes from which 4

capacities may be calculated:

o Tidal Volume = amount (volume) of air that

enters the lungs during normal inspiration and
leaves the lungs during normal expiration;
approximately 500 ml;

o Inspiratory Reserve Volume (IRV) = the

amount of air the can be forcibly inhaled after a
normal tidal inspiration; approximately 3000
ml;

o Expiratory Reserve Volume (ERV) = the

amount of air that can be forcibly exhaled after
a normal tidal expiration; approximately 1100
ml;

Residual Volume (RV) = amount of air that always remains in lungs; 1200 m

o Vital Capacity (VC) = the maximum amount of

air that can be exhaled after a maximum
inhalation;
15
 • VC = TV + IRV + ERV = 4600 ml.

o Inspiratory Capacity = total amount of air that

can be inspired after a tidal expiration.

• IC = TV + IRV

o Functional Residual Capacity = amount of air

left in the lungs after a tidal expiration.

• FRC = ERV + RV

o Total Lung Capacity = VC + RV;

approximately 6 L.

5. Alveolar Ventilation

a. Minute Ventilation (MV) = TV X RR (respiratory

rate)

o Amount of air that enters and exits respiratory

system in one minute

o About 6000mL

b. Anatomic dead space (ADS) – air space in respiratory

passageways not involved in gas exchange = 150mL

c. Alveolar ventilation = the actual amount of air

involved in gas exchange

o AV = (TV – ADS) X RR

o AV = (500mL – 150mL) X 12 breaths per

minute

o AV = 350mL X 12 b/m

o AV = 4200mL
16
IV. CONTROL OF BREATHING

A. Normal breathing = rhythmic; involuntary.

B. Nervous Control = Respiratory Center:

1. located in pons & medulla of brain stem;

ALVEOLAR GAS EXCHANGES

(External Respiration)

A. Definition = the exchange of oxygen and carbon dioxide between the

alveoli and lung blood capillaries.

B. The pressure of gas determines the rate at which it will diffuse from
region to region (Dalton's Law).

C. Air is a mixture of gases:

1. 78% Nitrogen

2. 21% Oxygen

3. .04% Carbon Dioxide

D. In a mixture of gases, the amount of pressure that each gas creates =

partial pressure.

In air: O2 = 21%; PO2 = 104 mm Hg

CO2 = .04%; PCO2 = 40 mm Hg

E. The partial pressure of a gas is directly related to the concentration of

that gas in a mixture.(Dalton’s Law of Partial Pressure)

17
 F. Diffusion of gases through the respiratory membrane proceeds
from where a gas is at high pp low pp.

Alveolus

PCO2 = 40 mm Hg

PO2 = 104 mm Hg

PROBLEMS WITH THE LUNGS

1. ASTHMA.

In allergic conditions, bronchioles will constrict, blocking air flow to the lungs This
can also be caused by irritants in the environment, especially by pollution in the city.

2.SMOKING

Smoking destroys cilia, and smoke of any kind is toxic. Particles in the lungs can’t
clear. Cigarettes contain tar, which is the same kind of tar used to pave roads. When
there is a thin lining of tar on the alveoli, there is no oxygen exchange to the lungs
there. Large chunks of the lung become useless. Damage to the lungs shows up
several ways.

3.CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)

It is a combination of two conditions:

1. CHRONIC BRONCHITIS: inflammation of the bronchi, produces mucous,

the openings become smaller = obstructed.

2. EMPHYSEMA: loss of elastic tissue on the bronchioles and alveoli, which

collapse now during exhalation. Alveoli lose their shape and their surface

18
 area. When you see someone at the mall with an oxygen tank, they probably
have emphysema, and need pure oxygen.

4. LUNG CANCER

There are many types of lung cancer

85% of lung cancer is caused from smoking.

5. SURFACTANT is a slippery agent that is made by the alveoli, which coats it and
keeps the walls of the alveoli from sticking together when they collapse during
exhalation

6. RESPIRATORY DISTRESS SYNDROME, which is the #1 cause of death in

premature babies. You know how hard it is to blow up a brand new balloon?
Imagine a baby having to do that with every single breath.

7. PNEUMONIA is when there is fluid in the lungs, usually from a viral or bacteria
infection of the bronchi and alveoli. Blood plasma leaks out and fills the lungs,
making it difficult to breathe. Needs hospitalization with iv antibiotics.

8. TUBERCULOSIS is an infection of a really bad bacteria that get in the lungs and
make themselves a capsule to hide in, where antibiotics can’t reach.

1.3 Circulatory SYSTEM

THORACIC CAVITY

The lungs and heart are located in the thoracic cavity.

THE HEART

The heart is the simplest organ in the body. It does only one thing: pumps blood. It
beats 42 million times a year. It’s about the size of your clenched fist. (Show life-
size model of heart). Some of you have big fists, some have smaller fists. Its
location is deep to the sternum. Take your fist and place it on the sternum, then angle

19
the bottom of your wrist to the left. When you say the Pledge of Allegiance, your
hand is not over your heart. It’s not on the left, it’s in the center.

HEART BEATS

The pressure of blood against blood vessel walls is called blood pressure.

Blood pressure is recorded systole over diastole. Normal resting blood pressure is
said to be 120/80.

When blood pressure is too high, it is called HYPERTENSION.

The sound your heart makes when it is beating is the sound of the valves closing.

The heart normally beats at a rate of 60-80 beats per minute. A faster or slower
heart rate is an indication of a problem.

CIRCULATORY DISEASE CONDITIONS

1. ATHEROSCLEROSIS is fat and cholesterol deposits underneath the

lining of arteries.

20
3. HYPERTENSION (High Blood Pressure)

High blood pressure is due to high pressure of blood against the walls of the blood
vessels; the blood vessels compensate by developing a thicker wall.

ANEURYSM can form, which is a weakening in the wall of the blood vessel,
causing it to expand like a balloon. If it ruptures, it’s very dangerous.

HEART

ARRHYTHMIA = improper heart beat; needs medicines or a pacemaker.

FIBRILLATION is when the heart beat is rapid and dangerously uncoordinated

HEART ATTACK

Severe pain from lack of blood to the heart is called ANGINA.

If there is complete blockage
not enough O2 to that area
that part of heart
muscle dies = MYOCARDIAL INFARCTION= HEART ATTACK. Heart
muscle never regenerates. If a large area dies, person will die.

Pulmonary and Systemic Circulations

Blood whose oxygen content has become partially depleted and carbon dioxide
content has increased as a result of tissue metabolism returns to the right atrium. This
blood then enters the ventricle, which pumps it into the pulmonary trunk and
pulmonary arteries. The pulmonary arteries branch to transport blood to the lungs,
where gas exchange occurs between the lung capillaries and the alveoli of the lungs.
Oxygen diffuses from the air to the capillary blood; while carbon dioxide diffuses in

21
the opposite direction. The blood that returns to the left atrium by way of the pul-
monary veins is therefore enriched in oxygen and partially depleted of carbon
dioxide. The blood that is ejected from the right ventricle to the lungs and back to the
left atrium completes one circuit: called the pulmonary circulation.

Oxygen-rich blood in the left atrium enters the left ventricle and is pumped into a
very large, elastic artery; the aorta. The aorta ascends for a short distance, makes a U-
turn, and then descends through the thoracic and abdominal cavities. Arterial
branches from the aorta supply oxygen-rich blood to all of the organ systems and are
thus part of the systemic circulation. As a result of cellular respiration, the oxygen
concentration is lower and the carbon dioxide concentration is higher in the tissues
than in the capillary blood. Blood that drains into the systemic veins is thus partially
depleted of oxygen and increased in carbon dioxide content. These veins empty into
two large veins; the superior and inferior venae cavae that return the oxygen-poor
blood to the right atrium. This completes the systemic circulation; from the heart
(left ventricle), through the organ systems, and back to the heart (right atrium).

Physiology of cardiac muscle

The heart is composed of three major types of cardiac muscle.

1- The atrial muscle.

2- The ventricular muscle.

3- Specialized excitatory and conductive muscle fibers; an excitatory system of the

heart that helps spread of the impulse (action potential) rapidly throughout the heart.

Innervations of the heart

The heart receives a rich supply of sympathetic and parasympathetic nerve fibers

Blood supply of the heart

The myocardial cells receive their blood supply through arteries that branch from the
aorta, named coronary arteries.

22
Heart Sounds

Heart sounds are associated with closure of the valves with their associated vibration
of the flaps of the valves and the surrounding blood under the influence of the sudden
pressure changes that develop across the valve. That is, heart sound does not
produced by the opening of the valve because this opening is a slow developing
process that makes no noise.

1-The first heart sound (S1): is caused by closure of the AV valves when ventricles
contract at systole. The vibration is soft, low-pitched lub.

2-The second heart sound (S2): is caused by closure of the aortic and pulmonary
valves when the ventricles relax at the beginning of diastole. The vibration is loud,
high-pitched dup. It is rapid sound because these valves close rapidly and continue for
only a short period i.e., rapid, short and of higher pitch dup.

3-The third heart sound (S3): is caused by rapid filling of the ventricles, by blood that
flow with a rumbling motion into the almost filled ventricles; at the middle one third
(1/3) of diastole i.e., it is caused by the vibrations of the ventricular walls during the
period of rapid ventricular filling that follows the opening of AV valves. It is a low-
pitched sound and can be heard after the S2. It is heard in normal heart; in children
and in adult during exercise. It is also heard in anemia, and AV valve regurgitation.

4-The fourth heart sound (S4): it is an aerial sound when the atria contract (at late
diastole). It is a vibration sound (similar to that of S3) associated with the flow of
blood into the ventricle. It is not heard in normal hearts but occurs during ventricular
overload as in severe anemia, Thyroitoxicosis (hyperthyroidism) or in reduced
ventricular compliance and in hypertension. If present, it is heard before S1. (S4, S1,
S2, S3).

23
Heart murmurs

They are abnormal sounds, can be produced by blood flowing rapidly in the usual
direction but through an abnormally narrowed valve (stenos is), by blood flowing
backward through a damaged, leaky valve (incompetent, regurgitate valve) or by
blood flowing between the two atria or two ventricles through a small hole: ASD
(aerial sepal defect), VSD (ventricular sepal defect).

Pitch = the audible range of frequencies (cycles/sec).

Properties of the cardiac muscle

In addition, to the syncytium property, the cardiac muscle has the property of:

• Automaticity and rhythm city (Autorhythmicity).

• Excitability and conductivity.

• Contractility

The Cardiac cycle

The cardiac events that occur from the beginning of one heartbeat to the beginning of
the next are called the cardiac cycle. Each cycle is initiated by spontaneous generation
of an action potential in the sinus node which travels rapidly through both atria and
then through the A-V bundle into the ventricles.

Because of this special arrangement of the conducting system from the atria into the
ventricles, there is a delay of more than 0.1 second during passage of the cardiac
impulse from the atria into the ventricles. This allows the atria to contract, pumping
blood into the ventricles before the strong ventricular contraction begins. Thus, the
atria act as primer pumps for the ventricles, and the ventricles in turn provide the
major source of power for moving blood through the body’s vascular system.

In a normal heart, cardiac activity is repeated in a regular cycle. At a normal heart rate
of about 72 beats/minute; for the atria, the cycle lasts for about 0.15 second in systole
and 0.65 second in diastole. For the ventricles, the duration of each cardiac cycle lasts
24
about 0.8 second. If the heart rate increases, the diastole decreases, which means that
the heart beating very fast may not remain relaxed long enough to allow complete
filling of the ventricles before the next contraction.

For the ventricles, the two major phases of the cardiac cycle are:

• The diastole; a period of ventricular relaxation in which the ventricles fill with
blood and it last for about 0.5 second.

• The systole; a period of ventricular contraction and blood ejection, lasting

about 0.3 second.

Phases of the cardiac cycle:

The cardiac cycle starts by atrial systole followed by ventricular systole then by
diastole of the whole heart.

Atrial systole (atria as a pump):

It is the first phase of cardiac cycle. Blood normally flows continually (passively)
from the veins into the atria and about 75% of the blood in the atria flow directly into
the ventricles even before the atrial contraction. Then, atrial contraction usually
causes an additional 25% filling of the ventricles. So the heart can continue to operate
satisfactorily under most condition without this extra 25%, yet this 25% is needed in
case of exercise.

Ventricular cardiac cycle

The ventricular cardiac cycle consists of three phases:

• Phase one: Ventricular filling.

• Phase two: Ventricular systole.

• Phase three: Isovolumic, isometric relaxation.

25
Ventricular filling

During ventricular systole, the accumulated large amounts of blood in the atria
because of the closed AV valves push the AV valves open and allow blood to flow
rapidly into the ventricles. During atrial contraction, an additional amount of blood
flows into the ventricles represent 25% of the filling of the ventricles.

Ventricular systole:

Subdivided into two phases:

• Isovolumic, isometric contraction (is volumetric contraction).

• Ventricular ejection.

Is volumetric contraction

It is ventricular contraction but without blood ejection (no emptying) just to close the
AV valves and to open semi lunar valves by the rise in intraventricular pressure (from
0 to 80 mmHg in the left ventricle). It is the is volumetric contraction, which means
only the tension is increasing in the ventricular muscle without shortening of the
muscle and with no change in blood volume

Ventricular ejection

The blood ejected from the ventricles into pulmonary trunk and aorta when
the ventricular pressure rises and forces the semi lunar valves open.

Left ventricular pressure rises above 80 mmHg.

Right ventricular pressure rises above 8 mmHg.

The electrocardiogram (ECG):

The ECG is the recording of the electrical potential of the heart that extend to
the body surface. By placing the electrodes of an ECG instrument on the skin surface,
you can record the waves of depolarization and depolarization that are generated by

26
the cardiac muscle. The apparatus used is called the electrocardiograph; it is formed
basically of a sensitive galvanometer and an amplifier.

A standard ECG consists of 12 leads:

• 3 Bipolar standard limb leads (I, II, III).

• 3 unipolar limb leads (AVER, AVL, AVF).

• 6 unipolar chest leads.

27
Cardiac arrhythmia

1- Abnormal rhythm city of the pacemaker.

2- Shift of the pacemaker from the sinus node to other parts of the heart.

3- Blocks at different points in the transmission of the impulse through the heart.

4- Abnormal pathways of impulse transmission through the heart.

5- Spontaneous generation of abnormal impulses in almost any part of the heart.

Tachycardia

The term "tachycardia" means fast heart rate, usually defined as faster than 100 beats
per minute. The electrocardiogram is normal except that the rate of heartbeat is
increased. The general causes of tachycardia are:

• increased body temperature,

• Stimulation of the heart by the sympathetic nerves.

Bradycardia

The term "bradycardia" means a slow heart rate, usually defined as less than 60 beats
per minute. Examples:

• Bradycardia in Athletes.

Cardiac output

Cardiac output is the amount of blood pumped by each ventricle per minute,
expressed in liters/minute. Normally, it is about 5 liters per minute.

The cardiac output (CO) is determined through multiplying the heart rate (HR) by the
stroke volume (SV).

CO = HR X SV

Heart rate = the number of heart beats/minute (aveage; 72 beat/minute).

28
Stroke volume = the volume of blood ejected by each ventricle with each beat.

If the HR = 72 beats/min., and the SV is of 70 ml;

Cardiac output = 72 X 70 = 5.04 Liters.

cardiac output= arterial blood flow = pulmonary blood flow.

Control of cardiac output:

The cardiac output is controlled (either increased or decreased or maintained) by the

following factors.

• Venous return (preload).

• Heart rate (HR)

• Myocardial contractility.

• Cardiac compliance.

• Afterload.

1.4 THE NERVOUS SYSTEM

The general function of the nervous system is to coordinate all body systems! This is
accomplished by the transmission of (electrochemical) signals from body parts to the
brain and back to the body parts.

A. The organs of the nervous system are divided into two major groups:

29
1. Central Nervous System (CNS) = brain & spinal cord

2. Peripheral Nervous System (PNS) = nerves that extend from the brain
(cranial nerves) and spinal cord (spinal nerves)

B. Three Major Functions

1. Sensory Input Function

a. PNS;

b. Sensory receptors (located at the ends of peripheral neurons) detect changes

(i.e. are stimulated) occurring in their surroundings;

c. Once stimulated, sensory receptors transmit a sensory impulse to the CNS.

d. A sensory impulse is carried on a sensory neuron.

2. Integrative Function

a. CNS (brain and/or spinal cord);

b. involves interpretation of an incoming sensory impulse (i.e. decision is made

concerning what's going to happen next, based on sensory impulse).

c. Integration occurs in interneuron's.

d. A motor impulse begins...

3. Motor Function

a. PNS;

b. involves the response of a body part;

c. Motor impulses are carried from CNS to responsive body parts called
effectors;

30
d. A motor impulse is carried on a motor neuron;

e. Effectors = 2 types:

o muscles (that contract);

o glands (that secrete a hormon

The nervous system is anatomically divided into two parts, the Central Nervous
System (the brain and the spinal cord) and the Peripheral Nervous System (ganglia,
12 pairs of cranial nerves and 31 of pair’s spinal nerves).

We have been introduced to the concept of homeostasis in physiology, that is,

the maintenance of a stable internal environment. A recurrent theme in physiology is
how homeostasis is maintained by feedback loops, covered in the first section of this
course. As a part of the feedback loop mechanism of control, the Central Nervous
System (CNS) often plays a significant role as the integration center. This gives you
the notion that it is for information processing, analysis and interpretation. The CNS
is responsible for intricate and complex neuronal processing, with each region of the
brain and spinal cord having distinct physiological functions. First, we will consider
some of the general and more specific roles of various areas of the brain. The
functions of the spinal cord are covered in the lab and lab manual. We will then cover
the Peripheral Nervous System (PNS). The PNS can be divided into two parts, the
Somatic Nervous System (SNS) and the Autonomic Nervous System (ANS). The
SNS is responsible for movement of the body (soma = body), and its effector tissue is
skeletal muscle. The ANS is responsible for automated responses that occur in the
body (e.g., heart rate) and the effector tissues are cardiac muscle, smooth muscle and
glands.

31
The Central Nervous System: The Brain

We can divide the brain into six parts in terms of physiological functions:

1. Cerebrum; 2. Hypothalamus; 3. Midbrain; 4. Cerebellum; 5. Pons; and 6.

Medulla oblongata.

1. Cerebrum - This is the most developed area of brain in the human species and is
considered to be the center of the highest functions. The major functions include:
awareness of sensory perception; voluntary control of movement (regulation of
skeletal muscle movement); language; personality traits; sophisticated mental
activities such as thinking, memory, decision making, predictive ability, creativity
and self-consciousness. We will examine 4 lobes of the cerebrum.

The Frontal Lobe - Concerned with higher intellectual functions and is involved in
the many behavioral aspects of humans. It inhibits certain primitive behaviors. The
Primary motor cortex controls the movement of the rest of the body while the
premotor cortex just adjacent to it is concerned with the initiation, activation, and
performance of the actual movement.

The Parietal Lobe - This lobe is primarily concerned with the interpretation and
integration of sensory inputs. The Somatosensory cortex is associated with reception
and perception of touch, vibration, and position sense of the body.

The Temporal Lobe - The temporal lobe contains the auditory cortex - for the
reception and interpretation of sound information, and the olfactory cortex - for the
sense of smell. It also houses the language cortex in the dominant hemisphere
(usually the left hemisphere) and participates in recognition and interpretation of
language.

The Occipital Lobe - This lobe contains the primary visual cortex for visual
information interpretation.

32
Functional Areas of the Cerebral Cortex:

Each cerebral hemisphere is divided into 4 lobes:

1. 1.Frontal Lobe (Primary Motor cortex)

2. 2. Parietal Lobe (Somatosensory:sensory cortex)

3. 3. Temporal Lobe (Auditory)

4. 4. Occipital Lobe ((Visual )

The cerebral cortex is divided into three functional areas: sensory, association and
motor.

Degenerative conditions in specific regions can cause problems in fine motor control.
Parkinson's disease is characterize by slow jerky movements; tremors of the face
and hands; muscle rigidity; and great difficulty initiating voluntary movements. In
Parkinson's disease, an overactive region acts like a stuck brake, continuously
inhibiting the motor cortex. The disease results from the degeneration of a region
called the substantial Ingra, in particular dompaminergic neurons (those using the
neurotransmitter dopamine) in this region. Huntington's disease involves an over
stimulation of motor activities, such that limbs jerk uncontrollably.

The Limbic system is a group of structures on the medial aspect of each hemisphere
and diencephalon and is more a functional system than an anatomical one. The limbic
system is the "emotional brain", participating in the creation of emotional states such
as fear, anger, pleasure, affection, arousal, etc. and processing vivid memories
associated with those states. For example, the amygdale is central for processing fear
and stimulates a sympathetic response. The amygdale enables us to recognize
menacing facial expressions in others and to detect the precise gaze of someone who
is looking at us.

33
Cerebral Lateralization

Although anatomically the two hemispheres of the cerebrum look very

similar, functionally the two sides are different. Thus, the term lateralization is used
to denote that each lobe has developed special functions that are not shared by other
lobes. In general:

Left side: Language, logic, analytical, sequential, verbal tasks, (holistic information
processing).

"Thinkers"

Right side: Spatial perception, artistic and musical endeavors (fragmentary

information processing)."Creators"

Specific examples are most obvious in the function of speech and word
recognition. For example, the primary cortical areas for language are Boca's area and
Weenie's area. The Boca's area (in the left frontal lobe) is responsible for speaking
ability, the mechanics of skeletal muscle control for verbal articulation (sound
production). Warnock's area (in the left juncture of parietal, temporal and occipital
lobes) is concerned with language comprehension, that is, understanding the words
that are read or heard. These exist on the left hemisphere only if you are left-brain
dominant - as most people who are right handed are. There functional areas on the
right side are different. For example, the emotional aspect of language is controlled in
the opposite hemispheres. Opposite Boca's area is the affective language area, which
gives intonation to words, in order to modify their meaning. The area opposite
Warnock's is concerned with recognizing the emotion content of another person's
speech. Think of someone saying "Oh great" with true excitement versus "Oh great"
with complete sarcasm! Same words, different meanings.

Language disorders caused by damage to specific cortical areas are known as

aphasias. Most aphasias are caused by strokes. A stroke can be defined as a
"cardiovascular accident", this occurs when a blood vessel in the brain (a cerebral
blood vessel) ruptures or is blocked by a clot. The result is that the region of the brain

34
being supplied by that vessel is deprived of the O2 and glucose that neurons require
constantly in order to function. Damage of the affected area can result.

2. Epithalamiums, Thalamus and Hypothalamus

The epithalamiums contains the pineal gland, a hormone secreting endocrine

structure. Under the influence of the hypothalamus, the pineal gland secretes the
hormone melatonin, which prepares the body for the night-time stage of the
sleep/wake cycle. The thalamus makes up about 80% of the diencephalon and is the
main relay center for the various sensory and motor functions.

The Hypothalamus controls and regulates many important functions of the body,
including:

1) Control of the Autonomic Nervous System - adjusts, coordinates, and integrates

the A.N.S. centers in the brain that regulate heart rate, blood pressure, bronchiole
diameter, sweat glands, G.I. tract activity, etc. It does this via the Parasympathetic
and Sympathetic divisions of the A.N.S.

2) Control of Emotional Responses - in association with the limbic system, it forms

part of the emotional brain. Regions involved in fear, pleasure, rage and sex drive are
located in the hypothalamus.

3) Regulation of Body Temperature - the body's thermostat and set point is located
in the hypothalamus. There are also 2 centers in the hypothalamus that respond to
changes in the set point.

Heat-losing center: activation of this center causes sweating and coetaneous

vasodilatation.

Heat-promoting center: activation of this center causes shivering and coetaneous

vasoconstriction.

4) Regulation of Hunger and Thirst Sensations - hypothalamus contains the

feeding and thirst centers.

35
 Feeding center: this center is always active and stimulates hunger which is
'fed' by eating.

Satiety center: stimulated when satisfied, this inhibits the always hungry
feeding center.

Thirst center: osmoreceptors detect changes in osmotic pressure of blood,

ECF, stimulate thirst.

5) Control of the Endocrine System - controls the release of pituitary hormones.

Controls the anterior pituitary gland, when the hypothalamus releases hormones, it
can stimulate or inhibit the release of other hormones form the pituitary (6 hormones).
Also, it makes the 2 hormones (oxytocin and ant diuretic hormone (ADH)) that are
stored in the posterior pituitary and released when signaled. All of these hormones
regulate many other organs in the body

3. Midbrain Portions receive visual input auditory input from the medulla oblongata
and are involved in cranial reflexes, e.g., when you turn your head if you thought you
heard your name called out.

4. Cerebellum - Means ‘little brain’. The Cerebellum has two primary functions:

1) Controls postural reflexes of muscles in body - i.e., it coordinates rapid, automatic

adjustments to maintain equilibrium, e.g. regaining your balance when you start to
fall.

2) Produces skilled movements - involved in implementing routines for fine tuned

movements. Controlled at the conscious and subconscious level, refines learned
routines (e.g. driving, skating, playing an instrument) until the action becomes
routine. This then reduces the need for conscious attention to the task. The cerebellum
gets incoming information from proprioceptors, a type of sensory receptor found in
movable joints, tendons and muscle tissue. Using the information from proprioceptors
in the body, the cerebellum can determine the relative position of various body parts
and compares motor commands and intended movements with the actual position of

36
the body part (legs, arms). In this way, it can perform any adjustments needed to
changes the direction or make the movement (action) smooth and coordinated.

5. Pons - Plays a role in the regulation of the respiratory system. Contains two
‘pentane’ respiratory centers: 1) the pneumotaxic center and 2) the apneustic center.
These two centers will be discussed later in the respiratory system. The pones is not
responsible for the rhythm of breathing (the medulla oblongata is) but controls the
changes in depth of breathing and the fine tuning of the rhythm of breathing set by the
medulla oblongata. The Pons also prevents over inflation of the lungs.

6. Medulla Oblongata

The medulla oblongata is the last division of the brain. It becomes continuous with
the spinal cord. It houses some very important visceral or vital centers, 1) the cardiac
center - adjusts the force and rate of the heartbeat; 2) the vasomotor center -
regulates the diameter of blood vessels and therefore systemic blood pressure
(constriction increases and dilation decrease blood pressure); and 3) the respiratory
center - for control of the basic rhythm and rate of breathing. Additional centers
regulate sneezing, coughing, hiccupping, swallowing and vomiting.

Spinal Cord

The physiology of the spinal cord will be covered in the lab component of this
physiology course. The basic structure of the spinal cord is that it is the downward
continuation of medulla oblongata starting at the foramen magnum. It descends to
about the level of the second lumbar vertebra, tapering to a structure called the cones
medullar is.

The cord projects 31 pairs of spinal nerves on either side (8 cervical, 12

thoracic, 5 lumbar, 5 sacral and 1 coccygeal) that are connected to the peripheral
nerves. A cross section of the spinal cord exhibits the butterfly-shaped gray matter in
the middle, surrounded by white matter. As in the cerebrum, the gray matter is
composed of nerve cell bodies. The white matter consists of various ascending and
descending tracts of militated axon fibers with specific functions.

37
 The spinal cord serves as a passageway for the ascending (going up) and
descending (going down) fiber tracts that connect the peripheral and spinal nerves
with the brain. Each of the 31 spinal segments is associated with a pair of dorsal root
ganglia. These contain sensory nerve cell bodies. The axons from these sensory
neurons enter the posterior aspect of the spinal cord via the dorsal root. The axons
from somatic and visceral motor neurons leave the anterior aspect of the spinal cord
via the ventral roots. Distal to each dorsal root ganglion the sensory and motor fibers
combine to form a spinal nerve - these nerves are classified as mixed nerves because
they contain both afferent (sensory) and efferent (motor) fibers.

The Cranial and Spinal Meanings

The delicate neural tissue of the brain and spinal cord is not only protected by
the bones of the skull and vertebral column but also by layers of specialized
membranes, called cranial and spinal meanings. Listed below are the 3 layers (from
outer most to inner most) and the spaces they create. Bone; Epidural space; Dura
mater; Subdural space; Arachnoids layer; Subarachnoid space; Pia mater and Nervous
tissue.

Cerebrospinal Fluid

Cerebrospinal fluid (CSF) flows within the ventricles of the brain, the central canal of
the spinal cord and out to the subarachnoid spaces surrounding the brain and spinal
cord. It serves as a medium for the transfer of substances between the blood and the
nervous tissues as well as a liquid buffer, absorbing mechanical shocks to the brain or
the cord. Most of CSF is provided by the choroid plexuses that reside in lateral, third
and fourth ventricles. In adults, the total volume of this fluid has been calculated to be
from 125 to 150 ml (4-5 oz). It is continuously formed, circulated and absorbed.
Approximately 450 ml (nearly 2 cups) of CSF are produced every day, or 0.35 ml per
minute in adults and 0.15 per minute in infants.

The CSF circulates throughout the base of the brain, down around the spinal cord as
well as upward over the cerebral hemispheres. The CSF is then absorbed primarily

38
through arachnoids villa into the superior sagittal sinus and re-joins the blood
circulation.

The obstruction of the normal CSF flow or overproduction of CSF from a choroid
plexus papilloma (a benign tumor of the choroid plexus) can lead to a condition
known as hydrocephalus - an excessive accumulation of CSF in the ventricles or in
the subarachnoid space. In newborns it results in an enlarged cranium, as the young
skull bones are not yet fused and the infant cranial cavity can expand. In adults,
however, it is typically accompanied by serious increase in intracranial pressure
(ICP).

Increased Intracranial Pressure

The normal values for intracranial pressure (ICP) are approximately 90-210 mm
Hg in adults and 15-80 mm Hg in infants

The Peripheral Nervous System

The central nervous system is connected to the peripheral nervous system by nerves.
The PNS can be viewed as an extension of the CNS, connected to it by sensory and
motor neurons and ganglion. The PNS can be divided into two parts, the Somatic
Nervous System (SNS) and the Autonomic Nervous System (ANS). The SNS is
responsible for movement of the body (soma = body), and its effector tissue is
skeletal muscle. The ANS is responsible for automated responses that occur in the
body (e.g., heart rate, blood pressure) and the effectors tissues are cardiac muscle,
smooth muscle and glands.

The Somatic Nervous System

The somatic nervous system is for the control of the skeletal muscle of the
body, so essentially this means it controls body movement. For the most part this is
voluntary, that is, it is under conscious control, you ‘think’ about it first. In fact, the
main region of the central nervous system that sends signals out to the SNS is located
in the frontal lobe (the precentral sulks). As we know from earlier, this is located in
the cerebrum, which is the seat of the conscious mind.
39
The Autonomic Nervous System

Parasympathetic Stimulation Sympathetic Stimulation

Thoracolumbar origin
Craniofacial origin

Effectors Tissue ACH acting on muscarinic NE acting on α and β receptors

receptors

Heart Heart rate decreased Heart rate and force increased

Lung Bronchioles Bronchial constriction Bronchial dilation

Iris (eye muscle) Pupil constriction Pupil dilation

Salivary Glands Saliva production increased Saliva production reduced

(watery increased) (mucus increased)

G. I. Tract Activity Secretions increased Secretions reduced

Motility increased Motility reduced

Liver No effect Increased conversion of glycogen

to glucose

Kidney Increased urine secretion Decreased urine secretion

40
Adrenal Medulla No effect Nor epinephrine and epinephrine
secreted
(Adrenal gland)

Arterioles and veins No effect Vasoconstriction - α receptors

Vasodilatation - β receptors

Bladder Wall contracted Wall relaxed

Sphincter relaxed Sphincter closed

EXTERNAL FEMALE ANATOMY

Vulva: the general term to describe all the external female sex organs.

Pudendum or Pubes: the area in the body where the sex organs are located.

Mons Pubis: a mound of fatty tissue which covers the pubic bone. At puberty this
area is covered with coarse pubic hair. The mons contains many touch sensitive
receptors.

Labia Majora: (large lips) two folds of skin running from the mons pubis to below
the vagianlopening. The labia majora meet and fold together forming protection for
the genitals. The labia majora are covered with pubic hair and contain many touch
sensitive receptors.

Labia Minora: two smaller folds of tissue which lie just within the labia majora.
The labia minora join at the top, forming a hood over the clitoris. The labia minora
are without hair and are rich in touch receptors and blood vessels.

Clitoris: the center of sexual sensation and stimulation in the female. It is composed
of erectiletissues and many sensitive nerve endings. It is found where the folds of the
labia minora meet in the front.

Urethra: below the clitoris, the opening to the bladder.

41
INTERNAL ORGANS

Hymen: a thin ring of tissue covering the opening to the vagina. It is the dividing
line between external and internal sex organs. It has been over emphasized as a sign
of virginity.

Vagina: female organ of intercourse, it is actually an empty passageway leading from

the vaginalopening to the uterus. It is only 3-4 inches long and shaped like a flattened
funnel. The vaginal walls are made of many small folds of membrane that stretch
greatly to accommodate a baby during birth. The vagina has three main functions: 1-
channel for the menstrual flow, 2- receptacle for the male penis during intercourse, 3-
birth canal.

Cervix: the neck or opening of the uterus. A normal healthy cervix is the strongest
muscle in the body. It dips down about half an inch into the vagina. It is normally
plugged by mucus. It stays tightly closed during pregnancy, but thins and opens for
the delivery of the baby.

Urethra: the uterus is a hollow, muscular organ shaped somewhat like an upside-
down pear, about three inches long and two inches wide. This uterus is lined with
endometrium. The uterus has one main function – to protect and nourish a fetus until
it is ready to live outside the mother’s body. The walls of the uterus stretch much like
a balloon that is blown up. After childbirth the uterus shrinks back to the original
shape in 6-8 weeks.

Oviducts (Fallopian Tubes): two tubes shaped like arched and twisting bridges,
high on eitherside of the uterus. They are about four inches long and 3/16 inch in
diameter (the size of cooked spaghetti). The oviducts carry egg cells toward the
uterus and sperm cells toward the egg cell. They are the location for fertilization.
Fertilization takes place in the outer third of the oviduct. The oviducts are funnel
shaped and near the ovary. They have finger-like projections that reach out and
encircle the ovum after ovulation takes place. Each oviduct is lined with many hair
like fibers called cilia. The cilia beat a blowing motion toward the uterus. This
motion carries the egg cell toward the uterus.
42
Ovaries: two solid egg-shaped structures about the size of peach pits. They are
attached to the uterus by ligaments. They are the counterpart of the male testicles.
They have two main functions: 1-produce female sex hormones ESTROGEN and
PROGESTERONE. Estrogen is responsible for the secondary sex characteristics and
the sex drive in females. It spurs the onset of puberty and is responsible for
OVULATION. Progesterone builds up the lining of the uterus called the
endometrium in preparation for the fertilized ovum, 2- stores and releases the ova or
female egg cell. The female baby is born with all the ova she will ever have (about
200,000 in each ovary). Some of the ova disappear; others are dormant until each is
ripened and released after puberty. Nature is very generous since only about 50,000
ova survive at adolescence and about 400 will never ripen to become available for
fertilization. After menopause the remaining ova no longer ripen or develop.

OTHER RELATED CONCERNS

D&C: Dilation and curettage, a common minor operation on women. The canal of
the uterus is dilated and the lining of the uterus is scraped with a spoon-shaped
instrument called a curet.

Endometriosis: presence in abnormal locations of fragments of the membrane which

lines the uterus (endometrium). The displaced tissue menstruates where it should not
and tends to form cysts. No one knows for sure why some women have
endometriosis. Some experts think it is caused by retrograde menstruation which
means the menstrual fluid backs up through the fallopian tubes and spills out onto the
pelvic organs. Others think that stray endometrial cells are in the pelvic cavity from
birth. For more information, contact your hospital education department.

Orgasm: Orgasm is characterized by the massive release of muscle tension which

has built up during excitement. It is series of rhythmic contractions in the vagina and
uterus. This relese is accompanied by very pleasurable sensations.

Dysmenorrhea: painful menstruation. Symptoms include breast tenderness,

irritability, cramping, nausea, and fluid retention. Dysmenorrheal results from high
levels of hormone-like substances in the blood that cause painful contractions in the
43
uterine lining. These contractions may be relieved by exercise and relaxation
techniques. Sometimes a warm bath may help. Aspirin and stronger prescription
medications help to relieve dysmenorrheal.

Hysterectomy: surgical removal of the uterus, either through an abdominal incision,

or through the vagina, which leaves no abdominal scar.

Tubal Ligation: an operation for sterilization of women. The surgeon makes a

small incision in the abdomen and cuts and ties the oviducts. This prevents the
meeting of the sperm and egg and makes conception capacity; the ovaries continue to
produce hormones. The operation should not be undertaken unless permanent
sterility is desired.

PMS (Premenstrual Syndrome): a syndrome whose symptoms may become

incapacitating: emotions get out of control, headaches, water retention, irritability,
and painful uteral cramps. Between ovulation and menstruation try exercising
vigorously, increasing protein in the diet, or taking a Vitamin B6 (50-100 mg.)
supplement, 1-2 times daily.

Toxic Shock Syndrome: caused by bacteria that live in the vagina, which multiply
and causes infection. Toxic Shock if often fatal; symptoms are diarrhea, high fever,
and low blood pressure. Methods of prevention: do not wear tampons all night (use a
pad instead), change tampons often, do not use super-absorbent tampons. A man can
get toxic shock from the heavy packing of a wound or sore (after a severe nosebleed
or major injury), if the packing is not changed often enough. Careful cleaning and
proper care of a wound is vital.

Menopause: around the age of 45-55, the menstrual cycle stops. A woman is no
longer capable of getting pregnant. The associated hormonal changes will cause
come transient physical and emotional changes.

44
Time Line:

Ages 9-12 Secondary sex characteristics appear

Ages 11-14 Menstrual cycle begins

Late 20-30’s Peak sexual urges

Ages 45-55 menopause (cycle stops, but sex urge continues)

THE MENSTRUAL CYCLE

The start of the menstrual cycle will occur after the beginning of puberty,
approximately ages 8-13. During the menstrual cycle, one ovary produces a mature
egg cell, the lining of the uterus prepares for a fertilized egg, and the lining breaks
down if an egg is not fertilized. The first menstrual cycle is called MENARCHE.

The menstrual cycle does not start in the sex organ, but in the brain. During the first
phase of the cycle the pituitary gland secretes FSH (Follicle Stimulating Hormone).
FSH stimulates the follicle or egg nest in the ovary to produce estrogen. Estrogen
stimulates the uterus to prepare for the egg. The follicle also produces a maturing egg
cell. As the egg cell matures it moves to the surface of the ovary and is released.
This process is called OVULATION. The mature egg moves through the fallopian
tube to the uterus. After ovulation the part of the follicle left in the ovary changes and
forms a temporary endocrine gland called the corpus luteum. The second phase of
the menstrual cycle is after ovulation. A second pituitary hormone LSH (Lutein
Stimulating Hormone) stimulates the corpus luteum to produce the hormone
progesterone. This hormone stimulates the lining of the uterus (endometrium) to
build up or thicken. The uterus is now ready to support a fertilized egg. If
fertilization takes place the corpus luteum continues to produce progesterone during
pregnancy.

If fertilization does not take place, the corpus luteum breaks down and
progesterone production ceases. Cells in the endometrium die, the lining is shed and
the dead tissue and the unfertilized egg passes out of the body through the vagina.

45
The release of this tissue and blood is called the menstrual flow or
MENSTRUATION. Menstruation occurs each month about two weeks after
ovulation and usually lasts three to seven days. During this time, about two ounces of
blood may be last. Every females’ cycle is different as to the length of time between
menstruation and how long the menstrual flow will last.

The menstrual cycle normally continue until a woman is in her 40s or 50s. as
the function of the ovaries decrease with age, menstrual cycles become irregular and
eventually cease. This is called MENOPAUSE.

1.5 Muscular skeletal:

The Muscular System

muscle is a specialized connective tissue and attach all bones in our body its start
from origin to insertion it is called as muscular system.

Muscle Tissue

Types of muscle tissue:

1. Skeletal muscle—also called striated or voluntary muscle
a. Is 40–50% of body weight (“red meat” attached to bones)
b. Microscope reveals cross-stripes or striations
c. Contractions can be voluntarily controlled
d. Each skeletal muscle is an organ composed mainly of skeletal muscle cells and
connective tissue
e. Muscles attach to bone by tendons
2. Cardiac muscle—composes bulk of heart
a. Cardiac muscle cells branch frequently
b. Characterized by unique dark bands called intercalated disks
c. Interconnected nature of cardiac muscle cells allows heart to contract efficiently as
a unit
3. Nonstriated muscle or involuntary muscle—also called smooth or visceral muscle
a. Lacks cross-stripes or striations when seen under a microscope; appears smooth

46
b. Found in walls of hollow visceral structures such as digestive tract, blood vessels,
and ureters
c. Contractions not under voluntary control; movement caused by contraction is
involuntary
B. Function—all muscle cells specialize in contraction (shortening)

STRUCTURE OF SKELETAL MUSCLE

A. Structure
1. Each skeletal muscle is an organ composed mainly of skeletal muscle cells and
connective tissue
2. Most skeletal muscles extend from one bone across a joint to another bone
3. Parts of a skeletal muscle
a. Origin—attachment to the bone that remains relatively stationary or fixed when
movement at the joint occurs
b. Insertion—point of attachment to the bone that moves when a muscle contracts
c. Body—main part of the muscle
4. Muscles attach to bone by tendons—strong cords of fibrous connective tissue;
some tendons enclosed in synovial-lined tubes and are lubricated by synovial fluid;
tubes called tendon sheaths
5. Bursae—small synovial-lined sacs containing a small amount of synovial fluid;
located between some tendons and underlying bones
B. Microscopic structure
1. Contractile cells called fibers—grouped into bundles
2. Fibers contain thick myofilaments (containing protein myosin) and thin
myofilaments (composed of actin)
3. Basic functional (contractile) unit called sarcomere—sarcomeres separated from
each other by dark bands called Z-lines
a. Sliding filament model explains mechanism of contraction
(1) Thick and thin myofilaments slide past each other as a muscle contracts
(2) Contraction requires calcium and energy-rich ATP molecules

47
TYPES OF MOVEMENTS PRODUCED BY SKELETAL MUSCLE
CONTRACTIONS

Flexion—movement that decreases the angle between two bones at their joint:
bending
B. Extension—movement that increases the angle between two bones at their joint:
straightening
C. Abduction—movement of a part away from the midline of the body
D. Adduction—movement of a part toward the midline of the body
E. Rotation—movement around a longitudinal axis
F. Supination and pronation—hand positions that result from rotation of the forearm;
supination results in a hand position with the palm turned to the anterior position;
pronation occurs when the palm faces posteriorly
G. Dorsiflexion and plantar flexion—ankle movements; dorsiflexion results in
elevation of the dorsum or top of the foot; during plantar flexion, the bottom of the
foot is directed downward

A major overall function of the skeletal system is support and protection of the body’s
internal organs. Bones make movement possible, store substances such as lipids and
calcium, and are the site for hemopoiesis (red cell formation) in red bone marrow.

Functions of the Skeletal System

The following functions are performed by the skeletal system:

a. Support—The skeletal system is a bony framework that supports tissues and
organs.
b. Protection—It encases delicate organs.
c. Movement—Muscles are anchored to bones and, as they contract, they pull on and
move bones.
d. Storage—Bones maintain homeostasis of blood calcium. When the amount of
calcium in blood increases to above normal, calcium moves out of blood and into
bones for storage. When blood calcium decreases to below normal, it comes out of

48
storage and enters the blood.
e. Hemopoiesis—Red bone marrow makes blood cells.

TYPES OF BONES

A. Long—example: humerus (upper arm)

B. Short—example: carpals (wrist)
C. Flat—example: frontal (skull)
D. Irregular—example: vertebrae (spinal cord)

STRUCTURE OF LONG BONES

A. Structural components
1. Diaphysis or shaft; a hollow tube made of compact bone
2. Medullary cavity; the hollow area inside the diaphysis that contains soft yellow
bone marrow
3. Epiphyses or ends of the bone; spongy bone contains red bone marrow
4. Articular cartilage; covers epiphyses as a cushion; thin layer of cartilage covering
each epiphysis; acts as a cushion between joint surfaces
5. Periosteum; strong membrane covering bone except at joint surfaces; a strong,
fibrous membrane that covers a long bone everywhere except at its joint surfaces
6. Endosteum; lines medullary cavity

MICROSCOPIC STRUCTURE OF BONE AND CARTILAGE

A. Bone types
1. Spongy
a. Texture results from needlelike threads of bone called trabeculae surrounded by a
network of open spaces
b. Found in epiphyses of bones
c. Spaces contain red bone marrow
2. Compact
a. Structural unit is haversian system—composed of concentric lamella, lacunae
containing osteocytes, and canaliculi, all covered by periosteum

49
B. Cartilage
1. Cell type called chondrocyte
2. Matrix is gel-like and lacks blood vessels

BONE FORMATION AND GROWTH

A. Sequence of development early—cartilage models replaced by calcified bone

matrix
B. Osteoblasts form new bone, and osteoclasts resorb bone

DIVISIONS OF THE SKELETON

Skeleton composed of the following divisions and their subdivisions:

A. Axial skeleton
1. Skull
2. Spine
3. Thorax
4. Hyoid bone
B. Appendicular skeleton
1. Upper extremities, including shoulder girdle
2. Lower extremities, including hip girdle

DIFFERENCES BETWEEN A MAN’S AND A WOMAN’S SKELETON

A. Size—male skeleton generally larger

B. Shape of pelvis—male pelvis deep and narrow; female pelvis broad and shallow
C. Size of pelvic inlet—female pelvic inlet generally wider; normally large enough
for baby’s head to pass through it
D. Pubic angle—angle between pubic bones of female generally wider

JOINTS (ARTICULATIONS)

A. Kinds of joints
1. Synarthroses (no movement)—fibrous connective tissue grows between
articulating bones; for example, sutures of skull

50
2. Amphiarthroses (slight movement)—cartilage connects articulating bones; for
example, symphysis pubis
3. Diarthroses (free movement)—most joints belong to this class
a. Structures of freely movable joints—joint capsule and ligaments hold adjoining
bones together but permit movement at joint
b. Articular cartilage—covers joint ends of bones and absorbs jolts
c. Synovial membrane—lines joint capsule and secretes lubricating fluid
d. Joint cavity—space between joint ends of bones
B. Types of freely movable joints—ball-and-socket, hinge, pivot, saddle, gliding, and
condyloid

1.3. REPRODUCTIVE SYSTEM:

COMMON STRUCTURAL AND FUNCTIONAL CHARACTERISTICS

BETWEEN THE SEXES

A. Common general structure and function can be identified between the systems in
both sexes
B. Systems adapted for development of sperm or ova followed by successful
fertilization, development, and birth of offspring
C. Sex hormones in both sexes important in development of secondary sexual
characteristics and normal reproductive system activity

MALE REPRODUCTIVE SYSTEM

A. Structural plan—organs classified as essential or accessory

1. Essential organs of reproduction are the gonads (testes), which produce sex cells
(sperm)
2. Accessory organs of reproduction
a. Ducts—passageways that carry sperm from testes to exterior
b. Sex glands—produce protective and nutrient solution for sperm
c. External genitals
B. Testes—the gonads of men
1. Structure and location
51
a. Testes in scrotum—lower temperature
b. Covered by tunica albuginea, which divides testis into lobules containing
seminiferous tubules
c. Interstitial cells produce testosterone
2. Functions
a. Spermatogenesis is process of sperm production
(1) Sperm precursor cells called spermatogonia
(2) Meiosis produces primary spermatocyte, which forms four spermatids with 23
chromosomes
(3) Spermatozoa—highly specialized cell
(a) Head contains genetic material
(b) Acrosome contains enzymes to assist sperm in penetration of ovum
(c) Mitochondria provide energy for movement
b. Production of testosterone by interstitial cells
(1) Testosterone “masculinizes” and promotes development of male accessory organs
(2) Stimulates protein anabolism and development of muscle strength
C. Reproductive ducts—ducts through which sperm pass after exiting testes until they
exit from the body
1. Epididymis—single coiled tube about 6 m in length; lies along the top and behind
the testis in the scrotum
a. Sperm mature and develop the capacity for motility as they pass through
epididymis
2. Ductus (vas) deferens—receives sperm from the epididymis and transports them
from scrotal sac through the abdominal cavity
a. Passes through inguinal canal
b. Joins duct of seminal vesicle to form the ejaculatory duct
D. Accessory or supportive sex glands—semen: mixture of sperm and secretions of
accessory sex glands. Averages 3–5 ml per ejaculation, with each milliliter containing
about 100 million sperm
1. Seminal vesicles
a. Pouchlike glands that produce about 60% of seminal fluid volume

52
b. Secretion is yellowish, thick, and rich in fructose to provide energy needed by
sperm for motility
2. Prostate gland
a. Shaped like a doughnut and located below bladder
b. Urethra passes through the gland
c. Secretion represents 30% of seminal fluid volume—is thin and milk-colored
d. Activates sperm and is needed for ongoing sperm motility
3. Bulbourethral (Cowper’s) glands
a. Resemble peas in size and shape
b. Secrete mucuslike fluid constituting less than 5% of seminal fluid volume
E. External genitals
1. Penis and scrotum called genitalia
2. Penis has three columns of erectile tissue—two dorsal columns called corpora
cavernosa and one ventral column surrounding urethra called corpus spongiosum
3. Glans penis covered by foreskin
4. Surgical removal of foreskin called circumcision

FEMALE REPRODUCTIVE SYSTEM

A. Structural plan—organs classified as essential or accessory

1. Essential organs are gonads (ovaries), which produce sex cells (ova)
2. Accessory organs of reproduction
a. Ducts or modified ducts—including oviducts, uterus, and vagina
b. Sex glands—including those in the breasts
c. External genitals
B. Ovaries
1. Structure and location
a. Paired glands weighing about 3 g each
b. Resemble large almonds
c. Attached to ligaments in pelvic cavity on each side of uterus
d. Microscopic structure
(1) Ovarian follicles—contain oocyte, which is immature sex cell (about 1 million at

53
birth)
(2) Primary follicles—about 400,000 at puberty are covered with granulosa cells
(3) About 350–500 mature follicles ovulate during the reproductive lifetime of most
women—sometimes called graafian follicles
(4) Secondary follicles have hollow chamber called antrum
(5) Corpus luteum forms after ovulation
2. Functions
a. Oogenesis—meiotic cell division that produces daughter cells with equal
chromosome numbers (23) but unequal cytoplasm: Ovum is large; polar bodies are
small and degenerate
b. Production of estrogen and progesterone
(1) Granulosa cells surrounding the oocyte in the mature and growing follicles
produce estrogen
(2) Corpus luteum produces progesterone
(3) Estrogen causes development and maintenance of secondary sex characteristics
(4) Progesterone stimulates secretory activity of uterine epithelium and assists
estrogen in initiating menses
C. Reproductive ducts
1. Uterine (fallopian) tubes
a. Extend about 10 cm from uterus into abdominal cavity
b. Expanded distal end surrounded by fimbriae
c. Mucosal lining of tube is directly continuous with lining of abdominal cavity
2. Uterus—composed of body, fundus, and cervix
a. Lies in pelvic cavity just behind urinary bladder
b. Myometrium is muscle layer
c. Endometrium lost in menstruation
d. Menopause—end of repetitive menstrual cycles (about 45 years of age)
3. Vagina
a. Distensible tube about 10 cm long
b. Located between urinary bladder and rectum in the pelvis
c. Receives penis during sexual intercourse and is birth canal for normal delivery of

54
baby at termination of pregnancy
D. Accessory or supportive sex glands
1. Bartholin’s (greater vestibular) glands
a. Secrete mucuslike lubricating fluid
b. Ducts open between labia minora
2. Breasts
a. Located over pectoral muscles of thorax
b. Size determined by fat quantity more than amount of glandular (milk-secreting)
tissue
c. Lactiferous ducts drain at nipple, which is surrounded by pigmented areola
d. Lymphatic drainage important in spread of cancer cells to other body areas
E. External genitals
1. Include mons pubis, clitoris, orifice of urethra, Bartholin’s gland, vagina, labia
minora and majora, and hymen
2. Perineum—area between vaginal opening and anus
a. Surgical cut during birth called episiotomy
F. Menstrual cycle—involves many changes in the uterus, ovaries, vagina, and
breasts
1. Length—about 28 days, varies from month to month in individuals and in the same
individual
2. Phases
a. Menses—about the first 4 or 5 days of the cycle, varies somewhat; characterized by
sloughing of bits of endometrium (uterine lining) with bleeding
b. Proliferative phase—days between the end of menses and secretory phase; varies in
length; the shorter the cycle, the shorter the proliferative phase; the longer the cycle,
the longer the proliferative phase; examples: in 28-day cycle, proliferative phase ends
on day 13, but in 26-day cycle, it ends on the 11th day and in 32-day cycle, it ends on
day 17; characterized by repair of endometrium
c. Secretory phase—days between ovulation and beginning of next menses; secretory
about 14 days before next menses; characterized by further thickening of
endometrium and secretion by its glands in preparation for implantation of fertilized

55
ovum; combined actions of the anterior pituitary hormones FSH and LH cause
ovulation; sudden sharp decrease in estrogens and progesterone bring on menstruation
if pregnancy does not occur.

SUMMARY OF MALE AND FEMALE REPRODUCTIVE SYSTEMS

A. In men and women, the organs of the reproductive system are adapted for the
specific sequence of functions that permit development of sperm or ova followed by
the successful fertilization and then the normal development and birth of offspring
B. The male organs produce, store, and ultimately introduce mature sperm into the
female reproductive tract
C. The female system produces ova, receives the sperm, and permits fertilization
followed by fetal development and birth, with lactation afterward
D. Production of sex hormones is required for development of secondary sex
characteristics and for normal reproductive functions in both sexes

Essential organs of the male reproductive system include the following:

a. Testes—produce sperm cells

Accessory organs of the male reproductive system include the following:
a. Epididymis—stores sperm cells
b. Vas deferens—receives sperm from epididymis
c. Ejaculatory duct—receives sperm from vas deferens
d. Urethra—passes sperm to exterior
e. Seminal vesicles—produce alkaline secretions
f. Cowper’s glands—produce alkaline secretions
g. Prostate—produces alkaline secretions
h. Scrotum—contains testes
i. Penis—organ of coitus
Essential organs of the female reproductive system include the following:
a. Ovaries—produce egg cells
Accessory organs of the female reproductive system include the following:

56
a. Uterine tubes—fertilization occurs here; if not fertilized, the egg will disintegrate
here
b. Uterus—holds the baby during pregnancy; sheds its lining if pregnancy does not
occur; and contracts during labor
c. Vagina—the organ through which sperm enter the female body and the organ from
which the baby emerges
d. Bartholdi's glands—secrete mucus like lubricating fluid
e. Breasts—function during lactation
f. External genitals—function to protect

1.6 Reproductive system:

1.INTRODUCTION

All living organisms must reproduce in order to continue their species. Humans
reproduce by sexual reproduction with internal fertilization, where a flagellated sperm
(from the male father) fertilizes an ovum (from the female mother) producing a
zygote. In sexual reproduction, the genetic information is contributed by both
parents, and therefore a unique combination of genetic information results in each
zygote.

II. THE FUNCTIONS OF THE REPRODUCTIVE SYSTEMS

The various reproductive organs work together to:

A. produce gametes;

B. transport gametes;

C. maintain gametes;

D. maintain developing zygote/fetus(female);

E. produce sex hormones:

1. male = testosterone;

57
2. female = estrogen and progesterone.

111. The Male Reproductive System

•Infections of the male GU tract

•STD’s

•Most common in young, sexually active men

•STD’S include:

–Urethritis – gonococcus & nongonococcal

–Genital ulcers – genital herpes, primary syphilis, chancroid, granulomainguinale

–Genital warts

–Scabies

–Pediculosis pubis

–Hepatitis

–Aids

•Treatment of STD’s must be targeted toward client as well as partner(s) &

sometimes an unborn child

•Must assess sexual history

•Identify partners at risk

•Partners of men with STD’s must be: examined & treated, as well as counseled to
prevent reinfection and complications and spread of STD

The Male Reproductive System

58
•Sexual abstinence during treatment & recovery is advised.

•Use condoms and spermicides with nonoxynol 9 for at least 6 months after
completion of TX to decrease transmission of human papilloma-virus (HPV) & HIV.

•Patients with 1 STD may have another. Its important to examine for other STD’s.

The Male Reproductive System

•Prostate problems

•Prostatitis – inflammation of the prostate gland caused by infection (bacteria, fungi,

mycoplasa) or other problems (urethral stricture or prostate hyperplasia)

•Symptoms – perineal discomfort, Burning, Urgency, Frequency and Pain with or

after ejaculation

The Male Reproductive System

•Acute bacterial prostatitis may present symptoms of:

•Fever & chills; Perineal, rectal or low back pain; Dysuria; Frequency; Urgency;
Nocturia ; Some patients have no symptoms

•Chronic bacterial prostatitis is a major cause of relapsing urinary tract infection in

men. Symptoms are mild:

–Frequency.

–Dysuria.

–Urethral discharge.

The Male Reproductive System

•Complications of prostatitis
59
–Swelling of the prostate gland

–Urinary retention

–Epididymitis

–Bacteremia

–Pyelonephritis

•Assessment for prostatitis

•History

•Culture of prostate fluid or tissue

•Histological exam

•Segmental urine culture – after cleaning, pt voids 10-15 ml into sterile container
(urethral urine) than continues to void 50 – 70ml into 2nd container (bladder urine)

•Prostatic massage done to obtain prostatic fluid for 3rd container

The Male Reproductive System

•Prostatitis – medical treatment

•Avoid abscess formation and septicemia

•Broad spectrum antibiotic give for 10 – 14 days

•May need IV antibiotics

• Bed rest; Sitz baths

•Analgesics; Antispasmodics and bladder sedatives

•Stool softeners
60
The Male Reproductive System

•Chronic prostatitis.

•Difficult to TX as most antibiotics diffuse poorly into the prostatic fluid.

•May need continuous low dose antibiotic therapy.

•UTI may recur.

•Teach patient about s/sx of UTI.

•Sitz baths.

•Stool softener.

•Evaluation of sexual partner to reduce cross-infection.

•Fluids are to treat thirst but are not “forced” to maintain effective medication level in
the urine.

•Avoid food & fluids that have diuretic effect or increase prostatic secretions such as
alcohol, coffee, chocolate, cola & spices.

•Avoid sitting for long periods.

•Medical follow-up needed for 6 months to 1 yr because prostatitis can recur.

The Male Reproductive System

•BPH - Benign prostatic Hyperplasia (enlarged prostate).

•Prostate glands can enlarge especially after age 50. It pushes into bladder
obstructing outflow of urine.

•It is the 2nd most common surgical intervention in men older that 60 yrs.

61
•Assessment for benign prostatic hyperplasia

–Large, rubbery non-tender prostate

–Increased frequency

–Nocturia, Urgency

–Hesitancy in starting urination

–Abdominal straining with urination

–Decrease in volume & force of urinary stream

–Dribbling

–Recurrent UTI’s

•Renal failure can eventually occur with urinary retention from BPH

•Pt may also experience: Fatigue; Anorexia; N/V; Epigastric discomfort

•DRE & other studies are done to assess degree of enlargement

•Urinalysis

•Renal function
The Male Reproductive System

Medical management of BPH:

•TX depends on cause, severity and condition of patient

•May need catheterization with stylet by urologist

•Alpha1-adrenergic receptor blockers – relax smooth muscle of bladder neck &

prostate.

62
•Antiandrogen agents (Proscar) – prevents the conversion of testosterone to
dihydrotesterone. Glandular activity is suppressed and prostate decreases in size.

–Side effects include gynecomastia, erectile dysfunction & flushing.

•Resection of prostate with lasers.

•Transuretheral needle ablation using low frequency radio waves produces heat
which destroys prostate tissue while sparing urethra, nerves, muscle & membranes.

•Microwave thermo therapy applies heat to prostatic tissue. Water cooling system
helps minimize damage to urethra.

The Male Reproductive System

•Cancer of the prostate.

•Second most common cancer in men.

•Second cause of cancer deaths in American men.

•1 in 5 men in US will develop cancer of prostate.

Cancer of the Prostate (cont’)

•Manifestations few symptoms in early stages.

•Urinary obstruction in later stage is a common complaint.

–Difficulty and frequency of urination.

–Urinary retention.

–Decreased size and force of urinary stream.

•Metastasizes to bone and lymph nodes with symptoms of

–Backache; Hip pain; Perineal & rectal discomfort

63
–Anemia; Weight loss; Weakness; N/V; oliguria

Assessment: Cancer of the Prostate

•If detected early cure rate is high.

•Every man over age 40 should have a DRE yearly.

•DX confirmed by histologic exam of prostatic tissue.

•PSA level is proportional to total prostatic mass. Also used to monitor response to
TX.

•Transrectal ultrasound used if elevated PSA and abnormal DRE.

•Bone scans x-rays.

•Sexual complications.

•Commonly experience sexual dysfunction before diagnosis made.

•Treatments also interfere with sexual function.

Medical management.

•Based on stage of disease and pt’s age & symptoms.

•Staging pg 1308 B&S.

Surgical management.

•Radical prostatectomy (removal of prostate & seminal vesicles) is the standard TX

for prostatic cancer thought to be curable.

•This results in sexual impotence & sometimes urinary incontinence.

64
Radiation therapy.

•May be curative.

–Teletherapy: 5days/wk for 6 – 7 weeks.

–Interstitial seed implantation – 80 – 100 seeds placed with ultrasound.

• Pt goes home.

• Instructed to avoid close contact with pregnant women and infants.

•Use condom for 2 weeks after implantation during intercourse.

•Side effects of radiation therapy include inflammation of rectum, bowel, &

bladder.

Cancer of the Prostate

•Hormonal therapy

–Orchiectomy (removal of testes)

–Medications

Cancer of the Prostate

•Orchiectomy – lowers plasma levels of testosterone since 93% originates in testes.

•This results in prostate atrophy.

•Does not have usual side effects of hormone therapy but does have significant
emotional impact.

•Estrogen therapy.

•Diethylstilbestrol (DES) inhibits gonadotropins interfering with androgenic activity.

•Relieves symptoms of advanced cancer.

65
•Reduces size of tumor.

•Many side effects including decreased libido, decreased sperm production &
gynecomastia.

•Newer hormonal therapies coming into use.

•Cry therapy used to ablate prostate cancer in patients not able to tolerate surgery or
have recurrence of cancer.

•Chemotherapy also used.

Cancer of the Prostate

•The Goal is to keep the urethra opening patent by resection or suprapubic catheter.

•Should be performed before damage occurs to the urinary tractor cancer progresses.

•TURP.

•Suprapubic prostatectomy.
Cancer of the Prostate

•TURP – most common approach

•Uses endoscopy

•Overnight hospital stay

•Strictures more frequent

•Infrequent erectile dysfunction

•May cause retrograde ejaculation

The Prostate

66
•Complications of prostatectomy: Hemorrhage; Clot formation

•Catheter obstruction and Sexual dysfunction - Sexual activity can be resumed in 6 –

8 weeks.

Prostatectomy

•A vasectomy may be done to prevent infection from spreading from prostatic urethra
thru the vas into epididymis.

•Nursing care for Prostatectomy

•Pain control; Irrigation of bladder with 50 cc NS - Be sure return is what is put into
the catheter.

•B & O suppositories.

•Ambulate; Don’t sit for long periods.

IV. ORGANS OF THE MALE REPRODUCTIVE SYSTEM

A. TESTES = The primary male sex organs which produce sperm and
male sex hormones. ovoid structures held within the scrotum (outside the male
body)

1. Descent of the Testes

a. Origin is as mass of tissue near adult kidney location

b. At 7-8 months gestation testes move through abdominal

wall to scrotum

c. Descent is stimulated by testosterone

d. Fibro muscular cords called the gubernaculums pulls

the testes and developing vas deferens and blood
vessels through the inguinal canal and into scrotum

67
 e. Vas and blood vessels make up adult spermatic cord

2. Internal Structure of testis:

a. Each testis is divided into lobules;

b. Each lobule contains:

• somniferous tubules (production of sperm cells under the influence of what

hormone?), which are separated by

• interstitial cells (of Leyden) (production of male sex hormones under the
influence of what hormone?)

c. The somniferous tubules unite and give rise to the epididymis on the outer
surface of the testis.

3. Germinal Epithelium:

a. The somniferous tubules are lined by stratified epithelium;

b. This germinal epithelium consists of two types of cells:

1. Spermatogenic cells which give rise to sperm cells;

2. Sustentacular cells (Sterol cells), which support and nourish the

spermatogenic cells.

IV. ORGANS OF THE MALE REPRODUCTIVE SYSTEM

A. TESTES (continued):

4. Spermatogenesis:

a. Males produce sperm from puberty and then throughout life:

b. The sperm is produced in the germinal epithelium of the somniferous tubules;

c. Sperm cells are produced from spermatogonia cells, which contain 23 pairs
(or 46) of chromosomes; (diploid)
68
d. Meiosis reduces this number by one-half, so that the number of chromosomes
in mature sperm cells is 23 chromosomes; (haploid)

e. Overall sequence:

o One spermatogonium (23 pairs of chromosomes) duplicates its DNA. This

gives rise to

o One primary spermatocyte (23 duplicated pairs of chromosomes) which

undergoes meiosis I. This gives rise to

o Two secondary spermatocytes (each with 23 duplicated chromosomes),

which undergo meiosis II. This gives rise to

o Four spermatids (each with 23 chromosomes). These cells mature into

o Four sperm cells (each with 23 chromosomes). The sperm cells collect in
the lumen of the seminiferous tubule.

f. The sperm travel to, mature, and are stored in the epididymis.

IV. ORGANS OF THE MALE REPRODUCTIVE SYSTEM

A. TESTES (continued):

5. Structure of a Sperm Cell:

The structure of a mature sperm cell consists of a head, a body, and a tail:

a. The head

1. contains enzymes to help penetrate the oocyte.

b. The body (mid-piece)

contains many mitochondria needed to produce ATP for energy for the sperm cell to
complete its long journey;

69
c. The tail is a flagellum provides locomotion for the sperm cell. See gray box
on page 838 concerning toxic chemicals that affect a sperm's ability to swim.

B. Epididymis:

1. tightly coiled tube leading to vas deferens;

2. site of storage of sperm cells.

C. Vas (Ductus) Deferens:

1. muscular tube which passes upward from testis, passes through parietal
peritoneum (inguinal canal) and into abdominal cavity;

The vas deferens, along with a testicular artery, autonomic nerves, testicular
veins, lymphatic vessels, and the cremaster muscle pass upward within the inguinal
canal and compose the spermatic cord;

2. fuses with duct from seminal vesicle to form ejaculatory duct (within
prostate gland).

3. site of Vasectomy.

D. Seminal Vesicle:

1. sac-like structure attached to vas deferens;

2. secrete an alkaline fluid that is rich in nutrients (fructose for sperm energy).

E. Prostate Gland:

1. surrounds urethra below bladder;

2. secrete a milky, alkaline fluid, which enhances sperm motility.

70
IV. ORGANS OF THE MALE REPRODUCTIVE SYSTEM

F. Bulbourethral Glands:

1. two small structures beneath prostate;

2. secrete lubricant for penis.

Semen = sperm cells (from testes), alkaline fluids (from prostate),

fructose (from seminal vesicle) and lubricant (from bulb urethral).

G. Scrotum:

1. pouch of skin and subcutaneous tissue that encloses the testes;

2. The cremated muscle is an extension of the internal oblique muscle that

elevates the scrotum during sexual arousal and on exposure to cold.

H. Penis:

1. male excitatory organ;

2. specialized to become erect for insertion into vagina during sexual

intercourse;

3. cylindrical body composed of three columns of erectile tissue.

4. completely surround urethra.

5. Structure:

a. pair of dorsally located corpora cavernous; whose cure (legs) are attached to
the pubic arch

b. single corpus spongiosum, which extends at its distal end to form the
enlarged glands penis; and enlarges at the proximal end to form the bulb of the
penis deep in the perineum

71
c. the curare are covered by the Ischiocavernosus muscle

d. the bulb is covered by the bulbospongiosus muscle

e. Each column is surrounded by a tough capsule of white fibrous CT called

tunica albuginea;

f. A loose fold of skin called the prepuce covers the glands as a sheath.

The prepuce is sometimes removed by a surgical procedure called a circumcision;

IV. ORGANS OF THE MALE REPRODUCTIVE SYSTEM

H. Penis

* Erection = vascular spaces within erectile tissue become engorged with

blood when male becomes sexually stimulated.

Caused by increased arterial flow filling the erectile tissues and

compressing the veins, thus trapping blood in the penis

Emission = movement of semen from epididymis into urethra.

Ejaculation = forceful movement of semen from urethra to outside.

Accomplished by the bulbospongiosus muscle and Ischiocavernosus muscle

Orgasm = culmination of sexual stimulation accompanied by involuntary

rhythmic contractions of the epididymis causing emission and ejaculation of semen,
resulting in a sense of psychological and physiological release.

72
IV. ORGANS OF THE MALE REPRODUCTIVE SYSTEM

H. Hormonal Control of Male Reproductive Function:

1. At puberty, the hypothalamus secretes a "releasing hormones"

that target the male’s anterior pituitary gland;

2. The anterior pituitary gland then secretes two gonadotropins:

a. Follicle stimulating hormone (FSH), which stimulates

spermatogenesis in the germinal epithelium of
Somniferous tubules (ST’s); and

b. Luteinizing hormone (LH), which stimulates the

interstitial cells between the ST's to produce male sex
hormones.

3. Male Sex Hormones = Androgens

a. Testosterone is the major androgen whose production

begins at puberty:

b. Testosterone targets the secondary sex organs of the

male:

o facial, axillaries, and inguinal hair follicles.

o bone and muscle

o vocal cords of larynx.

c. Actions include development of male secondary sexual

characteristics at puberty and then maintenance
throughout life

o increased growth of body hair;

73
 o lower-pitched voice;

o increased muscular growth;

o strengthening of bones.

V. THE FEMALE REPRODUCTIVE SYSTEM

A. Organs

1. OVARIES

d. Follicle Maturation:

o During child bearing years, each month FSH

stimulates one primordial follicle to mature:
The following events occur over a 14 day period
(approximately).

1. Primary acolyte enlarges and undergoes meiosis I ;

2. The follicular cells multiply and give rise to stratified epithelium composed of
granulose cells;

3. A layer called the zone pellucid appears and separates the acolyte from the
granulose cells.

• The follicle is now called a primary follicle.

4. A fluid-filled cavity, called the ant rum appears.

• A crown of granulose cells surrounds the acolyte (corona radiate).

• The follicle is now called a secondary follicle.

74
e. Ovulation:

Cogenesis (meiosis I) is complete as the follicle matures (approximately 14 days);

Upon maturation, luteinizing hormone (LH) causes the follicle to burst, releasing a
secondary acolyte

After ovulation, the acolyte is drawn into the fallopian tube (via fimbriae).

THE FEMALE REPRODUCTIVE SYSTEM

A. Organs (continued)

2. Fallopian Tubes (Uterine Tubes, Oviduct)

a. Tubes which pass medially from ovaries to uterus;

b. Distal ends are expanded over ovary and form extensions called fimbriae; .

c. Inner lining is covered with cilia to aid oocyte movement;

d. Fertilization typically occurs in fallopian tube.

3. Uterus:

a. A muscular organ that receives embryo and sustains its life during
development;

b.Is located within the pelvis.

c. The uterine wall has three layers: Endometrial = inner lining;

• Site of implantation of blast cyst.

• Endometriosis = endometrial tissue in locations other than uterus; tissue

bleeds, but does not shed, resulting in scars or adhesions; painful and possibly
infertile condition.

Myometrium = bundles of smooth muscle; bulk of uterus;

Perimetrium = visceral covering.

75
d. Lower one-third of uterus narrows to form cervix:

o internal os;

o cervical canal;

o external os;

o posterior/anterior fornix.

• Pap smears are taken from cervical tissue.

V. THE FEMALE REPRODUCTIVE SYSTEM

A. Organs (continued)

4. Vagina:

a. passageway from cervix to outside;

b. serves to receive erect penis, to convey uterine secretions, and to transport

offspring during birth.

c. The hymen is a membrane composed of epithelium and connective tissue,

which partially closes the vaginal orifice.

5. Labia:

a. external organs;

b. encloses and protects underlying organs and tissues;

c. composed of labia majored and labia minored.

d. The space enclosed by the labia minora = vestibule of vulva.

6. Clitoris:

a. external excitatory organ;

76
b. small projection at the anterior end of the labia, which corresponds to the male
penis;

c. composed of two columns of erectile tissue.

Erection = erectile tissues of clitoris become engorged with blood and

swell during sexual stimulation.

Orgasm = rhythmic contraction of muscles of perineum, uterine wall and

fallopian tubes, which result in a feeling of psychological and physiological release.

V. THE FEMALE REPRODUCTIVE SYSTEM

THE FEMALE REPRODUCTIVE SYSTEM

B. Hormonal Control of Female Reproductive Functions

1. Secretion of Gonadotropins:

The female body remains reproductively immature until about eight years of age
when secretion of gonadotropins (FSH and LH) from the anterior pituitary gland
increases. (What gland causes the anterior pituitary to secrete these?)

a. FSH causes maturation of a follicle

o FSH is secreted from Day 0 through 14 of the

reproductive cycle and causes the following events
to occur:

1. Primary octet enlarges and undergoes meiosis I ;

2. The follicular cells multiply and give rise to stratified epithelium composed of
granulose cells;

3. A layer called the zone pellucid appears and separates the octet from the
granulose cells.

• The follicle is now called a primary follicle.

77
4. A fluid-filled cavity, called the antrum appears.

• A crown of granulosa cells surrounds the oocyte (corona radiata).

• The follicle is now called a secondary follicle

 LH causes ovulation.

• A surge of LH on day 14 of the reproductive cycle causes:

• The secondary oocyte to be released into a fallopian tube and

• The follicle becomes the corpus luteum..

V. THE FEMALE REPRODUCTIVE SYSTEM

B. Hormonal Control of Female Reproductive Functions

2. Secretion of Female Sex hormones:

Estrogen is produced by the maturing follicle (of the ovary);

Days 1-14. is responsible for the development of female secondary sexual

characteristics at puberty, and then maintains them throughout life.

Targets:

1 axillary and inguinal hair follicles.

2 breasts and mammary glands.

3 adipose tissue in hips, buttocks, and

thighs

4 endometrium of uterus.

78
Effects include:

increased hair growth in axillary and inguinal regions.development of breasts and

mammary glands.increased fat deposition in breasts, thighs, and buttocks. primes
endometrium.

Progesterone

• is produced by the corpus luteum (of the ovary);

• Day 14-24;

• targets the endometrium of the uterus.

• prepares the uterus for implantation of the zygote:

• thickens the lining;

• promotes formation of glands and blood vessels.

THE FEMALE REPRODUCTIVE SYSTEM

C. Female Reproductive Cycle:

The female reproductive cycle is approximately 28 days in length and involves the
interaction between several glands, hormones, and target sites.

1. Beginning at puberty, on Day 0, the hypothalamus secretes a

releasing hormone that targets the anterior pituitary gland to
secrete FSH.

a. FSH is secreted from Days 0-14.

b. FSH targets a primordial follicle and causes it to

mature.

o The maturing follicle secretes estrogen.

1 Estrogen is secreted from Days 1-14.

79
 2 Estrogen targets the secondary sex
organs to develop at puberty, and then
maintains them throughout life.

2. On Day 14, the hypothalamus secretes a second releasing

hormone that targets the anterior pituitary gland to secrete LH.

a. LH is secreted on Day 14 only.

b. LH targets the mature secondary follicle and causes it

to burst.

• The secondary oocyte is released into the fallopian tube.

• The follicle becomes the corpus luteum.

• The corpus luteum secretes progesterone.

• Progesterone is secreted from Days 14-24. Progesterone targets the uterine

endometrium to prepare for implantation.

• Progesterone causes the endometrium to become thick, glandular, and

vascular.

THE FEMALE REPRODUCTIVE SYSTEM

c) Female Reproductive Cycle:

• If implantation does not occur by Day 24, the corpus luteum degenerates and
levels of progesterone (and estrogen) decline.

• This decline occurs from Days 24-28.

• The hypothalamus detects this decrease and initiates a new cycle by secreting
a releasing hormone that targets the anterior pituitary gland to secrete FSH on
Day 0.

• FSH begins new cycle by maturing follicle.

80
 • FSH ends previous cycle through menstruation of the endometrium.

• If implantation does occur by Day 24, the corpus luteum continues to secrete
progesterone to maintain the developing embryo, until the placenta is formed
(end of month 3).

5. During this cycle, estrogen and progesterone inhibit the release of LH and
FSH.

a.As the anterior pituitary senses the fall in the concentrations of these hormones, it
secretes them again (negative feedback), initiating a new menstrual cycle.

81
 Summary of Female Reproductive Cycles: Keyed at the end of this outline.

HORMONE

secreted by
what organ or
gland?

days of
secretion

target(s) of
hormone

Response

82
VI. MAMMARY GLANDS (within breast tissue):

A. modified soporiferous (porcine) glands that produce milk;

B. consist of 15-20 lobes separated by adipose tissue;

C. Each lobe is composed of lobules composed of CT and milk-secreting glands

called alveoli;

D. Production/Flow of milk:

1. Milk is produced by alveoli & passes into

2. secondary tubules then into

3. mammary ducts then into

4. lactiferous sinuses (near nipple) then into

5. lactiferous ducts and exits through the

6. nipple.

VII. Birth Control Methods:

VIII. Sexually Transmitted Diseases for more information.

A. AIDS

B. Chlamydia

C. Genital Herpes

D. Genital Warts

E. Gonorrhea

F. Syphilis

83
IX. Other Disorders/Imbalances

A. Male disorders:

1.Erectile Dysfunction.

2. Testicular cancer:

3. Prostate Enlargement:

4. Infertility.

B. Female Disorders:

1. Ad enosis.

2. Infertility.

3. Breast Cancer.

X. Other Interesting Topics:

A. Assisted Reproductive Technologies.

B. Human Milk- The Perfect Food for Human Babies.

XI. Clinical Terms Related to the Reproductive Systems.

XI. Interconnections of the Reproductive System.

84
Comparison of Mitosis and Meiosis:

Event Mitosis Meiosis

DNA Replication Occurs during interphase Occurs during

before nuclear division interphase before
occurs. nuclear division
occurs.

Number of One (PMAT) Two (2xPMAT); no

Divisions replication between
divisions; synapsis
occurs during
Prophase I.

Number of Two, each diploid (2n) Four, haploid cells

daughter cells & and genetically identical to (1n), genetically non-
genetic composition parent cell. identical to parent cell.

Importance Growth, repair, Production of gametes;

development of multi- reduces chromosome #
cellular organism from by ½;
zygote.
variation.

69
Male Reproductive Organ Summary Table

Name of Organ Structure Function

Testes solid ovoid structure held in production of sperm

scrotum; (seminiferous tubules/FSH);

lobules of seminiferous tubules secretion of testosterone

separated by interstitial cells; (interstitial cells, LH)

Epididymis tightly coiled tubule superior storage of sperm

to testes; leads to vas deferens

Vas Deferens muscular tube leading from movement of sperm

epididymis into abdominal
cavity

70
Seminal Vesicle sac-like structure attached to addition of fructose (energy
vas deferens source) to sperm/semen

Prostate Gland sponge-like structure below addition of milky alkaline fluid

bladder and surrounding to semen for sperm motility
urethra

Bulbourethral two pea-shaped structures addition of penis lubricant to

Glands below prostate sperm/semen

Urethra tube leading from transport of sperm and urine to

bladder/prostate to outside; outside
held within penis

Penis male excitatory organ; is held in female vagina during

vascular columns fill with intercourse for transfer of
blood causing erection sperm

Scrotum pouch of skin and fat that hold testes at cooler

holds testes temperature to insure optimum
sperm production

71
FEMALE REPRODUCTIVE Organs Summary Table

Name of Organ Structure Function

Ovary solid, ovoid structures on production of secondary

posterior pelvic cavity; oocytes for fertilization;
production of estrogen for
cortex of ovarian follicles
development of 2o sex organs;

production of progesterone to
prepare endometrium for
implantation

Fallopian Tube tubes that pass medially from site of fertilization;

ovaries to uterus; lined with transportation of fertilized egg
cilia, expanded ends to uterus
(fimbriae) over ovary

Uterus muscular (smooth) organ that houses developing embryo/fetus

houses developing embryo,
fetus; 3 layers

72
 Cervix lower one-third of uterus Pap smear location

Vagina passageway from cervix to birth canal; houses erect penis

outside during intercourse

Labia external reproductive organs protect underlying organs

Clitoris small projection at anterior female excitatory organ

end of labia; two columns of
vascular tissue

Summary of Female Reproductive Cycle

FSH LH estrogen progesterone

secreted by anterior anterior maturing corpus luteum

73
what organ or pituitary gland pituitary gland ovarian follicle
gland?

days of Days 0-14 day 14 days 1-14 days 14-24

secretion

target(s) of primordial Secondary secondary sex endometrium

hormone ovarian follicle (mature) organs of uterus
ovarian follicle (breasts, hair
follicles in
axillary and
inguinal
region, adipose
tissue in
buttocks and
thigh region)

response maturation of bursting of development at causes

ovarian follicle ovarian puberty; endometrium
and oocyte follicle; maintenance to thicken,
(Meiosis I) ovulation = throughout life become
release of until vascular and
secondary menopause glandular;
oocyte preparation for
implantation

74
1.7 Excretory system:

Excretory systems regulate solute movement

between internal fluids and the external between internal fluids and the external

environment

Excretory Processes

Most excretory systems produce urine by refining

a filtrate derived from body fluids a filtrate derived from body fluids.

Key functions of most excretory systems:

1. Filtration: pressure-filtering of body fluids

2. Reabsorption: reclaiming valuable solutes

3. Secretion: adding toxins and other solutes from the body fluids to the filtrate.

4. Excretion: removing the filtrate from the system.

1.8 Endocrine glands:

MECHANISMS OF HORMONE ACTION

A. Endocrine glands secrete chemicals (hormones) into the blood

B. Hormones perform general functions of communication and control but a
slower, longer-lasting type of control than that provided by nerve impulses
C. Cells acted on by hormones are called target organ cells
D. Protein hormones (first messengers) bind to receptors on the target cell
membrane, triggering second messengers to affect the cell’s activities
E. Steroid hormones bind to receptors within the target cell nucleus and influence
cell activity by acting on DNA

REGULATION OF HORMONE SECRETION

A. Hormone secretion is controlled by homeostatic feedback

B. Negative feedback—mechanisms that reverse the direction of a change in a
physiological system

75
C. Positive feedback—(uncommon) mechanisms that amplify physiological
changes

PROSTAGLANDINS

A. Prostaglandins (PGs) are powerful substances found in a wide variety of body

tissues
B. PGs are often produced in a tissue and diffuse only a short distance to act on
cells in that tissue
C. Several classes of PGs include prostaglandin A (PGA), prostaglandin E (PGE),
and prostaglandin F (PGF)
D. PGs influence many body functions, including respiration, blood pressure,
gastrointestinal secretions, and reproduction

PITUITARY GLAND

A. Anterior pituitary gland (adenohypophysis)

1. Names of major hormones
a. Thyroid-stimulating hormone (TSH)
b. Adrenocorticotropic hormone (ACTH)
c. Follicle-stimulating hormone (FSH)
d. Luteinizing hormone (LH)
e. Melanocyte-stimulating hormone (MSH)
f. Growth hormone (GH)
g. Prolactin (lactogenic hormone)
Functions of major hormones
a. TSH—stimulates growth of the thyroid gland; also stimulates it to secrete
thyroid hormone
b. ACTH—stimulates growth of the adrenal cortex and stimulates it to secrete
glucocorticoids (mainly cortisol)
c. FSH—initiates growth of ovarian follicles each month in the ovary and
stimulates one or more follicles to develop to the stage of maturity and ovulation;
FSH also stimulates estrogen secretion by developing follicles; stimulates sperm
production in the male
d. LH—acts with FSH to stimulate estrogen secretion and follicle growth to
maturity; causes ovulation; causes luteinization of the ruptured follicle and

76
stimulates progesterone secretion by corpus luteum; causes interstitial cells in the
testes to secrete testosterone in the male
e. MSH—causes a rapid increase in the synthesis and spread of melanin (pigment)
in the skin
f. GH—stimulates growth by accelerating protein anabolism; also accelerates fat
catabolism and slows glucose catabolism; by slowing glucose catabolism, tends to
increase blood glucose to higher than normal level (hyperglycemia)
g. Prolactin or lactogenic hormone—stimulates breast development during
pregnancy and secretion of milk after the delivery of the baby
B. Posterior pituitary gland (neurohypophysis)
1. Names of hormones
a. Antidiuretic hormone (ADH)
b. Oxytocin
2. Functions of hormones
a. ADH—accelerates water reabsorption from urine in the kidney tubules into the
blood, thereby decreasing urine secretion
b. Oxytocin—stimulates the pregnant uterus to contract; may initiate labor; causes
glandular cells of the breasts to release milk into ducts

HYPOTHALAMUS

A. Actual production of ADH and oxytocin occurs in the hypothalamus

B. After production in the hypothalamus, hormones pass along axons into the
pituitary gland
C. The secretion and release of posterior pituitary hormones is controlled by
nervous stimulation
D. The hypothalamus controls many body functions related to homeostasis
(temperature, appetite, and thirst)

THYROID GLAND

A. Names of hormones
1. Thyroid hormone—thyroxine (T4) and triiodothyronine (T3)
2. Calcitonin
B. Functions of hormones
1. Thyroid hormones—accelerate catabolism (increase the body’s metabolic rate)

77
2. Calcitonin—decreases the blood calcium concentration by inhibiting
breakdown of bone, which would release calcium into the blood

PARATHYROID GLANDS

A. Name of hormone—parathyroid hormone (PTH)

B. Function of hormone—increases blood calcium concentration by increasing the
breakdown of bone with the release of calcium into the blood

ADRENAL GLANDS

A. Adrenal cortex
1. Names of hormones (corticoids)
a. Glucocorticoids (GCs)—chiefly cortisol (hydrocortisone)
b. Mineralocorticoids (MCs)—chiefly aldosterone
c. Sex hormones—small amounts of male hormones (androgens) secreted by
adrenal cortex of both sexes
2. Cell layers (zones)
a. Outer layer—secretes mineralocorticoids
b. Middle layer—secretes glucocorticoids
c. Inner layer—secretes sex hormones
3. Mineralocorticoids—increase blood sodium and decrease body potassium
concentrations by accelerating kidney tubule reabsorption of sodium and excretion
of potassium
4. Functions of glucocorticoids
a. Help maintain normal blood glucose concentration by increasing
gluconeogenesis—the formation of “new” glucose from amino acids produced by
the breakdown of proteins, mainly those in muscle tissue cells; also the conversion
to glucose of fatty acids produced by the breakdown of fats stored in adipose
tissue cells
b. Play an essential part in maintaining normal blood pressure—make it possible
for epinephrine and norepinephrine to maintain a normal degree of
vasoconstriction, a condition necessary for maintaining normal blood pressure
c. Act with epinephrine and norepinephrine to produce an anti-inflammatory
effect, to bring about normal recovery from inflammations of various kinds
d. Produce anti-immunity, antiallergy effect; bring about a decrease in the number

78
of lymphocytes and plasma cells and therefore a decrease in the amount of
antibodies formed
e. Secretion of glucocorticoid quickly increases when the body is thrown into a
condition of stress; high blood concentration of glucocorticoids, in turn, brings
about many other stress responses ( 9-10)
B. Adrenal medulla
1. Names of hormones—epinephrine (adrenaline) and norepinephrine
2. Functions of hormones—help the body resist stress by intensifying and
prolonging the effects of sympathetic stimulation; increased epinephrine secretion
is the first endocrine response to stress

PANCREATIC ISLETS

A. Names of hormones
1. Glucagon—secreted by alpha cells
2. Insulin—secreted by beta cells
B. Functions of hormones
1. Glucagon increases the blood glucose level by accelerating liver glycogenolysis
(conversion of glycogen to glucose)
2. Insulin decreases the blood glucose by accelerating the movement of glucose
out of the blood into cells, which increases glucose metabolism by cells

FEMALE SEX GLANDS

The ovaries contain two structures that secrete hormones—the ovarian follicles
and the corpus luteum
A. Effects of estrogen (feminizing hormone)
1. Development and maturation of breasts and external genitals
2. Development of adult female body contours
3. Initiation of menstrual cycle

MALE SEX GLANDS

The interstitial cells of testes secrete the male hormone testosterone

A. Effects of testosterone (masculinizing hormone)
1. Maturation of external genitals
2. Beard growth

79
3. Voice changes at puberty
4. Development of musculature and body contours typical of the male

THYMUS

A. Name of hormone—thymosin
B. Function of hormone—plays an important role in the development and function
of the body’s immune system

PLACENTA

A. Name of hormones—chorionic gonadotropins, estrogens, and progesterone

B. Functions of hormones—maintain the corpus luteum during pregnancy

PINEAL GLAND

A. A cone-shaped gland near the roof of the third ventricle of the brain
1. Glandular tissue predominates in children and young adults
2. Becomes fibrous and calcified with age
B. Called third eye because its influence on secretory activity is related to the
amount of light entering the eyes
C. Secretes melatonin, which:
1. Inhibits ovarian activity
2. Regulates the body’s internal clock

OTHER ENDOCRINE STRUCTURES

A. Many organs (for example, the stomach, intestines, and kidney) produce
endocrine hormones

The following is a list of the primary endocrine glands, their location, and their
hormonal secretions.
➢ Pituitary gland—lies deep in the cranial cavity, in the small depression of the
sphenoid bone called the sella turcica. Secretions of the anterior lobe include
growth hormone, thyroid stimulating hormone, adrenocorticotropic hormone,
follicle-stimulating hormone, luteinizing hormone, melanocyte-stimulating
hormone, and prolactin. Secretions of the posterior lobe include antidiuretic
hormone and oxytocin

80
➢ Thyroid gland—lies in the neck, just below the larynx; secretes thyroxine,
triiodothyronine, and calcitonin
➢ Parathyroid glands—four small glands found on the back of the thyroid;
secrete parathyroid hormone
➢ Adrenal glands—located over the top of each kidney. The adrenal cortex
secretes mineralocorticoids, glucocorticoids, and small amounts of sex hormones.
The adrenal medulla secretes epinephrine and norepinephrine
➢ Islets of Langerhans—clumps of cells scattered among pancreatic cells; secrete
glucagon and insulin
➢ Sex glands—ovaries of the female located toward the back of the pelvic cavity;
secrete estrogen and progesterone. Testes of the male located in the scrotum;
secrete testosterone
➢ Thymus—located in the mediastinum; secretes thymosin
➢ Placenta—temporary endocrine gland formed during pregnancy; secretes
chorionic gonadotropin
➢ Pineal gland—small, cone-shaped gland that lies near the roof of the third
ventricle of the brain; secretes melatonin

1.9 Special Sense Organs

The body has an innate ability to sense change in its internal and external
environment, which enables it to maintain a state of homeostasis and continued
survival.
Special sense organs are characterized by large and complex organs, each with a
unique function. The following is a list of the of special sense organs:
1. Eye
2. Ear
3. Nose
4. Taste buds (tongue)

The Eye

1. Layers of eyeball
a. Sclera—tough outer coat; “white” of eye; cornea is transparent part of sclera
over iris

81
b. Choroid—pigmented vascular layer prevents scattering of light; front part of
this layer made of ciliary muscle and iris, the colored part of the eye; the pupil is
the hole in the center of the iris; contraction of iris muscle dilates or constricts
pupil
c. Retina (innermost layer of the eye; contains rods (receptors for night vision) and
cones (receptors for day vision and color vision)
2. Conjunctiva—mucous membrane covering the front surface of the sclera and
lining the eyelid
3. Lens—transparent body behind the pupil; focuses light rays on the retina
4. Eye fluids
a. Aqueous humor—in the anterior cavity in front of the lens
b. Vitreous humor—in the posterior cavity behind the lens
5. Visual pathway
a. Innermost layer of retina contains rods and cones
b. Impulse travels from the rods and cones through the bipolar and ganglionic
layers of retina
c. Nerve impulse leaves the eye through the optic nerve; the point of exit has no
receptors and is therefore called the blind spot
d. Visual interpretation occurs in the visual cortex of the cerebrum

The Ear

1. The ear functions in hearing and in equilibrium and balance

a. Receptors for hearing and equilibrium are mechanoreceptors
2. Divisions of the ear
a. External ear
(1) Auricle (pinna)
(2) External auditory canal
(a) Curving canal 2.5 cm (1 inch) in length
(b) Contains ceruminous glands
(c) Ends at the tympanic membrane
b. Middle ear
(1) Houses ear ossicles—malleus, incus, and stapes
(2) Ends in the oval window
(3) The auditory (eustachian) tube connects the middle ear to the throat

82
(4) Inflammation called otitis media
c. Inner ear
(1) Bony labyrinth filled with perilymph
(2) Subdivided into the vestibule, semicircular canals, and cochlea
(3) Membranous labyrinth filled with endolymph
(4) The receptors for balance in the semicircular canals are called cristae
ampullaris
(5) Specialized hair cells on the organ of Corti respond when bent by the
movement of surrounding endolymph set in motion by sound waves

The Taste Receptors

1. Receptors are chemoreceptors called taste buds

2. Cranial nerves VII and IX carry gustatory impulses
3. Only four kinds of taste sensations—sweet, sour, bitter,
salty
4. Gustatory and olfactory senses work together

83
UNIT:2

MEDICAL TERMINOLOGY

2.1. Reasons for using medical terms:

1. Understanding word components and organizing Anatomy &Physiology

2. Eliminate misunderstanding

3. Specifies- eliminate generalities, vagueness, very specific term during surgery.

4. Language barrier

5. Solving medical dilemma.

Basic Concepts of Medical Terminology

“Medical terminology is the professional language of those who are directly or

indirectly engaged in the art of healing.” (Frenay and Mahoney, 1998) Most
medical terms have Greek or Latin origins, though some are derived from modern
languages, particularly German, French, and English. In general, terms dealing
with diagnosis and surgery have Greek origins, whereas anatomical terms have
Latin origins. An understanding of the structure of medical terms, and an ability to
break down a medical term into its parts helps you get the most out of using a
medical dictionary, and makes dealing with medical terminology less challenging
than it first appears.

Medical terms are formed from word roots, prefixes, suffixes, and combining
vowels/forms, defined below:

Root – the foundation of the word, it can be combined with a prefix or suffix;
nearly all medical terms have one or more roots; usually Greek or Latin

Prefix – placed before the root to modify its meaning

Suffix – placed after the root to modify and give essential meaning to the root;
forms a noun, verb, or adjective

84
Combining form – has no meaning of its own; root with a combining vowel
attached (e.g. lip/o-); joins a root to another root or to a suffix; makes the word
easier to pronounce; o is the most common combining vowel, followed by “a”

In “decoding” medical terms, it is best to look first at the meaning of the suffix,
then at the meaning of the root or root and prefix.

Example: hyperlipoproteinemia

hyper- (prefix) = excessive

lip (root) = fat

o (vowel used to create a combining form, lipo-)

protein (root) = protein

-emia (suffix) = blood condition

Hyperlipoproteinemia is a blood condition, characterized by an excessive amount

of fat and protein

Example: pericarditis

peri- (prefix) = around

cardi (root) = heart

-itis (suffix) = inflammation

Pericarditis literally means “inflammation around the heart” but the dictionary
states that this terms means inflammation of the pericardium (-ium is a suffix
meaning tissue), the sac that encloses the heart.

Various medical terms refer to divisions of the body, body position and direction,
planes of the body, and body cavities. Examples of these are: epigastric region
and lower right quadrant of the abdomen; sacral region of the back; superficial
position; efferent direction; horizontal plane; and frontal sinus. It may be helpful
to familiarize yourself with some of these terms.

85
Medical Terminology: Prefixes

Prefix Definition Example

a-, an- without; lacking aphasia - without speech

anemia - lack of blood

ab- away from abductor - leading away from

ad- toward; near adductor- leading toward

adrenal - near the kidney

An- without or absence of

Ana- up; again; backward

Ante- before

anti-/contra- against anticoagulant - prevent blood

clotting

contraception - prevent
conception/impregnation

Apo- upon

Bi/bin- two

Brady- slow

Cata- down

Con- together

Contra- against

De- from; down from; lack of

Dia- thorough; complete

Dis- to undo; free from

86
Dys- difficult; labored; painful;

abnormal

ect-, ecto-, ex-, exo- outer; outside ectoderm - outer skin

end-, endo-, ent within; inner endocranial - within the

cranium

endodontium - dental pulp

Epi- on; upon; over

Eso- inward

Eu- normal; good

Extra- outside of; beyond

Hemi- half

Hyper- above, beyond, excessive hyperglycemia - high glucose

hypertension - high blood

pressure

hyp-, hypo- under, deficient hypothermia - low body

temperature

hypothyroidism - thyroid
deficiency

In- In; into; not

infra- beneath; below infraorbital - beneath the eye

inter- between intercostal - between the rib

intra- within intravenous - within a vein

Mal- bad

Meso- middle

87
Meta- after; beyond; change

Micro- small

Multi- many

neo- new neonate - newly born

Nulli- none

Pan- all; total

Para- beside; beyond; around

Per- through

peri- around periodontal - around the

tooth

periosteum - around bone

poly- many, excessive polycystic - many cysts

polydipsia - excessive thirst

Ost- after

Pre- before; in front of

Pro- before

Re- back

Retro- back; behind

Semi- half

sub- under subcutaneous - under the

skin

88
 sublingual - beneath the
tongue

Super- over; above

Supra- above

Sym-, syn- together; joined

Tachy- fast; rapid

Tetra- four

Trans- through; across; beyond

Tri- three

Ultra- beyond; excess

Uni- one

Medical Terminology: Suffixes

Suffix Definition Example

-agra excessive pain

-algia, -dynia pain neuralgia - pain in nerves

-apheresis removal

-ase enzyme

-asthenia weakness

-atresia absence of a normal body opening;

occlusion; closure

89
-capnia carbon dioxide

-cele hernia; protrusion

-centesis surgical puncture to amniocentesis - amniotic

fluid
remove fluid

-cidal killing

-clasia, -clasis, -clast break

-lysis irrigating; washing

-coccus (pl. cocci) berryshaped ( a form of bacterium)

-crine separate; secrete

-crit to separate

-cyte cell

-desis surgical fixation; fusion

-drome run; running

-ectasis stretching out; dilatation; expansion

-ectomy cut out, excision appendectomy - removal of

the appendix

-ectopia displacement

-emesis vomiting

-emia blood condition anemia - low/lack of red

blood cells

leukemia - malignant blood

disease

-esis -ity state or condition anesthesia - loss of

sensation

90
-iasis -ia psoriasis - skin condition

-osis -y scoliosis - spine curvature

-en substance or agent that produces or causes

-genesis origin; cause

-genic producing; originating; causing

-gram, -graphy recording, written mammogram - x-ray of

breast

cardiography - record of
physical or functional
aspect of the heart

-ia condition of diseased or abnormal

state

-iatry physician; treatment

-ician one who

-ictal seizure; attack

-ism state of

-ites, -itis inflammation carditis - inflammation of

the heart

-lepsy seizure

-lysis loosening; dissolution; separating

-lytic destroy; reduce

-malacia softening

-mania madness; insane desire

-megaly enlargement

91
-meter instrument used to measure

-metry measurement

-morph form; shape

-odia smell

-odynia pain

-oid resembling

-ologist one who studies and practices (specialist)

-ology study of

-oma tumor lymphoma -

lymph tissue

melanoma -
tumor of pigment
tissue

opia vision (condition)

opsy to view

oorhagia rapid flow of blood

orrhaphy suturing; repairing

orrhea flow; excessive discharge

orrhexis rupture

osis abnormal condition (means increased

when used

with blood cell word roots)

ostomy creation of an artificial opening

92
otomy cut into or incision

oxia oxygen

paresis slight paralysis

pathy disease

-penia deficiency, lack of glycopenia -

sugar deficiency
in tissues

-pepsia digestion

-pexy surgical fixation; suspension

-phagia, phagy eating, devouring tachyphagia -

eating fast

-philia, -phily love

-phobia abnormal fear of or aversion to specific

objects or things

-phonia sound or voice

-phoria feeling

-physis growth

-plasia formation; development; a growth

-plasm growth; substance; formation

-plasty surgical shaping genioplasty - chin

rhinoplasty - nose

-pnea breathing apnea - cessation

of breathing

dyspnea - labored

93
 breathing

-poiesis formation

-porosis passage

-prandial meal

-praxia in front of; before

-ptosis dropping; sagging; prolapse

-ptysis spitting

-rrhaphy suture gastrorrhaphy -

stomach

-rrhea flow or discharge rhinorrhea - nasal

-salpinx fallopian
tube

-sarcoma malignant
tumor

-schisis split;
fissure

-sclerosis hardening

-scope instrument
used for

visual
examinatio
n

-scopy, -scopic to examine cystoscopy -

bladder

cytoscoy - cells

94
-sepsis infection

-sis state of

spasm sudden
involuntary
muscle
contraction

-stasis control;
stop

-stalsis contraction

-stenosis constrictio
n;
narrowing

-stomy surgical colosto

opening my -
into the
colon

tracheos
tomy -
into the
trachea

-thorax chest

-tocia birth; labor

-tome instrument
used to cut

-tomy cutting; incision phleboto

my -
into the

95
 vein

-tripsy surgical
crushing

-trophy nourishme
nt

-ule little

-uria urine;
urination

Glossary of medical terms: major diseases and medical specialties:

The following are health and medical definitions of terms that appear in
the Doctors: Specialties and Training article.

Allergy: A misguided reaction to foreign substances by the immune system, the

body system ...

96
See the NERVOUS SYSTEM

CENTRAL NERVOUS SYSTEM PERIPHERAL

NERVOUS SYSTEM

(BRAIN & SPINAL CORD) (CRANIAL

NERVES & SPINAL NERVES)

(INTERNEURONS)

SENSORY MOTOR

(INPUT INTO CNS) (OUTPUT FROM

CNS)

(AFFERENT NEURONS) (EFFERENT

NEURONS)

SOMATIC AUTONOMIC

97
(EFFECTORS: SKELETAL MUSCLE) (EFFECTORS: SMOOTH
MUSCLE;

(CONSCIOUS CONTROL) CARDIAC MUSCLE; GLANDS)

(UNCONSCIOUS CONTROL)

PARASYMPATHETIC SYMPATHETIC

(HOMEOSTASIS) (FIGHT-OR-FLIGHT)

(NT: ACETYLCHOLINE) (NT: NOREPINEPHRINE)

Major disease and medical specialties.

Allergist or Immunologist - conducts the diagnosis and treatment of allergic

conditions.

Anesthesiologist - treats chronic pain syndromes; administers anesthesia and

monitors the patient during surgery.

Cardiologist - treats heart disease

Dermatologist -treats skin diseases, including some skin cancers

Gastroenterologist - treats stomach disorders

Hematologist/Oncologist - treats diseases of the blood and blood-forming tissues

(oncology including cancer and other tumors)

Internal Medicine Physician - treats diseases and disorders of internal structures

of the body.

Nephrologist - treats kidney diseases.

98
Neurologist - treats diseases and disorders of the nervous system.

Neurosurgeon - conducts surgery of the nervous system.

Obstetrician - treats women during pregnancy and childbirth

Gynecologist - treats diseases of the female reproductive system and genital tract.

Nurse-Midwifery - manages a woman's health care, especially during pregnancy,

delivery, and the postpartum period.

Occupational Medicine Physician - diagnoses and treats work-related disease

or injury.

Ophthalmologist - treats eye defects, injuries, and diseases.

Oral and Maxillofacial Surgeon - surgically treats diseases, injuries, and defects
of the hard and soft tissues of the face, mouth, and jaws.

Orthopaedic Surgeon - preserves and restores the function of the

musculoskeletal system.

Otolaryngologist (Head and Neck Surgeon) - treats diseases of the ear, nose, and
throat,and some diseases of the head and neck, including facial plastic surgery.

Pathologist - diagnoses and treats the study of the changes in body tissues and
organs which cause or are caused by disease

Pediatrician - treats infants, toddlers, children and teenagers.

Plastic Surgeon - restores, reconstructs, corrects or improves in the shape and

appearance of damaged body structures, especially the face.

Podiatrist - provides medical and surgical treatment of the foot.

Psychiatrist - treats patients with mental and emotional disorders.

Pulmonary Medicine Physician - diagnoses and treats lung disorders.

99
Radiation Onconlogist - diagnoses and treats disorders with the use of
diagnostic imaging, including X-rays, sound waves, radioactive substances,
and magnetic fields.

Diagnostic Radiologist - diagnoses and medically treats diseases and disorders of

internal structures of the body.

Rheumatologist - treats rheumatic diseases, or conditions characterized by

inflammation, soreness and stiffness of muscles, and pain in joints and associated
structures

Urologist - diagnoses and treats the male and female urinary tract and the male
reproductive system

100
 UNIT: 3

ROOTS, PREFIXES, SUFFIXES, ABBRVATIONS AND

This is a list of roots, suffixes, and prefixes used in medical terminology, their
meanings, and their etymology. There are a few rules when using medical roots.
Firstly, prefixes and suffixes, primarily in Greek, but also in Latin, have a
droppable -o-. As a general rule, this -o- almost always acts as a joint-stem to
connect two consonantal roots, e.g. arthr- + -o- + logy = arthrology. But generally,
the -o- is dropped when connecting to a vowel-stem; e.g. arthr- + itis = arthritis,
instead of arthr-o-itis. Secondly, medical roots generally go together according to
language: Greek prefixes go with Greek suffixes and Latin prefixes with Latin
suffixes. Although it is technically considered acceptable to create hybrid words,
it is strongly preferred to not mix different lingual roots.

3.1 common routs: elements referring to, usage and definition

Root Definition Example

aden- [Gr.] gland adenoma

blephar- [Gr.] eyelid blepharoplasty

cardi- [Gr.] heart cardiography

derm(at)- [Gr.] skin dermatitis

gastr- [Gr.] stomach gastrostomy

grav- [L.] heavy multigravida

lingu- [L.] tongue sublingual

phob- [Gr.] fear agoraphobia

spirat- [L.] breathe inspiratory

thorac- [Gr.] chest thoracoplasty

Abdomen abdomen

101
Acanth thorny, spiny

Acetabul acetabulum (hip socket)

Acou hearing

Acr extremities; height

Actin ray; radius

Adenoid adenoids

Aden gland

Adrenal adrenal gland

Adren adrenal gland

Aer air; gas

Albumin albumin

Algesi pain

Alveoli alveolus

Ambly dull; dim

Amni amnion

Amnion amnion

Amyl starch

Andr male

Angi vessel

Anis unequal; dissimilar

Ankyl crooked; stiff; bent

Antr antrum

102
An anus

Aort aorta

Aponeur aponeurosis

arche first; beginning

arteri artery

arteriol arteriole (small artery)

arthr joint

articul joint

atel imperfect; incomplete

ather yellowish; fatty plaque

atri atrium

aur ear

aut self

axill armpit

azot urea; nitrogen

bacteri bacteria

balan glans penis

bi life

bil bile

blast developing cell

blephar eyelid

103
brachi arm

bronch bronchus

bronchiol bronchiole

bucc cheek

burs bursa (cavity)

calc calcium

cancer cancer

carcin cancer

cardi heart

carp carpals (wrist bones)

caud tail; toward the lower part of

the body

cec cecum

celi abdomen (abdominal cavity)

cephal head

cerebell cerebellum

cerebr cerebrum, brain

cerumin cerumen (earwax)

cervic cervix

cheil lip

chir hand

cholangi bile duct

104
chol gall; bile

choledoch common bile duct

chondr cartilage

chori chorion

chrom color

clavic clavicle (collarbone)

clavicul clavicle (collarbone)

col colon

colp vagina

coni dust

conjunctiv conjunctiva

core pupil

corne cornea

coron heart

cortic cortex (outer layer of body

organ)

cor pupil

cost rib

crani cranium (skull)

cry cold

crypt hidden

culd culdesac

105
cutane skin

cyan blue

cyes pregnancy

cyst bladder; sac

cyt cell

dacry tear, tear duct

dactyl fingers or toes

dent tooth

dermat skin

derm skin

dextr right

diaphor sweat

diaphragmat diaphragm

dipl two; double

dips thirst

disk intervertebral disk

diverticul diverticulum

dors back (of the body)

duoden duodenum

dur hard; dura mater

dynam power or strength

ech sound

106
ectop located away from usual
place

electr electricity, electrical activity

embry embryo; to be full

emmetr a normal measues

encephal brain

endocrin endocrine

enter intestines

epididym epididymis

epiglott epiglottis

episi vulva

epitheli epithelium

erythr red

esophag esophagus

esthesi sensation, sensitivity, feeling

eti cause (of disease)

faci face

femor femur (upper leg bone)

fet fetus; unborn child

fibr fibrous tissue, fibers

fibul fibula (lower leg)

gangli ganglion

107
ganglion ganglion

gastr stomach

ger old age; aged

geront old age; aged

gingiv gum

glomerul glomerulus

gloss tongue

gluc sweetness; sugar

glyc sugar

glycos sugar

gnath jaw

gnos knowledge

gon seed

gravid pregnancy

gynec woman

gyn woman

hem bloo

blood

hepat liver

herni hernia

heter other

hidr sweat

108
hist tissue

hom same

home sameness; unchanging

humer humerus (upper arm bone)

hydr water

hymen hymen

hypn sleep

hyster uterus

iatr medicine; physician

ichthy fish

ile ileum

ili ilium

immun immune

irid iris

iri iris

ischi ischium

isch deficiency; blockage

is equal; same

jejun jejunum

kal potassium

kary nucleus

kerat cornea

109
kerat horny tissue; hard

kin movement

kinesi movement; motion

kyph hump

labi lips

labyrinth labyrinth

lacrim tear duct, tear

lact milk

lamin lamina (thin; flat plate or

layer)

lapar abdomen

laryng larynx

later side

lei smooth

leuk white

lingu tongue

lip fat

lith stone; calculus

lob lobe

lord bent forward

lymph lymph

macr abnormal largeness

110
mamm breast

mandibul mandible (lower jawbone)

mast breast

mastoid mastoid

maxill maxilla (upper jawbone)

meat meatus (opening)

melan black

mening meninges

menisc meniscus (crescent)

men menstruation

ment mind

metr uterus

mon one

morph form; shape

muc mucus

myc fungus

myel bone marrow; spinal cord

myelon bone marrow

myos muscle

myring eardrum

my muscle

narc stupor

111
nas nose

nat birth

necr death (cells; body)

nephr kidney

neur nerve

noct night

nyct night

nyctal night

ocul eye

olig scanty; few

omphal umbilicu; navel

onc tumor

onych nail

oo egg; ovum

oophor ovary

ophthalm eye

opt vision

orchid testis; testicle

orchi testis; testicle

orch testis; testicle

organ organ

or mouth

112
orth straight

oste bone

ot ear

ov egg

ox oxygen

pachy thick

palat palate

pancreat pancreas

papill nipple

parathyroid parathyroid gland

par bear; give birth to; labor

patell patella (kneecap)

path disease

part bear; give birth to; labor

pector chest

ped child; foot

pelv pelvis; pelvic bone

perine perineum

peritone peritoneum

petr stone

phac lens of the eye

phag eat; swallow

113
phak lens of the eye

phalang pharynx

phas speech

phleb vein

phot light

phren mind

physi nature

plasm plasma

pleur pleura

pneumat lung; air

pneum lung; air

pneumon lung; air

pod foot

poli gray matter

poikil varied; irregular

polyp polyp; small growth

poster back (of body)

prim first

proct rectum

prostat prostate gland

pseud fake; false

psych mind

114
pub pubis

puerper childbirth

pulmon lung

pupill pupil

pyel renal pelvis

pylor pylorus (pyloric sphincter)

py pus

pyr fever; heat

quadr four

rachi vertebra; spinal or

vertebral column

radic nerve root

radicul nerve root

radi radius (lower arm bone)

rect rectum

ren kidney

retin retina

rhabd rodshaped, striated

rhin nose

rhytid wrinkles

rhiz nerve root

salping fallopian (uterine) tube

115
sarc flesh; connective tissue

scapul scapula (shoulder bone)

scler sclera

scoli crooked, curved

seb sebum (oil)

sept septum

sial saliva

sigmoid sigmoid

sinus sinus

somat body

somn sleep

son sound

spermat spermatozoan; sperm

sperm spermatozoan; sperm

sphygm pulse

spir breathe; breathing

splen spleen

spondyl vertebra; spinal or

vertebral column

staped stapes (middle ear bone)

staphyl grapelike clusters

stern sternum (breastbone)

116
steth chest

stomat mouth

strept twisted chains

synovi synovia; synovial

membrane

system system

tars tarsals (ankle bones)

tars edge of eyelid; tarsal

(instep of foot)

tendin tendon

tend tendon

ten tendon

test testis; testicle

therm heat

thorac thorax (chest)

thromb clot

thym thymus gland

thyroid thyroid gland

thyr thyroid gland

tibi tibia (lower leg bone)

tom cut; section

ton tension, pressure

tonsill tonsils

117
top place

toxic poison

trachel neck; necklike

trache trachea

trich hair

tympan eardrum; middle ear

uln ulna (lower arm bone)

ungu nail

ureter ureter

urethr urethra

urin urine; urinary tract

ur urine; urinary tract

uter uterus

uvul uvula

vagin vagina

valv valve

valvul valve

vas vessel; duct

ven vein

ventricul ventricle

vertebr vertebra; spinal or

vertebral column

118
vesic bladder; sac

vesicul seminal vesicles

viscer internal organs

vulv vulva

xanth yellow

xer dry

Definition:

This is a list of abbreviations used in medical prescriptions (sometimes referred

to as sig codes). This listing does not include abbreviations for actual
pharmaceuticals (which is a separate article in itself). Capitalization and the use of
periods is a matter of style. In the attached list, Latin is not capitalized whereas
English acronyms are. The period is used wherever there are letters omitted in the
abbreviation. Abbreviations which are officially not to be used as required by
the Joint Commission are marked in red. Those abbreviations which are
discouraged from use by other organizations are marked in orange.

3.2 common prefix and suffix:

List of abbreviations used in medical prescription

Abbreviation Latin Meaning Possible confusion

Aa Ana of each

AAA apply to affected

area

a.c. ante cibum before meals

a.d. auris dextra right ear "a" can be mistaken as an

"o" which could read

119
 "o.d.", meaning right eye

ad lib. ad libitum use as much as one

desires; freely

admov. admove Apply

Agit Agita stir/shake

alt. h. alternis horis every other hour

a.m.m. ad manu at doctors hand

medicae

a.m. ante morning, before

meridiem noon

Amp Ampule

Amt Amount

Aq Aqua Water

a.l., a.s. auris laeva, left ear "a" can be mistaken as an

auris sinistra "o" which could read
"o.s." or "o.l", meaning
left eye

A.T.C. around the clock

a.u. auris utraque both ears "a" can be mistaken as an

"o" which could read
"o.u.", meaning both eyes

Bis Bis Twice

b.d./b.i.d. bis in die twice daily

B.M. bowel movement

BNF British National

120
 Formulary

bol. bolus as a large single

dose (usually
intravenously)

B.S. blood sugar

B.S.A body surface areas

b.t. Bedtime mistaken for "b.i.d",

meaning twice daily

BUCC bucca inside cheek

cap., caps. capsula Capsule

c, c. Cum with (usually

written with a bar
on top of the "c")

cib. Cibus Food

Cc cum cibo with food, (but also mistaken for "U",

cubic centimetre) meaning units; also has
an ambiguous meaning;
use "mL" or "milliliters"

Cf with food

comp. Compound

cr., crm Cream

CST Continue same

treatment

D or d days or doses ambiguous meaning,

write out "days" or
"doses"

121
D5W dextrose 5%
solution (sometimes
written as D5W)

D5NS dextrose 5% in
normal saline
(0.9%)

D.A.W. dispense as written

(i.e., no generic
substitution)

dc, D/C, disc discontinue or ambiguous meaning

discharge

dieb. alt. diebus every other day

alternis

dil. Dilute

disp. dispersible or
dispense

div. Divide

dL Deciliter

d.t.d. dentur tales give of such doses

doses

DTO deodorized tincture can easily be confused

of opium with "diluted tincture of
opium," which is 1/25th
the strength of
deodorized tincture of
opium; deaths have
resulted due to massive
morphine overdose

122
D.W. distilled water

elix. Elixir

e.m.p. exmodo as directed

prescripto

emuls. emulsum Emulsion

Et Et And

Eod every other day

ex aq ex aqua in water

fl., fld. Fluid

ft. Fiat make; let it be made

G Gram

Gr Grain

gtt(s) gutta(e) drop(s)

H Hypodermic

h, hr Hora Hour

h.s. hora somni at bedtime

h.s hour sleep or half- ambiguous meaning

strength

ID Intradermal

IJ, inj injectio Injection mistaken for "IV",

meaning intravenously

IM intramuscular (with
respect to
injections)

123
IN Intranasal mistaken for "IM",
meaning intramuscular,
or "IV", meaning
intravenously

IP intraperitoneal

IU international unit mistaken for "IV" or

"10", spell out
"international unit"

IV intravenous

IVP intravenous push

IVPB intravenous
piggyback

Kg Kilogram

L.A.S. label as such

LCD coal tar solution

Lin linimentum Liniment

Liq liquor Solution

lot. Lotion

MAE Moves All

Extremities

Mane Mane in the morning

M. Misce Mix

m, min minimum a minimum

Mcg microgram Recommended

replacement for "µg"

124
 which may be confused
with "mg"

m.d.u. more dicto to be used as

utendus directed

mEq milliequivalent

Mg Milligram

mg/dL milligrams per

deciliter

MgSO4 magnesium sulfate may be confused with

"MSO4", spell out
"magnesium sulfate"

mist. mistura Mix

Mitte Mitte Send

Ml Milliliter

MS morphine can mean either

sulfate ormagnesiu morphine sulfate or
m sulfate magnesium sulfate, spell
out either

MSO4 morphine sulfate may be confused with

"MgSO4", spell out
"morphine sulfate"

Nebul nebula a spray

N.M.T. not more than

noct. Nocte at night

non rep. non repetatur no repeats

125
NPO nil per os nothing by mouth

NS normal saline
(0.9%)

1/2NS half normal saline

(0.45%)

N.T.E. not to exceed

o_2 both eyes,

sometimes written
as o2

Od omne in die every day/once

daily (preferred to
qd in the UK[4])

Od oculus dexter right eye "o" can be mistaken as an

"a" which could read
"a.d.", meaning right ear,
confusion with omne in
die

Om omne mane every morning

On omne nocte every night

o.p.d. once per day

o.s. oculus left eye "o" can be mistaken as an

sinister "a" which could read
"a.s.", meaning left ear

o.u. oculus both eyes "o" can be mistaken as an

uterque "a" which could read
"a.u.", meaning both ears

Oz ounce

126
Per Per by or through

p.c. post cibum after meals

pig./pigm. pigmentum Paint

p.m. post evening or

meridiem afternoon

p.o. per os by mouth or orally

p.r. per rectum by rectum

PRN, prn pro re nata as needed

pulv. pulvis Powder

PV per vaginam via the vagina

Q quaque every, per

q.a.d. quaque every other day

alternis die

q.a.m. quaque die every day before

ante noon
meridiem

q.d.s. quater die four times a day can be mistaken for "qd"
sumendus (every day)

q.p.m. quaque die every day after

post noon or every
meridiem evening

q.h. quaque hora every hour

q.h.s. quaque hora every night at

somni bedtime

q.1 h, q.1° quaque 1 hora every 1 hour; (can

127
 replace "1" with
other numbers)

q.d., q1d quaque die every day mistaken for "QOD" or

"qds," spell out "every
day" or "daily"

q.i.d. quater in die four times a day can be mistaken for "qd"
or "qod," write out "four
times a day"

q4PM at 4pm mistaken to mean every

four hours

q.o.d. every other day mistaken for "QD," spell

out "every other day"

Qqh quater quaque every four hours

hora

q.s. quantum a sufficient quantity

sufficiat

QWK every week

R Rectal

rep., rept. repetatur Repeats

RL, R/L Ringer's lactate

S Sine without (usually

written with a bar
on top of the "s")

s.a. secundum according to the art

artem (accepted practice);
use your judgement

128
SC, subc, Subcutaneous "SC" can be mistaken for
subcut, subq, "SL," meaning
SQ sublingual; "SQ" can be
mistaken for "5Q"
meaning five every dose

s.i.d/SID semel in die once a day used exclusively in

veterinary medicine

Sig Signa write on label

SL sublingually, under
the tongue

Sol solutio Solution

s.o.s., si op. sit si opus sit if there is a need

Ss Semis one half or sliding mistaken for "55" or

scale "1/2"

SSI, SSRI sliding scale insulin mistaken to mean

or sliding scale "strong solution of iodine
regularinsulin " or "selective serotonin
reuptake inhibitor"

SNRI Serotonin–
(antidepressant norepinephrine
) reuptake inhibitor

SSRI selective serotonin

(antidepressant reuptake inhibitor
)
(a specific class of
antidepressant)

Stat statim Immediately

SubQ subcutaneously

129
Supp Suppositoriu suppository
m

Susp Suspension

Syr syrupus Syrup

Tab tabella Tablet

tal., t talus Such

Tbsp tablespoon

Troche trochiscus Lozenge

t.d.s. ter die three times a day

sumendum

t.i.d. ter in die three times a day

t.i.w. three times a week mistaken for twice a

week

top. Topical

T.P.N. total parenteral

nutrition

tr, tinc., tinct. Tincture

Tsp teaspoon

U Unit mistaken for a "4", "0" or

"cc", spell out "unit"

u.d., ut. dict. ut dictum as directed

ung. unguentum Ointment

U.S.P. United States

Pharmacopoeia

130
Vag Vaginally

W With

w/a while awake

Wf with food (with

meals)

w/o, s Without

X Times

Y.O. years old

Μg microgram mistaken for "mg",

meaning milligram

List of symbols used in prescriptions

Symbols Latin Meaning Possible confusion

@ At mistaken for "2"; spell

out "at"

> greater than mistaken for a "7"

< less than mistaken for an "L"

 recipe take, take this, or

take thus

When expressing a numerical quantity, roman numerals are commonly used in

place of actual digits so as to avoid confusion and foil attempts to receive more
medication than prescribed. For numbers 1-3 however, a special abbreviation is
used. The number one is written as a capital letter T with one dot overhead. The
number two consists of two capital "T" letters connected at the top with a dot over
each (resembling the Greek letter pi). The number three is likewise three "T"

131
letters with three dots overhead. A similar system of numbering exists using the
lower case letter "i" for the number one.

• 2 Discouraged practices

• Abbreviating names of drugs

• Using apothecary's units

• Using trailing zeros or not using a leading zero

3.3 Common , Abbreviations and Symbols

Each facility will have a list of approved acronyms, abbreviations, and symbols. P
lease ask to review this list at each facility. An acronym or abbreviation may have

more than one meaning. Evaluate the acronym or abbreviation in context. abbrevi
ations that the Joint Commission for Accreditation of Healthcare Facilities require
s for all healthcare institutions. Each facility is also supposed to add additional “d
o not use” acronyms, etc. Do NOT use these acronyms, abbreviations, or symbols
. You will still see them in charts (old habits die hard) so you need to know them.
In addition, drug names are not to be abbreviated with the exception of ASA, HC
TZ, and vitamins.

In addition to the abbreviation, you should know the definition of the word or hav
e an idea of the condition described by the acronym or abbreviation. You should a
lso know metric abbreviations (L, mg, ml, etc) and abbreviations of common mine
rals along with valence.

ā before (ante) act before meals

AAA abdominal aortic aneurysm, acute anxiety attack

AAAAA aphasia, amnesia, paraxial, graphic, alexia

ACE angiotensin-converting enzyme

ACLS advanced cardiac life support

AD admitting diagnosis

132
ADH ant diuretic hormone

ADL activities of daily living ad lib as desired AH abdominal hysterectomy

AHD arteriosclerotic heart disease

AIDS acquired immune deficiency syndrome

AK above the knee AKA above the knee amputation AMA

against medical advice; American Medical Association

AMI acute myocardial infarction ANP advanced nurse practitioner ARC

AIDS-related complex

ARF acute renal failure

ARI acute respiratory infection

ARDS adult respiratory distress syndrome; acute respiratory distress syndrome.

art arterial2

ATN acute tubular necrosis

ASA aspirin

ASCVD arteriosclerotic cardiovascular disease

ATN acute tubular necrosis

Aus© auscultation A&W alive and well

BG blood glucose

bid twice daily

Bil(at) bilateral

BK below knee BKA below the knee amputation BLE both lower extremities

BM bowel movement; bone marrow

133
B/O because of bol bolus

BP blood pressure; bathroom privileges; bedpan

BPH benign prostatic hypertrophy

bronch bronchoscopy; bronchoscope

BS blood sugar BSA body surface area BSN Bachelor of Science in Nursing

CA cancer, carcinoma

CAB coronary artery bypass

CABG coronary artery bypass graft

CAD coronary artery disease

CAT computerized axial tomography

cath catheter, catheterize

CC chief complaint; complications and co-morbidities

CCRN Certified Critical Care Registered Nurse

CCU cardiac care unit, coronary care unit

CEU continuing education unit

CICU cardiac (coronary) intensive care unit

CHF congestive heart failure

CAPD continuous ambulatory peritoneal dialysis

CKD chronic kidney disease

CN charge nurse

CNM certified nurse -midwife; clinical nurse manager CNSN

Certified Nutrition Support Nurse

134
COPD chronic obstructive pulmonary disease CP chest pain3

CPAP continuous (constant) positive airway pressure

CRF chronic renal failure

CSF cerebrospinal fluid

CVA cerebrovascular accident

CVD cardiovascular disease

CXR chest x-ray

DAT diet as tolerated DC, dc discontinue

D/C discharge (unacceptable abbreviation) DD differential diagnosis

decub lying down (decubitus) DM diabetes mellitus

DNR do not resuscitate

DOB date of birth

DOA date of admission DOE dyspnea on exertion DON director of nurses

Decub decubitus ulcer DRG Diagnosis Related Group

DSM Diagnostic and Statistical Manual of Mental Disorders

DT delirium tremens

DVT deep vein thrombosis

DW distilled water; dry weight

Dx diagnosis

EBL estimated blood loss

EC enteric coated

135
ECF extended care facility

Echo echocardiogram E coli Escherichia coli ECMO

extracorporeal membrane oxygenation ECV extracellular volume

ECW extracellular water ED emergency department

EDC estimated date of confinement

edent edentulous

EEG electroencephalogram EENT eye, ear, nose, throat4

EEP end expiratory pressure

EF ejection fraction EFA essential fatty acids

EGA estimated gestational age

EKG electrocardiogram ELISA

enzyme-linked immunosorbent assay (immunological testing) EN
enteral nutrition EOMB explanation of medical benefits

EPAP expiratory positive airway pressure

EPI epinephrine

EPO erythropoietin

EPS extrapyramidal symptoms

ESLD end-stage liver disease ESRD end-stage renal disease

ET endotracheal tube ETD estimated time of death

Etiol etiology

ETOH ethyl alcohol

Exp expired

F female

136
FBG fasting blood glucose

FAS fetal alcohol syndrome

FBS fasting blood sugar FOB foot of bed FTN full-term nursery

FTP failure to progress

FTT failure to thrive

F/O follow-up FUO fever of undetermined origin

Fx fracture G GALT gut-associated lymphoid tissue GB gallbladder GBD

gallbladder disease

GBS gallbladder series

GC gonococcus

GERD gastroesophageal reflux disease

GFR glomerular filatration rate GI gastrointestinal

G gravida GSW gunshot wound5

GU gastric ulcer, genitourinary

HA headache

HCO3 bicarbonate HCTZ hydrochlorothiazide HDN

hemolytic disease of the newborn

HD hemodialysis

HEENT head, eyes, ears, nose, and throat

hemi hemiplegia, hemiplegic

HH hiatal hernia

HHNKS hyperglycemic, hyperosomolar nonketotic syndrome

137
HI head injury

HIV hum immunodeficiency virus

HL hearing loss

HLHS hypoplastic left heart syndrome

H&N head and neck

H&P history and physical

H/O; h/o history of

HOB head of bed

HOH hard of hearing HR heart rate

hs bedtime

Htn hypertension Hx history

IBD inflammatory bowel disease

IBS irritable bowel syndrome

ICW intracellular water

IGT impaired glucose tolerance

IHD ischemic heart disease

INH isoniazid

I & O intake and output

IUGR intrauterine growth retardation

IVP intravenous pyelography; intravenous push

IVPB Intravenous piggyback

ISVD interventricular septal defect

138
J6

JCAHO Joint Commission on Accreditation of Healthcare Organizations

K potassium KCl potassium chloride KDC infant warming bed KLS

kidney, liver, spleen

KVO keep vein open (IV rate of usually 25 cc/hr with NS or D5W) KUB
kidney, ureter, bladder

lap Laporotomy

LBW Low birth weight

LCSW Licensed clinical social worker LES lower Esopohageal spinChter LFT
liver function tests

LGA large for gestational age

LLQ lower left quadrant LMP last menstrual period LOC

laxative of choice (unacceptable abbreviation); level of consciousness

LOS length of stay

LP lumbar puncture

LR lactated ringers

LRQ lower right quadrant

LTC long term care

LVH left ventricular hypertrophy

lytes electrolytes M M Male, married MAOI monamine oxidase inhibitor

MDD major depressive disorder mec meconium med-surg medical-surgical

MEq milliequivalents

139
MEq/L milliequivalents per liter met(s) metastasis, metastasize, metastasizing
MI myocardial infarction

MICU medical intensive care unit

MM millimole

M&M morbidity & mortality

mmHg millimeters of mercury (BP unit)7

MO mineral oil; months old

MOM milk of magnesia

Mono monocyte; mononucleosis

Mosm milliosmol

MR magnetic resonance; medical records; mental retardation MRSA

methicillin resistant staph aureus

MRI magnetic resonance imaging MS mitral stenosis; multiple sclerosis

MSW Master of Social Work

MT medical technologist

MVA motor vehicle accident MVP mitral valve prolapse

N/A not available

NAD no acute distress

NAS no added salt

NEC necrotizing enterocolitis

NG(T) nasogastric (tube) NH(P) nursing home (placement) NKA

no known allergies

Nl normal

140
NIDDM non-insulin dependant diabetes mellitus (not to be used anymore) NOS
not otherwise specified; no organisms seen

NPO nil per os (nothing by mouth) NS normal saline; neurosurgey

NSAID nonsteroidal anti-inflammatory drug N & V nausea meting

NVD nausea, vomiting, diarrhea

O OB obstetrics

OBS organic brain syndrome

OC oral contraceptive

OOB out of bed

OR operating room Ortho orthopedics

O2 sat oxygen saturation OT occupational therapy

OTC over-the-counter8

p post; after P para; phosphorus; pulse

PA pernicious anemia; Physician’s Assistant

P&A percussion and auscultation PACU postanaesthesia care unit

Para para (nullipara, primiparia, Para !, Para II, etc) Path pathology

p.c. after meals

PCA patient-controlled analgesia

PVN penicillin

PCOD polycystic ovarian disease

PDA patent ductus arteriosus

PE pelvic exam; physical exam PEEP positive end-expiratory pressure

141
PEG percutaneous endoscopic gastrostomy

PERRLA pupils equal, round, reactive to light and accommodation PFT

pulmonary function test

PH past history

PT physical therapy

PTA prior to admission/arrival

PICC peripherally inserted central catheter PIP positive

aspiratory pressure

PKU phenylketonuria

PMH past medical history

PN parenteral nutrition PO; po per os (by mouth); phone order POD#

postoperative day#

Post-op postoperative

PP postpartum; post-prandial

PPBS post-prandial blood sugar PR; pr per rectum Pre-op pre-operative

PRN pro re nata (as necessary) Prog prognosis; progress

PSA prostate specific antigen PTA prior to admission PUD

peptic ulcer disease

Pulm pulmonary

PVC premature ventricular contraction P/Y; PY pack year (cigarettes)9

q every

QD; qd every day (unacceptable abbreviation) QH; qh every hour QOD; qod
every other day (unacceptable abbreviation)

142
R

R rectal; respiration; right

RA rheumatoid arthritis; right atrium; room air Resp respiratory; respiration

RDS respiratory distress syndrome

Re concerning Rh rhesus factor (will be + or -) RIA radioimmunoassay

RLE right lower extremity

RLL right lower lobe

RLQ right lower quadrant

RN registered nurse

R/O rule out

ROM range of motion; rupture of membranes

ROS review of symptoms

RQ respiratory quotient

RR respiratory rate; recovery room RRR regular rate and rhythm RT

respiratory therapist; radiation therapy

RUE right upper extremity

RUQ right upper quadrant Rx prescription, take, therapy, treatment

s without SAH subarachnoid hemorrhage SB small bowel; short bowel

SBE shortness of breath on exertion, subacute bacterial endocarditis

SBO small bowel obstruction SC sickle cell

SCN special care nursery

143
SGA small for gestational age SIADH
syndrome of inappropriate antidiuretic hormone

SIDS sudden infant death syndrome10

SLE systemic lupus erythematosus

SNF skilled nursing facility

SO significant other S/O signed out

SOAP subjective, objective, assessment, plan SOB shortness of breath Sol

solution

S/P; s/p status post

SQ subcutaneous

S&S, S/S signs and symptoms

ss; SS;SSE soapsuds (enema) s s one-half (not acceptable) ST speech therapist

Staph staphyloccus

STD sexually transmitted disease; short-term disability

stat statim (immediately) Strep streptococcus

Subq subcutaneous

supp suppository

susp suspension Sz seizure

T, temp temperature; time

T max maximum temperature

tab tablet

TAC temporal artery catheter

144
tachy tachycardia

TAH total abdominal hysterectomy

TB tuberculosis

TBSA total burn surface area TBLC term birth, living child

TBW total body water T&C type and crossmatch

TF tube feeding THR total hip replacement

TIA transient ischemic attack

tid three times a day

TO telephone order

top topically

Lol tolerate, tolerated, tolerance

TPN total parenteral nutrition

TURP transurethral resection of prostate

TWE tap water enema11

Tx treatment

U, u unit (unacceptable abbreviation) UAC umbilical artery catheter UAO

upper airway obstruction unk unknown

UOP urinary output

up ad lib up (out of bed) as disired (adlibitum) UR

upper respiratory; utilization review

URI upper respiratory infection Urol urology; urologist

US; U/S ultrasound

145
USP United States Pharmacopeia

UTI urinary tract infection

V ventricular; volume

VH vaginal hysterectomy

V/D vomiting and diarrhea

Vent ventral; ventricular; ventilator viz that is, namely

VLBW very low birth weight

VO verbal order VO2 oxygen consumption vol volume

VP venous pressure

VRSA vancomycin resistant staph aureus

VS vital signs

W white; widowed WB weight bearing WBN well baby nursery

WC; w/c wheelchair w/d well developed; warm and dry

WD well developed WF; wf white female

WFL within functional limits

WM; wm white male12

WN;w/n well nourished

WNL within normal limits

Wt weight

W/U;w/u work-up

146
X times

X-match cross match

YO; y/o year(s) old

YTD year to date

Departments:

1. A distinct, usually specialized division of a large organization, especially:

a. A principal administrative division of a government: the department of public

works.

b. A division of a business specializing in a particular product or

service: the personnel department.

c. A division of a school or college dealing with a particular field of

knowledge: the physics department.

2. Department One of the principal executive divisions of the federal

government of the United States, headed by a cabinet officer.

3. A section of a department store selling a particular line of

merchandise: the home furnishings department.

4. An administrative district in France.

5. A unit of a warship's crew, organized by function, such as gunnery

or engineering.

6. An area of particular knowledge or responsibility; a specialty: Getting the kids

to bed is my department.

147
Time:

Definition:

Common time (also “imperfect time”) refers to the 4/4time signature, which
signifies four quarter-note beats per measure. It may be written as a fraction, or
with a c-shaped semicircle. If this symbol has a vertical strikethrough, it’s known
as “cut common time.”

Alphabetically sorted - click on any acronym or abbreviation for more

information. Note that some of the abbreviations are not unique, these will have
several entries in the list. Other time zones have many common names, and each
of these will be listed as well.

Abbreviation Full name Location Time zone

A Alpha Time Zone Military UTC + 1 hour

ACDT Australian Central Daylight Australia UTC + 10:30

Time hours

ACST Australian Central Standard Australia UTC + 9:30

Time hours

ADT Atlantic Daylight Time Atlantic UTC - 3

hours

ADT Atlantic Daylight Time North UTC - 3

America hours

AEDT Australian Eastern Australia UTC + 11

Daylight Time hours

AEST Australian Eastern Standard Australia UTC + 10

Time hours

AFT Afghanistan Time Asia UTC + 4:30

hours

148
AKDT Alaska Daylight Time North UTC - 8
America hours

AKST Alaska Standard Time North UTC - 9

America hours

ALMT Alma-Ata Time Asia UTC + 6

hours

AMST Armenia Summer Time Asia UTC + 5

hours

AMST Amazon Summer Time South UTC - 3

America hours

AMT Armenia Time Asia UTC + 4

hours

AMT Amazon Time South UTC - 4

America hours

ANAST Anadyr Summer Time Asia UTC + 12

hours

ANAT Anadyr Time Asia UTC + 12

hours

AQTT Aqtobe Time Asia UTC + 5

hours

ART Argentina Time South UTC - 3

America hours

AST Arabia Standard Time Asia UTC + 3

hours

AST Atlantic Standard Time Atlantic UTC - 4

hours

149
AST Atlantic Standard Time Caribbean UTC - 4
hours

AST Atlantic Standard Time North UTC - 4

America hours

AWDT Australian Western Daylight Australia UTC + 9

Time hours

AWST Australian Western Standard Australia UTC + 8

Time hours

AZOST Azores Summer Time Atlantic UTC

AZOT Azores Time Atlantic UTC - 1 hour

AZST Azerbaijan Summer Time Asia UTC + 5

hours

AZT Azerbaijan Time Asia UTC + 4

hours

B Bravo Time Zone Military UTC + 2

hours

BNT Brunei Darussalam Time Asia UTC + 8

hours

BOT Bolivia Time South UTC - 4

America hours

BRST Brasilia Summer Time South UTC - 2

America hours

BRT Brasília time South UTC - 3

America hours

BST Bangladesh Standard Time Asia UTC + 6

hours

150
BST British Summer Time Europe UTC + 1 hour

BTT Bhutan Time Asia UTC + 6

hours

C Charlie Time Zone Military UTC + 3

hours

CAST Casey Time Antarctica UTC + 8

hours

CAT Central Africa Time Africa UTC + 2

hours

CCT Cocos Islands Time Indian Ocean UTC + 6:30

hours

CDT Cuba Daylight Time Caribbean UTC - 4

hours

CDT Central Daylight Time North UTC - 5

America hours

CEST Central European Summer Time Europe UTC + 2

hours

CET Central European Time Africa UTC + 1 hour

CET Central European Time Europe UTC + 1 hour

CHADT Chatham Island Daylight Time Pacific UTC + 13:45

hours

CHAST Chatham Island Standard Time Pacific UTC + 12:45

hours

CKT Cook Island Time Pacific UTC - 10

hours

CLST Chile Summer Time South UTC - 3

151
 America hours

CLT Chile Standard Time South UTC - 4

America hours

COT Colombia Time South UTC - 5

America hours

CST China Standard Time Asia UTC + 8

hours

CST Central Standard Time Central UTC - 6

America hours

CST Cuba Standard Time Caribbean UTC - 5

hours

CST Central Standard Time North UTC - 6

America hours

CVT Cape Verde Time Africa UTC - 1 hour

CXT Christmas Island Time Australia UTC + 7

hours

ChST Chamorro Standard Time Pacific UTC + 10

hours

D Delta Time Zone Military UTC + 4

hours

DAVT Davis Time Antarctica UTC + 7

hours

E Echo Time Zone Military UTC + 5

hours

EASST Easter Island Summer Time Pacific UTC - 5

hours

152
EAST Easter Island Standard Time Pacific UTC - 6
hours

EAT Eastern Africa Time Africa UTC + 3

hours

EAT East Africa Time Indian Ocean UTC + 3

hours

ECT Ecuador Time South UTC - 5

America hours

EDT Eastern Daylight Time Caribbean UTC - 4

hours

EDT Eastern Daylight Time North UTC - 4

America hours

EDT Eastern Daylight Time Pacific UTC + 11

hours

EEST Eastern European Summer Time Africa UTC + 3

hours

EEST Eastern European Summer Time Asia UTC + 3

hours

EEST Eastern European Summer Time Europe UTC + 3

hours

EET Eastern European Time Africa UTC + 2

hours

EET Eastern European Time Asia UTC + 2

hours

EET Eastern European Time Europe UTC + 2

hours

153
EGST Eastern Greenland Summer North UTC
Time America

EGT East Greenland Time North UTC - 1 hour

America

EST Eastern Standard Time Central UTC - 5

America hours

EST Eastern Standard Time Caribbean UTC - 5

hours

EST Eastern Standard Time North UTC - 5

America hours

ET Tiempo del Este Central UTC - 5

America hours

ET Tiempo del Este Caribbean UTC - 5

hours

ET Tiempo Del Este North UTC - 5

America hours

F Foxtrot Time Zone Military UTC + 6

hours

FJST Fiji Summer Time Pacific UTC + 13

hours

FJT Fiji Time Pacific UTC + 12

hours

FKST Falkland Islands Summer Time South UTC - 3

America hours

FKT Falkland Island Time South UTC - 4

America hours

154
FNT Fernando de Noronha Time South UTC - 2
America hours

G Golf Time Zone Military UTC + 7

hours

GALT Galapagos Time Pacific UTC - 6

hours

GAMT Gambier Time Pacific UTC - 9

hours

GET Georgia Standard Time Asia UTC + 4

hours

GFT French Guiana Time South UTC - 3

America hours

GILT Gilbert Island Time Pacific UTC + 12

hours

GMT Greenwich Mean Time Africa UTC

GMT Greenwich Mean Time Europe UTC

GST Gulf Standard Time Asia UTC + 4

hours

GYT Guyana Time South UTC - 4

America hours

H Hotel Time Zone Military UTC + 8

hours

HAA Heure Avancée de l'Atlantique Atlantic UTC - 3

hours

HAA Heure Avancée de l'Atlantique North UTC - 3

America hours

155
HAC Heure Avancée du Centre North UTC - 5
America hours

HADT Hawaii-Aleutian Daylight Time North UTC - 9

America hours

HAE Heure Avancée de l'Est Caribbean UTC - 4

hours

HAE Heure Avancée de l'Est North UTC - 4

America hours

HAP Heure Avancée du Pacifique North UTC - 7

America hours

HAR Heure Avancée des Rocheuses North UTC - 6

America hours

HAST Hawaii-Aleutian Standard Time North UTC - 10

America hours

HAT Heure Avancée de Terre-Neuve North UTC - 2:30

America hours

HAY Heure Avancée du Yukon North UTC - 8

America hours

HKT Hong Kong Time Asia UTC + 8

hours

HLV Hora Legal de Venezuela South UTC - 4:30

America hours

HNA Heure Normale de l'Atlantique Atlantic UTC - 4

hours

HNA Heure Normale de l'Atlantique Caribbean UTC - 4

hours

156
HNA Heure Normale de l'Atlantique North UTC - 4
America hours

HNC Heure Normale du Centre Central UTC - 6

America hours

HNC Heure Normale du Centre North UTC - 6

America hours

HNE Heure Normale de l'Est Central UTC - 5

America hours

HNE Heure Normale de l'Est Caribbean UTC - 5

hours

HNE Heure Normale de l'Est North UTC - 5

America hours

HNP Heure Normale du Pacifique North UTC - 8

America hours

HNR Heure Normale des Rocheuses North UTC - 7

America hours

HNT Heure Normale de Terre-Neuve North UTC - 3:30

America hours

HNY Heure Normale du Yukon North UTC - 9

America hours

HOVT Hovd Time Asia UTC + 7

hours

I India Time Zone Military UTC + 9

hours

ICT Indochina Time Asia UTC + 7

hours

157
IDT Israel Daylight Time Asia UTC + 3
hours

IOT Indian Chagos Time Indian Ocean UTC + 6

hours

IRDT Iran Daylight Time Asia UTC + 4:30

hours

IRKST Irkutsk Summer Time Asia UTC + 9

hours

IRKT Irkutsk Time Asia UTC + 9

hours

IRST Iran Standard Time Asia UTC + 3:30

hours

IST Israel Standard Time Asia UTC + 2

hours

IST India Standard Time Asia UTC + 5:30

hours

IST Irish Standard Time Europe UTC + 1 hour

JST Japan Standard Time Asia UTC + 9

hours

K Kilo Time Zone Military UTC + 10

hours

KGT Kyrgyzstan Time Asia UTC + 6

hours

KRAST Krasnoyarsk Summer Time Asia UTC + 8

hours

KRAT Krasnoyarsk Time Asia UTC + 8

158
 hours

KST Korea Standard Time Asia UTC + 9

hours

KUYT Kuybyshev Time Europe UTC + 4

hours

L Lima Time Zone Military UTC + 11

hours

LHDT Lord Howe Daylight Time Australia UTC + 11

hours

LHST Lord Howe Standard Time Australia UTC + 10:30

hours

LINT Line Islands Time Pacific UTC + 14

hours

M Mike Time Zone Military UTC + 12

hours

MAGST Magadan Summer Time Asia UTC + 12

hours

MAGT Magadan Time Asia UTC + 12

hours

MART Marquesas Time Pacific UTC - 9:30

hours

MAWT Mawson Time Antarctica UTC + 5

hours

MDT Mountain Daylight Time North UTC - 6

America hours

MESZ Mitteleuropäische Sommerzeit Europe UTC + 2

159
 hours

MEZ Mitteleuropäische Zeit Africa UTC + 1 hour

MHT Marshall Islands Time Pacific UTC + 12

hours

MMT Myanmar Time Asia UTC + 6:30

hours

MSD Moscow Daylight Time Europe UTC + 4

hours

MSK Moscow Standard Time Europe UTC + 4

hours

MST Mountain Standard Time North UTC - 7

America hours

MUT Mauritius Time Africa UTC + 4

hours

MVT Maldives Time Asia UTC + 5

hours

MYT Malaysia Time Asia UTC + 8

hours

N November Time Zone Military UTC - 1 hour

NCT New Caledonia Time Pacific UTC + 11

hours

NDT Newfoundland Daylight Time North UTC - 2:30

America hours

NFT Norfolk Time Australia UTC + 11:30

hours

NOVST Novosibirsk Summer Time Asia UTC + 7

160
 hours

NOVT Novosibirsk Time Asia UTC + 6

hours

NPT Nepal Time Asia UTC + 5:45

hours

NST Newfoundland Standard Time North UTC - 3:30

America hours

NUT Niue Time Pacific UTC - 11

hours

NZDT New Zealand Daylight Time Antarctica UTC + 13

hours

NZDT New Zealand Daylight Time Pacific UTC + 13

hours

NZST New Zealand Standard Time Antarctica UTC + 12

hours

NZST New Zealand Standard Time Pacific UTC + 12

hours

O Oscar Time Zone Military UTC - 2

hours

OMSST Omsk Summer Time Asia UTC + 7

hours

OMST Omsk Standard Time Asia UTC + 7

hours

P Papa Time Zone Military UTC - 3

hours

PDT Pacific Daylight Time North UTC - 7

161
 America hours

PET Peru Time South UTC - 5

America hours

PETST Kamchatka Summer Time Asia UTC + 12

hours

PETT Kamchatka Time Asia UTC + 12

hours

PGT Papua New Guinea Time Pacific UTC + 10

hours

PHOT Phoenix Island Time Pacific UTC + 13

hours

PHT Philippine Time Asia UTC + 8

hours

PKT Pakistan Standard Time Asia UTC + 5

hours

PMDT Pierre & Miquelon Daylight North UTC - 2

Time America hours

PMST Pierre & Miquelon Standard North UTC - 3

Time America hours

PONT Pohnpei Standard Time Pacific UTC + 11

hours

PST Pacific Standard Time North UTC - 8

America hours

PST Pitcairn Standard Time Pacific UTC - 8

hours

PT Tiempo del Pacífico North UTC - 8

162
 America hours

PWT Palau Time Pacific UTC + 9

hours

PYST Paraguay Summer Time South UTC - 3

America hours

PYT Paraguay Time South UTC - 4

America hours

Q Quebec Time Zone Military UTC - 4

hours

R Romeo Time Zone Military UTC - 5

hours

RET Reunion Time Africa UTC + 4

hours

S Sierra Time Zone Military UTC - 6

hours

SAMT Samara Time Europe UTC + 4

hours

SAST South Africa Standard Time Africa UTC + 2

hours

SBT Solomon IslandsTime Pacific UTC + 11

hours

SCT Seychelles Time Africa UTC + 4

hours

SGT Singapore Time Asia UTC + 8

hours

SRT Suriname Time South UTC - 3

163
 America hours

SST Samoa Standard Time Pacific UTC - 11

hours

T Tango Time Zone Military UTC - 7

hours

TAHT Tahiti Time Pacific UTC - 10

hours

TFT French Southern and Antarctic Indian Ocean UTC + 5

Time hours

TJT Tajikistan Time Asia UTC + 5

hours

TKT Tokelau Time Pacific UTC + 13

hours

TLT East Timor Time Asia UTC + 9

hours

TMT Turkmenistan Time Asia UTC + 5

hours

TVT Tuvalu Time Pacific UTC + 12

hours

U Uniform Time Zone Military UTC - 8

hours

ULAT Ulaanbaatar Time Asia UTC + 8

hours

UTC Universal Time Coordinated Universal UTC

UYST Uruguay Summer Time South UTC - 2

America hours

164
UYT Uruguay Time South UTC - 3
America hours

UZT Uzbekistan Time Asia UTC + 5

hours

V Victor Time Zone Military UTC - 9

hours

VET Venezuelan Standard Time South UTC - 4:30

America hours

VLAST Vladivostok Summer Time Asia UTC + 11

hours

VLAT Vladivostok Time Asia UTC + 11

hours

VUT Vanuatu Time Pacific UTC + 11

hours

W Whiskey Time Zone Military UTC - 10

hours

WAST West Africa Summer Time Africa UTC + 2

hours

WAT West Africa Time Africa UTC + 1 hour

WEST Western European Summer Africa UTC + 1 hour

Time

WEST Western European Summer Europe UTC + 1 hour

Time

WESZ Westeuropäische Sommerzeit Africa UTC + 1 hour

WET Western European Time Africa UTC

WET Western European Time Europe UTC

165
WEZ Westeuropäische Zeit Europe UTC

WFT Wallis and Futuna Time Pacific UTC + 12

hours

WGST Western Greenland Summer North UTC - 2

Time America hours

WGT West Greenland Time North UTC - 3

America hours

WIB Western Indonesian Time Asia UTC + 7

hours

WIT Eastern Indonesian Time Asia UTC + 9

hours

WITA Central Indonesian Time Asia UTC + 8

hours

WST Western Sahara Summer Time Africa UTC + 1 hour

WST West Samoa Time Pacific UTC + 13

hours

WT Western Sahara Standard Time Africa UTC

X X-ray Time Zone Military UTC - 11

hours

Y Yankee Time Zone Military UTC - 12

hours

YAKST Yakutsk Summer Time Asia UTC + 10

hours

YAKT Yakutsk Time Asia UTC + 10

hours

YAPT Yap Time Pacific UTC + 10

166
 hours

YEKST Yekaterinburg Summer Time Asia UTC + 6

hours

YEKT Yekaterinburg Time Asia UTC + 6

hours

Z Zulu Time Zone Military UTC

General health care

AAHAM American Association of Healthcare

Administrative Management

AAHP American Association of Health Plans

AAPCC Average Adjusted Per Capita Cost

AARP American Association of Retired Persons

ABN Advance Beneficiary Notice

ACHE American College of Healthcare Executives

ACR Adjusted Community Rating

ACS American Cancer Society … also American

College of Surgeons

ACU Ambulatory Care Unit

ADA Americans with Disabilities Act … also American

Diabetes Association

ADC Average Daily Census

167
ADS Alternative Delivery System

AG Attorney General

AGPA American Group Practice Association

AHA American Hospital Association … or American

Heart Association

AHRQ Agency for Health Care Research and Quality

AIDS Acquired Immune Deficiency Syndrome

ALJ Administrative Law Judge

ALOS Average Length of Stay

AMA American Medical Association

AMCRA American Medical Care and Review Association

ANA American Nurses Association

AONE American Organization of Nurse Executives

APC Ambulatory Payment Classification

APG Ambulatory Patient Group

APR-DRG All Payer Refined Diagnostic Related Group

ARC American Red Cross

ASC Ambulatory Surgery Center

ASO Administrative Services Only contract

BBA Balanced Budget Act of 1997

BBRA Balanced Budget Relief Act of 1999

BCAA Blue Cross Association of America

168
BCBSI Blue Cross/Blue Shield of Iowa now known as

Wellmark Blue Cross Blue Shield of Iowa

BCLS Basic Cardiac Life Support

BHAI Behavioral Health Affiliate of Iowa

BIA Bureau of Indian Affairs

BIPA Benefits Improvement & Protection Act of 2000

BLS Bureau of Labor Statistics

CAH Critical Access Hospital

Cahaba GBA Cahaba Government Benefit Administrators, LLC

(administers Medicare health insurance for the

Centers for Medicare & Medicaid Services (CMS)

CAM Complementary and Alternative Medicine

CARF Commission on Accreditation of Rehabilitation

Facilities

CAT Computerized Axial Tomography

CBSA Core Based Statistical Area

CCI Correct Coding Initiative

CCR Cost-to-Charge Ratio

CCU Cardiac Care Unit

CDC Centers for Disease Control and Prevention

CHA Catholic Health Association

CHAMPUS Civilian Health and Medical Program of the

Uniformed Services

169
CHAMPVA Civilian Health and Medical Program of the

Veterans Administration

CICU Cardiac Intensive Care Unit

CIPI Capital Input Price Index

CISM Critical Incident Stress Management

CLIA Clinical Laboratory Improvement Act (1967) … also Clinical Laboratory

Improvement

Amendments (1988)

CMHC Community Mental Health Center

CMI Case Mix Index

CMP Competitive Medical Plan … also Civil Monetary

CMS Centers for Medicare and Medicaid Services

COB Coordination of Benefits

COBRA Consolidated Omnibus Budget Reconciliation Act of 1985

COI Certificate of Insurance

CON Certificate of Need

COP Condition of Participation

CORF Comprehensive Outpatient Rehabilitative Facility

CPI Consumer Price Index

CPR Customary, Prevailing, and Reasonable (charges)

CPT Current Procedural Terminology

CQI Continuous Quality Improvement

170
DEA Drug Enforcement Administration

DHS Department of Human Services (Iowa)

DMAT Disaster Medical Assistance Team

DME Durable Medical Equipment … also Direct

Medical Education

DNR Department of Natural Resources … also Do Not

Resuscitate … also Do Not Report

DRA Deficit Reduction Act of 2005

DRG Diagnosis Related Group

DSA Disproportionate Share Adjustment

DSH Disproportionate Share Hospital

EBP Evidence Based Practice

ECF Extended Care Facility

EEOC Equal Employment Opportunity Commission

EHR Electronic Health Record

EMR Electronic Medical Record

EMS Emergency Medical Services

EMTALA Emergency Medical

Transfer Active Labor Act

EOB Explanation of Benefits

EOC Episode of Care …

EOMB Explanation of Medicare Benefits

EPA Environmental Protection Agency

171
EPO Exclusive Provider Organization

EPSDT Early Periodic Screening Diagnosis and Treatment Program

ER/ED Emergency Room/Emergency Department

ERISA Employee Retirement Income Security Act

FAQ Frequently Asked Questions

FDA Food and Drug Administration

FEC Freestanding Emergency Center

FEHBP Federal Employees Health Benefits Plan

FFS Fee For Service

FI Fiscal Intermediary

FPL Federal Poverty Level

FQHC Federally Qualified Health Center

FSA Flexible Spen

ding Accounts

FTC Federal Trade Commission

FTE Full-Time Equivalent

GAF Geographic Adjustment Factor

GAO U.S. General Accountability Office

GHAA Group Health Association of America

GME Graduate Medical Education

GPCI Geographic Practice Cost Index

172
HANYS Healthcare Association of New York State

HAWK-I Healthy and Well Kids in Iowa

HCPCS Healthcare Common Procedure Coding System

HEDIS Health Plan Employer Data and Information.

Routs of medication:

Common Dosage Forms of Medications

 Tablet

o Hard, compressed medication in round, oval, or square shape

o
Some have enteric coating or other types of coatings, which delay release of the dr
ug

and can not be crushed or chewed

 Capsule

o In a gelatin container that may be hard or soft

o Dissolves quickly in stomach

 Liquid – different types of liquid medications

o Solution – a liquid containing dissolved medication

oSuspension a liquid holding undissolved particles of medication that must be

shaken before measuring and administering to resident

o Syrup – a liquid medication dissolved in a sugar water to disguise its taste

o Elixir – a sweet alcohol based solution in which medications are dissolved

 Suppository

o Small solid medicated substance, usually cone‐shaped

173
o Melts at body temperature

o May be administered by rectum or vagina

o Refrigerate as directed by manufacturer

 Inhalant

o Medication carried into the respiratory tract using air, oxygen or steam

o Inhalants may be used orally or nasally

Topical –
applied directly to the skin surface. Topical medications include the following:

oOintment –
a semisolid substance for application of medication to the skin or eye

o Lotion – a medication dissolved in liquid for applying to the skin

o Paste – a semisolid substance thicker and stiffer than an ointment containing

medications

o Cream – semisolid preparation holding medication so it can be applied to skin

o Shampoo – liquid containing medication that is applied to the scalp and hair

oPatches (transdermal) –
medication encased in a round, square, or oval disc that is affixed to the skin

oPowder –
fine, ground form of medication that may be used to be swallowed, or may be

used as on the skin for rashes

oAerosol sprays –
solution that holds the medication suspended until it is dispensed in the

form of a mist to spray on the skin

174
 3.4. symbols

Medical Acronyms, Abbreviations and Symbols

Each facility will have a list of approved acronyms, abbreviations, and symbols.

Please ask to review this list at each facility. An acronym or abbreviation may ha
ve more than one meaning. Evaluate the acronym or abbreviation in context.

Some acronyms, abbreviations, and symbols have become unacceptable to use

due to their high propensity for error. Some are included in this list, followed by

(unacceptable abbreviation). At the end of this file is a table of unacceptable

abbreviations that the Joint Commission for Accreditation of Healthcare Facilities
requires for all healthcare institutions. Each facility is also supposed to add additi
onal “do not use” acronyms, etc. Do NOT use these acronyms, abbreviations, or s
ymbols.

You will still see them in charts (old habits die hard) so you need to know them.
In addition, drug names are not to be abbreviated with the exception of ASA, HCT
Z, and vitamins.

In addition to the abbreviation, you should know the definition of the word or hav
e an idea of the condition described by the acronym or abbreviation. You should a
lso know metric abbreviations (L, mg, ml, etc) and abbreviations of common mine
rals along with valence.

ā before (ante) āc before meals

AAA abdominal aortic aneurysm, acute anxiety attack

AAAAA aphasia, agnosia, apraxia, agraphia, alexia

ACE angiotensin-converting enzyme

ACLS advanced cardiac life support

AD admitting diagnosis

175
ADH antidiuretic hormone

ADL activities of daily living ad lib as desired AH abdominal hysterectomy

AHD arteriosclerotic heart disease

AIDS acquired immune deficiency syndrome

AK above the knee AKA above the knee amputation AMA

against medical advice; American Medical Association

AMI acute myocardial infarction ANP advanced nurse practitioner ARC

AIDS-related complex

ARF acute renal failure

ARI acute respiratory infection

ARDS adult respiratory distress syndrome; acute respiratory distress syndrome.

art arterial2

ATN acute tubular necrosis

ASA aspirin

ASCVD arteriosclerotic cardiovascular disease

ATN acute tubular necrosis

Aus© auscultation A&W alive and well

BG blood glucose

bid twice daily

Bil(at) bilateral

BK below knee BKA below the knee amputation BLE both lower extremities

BM bowel movement; bone marrow

176
B/O because of bol bolus

BP blood pressure; bathroom privileges; bedpan

BPH benign prostatic hypertrophy

bronch bronchoscopy; bronchoscope

BS blood sugar BSA body surface area BSN Bachelor of Science in Nursing

CA cancer, carcinoma

CAB coronary artery bypass

CABG coronary artery bypass graft

CAD coronary artery disease

CAT computerized axial tomography

cath catheter, catheterize

CC chief complaint; complications and co-morbidities

CCRN Certified Critical Care Registered Nurse

CCU cardiac care unit, coronary care unit

CEU continuing education unit

CICU cardiac (coronary) intensive care unit

CHF congestive heart failure

CAPD continuous ambulatory peritoneal dialysis

CKD chronic kidney disease

CN charge nurse

CNM certified nurse -midwife; clinical nurse manager CNSN

Certified Nutrition Support Nurse

177
COPD chronic obstructive pulmonary disease CP chest pain3

CPAP continuous (constant) positive airway pressure

CRF chronic renal failure

CSF cerebrospinal fluid

CVA cerebrovascular accident

CVD cardiovascular disease

CXR chest x-ray

DAT diet as tolerated DC, dc discontinue

D/C discharge (unacceptable abbreviation) DD differential diagnosis

decub lying down (decubitus) DM diabetes mellitus

DNR do not resuscitate

DOB date of birth

DOA date of admission DOE dyspnea on exertion DON director of nurses

Decub decubitus ulcer DRG Diagnosis Related Group

DSM Diagnostic and Statistical Manual of Mental Disorders

DT delirium tremens

DVT deep vein thrombosis

DW distilled water; dry weight

Dx diagnosis

EBL estimated blood loss

EC enteric coated

178
ECF extended care facility

Echo echocardiogram E coli Escherichia coli ECMO

extracorporeal membrane oxygenation ECV extracellular volume

ECW extracellular water ED emergency department

EDC estimated date of confinement

edent edentulous

EEG electroencephalogram EENT eye, ear, nose, throat4

EEP end expiratory pressure

EF ejection fraction EFA essential fatty acids

EGA estimated gestational age

EKG electrocardiogram ELISA

enzyme-linked immunosorbent assay (immunological testing) EN
enteral nutrition EOMB explanation of medical benefits

EPAP expiratory positive airway pressure

EPI epinephrine

EPO erythropoietin

EPS extrapyramidal symptoms

ESLD end-stage liver disease ESRD end-stage renal disease

ET endotracheal tube ETD estimated time of death

Etiol etiology

ETOH ethyl alcohol

Exp expired

F female

179
FBG fasting blood glucose

FAS fetal alcohol syndrome

FBS fasting blood sugar FOB foot of bed FTN full-term nursery

FTP failure to progress

FTT failure to thrive

F/O follow-up FUO fever of undetermined origin

Fx fracture G GALT gut-associated lymphoid tissue GB gallbladder GBD

gallbladder disease

GBS gallbladder series

GC gonococcus

GERD gastroesophageal reflux disease

GFR glomerular filatration rate GI gastrointestinal

G gravida GSW gunshot wound5

GU gastric ulcer, genitourinary

HA headache

HCO3 bicarbonate HCTZ hydrochlorothiazide HDN

hemolytic disease of the newborn

HD hemodialysis

HEENT head, eyes, ears, nose, and throat

hemi hemiplegia, hemiplegic

HH hiatal hernia

HHNKS hyperglycemic, hyperosomolar nonketotic syndrome

180
HI head injury

HIV hum immunodeficiency virus

HL hearing loss

HLHS hypoplastic left heart syndrome

H&N head and neck

H&P history and physical

H/O; h/o history of

HOB head of bed

HOH hard of hearing HR heart rate

hs bedtime

Htn hypertension Hx history

IBD inflammatory bowel disease

IBS irritable bowel syndrome

ICW intracellular water

IGT impaired glucose tolerance

IHD ischemic heart disease

INH isoniazid

I & O intake and output

IUGR intrauterine growth retardation

IVP intravenous pyelography; intravenous push

IVPB Intravenous piggyback

ISVD interventricular septal defect

181
J6

JCAHO Joint Commission on Accreditation of Healthcare Organizations

K potassium KCl potassium chloride KDC infant warming bed KLS

kidney, liver, spleen

KVO keep vein open (IV rate of usually 25 cc/hr with NS or D5W) KUB
kidney, ureter, bladder

lap laporotomy

LBW low birth weight

LCSW licensed clinical social worker LES lower esopohageal spinchter LFT
liver function tests

LGA large for gestational age

LLQ lower left quadrant LMP last menstrual period LOC

laxative of choice (unacceptable abbreviation); level of consciousness

LOS length of stay

LP lumbar puncture

LR lactated ringers

LRQ lower right quadrant

LTC long term care

LVH left ventricular hypertrophy

lytes electrolytes M M Male, married MAOI monamine oxidase inhibitor

MDD major depressive disorder mec meconium med-surg medical-surgical

mEq milliequivalents

182
mEq/L milliequivalents per liter met(s) metastasis, metastasize, metastasizing
MI myocardial infarction

MICU medical intensive care unit

mM millimole

M&M morbidity & mortality

mmHg millimeters of mercury (BP unit)7

MO mineral oil; months old

MOM milk of magnesia

Mono monocyte; mononucleosis

Mosm milliosmol

MR magnetic resonance; medical records; mental retardation MRSA

methicillin resistant staph aureus

MRI magnetic resonance imaging MS mitral stenosis; multiple sclerosis

MSW Master of Social Work

MT medical technologist

MVA motor vehicle accident MVP mitral valve prolapse

N/A not available

NAD no acute distress

NAS no added salt

NEC necrotizing enterocolitis

NG(T) nasogastric (tube) NH(P) nursing home (placement) NKA

no known allergies

Nl normal

183
NIDDM non-insulin dependant diabetes mellitus (not to be used anymore) NOS
not otherwise specified; no organisms seen

NPO nil per os (nothing by mouth) NS normal saline; neurosurgery

NSAID nonsteroidal anti-inflammatory drug N & V nausea and vomiting

NVD nausea, vomiting, diarrhea

O OB obstetrics

OBS organic brain syndrome

OC oral contraceptive

OOB out of bed

OR operating room Ortho orthopedics

O2 sat oxygen saturation OT occupational therapy

OTC over-the-counter8

p post; after P para; phosphorus; pulse

PA pernicious anemia; Physician’s Assistant

P&A percussion and auscultation PACU postanaesthesia care unit

Para para (nullipara, primiparia, Para !, Para II, etc) Path pathology

p.c. after meals

PCA patient-controlled analgesia

PVN penicillin

PCOD polycystic ovarian disease

PDA patent ductus arteriosus

PE pelvic exam; physical exam PEEP positive end-expiratory pressure

184
PEG percutaneous endoscopic gastrostomy

PERRLA pupils equal, round, reactive to light and accommodation PFT

pulmonary function test

PH past history

PT physical therapy

PTA prior to admission/arrival

PICC peripherally inserted central catheter PIP positive inspiratory pressure

PKU phenylketonuria

PMH past medical history

PN parenteral nutrition PO; po per os (by mouth); phone order POD#

postoperative day#

Post-op postoperative

PP postpartum; post-prandial

PPBS post-prandial blood sugar PR; pr per rectum Pre-op pre-operative

PRN pro re nata (as necessary) Prog prognosis; progress

PSA prostate specific antigen PTA prior to admission PUD

peptic ulcer disease

Pulm pulmonary

PVC premature ventricular contraction P/Y; PY pack year (cigarettes)9

q every

QD; qd every day (unacceptable abbreviation) QH; qh every hour QOD; qod
every other day (unacceptable abbreviation)

185
R rectal; respiration; right

RA rheumatoid arthritis; right atrium; room air Resp respiratory; respiration

RDS respiratory distress syndrome

Re concerning Rh rhesus factor (will be + or -) RIA radioimmunoassay

RLE right lower extremity

RLL right lower lobe

RLQ right lower quadrant

RN registered nurse

R/O rule out

ROM range of motion; rupture of membranes

ROS review of symptoms

RQ respiratory quotient

RR respiratory rate; recovery room RRR regular rate and rhythm RT

respiratory therapist; radiation therapy

RUE right upper extremity

RUQ right upper quadrant Rx prescription, take, therapy, treatment

s without SAH subarachnoid hemorrhage SB small bowel; short bowel

SBE shortness of breath on exertion, subacute bacterial endocarditis

SBO small bowel obstruction SC sickle cell

SCN special care nursery

SGA small for gestational age SIADH

syndrome of inappropriate antidiuretic hormone

186
SIDS sudden infant death syndrome10

SLE systemic lupus erythematosus

SNF skilled nursing facility

SO significant other S/O signed out

SOAP subjective, objective, assessment, plan SOB shortness of breath Sol

solution

S/P; s/p status post

SQ subcutaneous

S&S, S/S signs and symptoms

ss; SS;SSE soapsuds (enema) s s one-half (not acceptable) ST speech therapist

Staph staphyloccus

STD sexually transmitted disease; short-term disability

stat statim (immediately) Strep streptococcus

Subq subcutaneous

supp suppository

susp suspension Sz seizure

T, temp temperature; time

T max maximum temperature

tab tablet

TAC temporal artery catheter

tachy tachycardia

TAH total abdominal hysterectomy

187
TB tuberculosis

TBSA total burn surface area TBLC term birth, living child

TBW total body water T&C type and crossmatch

TF tube feeding THR total hip replacement

TIA transient ischemic attack

tid three times a day

TO telephone order

top topically

tol tolerate, tolerated, tolerance

TPN total parenteral nutrition

TURP transurethral resection of prostate

TWE tap water enema11

Tx treatment

U, u unit (unacceptable abbreviation) UAC umbilical artery catheter UAO

upper airway obstruction unk unknown

UOP urinary output

up ad lib up (out of bed) as disired (adlibitum) UR

upper respiratory; utilization review

URI upper respiratory infection Urol urology; urologist

US; U/S ultrasound

USP United States Pharmacopeia

UTI urinary tract infection

188
V

V ventricular; volume

VH vaginal hysterectomy

V/D vomiting and diarrhea

Vent ventral; ventricular; ventilator viz that is, namely

VLBW very low birth weight

VO verbal order VO2 oxygen consumption vol volume

VP venous pressure

VRSA vancomycin resistant staph aureus

VS vital signs

W white; widowed WB weight bearing WBN well baby nursery

WC; w/c wheelchair w/d well developed; warm and dry

WD well developed WF; wf white female

WFL within functional limits

WM; wm white male12

WN;w/n well nourished

WNL within normal limits

Wt weight

W/U;w/u work-up

X times

X-match cross match

189
Y

YO; y/o year(s) old

YTD year to date

Symbols

↓ decrease

↑ increase

O ♀ female

□ ♂ male

1° primary

2° secondary

ά lower-case alpha;

β lower-case beta; prefix denoting the second of a series

γ lower-case gamma; prefix denoting third of a series

∆ upper-case delta; amount of change or difference

µ lower-case mu, micrometer (micron). Unacceptable symbol.1314

DO NOT USE

Medical Acronyms & Abbreviations

Abbreviation Potential Problem Preferred Term

U (for unit) Mistaken as zero, four or cc

Write "unit"

IU (for international unit) Mistaken as IV

(intravenous) or 10 (ten) Write "international unit"

190
Q.D.,

Q.O.D.

(Latin abbreviation for once daily and every other day)

Mistaken for each other. The period after the Q

can be mistaken for an

"I" and the "O" can be

mistaken for "I".

Write "daily" and "every

other day"

Trailing zero (X.0 mg)

[Note: Prohibited only for medication-related

notations];

Lack of leading zero (.X

mg)

Decimal point is missed. Never write a zero by

itself after a decimal

point (X mg), and always

use a zero before a

decimal point (0.X mg)

MS MSO4 MgSO4

Confused for one another. Can mean morphine sulfate or magnesium sulfate.

Write "morphine sulfate" or "magnesium sulfate"

mg

191
(for microgram) Mistaken for mg

(milligrams) resulting in

one thousand-fold

dosing overdose.

Write "mcg"

H.S.

(for half-strength or Latin

abbreviation for bedtime)

Mistaken for either half- strength or hour of sleep

(at bedtime). q.H.S. mistaken for every hour. All can result in a dosing error.

Write out "half-strength"

or "at bedtime"

T.I.W.

(for three times a week) Mistaken for three times

a day or twice weekly

resulting in an overdose.

Write "3 times weekly"

or "three times weekly"15

S.C. or S.Q.

(for subcutaneous) Mistaken as SL for sublingual, or "5 every"

Write "Sub-Q", "subQ", or "subcutaneously"

D/C

(for discharge)

192
Interpreted as

discontinue whatever medications follow

(typically discharge meds).

Write "discharge"

c.c.

(for cubic centimeter) Mistaken for U (units) when poorly written.

Write "ml" for milliliters

A.S., A.D., A.U.

(Latin abbreviation for left,

right, or both ears)

Mistaken for OS, OD,

and OU, etc.). Write: "left ear," "right

ear" or "both ears"

Medical Abbreviations and Symbols

Each facility will have a list of approved acronyms, abbreviations, and symbols.

Please ask to review this list at each facility. An acronym or abbreviation may ha
ve more than one meaning. Evaluate the acronym or abbreviation in context.

Some acronyms, abbreviations, and symbols have become unacceptable to use

due to their high propensity for error. Some are included in this list, followed by (
unacceptable abbreviation). At the end of this file is a table of unacceptable abbre
viations that the Joint Commission for Accreditation of Healthcare Facilities requi
res for all healthcare institutions. Each facility is also supposed to add additional

193
“do not use” acronyms, etc. Do NOT use these acronyms, abbreviations, or symb
ols.

You will still see them in charts (old habits die hard) so you need to know them.
In addition, drug names are not to be abbreviated with the exception of ASA, HCT
Z, and
vitamins.In addition to the abbreviation, you should know the definition of the wo
rd or have an idea of the condition described by the acronym or abbreviation. You
should also know metric abbreviations (L, mg, ml, etc) and abbreviations of com
mon minerals along with valence.

ā before (ante) āc before meals

AAA abdominal aortic aneurysm, acute anxiety attack

AAAAA aphasia, agnosia, apraxia, agraphia, alexia

ACE angiotensin-converting enzyme

ACLS advanced cardiac life support

AD admitting diagnosis

ADH antidiuretic hormone

ADL activities of daily living ad lib as desired AH abdominal hysterectomy

AHD arteriosclerotic heart disease

AIDS acquired immune deficiency syndrome

AK above the knee AKA above the knee amputation AMA

against medical advice; American Medical Association

AMI acute myocardial infarction ANP advanced nurse practitioner ARC

AIDS-related complex

ARF acute renal failure

ARI acute respiratory infection

194
ARDS adult respiratory distress syndrome; acute respiratory distress syndrome.

art arterial2

ATN acute tubular necrosis

ASA aspirin

ASCVD arteriosclerotic cardiovascular disease

ATN acute tubular necrosis

Aus© auscultation A&W alive and well

BG blood glucose

bid twice daily

Bil(at) bilateral

BK below knee BKA below the knee amputation BLE both lower extremities

BM bowel movement; bone marrow

B/O because of bol bolus

BP blood pressure; bathroom privileges; bedpan

BPH benign prostatic hypertrophy

bronch bronchoscopy; bronchoscope

BS blood sugar BSA body surface area BSN Bachelor of Science in Nursing

CA cancer, carcinoma

CAB coronary artery bypass

CABG coronary artery bypass graft

CAD coronary artery disease

195
CAT computerized axial tomography

cath catheter, catheterize

CC chief complaint; complications and co-morbidities

CCRN Certified Critical Care Registered Nurse

CCU cardiac care unit, coronary care unit

CEU continuing education unit

CICU cardiac (coronary) intensive care unit

CHF congestive heart failure

CAPD continuous ambulatory peritoneal dialysis

CKD chronic kidney disease

CN charge nurse

CNM certified nurse -midwife; clinical nurse manager CNSN

Certified Nutrition Support Nurse

COPD chronic obstructive pulmonary disease CP chest pain3

CPAP continuous (constant) positive airway pressure

CRF chronic renal failure

CSF cerebrospinal fluid

CVA cerebrovascular accident

CVD cardiovascular disease

CXR chest x-ray

DAT diet as tolerated DC, dc discontinue

D/C discharge (unacceptable abbreviation) DD differential diagnosis

196
decub lying down (decubitus) DM diabetes mellitus

DNR do not resuscitate

DOB date of birth

DOA date of admission DOE dyspnea on exertion DON director of nurses

Decub decubitus ulcer DRG Diagnosis Related Group

DSM Diagnostic and Statistical Manual of Mental Disorders

DT delirium tremens

DVT deep vein thrombosis

DW distilled water; dry weight

Dx diagnosis

EBL estimated blood loss

EC enteric coated

ECF extended care facility

Echo echocardiogram E coli Escherichia coli ECMO

extracorporeal membrane oxygenation ECV extracellular volume

ECW extracellular water ED emergency department

EDC estimated date of confinement

edent edentulous

EEG electroencephalogram EENT eye, ear, nose, throat4

EEP end expiratory pressure

EF ejection fraction EFA essential fatty acids

EGA estimated gestational age

197
EKG electrocardiogram ELISA
enzyme-linked immunosorbent assay (immunological testing) EN
enteral nutrition EOMB explanation of medical benefits

EPAP expiratory positive airway pressure

EPI epinephrine

EPO erythropoietin

EPS extrapyramidal symptoms

ESLD end-stage liver disease ESRD end-stage renal disease

ET endotracheal tube ETD estimated time of death

Etiol etiology

ETOH ethyl alcohol

Exp expired

F female

FBG fasting blood glucose

FAS fetal alcohol syndrome

FBS fasting blood sugar FOB foot of bed FTN full-term nursery

FTP failure to progress

FTT failure to thrive

F/O follow-up FUO fever of undetermined origin

Fx fracture G GALT gut-associated lymphoid tissue GB gallbladder GBD

gallbladder disease

GBS gallbladder series

GC gonococcus

198
GERD gastroesophageal reflux disease

GFR glomerular filatration rate GI gastrointestinal

G gravida GSW gunshot wound5

GU gastric ulcer, genitourinary

HA headache

HCO3 bicarbonate HCTZ hydrochlorothiazide HDN

hemolytic disease of the newborn

HD hemodialysis

HEENT head, eyes, ears, nose, and throat

hemi hemiplegia, hemiplegic

HH hiatal hernia

HHNKS hyperglycemic, hyperosomolar nonketotic syndrome

HI head injury

HIV hum immunodeficiency virus

HL hearing loss

HLHS hypoplastic left heart syndrome

H&N head and neck

H&P history and physical

H/O; h/o history of

HOB head of bed

HOH hard of hearing HR heart rate

hs bedtime

199
Htn hypertension Hx history

IBD inflammatory bowel disease

IBS irritable bowel syndrome

ICW intracellular water

IGT impaired glucose tolerance

IHD ischemic heart disease

INH isoniazid

I & O intake and output

IUGR intrauterine growth retardation

IVP intravenous pyelography; intravenous push

IVPB Intravenous piggyback

ISVD interventricular septal defect

J6

JCAHO Joint Commission on Accreditation of Healthcare Organizations

K potassium KCl potassium chloride KDC infant warming bed KLS

kidney, liver, spleen

KVO keep vein open (IV rate of usually 25 cc/hr with NS or D5W) KUB
kidney, ureter, bladder

lap laporotomy

LBW low birth weight

200
LCSW licensed clinical social worker LES lower esopohageal spinchter LFT
liver function tests

LGA large for gestational age

LLQ lower left quadrant LMP last menstrual period LOC

laxative of choice (unacceptable abbreviation); level of consciousness

LOS length of stay

LP lumbar puncture

LR lactated ringers

LRQ lower right quadrant

LTC long term care

LVH left ventricular hypertrophy

lytes electrolytes M M Male, married MAOI monamine oxidase inhibitor

MDD major depressive disorder mec meconium med-surg medical-surgical

mEq milliequivalents

mEq/L milliequivalents per liter met(s) metastasis, metastasize, metastasizing

MI myocardial infarction

MICU medical intensive care unit

mM millimole

M&M morbidity & mortality

mmHg millimeters of mercury (BP unit)7

MO mineral oil; months old

MOM milk of magnesia

Mono monocyte; mononucleosis

Mosm milliosmol

201
MR magnetic resonance; medical records; mental retardation MRSA
methicillin resistant staph aureus

MRI magnetic resonance imaging MS mitral stenosis; multiple sclerosis

MSW Master of Social Work

MT medical technologist

MVA motor vehicle accident MVP mitral valve prolapse

N/A not available

NAD no acute distress

NAS no added salt

NEC necrotizing enterocolitis

NG(T) nasogastric (tube) NH(P) nursing home (placement) NKA

no known allergies

Nl normal

NIDDM non-insulin dependant diabetes mellitus (not to be used anymore) NOS

not otherwise specified; no organisms seen

NPO nil per os (nothing by mouth) NS normal saline; neurosurgery

NSAID nonsteroidal anti-inflammatory drug N & V nausea and vomiting

NVD nausea, vomiting, diarrhea

O OB obstetrics

OBS organic brain syndrome

OC oral contraceptive

OOB out of bed

OR operating room Ortho orthopedics

202
O2 sat oxygen saturation OT occupational therapy

OTC over-the-counter8

p post; after P para; phosphorus; pulse

PA pernicious anemia; Physician’s Assistant

P&A percussion and auscultation PACU postanaesthesia care unit

Para para (nullipara, primiparia, Para !, Para II, etc) Path pathology

p.c. after meals

PCA patient-controlled analgesia

PVN penicillin

PCOD polycystic ovarian disease

PDA patent ductus arteriosus

PE pelvic exam; physical exam PEEP positive end-expiratory pressure

PEG percutaneous endoscopic gastrostomy

PERRLA pupils equal, round, reactive to light and accommodation PFT

pulmonary function test

PH past history

PT physical therapy

PTA prior to admission/arrival

PICC peripherally inserted central catheter PIP positive inspiratory pressure

PKU phenylketonuria

PMH past medical history

203
PN parenteral nutrition PO; po per os (by mouth); phone order POD#
postoperative day#

Post-op postoperative

PP postpartum; post-prandial

PPBS post-prandial blood sugar PR; pr per rectum Pre-op pre-operative

PRN pro re nata (as necessary) Prog prognosis; progress

PSA prostate specific antigen PTA prior to admission PUD

peptic ulcer disease

Pulm pulmonary

PVC premature ventricular contraction P/Y; PY pack year (cigarettes)9

q every

QD; qd every day (unacceptable abbreviation) QH; qh every hour QOD; qod
every other day (unacceptable abbreviation)

R rectal; respiration; right

RA rheumatoid arthritis; right atrium; room air Resp respiratory; respiration

RDS respiratory distress syndrome

Re concerning Rh rhesus factor (will be + or -) RIA radioimmunoassay

RLE right lower extremity

RLL right lower lobe

RLQ right lower quadrant

RN registered nurse

R/O rule out

204
ROM range of motion; rupture of membranes

ROS review of symptoms

RQ respiratory quotient

RR respiratory rate; recovery room RRR regular rate and rhythm RT

respiratory therapist; radiation therapy

RUE right upper extremity

RUQ right upper quadrant Rx prescription, take, therapy, treatment

s without SAH subarachnoid hemorrhage SB small bowel; short bowel

SBE shortness of breath on exertion, subacute bacterial endocarditis

SBO small bowel obstruction SC sickle cell

SCN special care nursery

SGA small for gestational age SIADH

syndrome of inappropriate antidiuretic hormone

SIDS sudden infant death syndrome10

SLE systemic lupus erythematosus

SNF skilled nursing facility

SO significant other S/O signed out

SOAP subjective, objective, assessment, plan SOB shortness of breath Sol

solution

S/P; s/p status post

SQ subcutaneous

S&S, S/S signs and symptoms

ss; SS;SSE soapsuds (enema) s s one-half (not acceptable) ST speech therapist

205
Staph staphyloccus

STD sexually transmitted disease; short-term disability

stat statim (immediately) Strep streptococcus

Subq subcutaneous

supp suppository

susp suspension Sz seizure

T, temp temperature; time

T max maximum temperature

tab tablet

TAC temporal artery catheter

tachy tachycardia

TAH total abdominal hysterectomy

TB tuberculosis

TBSA total burn surface area TBLC term birth, living child

TBW total body water T&C type and crossmatch

TF tube feeding THR total hip replacement

TIA transient ischemic attack

tid three times a day

TO telephone order

top topically

tol tolerate, tolerated, tolerance

TPN total parenteral nutrition

206
TURP transurethral resection of prostate

TWE tap water enema11

Tx treatment

U, u unit (unacceptable abbreviation) UAC umbilical artery catheter UAO

upper airway obstruction unk unknown

UOP urinary output

up ad lib up (out of bed) as disired (adlibitum) UR

upper respiratory; utilization review

URI upper respiratory infection Urol urology; urologist

US; U/S ultrasound

USP United States Pharmacopeia

UTI urinary tract infection

V ventricular; volume

VH vaginal hysterectomy

V/D vomiting and diarrhea

Vent ventral; ventricular; ventilator viz that is, namely

VLBW very low birth weight

VO verbal order VO2 oxygen consumption vol volume

VP venous pressure

VRSA vancomycin resistant staph aureus

VS vital signs

207
W

W white; widowed WB weight bearing WBN well baby nursery

WC; w/c wheelchair w/d well developed; warm and dry

WD well developed WF; wf white female

WFL within functional limits

WM; wm white male12

WN;w/n well nourished

WNL within normal limits

Wt weight

W/U;w/u work-up

X times

X-match cross match

YO; y/o year(s) old

YTD year to date

208
UNIT: 4

ILLNESS:

4.1. Defining illness:

Just Diagnosed

Certain serious and life-threatening diseases that occur in HIV-positive

people are called "AIDS-defining" illnesses. When a person gets one of these
illnesses, he or she is diagnosed with the advanced stage of HIV infection known
as AIDS.

The Centers for Disease Control and Prevention (CDC) has developed a list
of these illnesses (see below). No single patient is likely to have all of these
problems. Some of the conditions, in fact, are rare.

• Candidacies of the esophagus, bronchi, trachea, or lungs (but NOT the

mouth, which is also known as thrush)

• Cervical cancer, invasive

• Coccidioidomycosis, disseminated or extra pulmonary

• Cryptococcosis, extra pulmonary

• Cryptosporidiosis, chronic intestinal (greater than one month's duration)

• Cytomegalovirus disease (other than liver, spleen, or nodes)

• Cytomegalovirus retinitis (with loss of vision)

• Encephalopathy, HIV related

• Herpes simplex: chronic ulcer(s) (more than 1 month in duration); or

bronchitis, pneumonitis, or esophagi is

• Histoplasmosis, disseminated or extra pulmonary

209
 • Isosporiasis, chronic intestinal (more than 1 month in duration)

• Kaposi sarcoma

• Lymphoma, Burkett’s (or equivalent term)

• Lymphoma, immune blasted (or equivalent term)

• Lymphoma, primary, of brain

• Mycobacterium valium complex or M kansasii, disseminated or extra

pulmonary

• Mycobacterium tuberculosis, any site (pulmonary or extra pulmonary)

• Mycobacterium, other species or unidentified species, disseminated or

extra pulmonary

• Pneumocystis jiroveci pneumonia

• Pneumonia, recurrent

• Progressive multifocal leucoxene phalopathy

• Salmonella septicemia, recurrent

• Toxoplasmosis of brain

Wasting syndrome due to HIV What illnesses spread this way?

Many illnesses spread through contact transmission. Examples are chicken

pox, common cold,

conjunctivitis (Pink Eye), Hepatitis A and B, herpes simplex (cold sores),

influenza, measles,

mononucleosis, Fifth disease, pertussis, adenoma/rhino viruses, Neustria

meningitides and

mycoplasma pneumonia.

210
Direct and indirect causes

Contact transmission is the most common form of transmitting diseases and

virus.

There are two

types of contact transmission: direct and indirect.

Direct contact transmission

occurs when there is physical contact between an infected person and a

susceptible person.

Indirect contact transmission

occurs when there is no direct human-to-human contact. Contact occurs

from a reservoir to contaminated surfaces or objects, or to vectors such as
mosquitoes, flies, mites, fleas, ticks, rodents or dogs.

How do infections spread?

Direct contact infections spread when disease-causing microorganisms pass

from the infected person to the healthy person via direct physical contact with
blood or body fluids. Examples of

direct contact are touching, kissing, sexual contact, contact with oral secretions, or
contact with body lesions.

Indirect contact infections spread when an infected person sneezes or coughs,

sending infectious droplets into the air. If healthy people inhale the infectious
droplets, or if the contaminated droplets land directly in their eyes, nose or mouth,
they risk becoming ill. Droplets generally travel between three and six feet and

211
land on surfaces or objects including tables, doorknobs and telephones. Healthy
people touch the contaminated objects with their hands, and then touch their eyes,
nose or mouth.

What illnesses spread this way?

Many illnesses spread through contact transmission. Examples are chicken

pox, common cold, conjunctivitis (Pink Eye), Hepatitis A and B, herpes simplex
(cold sores), influenza, measles,

mononucleosis, Fifth disease, pertussis, adenoma/rhino viruses, Neustria

meningitides and mycoplasma pneumonia.

How can one prevent disease transmission?

Delaware’s Division of Public Health (DPH) recommends frequent and

thorough hand washing as the best method to prevent disease transmission. DPH
also recommends regular disinfection

of frequently touched surfaces such as doorknobs, handles, handrails, restroom

surfaces, medical instruments, computer keyboards, phones, office supplies and
children's toys. Using barriers such as gloves, masks or condoms can help avoid
the spread of germs. Many infections can be prevented by keeping healthy with
attention to good personal hygiene.

PREVENTION OF ILLNESS:

prevents a long list of diseases that can cause chronic or severe illness, disability,
and even death, including cancer, heart disease, stroke, high blood pressure,
vascular disease, diabetes, obesity, and osteoporosis. Exercise also prevents
mental health illness and disease disorders, including depression, anxiety, and
stress. While some of these disease processes can be reversed with exercise and
healthy life-style, some cannot. Preventing them from starting is the number one
goal.

212
Not Smoking
The most negative lifestyle behavior is smoking. Smoking contributes to the
development of almost all diseases, notably cancer, heart disease, high blood
pressure, high cholesterol, diabetes, and asthma. Smoking has the following
negative health effects: lowers immunity, making you more likely to get
bronchitis, colds, and other infections; interferes with breathing by causing
wheezing and asthma; causes snoring and sleep apnea; impairs fine motor skills,
leaving you shaky and unable to control your hands. Athletes who smoke have
decreased endurance and are more likely to suffer from exercise-induced asthma.

If you quit smoking before the diseases becomes chronic, you can reverse most of
the effects smoking has on the body—breathing, snoring, immunity, and risk of
cancer, heart disease, and high blood pressure all improves. Problems exist,
however, if smoking has done permanent damage. Severe smoking-related
diseases, including cancer, emphysema, and coronary artery disease, are
permanent.

HEALTH TIP The best thing you can do for your body is exercise; the worst is
smoke.

See Your Doctor

Because doctors and health professionals are trained to recognize, treat, and
prevent illness, following their advice is recommended. Each person has different
risks of diseases based on genetics and other health history; therefore health
recommendations can be slightly different for each individual.

Still, following the basic recommendations outlined below will reduce your risk of
severe diseases.

Recommended Medical Testing and Check-Ups

• Yearly check-up (every other year if no health risks)

• Yearly dental exam

• Monthly breast self-exams

213
 • Yearly Pap smear/OBGYN visit after the age of 18 or when sexual activity
begins

• Mammogram initially by age 40; high risk by age 35

• Colonoscopy initially by age 40; high risk by age 35

• EKG as recommended by your primary physician

Disease Prevention Through Nutrition

The health benefits and risks of foods has been and will always be a source of
excitement, controversy, and research. Although it might seem that dietary
recommendations change frequently, the consistent findings are that getting
adequate sources of vitamins, minerals, and antioxidants through foods are the
best way to stay healthy. Eating a diet rich in fruits and vegetables, and moderate
in everything else, has been consistently found to be most beneficial. A general
rule is that the darker the color of the fruit or vegetable, the more nutritional value
it has. Cancer-fighting chemical groups include phytochemicals and antioxidants.
Some of the most beneficial foods, according to recent research include the
following:

• Tomatoes—Tomatoes and tomato products contain vitamin C and

lycopenes, antioxidant cancer-fighting chemicals that reduce digestive
tract (and for men, prostate) and other types of cancer.

• Broccoli—Broccoli contains phytochemicals that are thought to make

cancer cells less toxic (destructive). Also contains beta-carotene, vitamin
C, calcium, and fiber.

• Spinach—Spinach is rich in folate, fiber, and iron—nutrients needed

especially in women. Other similar beneficial vegetables include kale,
Swiss chard, and collard greens.

• Tea—Tea contains phytochemicals, which are cancer-cell fighters. Green

tea has been associated with a lower risk of stomach, esophageal, and liver
cancers.

214
 • Nuts—Monounsaturated and polyunsaturated fats in nuts improve levels of
cholesterol by lowering triglycerides and LDL along with raising HDL,
preventing heart disease and stroke. Nuts also contain fiber and Vitamin E,
both of which prevent heart disease and cancer.

4.2. Classification and description of disease

ICD-10 is the 10th revision of the International Statistical Classification of

Diseases and Related Health Problems (ICD), a medical classification list by
the World Health Organization (WHO). It codes for diseases, signs and
symptoms, abnormal findings, complaints, social circumstances, and external
causes of injury or diseases.

The code set allows more than 14,400 different codes and permits the
tracking of many new diagnoses. The codes can be expanded to over 16,000 codes
by using optional sub-classifications. The detail reported by ICD can be further
increased, with a simplified multi-axial approach, by using codes meant to be
reported in a separate data field.

The WHO provides detailed information about ICD online, and makes
available a set of materials online, such as an ICD-10 online browser, ICD-10
Training, ICD-10 online training, ICD-10 online training support, and study guide
materials for download.

Description of disease:

The International version of ICD should not be confused with national

Clinical Modifications of ICD that frequently include much more detail, and
sometimes have separate sections for procedures. The US ICD-10 CM, for
instance, has some 68,000 codes. The US also has ICD-10 PCS, a procedure code
system not used by other countries that contains 76,000 codes.

215
International Statistical Classification of Diseases and
Related Health Problems 10th Revision

Chapter Blocks Title

A00–
I Certain infectious and parasitic diseases
B99

C00–
II Neoplasms
D48

Diseases of the blood and blood-forming

D50–
III organs and certain disorders involving the
D89
immune mechanism

E00– Endocrine, nutritional and metabolic

IV
E90 diseases

F00–
V Mental and behavioural disorders
F99

G00–
VI Diseases of the nervous system
G99

H00–
VII Diseases of the eye and adnexa
H59

H60–
VIII Diseases of the ear and mastoid process
H95

IX I00–I99 Diseases of the circulatory system

J00–
X Diseases of the respiratory system
J99

216
 K00–
XI Diseases of the digestive system
K93

L00– Diseases of the skin and subcutaneous

XII
L99 tissue

M00– Diseases of the musculoskeletal system

XIII
M99 and connective tissue

N00–
XIV Diseases of the genitourinary system
N99

O00–
XV Pregnancy, childbirth and the puerperium
O99

P00– Certain conditions originating in the

XVI
P96 perinatal period

Q00– Congenital malformations, deformations

XVII
Q99 and chromosomal abnormalities

Symptoms, signs and abnormal clinical

R00–
XVIII and laboratory findings, not elsewhere
R99
classified

S00– Injury, poisoning and certain other

XIX
T98 consequences of external causes

V01– External causes of morbidity and

XX
Y98 mortality

Z00– Factors influencing health status and

XXI
Z99 contact with health services

XXII U00– Codes for special purposes

217
UNIT: 5

INFECTION CONTROL:

MEDICAL ASEPSIS, Nosocomial infection and communicable diseases:

Aseptic technique

The media on which you culture desirable microorganisms will readily grow
undesirable contaminants, especially molds and other types of fungus, and
bacteria from your skin and hair. It is therefore essential that you protect your
cultures from contamination from airborne spores and living microorganisms,
surface contaminants that may be on your instruments, and from skin contact.

Bacteria and other contaminants cannot fly. Nearly all forms of contamination are
carried on microscopic dust particles that make their way onto sterile surfaces
when they are carelessly handled. One exception is insect contamination, such as
by ants for fruit flies. Fruit flies are a particular nuisance because they can crawl
under the lids of agar plates and lay eggs. You would think that people doing
gentics research would have developed a model by now that can't fly into other
peoples' experiements!

• Never leave a culture dish open, even for a short time when viewing
colonies of organisms, unless you intend to destroy it.

• When it is necessary to open a dish, keep the lid close to the dish, open it
only as far and as long as is necessary to accomplish the procedure, and
keep the lid between your face (and your germs!) and the agar surface.

• For most bacterial cultures you will use a sterile loop or needle to
inoculate or to obtain an inoculum.

• Flame a loop or needle to red-hot just prior to use, burning off any organic
material

• Cool the instrument by touching the sterile agar or liquid surface prior to
touching a culture (or else you will kill it)

218
 • Re-sterilize the instrument after performing the procedure, putting down
safely without burning the bench, you, or another student.

• Pass the neck of a culture tube or any container with a culture or sterile
contents through a flame before taking off the cap. Hold the cap with
opening down, and the tube horizontal or nearly so. Convection from the
heated neck will prevent dust from falling into the opening. Flame again
before putting the cap back [see 'preparing a bacterial smear' in the
staining section]

• Use sterile disposable pipets to remove samples from a broth culture that
must be kept uncontaminated.

• Always be aware of where your hands are, where your face is, and whether
or not your culture is in a position to be contaminated. If you have long
hair, make sure it does not hang into your plate. Hair is full of potential
contaminants, and is one of the principle sources of contaminating
microorganisms.

• If you have an open flame, long hair that is not tied back or loose clothing
can be hazardous to your health.

• Keep flammables away from the flames, including alcohol used for
sterilizing instruments; do not place a heated loop or glass rod into an
alcohol dish

A contaminated culture can often be rescued, however there is always the risk that
you will re-isolate the wrong microorganism. Besides, you don't have that kind of
time to waste. Exercise extreme care to keep your cultures pure.

Using a sterile cabinet

Unlike a fume hood, which is designed to keep airborne substances from escaping
into the laboratory environment, a sterile cabinet keeps airborne contaminants
from getting into the hood. A simple laminar flow hood protects exposed sterile
surfaces that are placed inside. A containment hood does both jobs, keeping
airborne particulate matter from going in or out. To use a hood properly,
remember these points.

219
 • Keep all surfaces clean and dry

• Frequently use the UV light to sterilize the interior surfaces; do not stare at
the light, which can cause retinal damage

• The opening must not exceed the recommended sash height

• Surfaces kept to back of the hood are more likely to remain sterile, as are
objects kept close to the table surface

• Keep non-sterile objects closer to the front, sterile objects to the back

• Keep the hood fairly uncluttered

• Never reach over a sterile surface - you WILL contaminate it; reach
around sterile surfaces if necessary

• Watch for long hair hanging over sterile surfaces

• Place lids with sterile side DOWN; don't turn lids upside down; nothing
will jump up and contaminate the lid

• Use slow, deliberate movements to avoid inadvertant contamination

Accumulated waste materials can pose a contamination hazard. A microbiology

laboratory can become inundated with old cultures unless a well organized system
for disposal of is in place. Even a few people can produce so much contaminated
material, that if teams don't take care of their own materials someone will spend at
least a week just cleaning up the place. All cultures must be sterilized before
disposal or cleaning of lab ware. To make disposal as efficient as possible, please
get rid of materials you no longer need as soon as possible, as described in
the special rules

1. Freedom from infection or infectious material.

2. The absence of viable pathogenic organisms; see also aseptic technique.

adj., adj asep´tic.(See accompanying table.)

Medical asepsis the use of practices aimed at destroying pathological organisms

after they leave the body; employed in the care of patients with infectious

220
diseases to prevent reinjection of the patient and to avoid the spread of infection
from one person to another. This is achieved by isolation precautions, in which the
objects in the patient's environment are protected from contamination or
disinfected as soon as possible after contamination.

Surgical asepsis the exclusion of all microorganisms before they can enter an
open surgical wound or contaminate a sterile field during surgery. See
accompanying table. Measures taken include sterilization of all instruments,
drapes, and all other inanimate objects that may come in contact with the surgical
wound. All personnel coming in contact with the sterile field perform a
surgical hand scrub with an antimicrobial agent and put on a surgical gown and
gloves. Further information concerning aseptic technique and technical aspects of
perioperative nursing practice can be found in the publication AORN Standards,

CONTROL OF COMMUNICABLE DISEASE

MEANING
capable of being easily communicated or transmitted: communicable information;
a communicable disease.

A communicable disease such as a cold is a disease that spreads from person to

person. Communicable diseases are diseases that you can "catch" from someone
or something else. Some people may use the words contagious or infectious when
talking about communicable diseases.

What do you "catch" when you get a communicable disease?

When a person becomes sick with a communicable disease it means a germ has
invaded their body. Germs fear soap and water. Washing your hands well and
often is the best way to beat these tiny warriors.

What are germs?

Germs are tiny organisms (living things) that may cause disease. Germs are so
small and sneaky that they creep into our body without being noticed. In fact,
germs are so tiny that you need to use a microscope to see them. We don't know
what hit us until we have symptoms (runny nose, cough, sore throat, fever, etc.)
that let us know we've been attacked!

221
Germs are microbes. A microbe is a tiny living organism that can only be seen
with a microscope. Microbes are the smallest form of life on Earth. Microbes
have existed for millions, and possibly even billions of years. Although some
microbes can make you sick or may even kill you. most are harmless, and some
are extremely helpful. Microbes can be found virtually anywhere - in air, water,
plants, animals and humans. A Germ is a microorganism that causes disease.
Germs are also known as pathogens.

REMEMBER - ALL microbes are NOT Germs!

We could not digest our food without microbes.

Garbage would not decay without microbes.

Plants would not grow without microbes.

The gas we pass is caused by bacteria in our intestines.

Without microbes there would be no life on earth.

Are there different types of germs?

There are four major types of germs:

Bacteria

Viruses

Fungi

Protozoa

Treatment of communicable diseases

The treatment of persons suffering from or suspected of suffering from one of the
communicable diseases specified in section 6 paragraph 1 sentence 1 nos. 1, 2 and
5 or section 34 paragraph 1 or infected by a pathogen specified in section 7 shall
be permitted, within the framework of the professional exercise of medicine, only
to physicians. Sentence 1 shall apply mutatis mutandis to sexually transmitted
diseases and diseases and pathogens which are also subject to compulsory
notification by an ordinance pursuant to section 15 paragraph 1. The direct and

222
indirect evidence of a pathogen for the detection of an infection or communicable
disease shall also be considered treatment within the meaning of sentences 1 and
2; section 46 shall apply mutatis mutandis.

Prevention of communicable diseases

General measures of the competent authority

(1) If circumstances are observed which could lead to the outbreak of a

communicable disease or if it can be assumed that such circumstances exist, the
competent authority shall take the measures necessary to avert the danger which
these circumstances pose to the individual or the public at large. The personal data
collected in the course of these measures may only be processed and used for the
purposes of this Act.

(2) In the cases specified in paragraph 1, the officers of the competent authority
and of the health office are entitled to enter upon land, rooms, facilities and
installations as well as means of transport of all types, and to inspect books or
other documents and to prepare copies, photocopies or excerpts from them as well
as to examine these and other objects and to demand or take samples for testing in
order to carry out investigations and to supervise the implementation of the
stipulated measures. The person who possesses actual power over said land,
rooms, facilities, installations and means of transport as well as other objects, shall
be obliged to allow the officers of the competent authorities and the health office
access to the same. Persons in a position to provide information on the
circumstances specified in paragraph

1, shall be obliged to furnish the requisite information particularly about the

establishment and the details of its operation inclusive of its control and submit
relevant documents inclusiveof technical plans that reflect the actual situation.
The obligated party can refuse to answer certain questions if he/she has reason to
fear that answering them could expose him/her or one of the relatives specified in
Section 383 paragraph 1 nos. 1 to 3 of the German Code of Civil Procedure
(Zivilprozeßordnung) to the danger of prosecution under criminal law or a lawsuit
according to the Act on Administrative Offences (Gesetz über

223
Ordnungswidrigkeiten); this provision shall apply accordingly to the submission
of documents.

(3) Where the ascertainment of the epidemiological situation so requires, the

competent authority can order the handing over of investigation materials
specified in paragraph 2 for the purpose of examination and safekeep to institutes
of the public health service or other institutions to be determined by the Land.

(4) The basic constitutional right to the inviolability of the home (Article 13
paragraph 1 of the Basic Law) shall be limited in respect of paragraphs 2 and 3.

(5) In cases where the person affected by the measures stipulated in paragraphs 1
and 2 has no legal capacity or restricted legal capacity, the person responsible for
the care of the former’s person shall ensure the fulfilment of the obligations
specified. The same obligations are to be fulfilled by the person having the care of
one who is affected by the measures stipulated in paragraphs 1 and 2 in so far as
the care of the person of the affected person falls within the scope of his/her
duties.

(6) The order that the measures specified in paragraph 1 are to be taken shall be
given by the competent authority at the proposal of the health office. Should the
competent authority be unable to obtain a proposal from the health office on time,
it shall immediately inform the health office of the measures implemented.

(7) In case of imminent danger, the health office itself may order that the
measures be implemented. It shall inform the competent authority immediately
thereof. The latter can modify or revoke the order. Should the order not be
revoked within the space of two working days after the competent authority is
informed, it shall be considered as an order made by the competent authority.

(8) Objections and actions to rescind measures taken under paragraphs 1 to 3 have
no suspensor effect.

224
Nosocomial infections

(1) Heads of hospitals and institutions for outpatient surgery are obliged to
continuously record and evaluate in a separate document the nosocomial
infections and the appearance of pathogens with special resistances and multiple
resistances stipulated by the Robert Koch Institute pursuant to section 4 paragraph
2 no. 2 letter b. The records pursuant to sentence 1 shall be kept for ten years. The
competent health office shall be given permission to inspect the records on
request.

(2) A Commission for Hospital Hygiene and Infection Prevention shall be set up
at the Robert Koch Institute. The Commission adopts Rules of Procedure that are
subject to the consent of the Federal Ministry for Health. The Commission drafts
recommendations on the prevention of nosocomial infections and on operational
and organizational as well as constructional and functional measures to ensure
hygiene in hospitals and other medical facilities. The recommendations of the
Commission shall be published by the Robert Koch Institute. The members of the
Commission are appointed by the Federal Ministry for Health in consultation with
the supreme health authorities of the Leander. Representatives of the Federal
Ministry for Health, the supreme health authorities of the Leander and the Robert
Koch Institute shall attend the session in an advisory capacity.

5.2 Reservoir, carrier and mode of transmission:

The Reservoir of Infection is the principal habitat where a specific infectious

agent lives and multiplies and from which it may spread to cause disease. The
reservoir is neccessary for the infectious agent either to survive, or to multiply in
sufficient amount to be transmitted to a susceptible host. Examples may
include primates(including human beings), the reservoir of pathogens such
as hepatitis A virus, hepatitis B virus, Polio virus (all 3 types), Bordetella
pertussis, Corynebacterium diphtheria, etc.

Other micro organisms have larger animal reservoirs, e.g. Salmonella species can
be found in almost every animal. The environment contains a large number of
reservoirs: soil, the reservoir for Clostridium tetani or water, the reservoir
for Legionella pneumophila.

225
In a number of articles the concept of 'source' and 'reservoir' are used as
synonyms, though strictly speaking they are not. A source usually can be found at
a specific time in a specific place (in other words: it often has 'an address').
Reservoirs are more generic 'homes' to micro organisms.

It is important to know the reservoir of pathogens, as this may offer opportunities

for control. For example, a disease like smallpox (variola major) could be
eradicated from this planet, in part because humans were the main reservoir. By
immunizing the majority of the reservoir population, and by rigorously keeping
infectious patients isolated and immunizing contacts, the smallpox virus could no
longer survive in nature. This is one of public health's great achievements
and currently similar attempts are underway to do the same with poliovirus.

Carriers (film)

Carriers:

is a 2009 American post-apocalyptic horror film written and directed by Àlex and
David Pastor. It stars Lou Taylor Pucci, Chris Pine, Piper Perabo and Emily
VanCamp as four people fleeing a viral pandemic.

Plot:

An infectious virus has spread worldwide, killing almost everyone. Two brothers,
Brian (Chris Pine) and Daniel "Danny" Green (Lou Taylor Pucci), along with
Brian's girlfriend, Bobby (Piper Perabo), and Danny's school friend, Kate (Emily
VanCamp), are heading to Turtle Beach in the southwestern United States, a
secluded beach motel where they believe they can wait for the viral pandemic to
die out and so they can start a new life.

On their way there, they meet a man, Frank Holloway (Christopher Meloni), and
his infected young daughter Jodie (Kiernan Shipka). After attempting to drive
away from them, their car breaks down. The four end up returning to Frank in
order to acquire his jeep, and are forced to take Frank and Jodie to a nearby high
school where a serum for the pandemic is rumored to have been developed. Upon
arrival they discover that the serum does not work, and the only doctor (Mark
Moses) still alive is about to commit suicide with a remaining group of infected

226
children (whom he plans to kill through non-voluntary euthanasia). Meanwhile,
Bobby is accidentally infected by Jodie while trying to help her when she coughs
blood on her. She hides her infection from the others. Brian leaves Frank and
Jodie behind and takes their car.

After this, they stop at a golf course hotel. Despite Bobby's efforts to prevent it,
Brian kisses her and inadvertently infects himself. The golf course is being used as
a base by a small group of armed survivalists who ambush and capture the group.
After a tenseMexican standoff, they declare their intent to keep the girls. As they
force the girls to disrobe to check them for infection, they discover Bobby's rashes
and bruises and force them away at gunpoint. Kate stresses that they will end up
dead if Bobby continues to travel with them, and Brian ends up leaving a weeping
Bobby behind at a deserted gas station.

They almost run out of fuel but encounter two women heading in the opposite
direction to them. Danny asks for help, but they refuse. A desperate Brian shoots
them for their fuel when they try to drive away. Brian later breaks down under the
pressure of having to make all of the difficult decisions in order to keep everyone
alive, and Danny discovers that his brother is also infected. At Brian's urging,
Danny shoots Brian and burns his mask and infected body. Afterward, Danny and
Kate reach Turtle Beach, but Danny realizes that without his brother the place that
had seemed so special to them as kids is now empty.

MODES OF TRANSMISSION

Once an infectious agent leaves a reservoir, it must get transmitted to a new host if
it is to multiply and cause disease. The route by which an infectious agent is
transmitted from a reservoir to another host is called the mode of transmission. It
is important for you to identify different modes of transmission, because
prevention and control measures differ depending on the type.
Various direct and indirect modes of transmission are summarised in Table 1.3
and discussed below it.

227
Mode of transmission Sub-types of transmission

Direct Touching

Sexual intercourse

Biting

Direct projection of droplets

Across the placenta

Indirect Airborne

Vehicle-borne

Vector-borne

Direct modes of transmission

Direct transmission refers to the transfer of an infectious agent from an infected

host to a new host, without the need for intermediates such as air, food, water or
other animals. Direct modes of transmission can occur in two main ways:

• Person to person: The infectious agent is spread by direct contact

between people through touching, biting, kissing, sexual intercourse or
direct projection of respiratory droplets into another person’s nose or
mouth during coughing, sneezing or talking. A familiar example is the
transmission of HIV from an infected person to others through sexual
intercourse.

• Transplacental transmission: This refers to the transmission of an

infectious agent from a pregnant woman to her fetus through the placenta.
An example is mother-to-child transmission (MTCT) of HIV.

228
Indirect modes of transmission

Indirect transmission is when infectious agents are transmitted to new hosts

through intermediates such as air, food, water, objects or substances in the
environment, or other animals. Indirect transmission has three subtypes:

• Airborne transmission: The infectious agent may be transmitted in dried

secretions from the respiratory tract, which can remain suspended in the air
for some time. For example, the infectious agent causing tuberculosis can
enter a new host through airborne transmission.

• Vehicle-borne transmission: A vehicle is any non-living substance or

object that can be contaminated by an infectious agent, which then
transmits it to a new host. Contamination refers to the presence of an
infectious agent in or on the vehicle.

• Vector-borne transmission: A vector is an organism, usually

an arthropod, which transmits an infectious agent to a new host.
Arthropods which act as vectors include houseflies, mosquitoes, lice and
ticks.

5.3 INFECTION CONTROL MEASURES

Infection control is the discipline concerned with preventing nosocomial or

healthcare-associated infection, a practical (rather than academic) sub-discipline
of epidemiology. It is an essential, though often under recognized and under
supported, part of the infrastructure of health care. Infection control and hospital
epidemiology are akin to public health practice, practiced within the confines of a
particular health-care delivery system rather than directed at society as a whole.

Infection control addresses factors related to the spread of infections within

the health-care setting (whether patient-to-patient, from patients to staff and from
staff to patients, or among-staff), including prevention (via hand hygiene/hand
washing, cleaning/disinfection/sterilization, vaccination, surveillance),
monitoring/investigation of demonstrated or suspected spread of infection within a
particular health-care setting (surveillance and outbreak investigation), and

229
management (interruption of outbreaks). It is on this basis that the common title
being adopted within health care is "Infection Prevention & Control."

Infection control in healthcare facilities

Aseptic technique is a key component of all invasive medical procedures.

Similarly, infection control measures are most effective when Standard
Precautions (health care) are applied because undiagnosed infection is common.

Hand hygiene

1. Independent studies by Lgnaz Semmelweis in 1847 in Vienna and Oliver

Wendell Holmes in 1843 in Boston established a link between the hands of health
care workers and the spread of hospital-acquired disease.

2. The Centers for Disease Control and Prevention (CDC) has stated that “It
is well documented that the most important measure for preventing the spread of
pathogens is effective hand washing.”

3. In the United States, hand washing is mandatory in most health care

settings and required by many different state and local regulations.

4. In the United States, Occupational Safety and Health Administration

(OSHA) standards require that employers must provide readily accessible hand
washing facilities, and must ensure that employees wash hands and any other skin
with soap and water or flush mucous membranes with water as soon as feasible
after contact with blood or other potentially infectious materials (OPIM).

Mean percentage changes in bacterial numbers

Change in
Method used
bacteria present

Paper towels (2-ply 100% recycled). - 48.4%

Paper towels (2-ply through-air dried, 50% recycled) - 76.8%

Warm air dryer + 254.5%

230
 Jet air dryer + 14.9%

5. Drying is an essential part of the hand hygiene process. In November

2008, a non-peer-reviewed study was presented to the European Tissue
Symposium by the University of Westminster, London, comparing the bacteria
levels present after the use of paper towels, warm air hand dryers, and modern jet-
air hand dryers.

6. Of those three methods, only paper towels reduced the total number of
bacteria on hands, with "through-air dried" towels the most effective.

The presenters also carried out tests to establish whether there was the potential
for cross-contamination of other washroom users and the washroom environment
as a result of each type of drying method. They found that:

• the jet air dryer, which blows air out of the unit at claimed speeds of
400 mph, was capable of blowing micro-organisms from the hands and the
unit and potentially contaminating other washroom users and the
washroom environment up to 2 metres away

• use of a warm air hand dryer spread micro-organisms up to 0.25 metres

from the dryer

• paper towels showed no significant spread of micro-organisms.

In 2005, in a study conducted by TUV Product und Unwept, different hand drying
methods were evaluated.

The following changes in the bacterial count after drying the hands were
observed:

Drying method Effect on bacterial count

Paper towels and roll Decrease of 24%

Hot-air drier Increase of 117%

231
Personal protective equipment

Disposable PPE

Personal protective equipment (PPE) is specialized clothing or equipment

worn by a worker for protection against a hazard. The hazard in a health care
setting is exposure to blood, saliva, or other bodily fluids or aerosols that may
carry infectious materials such as Hepatitis C, HIV, or other blood borne or bodily
fluid pathogen. PPE prevents contact with a potentially infectious material by
creating a physical barrier between the potential infectious material and the
healthcare worker.

In the United States, the Occupational Safety and Health Administration (OSHA)
requires the use of Personal protective equipment (PPE) by workers to guard
against blood borne pathogens if there is a reasonably anticipated exposure to
blood or other potentially infectious materials.

Components of Personal protective equipment (PPE) include gloves, gowns,

bonnets, shoe covers, face shields, CPR masks, goggles, surgical masks, and
respirators. How many components are used and how the components are used is
often determined by regulations or the infection control protocol of the facility in
question. Many or most of these items are disposable to avoid carrying infectious
materials from one patient to another patient and to avoid difficult or costly
disinfection. In the United States, OSHA requires the immediate removal and
disinfection or disposal of worker's PPE prior to leaving the work area where
exposure to infectious material took place.

Antimicrobial surfaces

Microorganisms are known to survive on non-antimicrobial in animate ‘touch’

surfaces (e.g., bedrails, over-the-bed trays, call buttons, bathroom hardware, etc.)
for extended periods of time. This can be especially troublesome in hospital
environments where patients with immune deficiencies are at enhanced risk for
contracting noso comical infections.

Products made with antimicrobial copper alloy (brasses, bronzes,

cupronickel, copper-nickel-zinc, and others) surfaces destroy a wide range of

232
microorganisms in a short period of time facilities in the U.K., Ireland, Japan,
Korea, France, Denmark, and Brazil.

Vaccination of health care workers

Health care workers may be exposed to certain infections in the course of their
work. Vaccines are available to provide some protection to workers in a
healthcare setting. Depending on regulation, recommendation, the specific work
function, or personal preference, healthcare workers or first responders may
receive vaccinations for hepatitis B; influenza; measles, mumps and rubella;
Tetanus, diphtheria, pertussis; N. meningitidis; and varicella. In general, vaccines
do not guarantee complete protection from disease, and there is potential for
adverse effects from receiving the vaccine.

Post exposure prophylaxis

In some cases where vaccines do not exist Post Exposure prophylaxis is another
method of protecting the health care worker exposed to a life threatening
infectious disease. For example, the viral particles for HIV-AIDS can be
precipitated out of the blood through the use of an antibody injection if given
within 4 hours of a significant exposure.

Surveillance for infections

Disease surveillance

Surveillance is the act of infection investigation using the CDC definitions.

Determining the presence of a hospital acquired infection requires an Infection
Control Practitioner (ICP) to review a patient's chart and see if the patient had the
signs and symptom of an infection. Surveillance definitions exist for infections of
the bloodstream, urinary tract, pneumonia,surgical sites and gastroenteritis.

Surveillance traditionally involved significant manual data assessment and entry

in order to assess preventative actions such as isolation of patients with an
infectious disease. Increasingly, computerized software solutions are becoming
available that assess incoming risk messages from microbiology and other online
sources. By reducing the need for data entry, software can reduce the data
workload of ICPs, freeing them to concentrate on clinical surveillance.

233
As approximately one third of healthcare acquired infections are preventable,
surveillance and preventative activities are increasingly a priority for hospital
staff. In the United States, a study on the Efficacy of Nosocomial Infection
Control Project (SENIC) by the CDC found that hospitals reduced their
nosocomial infection rates by approximately 32 per cent by focusing on
surveillance activities and prevention efforts.

Isolation

Isolation refers to various physical measures taken to interrupt nosocomial spread

of contagious diseases. Various forms of isolation exist, and are applied
depending on the type of infection and agent involved, to address the likelihood of
spread via airborne particles or droplets, by direct skin contact, or via contact with
body fluid

Outbreak investigation

When an unusual cluster of illness is noted, infection control teams undertake an

investigation to determine whether there is a true outbreak, a pseudo-outbreak (a
result of contamination within the diagnostic testing process), or just random
fluctuation in the frequency of illness. If a true outbreak is discovered, infection
control practitioners try to determine what permitted the outbreak to occur, and to
rearrange the conditions to prevent ongoing propagation of the infection. Often,
breaches in good practice are responsible, although sometimes other factors (such
as construction) may be the source of the problem.

Outbreaks investigations have more than a single purpose. These investigations

are carried out in order to prevent additional cases in the current outbreak, prevent
future outbreaks, learn about a new disease or learn something new about an old
disease. Reassuring the public, minimizing the economic and social disruption as
well as teaching epidemiology are some other obvious objectives of outbreak
investigations.

According to the WHO, outbreak investigations are meant to detect what is

causing the outbreak, how the pathogenic agent is transmitted, where it all started
from, what is the carrier, what is the population at risk of getting infected and
what are the risk factors.

234
The results of outbreak investigations are always made public in the means of a
report in which the findings are communicated to the authorities, media, scientific
community and so on. These reports are commonly used as pedagogical tools.

Training in infection control and health care epidemiology

Practitioners can come from several different educational streams. Many begin as
nurses, some as medical technologists (particularly in clinical microbiology), and
some as physicians (typically infectious disease specialists). Specialized training
in infection control and health care epidemiology are offered by the professional
organizations described below. Physicians who desire to become infection control
practitioners often are trained in the context of an infectious disease fellowship.

In the United States, Certification Board of Infection Control and Epidemiology is

a private company that certifies infection control practitioners based on their
educational background and professional experience, in conjunction with testing
their knowledge base with standardized exams. The credential awarded is CIC,
Certification in Infection Control and Epidemiology. It is recommended that one
has 2 years of Infection Control experience before applying for the exam.
Certification must be renewed every five years.

A course in hospital epidemiology (infection control in the hospital setting) is

offered jointly each year by the Centers for Disease Control and Prevention
(CDC) and the Society for Healthcare Epidemiology of America.

The Association for Professionals in Infection Control and Epidemiology, Inc.

(APIC) offers training and courses in infection control.

1. The community facilities mentioned in section 33 as well as hospitals,

preventive or rehabilitative health care facilities, institutions for outpatient
surgery, dialysis facilities, day hospitals, maternity hospitals, institutions pursuant
to section 1 paragraphs 1, 1a of the Act on Residential Accommodation
(Heimgesetz), similar therapeutic, care or treatment facilities as well as shelters
for the homeless, community facilities for asylum-seekers, repatriates and

235
refugees as well as other mass accommodation and prisons shall lay down in
hygiene plans internal protocols on infection control hygiene. The foregoing
entities are subject to the monitoring of infection control hygiene by the health
office.

2. Practices of dental surgeons and physicians as well as the practices of other

paramedical professions in which invasive interventions are performed as well as
other facilities and

professions which involve manipulations of the human body in the course of

which pathogens can be transmitted via blood, may be monitored by the health
office in terms of infection control hygiene.

3.Persons who are to be accepted into homes for the elderly, residential homes for
the elderly, nursing homes or similar establishments according to section 1
paragraph 1 of the Act on Residential Accommodation or into a community
facility for homeless persons, refugees, asylum-seekers or into an initial reception
centre of the Federal Government for repatriates must submit a medical certificate
to the management of the facility, before or immediately after their acceptance,
stating that they present no signs of contagious pulmonary tuberculosis. To gain
admission to a community facility for refugees or asylum-seekers or to an initial
reception centre of the Federal Government for repatriates, the certificate for
persons aged 15 years or over must be based on an X-ray of the lung made in the
territory covered by this Act; if they are admitted for the first time, the findings
may not be older than 6 months, for repeated admissions 12 months. Pregnant
women shall be exempted from taking the X-ray examination; instead, they shall
present a medical certificate stating that, on the strength of the other findings,
there is no reason to fear the existence of contagious pulmonary tuberculosis.

4. The basic rights to the inviolability of the home (Article 13 paragraph 1 of the
Basic Law) and to physical integrity (Article 2 paragraph 2 sentence 1 of the Basic
Law) shall be limited in this respect.

236
5.4. Sterilization and aseptic techniques:

Sterilization is a process intended to kill all microorganisms and is the

highest level of microbial kill that is possible. Sterilizers may be heat only, steam,
or liquid chemical. Effectiveness of the sterilizer (e.g., a steam autoclave) is
determined in three ways.

First, mechanical indicators and gauges on the machine itself indicate

proper operation of the machine. Second heat sensitive indicators or tape on the
sterilizing bags change color which indicate proper levels of heat or steam. And,
third (most importantly) is biological testing in which a highly heat and chemical
resistant microorganism (often the bacterial endospore) is selected as the standard
challenge. If the process kills this microorganism, the sterilizer is considered to be
effective. It should be noted that in order to be effective, instruments must be
cleaned, otherwise the debris may form a protective barrier, shielding the
microbes from the lethal process. Similarly care must be taken after sterilization to
ensure sterile instruments do not become contaminated prior to use.

Disinfection refers to the use of liquid chemicals on surfaces and at room

temperature to kill disease causing microorganisms. Ultraviolet cleaning devices
have also been used to disinfect the rooms of patients infected with Clostridium
edificial after discharge.

Disinfection is a less effective process than sterilization because it does

not kill bacterial endospores.

Sterilization, if performed properly, is an effective way of preventing bacteria

from spreading. It should be used for the cleaning of the medical instruments or
gloves, and basically any type of medical item that comes into contact with the
blood stream and sterile tissues.

There are four main ways in which such items can be sterilized: autoclave
(by using high-pressure steam), dry heat (in an oven), by using chemical sterilants
such as glutaraldehydes or formaldehyde solutions or by radiation (with the help
of physical agents). The first two are the most used methods of sterilizations

237
mainly because of their accessibility and availability. Steam sterilization is one of
the most effective types of sterilizations, if done correctly which is often hard to
achieve. Instruments that are used in health care facilities are usually sterilized
with this method. The general rule in this case is that in order to perform an
effective sterilization, the steam must get into contact with all the surfaces that are
meant to be disinfected. On the other hand, dry heat sterilization, which is
performed with the help of an oven, is also an accessible type of sterilization,
although it can only be used to disinfect instruments that are made of metal or
glass. The very high temperatures needed to perform sterilization in this way are
able to melt the instruments that are not made of glass or metal.

Steam sterilization is done at a temperature of 121 C (250 F) with a pressure

of 106 kPa (15 lbs/in2). In these conditions, unwrapped items must be sterilized
for 20 minutes, and wrapped items for 30 minutes. The time is counted once the
temperature that is needed has been reached. Steam sterilization requires four
conditions in order to be efficient: adequate contact, sufficiently high temperature,
correct time and sufficient moisture.

Sterilization using steam can also be done at a temperature of 132 C (270 F), at a
double pressure. Dry heat sterilization is performed at 170 C (340 F) for one hour
or two hours at a temperature of 160 C (320 F). Dry heat sterilization can also be
performed at 121 C, for at least 16 hours.

Chemical sterilization, also referred to as cold sterilization, can be used to

sterilize instruments that cannot normally be disinfected through the other two
processes described above. The items sterilized with cold sterilization are usually
those that can be damaged by regular sterilization. Commonly, glutaraldehydes
and formaldehyde are used in this process, but in different ways. When using the
first type of disinfectant, the instruments are soaked in a 2-4% solution for at least
10 hours while a solution of 8% formaldehyde will sterilize the items in 24 hours
or more. Chemical sterilization is generally more expensive than steam
sterilization and therefore it is used for instruments that cannot be disinfected
otherwise. After the instruments have been soaked in the chemical solutions, they
are mandatory to be rinsed with sterile water which will remove the residues from
the disinfectants. This is the reason why needles and syringes are not sterilized in

238
this way, as the residues left by the chemical solution that has been used to
disinfect them cannot be washed off with water and they may interfere with the
administered treatment. Although formaldehyde is less expensive than
glutaraldehydes, it is also more irritating to the eyes, skin and respiratory tract and
is classified as a potential carcinogen.[10]

Other sterilization methods exist, though their efficiency is still controversial.

These methods include gas sterilization, UV sterilization, and sterilization with
other chemical agents such as peroxyacetic acid, paraformaldehyde and gas
plasma sterilization.

Infections can be prevented from occurring in homes as well. In order to reduce

their chances to contract an infection, individuals are recommended to maintain a
good hygiene by washing their hands after every contact with questionable areas
or bodily fluids and by disposing the garbage at regular intervals to prevent germs
from growing.

5.5 Infection control committee: purpose, composition and terms of

reference:

Infection control committee

Scope:

1. Infection control programme in Father Muller Medical College Hospital

provide and maintain a continuous systematic monitoring of all
identified/suspected health care associated infections.

2. Reduce infection risk to patients HCW visitors, provide infection control

education to health care workers and create a clean and safe environment.

3. It is a hospital wide programme which coordinates and collaborates with all

hospital departments and services dealing with the delivery of patient care or the
support of patient care.

239
AIM is to:

- Secure the lowest possible rate of hospital acquired infection

- Protects staff and visitors from necessary risk

Responsibilities:

1. Advice staff on all aspects of infection control and maintain a safe environment
for patients and staff

2. Provide educational programmes on the prevention of hospital infection for all

hospital personnel

3. Provide a basic manual of policies and procedures and ensure that local written
guidelines based on these are in existence

4. Establish systems of surveilence of hospital infection in order to identify at-risk

patients and problem areas that need intervention. Methods for surveilence may
include case findings by ward rounds and chart reviews, reviews of laboratory
reports, and targeted prevalence of incidence surveys

5. Advise management of patients requiring special isolation and control measures

6. Investigate and control outbreaks of infection in collaboration with medical and

nursing staff

7. Ensure that an antibiotic policy is in existance

8. Liaise with the hospital doctors and administration (managerial and nursing),
community health doctors and nurses and infection control staff

Infection control is the discipline concerned with preventing nosocomial or

healthcare-associated infection, a practical (rather than academic) sub-discipline
of epidemiology. It is an essential, though often under recognized and under
supported, part of the infrastructure of health care. Infection control and hospital
epidemiology are akin to public health practice, practiced within the confines of a
particular health-care delivery system rather than directed at society as a whole.

240
 Infection control addresses factors related to the spread of infections within
the health-care setting (whether patient-to-patient, from patients to staff and from
staff to patients, or among-staff), including prevention (via hand hygiene/hand
washing, cleaning/disinfection/sterilization, vaccination, surveillance),
monitoring/investigation of demonstrated or suspected spread of infection within a
particular health-care setting (surveillance and outbreak investigation), and
management (interruption of outbreaks). It is on this basis that the common title
being adopted within health care is "Infection Prevention & Control."

Infection control in healthcare facilities

Aseptic technique is a key component of all invasive medical procedures.

Similarly, infection control measures are most effective when Standard
Precautions (health care) are applied because undiagnosed infection is common.

Hand hygiene

1. Independent studies by Lgnaz Semmelweis in 1847 in Vienna and Oliver

Wendell Holmes in 1843 in Boston established a link between the hands of health
care workers and the spread of hospital-acquired disease.

2. The Centers for Disease Control and Prevention (CDC) has stated that “It
is well documented that the most important measure for preventing the spread of
pathogens is effective hand washing.”

3. In the United States, hand washing is mandatory in most health care

settings and required by many different state and local regulations.

4. In the United States, Occupational Safety and Health Administration

(OSHA) standards require that employers must provide readily accessible hand
washing facilities, and must ensure that employees wash hands and any other skin
with soap and water or flush mucous membranes with water as soon as feasible
after contact with blood or other potentially infectious materials (OPIM).

241
 Mean percentage changes in bacterial numbers

Change in
Method used
bacteria present

Paper towels (2-ply 100% recycled). - 48.4%

Paper towels (2-ply through-air dried, 50% recycled) - 76.8%

Warm air dryer + 254.5%

Jet air dryer + 14.9%

5. Drying is an essential part of the hand hygiene process. In November

2008, a non-peer-reviewed study was presented to the European Tissue
Symposium by the University of Westminster, London, comparing the bacteria
levels present after the use of paper towels, warm air hand dryers, and modern jet-
air hand dryers.

6. Of those three methods, only paper towels reduced the total number of
bacteria on hands, with "through-air dried" towels the most effective.

The presenters also carried out tests to establish whether there was the potential
for cross-contamination of other washroom users and the washroom environment
as a result of each type of drying method. They found that:

• the jet air dryer, which blows air out of the unit at claimed speeds of
400 mph, was capable of blowing micro-organisms from the hands and the
unit and potentially contaminating other washroom users and the
washroom environment up to 2 metres away

• use of a warm air hand dryer spread micro-organisms up to 0.25 metres

from the dryer

• paper towels showed no significant spread of micro-organisms.

In 2005, in a study conducted by TUV Product und Unwept, different hand drying
methods were evaluated.

242
 The following changes in the bacterial count after drying the hands were
observed:

Drying method Effect on bacterial count

Paper towels and roll Decrease of 24%

Hot-air drier Increase of 117%

Cleaning, disinfection and sterilization

Sterilization is a process intended to kill all microorganisms and is the

highest level of microbial kill that is possible. Sterilizers may be heat only, steam,
or liquid chemical. Effectiveness’ of the sterilizer (e.g., a steam autoclave) is
determined in three ways.

First, mechanical indicators and gauges on the machine itself indicate

proper operation of the machine. Second heat sensitive indicators or tape on the
sterilizing bags change color which indicate proper levels of heat or steam. And,
third (most importantly) is biological testing in which a highly heat and chemical
resistant microorganism (often the bacterial endoscope) is selected as the standard
challenge. If the process kills this microorganism, the sterilizer is considered to be
effective. It should be noted that in order to be effective, instruments must be
cleaned, otherwise the debris may form a protective barrier, shielding the
microbes from the lethal process. Similarly care must be taken after sterilization to
ensure sterile instruments do not become contaminated prior to use.

Disinfection refers to the use of liquid chemicals on surfaces and at room

temperature to kill disease causing microorganisms. Ultraviolet cleaning devices
have also been used to disinfect the rooms of patients infected with Clostridium
edificial after discharge.

Disinfection is a less effective process than sterilization because it does

not kill bacterial endosperms.

243
 Sterilization, if performed properly, is an effective way of preventing
bacteria from spreading. It should be used for the cleaning of the medical
instruments or gloves, and basically any type of medical item that comes into
contact with the blood stream and sterile tissues.

There are four main ways in which such items can be sterilized: autoclave (by
using high-pressure steam), dry heat (in an oven), by using chemical sterility such
as glutaraldehydes or formaldehyde solutions or by radiation (with the help of
physical agents). The first two are the most used methods of sterilizations mainly
because of their accessibility and availability. Steam sterilization is one of the
most effective types of sterilizations, if done correctly which is often hard to
achieve. Instruments that are used in health care facilities are usually sterilized
with this method. The general rule in this case is that in order to perform an
effective sterilization, the steam must get into contact with all the surfaces that are
meant to be disinfected. On the other hand, dry heat sterilization, which is
performed with the help of an oven, is also an accessible type of sterilization,
although it can only be used to disinfect instruments that are made of metal or
glass. The very high temperatures needed to perform sterilization in this way are
able to melt the instruments that are not made of glass or metal.

Steam sterilization is done at a temperature of 121 C (250 F) with a pressure

of 106 kPa (15 lbs/in2). In these conditions, unwrapped items must be sterilized
for 20 minutes, and wrapped items for 30 minutes. The time is counted once the
temperature that is needed has been reached. Steam sterilization requires four
conditions in order to be efficient: adequate contact, sufficiently high temperature,
correct time and sufficient moisture.

Sterilization using steam can also be done at a temperature of 132 C (270 F), at a
double pressure. Dry heat sterilization is performed at 170 C (340 F) for one hour
or two hours at a temperature of 160 C (320 F). Dry heat sterilization can also be
performed at 121 C, for at least 16 hours.[11]

Chemical sterilization, also referred to as cold sterilization, can be used to

sterilize instruments that cannot normally be disinfected through the other two
processes described above. The items sterilized with cold sterilization are usually
those that can be damaged by regular sterilization. Commonly, glutaraldehydes

244
and formaldehyde are used in this process, but in different ways. When using the
first type of disinfectant, the instruments are soaked in a 2-4% solution for at least
10 hours while a solution of 8% formaldehyde will sterilize the items in 24 hours
or more. Chemical sterilization is generally more expensive than steam
sterilization and therefore it is used for instruments that cannot be disinfected
otherwise. After the instruments have been soaked in the chemical solutions, they
are mandatory to be rinsed with sterile water which will remove the residues from
the disinfectants. This is the reason why needles and syringes are not sterilized in
this way, as the residues left by the chemical solution that has been used to
disinfect them cannot be washed off with water and they may interfere with the
administered treatment. Although formaldehyde is less expensive than
glutaraldehydes, it is also more irritating to the eyes, skin and respiratory tract and
is classified as a potential carcinogen.

Other sterilization methods exist, though their efficiency is still controversial.

These methods include gas sterilization, UV sterilization, and sterilization with
other chemical agents such as peroxyacetic acid, par formaldehyde and gas plasma
sterilization.

Infections can be prevented from occurring in homes as well. In order to reduce

their chances to contract an infection, individuals are recommended to maintain a
good hygiene by washing their hands after every contact with questionable areas
or bodily fluids and by disposing the garbage at regular intervals to prevent germs
from growing.

Personal protective equipment

Disposable PPE

Personal protective equipment (PPE) is specialized clothing or equipment

worn by a worker for protection against a hazard. The hazard in a health care
setting is exposure to blood, saliva, or other bodily fluids or aerosols that may
carry infectious materials such as Hepatitis C, HIV, or other blood borne or bodily
fluid pathogen. PPE prevents contact with a potentially infectious material by
creating a physical barrier between the potential infectious material and the
healthcare worker.

245
In the United States, the Occupational Safety and Health Administration (OSHA)
requires the use of Personal protective equipment (PPE) by workers to guard
against blood borne pathogens if there is a reasonably anticipated exposure to
blood or other potentially infectious materials.

Components of Personal protective equipment (PPE) include gloves, gowns,

bonnets, shoe covers, face shields, CPR masks, goggles, surgical masks, and
respirators. How many components are used and how the components are used is
often determined by regulations or the infection control protocol of the facility in
question. Many or most of these items are disposable to avoid carrying infectious
materials from one patient to another patient and to avoid difficult or costly
disinfection. In the United States, OSHA requires the immediate removal and
disinfection or disposal of worker's PPE prior to leaving the work area where
exposure to infectious material took place.

Antimicrobial surfaces

Microorganisms are known to survive on non-antimicrobial in animate ‘touch’

surfaces (e.g., bedrails, over-the-bed trays, call buttons, bathroom hardware, etc.)
for extended periods of time. This can be especially troublesome in hospital
environments where patients with immune deficiencies are at enhanced risk for
contracting noso comical infections.

Main article: Antimicrobial copper-alloy touch surfaces

Products made with antimicrobial copper alloy (brasses, bronzes,

cupronickel, copper-nickel-zinc, and others) surfaces destroy a wide range of
microorganisms in a short period of time. The United States Environmental
Protection Agency has approved the registration of 355 different antimicrobial
copper alloys that kill E. coli O157:H7, methicillin-resistant Staphylococcus aures
(MRSA), Staphylococcus, Enterobacter aerogenes, and Pseudomonas aeruginosa
in less than 2 hours of contact. Other investigations have demonstrated the
efficacy of antimicrobial copper alloys to destroy Clostridium difficile, influenza
A virus, adenovirus, and fungi. As a public hygienic measure in addition to
regular cleaning, antimicrobial copper alloys are being installed in healthcare
facilities in the U.K., Ireland, Japan, Korea, France, Denmark, and Brazil.

246
Vaccination of health care workers

Health care workers may be exposed to certain infections in the course of their
work. Vaccines are available to provide some protection to workers in a
healthcare setting. Depending on regulation, recommendation, the specific work
function, or personal preference, healthcare workers or first responders may
receive vaccinations for hepatitis B; influenza; measles, mumps and rubella;
Tetanus, diphtheria, pertussis; N. meningitidis; and varicella. In general, vaccines
do not guarantee complete protection from disease, and there is potential for
adverse effects from receiving the vaccine.

Post exposure prophylaxis

In some cases where vaccines do not exist Post Exposure prophylaxis is another
method of protecting the health care worker exposed to a life threatening
infectious disease. For example, the viral particles for HIV-AIDS can be
precipitated out of the blood through the use of an antibody injection if given
within 4 hours of a significant exposure.

Surveillance for infections

Disease surveillance

Surveillance is the act of infection investigation using the CDC definitions.

Determining the presence of a hospital acquired infection requires an Infection
Control Practitioner (ICP) to review a patient's chart and see if the patient had the
signs and symptom of an infection. Surveillance definitions exist for infections of
the bloodstream, urinary tract, pneumonia,surgical sites and gastroenteritis.

Surveillance traditionally involved significant manual data assessment and entry

in order to assess preventative actions such as isolation of patients with an
infectious disease. Increasingly, computerized software solutions are becoming
available that assess incoming risk messages from microbiology and other online
sources. By reducing the need for data entry, software can reduce the data
workload of ICPs, freeing them to concentrate on clinical surveillance.

As approximately one third of healthcare acquired infections are preventable,

surveillance and preventative activities are increasingly a priority for hospital

247
staff. In the United States, a study on the Efficacy of Nosocomial Infection
Control Project (SENIC) by the CDC found that hospitals reduced their
nosocomial infection rates by approximately 32 per cent by focusing on
surveillance activities and prevention efforts.

Isolation

Isolation refers to various physical measures taken to interrupt nosocomial spread

of contagious diseases. Various forms of isolation exist, and are applied
depending on the type of infection and agent involved, to address the likelihood of
spread via airborne particles or droplets, by direct skin contact, or via contact with
body fluid

Outbreak investigation

When an unusual cluster of illness is noted, infection control teams undertake an

investigation to determine whether there is a true outbreak, a pseudo-outbreak (a
result of contamination within the diagnostic testing process), or just random
fluctuation in the frequency of illness. If a true outbreak is discovered, infection
control practitioners try to determine what permitted the outbreak to occur, and to
rearrange the conditions to prevent ongoing propagation of the infection. Often,
breaches in good practice are responsible, although sometimes other factors (such
as construction) may be the source of the problem.

Outbreaks investigations have more than a single purpose. These investigations

are carried out in order to prevent additional cases in the current outbreak, prevent
future outbreaks, learn about a new disease or learn something new about an old
disease. Reassuring the public, minimizing the economic and social disruption as
well as teaching epidemiology are some other obvious objectives of outbreak
investigations.

According to the WHO, outbreak investigations are meant to detect what is

causing the outbreak, how the pathogenic agent is transmitted, where it all started
from, what is the carrier, what is the population at risk of getting infected and
what are the risk factors.

248
The results of outbreak investigations are always made public in the means of a
report in which the findings are communicated to the authorities, media, scientific
community and so on. These reports are commonly used as pedagogical tools.

Training in infection control and health care epidemiology

Practitioners can come from several different educational streams. Many begin as
nurses, some as medical technologists (particularly in clinical microbiology), and
some as physicians (typically infectious disease specialists). Specialized training
in infection control and health care epidemiology are offered by the professional
organizations described below. Physicians who desire to become infection control
practitioners often are trained in the context of an infectious disease fellowship.

In the United States, Certification Board of Infection Control and Epidemiology is

a private company that certifies infection control practitioners based on their
educational background and professional experience, in conjunction with testing
their knowledge base with standardized exams. The credential awarded is CIC,
Certification in Infection Control and Epidemiology. It is recommended that one
has 2 years of Infection Control experience before applying for the exam.
Certification must be renewed every five years.

A course in hospital epidemiology (infection control in the hospital setting) is

offered jointly each year by the Centers for Disease Control and Prevention
(CDC) and the Society for Healthcare Epidemiology of America.

The Association for Professionals in Infection Control and Epidemiology, Inc.

(APIC) offers training and courses in infection control.

249