Mosby's Medical Dictionary (E)

e-, prefix meaning “out from”: ebonation, egesta, emollient.
E transmit vibrations caused by sound waves reaching the tym-

E, ε. See epsilon. panic membrane to the oval window of the inner ear. The
E, symbol for expired gas. leverage of the ossicles, or middle-ear bones, increases the
E, 1. symbol for elastance. 2. symbol for energy. 3. symbol intensity of sound vibrations by more than 25 dB. Because
for expectancy. 4. symbol for electromotive force. 5. symbol the inner ear is filled with fluid, the increased intensity helps
for illumination. compensate for the loss of signal normally caused by sound-
E1, symbol for monomolecular elimination reaction. wave reflection of the fluid. The inner ear contains two sepa-
E2, symbol for bimolecular reaction. rate organs: the vestibular apparatus, which provides the
ea, abbreviation for each. sense of balance, and the cochlea, with the organ of Corti,
Eakes, Georgene Gaskill, a nursing theorist who, with which receives vibrations from the middle ear and translates
Mary Lermann Burke and Margaret A. Hainsworth, devel- them into nerve impulses, which are again interpreted by
oped the Theory of Chronic Sorrow to describe the ongoing brain cells as specific sounds.
feelings of loss that arise from illness, debilitation, or death. earache /ir′āk/ [AS, eare + acan, to hurt], a pain in the
Eales’ disease /ēlz/ [Henry Eales, British physician, 1852– ear, sensed as sharp, dull, burning, intermittent, or constant.
1913], a condition marked by recurrent hemorrhages into The cause is not necessarily a disease of the ear, because
the retina and vitreous, affecting mainly males in the second infections and other disorders of the nose, oral cavity, larynx,
and third decades of life. and temporomandibular joint can produce referred pain in
E and GW, abbreviation for Economic and General the ear. Also called otalgia, otodynia.
Welfare. ear care, a nursing intervention from the Nursing Inter-
ear [AS, eare], one of two organs of hearing and balance, ventions Classification (NIC) defined as prevention or
consisting of the external, middle, and internal ear. The minimization of threats to ear or hearing. See also Nursing
external ear includes the skin-covered cartilaginous auricle Interventions Classification.
visible on either side of the head and the part of the external eardrop instillation, the instillation of a medicated solu-
auditory canal outside the skull. Together they form a funnel tion into the external auditory canal of the ear. The patient is
that directs sound waves toward the eardrum, or tympanic asked to turn the head to the side so that the ear being treated
membrane, which marks the boundary between the external faces upward. The orifice is exposed, and the drops of medi-
ear and the air-filled middle ear. The middle ear contains cine are directed toward the internal wall of the canal. The
three very small bones, the malleus, incus, and stapes, which pinna is pulled upward and outward in a person more than
External ear (not to scale) Middle ear Inner ear
Auricle External acoustic Temporal Tympanic

(pinna) meatus bone membrane
Semicircular canals
Copyright © 2013. Elsevier Health Sciences. All rights reserved.
Oval window
Facial nerve
Vestibular nerve
Vestibulocochlear
Cochlear nerve nerve (CN VIII)
Cochlea
Vestibule
Malleus Incus Stapes Round window
Auditory tube
Auditory
ossicles
Structures of the ear (Patton and Thibodeau, 2010)
scu on 2018-01-21 21:41:10. 579

Mosby. Mosby's Medical Dictionary, Elsevier Health Sciences, 2013. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/scu/detail.action?docID=1746285.
Created from
eardrops 580 eccentric implantation
3 years of age and down and back in a younger child. The overexercising or binging and purging of food and fluids. See
tragus is pushed against the ear canal to ensure that the drops also Nursing Interventions Classification.
stay in the canal. Eaton agent pneumonia. See mycoplasma pneumonia.
Eaton-Lambert syndrome [Lee M. Eaton, American neu-
rologist; Edward H. Lambert, twentieth-century American
physiologist], a form of myasthenia that tends to be associ-
ated with lung cancer.
EAV, abbreviation for electroacupuncture after Voll.
Ebbecke’s reaction. See autographism.
EBCT, abbreviation for electron beam computed
tomography.
Ebner’s glands [Victor von Ebner, Austrian histologist,
1842–1925], serous glands of the tongue, opening at the
bottom of the trough surrounding the circumvallate papillae.
Ebola virus disease /ēbō′lə/ [Ebola River District,
Congo], an infection caused by a species of ribonucleic
acid viruses of the Filovirus genus. There are four identi-
fied subtypes of Ebola virus: Côte d’Ivoire, Sudan, and
Zaire, which have been associated with human disease, and
Reston, which causes fatal hemorrhagic disease in nonhu-
man primates and originated in the Philippines. The usually
Eardrop instillation (Potter et al, 2011)
lethal disease is characterized by hemorrhage and fever. The
natural reservoir and method of transmission of primary
infections are unknown, but secondary infection is by direct
contact with infectious blood or other body secretions, in
eardrops [AS, eare + dropa], a topical, liquid form of research settings, or by airborne particles. The incubation
medication for the local treatment of various conditions period ranges from 2 to 21 days. Initial symptoms include
of the ear, such as inflammation or infection of the lin- high fever, headache, chills, myalgia, sore throat, red itchy
ing of the external auditory canal or impacted cerumen eyes, and malaise. Later symptoms include severe abdomi-
(earwax). nal pain, chest pain, bleeding, shock, vomiting, and diarrhea.
eardrum. See tympanic membrane. Maculopapular rash may occur in some patients. Treatment
Early and Periodic Screening Diagnosis and Treatment is supportive; in nearly 90% of cases, death occurs within 1
(EPSDT), a section of the Medicaid program that requires week. It is not known why some patients are able to recover
all states to maintain a program to determine the physical from the Ebola virus while others are not, but the latter have
and mental defects of persons who are covered by the pro- no detectable immune response to the infection. The Ebola
gram and to provide short- and long-range treatment. See virus is related to the Marburg virus. Also called African
also Medicaid. hemorrhagic fever, Ebola hemorrhagic fever. See also
early childhood caries, a chronic oral disease of young Marburg virus disease.
children characterized by the presence of one or more EBP, abbreviation for epidural blood patch.
decayed, missing, or filled tooth surfaces. Ebstein’s anomaly [Wilhelm Ebstein, German physician,
ear oximeter [AS, eare + Gk, oxys, sharp, genein, to pro- 1836–1912; Gk, anomalia, irregularity], a congenital heart
duce, metron, measure], a device placed over the earlobe defect in which the tricuspid valve is displaced downward
that transmits a beam of light through the earlobe tissue into the right ventricle. The abnormality is often associated
to a receiver. It is a noninvasive method of measuring the with right-to-left atrial shunting and Wolff-Parkinson-
level of saturated hemoglobin in the blood. As the amount of White syndrome.
saturated hemoglobin alters the wavelengths of light trans- EBV, abbreviation for Epstein-Barr virus.
mitted through the earlobe, analysis of the light received is EC, abbreviation for Enzyme Commission.
translated into percentage of oxygen saturation (SO2) of the ec-, prefix meaning “out of ”: ecbolic, eccephalosis,
blood. See also pulse oximeter. ecchondroma.
ear speculum [AS, eare + L, speculum, mirror], a short, ECC, 1. abbreviation for emergency cardiac care.
funnel-shaped tube attached to an otoscope for examining 2. abbreviation for external cardiac compression.
the ear canal. eccentric /eksen′trik/ [Gk, ek, out, centre, center], 1. per-
ear thermometry, the measurement of the temperature taining to an object or activity that departs from the usual
of the tympanic membrane by detection of infrared radia- course or practice. 2. pertaining to behavior that may appear
tion from the eardrum. See also tympanic membrane to be odd or unconventional but does not necessarily reflect
thermometer. a disorder.
earwax. See cerumen. eccentric contraction, a type of muscle contraction that
East African sleeping sickness. See Rhodesian occurs as the muscle fibers lengthen, such as when a weight
trypanosomiasis. is lowered through a range of motion. The contractile force
eastern equine encephalitis. See equine encephalitis. generated by the muscle is weaker than an opposing force,
eating disorders, a group of behaviors often fueled by which causes the muscle to stretch. Compare concentric
unresolved emotional conflicts symptomized by altered food contraction.
consumption. Disorders include anorexia nervosa, bulimia eccentric exercise, a voluntary muscle activity in which
nervosa, and binge eating. Compare pica. there is an overall lengthening of the muscle in response to
eating disorders management, a nursing intervention external resistance.
from the Nursing Interventions Classification (NIC) defined eccentric implantation [Gk, ek, out, centre, center], (in
as prevention and treatment of severe diet restriction and embryology) the embedding of the blastocyst within a fold
Created from scu on 2018-01-21 21:41:10.
eccentricity 581 echocardiogram
or recess of the uterine wall, which then closes off from the secretion, which is clear, has a faint odor, and contains
main cavity. water, sodium chloride, and traces of albumin, urea, and
eccentricity /ek′sentris′itē/, behavior that is regarded as odd other compounds. Compare apocrine gland. See also
or peculiar for a particular culture or community, although sudoriferous gland.
not unusual enough to be considered pathological. eccyesis. See ectopic pregnancy.
eccentric jaw relation, any jaw relation other than centric ECF, 1. abbreviation for extended care facility. 2. abbre-
relation at closure. viation for extracellular fluid.
eccentric occlusion [Gk, ek + centre + L, occludere, to close ECG, 1. abbreviation for electrocardiogram. 2. abbrevia-
up], a closed position of the teeth that does not coincide tion for electrocardiograph. 3. abbreviation for electrocar-
with centric relation, resulting in premature tooth contacts. diography. 4. abbreviation for echoencephalogram.
Also called acentric occlusion. -echia, suffix meaning a “condition of holding”: asynechia,
ecchondroma /ek′əndrō′mə/ [Gk, ek + chondros, cartilage, blepharosynechia, synechia.
oma, tumor], a benign tumor that develops on the surface echinacea, a perennial herb found only in Missouri,
of a cartilage or under the periosteum of bone. Also called Nebraska, and Kansas in the United States.
ecchondrosis. n uses: It is used for those with low immune status, for
ecchymoma /ek′imō′mə/, a swelling caused by accumula- hard-to-heal superficial wounds, and as a sun protectant. It
tion of blood on the site of a bruise. is most commonly used to treat the common cold and upper
ecchymosis /ek′imō′sis/ pl. ecchymoses [Gk, ek + chymos, respiratory infections. It has no apparent protective effects
juice], bluish discoloration of an area of skin or mucous but may decrease the duration and symptoms of the infection
membrane caused by the extravasation of blood into the if started when symptoms are first noticed. There are insuf-
subcutaneous tissues as a result of trauma to the underly- ficient reliable data for other indications.
ing blood vessels or fragility of the vessel walls. Also called n contraindications: It is not recommended during preg-
bruise. Compare contusion, petechiae. nancy and lactation or in children. It is also contraindicated
in people who have autoimmune diseases such as lupus ery-
thematosus, multiple sclerosis, HIV/AIDS, or collagen dis-
ease and in people with tuberculosis or hypersensitivity to
Bellis species or the Compositae family of herbs. Immuno-
suppression may occur after extended therapy with this herb.
It should not be used for more than 8 weeks.
echino-, prefix meaning “spine or spiny”: echinochroma,
echinosis, echinostomiasis.
echinococcosis /ekī′nōkokō′sis/ [Gk, echinos, prickly husk,
kokkos, berry, osis, condition], an infestation, usually of the
liver, caused by the larval stage of a tapeworm of the genus
Echinococcus. Dogs are the principal hosts of the adult
worm; sheep, goats, horses, camels, cattle, rodents, and deer
are the natural intermediate hosts for the larvae. Humans,
especially children, can become infested with larvae by
ingesting eggs shed in the stool of infected dogs and cats or
by petting or handling household dogs or cats. The disease is
most common in countries where livestock is raised with the
help of dogs. Fluid-filled cysts form in affected organs such
as the liver, lungs, brain, bones, or heart. Clinical manifesta-
tions and prognosis vary, depending on the tissue invaded
and the extent of infestation. Diagnosis is made by skin tests
for sensitivity, serological tests, radiological evidence of

Ecchymosis (Moll, 1997) cyst formation, and identification of larval cysts in infected
tissue. Treatment is an extended course of benzimidazole;
puncture, aspiration, injection, and reaspiration of cysts; or
ecchymotic /ek′imot′ik/ [Gk, ek, out, chymos, juice], per- careful removal of cysts, avoiding rupture of a cyst, which
taining to a discolored area on the skin or membrane caused could cause severe allergic reactions or disseminate infec-
by blood seeping into the tissue as a result of a contusion. tion. The disease can be prevented by avoiding contact with
Compare bruise. infected dogs, deworming pet animals, and preventing dogs
ecchymotic mask [Gk, ek + chymos + Fr, masque], a cya- from eating carcasses of infected intermediate hosts. Also
notic or bluish discoloration of the face of a victim of trau- called hydatid disease, hydatidosis. See also cysticercosis,
matic asphyxia, as in strangulation or choking. The color is tapeworm infection.
the result of petechial hemorrhages. Echinococcus /ekī′nōkok′əs/ [Gk, echinos, prickly husk,
ecchymotic rash [Gk, ek + chymos, juice; OFr, rasche, kokkos, berry], a genus of small tapeworms that primarily
scurf], a skin eruption characterized by black-blue spots infect canines. See also echinococcosis.
caused by extravasation of blood into the tissues, usually as echinocyte. See burr cell.
a result of a contusion. echo /ek′ō/, 1. the reflection of an ultrasound wave back
eccrine /ek′rin/ [Gk, ekkrinein, to secrete], pertaining to to the transducer from a structure in the plane of the sound
a sweat gland that secretes outwardly through a duct to the beam. 2. (informal) echoradiography.
surface of the skin. See also exocrine. echo beat. See reciprocal beat.
eccrine gland, one of the sudoriferous glands located echocardiogram /ek′ōkär′dē·əgram′/ [Gk, echo, sound,
in the dermis. Such glands are unbranched, coiled, and kardia, heart, gramma, record], a graphic outline of the
tubular. They promote cooling by evaporation of their movements of heart structures produced by ultrasonography.
echocardiography 582 eclampsia
a major shift of midline structures caused by an expand-
ing lesion. See also ultrasonography. —echoencephalo-
graphic, adj.
echogram /ek′ōgram/ [Gk, echo, sound, gramma,
record], a recording of ultrasound echo patterns of a body
structure, such as a gravid uterus.
echographia. See pseudoagraphia.
echography. See ultrasonography.
echo home, an independent housing facility for an older
person in or near the family home.
echolalia /ek′ōlā′lyə/ [Gk, echo + lalein, to babble], 1. (in
psychiatry) the automatic and meaningless repetition of
another’s words or phrases, especially as seen in schizo-
phrenia. A kind of echolalia is delayed echolalia. 2. (in
pediatrics) a baby’s imitation or repetition of sounds or
words produced by others. It occurs normally in early child-
hood development. Also called echophrasia, echo speech.
—echolalic, adj.
echo planar imaging (EPI), a fast magnetic resonance
imaging mode.
echopraxia /ek′ōprak′sē·ə/ [Gk, echo + prassein, to prac-
tice], imitation or repetition of the body movements of
another person, sometimes practiced by schizophrenic
patients.
echoradiography /ek′ōrā′dē·og′rəfē/ [Gk, echo + L, radius,
Echocardiogram (Goldman et al, 2008) ray; Gk, graphein, to record], a diagnostic procedure using
ultrasonography and various devices for the visualization of
echocardiography /ek′ōkär′dē·og′rəfē/ [Gk, echo + kar- internal structures of the body.
dia, heart, graphein, to record], a diagnostic, noninvasive echo sign, 1. a repeated sound heard on percussion of a
procedure for studying the structure and motion of the heart. hydatid cyst. 2. an involuntary repetition of words heard.
Ultrasonic waves directed through the heart are reflected See also echolalia.
backward, or echoed, when they pass from one type of tissue echo speech. See echolalia.
to another, such as from cardiac muscle to blood. The sound echothiophate iodide /-thī′ōfāt/, an anticholinesterase
waves are transmitted from and received by a transducer and used for ophthalmic purposes.
are recorded on a strip chart. Major diagnostic uses include n indications: It is prescribed for the treatment of chronic
the detection of atrial tumors and pericardial effusion, mea- open-angle glaucoma and accommodative esotropia.
surement of the ventricular septa and ventricular chambers, n contraindications: Uveal inflammation, most types of
evaluation or monitoring of prosthetic valve function, and angle-closure glaucoma, or known hypersensitivity to this
determination of mitral valve motion abnormalities and con- drug prohibits its use.
genital lesions. Also called ultrasonic cardiography. See n adverse effects: Among the more serious adverse
also phonocardiograph, ultrasonography. effects are retinal detachment, nonreversible cataract, lens
opacity, activation of iritis or uveitis, and iris cysts.
ECHO virus /ek′ō vī′rəs/ [enteric cytopathogenic human
orphan + L, virus, poison], a picornavirus associated with
many clinical syndromes but not identified as the causative
organism of any specific disease. ECHO stands for enteric,

cytopathic, human, orphan. There are many ECHO viruses.
More than 30 serotypes have been identified; many are harm-
less. Bacterial or viral disease may be complicated by ECHO
virus infection, as aseptic meningitis accompanying some
severe bacterial and viral infections.
Eck’s fistula [Nikoli V. Eck, Russian physiologist, 1849–
1917], an artificial passage between the end of the hepatic
portal vein and the side of the inferior vena cava. It is used to
treat esophageal varices in portal hypertension.
eclampsia /iklamp′sē·ə/ [Gk, ek, out, lampein, to flash], the
gravest form of pregnancy-induced hypertension. It is charac-
terized by grand mal seizure, coma, hypertension, proteinuria,
and edema. The symptoms of impending seizure often include
Color-flow echocardiography (Goldman et al, 2004) body temperature of up to 104° F, anxiety, epigastric pain,
severe headache, and blurred vision. The nurse is alert to per-
echoencephalogram (EEG) /ek′ōensef′ələgram′/ [Gk, sistently and extremely high blood pressure and to increasingly
echo + enkephalos, brain, gramma, record], a recording hyperactive deep-tendon reflexes, or clonus. Convulsions may
produced by an echoencephalograph. be prevented by bed rest in a quiet, dimly lit room and paren-
echoencephalography /ek′ō·ensef′əlog′rəfē/, the use of teral administration of magnesium sulfate and antihyperten-
ultrasound to study the intracranial structures of the brain. sive medications. The nurse attentively monitors the mother’s
The technique is useful for showing ventricular dilation and general condition, including respiration, deep tendon reflexes,
eclectic 583 ectomorph
blood pressure, magnesium sulfate levels, and urine and pro- ectatic emphysema. See panacinar emphysema.
tein excretion, as well as the baby’s heart rate. Treatment of a ecthyma /ek′thimə/ [Gk, ek, out, thyein, to rush], an
convulsion must include maintenance of the mother’s airway, ulcerative pyoderma characterized by large pustules, crusts,
protection of the mother against self-injury, and administration and ulcerations surrounded by erythema. It is caused by a
of medication to check the convulsion and decrease the blood streptococcal infection after a minor trauma. The skin of the
pressure. Once this is accomplished, delivery is indicated. legs is most frequently affected. Treatment includes vigorous
Convulsions rarely occur in the puerperium. Complications cleansing, application of compresses of cool Burow’s solu-
of eclampsia include cerebral hemorrhage, pulmonary edema, tion to soften and remove crusts, and systemic administration
renal failure, liver necrosis, abruptio placentae, hypofibrino- of antibiotics. Compare folliculitis, impetigo.
genemia, hemolysis, and retinal hemorrhages, sometimes with
temporary blindness. The maternal mortality rate in eclampsia
is 10%; the fetal mortality rate is 25%. Eclampsia occurs in
0.2% of pregnancies. The cause is not known.
eclectic /iklek′tik/ [Gk, eklektikos, selecting], pertaining
to a therapy that selects, combines, and incorporates diverse
techniques from several systems or theories into an inte-
grated approach.
eclipse scotoma /iklips′/ [Gk, ekleipsis, abandoning,
skotos, darkness, oma, tumor], a small central area of
depressed or lost vision caused by looking directly at the sun
without adequate protection. Also called solar maculopa-
thy, solar retinopathy.
ECM, abbreviation for erythema chronicum migrans.
ECMO, abbreviation for extracorporeal membrane
oxygenator.
-ecoia, suffix meaning “(condition of the) sense of hear-
ing”: bradyecoia, dysecoia, oxyecoia.
E. coli, abbreviation for Escherichia coli.
ecological chemistry /ikəloj′ik/, the study of chemical
compounds synthesized by plants that influence ecological
characteristics through chemical communication or toxic
effects.
ecological fallacy, a false assumption that the presence
of a pathogenic factor and a disease in a population can be Ecthyma (James, 2006)
accepted as proof that a particular individual is the cause of
the disease.
ecology /ikol′əjē/ [Gk, oekos, house, logos, science], the ecthyma contagiosum. See contagious pustular
study of the interaction between organisms and their dermatitis.
environment. ecto-, prefix meaning “outside”: ectoblast, ectocolon,
econazole /ikon′əzōl/, a topical antifungal agent. ectodermal.
n indications: It is prescribed in the treatment of tinea ectocytic /ek′təsit′ik/ [Gk, ektos, outside, kytos, cell], out-
pedis, tinea cruris, tinea corporis, tinea versicolor, and side a cell and not part of its organization.
candidiasis. ectoderm /ek′tədurm/ [Gk, ektos, outside, derma,
n contraindication: Known sensitivity to this drug pro- skin], the outermost of the three primary cell layers of an
hibits its use. embryo. The ectoderm gives rise to the nervous system; the
n adverse effects: Among the most serious adverse organs of special sense, such as the eyes and ears; the epider-
effects are local irritation and hypersensitivity of the skin. mis and epidermal tissue, such as fingernails, hair, and skin
Economic and General Welfare (E and GW), a struc- glands; and the mucous membranes of the mouth and anus.
tural unit of the American Nurses Association and state See also embryo, endoderm, mesoderm. —ectodermal,
nurses’ associations whose major goal is to upgrade the sala- ectodermic, adj.
ries, benefits, and working conditions of nurses. ectodermal cloaca /ek′tədur′məl/, a part of the cloaca in
ecosystem /ek′ōsis′təm/, the total of all living things within the developing embryo that lies external to the cloacal mem-
a particular area and the nonliving things with which they brane and eventually gives rise to the anus and anal canal.
interact. Compare endodermal cloaca.
EC space, abbreviation for extracellular space. See ectodermal dysplasia, any of a group of hereditary dis-
extracellular. orders involving tissues and structures derived from the
ecstasy /ek′stəsē/ [Gk, ekstasis, derangement], 1. an embryonic ectoderm. Ectodermal dysplasia is a component
emotional state characterized by exultation, rapturous of various syndromes, including anhidrotic ectodermal
delight, or frenzy. Compare euphoria, mania. —ecstatic, dysplasia and EEC syndrome.
adj. 2. (informal) popular name for 3,4-methylenedioxy- ectodermic. See ectoderm.
methamphetamine, a hallucinogenic drug of abuse. See also ectodermoidal /ek′tədərmoi′dəl/ [Gk, ektos, outside,
drug abuse. derma, skin, eidos, form], resembling or having the char-
ECT, 1. abbreviation for electroconvulsive therapy. acteristics of ectoderm.
2. abbreviation for emission computed tomography. ectomorph /ek′təmôrf′/ [Gk, ektos + morphe, form], a per-
-ectasia, suffix meaning “dilatation, dilation, extension, son whose physique is characterized by slenderness, fragility,
or distension of an organ”: esophagectasia, lymphectasia, and a predominance of structures derived from the ectoderm.
pharyngectasia. Compare endomorph, mesomorph. See also asthenic habitus.
-ectomy 584 ectrosyndactyly
-ectomy, suffix meaning the “surgical removal” of some- ectopic ureter, a ureter that opens in a place other than
thing specified: lobectomy, thrombectomy, thyroidectomy. the bladder wall. In women it may open into the vestibule,
ectoparasite /ek′tōper′əsīt/ [Gk, ektos + parasitos, terminal urethra, vagina, cervix, or uterine cavity. In men it
guest], (in medical parasitology) an organism that lives on invariably enters the genital or urinary tract above the level
the outside of the body of the host, such as a louse. of the external sphincter.
-ectopia, suffix meaning a “condition in which a (specified) ectoplasm, the compact, peripheral portion of the cyto-
organ or part is out of its normal place”: corectopia, osteec- plasm of a cell.
topia, tarsectopia. ectopy /ek′təpē/ [Gk, ek, out, topos, place], a condition in
ectopic /ektop′ik/ [Gk, ek + topos, place], 1. (of an object which an organ or substance is not in its natural or proper
or organ) situated in an unusual place, away from its normal place, such as an ectopic pregnancy that develops outside the
location, for example, an ectopic pregnancy, which occurs out- uterus or an ectopic heartbeat.
side the uterus. 2. (of an event) occurring at the wrong time, ectotoxin. See exotoxin.
as a premature heartbeat or premature ventricular contraction. ectro-, prefix meaning “loss or absence of, miscarriage,
ectopic beat [Gk, ek, out, topos, place; AS, beatan], an abortion”; used primarily to indicate a loss of limbs or body
impulse that originates in the heart at a site other than the parts: ectrodactyly, ectromelia.
sinus node. Also called extrasystole. ectrodactyly /ek′trōdak′təlē/ [Gk, ektrosis, miscarriage,
ectopic focus, an area in the heart that initiates abnormal daktylos, finger], a congenital anomaly characterized by
beats. Ectopic foci may occur in both healthy and diseased the absence of part or all of one or more of the fingers or
hearts and are usually associated with irritation of a small toes. Also called ectrodactylia, ectrodactylism.
area of myocardial tissue. They are produced in association
with myocardial ischemia, drug (catecholamine) effects,
emotional stress, and stimulation by foreign objects, includ-
ing pacemaker catheters. Also called ectopic pacemaker.
ectopic kidney, a kidney not in the usual position. The
most common types are abdominal, lumbar, pelvic, thoracic,
and crossed fused ectopic kidneys.
ectopic myelopoiesis. See extramedullary myelopoiesis.
ectopic pacemaker. See ectopic focus.
ectopic pregnancy, an abnormal pregnancy in which the
conceptus implants outside the uterine cavity. Kinds of ectopic
pregnancy are abdominal pregnancy, ovarian pregnancy,
and tubal pregnancy. Also called eccyesis /ek′sī·ē′sis/.
ectopic rhythm [Gk, ek + topos, place, rhythmos, beat], an
abnormal heart rhythm caused by the formation of impulses
in a focus outside the sinus node. Such a rhythm may be pro-
tective in cases of failure of the sinus node or excessive slow-
ing of its rhythm, or it may indicate an active abnormal focus. Ectrodactyly involving the hands (Moore, Persaud, and
ectopic tachycardia [Gk, ek + topos, place, tachys, swift, Shiota, 2000/Courtesy Dr. A.E. Chudley, Department of Pediatrics and
kardia, heart], an abnormally rapid heartbeat caused by Child Health, University of Manitoba, Children’s Hospital)
excitation arising from a focus outside the sinus node.
ectopic teratism, a congenital anomaly in which one or
more parts are misplaced, such as dextrocardia, palatine ectrodactyly-ectodermal dysplasia-clefting syndrome.
teeth, and transposition of the great vessels. See EEC syndrome.
ectopic testis, a testis that has descended from the abdomi- ectrogenic. See ectrogeny.
nal cavity and settled in the suprapubic area, the thigh, or the ectrogenic teratism /-jen′ik/ [Gk, ektrosis + genein, to
perineum instead of the scrotum. Therapy requires surgery. produce, teras, monster], a congenital anomaly caused by
See also cryptorchidism. developmental failure in which one or more parts or organs
are missing.
ectrogeny /ektroj′ənē/ [Gk, ektrosis + genein, to pro-
Superficial ring
Ectopic testis duce], the congenital absence or defect of any organ or part
of inguinal canal of the body. —ectrogenic, adj.
ectromelia /ek′trōmē′lyə/ [Gk, ektrosis + melos, limb], the
congenital absence or incomplete development of the long
bones of one or more of the limbs. Kinds of ectromelia are
amelia, hemimelia, and phocomelia. —ectromelic, adj.,
ectromelus, n.
ectropic /ektrop′ik/, inside-out.
ectropion /ektrō′pē·on/ [Gk, ek + trepein, to turn], ever-
sion, most commonly of the eyelid, exposing the conjuncti-
val membrane lining the eyelid and part of the eyeball. The
condition may involve only the lower eyelid or both eyelids.
The cause may be paralysis of the facial nerve, scarring, neo-
plasia, or, in an older person, atrophy of the eyelid tissues.
Compare entropion.
ectrosyndactyly /ek′trōsindak′təlē/ [Gk, ektrosis + syn,
together, daktylos, finger], a congenital anomaly character-
Usual locations of ectopic testes (Moore and Persaud, 2008) ized by the absence of some but not all of the digits, with
ECU 585 eddy currents
eczema herpeticum, a generalized vesiculopustular rash
caused by herpes simplex virus or vaccinia virus infection
of a preexisting rash such as atopic dermatitis. Also called
Kaposi’s varicelliform eruption.
Ectropion (Kanski, 2007/Courtesy A. Pearson)
those that are formed webbed so as to appear fused. Also

called ectrosyndactylia.
ECU, abbreviation for environmental control unit.
eculizumab, a monoclonal antibody.
n indications: This drug is used to treat proximal noc-
turnal hemoglobinuria, a rare, genetic form of hemolytic
anemia.
n contraindications: Known hypersensitivity to this
drug prohibits its use. Rapid discontinuation may result in
serious hemolysis.
n adverse effects: Adverse effects of this drug include Eczema herpeticum (Stone and Gorbach, 2000)
rash, dyspnea, calf or leg pain, chest pain, confusion, cough-
ing up blood, sensitivity to light, fever, chills, persistent sore eczema marginatum. See tinea cruris.
throat, mental changes, headache, nausea, vomiting, fever, eczematous. See eczema.
stiff neck or back, mouth sores, fever blisters, and severe eczematous conjunctivitis /eksem′ətəs/, conjunctival and
muscle aches. A life-threatening side effect is meningococcal corneal inflammation associated with multiple tiny ulcerated
infection. Common side effects are headache, nasopharyngi- vesicles. The cause is believed to be a delayed hypersensitiv-
tis, back pain, nausea, fatigue, and cough. ity to bacterial protein. If untreated, the condition may lead
eczema /ek′simə/ [Gk, ekzein, to boil over], a general to ingrowth of small blood vessels in the cornea, eventually
superficial dermatitis of unknown cause. In the early stage it obscuring vision. Treatment usually includes topical instilla-
may be pruritic, erythematous, papulovesicular, edematous, tion of corticosteroids. Also called staph marginal disease.
and weeping. Later it becomes crusted, scaly, thickened, or eczopiclone, a sedative/hypnotic.
lichenified. Exacerbating factors include sudden temperature n indication: This drug is used to treat insomnia.
changes, humidity, psychological stress, illness, allergies, n contraindication: Known hypersensitivity to this drug
fibers, detergents, and perfumes. Eczema is not a distinct dis- prohibits its use.
ease entity. See also atopic dermatitis, nummular derma- n adverse effects: Adverse effects of this drug include
titis. —eczematous, adj. depression, hallucinations, headache, daytime drowsiness,
peripheral edema, chest pain, dry mouth, bitter taste, and
rash.
ED, 1. abbreviation for effective dose. 2. abbreviation for
emergency department.
ED50, symbol for median effective dose.
ED90, the dose of a therapeutic agent that eradicates 90% of
the target pathogen.
edaphon /ed′əfon/, the composite of organisms that live in
the soil. —edaphic, adj.
EDB, 1. abbreviation for ethylene dibromide. 2. abbre-
viation for expected date of birth. See expected date of
delivery.
EDC, abbreviation for expected date of confinement. See
expected date of delivery.
EDD, abbreviation for expected date of delivery.
eddy currents, small circular electric fields induced when
a magnetic field is created. They result in intramolecular
oscillation or vibration of tissue contents, causing generation
Nummular eczema (White and Cox, 2006) of heat.
Edecrin Sodium 586 edrophonium test
Edecrin Sodium, a trademark for a loop diuretic (ethac- edematogenic /ēdem′ətōjen′ik/, causing edema.
rynate sodium). edentulism /eden′tulizem/, the condition of being without
EDE limit, abbreviation for effective dose equivalent natural teeth.
limit. edentulous /ēden′chələs/, lacking natural teeth.
edema /idē′mə/ [Gk, oidema, swelling], the abnormal edetate calcium disodium (EDTA) /ed′ətāt/, a chelating
accumulation of fluid in interstitial spaces of tissues, such agent used to treat lead poisoning. It is not the same as ede-
as in the pericardial sac, intrapleural space, peritoneal cav- tate disodium.
ity, or joint capsules. Edema may be caused by increased edetate disodium, a parenteral chelating agent used to
capillary fluid pressure; venous obstruction such as occurs lower plasma calcium levels.
in varicosities; thrombophlebitis; pressure from casts, tight n indications: It should be prescribed only when clini-
bandages, or garters; congestive heart failure; overloading cal conditions such as hypercalcemic crisis or ventricular
with parenteral fluids; renal failure; hepatic cirrhosis; hyper- arrhythmia and heart block resulting from digitalis toxicity
aldosteronism such as in Cushing’s syndrome; corticosteroid mandate aggressive therapy. It must be administered slowly
therapy; and inflammatory reactions. Edema may also result and the recommended dosage should not be exceeded.
from loss of serum protein in burns, draining wounds, fistu- n contraindications: Hypocalcemia, kidney disease, or
las, hemorrhage, nephrotic syndrome, or chronic diarrhea; in known hypersensitivity to this drug prohibits its use.
malnutrition, especially kwashiorkor; in allergic reactions; n adverse effects: Among the more serious adverse
and in blockage of lymphatic vessels caused by malignant effects are hypocalcemia, which can lead to tetany, arrhyth-
diseases, filariasis, or other disorders. Treatment of edema mia, seizures, and death from respiratory arrest. Other
focuses on correcting the underlying cause. Potassium-spar- adverse effects include nausea, vomiting, cramps, fever,
ing diuretics may be administered to promote excretion of thrombophlebitis, kidney damage, and hemorrhage associ-
sodium and water. Edematous parts of the body should be ated with hypocoagulability.
protected from prolonged pressure, injury, and temperature edetic acid (EDTA) /idet′ik/, a chelating agent.
extremes. In the evaluation of tissue turgor, edema may be EDG, abbreviation for electrodynograph.
evaluated by position change, specific location, and response edge /ej/ [ME, egge], 1. a thin side or border. 2. the end
to pressure, as in pitting edema when pressing the fingers of a surface, e.g., the edge of a cliff.
into the edematous area causes a temporary indentation. edge enhancement, the enhancement of structure margins
An ultrasound evaluation of the affected extremity is indi- (edges) using digital processing techniques.
cated to rule out thrombosis. When a limb is edematous edge response function (ERF), the ability of a computed
as a result of venous stasis, elevating the extremity and tomography system to produce a sharp image of a high-con-
applying an elastic stocking or sleeve facilitate venous trast edge, such as the edge of the heart.
return. Also spelled oedema. See also anasarca, lymph- edgewise appliance, a fixed orthodontic appliance whose
edema. —edematose, edematous, adj. attachment brackets have a rectangular slot that engages a
round or rectangular arch wire. The most widely prescribed
orthodontic appliance, it is used to correct or improve
malocclusion.
EDI, abbreviation for Electronic Data Interchange.
edible, pertaining to a substance that can be eaten.
EDRF, abbreviation for endothelial-derived relaxing
factor, a term which is now used synonymously with nitric
oxide.
edrophonium chloride /ed′rōfō′nē·əm/, a cholinesterase
inhibitor that acts as an antidote to curare and other nonde-
polarizing neuromuscular blockers and is an aid in the diag-
nosis of myasthenia gravis.
n indications: It is prescribed to reverse neuromuscular

blockade, to treat curare toxicity, and to aid in the diagnosis
of suspected myasthenia gravis.
n contraindications: Obstruction of the GI or urinary
tract, hypotension, bradycardia, or known hypersensitivity
to this drug prohibits its use. Should be used with caution
in patients with asthma and those taking cardiac glycosides.
n adverse effects: Among the most serious adverse
effects are respiratory paralysis, hypotension, bradycardia,
and bronchospasm.
Pitting edema (Bloom and Ireland, 1992) edrophonium test, a test for myasthenia gravis in which
an IV solution of edrophonium chloride is injected into a
-edema, -edem, suffix meaning “swelling resulting from patient. A total of 10 mg of the cholinergic drug is prepared,
an excessive accumulation of serous fluid in the tissues of the and a 2-mg dose is injected. If there is no reaction in 30 sec-
body in (specified) locations”: cephaledema, dactyledema, onds, the remaining 8 mg is administered. A brief improve-
papilledema. ment in muscle activity is regarded as a positive result.
edema of glottis [Gk, oidema, swelling, glossa, tongue], a Edrophonium chloride is also used to distinguish between
swelling caused by fluid accumulation in the soft tissues of myasthenia gravis and a cholinergic crisis. Because edropho-
the larynx. Symptoms include stridor, hoarseness, and dys- nium chloride can precipitate respiratory depression, the test
pnea. The condition, usually inflammatory, may result from should not be performed unless an anticholinergic antidote,
infection, injury, or inhalation of toxic gases. Also called such as atropine, and respiratory resuscitation equipment are
laryngeal edema. available. For further explanation of electroencephalographic
Edsall’s disease 587 efferent nerve
recording of brain waves. See also alpha wave, beta wave, effect, the result of an agent or cause.
delta wave, theta wave. effective atomic number, the average atomic number
Edsall’s disease [David L. Edsall, American physician, obtained from a weighted summation of the atomic constitu-
1869–1945], a cramping condition that is the result of ents of a compound. See also atomic number.
excessive exposure to heat. Also called heat cramp. effective compliance /ifek′tiv/ [L, effectus, perfor-
EDTA, 1. abbreviation for ethylene-diamineteraacetic mance], the ratio of tidal volume to peak airway pressure.
acid (edetic acid). 2. abbreviation for edetate calcium effective dose (ED), 1. on a graded dose-response curve
disodium. 3. abbreviation for edetic acid. in the laboratory, the dosage of a drug that may be expected
educational psychology /ej′əkā′shənəl/ [L, educatus, to to cause a response of the desired magnitude. 2. in a clinical
rear; Gk, psyche, mind, logos, science], the application setting, the dose needed to cause the desired response in a
of psychological principles, techniques, and tests to educa- percentage of the people to whom it is given (e.g., an ED50
tional problems, such as the determination of more effective dosage of a drug is expected to produce a response in 50% of
instructional methods, the assessment of student advance- the patients receiving it).
ment, and the selection of students for specialized programs. effective dose equivalent limit (EDE limit), the largest
See also applied psychology. amount of ionizing radiation a person may receive according
Edwards’ syndrome. See trisomy 18. to radiation protection guidelines. It combines both internal
EEC syndrome, an autosomal-dominant syndrome involv- and external dose and has replaced the concept of maximum
ing both ectodermal and mesodermal tissues, with ectoder- permissible dose for occupational exposures. The EDE limit is
mal dysplasia associated with hypopigmentation of skin and prescribed for various organs as well as whole body and for
hair, scanty hair and eyebrows, absence of lashes, nail dys- various working conditions. The current EDE limit for occu-
trophy, small or missing teeth, missing digits, and cleft lip pational exposures is 100 mrem/wk (or 1 mSv/wk). The annual
and palate. Also called ectrodactyly-ectodermal dysplasia- EDE limit is 5000 mrem/yr or (50 mSv/yr). Effective dose lim-
clefting syndrome. its are regulated, and guidelines are published by the National
EEE, abbreviation for eastern equine encephalitis. See Council of Radiation Protection (NCRP) and the FDA. Also
equine encephalitis. called maximum permissible dose. See also dose equivalent.
EEG, 1. abbreviation for electroencephalogram. 2. abbre- effective half-life (ehl), the time required for a radioactive
viation for electroencephalograph. 3. abbreviation for element in an animal body to be diminished by 50% as a
electroencephalography. result of radioactive decay and biological elimination. The
eelworm /ēl′werm/, a nematode, especially any of various effective half-life is equal to the product of the biological
small, free-living or plant parasitic roundworms. half-life (bhl) and the radioactive half-life (rhl) divided by
EENT, abbreviation for eyes, ears, nose, and throat. the sum of the bhl and the rhl: ehl |m= (bhl × rhl)/(bhl + rhl).
EEOC, abbreviation for Equal Employment Opportunity See also biological half-life.
Commission. effective osmotic pressure, the part of total osmotic pres-
ef-. See ex-. sure of a solution that determines the tendency of the solvent to
EFA, abbreviation for essential fatty acid. pass through a boundary, such as a semipermeable membrane.
efalizumab, a rarely used immunosuppressant. effective radiating area, the total area of the surface of the
n indications: This drug is used in adults 18 years of age transducer that actually produces the sound wave.
and older to treat moderate to severe plaque psoriasis. effective refractory period. See refractory period.
efavirenz, an antiviral. effector /ifek′tər/ [L, efficere, to accomplish], 1. an
n indications: It is used to treat HIV-1 in combination organ that produces an effect, such as glandular secretion,
with other antiretroviral agents. as a result of nerve stimulation. 2. a molecule, such as an
n contraindications: Known hypersensitivity to this enzyme, that can start or stop a chemical reaction.
drug prohibits its use. effector cell, 1. a terminally differentiated leukocyte that
n adverse effects: Adverse effects include abdominal performs more than one specific function. 2. a muscle cell
pain, headache, dizziness, fatigue, impaired concentration, or gland cell.
insomnia, abnormal dreams, and depression. Common side effeminate /ifem′init/ [L, effeminare, to make woman-
effects include diarrhea, nausea, and rash. ish], womanly or female in physical and mental character-
effacement /ifās′mənt/ [Fr, effacer, to erase], the shorten- istics, regardless of biological sex.
ing of the vaginal portion of the cervix and thinning of its efferent /ef′ərənt/ [L, effere, to carry out], directed away
walls as it is stretched and dilated by the fetus during labor. from a center, such as certain arteries, veins, nerves, kidney,
When the cervix is fully effaced, the constrictive neck of the and lymphatic vessels. Compare afferent.
uterus is obliterated; the cervix is then continuous with the efferent duct, any duct through which a gland releases its
lower uterine segment. The extent of effacement, determined secretions.
by vaginal examination, is expressed as a percentage of full efferent nerve, a nerve that transmits impulses away or
effacement. See also birth, cervix, dilation, station. outward from a nerve center, such as the brain or spinal cord,
Before Early Complete Complete

labor effacement effacement dilation
Cervical effacement (Bonewit-West, 2012)
efferent pathway 588 ego-dystonic homosexuality
usually causing a muscle contraction or release of a glandu- junctions, fractured ribs, or cervical spondylosis. Also called
lar secretion. neurocirculatory asthenia.
efferent pathway [L, effere, to carry out; ME, paeth + effort thrombosis, an abnormal condition in which a clot
weg], 1. the route of nerve fibers carrying impulses away develops within the subclavian or axillary vein following
from a nerve center. 2. the system of blood vessels that con- strenuous exercise. The condition is accompanied by pain,
veys blood away from a body part. Compare afferent. edema, and skin discoloration in the shoulder and upper
effervesce [Gk, effervescere, to foam up], to produce small arm. Also called Paget-Schroetter’s syndrome, Paget-von
bubbles or foam on the release of gas from a fluid. Schroetter’s syndrome.
effervescence /ef′ərves′əns/ [L, effervescere, to foam effraction /ifrak′shən/, a breaking open or weakening.
up], the production of small bubbles or foam associated effusion /ifyoo′zhən/ [L, effundere, to pour out], 1. the
with the escape of gas from a fluid. escape of fluid, for example, from blood vessels as a result
effervescent /ef′ərves′ənt/, producing and releasing gas of rupture or seepage, usually into a body cavity. The condi-
bubbles. tion is usually associated with a circulatory or renal disorder
efficacy /ef′əkəsē/ [L, effectus, performance], (of a drug or and is often an early sign of congestive heart disease. The
treatment) the ability of a drug or treatment to produce a spe- term may be associated with an affected body area, as pleural
cific result, regardless of dosage. Opioids have a nearly iden- or pericardial effusion. See also edema, transudate. 2. the
tical efficacy but require various dosages to obtain the effect. outward spread of a bacterial growth.
efficiency /ifish′ənsē/, 1. the production of desired results eflornithine hydrochloride /eflôr′nithēn/, an inhibitor of
with the minimum waste of time and effort. 2. the amount the enzyme ornithine decarboxylase, applied in creams by
of achievement compared with the effort expended. 3. (in females over age 12 to limit unwanted facial hair growth and
radioassay) the counts perceived by a beta or gamma coun- administered by injection to treat the meningoencephalitic
ter relative to the known disintegration rate of a comparable stage (sleeping sickness) of a protozoal infection caused by
standard radioactive source. Trypanosoma brucei.
effleurage /ef′ləräzh′/ [Fr, skimming the surface], a tech- EFM, abbreviation for electronic fetal monitor.
nique in massage in which long, light, or firm strokes are used, Efudex, a trademark for an antineoplastic (fluorouracil).
usually over the spine and back. Fingertip effleurage is a light EGD, abbreviation for esophagogastroduodenoscopy.
technique performed with the tips of the fingers in a circular egest /ijest′/ [L, egerere, to expel], to discharge or evacu-
pattern over one part of the body or in long strokes over the ate a substance from the body, especially to evacuate unab-
back or an extremity. Fingertip effleurage of the abdomen is sorbed residue of foods from the intestines. —egesta, n. pl.,
a technique commonly used in the Lamaze method of natural egestive, adj.
childbirth. Compare pétrissage, rolling effleurage. EGF, abbreviation for epidermal growth factor.
egg /eg/ [ONorse], a female reproductive cell at any stage
before fertilization. After fertilization and fusion of the pro-
nuclei, it is called a zygote. Also called ovum.
eglandulous /ēglan′dyələs/, describing an absence of
glands.
ego /ē′gō, eg′ō/ [Gk, I or self], 1. the conscious sense of
the self; those elements of a person, such as thinking, feel-
ing, and willing, that distinguish him or her as an individual.
2. (in psychoanalysis) the part of the psyche that experi-
ences and maintains conscious contact with reality and tem-
pers the primitive drives of the id and the demands of the
superego with the social and physical needs of society. It
represents the rational element of the personality, is the seat
of such mental processes as perception and memory, and
develops defense mechanisms against anxiety. See also id,

superego.
ego-alien. See ego-dystonic.
Effleurage (Harkreader, Hogan, and Thobaben, 2007) ego analysis, (in psychoanalysis) the intensive study of the
ego, especially the defense mechanisms.
effluent /ef′loo·ənt/, a liquid, solid, or gaseous emission, ego boundary, (in psychiatry) a sense or awareness that
such as the discharge or outflow from a machine or an indus- there is a distinction between the real and unreal. In some
trial process. psychoses the person does not have an ego boundary and
effluvium /ifloo′vē·əm/ [L, effluvium, a flowing out], an cannot differentiate his or her personal perceptions and feel-
outflow of gas or vapor, usually malodorous or toxic. ings from those of other people.
effort syndrome [Fr, exertion; Gk, syn, together, dromos, egocentric /ē′gōsen′trik/ [Gk, ego + kentron, cen-
course], an abnormal condition characterized by chest ter], 1. adj, regarding the self as the center, object, and
pain; dizziness; fatigue; palpitations; cold, moist hands; and norm of all experience and having little regard for the needs,
sighing respiration. The condition is often associated with interests, ideas, and attitudes of others. 2. n, a person pos-
soldiers in combat but occurs also in other individuals. The sessing these characteristics.
pain often mimics angina pectoris but is more closely con- ego-defense mechanism. See defense mechanism.
nected to anxiety states and occurs after rather than during ego-dystonic /ē′gōdiston′ik/, describing elements of a per-
exercise. Because angina may also be associated with anxi- son’s behavior, thoughts, impulses, drives, and attitudes that
ety, positive diagnosis of effort syndrome may require an are unacceptable to him or her and cause anxiety. Also called
exercise electrocardiogram. Other chest pains that mimic ego-alien, self-alien. Compare ego-syntonic.
effort syndrome and angina may be caused by musculosk- ego-dystonic homosexuality, a psychosexual disor-
eletal problems, such as inflammation of the costochondral der characterized by discomfort with one’s sexuality and a
ego ideal 589 eidetic image
persistent desire to change sexual orientation to heterosexu- is usually normal. Treatment includes symptomatic therapy,
ality. See also homosexual. emotional support for the patient and family, and emphasis
ego ideal, the image of the self to which a person aspires on avoiding trauma in childhood.
both consciously and unconsciously and against which he or
she measures himself or herself and judges personal perfor-
mance. It is usually based on a positive identification with
the significant and influential figures of the early childhood
years. See also identification.
ego-integrity, an acceptance of self, both successes and
failure. It implies a healthy psychological state. Despair
often precedes ego-integrity.
egoism /ē′gō·iz′əm, eg′-/, 1. selfishness, an overvaluation
of the importance of the self, expressed as a willingness to
gain an advantage at the expense of others. See also egotism.
2. the belief that individual self-interest is, or ought to be,
the basic motive for all conscious behavior.
egoist /ē′gō·ist, eg′-/, 1. a selfish person, one who seeks to
satisfy his or her own interests at the expense of others. See
also egotist. 2. a person who believes in or acts in accor- Skin laxity in Ehlers-Danlos syndrome
dance with the concept that all conscious action is justifiably (Graham-Brown and Bourke, 2007)
motivated by self-interest. —egoistic, egoistical, adj.
ego libido, (in psychoanalysis) concentration of the libido Ehrlichia, a genus of small spherical to ellipsoidal, non-
on the self; self-love, narcissism. motile gram-negative bacteria. They occur singly or in
egomania /ē′gōmā′nē·ə/ [Gk, ego, I, mania, madness], a compact inclusions in circulating mammalian leukocytes.
pathological preoccupation with the self and an exaggerated Some species are the causative agents of ehrlichiosis and are
sense of one’s own importance. transmitted by ticks. Two human tick-borne diseases have
egophony /ēgof′ənē/, a change in the voice sound of a been associated with Ehrlichia species: human monocytic
patient with pleural effusion or pneumonia as heard on aus- ehrlichiosis caused by E. chaffeensis, and human granulo-
cultation. When the patient is asked to make /ē-ē-ē/ sounds, cytic ehrlichiosis caused by E. equi.
they are heard over the peripheral chest wall as /ä-ä-ä/, par- ehrlichiosis, a sometimes fatal tick-borne infection with
ticularly over an area of consolidated or compressed lung symptoms similar to those of Lyme disease. The great
above the effusion. Also called tragophony. majority of infections are asymptomatic. Most cases pres-
ego strength, (in psychotherapy) the ability to maintain the ent as mild to moderate acute febrile illness. The disease
ego by a cluster of traits that together contribute to good men- usually begins about 10 days after the bite of an infected
tal health. The traits usually considered important include tick, although some cases have begun abruptly, within
tolerance of the pain of loss, disappointment, shame, or guilt; hours, with influenza-like symptoms, including painful
forgiveness of those who have caused an injury, with feelings muscle aches, headaches, fever, chills, loss of appetite, and
of compassion rather than anger and retaliation; acceptance depressed blood cell counts. Although similar to Lyme dis-
of substitutes and ability to defer gratification; persistence ease, the infection does not respond to the antibiotics used
and perseverance in the pursuit of goals; openness, flexibil- to treat Lyme disease. However, ehrlichiosis does respond
ity, and creativity in learning to adapt; and vitality and power to early treatment with tetracycline antibiotics. The tick
in the activities of life. The psychiatric prognosis for a client that carries the ehrlichiosis infection is the same species as
correlates positively with ego strength. the vector of Lyme disease, Borrelia burgdorferi, but the
ego-syntonic /ē′gō sinton′ik/, describing those elements of patient usually recovers within 8 weeks without the chronic
a person’s behavior, thoughts, impulses, drives, and attitudes arthritis symptoms associated with Lyme disease. Diagno-
that are acceptable to him or her and are consistent with the sis is difficult because of the similarities with Lyme disease,
total personality. Compare ego-dystonic. and cases of simultaneous infections of both types of bacte-
egotism /ē′gətiz′əm, eg′-/, vanity, conceit, or overvaluation ria have been reported. Also, one of the organisms associ-
of the importance of the self and undervaluation or contempt ated with ehrlichiosis, Ehrlichia equi, is nearly identical to
of others. See also egoism. —egotistic, egotistical, adj. a bacterium that causes fevers in horses. Also called human
egotist /ē′gətist, eg′-/, one who is vain or conceited or who granulocytic ehrlichiosis, human monocytic ehrlichiosis.
places too much importance on the self and is boastful, ego- See also Ehrlichia.
centric, and arrogant. See also egoist. eicosanoic acid /ī′kōsənō′ik/ [Gk, eikosa, twenty], a
egotistic, egotistical. See egotism. saturated fatty acid containing 20 carbon atoms in a straight
egress /ē′gres/, the act of emerging or moving forward. chain, found in peanut oil, butter, and other fats. Also called
Egyptian ophthalmia. See trachoma. arachidic acid.
EHD, abbreviation for electrohemodynamics. eicosapentaenoic acid /ī·kō′sə·pen′tə·ē·nō′ik/, an omega-
EHEC, abbreviation for enterohemorrhagic Escherichia 3, 20-carbon fatty acid found almost exclusively in fish and
coli. marine animal oils.
ehl, abbreviation for effective half-life. EID, abbreviation for electronic infusion device.
Ehlers-Danlos syndrome /ā′lərz dan′ləs/ [Edward Ehlers, eidetic /īdet′ik/ [Gk, eidos, a form or shape seen], 1. adj,
Danish physician, 1863–1937; Henri A. Danlos, French phy- pertaining to or characterized by the ability to visualize and
sician, 1844–1912], a hereditary disorder of connective tis- reproduce accurately the image of objects or events previ-
sue, marked by hyperplasticity of skin, tissue fragility, and ously seen or imagined. 2. n, a person possessing such
hypermotility of joints. Minor trauma may cause a gaping ability.
wound with little bleeding. Sprains, joint dislocations, and eidetic image, an unusually vivid, elaborate, and appar-
synovial effusions are common. However, life expectancy ently exact mental image resulting from a visual experience
eighth cranial nerve 590 elastic cartilage
and occurring as a fantasy, dream, or memory. See also of no clinical significance in pregnant women and in many
image. other healthy people. Compare systolic click. See also ejec-
eighth cranial nerve. See vestibulocochlear nerve. tion sound.
einsteinium (Es) /īnstī′nē·əm/ [Albert Einstein, German- ejection fraction (EF), the fraction of the total ventricular
born physicist and Nobel laureate, 1879–1955], a synthetic filling volume that is ejected during each ventricular contrac-
transuranic metallic element. Its atomic number is 99. The tion. The normal EF of the left ventricle is 65%.
mass of its longest-lived, best-known isotope is 254. Einstei- ejection murmur. See systolic murmur.
nium was first found in the debris from a hydrogen bomb ejection period, the second phase of ventricular systole,
explosion. It decays rapidly into berkelium. when the semilunar valves are open and blood is being dis-
Einthoven’s formula /īnt′hōvənz/ [Willem Einthoven, charged into the aortic and pulmonary arteries. Also called
Dutch physiologist, scientist, and Nobel laureate, 1860– sphygmic interval.
1927; L, forma, pattern], a mathematical expression relat- ejection sound, a sharp, clicking sound heard early in sys-
ing the voltages measured by electrocardiographic leads. The tole, coinciding with the onset of either right or left ventricu-
formula states that the sum of the voltages from lead I plus lar ejection. Aortic ejection sounds are commonly heard in
those from lead III minus those from lead II equals zero (I + aortic valvular stenosis, aortic insufficiency, coarctation of
III − II |m= 0). This formula is based on the principle that the the aorta, and hypertension with aortic dilation. Pulmonary
sum of the voltages in any closed path equals zero. Because ejection sounds are heard in mild to moderate pulmonary
the positive and negative electrodes of lead II are reversed, stenosis, pulmonary hypertension, and dilation of the pulmo-
the voltage from lead II is subtracted instead of added to the nary artery. See also ejection click.
voltages from leads I and III. See also Einthoven’s triangle. Ekbom’s syndrome. See restless legs syndrome.
Einthoven’s triangle [Willem Einthoven], an equilateral EKC, abbreviation for epidemic keratoconjunctivitis.
triangle whose vertices lie at the left and right shoulders and EKG, abbreviation for electrocardiogram.
the pubic region and whose center corresponds to the vector elaboration /ilab′ərāshən/ [L, elaborare, to work out], (in
sum of all electric activity occurring in the heart at any given endocrinology) a process by which a gland synthesizes a
moment, allowing for the determination of the electrical axis. complex substance from simpler substances and secretes it,
Einthoven’s triangle is approximated by the triangle formed usually under the stimulation of a tropic hormone from the
by the axes of the bipolar electrocardiographic (ECG) limb pituitary gland. This process, regulated by a negative feed-
leads I, II, and III. The center of the triangle offers a refer- back system, which includes the hypothalamus, pituitary,
ence point for the unipolar ECG leads. and target gland, serves to maintain homeostasis in body
Eisenmenger’s complex /ī′sənmeng′ərz/ [Victor Eisen- function. —elaborate, adj.
menger, German physician, 1864–1932; L, complexus, elaio-. See eleo-.
encirclement], a congenital heart disease characterized by elapid /el′äpid/, 1. adj, pertaining to the members of a fam-
a defect of the ventricular septum, a malpositioned aortic ily of pit vipers that includes the genera Micruroides and
root that overrides the interventricular septum, and a dilated Micrurus. 2. n, any of the members of this group.
pulmonary artery. Elaprase, a trademark for idursulfase.
Eisenmenger’s syndrome /i′sən·meng′ərz/ [Victor Eisen- Elase, a trademark for a topical fixed-combination drug
menger, German physician, 1864-1932], ventricular septal containing enzymes (fibrinolysin and desoxyribonuclease).
defect with pulmonary hypertension and cyanosis resulting Elase with Chloromycetin, a trademark for a topi-
from right-to-left (reversed) shunt of blood. It is sometimes cal fixed-combination drug containing two lytic enzymes
defined as pulmonary hypertension and cyanosis with the (fibrinolysin and desoxyribonuclease) and an antibacterial
shunt being at the atrial, ventricular, or great vessel area. (chloramphenicol).
ejaculate /ijak′yəlit/, n. the semen discharged in a single elastance /ilas′təns/ [Gk, elaunein, to drive], 1. the
emission. See also ejaculation. —ejaculate /ijak’yəlāt/, v. quality of recoiling or returning to an original form after
ejaculation /-ā′shən/ [L, ejaculari, to hurl out], the sud- the removal of pressure. 2. the degree to which an air- or
den emission of semen from the male urethra, usually during fluid-filled organ, such as a lung, bladder, or blood vessel,
copulation, masturbation, or nocturnal emission. It is a reflex can return to its original dimensions when a distending or
action in two phases. In the first phase, sperm, seminal fluid, compressing force is removed. 3. the measurement of the
and prostatic and bulbourethral gland secretions are moved unit volume of change in such an organ per unit of decreased
into the urethra. In the second phase, strong spasmodic peri- pressure change. 4. the reciprocal of compliance.
staltic contractions force ejaculation. The sensation of ejacu- elastase, an enzyme that cleaves bonds adjacent to neutral
lation is commonly also called orgasm. The fluid volume of amino acids in elastin.
the ejaculate is usually between 2 and 5 mL. Each millili- elastic bandage /ilas′tik/ [Gk, elaunein, to drive; Fr, bande,
ter usually contains 50 million to 150 million spermatozoa. strip], a bandage of stretchable fabric that provides support
—ejaculatory /ijak’yələtôr’ē/, adj. and allows movement. Among its uses is application to swol-
ejaculator urinae. See bulbospongiosus. len extremities, such as knees or wrists, varicose veins, and
ejaculatory duct /ijak′yələtôr′ē/, the passage formed by broken ribs.
the junction of the duct of the seminal vesicles and ductus elastic-band fixation, a method of treatment of fractures of
deferens through which semen enters the urethra. the jaw using rubber bands to connect metal splints or wires
ejection /ijek′shən/ [L, ejicere, to cast out], forceful that are attached to the maxilla and mandible. The rubber
expulsion, as of blood from a ventricle of the heart. bands produce traction and draw the teeth into occlusion and
ejection click, a sharp, clicking sound arising from near proper alignment while the fracture is healing. Rubber bands
the heart. It may be caused by sudden swelling of a pulmo- are safer than rigid wires in the event of vomiting. See also
nary artery, abrupt dilation of the aorta, or forceful opening maxillomandibular fixation, nasomandibular fixation.
of the aortic cusps. Ejection clicks are often heard during elastic bougie, a flexible bougie that can be passed through
examination of individuals with septal defects or patent duc- angular or winding channels. See also bougie.
tus arteriosus. Although they are associated with high pul- elastic cartilage, the most pliant of the three kinds of car-
monary resistance and hypertension, they are common and tilage, consisting of elastic fibers in a flexible fibrous matrix.
elasticity 591 elder abuse
It is yellow and is located in various parts of the body, such
as the external ear, the auditory tube, and the epiglottis. Also
called yellow cartilage. Compare hyaline cartilage, white
fibrocartilage. Olecranon
elasticity /i′lastis′itē/, the ability of tissue to regain its origi- bursa
nal shape and size after being stretched, squeezed, or other- Humerus
wise deformed. Muscle tissue is generally regarded as elastic Medial
because it is able to change size and shape and return to its Lateral epicondyle
original condition. epicondyle
elastic membrane. See cricothyroid membrane. Olecranon
elastic recoil /rē′koil/, the difference between intrapleural Annular Coronoid
pressure and alveolar pressure at a given lung volume under ligament process
static conditions.
elastic stocking, a type of hosiery that applies gradient Ulna
pressure to the legs to prevent excessive blood accumulation Radius
in the lower extremities caused by faulty vein valves. The
stockings are commonly prescribed for patients with vari-
cose veins. Compare antiembolism (AE) hose.
Structures of the elbow (Seidel et al, 2011)
elbow bone. See ulna.

elbow jerk. See triceps reflex.
elbow joint, the hinged articulation of the humerus, the
ulna, and the radius. It is covered by a protective capsule
associated with three ligaments and an extensive synovial
membrane. The elbow joint allows flexion and extension of
the forearm and accommodates the radioulnar articulation.
Also called articulatio cubiti.
elbow reflex. See triceps reflex.
elder, an herb found in the United States and Europe as a
tall shrub.
n uses: This berry or flower may be useful for limiting
the duration of symptoms from colds and flu; the flower is
Elastic stocking (Sorrentino, 2012) also used as a mouthwash and applied topically as an astrin-
gent for nasal and chest congestion, earache associated with
chronic congestion, and hay fever.
elastic tissue [Gk, elaunein, to drive; OFr, tissu], a type of n contraindications: It is not recommended during preg-
connective tissue containing elastic fibers. It is found in liga- nancy and lactation, in children, or in those with known
ments of the spinal column, in the cartilage of the external hypersensitivity to this plant or similar plants. Raw or unripe
ear, and in the walls of some large blood vessels. fruit can cause nausea, vomiting, and severe diarrhea.
elastic traction [Gk, elaunein + L, trahere, to draw], any elder abuse, a reportable offense of physical, sexual, psy-
therapeutic apparatus that uses an elastic device to pull on a chological, or material abuse, as well as violation of the
limb. rights of safety, security, and adequate health care of older
elastin /ilas′tin/ [Gk, elaunein, to drive], a protein that adults. Contributing factors may include economic consid-
forms the principal substance of yellow elastic tissue erations, interpersonal conflicts, health, and dependency.
fibers. Often the abused person denies that abusive acts occur and
elastofibroma /ilas′tōfībrō′mə/, a benign nonencapsulated feels helpless and resigned to abuse. Health care workers are
mass of collagenous, fibrous, and elastic tissue that develops required to report suspected abuse, and perpetrators may be
in subscapular fatty tissue in older persons. subject to criminal charges. Also called abuse of the elderly.
elastomer /i·las′tōmər/ [Gk, elaunein, to drive + meros, n observations: Manifestations are dependent on the form
part], a synthetic rubber; any of various soft, elastic, rub- of abuse. Physical abuse signs include cuts; lacerations;
berlike polymers used in dentistry as an impression material bruises; welts; black eyes; broken bones and sprains; dislo-
and for maxillofacial extraoral prostheses. —elastomeric, cations; injury incompatible with history; broken eyeglasses;
adj. torn clothing; physical signs of punishment or restraint;
elation /ilā′shən/ [L, elatus, a lifting up], an emotional laboratory findings of medication overdose or underuse of
reaction characterized by euphoria, excitement, extreme joy- prescription drugs; elder report of being hit, slapped, kicked,
fulness, optimism, and self-satisfaction. It is considered to be or maltreated; and caregiver’s refusal to allow visitors to see
of pathological origin when such a response does not realisti- elder alone. Sexual abuse signs include bruises around the
cally reflect a person’s actual circumstances. Thus an elated breasts or genitalia; unexplained venereal disease or geni-
mood may be characteristic of a manic state. tal infections; unexplained vaginal or rectal bleeding; torn,
Elavil, a trademark for a tricyclic antidepressant (amitripty- stained, or bloody underclothing; and elder report of being
line hydrochloride). assaulted or raped. Emotional abuse signs include emotional
elbow [AS, elboga], the bend of the upper limb at the joint upset or agitation; hesitation to speak; extreme withdrawal;
that connects the arm and the forearm. It is a common site unusual behavior usually attributed to dementia; implausible
of inflammation and injuries, such as those incurred during stories; and reports of being verbally or emotionally abused.
participation in various sports. See also elbow joint. Neglect signs include dirty appearance; presence of feces
elderly primigravida 592 electrically stimulated osteogenesis
and/or urine; environmental safety hazards; dehydration; elective abortion, induced termination of a pregnancy
malnutrition; untreated bed sores; poor personal hygiene; (TOP), usually before the fetus has developed enough to
untreated health care problems; and elder report of mistreat- live if born, deemed necessary by the woman carrying it and
ment. Abandonment signs include desertion of an elder at performed at her request. Commonly (but incorrectly) called
a public institution or location such as a hospital, clinic, or therapeutic abortion. See also induced abortion.
shopping center, and elder self-report of abandonment. Signs elective induction of labor. See induction of labor.
of exploitation include unusual, sudden, or inappropriate Electra complex /ilek′trə/, (in psychiatry) the libidinous
activity in bank accounts; signatures on checks that do not desire of a daughter for her father. Compare oedipus com-
resemble the older person’s signature; unusual concern by plex. See also phallic stage.
caregiver that an excessive amount of money is being spent electret /ilek′trət/, an insulator carrying a permanent charge
on care of the older person; numerous unpaid bills; overdue similar to a permanent magnet.
rent; abrupt changes in a will or other financial documents; electrically stimulated osteogenesis /ilek′triklē/ [Gk,
unexplained disappearance of funds or valuable possessions; elektron, amber; L, stimulare, to incite; Gk, osteon, bone,
and unexplained or sudden transfer of assets to a family genein, to produce], a bone regeneration process induced
member or someone outside the family. Signs of self-neglect by surgically implanted electrodes conveying electric current,
include dehydration; malnutrition; untreated or improperly especially at nonunion fracture sites. The process is effective
attended medical conditions; poor personal hygiene; hazard- because of the different electric potentials within bone tissue.
ous or unsafe living conditions; inappropriate or inadequate Viable nonstressed bone is electronegative in the metaphyseal
clothing; and overall lack of self-care. Diagnosis is typically regions and over a fracture callus and electropositive in the
made by social service, health care, and legal experts after diaphyses and other less active regions. Electric stimulation
history, investigation, and physical examination. Laboratory of fractures can accelerate osteogenesis, forming bone more
tests and drug screening may be done to determine the extent quickly in the area of a surgically inserted negative electrode.
of malnutrition, dehydration, and medication drug levels. The precise mechanisms by which electricity induces osteo-
Severe injury, disfigurement, and death are all complications genesis are not understood, but research shows that when
of chronic or severe physical abuse. cathodes are implanted at a fracture site and an electric poten-
n interventions: Obvious signs of abuse are reported to tial of less than 1 volt is applied, oxygen is consumed at the
the local authorities for immediate investigation and elder cathode, and hydroxyl ions are produced, decreasing the oxy-
protection. If the elder is perceived to be in immediate dan- gen tension of the local tissue and increasing the alkalinity.
ger, elder protection should be sought through the local Adult Low tissue oxygen tension encourages bone formation, which
Protective Services or the county Department of Social Ser- follows a predominantly anaerobic metabolic pathway. Stud-
vices. If signs are vague or inconsistent, observations are ies of bone-forming junctions demonstrate that an alkaline
documented and reported to appropriate local authorities for pH exists in the zone of hypertrophic cells of the bone growth
investigation. plate when calcification starts. Electrically stimulated osteo-
n nursing considerations: Nurses serve as a frontline genesis can be achieved with a device that stimulates the frac-
resource for the detection, intervention, and prevention of ture site electrically by means of several surgically implanted
elder abuse. This includes the identification of high-risk cathodes. Cathode pins are connected to an external power
dependent elder relationships, such as those where an elder is supply that delivers 20 μA to each pin. The cathodes are
dependent on caretakers; elders with functional impairments; inserted and positioned in the fracture space with the aid of
previous history of abuse or neglect; evidence of substance image intensification or other radiographic techniques. Other
abuse or polypharmacy; signs of depression; and lack of or methods for applying electrical current to fractured bone
limited financial and/or support resources. The nurse needs involve open surgical procedures and implantation of elec-
to do a thorough assessment for signs of coercive caretaker trodes. The percutaneous technique involving the insertion of
arrangements or lack of caretaker skills, identification of cathode pins is performed with a local anesthetic and usually
family crises that could trigger abuse or neglect, and iden- involves less postoperative pain than open surgery methods.
tification of signs of abuse or neglect. All evidence should The number and the position of the cathodes in the percutane-
be carefully documented and reported to appropriate sources. ous technique vary, depending on the bone involved. Gener-
The nurse is also instrumental in assisting elder and family ally two cathodes are used for nonunion fractures of small
to seek respite care services, counseling, and support groups. bones, such as the medial malleolus or the carpal navicular.
Social agency referrals are needed for financial and functional Three or more cathodes are used in the clavicle and the bones
assistance (e.g., housekeeping, cooking, and shopping). of the forearm. Four cathodes are used in the treatment of
Skill-building workshops for family members, coordinated large bones, such as the tibia, the femur, and the humerus.
care of elderly needs, public education about the problem, Cathodes are generally inserted from opposite directions into
and coordination among state agencies and service providers the nonunion site. If four cathodes are used, two are placed
are all mechanisms for prevention. Education includes care- above, and two below the fracture site. The exposed tips of
giver instruction about alternative forms of venting frustra- the cathodes rest directly in the nonunion space. Patients
tions and information about available community resources. who receive such treatment are routinely released from the
elderly primigravida, a woman who becomes pregnant hospital the day after the procedure, and the stimulation of
for the first time after the age of 34. Although an elderly their fractures by a portable power supply strapped to the skin
primigravida was in the past at greater risk of adverse com- over the fracture site continues during the healing period. The
plications of a pregnancy, newer techniques and drugs have osteogenesis is radiographically monitored, and after about
eliminated most of the risk and made it possible even for 12 weeks the cathode pins are removed and the affected por-
women of menopausal age to bear children. tion of the limb involved is placed in a weight-bearing cast.
Eldopaque, a trademark for a dermatological bleaching Use of the cathode-pin method of electrically stimulated
agent (hydroquinone). osteogenesis is contraindicated in the treatment of pathologi-
elective /ilek′tiv/ [L, eligere, to choose], pertaining to a cal fractures associated with benign or malignant tumors and
procedure that is performed by choice and is not essential, in the treatment of congenital conditions such as congenital
such as elective surgery. pseudarthrosis and osteogenesis imperfecta. The cathode-pin
electrical silence 593 electroanesthesia
method is also contraindicated in the presence of active electric current, the net movement of electrons along a
systemic infections, clinically active osteomyelitis, proven conducting medium.
patient sensitivity to the nickel or chromium from which the electric field, the lines of force exerted on charged ions in
pins are made, or synovial pseudarthrosis, unless the fluid- the tissues by the electrodes that cause charged particles to
filled cavity at the nonunion site is excised before the cathode move from one pole to another.
pins are inserted. The success rate of treatment with the per- electric impedance, an opposition to electron flow in a
cutaneous method of electrically stimulated osteogenesis is conducting material.
significantly reduced in nonunions in which the gap is wider electricity /i′lektris′itē/ [Gk, elektron, amber], a form of
than one half the diameter of the bone involved. Compare energy expressed by the activity of electrons and other sub-
oedipus complex. See also phallic stage. atomic particles in motion, as in dynamic electricity, or at
electrical silence, in electroencephalography and elec- rest, as in static electricity. Electricity can be produced by
tromyography, absence of measurable electrical activity in heat generated by a voltaic cell or produced by induction,
tissue. rubbing of nonconductors with dry materials, or chemical
electric blood warmer, a device for heating blood before activity. Electricity may be negative, when there is a surplus
infusions, especially massive transfusions in which cold of electrons, or positive, when there is a surplus of protons or
blood may cause a state of shock. The electric blood warmer a deficiency of electrons.
includes a receptacle containing an electric heater and space electric muscle stimulator (EMS), a therapeutic electric
for the insertion of a disposable blood-warming bag com- current used to stimulate muscle directly, such as when the
posed of parallel plastic tubes. The warmer is also equipped muscle is denervated and peripheral nerves are not function-
with a temperature indicator, which shows when the heating ing. See also electrostimulation.
bag reaches the proper temperature of 99° F (37.6° C). An IV electric potential, the potential difference between charged
Y-set is commonly used in transfusions involving the electric particles. See also potential.
blood warmer. electric potential gradient. See membrane potential.
electric burn, the tissue damage resulting from heat of electric shock, a traumatic physical state caused by the
up to 5000° C generated by an electric current. The points passage of electric current through the body. It usually
of entrance and exit on the skin are burned, along with the involves accidental contact with exposed parts of electric
muscle and subcutaneous tissues through which the current circuits in home appliances and domestic power supplies
passes. Fatal cardiac arrhythmia may result. but may also result from lightning or contact with high-volt-
age wires. The resultant damage depends on the intensity
of the electric current, the type of current, and the duration
and the frequency of current flow. Alternating current (AC),
direct current (DC), and mixed current cause different kinds
and degrees of damage. High-frequency current produces
more heat than low-frequency current and can cause burns,
coagulation, and necrosis of affected body parts. Low-
frequency current can burn tissues if the area of contact is
small and concentrated. Severe electric shock commonly
causes unconsciousness, respiratory paralysis, muscle
contractions, bone fractures, and cardiac disorders. Even
passage of small electric currents through the heart can
cause fibrillation. About 1000 persons in the United States
die from electric shock each year. Treatment may involve
such measures as cardiopulmonary resuscitation, defibrilla-
tion, and IV administration of electrolytes to help stabilize
vital functions. See also cardiogenic shock, hypovolemic
shock.
electric shock therapy. See electroconvulsive therapy.
electric spinal orthosis (ESO), an electric device that
helps control curvature of the spine by stimulating back mus-
cles. The portable battery-powered machine does not correct
scoliosis but prevents it from worsening.
electro-, prefix meaning “electricity”: electrobiology, elec-
trocatalysis, electrolepsy.
electroacupuncture after Voll (EAV), a system of diag-
nosis and treatment based on the measurement of the elec-
trical characteristics of acupoints, the results being used to
determine a specific remedy.
electroanalgesia /ilek′trō·an′əljē′sē·ə/, the use of an electric
current to relieve pain. See also transcutaneous electrical
nerve stimulation.
Entry site (top) and exit site (bottom) of an electric electroanalytic chemistry /-an′əlit′ik/ [Gk, elektron +
burn (Sanders et al, 2007) analysis, a loosening, chemeia, alchemy], the branch of
chemistry concerned with the analysis of compounds by use
electric cautery. See electrocautery. of electrical properties to produce characteristic observable
electric circuit, the path of the electron flow from a gen- change in the substance being studied. See also chemistry.
erating source through various components and back to the electroanesthesia /-an′esthē′zhə/, the use of an electric
generating source. current to produce local anesthesia.
electroaxonography 594 electrodermal activity therapy
electroaxonography. See axonography. electrochemistry, the study of the electric effects that
electrocardiogram (ECG, EKG) /-kär′dē·əgram′/ [Gk, accompany chemical action and the chemical activity pro-
elektron + kardia, heart, gramma, record], a graphic record duced by electric influence.
produced by an electrocardiograph, a device for recording electrocoagulation /-kō·ag′yəlā′shən/ [Gk, elektron +
electrical conduction through the heart. L, coagulare, to curdle], a therapeutic destructive form
electrocardiograph (ECG) /-kär′dē·əgraf′/, a device used of electrosurgery in which tissue is hardened by the pas-
for recording the electrical activity of the myocardium to detect sage of high-frequency current from an electric cau-
transmission of the cardiac impulse through the conductive tery device. Also called surgical diathermy. Compare
tissues of the muscle. Electrocardiography allows diagnosis electrodesiccation.
of specific cardiac abnormalities. Leads are affixed to certain electroconvulsive therapy (ECT) /-kənvul′siv/, the
anatomical points on the patient’s chest, usually with an adhe- induction of a brief convulsion by passing an electric cur-
sive gel that promotes transmission of the electric impulse to rent through the brain for the treatment of affective disor-
the recording device. —electrocardiographic, adj. ders, especially in patients resistant to psychoactive-drug
electrocardiographic technician /-kär′dē·ōgraf′ik/, an therapy. ECT is primarily used when rapid definitive
allied health worker with special training and experience in response is required for either medical or psychiatric rea-
operating and maintaining electrocardiographic equipment and sons, such as for a patient who is extremely suicidal and
providing recorded data for diagnostic review by a physician. when the risks of other treatments outweigh the risk of
electrocardiograph lead /lēd/, 1. an electrode placed on ECT. A secondary use of ECT is treatment failure of other
part of the body and connected to an electrocardiograph. 2. a choices. Also called electric shock therapy, electroshock
record, made by the electrocardiograph, that varies with the therapy, electrotherapy.
site of the electrode. Electrocardiography is generally per- electroconvulsive therapy (ECT) management, a
formed with the use of six limb leads and six leads placed on nursing intervention from the Nursing Interventions Clas-
the precordium. The peripheral or extremity leads are des- sification (NIC) defined as assisting with the safe and effi-
ignated I, II, III, AVR, AVL, and AVF. The chest leads are cient provision of electroconvulsive therapy in the treatment
designated V1, V2, V3, V4, V5, and V6 to indicate the points of psychiatric illness. See also Nursing Interventions
on the precordium on which the electrodes are placed. Classifications.
electrocardiography (ECG) /-kär′dē·og′rəfē/ [Gk, elek- electrocution /-kyoo′shən/, death caused by the passage of
tron + kardia, heart, graphein, to record], the study of electric current through the body. See also electric shock.
records of electric activity generated by the heart muscle. electrode /ilek′trōd/ [Gk, elektron + hodos, way], 1. a
Also called cardiography. contact for the induction or detection of electrical activity.
electrocardiophonograph. See phonocardiograph. 2. a medium for conducting an electrical current from the
electrocatalysis, the chemical decomposition of tissues body to physiological monitoring equipment.
caused by the application of electric current to the body. electrodermal /-dur′məl/, pertaining to electrical proper-
electrocautery /ilek′trōkô′tərē/ [Gk, elektron + kauterion, ties of the skin, particularly altered resistance.
branding iron], the application of a needle or snare heated electrodermal activity therapy, a type of biofeedback
by electric current for the destruction of tissue, such as for therapy in which sensors attached to the palm or the palmar
removing warts or polyps and cauterizing small blood vessels aspect of the fingers are used to monitor sweat output in
to limit blood loss during surgery. Also called electric cau- response to stress. It is used in the treatment of stress, anxiety
tery, galvanic cautery, galvanocautery. See also diathermy. disorders, chronic pain, and hyperhidrosis.
Time (1 second)
0 0.2 0.4 0.6 0.8
R 5mm
(0.2 second)
1mm
(0.04 second)
P-R
segment
S-T
segment
Isoelectric T
line P
U
1.0 millivolt (mV)
Q
P-R
interval S
0.5 mV
QRS
complex
0.1 mV
Q-T
interval
QRS complex and Q-T interval on a normal ECG waveform (Black and Hawks, 2005)
electrodermal audiometry 595 electroencephalography
electrodermal audiometry [Gk, elektron + derma, skin; L, electroencephalogram (EEG) /ilek′trō·ensef′ələgram′/
audire, to hear; Gk, metron, measure], a method for deter- [Gk, elektron + enkephalos, brain, gramma, record], a
mining hearing thresholds in which a harmless electric shock graphic chart on which is traced the electric potential pro-
is used to condition the subject to a pure tone, which there- duced by the brain cells, as detected by electrodes placed
after, coupled with the anticipation of a shock, elicits a brief on the scalp. The resulting brain waves are called alpha,
electrodermal response. The lowest intensity of the sound beta, delta, and theta rhythms, according to the frequen-
that produces the skin response is considered the subject’s cies they produce, which range from 2 to 12 cycles per sec-
hearing threshold. It is a very old procedure and rarely used ond with an amplitude of up to 100 μV. Variations in brain
today. wave activity are correlated with neurological conditions,
electrodesiccation /-des′ikā′shən/ [Gk, elektron + desic- psychological states, and level of consciousness. See also
care, to dry up], a technique in electrosurgery in which tis- encephalography.
sue is destroyed by burning with an electric spark. It is used electroencephalograph (EEG) /ilek′trō·ensef′ələgraf′/,
primarily for eliminating small superficial growths but may an instrument for receiving and recording the electric poten-
be used with curettage to eradicate abnormal tissue deeper in tial produced by the brain cells. It consists of a vacuum
the skin or to stop bleeding. In the latter case, layers of skin tube amplifier that magnifies the electrical currents received
may be burned, then successively scraped away. The proce- through electrodes placed on the scalp and electromag-
dure is performed under local anesthesia. netically records the patterns on a graphic chart. See also
electrodiagnosis /-dī′agnō′sis/ [Gk, elektron + dia, twice, electroencephalography.
gnosis, knowledge], the diagnosis of disease or injury by electroencephalographic technologist /ilek′trō·ensef′əl
electric stimulation of various nerves and muscles. əgraf′ik/, a person trained in the management of an elec-
electrodynamics /-dīnam′iks/, the study of electrostatic troencephalographic laboratory. The technologist may
charges in motion, such as the flow of electrons in an electric supervise electroencephalographic technicians, who are gen-
current. Compare electrohemodynamics. erally responsible for the operation and maintenance of the
electrodynograph (EDG) /-din′əgraf′/ [Gk, elektron + equipment.
dynamis, force, graphein, to record], an electronic device electroencephalography (EEG) /ilek′trō·ensef′əlog′r
used to measure pressures exerted in biological activity, such əfē/, the process of recording brain wave activity. Electrodes
as those exerted by the human foot in walking, running, jog- are attached to various areas of the patient’s head with col-
ging, or climbing stairs. lodion. During the procedure the patient remains quiet, with
Fp1-F7
F7-T3
T3-T5
T5-01
Fp1-F3
F3-C3
C3-P3
P3-01
Fz-Cz
Cz-Pz
Fp2-F4
F4-C4
C4-P4
P4-02
Fp2-F8
F8-T4
T4-T6
T6-02
LEOG
REOG
EKG
Electroencephalogram: normal awake adult (Goldman et al, 2012)
electrogram 596 electrolyte management: hypermagnesemia
eyes closed, and refrains from talking or moving. In certain relaxation of cardiac muscle. Sodium (Na+) is essential in
cases prescribed activities, especially hyperventilation, may maintaining fluid balance. Certain diseases, conditions, and
be requested. The test is used to diagnose seizure disorders, medications may lead to a deficiency of one or more electro-
brainstem disorders, focal lesions, and impaired conscious- lytes and to an imbalance among them; for example, certain
ness. During neurosurgery the electrodes can be applied diuretics and a low-sodium diet prescribed in hypertension
directly to the surface of the brain (intracranial electroen- may cause hypokalemic shock as a result of a loss of potas-
cephalography) or placed within the brain tissue (depth elec- sium. Diarrhea may cause a loss of many electrolytes, lead-
troencephalography) to detect lesions or tumors. See also ing to hypovolemia and shock, especially in infants. Careful
electroencephalogram. —electroencephalographic, adj. and regular monitoring of electrolytes and IV replacement
electrogram /ilek′trōgram′/ [Gk, elektron + gramma, of fluid and electrolytes are aspects of acute care in many
record], a unipolar or bipolar record of the electric activ- illnesses. —electrolytic, adj.
ity of the heart as recorded by electrodes within the car- electrolyte & acid/base balance, a nursing outcome from
diac chambers or on the epicardium. Examples are the the Nursing Outcomes Classification (NOC) defined as the
atrial electrogram, ventricular electrogram, and His bundle balance of electrolytes and nonelectrolytes in the intracel-
electrogram. lular and extracellular compartments of the body. See also
electrohemodynamics (EHD) /ilek′trōhē′mōdīnam′iks/ Nursing Outcomes Classification.
[Gk, elektron + haima, blood, dynamis, force], a technique electrolyte balance, the equilibrium between electrolytes
for noninvasively measuring the mechanical properties and in the body.
hemodynamic characteristics of the vascular system, includ- electrolyte imbalance, the serum concentrations of an
ing arterial blood pressure, electric impedance, blood flow, electrolyte that are either higher or lower than normal. See
and resistance to blood flow. also electrolyte.
electroimmunodiffusion. See immunodiffusion. electrolyte management, a nursing intervention from the
electrolarynx /i·lek′troler′ingks/ [Gr, elektron, amber + lar- Nursing Interventions Classification (NIC) defined as pro-
ynx], an electromechanical device that enables a laryngec- motion of electrolyte balance and prevention of complica-
tomized person to speak. When it is placed against the region tions resulting from abnormal or undesired serum electrolyte
of the laryngectomy a buzzing sound is produced, which is levels. See also Nursing Interventions Classification.
converted into simulated speech by movements of the organs electrolyte management: hypercalcemia, a nursing
of articulation (lips, tongue, glottis). intervention from the Nursing Interventions Classification
electrolysis /il′ektrol′isis/ [Gk, elektron + lysis, loosen- (NIC) defined as the promotion of calcium balance and
ing], a process in which electric energy causes a chemi- prevention of complications resulting from serum calcium
cal change in a conducting medium, usually a solution or a levels higher than desired. See also Nursing Interventions
molten substance, or the decomposition of a substance such Classification.
as hair follicles. —electrolytic, adj. electrolyte management: hyperkalemia, a nursing
electrolyte /ilek′trōlīt/ [Gk, elektron + lytos, soluble], an intervention from the Nursing Interventions Classification
element or compound that, when melted or dissolved in water (NIC) defined as the promotion of potassium balance and
or another solvent, dissociates into ions and is able to con- prevention of complications resulting from serum potassium
duct an electric current. Electrolytes differ in their concen- levels higher than desired. See also Nursing Interventions
trations in blood plasma, interstitial fluid, and cell fluid and Classification.
affect the movement of substances between those compart- electrolyte management: hypermagnesemia, a nursing
ments. Proper quantities of principal electrolytes and balance intervention from the Nursing Interventions Classification
among them are critical to normal metabolism and function. (NIC) defined as promotion of magnesium balance and pre-
For example, calcium (Ca++) is necessary for relaxation of vention of complications resulting from serum magnesium
skeletal muscle and contraction of cardiac muscle; potas- levels higher than desired. See also Nursing Interventions
sium (K+) is required for contraction of skeletal muscle and Classification.
Clinical manifestations of electrolyte imbalance

Imbalance Clinical manifestations Causes
Hyponatremia Fatigue, abdominal cramps, diarrhea, weak- Excess sweating, excess intake of water, diuretics, adrenal
Na <135 mEq/L ness, hypotension, cool clammy skin insufficiency, renal failure
Hypernatremia Thirst, dry, sticky mucous membranes, dry Diarrhea, decreased water intake, saltwater ingestion,
Na >145 mEq/L tongue and skin, flushed skin, increased impaired renal function, febrile illness, inability to swal-
temperature low, burns, diabetes insipidus
Hypokalemia Weakness, fatigue, anorexia, abdominal Diarrhea, vomiting, diuretics, burns, heat stress, ulcerative
K <3.5 mEq/L distention, cardiac arrhythmias colitis, potassium-free IV fluids, metabolic acidosis,
steroids
Hyperkalemia Cardiac arrhythmias, anxiety, increased Acute/chronic renal failure, burns, crush injuries, metabolic
K >5.0 mEq/L bowel sounds, abdominal cramps acidosis, potassium-sparing diuretics
Hypocalcemia Abdominal cramps, tingling, muscle spasm, Parathyroid dysfunction, vitamin D deficiency, pancreatitis
Ca <4.5 mg/dl convulsions
Hypercalcemia Bone pain, nausea, vomiting, constipation Parathyroid tumor, bone cancer/metastasis, osteoporosis
Ca >5.6 mg/dl
Adapted from ENA: Sheehy’s emergency nursing: principles and practice, ed 6, St Louis, 2010, Mosby.
electrolyte management: hypernatremia 597 electromyogram
electrolyte management: hypernatremia, a nursing current in a circuit when it is passed through a changing mag-
intervention from the Nursing Interventions Classification netic field.
(NIC) defined as the promotion of sodium balance and pre- electromagnetic radiation, radiation that is produced
vention of complications resulting from serum sodium lev- with a combination of magnetic and electric forces. It exists
els higher than desired. See also Nursing Interventions as a continuous spectrum of radiation, from that with the
Classification. highest energy level and shortest wavelength (gamma rays)
electrolyte management: hyperphosphatemia, a nurs- to that with the lowest energy and longest wavelength (long
ing intervention from the Nursing Interventions Classifica- radio waves). The visible part of the electromagnetic spec-
tion (NIC) defined as the promotion of phosphate balance trum has a wavelength between 400 and 700 nm. Ultraviolet
and prevention of complications resulting from serum phos- and infrared radiation have wavelengths just below the short
phate levels higher than desired. See also Nursing Interven- end and above the long end of the visible spectrum, respec-
tions Classification. tively. X-rays have wavelengths from about 0.005 to 10 nm.
electrolyte management: hypocalcemia, a nursing All forms of electromagnetic radiation travel at the speed of
intervention from the Nursing Interventions Classification light.
(NIC) defined as the promotion of calcium balance and electromagnetic spectrum, the range of frequencies and
prevention of complications resulting from serum calcium wavelengths associated with radiant energy.
levels lower than desired. See also Nursing Interventions electromallet condenser /-mal′ət/ [Gk, elektron + OFr,
Classification. mail, maul; L, condensare, to make dense], an electrome-
electrolyte management: hypokalemia, a nursing inter- chanical device formerly used for compacting direct-filling
vention from the Nursing Interventions Classification (NIC) gold, such as gold foil restorations in prepared tooth cavities.
defined as the promotion of potassium balance and preven- electromechanical dissociation. See pulseless electrical
tion of complications resulting from serum potassium lev- activity.
els lower than desired. See also Nursing Interventions electromotive force (EMF) /-mō′tiv/, the electric poten-
Classification. tial, or ability of electric energy to perform work. EMF is
electrolyte management: hypomagnesemia, a nursing usually measured in joules per coulomb, or volts. The higher
intervention from the Nursing Interventions Classification the voltage, the greater the potential of electric energy. Any
(NIC) defined as the promotion of magnesium balance and device, such as a storage battery, that converts some form of
prevention of complications resulting from serum magne- energy into electricity is a source of EMF.
sium levels lower than desired. See also Nursing Interven- electromyogram (EMG) /ilek′trōmī′əgram′/, a record
tions Classification. of the intrinsic electric activity in a skeletal muscle. Such
electrolyte management: hyponatremia, a nursing data aid the diagnosis of neuromuscular problems and are
intervention from the Nursing Interventions Classifica- obtained by applying surface electrodes or by inserting a
tion (NIC) defined as the promotion of sodium balance and needle electrode into the muscle and observing electric activ-
prevention of complications resulting from serum sodium ity with an oscilloscope and a loudspeaker. Some electro-
levels lower than desired. See also Nursing Interventions myograms show abnormalities, such as spontaneous electric
Classification. potentials within the muscle under study, and help pinpoint
electrolyte management: hypophosphatemia, a nurs- lesions of motor nerves. Electromyograms also measure
ing intervention from the Nursing Interventions Classifica- electric potentials induced by voluntary muscular contrac-
tion (NIC) defined as the promotion of phosphate balance tion. See also electroneuromyography.
and prevention of complications resulting from serum phos-
phate levels lower than desired. See also Nursing Interven-
tions Classification.
electrolyte monitoring, a nursing intervention from the
Nursing Interventions Classification (NIC) defined as collec-
tion and analysis of patient data to regulate electrolyte bal-
ance. See also Nursing Interventions Classification.

electrolyte solution, any solution containing electrolytes
prepared for oral, parenteral, or rectal administration for the
replacement or supplementation of ions necessary for homeo-
stasis. The loss of potassium ion (K+) by vomiting, by diarrhea,
or by the action of certain medications, including diuretics
and corticosteroids, may be corrected by administering a solu-
tion high in potassium. Other electrolyte solutions containing
combinations of sodium, potassium, calcium, magnesium,
chloride, bicarbonate, phosphate, and/or lactate may be given
to treat acid-base disturbance, as seen in chronic renal dys-
function or diabetic ketoacidosis. The solutions are available
in a wide range of balanced formulas for replacement or main-
tenance, and most include various trace minerals.
electrolytic. See electrolysis.
electromagnetic /-magnet′ik/ [Gk, elektron, Magnesia,
ancient source of lodestone], 1. pertaining to magnetism
that is induced by an electric current. 2. pertaining to radia-
tion such as light, microwaves, x-rays, gamma rays, or radio
waves.
electromagnetic induction [Gk, elektron + magnes, lode-
stone; L, inducere, to bring in], the production of electric Electromyogram (Mourad, 1991)
electromyographic biofeedback 598 electronic infusion device
electroneurodiagnostic technologist, an allied health
professional who, in collaboration with an electroencepha-
Stimulator lographer, obtains interpretable recordings of a patient’s
transformer nervous system function. The electrodiagnostic technologist
Stimulator takes a patient history; applies adequate recording electrodes
over nerve and uses optimal EEG, EP, and PSG techniques; and docu-
ments the clinical condition of patients.
electroneurography, an electrodiagnostic test that
assists in detecting and locating peripheral nerve injury
or disease. This study is usually done in conjunc-
tion with electromyography and may also be called
INPUT electromyoneurography.
BOX electroneuromyography /ilek′trōn ˘ oor′ōmī·og′rəfē/ [Gk,
elektron + neuron, nerve, mys, muscle, graphein, to
record], a procedure for testing and recording neuromus-
cular activity by electric stimulation of nerves. Needle elec-
Active trodes are inserted into any skeletal muscle being studied,
electrode electric current is applied to the electrodes, and neuromuscu-
in muscle lar functions are observed and recorded by means of instru-
ments, such as a cathode-ray oscilloscope and an appropriate
Ground
recording device. The procedure is helpful in the study of
Reference neuromuscular conduction, the extent of nerve lesions, and
electrode reflex responses. Compare nerve conduction test. See also
over muscle electromyogram.
electronic bulletin board /ilektron′ik/, a computer-
Electromyogram (Black and Hawks, 2005) ized communication system that allows users to compose
and store information to be retrieved by other users of the
system.
electromyographic biofeedback /-mī′əgraf′ik/, a thera- Electronic Data Interchange (EDI), a method by which
peutic procedure that uses electronic or electromechanical two or more autonomous computer systems exchange com-
instruments to measure, process, and feed back reinforcing puter-readable transaction data. It is possible even when
information with auditory and visual signals accurately. It the computers use different operating systems. It is the key
is used to provide information about muscle activity during factor in achieving automated medical records that can be
ambulation, for example, in clients with brain injury, stroke, shared electronically among providers.
or cerebral palsy. electronic fetal monitor (EFM) [Gk, elektron + L, fetus +
electromyographic technician /-mī′əgraf′ik/, a health monere, to warn], a device that allows observation of the
care provider with special training and experience to assist fetal heart rate and the maternal uterine contractions. It may
the physician in recording and analyzing muscle action be applied externally or internally. With an external monitor
potentials with the use of various electronic devices. the fetal heart is detected by an ultrasound transducer posi-
electromyography (EMG) /-mī·og′rəfē/, the electrical tioned on the abdomen. Internal monitoring of the fetal heart
recording of muscle action potentials. rate is accomplished via an electrode clipped to the fetal
electromyography of pelvic floor sphincter, an elec- scalp.
trodiagnostic test performed to evaluate the neuromuscular electronic fetal monitoring: antepartum, a nursing
function of the urinary or anal sphincter. It is done most often intervention from the Nursing Interventions Classification
in patients with urinary or fecal incontinence. (NIC) defined as electronic evaluation of fetal heart rate
electron /ilek′tron/ [Gk, elektron, amber], 1. a nega- response to movement, external stimuli, or uterine contrac-
tively charged elementary particle that has a specific charge, tions during antepartal testing. See also Nursing Interven-
mass, and spin. The number of electrons associated with tions Classification.
the nucleus of an atom is equal to the atomic number of the electronic fetal monitoring: intrapartum, a nursing
substance. 2. a negative beta particle emitted from a radio- intervention from the Nursing Interventions Classification
active substance. See also atom, element, ion, neutron, (NIC) defined as electronic evaluation of fetal heart rate
proton. response to uterine contractions during intrapartal care. See
electronarcosis /ilek′trōnärkō′sis/ [Gk, elektron + nar- also Nursing Interventions Classification.
kosis, numbness], anesthesia produced by passing an elec- electronic health record (EHR) a computerized reposi-
tric current through the brain. The experimental procedure tory for a patient’s health information providing infor-
has been used in the former USSR. Compare electrosleep mation to members of the health care team regarding a
therapy. clinical encounter. Many systems can also provide deci-
electron beam computed tomography (EBCT), ultra- sion support, quality assurance information and outcome
fast computed tomography done with a scanner in which the data.
patient is surrounded by a large circular anode that emits electronic infusion device (EID), an automated system of
x-rays as the electron beam is guided around it. introducing a fluid other than blood into a vein. The device
electron capture, a radioactive decay process in which may have programmable settings that control the amount of
an atomic nucleus with an excess of protons draws an elec- fluid to be infused, rate, low-volume notification level, and
tron into itself, creating a neutron out of a proton and thus a keep-vein-open rate. Some EIDs have titration modes that
decreasing the atomic number by 1. Often the resulting allow a change in the delivery rate without interrupting fluid
nucleus is unstable and achieves stability by giving off a flow. They also allow delivery in milliliters per hour. Also
gamma ray. called IV pump.
electronic mail 599 electroshock therapy
electron scanning microscope. See scanning electron
microscope.
electron transfer flavoprotein (ETF), a component of a
side chain of redox reactions by which electrons are funneled
to ubiquinone and thus the electron transport chain. Elec-
trons from acyl coenzyme A (CoA) thioesters and choline
are transferred via the flavin of acyl CoA dehydrogenases,
dimethylglycine dehydrogenase, and sarcosine dehydroge-
nase to the flavin adenine dinucleotide prosthetic group of
ETF, which is then oxidized by reduction of electron transfer
flavoprotein ubiquinone oxidoreductase. Deficiency of ETF
results in glutaric aciduria, type II.
electron volt (eV), a unit of energy equal to the energy
acquired by an electron falling through a potential difference
of 1 volt. One eV equals 1.6 × 10−12 erg or 1.6 × 10−19 J.
electronystagmography /ilek′trōnis′tagmog′rəfē/ [Gk,
Electronic infusion device (Elkin, Perry, and Potter, 2011) elektron + nystagmos, nodding, graphein, to record], a
method of assessing and recording eye movements by mea-
electronic mail (email, e-mail, E-mail), messages sent suring the electric activity of the extraocular muscles. See
by one user of a computerized communications system and also electroencephalogram, nystagmus.
retrieved almost instantaneously by other users. The mes- electropalatography, a technique for recording the timing
sages may be transmitted via modem through telephone and location of tongue contact with the hard palate during
lines, a wireless network, or, in some instances, by shortwave speech, using an artificial palate that fits against the roof of
radio. See also electronic bulletin board. the mouth and has electrodes embedded in the surface that
electronic stethoscope, a stethoscope designed and faces the tongue. A computer records and displays the pat-
equipped to detect and amplify body sounds. tern of the pulses generated by contact of the tongue with the
electronic thermometer, a battery-powered thermometer electrodes.
that registers temperature by electronic means. electrophoresis /ilek′trōfərē′sis/ [Gk, elektron + pherein,
to bear], the movement of charged suspended particles
through a liquid medium in response to changes in an elec-
tric field. Charged particles of a given substance migrate
in a predictable direction and at a characteristic speed. The
pattern of migration can be recorded in bands on an electro-
phoretogram. The technique is widely used to separate and
identify serum proteins and other substances. —electropho-
retic, adj.
electrophysiological study (EPS), an invasive electrodi-
agnostic or manometric procedure that uses electrode cath-
eters to pace the heart and potentially induce arrhythmias.
The test identifies defects in the heart conduction system and
arrhythmias that are otherwise inapparent. It also is used to
assess the effectiveness of antiarrhythmic drugs.
electrophysiology /-fis′ē·ol′əjē/ [Gk, elektron + physis,
nature, logos, science], a branch of biology concerned with
the relationship between electric phenomena and biological
function.
electropiezo activity. See piezoelectric activity.
Electronic thermometer (Potter and Perry, 2007) electroplating /i·lek′trōplāt′ing/ [Gk, electron, amber + Fr,
plat, flat dish], plating or coating of an object with a layer
electron microscope, an electronic instrument that scans of metal through the use of electrolytic processes.
cell and tissue sections with a beam of electrons instead of electroporation /-pôrā′shən/, a type of osmotic transfec-
visible light. The specimen is stained with electron-opaque tion in which an electric current is used to produce temporary
dyes. With its high magnification power, it creates an image holes in cell membranes, allowing the entry of nucleic acids
that can be photographed or viewed on a fluorescent screen. or macromolecules (a way of introducing new deoxyribo-
Compare scanning electron microscope. See also electron nucleic acid into the cell). See also transfection.
microscopy. electroresection /-risek′shən/ [Gk, elektron + L, re, again,
electron microscopy, a technique using an electron secare to cut], a technique for the removal of bladder
microscope in which a beam of electrons is focused by an tumors or prostate tissue by electrocautery. A wire is guided
electromagnetic lens and directed onto an extremely thin to the site through the urethra with the aid of an optic probe.
specimen. The electrons emerging are focused and directed Electricity is passed through the wire when the wire is prop-
by a second lens onto a fluorescent screen. The magnified erly located in the tissue to be destroyed. The procedure is
image produced is 1000 times greater than that produced performed after administration of an anesthetic.
by an optic microscope and well resolved, but it is two- electroshock [Gk, elektron + Fr, choc], a condition of
dimensional because of the thinness of the specimen. Also shock caused by accidental contact with an electric current.
called transmission electron microscopy. Compare scan- The symptoms are similar to those of shock produced by
ning electron microscopy, transmission scanning elec- thermal burns, trauma, or coronary thrombosis.
tron microscopy. electroshock therapy. See electroconvulsive therapy.
electrosleep therapy 600 ellipsoid joint
electrosleep therapy [Gk, elektron + AS, slaep + Gk, thera- eleo-, prefix meaning “oil”: eleoma, eleomyenchysis,
peia, treatment], a technique designed to induce sleep, eleopten.
especially in psychiatric patients, by administering a low- eleoma /ē′lē·ō′mə/, a lipogranuloma, or swelling, usually
amplitude pulsating current to the brain. The cathode is caused by subcutaneous injection of oil.
placed supraorbitally, and the anode is placed over the mas- elephantiasis /el′əfəntī′əsis/ [Gk, elephas, elephant, osis,
toid process. The current, which is discharged for 15 to 20 condition], the end-stage lesion of filariasis, characterized
minutes, produces a tingling sensation but does not always by extensive swelling, usually of the external genitalia and
induce sleep. The procedure is repeated from 5 to 30 times. the legs, resulting from obstruction of the lymphatics by
Electrosleep therapy is said to be beneficial for patients with filariae. The overlying skin becomes dark, thick, and coarse.
anxiety, depression, gastric distress, insomnia, personality Elephantiasis results from filariasis of many years’ duration.
disorders, and schizophrenia. Compare electronarcosis. Nonfilarial elephantiasis occurring in the absence of filarial
electrostatic imaging /-stat′ik/ [Gk, elektron + stasis, infection, seen mainly in the central African mountains, may
standing still; L, imago, image], a radiographic technique be caused by persistent contact with volcanic ash. Nonfilarial
in which the ionic charge liberated during the irradiation elephantiasis is difficult to diagnose in the early stages, when
process is converted into a visible image. The image may it is most responsive to treatment. See also filariasis.
be produced by an electronic read-out device or by liquid or elephantine psoriasis /el′əfan′tīn/, a rare form of psoria-
powdered toner. sis that is characterized by thick, scaly plaques on the hips,
electrostimulation /-stim′yəlā′shən/, the application of thighs, and back.
electric current to stimulate bone or muscle tissue for thera- elephantoid fever. See elephantiasis, filariasis.
peutic purposes, such as facilitation of muscle activation and eletriptan, an antimigraine agent used for the acute treat-
muscle strengthening. See also electric muscle stimulator. ment of migraine with or without aura.
electrosurgery /-sur′jərē/ [Gk, elektron + cheiourgos, sur- elevation /el′əva′shən/ [L, elevare, to lift], a raised area,
geon], surgery performed with various electric instruments or point of greater height.
that operate on high-frequency electric current. Kinds of elec- elevator /el′əvā′tər/ [L, elevare, to lift], an instrument for
trosurgery include electrocoagulation, electrodesiccation. lifting tissues, extracting teeth, removing bony fragments, or
electrotherapeutic current, any of three types of elec- removing roots of teeth.
tric current, which, when introduced into biological tissue, eleventh cranial nerve. See accessory nerve.
is capable of producing specific physiological changes. The elfin facies syndrome. See Williams syndrome.
three types are direct monophasic, alternating biphasic, and eligibility /el′əjəbil′itē/, entitlement of an individual to
pulsed polyphasic electric current. receive services based on that individual’s enrollment in a
electrotherapist /-ther′əpist/, a health care provider who health care plan.
has specific training and experience in the therapeutic uses Eligibility Guarantee Payment, a contract provision for
of electricity. guaranteeing payment from the health maintenance orga-
electrotherapy. See electroconvulsive therapy. nization to the provider for services already delivered to
electrotonic current [Gk, elektron + tonos, tension], a cur- enrollees whose coverage is terminated retroactively. Not
rent induced in a nerve sheath without the generation of new applicable in Canada.
current by an action potential. elimination /i·lim′i·nā′shən/ [L, ex, out + limen, thresh-
electrotonic synapse, a gap junction that transmits electri- old], 1. the act of expulsion or of extrusion, especially of
cal impulses in electrically excitable tissue. See also gap expulsion from the body. See also clearance, defecation,
junction. excretion, urination. 2. omission or exclusion, as in an
electrovalence, the valence of an ion, equal to the absolute elimination diet.
value of its charge. See also valence, valence electron. elimination diet /ilim′inā′shən/ [L, eliminare, to expel; Gk,
eleidin /əlē′ədin/ [Gk, elaia, olive tree], a transparent, diata, way of living], a procedure for identifying a food or
proteinaceous substance resembling keratin, found in the foods to which a person is allergic by successively omitting
outer stratum lucidum of the epidermis. from the diet certain foods in order to detect those respon-
element [L, elementum, first principle], one of more than sible for the symptoms.
100 primary, simple substances that cannot be broken down ELISA /əlī′zə/, abbreviation for enzyme-linked immuno-
by chemical means into any other substance. Each atom sorbent assay, a technology used to measure a variety of
of any element contains a specific number of protons in proteins and antigens.
the nucleus and an equal number of electrons outside the elixir /ilik′sər/ [Ar, il-iksir, seen as the philosopher’s
nucleus. In most elements, the nucleus may contain a vari- stone], a clear liquid containing water, alcohol, sweeteners,
able number (high or low) of neutrons. An element with a or flavors, used primarily as a vehicle for the oral administra-
disproportionate number of neutrons may be unstable, in tion of a drug.
which case the nucleus undergoes radioactive decay into a Elixophyllin, a trademark for a bronchodilator (theophyl-
more stable element. See also atom, compound, molecule, line) used as a bronchodilator.
radioactivity. Elliot forceps. See obstetric forceps.
element 104. See rutherfordium. ellipsis /ilip′sis/, (in psychiatry) the omission by a patient
element 105. See dubnium. of meaningful thoughts and ideas while undergoing
element 106. See seaborgium. therapy.
element 107, an element reportedly synthesized in 1976 ellipsoidal, describing an object that has the shape of a
by Russian scientists who bombarded isotopes of bismuth spindle or an ellipse.
with heavy nuclei of chromium-54. The finding was not ellipsoid joint, a synovial joint in which a condyle is
confirmed by scientists of other nations. It has been named received into an elliptic cavity, as the wrist joint. A condyloid
bohrium (Bh). joint permits no axial rotation but allows flexion, extension,
elemental formula. See defined formula diet. adduction, abduction, and circumduction. Also called con-
elementary particle, (in physics) a subatomic particle, dyloid joint. Compare ball-and-socket joint, pivot joint,
such as an electron, neutron, or proton. saddle joint. See also joint.
elliptical trainer 601 embolic
elliptical trainer, exercise equipment designed to simulate eluate /el′yoo·āt/ [L, eluere, to wash out], a solution or
motions such as stair-climbing and running by using ped- substance that results from an elution process. In column
als that move back and forth in an oval (elliptical) pattern to chromatography the eluate is collected as it drips from the
minimize the impact on the hips, back and knees. column.
elliptocyte /ilip′təsīt/ [Gk, elleipsis, ellipse, kytos, eluent /el′yoo·ənt/, a solvent or solution used in an elution
cell], an oval red blood cell. See also elliptocytosis, ovalo- process, such as column chromatography.
cytes, ovalocytosis. elution /eloo′shən/, the removal of an absorbed substance
from a porous bed or chromatographic column by means of
a stream of liquid or gas or the application of heat. The tech-
nique may consist of washing a material that dissolves out of
just one component of a mixture. The term is also applied to
the removal of antibodies or radioactive tracers from erythro-
cytes. In heat elution of antibodies, red cells in a saline solu-
tion are heated to 56° C and then centrifuged. Liquid elution
of antibodies usually uses ether as the solvent.
em, abbreviation for extrinsic muscle.
EM, abbreviation for erythema multiforme.
em-, prefix meaning “in, on”: embolism, empasma.
emaciation /imā′shi·ā′shən/ [L, emaciare, to make
lean], 1. excessive leanness caused by disease or lack of
nutrition. —emaciated, /imā′shē·ā′tid/ adj. 2. character-
ized by an extreme loss of subcutaneous fat that results in an
abnormally lean body, such as with starvation.
e-mail. See electronic mail.
emancipated minor /iman′sipā′tid/ [L, emancipare, to set
free], a person who is not legally an adult but who, because
he or she is married, in the military, or otherwise no longer
Elliptocyte (Carr and Rodak, 2008) dependent on the parents, may not require parental permis-
sion for medical or surgical care. State and national laws
vary in specific interpretations of the rule.
elliptocytic anemia, hereditary elliptocytosis. See also emasculation /imas′kyəlā′shən/, a loss of the testes or penis
elliptocytosis, ovalocytosis. or both. See also castration.
elliptocytosis /ilip′tōsītō′sis/ [Gk, elleipsis + kytos + embalming /embä′ming/, the practice of applying antisep-
osis, condition], an abnormal condition of the blood tics and preservatives to a corpse to retard the natural decom-
characterized by increased numbers of elliptocytes. Less position of tissues.
than 15% of the red blood cells appear in this form in nor- Embden-Meyerhof defects /emb′den mī′ərhof/ [Gus-
mal blood; modest increases occur in a variety of anemias, tav G. Embden, German biochemist, 1874–1933; Otto F.
including a rare congenital disorder, hereditary ellipto- Meyerhof, German biochemist, 1884–1951], a group of
cytosis. Also called ovalocytosis. Compare spherocyto- hereditary hemolytic anemias caused by enzyme deficien-
sis. See also acanthocytosis, congenital nonspherocytic cies. The most common form of the disorder is a pyruvate
hemolytic anemia, sickle cell anemia, spherocytic kinase deficiency. The condition is characterized by an
anemia. absence of spherocytes and the presence of small numbers
Ellis–van Creveld syndrome. See chondroectodermal of crenated erythrocytes. The trait is transmitted as an auto-
dysplasia. somal-recessive gene, and the hemolytic anemia occurs only
elongation /i′longā′shən/ [L, elongatio, a prolonging], a in homozygotes.
state of being lengthened or extended. Embden-Meyerhof pathway. See glycolysis.

elope /ilōp′/ [ME, gantlopp, to run away], (informal) to embedded tooth, an unerupted tooth, usually completely
leave a locked or secured psychiatric institution without covered with bone. Also spelled imbedded tooth. Compare
notice or permission. impacted tooth.
elopement occurrence, a nursing outcome from the embol-, 1. prefix meaning “to insert”: embolia, embole.
Nursing Outcomes Classification (NOC) defined as the 2. prefix meaning “embolus or plug”: embolectomy.
number of times in the past 24 hours/1 week/1 month embolectomy /em′bəlek′təmē/ [Gk, embolos, plug,
(select one) that an individual with a cognitive impair- ektomē, excision], a surgical incision into an artery for
ment escapes a secure area. See also Nursing Outcomes the removal of an embolus or clot, performed as emer-
Classification. gency treatment for arterial embolism. The operation is
elopement precautions, a nursing intervention from the done as soon as possible after a decrease in perfusion is
Nursing Interventions Classification (NIC) defined as mini- detected. Thrombi tend to lodge at the juncture of major
mizing the risk of a patient leaving a treatment setting with- arteries. More than half lodge in the aorta, in arteries of
out authorization when departure presents a threat to the the lower extremities, in the common carotid arteries, or
safety of patient or others. See also Nursing Interventions in the pulmonary arteries. Before surgery, heparin may
Classification. be administered, and an arteriogram may be used to iden-
elopement propensity risk, a nursing outcome from tify the affected artery. A longitudinal incision is made in
the Nursing Outcomes Classification (NOC) defined as the artery, and the embolus is removed. After surgery the
the propensity of an individual with cognitive impair- blood pressure is maintained close to the level of the pre-
ment to escape a secure area. See also Nursing Outcomes operative baseline, as a decrease might predispose to new
Classification. clot formation.
Elspar, a trademark for an antineoplastic (asparaginase). embolic. See embolus, embolism.
embolic gangrene 602 embryoma of the ovary
embolic gangrene [Gk, embolos + gaggraina], the death Mandibular
and decay of body tissues caused by an embolus blocking the (I) arch Location of
blood supply to that part. Maxillary auditory vesicle
embolic necrosis, death of a portion of tissue that results process
from an infarction caused by an embolus. Hyomandibular cleft
embolic thrombosis [Gk, embolos, plug, thrombos, lump,
osis, condition], a clot that develops at the site of an Hyoid (II) arch
impacted embolus (foreign body) in a blood vessel.
emboliform nucleus, a small cerebellar nucleus lying Third
between the dentate nucleus and the globose nucleus and pharyngeal
contributing to the superior cerebellar peduncles. Eye arch
embolism /em′bəliz′əm/, an abnormal condition in which
an embolus travels through the bloodstream and becomes Nasal pit
lodged in a blood vessel. Symptoms vary with the charac- Fourth
ter of the embolus, the degree of occlusion that results, and Cardiac
pharyngeal
the size, nature, and location of the occluded vessel. Kinds prominence
arch
of embolism include air embolism, fat embolism, and gas
embolism. —embolic, adj. Arm bud
embolization agent, a substance used to occlude or drasti-
Umbilical
cord
cally reduce blood flow within a vessel. Examples include
microfibrillar collagen, absorbable gelatin sponge (Gel-
foam), polyvinyl alcohol particles, tris-acryl gelatin micro- Tail
spheres, and silicone beads. Mesonephric
embolized atheroma, a fat particle lodged in a blood vessel. prominence
emboloid. See embolus. Leg bud
embolotherapy /em′bəlōther′əpē/, a technique of blocking
a blood vessel with a balloon catheter. It is used for treat- Embryo: end of fourth week (Carlson, 2009)
ing bleeding ulcers and blood vessel defects and for stopping
blood flow to a tumor during surgery. embryo-, prefix meaning a “fetus”: embryoctony,
embolus /em′bələs/ pl. emboli [Gk, embolos, plug], a for- embryology.
eign object, quantity of air or gas, bit of tissue or tumor, or embryocidal /em′brē·əsī′dəl/, pertaining to the killing of an
piece of a thrombus that circulates in the bloodstream until it embryo.
becomes lodged in a vessel. —embolic, emboloid, adj. embryoctony /em′brē·ok′tənē/ [Gk, en + bryein + kteinein,
embolus care: peripheral, a nursing intervention from to kill], the intentional destruction of a living embryo or
the Nursing Interventions Classification (NIC) defined as fetus in utero. Also called feticide. See also abortion.
limitation of complications for a patient experiencing, or at embryogenesis /em′brē·ōjen′əsis/ [Gk, en + bryein +
risk for, occlusion of peripheral circulation. See also Nurs- genein, to produce], the process in sexual reproduction by
ing Interventions Classification. which an embryo forms from the fertilization of an ovum.
embolus care: pulmonary, a nursing intervention from Also called embryogeny /em′brē·oj′ənē/. See also hetero-
the Nursing Interventions Classification (NIC) defined as genesis, homogenesis. —embryogenetic, embryogenic,
limitation of complications for a patient experiencing, or at adj.
risk for, occlusion of pulmonary circulation. See also Nurs- embryological development /-loj′ik/, the various intra-
ing Interventions Classification. uterine stages and processes involved in the growth and dif-
embolus precautions, a nursing intervention from the ferentiation of the conceptus from the time of fertilization
Nursing Interventions Classification (NIC) defined as reduc- of the ovum until the eighth week of gestation. The stages
tion of the risk of an embolus in a patient with thrombi or are related to the biological status of the unborn child and
at risk for thrombus formation. See also Nursing Interven- involve the differentiation of the various cells, tissues, and
tions Classification. organ systems and the development of the main external fea-
embolysis /embol′isis/, the dissolution of an embolus, espe- tures of the embryo. It occurs from approximately the end of
cially one caused by a blood clot. See also thrombolysis. the second week to the eighth week of intrauterine life. The
embrasure /embrā′zhər/, a normally occurring space fetal stage follows these stages, beginning at about the ninth
between adjacent teeth on the same arch (maxillary or man- week of gestation. The entire process of growth and devel-
dibular) resulting from variations in the positions and con- opment of the embryo and fetus is loosely called prenatal
tours of teeth. Embrasures provide a spillway for the escape development. See also prenatal development.
of food during mastication. See also spillway. embryologic, embryological. See embryology.
embryatrics. See fetology. embryologist /em′brē·ol′əjist/, one who specializes in
embryectomy /em′brē·ek′təmē/ [Gk, en, in, bryein, to grow, embryology.
ektomē, excision], the surgical removal of an embryo, most embryology /em′brē·ol′əjē/ [Gk, en, bryein + logos, sci-
commonly in an ectopic pregnancy. ence], the study of the origin, growth, development, and
embryo /em′brē·ō/ [Gk, en, in, bryein, to grow], 1. any function of an organism from fertilization to birth. Kinds of
organism in the earliest stages of development. 2. in humans embryology include comparative embryology, descriptive
the stage of prenatal development from the time of fertiliza- embryology, and experimental embryology. —embryo-
tion of the ovum (conception) until the end of the eighth logic, embryological, adj.
week. The period is characterized by rapid growth, differen- embryoma /em′brē·ō′mə/ pl. embryomas, embryomata
tiation of the major organ systems, and development of the [Gk, en + bryein + oma, tumor], a tumor that arises from
main external features. Compare fetus, zygote. —embryo- embryonic cells or tissues.
nal, embryonic, embryonoid, adj. embryoma of the ovary. See dysgerminoma.
embryomorph 603 embryulcia
embryomorph /embrē′əmôrf′/ [Gk, en + bryein + morphe, mesoderm. The disk develops from the ectoderm and endo-
form], any structure that resembles an embryo, especially derm. Also called embryonic area, gastrodisk, germ disk,
a mass of tissue that may represent an aborted conceptus. germinal area.
—embryomorphous, adj. embryonic layer, one of the three layers of cells in the
embryonal. See embryo. embryo: the endoderm, the mesoderm, and the ectoderm.
embryonal adenomyosarcoma, embryonal adenosar- From these layers of cells arise all of the structures and
coma. See Wilms’ tumor. organs and parts of the body. The endoderm and the ectoderm
embryonal carcinoma /em′brē·ənəl/, a malignant neo- are the first to develop. During the third week of gestation the
plasm derived from germinal cells that usually develops in mesoderm arises between the ectoderm and the endoderm.
gonads, especially the testes. The tumor, a firm nodular mass embryonic period, the earliest period or phase of lung
with hemorrhagic areas, is characterized histologically by development in utero, lasting from the third week after con-
large, undifferentiated cells with indistinct borders, eosino- ception to the sixth week. It is sometimes not named as a
philic cytoplasm, and prominent nucleoli in pleomorphic defined period of lung development, which is instead con-
nuclei. Bodies resembling a 1- or 2-week-old embryo are sidered to begin with the following pseudoglandular period.
occasionally seen in these tumors. The neoplasm is relatively During this period, a ventral respiratory diverticulum (lung
resistant to radiation therapy. The tumor metastasizes by way bud) arises from the caudal end of the laryngotracheal groove
of lymph channels. Surgery and chemotherapy are usually and grows into bronchial buds and the primordial trachea.
used in the treatment. See also choriocarcinoma. Also called embryonic phase.
embryonic pole, the area of the blastocyst where the
embryoblast and the trophoblast are in contact. The embryo-
blast attaches to the endometrial epithelium at this pole.
embryonic rest, a portion of embryonic tissue that remains
in the adult organism. Also called epithelial rest, fetal rest.
embryonic stage, (in embryology) the interval of time
from fertilization to the eighth week.
embryonic tissue [Gk, en + bryein, to grow; OFr, tissu],
1. also called mucous tissue, mucoid tissue, a loose, gelat-
inous mass of connective tissue cells. The gelatinous matrix
is caused by the presence of mucopolysaccharides. 2. per-
taining to tissue of an embryo.
embryoniform /em′brē·on′ifôrm′/ [Gk, en + bryein + L,
forma, form], resembling an embryo.
embryonoid. See embryo.
embryopathy /em′brē·op′əthē/ [Gk, en + bryein + pathos,
disease], any anomaly occurring in the embryo or fetus as a
result of interference with normal intrauterine development.
A kind of embryopathy is rubella embryopathy.
embryoplastic /em′brē·ōplas′tik/ [Gk, en + bryein + plas-
sein, to mold], pertaining to the formation of an embryo,
usually with reference to cells.
embryoscopy /em′brē·os′kəpē/, the direct examination of
an embryo by insertion of a lighted instrument through the
mother’s abdominal wall and uterus. The technique may be
Embryonal carcinoma (Kumar et al, 2007) used to obtain tissue specimens for analysis or to perform
needed surgery.
embryonal leukemia. See stem cell leukemia. embryotome /em′brē·ətōm′/ [Gk, en + bryein + temnein, to
embryonate /em′brē·ənāt′/ [Gk, en + bryein + L, atus, cut], a cutting instrument for the removal of a fetus when
shaped like], 1. impregnate. 2. pertaining to or resembling normal birth is not possible. See also embryotomy.
an embryo. 3. containing an embryo. embryotomy /em′brē·ot′əmē/ [Gk, en + bryein + temnein,
embryonic. See embryo. to cut], 1. the dismemberment or mutilation of a fetus for
embryonic abortion, 1. termination of pregnancy before removal from the uterus when normal delivery is not pos-
the twentieth week of gestation. 2. products of conception sible. 2. the dissection of an embryo for examination and
expelled before the twentieth week. Compare fetal abortion. analysis.
embryonic anideus [Gk, en + bryein + an, not, eidos, embryo transfer, a process of implanting a fertilized ovum
form], a blastoderm in which the axial elongation of the in a uterus.
primitive streak and primitive groove fail to develop. embryotroph /em′brē·ətrof′/ [Gk, en + bryein + trophe,
embryonic area. See embryonic disk. nourishment], the liquefied uterine nutritive material, com-
embryonic blastoderm, the area of the blastoderm that posed of glandular secretions and degenerative tissue, that
gives rise to the primitive streak from which the embryonic nourishes the mammalian embryo until placental circulation
body develops. Compare extraembryonic blastoderm. is established. Also called embryotroph /-trōf′/, histotroph,
embryonic competence, the ability of an embryonic cell histotrophic nutrition. Compare hemotroph.
to react normally to the stimulation of an inductor, allowing embryotrophy /em′brē·ot′trəfē/, the nourishment of the
continued normal growth or differentiation of the embryo. embryo. See also embryotroph, hemotroph. —embryot-
embryonic disk, the thickened plate from which the rophic, adj.
embryo develops in the second week of pregnancy. Scattered embryulcia /em′brē·ul′sē·ə/ [Gk, en + bryein + elkein, to
cells from the border of the disk migrate to the space between draw], the surgical extraction of the embryo or fetus from
the trophoblast and yolk sac and become the embryonic the uterus.
Emcyt 604 emergency medical service
Emcyt, a trademark for an antineoplastic agent (estramus- the sac is snipped or torn behind the baby’s neck and peeled
tine phosphate sodium). away from the face so that the baby can breathe. If necessary,
eme-, prefix meaning “to vomit”: emetocathartic, emetine. the nares, nasopharynx, and mouth may be suctioned with the
emedastine /em′ĕdas′tēn/, an antihistamine applied topi- bulb syringe, taking care not to slow the heart rate by stimulat-
cally to the conjunctiva as emedastine difumarate in treating the vagus nerve with the tip of the syringe on the back of
ment of allergic conjunctivitis. the throat. The baby is kept warm and held with the head lower
Emend, a trademark for aprepitant. than the chest; it may be laid skin-to-skin on the mother’s abdo-
emergence /imur′jəns/ [L, emergere, to come forth], the men. The baby may thus be positioned, observed, and warmed
point in the process of recovery from general anesthesia at which in one place as the nurse or other helper covers the mother
a return of spontaneous respiration, protective airway reflexes, and baby with a dry blanket or towel and continues to provide
and consciousness occurs. See also postanesthesia care. emergency care as necessary through the third stage of labor.
emergency /imur′jənsē/ [L, emergere, to come forth], a There is no urgent need to cut the cord or to deliver the pla-
perilous situation that arises suddenly and threatens the life centa. When it is desired, the cord may be cut by clamping it in
or welfare of a person or a group of people, as a natural disas- two places several inches from the baby and cutting it between
ter, medical crisis, or trauma situation. the clamps with sterile scissors. The cord clamp may be put on
emergency cardiac care (ECC) [L, emergeere, to come later. If possible, an Apgar score is taken first at 5 minutes of
forth; Gk, kardia + ME, caru, sorrow], the concentration age, then at 10. The placenta is ready to be delivered when the
of personnel and facilities organized to sustain the cardio- cord is seen to advance a few inches, the uterus becomes firmer
vascular and pulmonary systems when a myocardial infarc- and rises in the abdomen, and a small gush of bright red blood
tion or cardiac arrest occurs. The interventions assure prompt emerges from the vagina. The mother may help expel it by
availability of basic life support, monitoring and treatment bearing down. The placenta is lifted out of the vagina slowly,
facilities, prevention of complications, and psychological with care, so that all of the membranes are drawn out with it.
reassurance. If cardiac arrest occurs outside a hospital, efforts The placenta and membranes are kept for further evaluation.
are devoted to stabilizing the patient’s cardiovascular and pul- The uterus is massaged to ensure that it is well contracted, and
monary systems before removing the individual to a hospital. the baby is put to breast if the mother wishes. The uterus is pal-
emergency care, a nursing intervention from the Nurs- pated frequently, and it is massaged when necessary. The baby
ing Interventions Classification (NIC) defined as providing is kept with the mother and observed for warmth, color, activ-
life-saving measures in life-threatening situations. See also ity, and respiration. After delivery of the placenta, the perianal
Nursing Interventions Classification. area is rinsed with warm sterile water and dried with a clean
emergency cart checking, a nursing intervention from towel or cloth, and an ice pack and a sanitary pad or small
the Nursing Interventions Classification (NIC) defined as towel are applied in such a way that the mother can hold them
the systematic review and maintenance of the contents of an in place by drawing her legs together.
emergency cart at established time intervals. See also Nurs- n outcome criteria: Almost all births are normal and
ing Interventions Classification. do not constitute true medical emergencies. If a mother is
emergency childbirth, a birth that occurs accidentally healthy and is not bleeding, if her vital signs are normal,
or precipitously in or out of the hospital, without standard and if the fetal heart sounds are normal, there is no imme-
obstetric preparations and procedures. Signs and symptoms diate cause for alarm, even if the birth is imminent. Emer-
of impending delivery include increased bloody show, fre- gency care is directed to ensuring that the newborn breathes
quent strong contractions, the mother’s desire to bear down well and is kept warm, that the mother is protected from
forcibly or her report that she feels as though she is going to hemorrhage, and that the mother’s privacy is maintained.
defecate, visible bulging of the bag of waters, and crowning The nurse is likely to be the person who must initially eval-
of the baby’s head at the vaginal introitus. uate the situation and decide whether to attempt to transfer
n method: If time permits, equipment is readied, but the or transport the mother or to prepare for emergency deliv-
delivery is not delayed for such preparations. Useful equip- ery. If a mother says the baby is coming, the attendant is
ment includes sterile gloves, towels, bulb syringe, receiving advised to believe her and to act accordingly. Throughout
blankets, scissors, two Kelly clamps, cord clamp or tie, and the delivery and the third stage of labor, the nurse works to
a basin for the placenta. The mother’s vital signs are taken, help the mother to feel calm, confident, and well cared for.
and the fetal heart sounds are listened to if time permits and emergency contraceptive. See postcoital contraceptive.
if equipment is available. The mother is reassured that emer- emergency department (ED), (in a health care facility) a
gency deliveries are usually simple and that all procedures and section of an institution that is staffed and equipped to provide
events will be explained. Despite her compelling urge to push rapid and varied emergency care, especially for those who are
and to deliver quickly, the mother is encouraged to ease the stricken with sudden and acute illness or who are the victims
baby out slowly by not pushing and by blowing air forcibly out of severe trauma. The emergency department may use a tri-
through pursed lips as she feels the strength of the urge build- age system of screening and classifying clients to determine
ing. As the head emerges, it is supported but allowed to rotate priority needs for the most efficient use of available personnel
naturally. A check is made immediately to determine whether and equipment. Formerly called emergency room.
or not the umbilical cord is wound around the neck. If it is, a emergency doctrine, (in law) a doctrine that assumes a per-
gentle attempt is made to slip it over the baby’s head; if it is too son’s consent to medical treatment when he or she is in immi-
tight, it is immediately clamped with two Kelly clamps placed nent danger and unable to give informed consent to treatment.
2 or 3 inches apart, cut between the clamps, and unwound from Emergency doctrine assumes that the person would consent if
the neck. If the baby does not deliver immediately, mucus and able to do so. Commonly known as implied consent.
fluid in the nose and mouth are sucked out with a bulb syringe. emergency handling of radiation accidents. See radia-
The shoulders are delivered one at a time by guiding the head tion exposure, emergency procedures.
downward to deliver the anterior (upper) shoulder under the emergency medical identification. See Medic Alert.
symphysis pubis, and then upward to deliver the posterior emergency medical service (EMS), a network of services
(lower) shoulder over the perineum. The rest of the baby is coordinated to provide aid and medical assistance from pri-
quickly born. If the membranes of the amniotic sac are intact, mary response to definitive care, involving personnel trained
emergency medical technician 605 emetic
in the rescue, stabilization, transportation, and advanced treat- in all the skills of EMTs of other levels and has additional
ment of traumatic or medical emergencies. Linked by a com- training in pharmacology and administration of emergency
munication system that operates on both a local and a regional drugs. See also emergency medical service.
level, EMS is a tiered system of care, which is usually initi- emergency medicine, a branch of medicine concerned
ated by citizen action in the form of a telephone call to an with the diagnosis and treatment of conditions resulting from
emergency number. Subsequent stages include the emergency trauma or sudden illness. The patient’s condition is stabi-
medical dispatch, first medical responder, ambulance person- lized, and care is transferred to the primary physician or to
nel, medium and heavy rescue equipment, and paramedic a specialist. Emergency medicine requires broad interdisci-
units, if necessary. In the hospital, service is provided by plinary training in the physiological and pathological charac-
emergency department nurses, emergency department phy- teristics of all body systems.
sicians, specialists, and critical care nurses and physicians. Emergency Nurses’ Association (ENA), a national pro-
See also emergency medical technician, emergency medi- fessional organization of emergency department nurses that
cal technician-advanced life support, emergency medical defines and promotes emergency nursing practice. The asso-
technician-intermediate, emergency medical technician- ciation, which was founded in 1970 and has more than 11,000
intravenous, emergency medical technician-paramedic. members, has written and implemented the Standards of Emer-
emergency medical technician (EMT), a person trained gency Nursing Practice. The association offers a certification
in and responsible for the administration of specialized emer- examination and awards the designation Certified Emergency
gency care and the transportation of victims of acute illness or Nurse (CEN) to nurses who successfully complete it. ENA
injury to a medical facility in compliance with national stan- publishes the Journal of Emergency Nursing and Continuing
dards developed by the U.S. Department of Transportation. In Education Core Curriculum of Emergency Nursing Practice.
addition to basic life-support skills, the EMT is trained in extri- The association, which has headquarters in Chicago, works
cation, operation of emergency vehicles, basic anatomy, basic closely with its members and with related associations to define
assessment of injury or illness, triage, care for specific inju- practice and to prepare professionals to deliver emergency care.
ries and illnesses, environmental emergencies, childbirth, and emergency nursing, nursing care provided to prevent immi-
transport of the patient. See also emergency medical service. nent severe damage or death or to avert serious injury. Activi-
ties that exemplify emergency nursing are basic life support,
cardiopulmonary resuscitation, and control of hemorrhage.
Inc
emergency readiness, a state of having made advance plans

rea
for coping with an unexpected natural disaster, civil distur-

sin
bance, or military attack that may threaten death and injury to a

ed
gl
local population. The planning includes educating the popula-

ev
vid
Bystanders
el
tion about location of shut off valves for utilities and about first
pro
of
aid, including cardiopulmonary resuscitation; ensuring that

re
kn
First
ca
adequate sources of food, water, basic medical supplies, and

ow
Responders
of
led
bedding materials will be available; arranging for the disposal

l
eve
ge
of human wastes when toilets are not functional; and establish-

,s
gl
EMT-Basics
ing procedures for emergency care of the elderly, infants, small
kill
sin
children, and women who may be pregnant. Plans for com-

,a
rea
nd
munication systems also may be part of emergency readiness.

Inc
res
emergency room (ER, E.R.), obsolete. See emergency

EMT-Intermediates
po
department.
ns
emergent /imur′jənt/ [L, emergens, emerging], arising, often

ibi
lity
EMT-Paramedics
unexpectedly, or improving or modifying an existing thing.
emergent evolution, the theory that evolution occurs in a
Pyramid of care (Shade et al, 2012) series of major changes at certain critical stages and results
from the total rearrangement of existing elements so that

emergency medical technician-advanced life support completely new and unpredictable characteristics appear
(EMT-ALS), a third-level EMT. The EMT-ALS is locally within the species. See also saltatory evolution.
certified in all the skills of the basic-level EMT and EMT-IV. Emery-Dreifuss syndrome /em′ərē drī′fəs/ [Alan E.H.
The EMT-ALS may also administer certain medications fol- Emery, British geneticist, b. 1928; Fritz E. Dreifuss, twentieth-
lowing the protocols or orders of the hospital physician, with century British physician, 1926–1997], an X-linked
whom radio contact is maintained. An EMT-ALS is also trained recessive form of muscular dystrophy that begins in early
in the use of advanced life support systems, including electrical childhood and is characterized by joint contractures and car-
defibrillation equipment. See also emergency medical service. diac conduction disorders. Patients who reach adulthood are
emergency medical technician-intermediate (EMT-I), often unable to work and require cardiac pacemakers to con-
a second-level emergency medical technician nationally cer- trol arryhthmias.
tified as both an EMT-ALS and an EMT-IV. See also emer- emesis. See vomit, def. 2.
gency medical service. -emesis, suffix meaning “to vomit”: hyperemesis.
emergency medical technician-intravenous (EMT- emesis basin /em′əsis, əmē′sis/ [Gk, emesis, vomiting; Fr,
IV), a second-level emergency medical technician. The bassin, hollow vessel], a kidney-shaped bowl or pan that
EMT-IV is trained and locally certified in IV therapy, endo- fits against the neck to collect vomitus.
tracheal intubation, and use of other antishock techniques. emesis gravidarum, vomiting associated with pregnancy.
See also emergency medical service. Emete-con, a trademark for an antiemetic (benzquinamide
emergency medical technician-paramedic (EMT-P), hydrochloride).
an advanced-level emergency medical technician who works emetic /imet′ik/, 1. adj, pertaining to a substance that
in prehospital care settings under the direction of a physician, causes vomiting. 2. n, an emetic agent. Apomorphine hydro-
often through radio contact. The EMT-P is nationally certified chloride, acting through the central nervous system, induces
-emetic, -emetical 606 emotional care of the dying patient
vomiting 10 to 15 minutes after parenteral administration. emmetropia /em′ətrō′pē·ə/ [Gk, emmetros, proportioned,
Syrup of ipecac is used in the emergency treatment of some opsis, vision], a state of normal vision characterized by the
drug overdosages and in certain cases of poisoning. proper relationship between the refractive system of the eye-
-emetic, -emetical, suffix meaning “to cause vomiting”: ball and its axial length. This correlation ensures that light
antiemetic, hematemetic, hyperemetic. rays entering the eye parallel to the optic axis are focused
Emetrol, a trademark for a fixed-combination drug con- exactly on the retina. Compare amblyopia, hyperopia,
taining fructose, glucose, and orthophosphoric acid, used to myopia. —emmetropic, adj.
treat nausea and vomiting. Emmet’s operation, a surgical procedure for repair of a
EMF, abbreviation for electromotive force. lacerated perineum or ruptured uterine cervix.
EMG, 1. abbreviation for electromyogram. 2. abbrevia- emollient /imol′yənt/ [L, emolliere, to soften], a substance
tion for electromyography. that softens tissue, particularly the skin and mucous membranes.
EMG syndrome, a hereditary disorder transmitted as an emollient bath, a bath taken in water containing an emol-
autosomal-recessive trait, characterized by umbilical hernia lient, such as bran, to relieve irritation and inflammation. See
(exomphalos), macroglossia, and gigantism, often accompa- also colloid bath.
nied by visceromegaly, dysplasia of the renal medulla, and emotion /imō′shən/ [L, emovere, to disturb], 1. the out-
enlargement of the cells of the adrenal cortex. Also called ward expression or display of mood or feeling states. 2. the
Beckwith-Wiedemann syndrome, exophthalmos-macro- affective aspect of consciousness as compared with volition
glossia-gigantism syndrome. and cognition. Physiological alterations often occur with a
marked change of emotion regardless of whether the feelings
are conscious or unconscious, expressed or unexpressed. See
also emotional need, emotional response.
emotional abuse /imō′shənəl/, the debasement of a per-
son’s feelings that causes the individual to perceive himself
or herself as inept, not cared for, and worthless.
emotional age [L, emovere, to disturb; L, aetas, age], the
age of an individual as determined by the stage of emotional
development reached.
emotional amalgam, an unconscious effort to deny or
counteract anxiety.
emotional amenorrhea, a suppression of menstrual dis-
charge from the uterus caused by psychological factors.
emotional care of the dying patient, the compassionate,
consistent support offered to help the terminally ill patient
and the family cope with impending death. See also hospice,
stages of dying.
n method: The professional person providing emotional
support for the terminally ill encourages the expression of per-
sonal feelings, anxieties, and experiences regarding death and
empathizes with the patient and the family. To prevent con-
flicting statements, it is essential to know what the physician,
other professionals, and family members tell the patient about
the outcome. Effective support in terminal illness involves a
Beckwith-Wiedemann syndrome. Note omphalocele nonjudgmental approach to the patient’s relatives and signifi-
and macroglossia. (Optiz, 2008/Courtesy R. Spencer, Los Angeles, cant others, an understanding of their problems, and efforts to
California, and J. B. Beckwith, Missoula, Montana) assist them in the grieving process. The patient needs relief
from pain, tender care, and continued attention through all

-emia, -aemia, -hemia, -haemia, a suffix meaning “blood the stages of dying. A patient may not progress through all of
condition”: anemia, polycythemia, hyperemia. these stages or may progress through them in a different order.
emissary veins /em′əser′ē/ [L, emittere, to send forth], the When the patient denies the prognosis and refuses to follow
small vessels in the skull that connect the sinuses of the dura directions, the nursing staff does not interfere with or support
mater with the veins on the exterior of the skull through a the denial mechanism but spends time with the sick person and
series of anastomoses. encourages self-care. During the stage of anger, often mani-
emission /imish′ən/ [L, emittere, to send out], a discharge fested by refusal of care and food and by abusive language
or release of something, as a fluid from the body, electronic and negative criticism of the staff, the patient is not allowed
signals from a radio transmitter, or an alpha or beta particle to indulge in physically harmful behavior but is encouraged
from an atomic nucleus during radioactive decay. to verbalize his or her anger. In the period in which the patient
emission computed tomography (ECT) [L, emittere, to tries to make bargains, such as “If I could live until…” it
send forth; computare, to count; Gk, tome, section, graphein, should be recognized that time is needed to accept death and
to record], a form of tomography in which the emitted that the person may appreciate discussing the importance of
decay products, as positrons or gamma rays, of an ingested various events and people in earlier life. When depression,
radioactive pharmaceutical are recorded in detectors outside marked by apathy, insomnia, inability to concentrate, poor
the body. Computer reconstruction of the data yields a cross- appetite, and weariness, sets in, efforts to cheer the patient or
sectional image of the body. interrupt crying are inappropriate. The patient may want only
emit [L, emittere, to send out], to give or send out some- the most beloved person to be present. In the final stage of
thing, such as energy, sound, heat, or radiation. acceptance the patient usually experiences less pain and dis-
emmetr-, prefix meaning “the correct measure”: emmetro- comfort, seems peaceful and lacking in emotional affect, and
pia, emmetrope. appreciates care from people who are close and familiar.
emotional deprivation 607 emphysema
n interventions: The nurse has the major role in provid- patient is encouraged to verbalize feelings and concerns, and
ing emotional care for the hospitalized terminally ill patient the attentive listener avoids interjecting clichés, such as “Don’t
and may help the family arrange for hospice care or home worry,” “Take it easy,” or “Everything will be all right.” The
care when it is possible and desirable. The nurse may teach nurse and other health team members realize that the patient
methods of care required at home, may assist the family in may express some fears but may act out others through anger,
realizing the patient’s need to live as normally and as long hostility, silence, or assumed joviality. Efforts to change the
as possible, and may refer the family to the social service patient, negative criticism, a judgmental attitude, and facial
department and to community resources for assistance. expressions that may indicate rejection are carefully avoided.
n outcome criteria: Sensitive emotional support appro- Opportunities to listen to the troubled patient and provide
priate to the stages of dying may help the person to move compassionate and realistic counseling and care are sought.
more rapidly to acceptance. The family usually goes through n interventions: The nurse establishes means of commu-
similar stages; therefore, support and counseling by an expe- nication, provides an atmosphere that invites the patient to
rienced person may greatly enhance the quality of life of the discuss worrisome feelings, and presents a caring attitude.
patient and family. This is especially important when the illness damages the
emotional deprivation [L, emovere, to disturb, deprivare, to person’s body image or self-concept.
deprive], a lack of adequate warmth, affection, and inter- n outcome criteria: Emotional support frequently
est, especially of a parent or significant nurturer. It is a rela- improves the patient’s psychological and physical state,
tively common problem among institutionalized persons or often enabling him or her to accept the illness and to adjust
children from broken homes. with less anxiety to the changes required.
emotional diarrhea, the frequent passage of liquid stools emotional support2, a nursing intervention from the Nurs-
caused by extreme emotional stress. ing Interventions Classification (NIC) defined as provision
emotional glycosuria, a temporary increase in the level of reassurance, acceptance, and encouragement during times
of sugar excretion in the urine resulting from extreme emo- of stress. See also Nursing Interventions Classification.
tional disturbances. empathic /empath′ik/ [Gk, en, into, pathos, feeling], per-
emotional hyperhidrosis, an autosomal-dominant dis- taining to or involving the entering of one person into the
order of the eccrine sweat glands, most often of the palms, emotional state of another while remaining objective and
soles, and axillae, in which emotional stimuli (e.g., anxi- distinctly separate.
ety) and sometimes mental or sensory stimuli elicit volar or empathy /em′pəthē/ [Gk, en, in, pathos, feeling], the
axillary sweating (usually not both in the same individual). ability to recognize and to some extent share the emotions
Eccrine sweat glands in other areas of the body are affected and states of mind of another and to understand the meaning
less often and are less sensitive to such stimuli. and significance of that person’s behavior. It is an essential
emotional illness. See mental disorder. quality for effective psychotherapy. Compare sympathy.
emotional lability, a condition of excessive emotional —empathic, adj., empathize, v.
reactions and frequent mood changes. emphysema /em′fəsē′mə/ [Gk, en + physema, a blow-
emotional need, a psychological or mental requirement of ing], an abnormal condition of the pulmonary system,
intrapsychic origin that usually centers on such basic feelings characterized by overinflation and destructive changes
as love, fear, anger, sorrow, anxiety, frustration, and depres- in alveolar walls. It results in a loss of lung elasticity and
sion and involves the understanding, empathy, and support of decreased gas exchange. When emphysema occurs early in
one person for another. Such needs normally occur in every- life, it is usually related to a rare genetic deficiency of serum
one but usually increase during periods of excessive stress alpha-1-antitrypsin, which inactivates the enzymes leuko-
or physical and mental illness and during various stages of cyte collagenase and elastase. More common causes are air
life, such as infancy, early childhood, and old age. If these pollution and cigarette smoking. Acute emphysema may be
needs are not routinely met by appropriate, socially accepted caused by the rupture of alveoli during severe respiratory
means, they can precipitate psychopathological conditions. efforts, as may occur in acute bronchopneumonia, suffoca-
Appropriate measures common in nursing for anticipat- tion, whooping cough, and, occasionally, labor. Patients with
ing and satisfying the emotional needs of patients in stress chronic emphysema may also have a component of chronic
include physical closeness, especially remaining with the bronchitis. Emphysema also occurs after asthma or tubercu-
person during periods when the feeling is acute; empathetic losis, conditions in which the lungs are overstretched until
listening as the patient discusses the feeling; encouragement the elastic fibers of the alveolar walls are destroyed. In old
to verbalize feelings; and planning activities that provide a age the alveolar membranes atrophy and may collapse, pro-
constructive outlet for the feeling or the situation causing it. ducing large, air-filled spaces and a decreased total surface
Compare dependency needs. See also emotion. area of the pulmonary membranes. There are three primary
emotional response, a reaction to a particular intrapsychic types: centriacinar emphysema, distal acinar emphysema,
feeling or feelings, accompanied by physiological changes and panacinar emphysema. —emphysematous, adj.
that may or may not be outwardly manifested but that moti- n observations: The patient may have dyspnea on exertion
vate or precipitate some action or behavioral response. See or at rest, cough, orthopnea, unequal chest expansion, tachy-
also emotion. pnea, tachycardia, diminished breath sounds caused by air
emotional support1, the sensitive, understanding approach trapping, or, atypically, an elevated temperature and breath
that helps patients accept and deal with their illnesses; com- sounds if there is an infection. Anxiety, increased PaCO2,
municate their anxieties and fears; derive comfort from a restlessness, confusion, weakness, anorexia, hypoxemia, and
gentle, sympathetic, caring person; and increase their ability respiratory failure are common in advanced cases. Chronic
to care for themselves. emphysema is characterized by increased anterior-posterior
n method: Essential in providing emotional support are chest diameter secondary to hyperinflation and air trapping
recognizing and respecting the individuality, personal prefer- and use of accessory muscles.
ences, and human needs of each patient. Understanding the n interventions: The primary treatment consists of breath-
sick and appreciating the psychological effects on the patient ing exercises, oxygen administration, and avoiding infec-
of the transition from health to illness are also important. The tion. The airway is kept open, and oxygen is administered to
emphysematous 608 empyema
maintain an arterial oxygen saturation of 92%. Bronchodila- or procedure affects improvement or cure. The empiric treat-
tors, antibiotics, expectorants when bronchitis is also pres- ment of a new disease may be based on observations and
ent, methylxanthines, and corticosteroids may be prescribed. experience gained in the management of analogous disor-
Sedation is to be avoided because sedatives depress respira- ders. —empirical, adj.
tory function. empirical formula, a chemical formula that shows the
n nursing considerations: The patient is taught breath- smallest whole number ratio of atoms of different elements
ing exercises and encouraged to drink between 2 and 3 L in a molecule. It does not indicate structural linkage. An
of fluids daily, if not contraindicated by cardiac function. example is CH2O, a carbohydrate.
Activity is encouraged to the limit of the patient’s tolerance. empiricism /empir′isiz′əm/, a form of therapy based on the
Fatigue, constipation, and upper respiratory tract infection therapist’s personal experience and that of other practitio-
and irritation are to be avoided. Mechanical ventilation and ners. —empiricist, n.
oxygen therapy may be prescribed for use at home. The empiric treatment. See treatment.
patient is taught the adverse role that smoking plays in the Employment Retirement Income Security Act
disease and is encouraged to stop smoking. (ERISA), a federal law, enacted in 1974, regulating
employee welfare benefit plans, including group health plans.
emprosthotonos /em′prosthot′ənəs/ [Gk, emprosthen, for-
ward, tenein, to cut], a position of the body characterized
by forward, rigid flexure at the waist. The position is the
result of a prolonged involuntary muscle spasm that is most
commonly associated with tetanus infection or strychnine
poisoning.
empty end-feel, the sensation in the examiner’s hand when
a joint is hypermobile. See end-feel.
empty follicle syndrome, a condition in which oocytes are
absent from stimulated follicles.
empty sella syndrome [AS, oemettig, unoccupied; L, sella,
saddle], an abnormal enlargement of the sella turcica filled
with cerebrospinal fluid. The pituitary gland may be smaller
than normal and flattened, or it may be absent. Signs and
Panacinar emphysema: ruptured alveoli symptoms of hormonal imbalance (for example, hypopitu-
(Kumar et al, 2010) itarism) may be present, as may headache, but some patients
are asymptomatic. The diagnosis may be made by com-
puted axial tomography scan, skull radiographic study, or
EMPHYSEMA pneumoencephalography.
empyema /em′pī·ē′mə, em′pē·ē′mə/ [Gk, en + ipyon,
pus], an accumulation of pus in the pleural space, as a
result of bacterial infection, such as pleurisy or tuberculo-
Enlargement and sis. It is usually removed by surgical incision, aspiration, and
destruction of drainage. Antibiotics, usually penicillin or vancomycin, are
alveolar walls administered to combat the underlying infection. Oxygen
therapy may also be administered.
Walls of alveoli are

damaged and cannot be
repaired. Alveoli fuse into
large air spaces.
Emphysema (Patton and Thibodeau, 2010)
emphysematous /em′fisem′ətəs/ [Gk, en, in, physema, a

blowing], pertaining to or affected with emphysema.
emphysematous abscess, an abscess in which air or gas
is present.
emphysematous chest. See barrel chest.
emphysematous gastritis, infectious gastritis in which
the infectious agents are gas-producing bacteria. Radiologi-
cally it resembles gastric emphysema but is much more seri-
ous, even life threatening.
emphysematous pyelitis, pyelitis with air or gas only in
the collecting system.
empiric /empir′ik/ [Gk, empeirikos, experimental], per-
taining to a method of treating disease based on observations
and experience without an understanding of the cause or
mechanism of the disorder or the way the therapeutic agent Empyema (Finkbeiner, Ursell, and Davis, 2009)
-empyema 609 emtricitabine
Common distinguishing features of emphysema and chronic bronchitis*
Patient data Emphysema (type A: pink puffer) Bronchitis (type B: blue bloater)
History
Lifestyle Smoker Smoker
Weight Weight loss Overweight
Onset of symptoms Usually after age 50 Usually after age 40
Sputum Mild, mucoid Excessive, purulent
Cough Minimal or absent Chronic; more severe in mornings
Dyspnea Progressive exertional dyspnea Mild to moderate, but may gradually progress to
severe exertional dyspnea
Patient complaints Dyspnea on exertion, fatigue, insomnia Chronic cough with mucopurulent sputum, chills,
malaise, muscle aches, fatigue, insomnia, loss
of libido
Physical signs
Edema Absent Present
Central cyanosis Absent Present in advanced disease
Use of accessory muscles to breathe Present Absent until end stage
Body build Thin, wasted Stocky, overweight
Anteroposterior chest diameter ‘‘Barrel chest,’’ 1:1 ratio anteroposterior Normal
chest diameter
Auscultation of chest Decreased breath sounds, decreased heart Wheezes, crackles, rhonchi, depending on the
sounds, prolonged expiration severity of disease
Percussion Hyperresonance Normal
Jugular vein distention Absent Present
Other Pursed-lip breathing Evidence of right-sided heart failure (cor
pulmonale)
General diagnostic tests
Chest radiography Narrowed mediastinum; normal or small Congested lung fields, increased bronchial
vertical heart; hyperinflation; low, flat vascular markings, enlarged horizontal heart
diaphragm; presence of blebs or bullae
Arterial blood gas analysis Decreased PaO2 (60-80 mm Hg); normal Decreased PaO2 (65 mm Hg); increased PaCo2
or increased PaCO2 (increases with
advancing disease)
Electrocardiography Normal or tall symmetrical P waves; Right axis deviation, right ventricular
tachycardia, if hypoxic hypertrophy, atrial arrhythmias
Hematocrit Normal Polycythemia
Pulmonary function tests
Functional residual capacity Increased Normal or slight increase
Residual volume Increased Increased
Total lung capacity Increased Normal
Forced expiratory volume Decreased Decreased
Vital capacity Decreased Normal or slight decrease
Static lung compliance Increased Normal
From Copstead LEC, Banasik JL: Pathophysiology, ed 4, Philadelphia, 2010, Saunders.
*Clinically, features of bronchitis and emphysema are not always clear-cut because many patients have a combined disease process.
-empyema, suffix meaning an “accumulation of pus”: EMT-D, abbreviation for emergency medical technician-defi-
arthroempyema, pneumoempyema, typhloempyema. brillator, a member of an emergency medical services crew with
EMS, 1. abbreviation for electric muscle stimulator. special training in the use of cardiac defibrillating equipment.
2. abbreviation for emergency medical service. 3. abbre- EMT-I, abbreviation for emergency medical technician-
viation for eosinophilia-myalgia syndrome. See eosino- intermediate.
philia-myalgia syndrome, tryptophan induced. EMT-IV, abbreviation for emergency medical technician-
EMS standing orders, routine medical procedures intravenous.
approved in advance for emergency medical service (EMS) EMT-P, abbreviation for emergency medical technician-
crews to perform before consulting a physician. paramedic.
EMT, abbreviation for emergency medical technician. emtricitabine, a retroviral.
EMT-A, abbreviation for emergency medical technician- n indication: This drug is used with other retrovirals to
ambulance, a member of an emergency medical services treat HIV infection.
crew. n contraindication: Known hypersensitivity to this drug
EMT-ALS, abbreviation for emergency medical techni- prohibits its use.
cian-advanced life support. n adverse effects: Adverse effects of this drug include
EMT-B, abbreviation for emergency medical technician- headache, abnormal dreams, depression, dizziness, insom-
basic, an entry-level emergency medical technician who is nia, neuropathy, paresthesia, arthralgia, myalgia, cough,
trained in basic emergency care skills, such as defibrillation, change in body fat distribution, rash, and skin discoloration.
airway maintenance, CPR, spinal immobilization, bleeding Common side effects include nausea, vomiting, diarrhea,
control, and fracture management. anorexia, abdominal pain, and dyspepsia.
Emtriva 610 -encephalia, -encephaly
Emtriva, a trademark for emtricitabine.
emulsification /imul′sifikā′shən/, the breakdown of large
fat globules into smaller, uniformly distributed particles. It
is accomplished mainly by bile acids in the small intestine.
Emulsification is the first preparation of fat for chemical
digestion by specific enzymes. See also emulsify.
emulsifier /imul′sifī′ər/ [L, emulgere, to milk out, facere, to
make], a substance such as egg yolk or gum arabic that can
cause oil to be suspended in water.
emulsify [L, emulgere, to milk out, facere, to make], to dis-
perse a liquid into another liquid with which it is immiscible,
making a colloidal suspension. Soaps and detergents emul-
sify by surrounding small globules of fat, preventing them
from settling out. Bile acts as an emulsifying agent in the
digestive tract by dispersing ingested fats into small glob-
ules. —emulsification, n.
emulsion /imul′shən/ [L, emulgere, to milk out], 1. a sys- Enamel hypocalcification (Heymann and Swift, 2006)
tem consisting of two immiscible liquids, one of which is
dispersed in the other in the form of small droplets. 2. (in fluorosis; rash-producing childhood diseases; congenital
photography) a composition sensitive to actinic rays of light, syphilis; injury or trauma to the mouth; or administration of
consisting of one or more silver halides suspended in gelatin tetracyclines during the second half of pregnancy or during
applied in a thin layer to film. early tooth development. Compare enamel hypocalcifica-
en-, prefix meaning “in, on”: enanthema, encelialgia, tion. See also amelogenesis imperfecta.
enostosis.
ENA, abbreviation for Emergency Nurses’ Association.
enabler /enā′blər/, a significant other of a substance abuser
who provides either implicit or explicit support of substance-
abusing or dysfunctional behavior.
enalapril maleate /enal′əpril/, an angiotensin-converting
enzyme (ACE) inhibitor used as an oral antihypertensive
drug.
n indications: It is prescribed in the treatment of hyperten-
sion or heart failure or as a preventive for myocardial infarc-
tion, stroke, or cardiovascular death.
n contraindications: It should be used with caution in
patients suffering severe salt or fluid depletion or in com-
bination with a potassium-sparing diuretic. ACE inhibitors
should not be used during pregnancy, especially during the
second and third trimesters.
n adverse effects: Among the more serious adverse
effects are hyperkalemia, cough, hypotension, dizziness, and
headache. Enamel hypoplasia (Regezi, Sciubba, and Jordan, 2008)
enamel /inam′əl/ [OFr, esmail], the hard, white crystal-
line substance of the minerals hydroxyapatite and/or fluor- enamel niche, either of two depressions on a tooth, located
apatite that forms the outermost covering of the clinical and between the lateral dental lamina and the developing dental
anatomical crown of a tooth. It contains no nerves or blood germ.

vessels and is the hardest bony substance in the body. It is enamel organ, a complex epithelial structure on the dental
produced by epithelial cells called ameloblasts. papilla. It produces enamel for the developing tooth.
enamel cell. See ameloblast. enanthema /en′anthē′mə/ [Gk, en + anthema, blossom-
enamel hypocalcification, a defect in which the enamel ing], a sudden eruptive lesion of the surface of a mucous
of the teeth is soft and undercalcified and opaque in appear- membrane. Also called enanthem /ənan′thəm/.
ance but normal in quantity. It is caused by defective matu- enantiomer, (in physical science) one of the two nonsuper-
ration of ameloblasts. The teeth are chalky in consistency, imposable mirror image forms of a chiral compound.
their surfaces wear down rapidly and are more susceptible to enarthrosis. See ball-and-socket joint.
caries, and a yellowish-brown stain appears on the teeth as en bloc /enblok′, äNblôk′/ [Fr, in a block], all together, or
the underlying dentin is exposed. The condition affects both as a whole.
primary and secondary teeth. Compare enamel hypoplasia. encapsulated /enkaps′yəlā′tid/ [Gk, en + L, capsula, little
See also amelogenesis imperfecta. box], (of arteries, muscles, nerves, and other body parts)
enamel hypoplasia, a defect in which the enamel of the enclosed in fibrous or membranous sheaths. It refers to
teeth is hard but thin and deficient in amount as a result of organisms that form a protective capsule. See also fascia
defective enamel matrix formation with a shortage of the bulbi, synovial sheath.
cementing substance. It is characterized by lack of contact -ence. See -ency.
between teeth, rapid breakdown of occlusal surfaces, and encephal-, prefix meaning “the brain”: encephalopathy,
a yellowish-brown stain that appears where the dentin is encephalitis.
exposed. The condition affects both primary and secondary encephalalgia /ənsef′əlal′jə/, headache. See also cephalalgia.
dentition. It is transmitted genetically or caused by envi- -encephalia, -encephaly, suffix meaning “(condition of
ronmental factors such as vitamin A, C, or D deficiency; the) brain”: amyelencephalia, rhinencephalia, synencephalia.
encephalitis 611 enchondroma
encephalitis /ensef′əlī′tis/ pl. encephalitides [Gk, enkephalos,
brain, itis, inflammation], an inflammatory condition of the
brain. The cause is usually an arbovirus infection transmitted
by the bite of an infected mosquito, but it may be the result
of lead or other poisoning or of hemorrhage. Certain proto-
zoal infections such as toxoplasmosis can cause encephalitis
in immunocompromised patients. Postinfectious encephalitis
occurs as a complication of another infection, such as chick-
enpox, influenza, or measles, or after smallpox vaccination.
The condition is characterized by headache, neck pain, fever,
nausea, and vomiting. Neurological disturbances, including
seizures, personality change, irritability, lethargy, paralysis,
weakness, and coma, may occur. The outcome depends on
the cause, the age and condition of the person, and the extent
of inflammation. Severe inflammation with destruction of
nerve tissue may result in a seizure disorder, loss of a spe-
cial sense or other permanent neurological problem, or death.
Usually the inflammation involves the spinal cord and brain;
hence, in most cases a more accurate term is encephalomy-
elitis. Compare meningitis. See also equine encephalitis.
Encephalocele (Cohen and Lemire, 1982)
encephalomeningocele. See meningoencephalocele.

encephalomyelitis /ensef′əlōmī′əlī′tis/ [Gk, enkephalos +
myelos, marrow, itis], an inflammatory condition of the
brain and spinal cord that damages myelin, characterized
by fever, headache, stiff neck, back pain, and vomiting.
Depending on the cause, the age and condition of the person,
and the extent of the inflammation and irritation to the central
nervous system, seizures, paralysis, personality changes, a
Herpes encephalitis (Kumar et al, 2010/Courtesy Dr. T.W. Smith, decreased level of consciousness, coma, or death may occur.
University of Massachusetts Medical School, Worcester, Massachusetts) Sequelae, such as seizure disorders or decreased mental abil-
ity, may occur after severe inflammation that causes exten-
encephalitis lethargica. See epidemic encephalitis. sive damage to the cells and tissues of the nervous system.
encephalitis neonatorum. See neonatorum encephalitis. See also acute disseminated encephalomyelitis, encepha-
encephalitis periaxialis diffusa. See Schilder’s disease. litis, equine encephalitis.
encephalocele /ensef′ələsēl′/ [Gk, enkephalos + koilia, cav- encephalomyocarditis /ensef′əlōmī′ōkärdī′tis/ [Gk,
ity], 1. protrusion of the brain through a congenital defect enkephalos + mys, muscle, kardia, heart, itis, inflamma-
in the skull. 2. hernia of the brain. See also neural tube tion], an infectious disease of the central nervous system
defect. and heart tissue caused by a group of small ribonucleic acid
encephalodysplasia, any congenital anomaly of the brain. picornaviruses. Rodents are a major reservoir of the infec-
encephalogram /ensef′ələgram′/ [Gk, enkephalos + tion. Human illness ranges from asymptomatic infection to
gramma, record], a radiograph of the brain made during severe encephalomyelitis. Symptoms are generally similar to
encephalography. those of poliomyelitis. Myocarditis is not a feature of infec-
encephalography /ensef′əlog′rəfē/, radiographic delinea- tion in humans, and most victims recover promptly without
tion of the structures of the brain containing fluid after the sequelae. Treatment is supportive. See also picornavirus.
cerebrospinal fluid is withdrawn and replaced by a gas, such encephalon [Gk, enkephalos, brain], 1. the cerebrum and
as air, helium, or oxygen. The procedure is used mainly its related structures of cerebellum, pons, and medulla oblon-
for indicating the site of cerebrospinal fluid obstruction in gata. 2. the contents of the cranium.
hydrocephalus or structural abnormalities of the posterior encephalopathy /ensef′əlop′əthē/ [Gk, enkephalos +
fossa. Because of the risks involved, it is used only when pathos, disease], any abnormal condition of the structure
results of computed tomography are not definitive. Kinds or function of brain tissues, especially chronic, destructive,
of encephalography are pneumoencephalography and or degenerative conditions, as Wernicke’s encephalopathy or
ventriculography. Also called air encephalography. Com- Schilder’s disease.
pare echoencephalography, electroencephalography. encephalotrigeminal angiomatosis. See Sturge-Weber
—encephalographic, adj. syndrome.
encephaloid carcinoma. See medullary carcinoma. -encephaly. See -encephalia.
encephalomeningitis /-men′injī′tis/ [Gk, enkephalos, enchondroma /en′kəndrō′mə/ pl. enchondromas, enchon-
brain, meninx, membrane, itis, inflammation], an inflam- dromata [Gk, en + chondros, cartilage, oma, tumor], a
mation of the brain and meninges. benign, slowly growing tumor of cartilage cells that arises
enchondromatosis 612 endemic goiter
in the extremity of the shaft of tubular bones in the hands or the intimal lining of an artery. The procedure is done to clear
feet. The growth of the neoplasm may distend the bone. Also a major artery that may be blocked by plaque accumulation.
called enchondrosis, true chondroma. Kinds of endarterectomy include disobliterative endarter-
enchondromatosis /en′kəndrō′mətō′sis/ [Gk, en + chon- ectomy and gas endarterectomy.
dros, cartilage, oma, tumor, osis, condition], a congenital
disorder characterized by the proliferation of cartilage within
the extremity of the shafts of bones, causing thinning of the
cortex and distortion in length. Also called dyschondropla-
sia, Ollier’s disease. Compare Maffucci’s syndrome.
enchondromatous myxoma /en′kondrō′mətəs/, a tumor
of the connective tissue, characterized by the presence of Internal carotid
cartilage between the cells of connective tissue. See also artery
myxoma. External carotid
enchondrosarcoma. See central chondrosarcoma. artery
enchondrosis. See enchondroma.
enchylema. See hyaloplasm. Incision reveals
-enchyma, suffix meaning the “liquid that nourishes tissue, atherosclerotic plaque
or tissue itself ”: karyenchyma, mesenchyma, sclerenchyma. Common
enclave /en′klāv, enklāv′/, a detached mass of tissue carotid
enclosed in an organ or in a different kind of tissue. artery
encode /enkōd′/ [Gk, en + L, caudex, book], 1. to trans- Aortic arch
late a message, signal, or stimulus into a code. 2. to rewrite
information into a form that can be interpreted by a computer
manually or automatically, as by a computer program.
encoded message, (in communication theory) a message
as transmitted by a sender to a receiver.
encopresis /en′kōprē′sis/, fecal holding with constipation
and fecal soiling. —encopretic, adj. Endarterectomy of the carotid artery
encounter [Gk, en + L, contra, against], (in psychotherapy) (Lewis, Heitkemper, and Dirksen, 2004)
the interaction between a patient and a psychotherapist, such
as occurs in existential therapy, or among several members of endarteritis /en′därtərī′tis/ [Gk, endon + arteria + itis,
a small group, such as encounter or sensitivity training groups. inflammation], inflammation of the inner layer of one or
In an encounter emotional change and personal growth are more arteries, which may become partially or completely
affected by participants’ expression of strong feelings. occluded. Also called acute endarteritis.
encounter data, information showing use of provider ser- endarteritis deformans. See chronic endoarteritis.
vices by health plan enrollees that is used to develop cost endarteritis obliterans, an inflammatory condition of the
profiles of a particular group of enrollees and then to guide lining of the arterial walls in which the intima proliferates,
decisions about or provide justification for the maintenance narrowing the lumen of the vessels and occluding the smaller
or adjustment of premiums. vessels. Also called arteritis obliterans.
encounter group, (in psychology) a small group of peo- end artery, a blood vessel that does not join with any other
ple who meet to increase self-awareness, promote personal vessel. Also called terminal artery.
growth, and improve interpersonal communication. Mem- end bud [AS, ende + Gk, bolbos, onion], a mass of undif-
bers focus on becoming aware of their feelings and on devel- ferentiated cells produced from the remnants of the primitive
oping the ability to express those feelings openly, honestly, node and the primitive streak at the caudal end of the devel-
and clearly. See also group therapy, psychotherapy, sensi- oping embryo after formation of the somites is completed.
tivity training group. In lower animals it gives rise to the tail or any other caudal
enculturation /enkul′chərā′shən/ [Gk, en + L, cultura, cul- appendage and part of the trunk. In humans it forms the cau-
tivation], the process of learning the concepts, values, and dal portion of the trunk. Also called tail bud.
behavioral standards of a particular culture. end bulbs of Krause. See Krause’s corpuscles.
-ency, -ance, -ancy, -ence, 1. suffixes meaning a “qual- end-diastolic pressure /-dī·əstol′ik/ [AS, ende + Gk, dia
ity or state”: deficiency, dependency. 2. suffixes meaning a + stellein, to set; L, premere, to press], the pressure of the
“person or thing in a state”: latency. 3. suffixes meaning an blood in the ventricles at the end of diastole.
“instance of a quality or state”: emergency. endemic /endem′ik/ [Gk, endemos, native], (of a disease
encyst /ensist′/, to form a cyst or capsule. See also cyst. or microorganism) the expected or “normal” incidence indig-
—encysted, adj. enous to a geographic area or population. See also epidemic,
encysted pleurisy, a form of pleurisy with adhesions that pandemic.
surround the effused material. Also called blocked pleurisy, endemic disease, a physical or mental disorder caused by
circumscribed pleurisy. health conditions constantly present within a community.
end, abbreviation for endoreduplication. It usually describes an infection that is transmitted directly
end-. See endo-. or indirectly between humans and is occurring at the usual
Endameba, any ameba of the genus Endamoeba. expected rate.
endamebiasis. See amebiasis. endemic goiter, an enlargement of the thyroid gland caused
Endamoeba, a genus of amebic parasites in invertebrates, by the intake of inadequate amounts of dietary iodine. Iodine
originally described from cockroaches. deprivation leads to diminished production and secretion of
endamoebiasis. See amebiasis. thyroid hormone by the gland. The pituitary gland, operat-
endarterectomy /en′därtərek′təmē/ [Gk, endon, within, ing on a negative feedback system, senses the deficiency and
arteria, airpipe, ektomē, excision], the surgical removal of secretes increased amounts of thyroid-stimulating hormone,
endemic syphilis 613 endocrinopathy
causing hyperplasia and hypertrophy of the thyroid gland. a few bundles of smooth muscle. It is continuous with the
The goiter may grow during the winter months and shrink endothelium of the great blood vessels. Compare epicar-
during the summer months when the person eats more dium, myocardium.
iodine-containing fresh vegetables. Initially the goiter is dif- endocervical /-sur′fikəl/ [Gk, endon + L, cervix,
fuse; later it becomes multinodular. Endemic goiter occurs neck], pertaining to the interior of the cervix. Also called
occasionally in adolescents at puberty and widely in popula- intracervical.
tion groups in geographic areas in which limited amounts of endocervicitis /en′dōsur′visī′tis/, an abnormal condition
iodine are present in soil, water, and food. The use of iodized characterized by inflammation of the epithelium and glands
salt is a prophylactic treatment. Desiccated thyroid given of the canal of the uterine cervix. See also cervicitis.
orally may prevent further growth of adult goiters and may endocervix /en′dōsur′viks/, 1. the membrane lining the
reduce the size of diffuse goiters. A large goiter may cause canal of the uterine cervix. 2. the opening of the cervix into
dysphagia, dyspnea, tracheal deviation, and cosmetic prob- the uterine cavity.
lems. Also called colloid nodular goiter. endochondral /-kon′drəl/ [Gk, endon, within, chondros,
endemic syphilis, a chronic infectious skin disease that cartilage], pertaining to something within the cartilage.
is closely related to Treponema pallidum and is frequently endochondral bone. See cartilaginous bone.
contracted in childhood without venereal contact. It is known endocrinasthenia /-krin′asthē′nē·ə/, a neural deficit caused
as bejel in heavily populated communities of undeveloped by an alteration of the endocrine system.
nations. Also called nonvenereal syphilis. endocrine /en′dəkrēn, -krīn/ [Gk, endon + krinein, to
endemic typhus. See murine typhus. secrete], pertaining to a process in which a group of cells
end-feel, the sensation imparted to the examiner’s hands secretes into the blood or lymph circulation a substance (for
at the end point of the available range of motion. It varies example, hormone) that has a specific effect on tissues in
according to the limiting structure or tissue. Types of end- another part of the body.
feel include capsular, bone-on-bone, spasm, and springy endocrine diabetes mellitus [Gk, endon, within, krinein, to
block. Empty end-feel is the absence of an end-feel during a secrete, diabainein, to pass through, mellitus, honeyed], a
range of motion examination when the patient stops further form of diabetes associated with diseases of other glands,
movement of a joint before the examiner senses any organic such as the adrenals, pituitary, or thyroid, classified under
resistance to the movement. other specific types in the American Diabetes Association
endo-, end-, ent-, ento-, prefix meaning “inward, within”: Classification.
endobiotic, endocranial, endognathion. endocrine fracture /-krēn/, any fracture that results from
endobronchitis /en′dōbrongkī′tis/, inflammation of the weakness of a specific bone caused by an endocrine disor-
smaller bronchi, often caused by a bronchial mucosal infection. der such as hyperparathyroidism, in which calcium loss from
endocardia. See endocardium. bone is accelerated.
endocardial, pertaining to the endocardium. endocrine gland, a ductless gland that produces and
endocardial candidiasis. See Candida endocarditis. secretes hormones into the blood or lymph nodes, affecting
endocardial cushion defect /en′dōkär′dē·əl/, any cardiac metabolism and other body processes. The endocrine glands
defect resulting from the failure of the endocardial cushions include the pituitary, pineal, hypothalamus, thymus, thyroid,
in the embryonic heart to fuse and form the atrial septum. It parathyroid, adrenal cortex, medulla, pancreatic islands of
is common in Down syndrome. See also atrial septal defect, Langerhans, and gonads. Cells in other structures, such as
congenital cardiac anomaly. the GI mucosa, the kidneys, the heart, and the placenta, also
endocardial cushions, a pair of thickened tissue sections have endocrine functions. Compare exocrine gland.
in the embryonic atrial canal. During embryonic develop- endocrine system [Gk, endon + krinein, to secrete; sys-
ment they meet and fuse to form a septum dividing the canal tema], the network of ductless glands and other structures that
into two channels which eventually become the atrioven- elaborate and secrete hormones directly into the bloodstream,
tricular orifices. affecting various processes throughout the body, such as metab-
endocardial fibroelastosis /fī′brō·ē′lastō′sis/ [Gk, endon + olism, growth, and secretions from other organs. Glands of the
kardia, heart; L, fibra, fiber; Gk, elaunein, to drive, osis, con- endocrine system include the thyroid, the parathyroid, the ante-
dition], an abnormal condition characterized by the devel- rior pituitary, the posterior pituitary, the pancreas, the suprare-
opment of a thick, fibroelastic endocardium that can cause nal glands, and the gonads. The pineal gland is also considered
failure of the heart to pump blood. an endocrine gland because it is ductless, although its precise
endocardial murmur, a continuous, soft sound made by endocrine function is not established beyond its involvement in
an abnormality within the heart. daily, monthly, and annual rhythms. Various other organs have
endocardial pacing. See pacing. some endocrinological function. Compare exocrine. See also
endocardial tubes, paired, longitudinal, endothelial-lined the Color Atlas of Human Anatomy, pp. A18–A19.
channels formed from the cardiogenic mesoderm in embry- endocrine therapy. See hormone therapy.
onic development that fuse to form the primordial heart tube. endocrino- [Gk, endon, within, krinein, to secrete], prefix
endocarditis /en′dōkärdī′tis/ [Gk, endon + kardia, heart, meaning “endocrine system, endocrine structures or func-
itis, inflammation], an inflammation of the endocardium tion”: endocrinology, endocrinopathy.
and heart valves. The condition is characterized by lesions endocrinologist /en′dōkrinol′əjist/, a physician who spe-
caused by a variety of diseases. Kinds of endocarditis are cializes in the endocrine system and its disorders.
bacterial endocarditis, nonbacterial thrombotic endocarditis, endocrinology /-krinol′əjē/ [Gk, endon + krinein, to
and Libman-Sacks endocarditis. All types of endocarditis are secrete, logos, science], the study of the anatomical, physi-
rapidly lethal if untreated, but most patients with endocardi- ological, and pathological characteristics of the endocrine
tis are successfully treated by various antibacterial and sur- system and of the treatment of endocrine problems.
gical measures. See also bacterial endocarditis, subacute endocrinopathy /-krinop′əthē/ [Gk, endon, within, krinein,
bacterial endocarditis. to secrete, pathos, disease], a disease involving an endo-
endocardium /en′dōkär′dē·əm/, pl. endocardia, the lining crine gland or a dysfunction that decreases the quality or
of the heart chambers, containing small blood vessels and quantity of the gland’s secretion or response to a hormone.
endocytosis 614 endometrial cancer
endocytosis /en′dōsītō′sis/ [Gk, endon, within, + kytos, endogenous obesity, obesity resulting from dysfunction
cell], uptake by a cell of material from the environment by of the endocrine or metabolic system. Compare exogenous
invagination of its plasma membrane, which may be either obesity. See also obesity.
phagocytosis or pinocytosis. Compare exocytosis. endogenous opioid, an opiate-like substance, such as an
endorphin, produced by the body.
endogenous uric acid [Gk, endon, within + genein, to pro-
duce + ouron, urine; L, acidus], uric acid produced by the
Outside the cell metabolism of purines in the body’s own nucleoproteins, as
Cell
membrane
distinguished from metabolism of purine products in foods.
endointoxication /en′dō·intok′sikā′shən/, poisoning caused
by a toxin produced within the body, such as from dead and
infected tissue in gangrene.
endolith. See denticle.
endolymph /en′dəlimf/ [Gk, endon + lympha, water], the
pale fluid in the membranous labyrinth (cochlear duct) of the
Vesicle internal ear. Compare perilymph.
endolymphatic appendage, an outgrowth of the otic vesi-
cle that forms the endolymphatic duct and sac during embry-
Cytoplasm onic development.
endolymphatic duct /-limfat′ik/, a labyrinthine passage
Endocytosis (Herlihy, 2011) joining an endolymphatic sac with the utricle and saccule.
endolymphatic sac, the blind end of an endolymphatic
duct.
endoderm /en′dədurm/ [Gk, endon + derma, skin], (in endomastoiditis /-mas′toidī′tis/, an inflammation within
embryology) the innermost of the cell layers that develop the mastoid cavity and cells.
from the embryonic disk of the inner cell mass of the blasto- endometrial /en′dōmē′trē·əl/ [Gk, endon + metra,
cyst. From the endoderm arises the epithelium of the trachea, womb], 1. pertaining to endometrium. 2. pertaining to the
bronchi, lungs, GI tract, liver, pancreas, urinary bladder, anal uterine cavity.
canal, pharynx, thyroid, tympanic cavity, tonsils, and para- endometrial biopsy, a microscopic examination of a sam-
thyroid glands. The endoderm thus comprises the lining of ple of endometrial tissue to assess corpus luteum function.
the cavities and passages of the body and the covering of It is performed in infertile women with regular ovulatory
most of the internal organs. Compare ectoderm, hypoblast, cycles and no identifiable reason for infertility, in women
mesoderm. with repeated first trimester abortions, in cases of abnormal
endodermal /-dur′məl/ [Gk, endon, within, derma, vaginal bleeding, and during ovulation induction therapy.
skin], pertaining to the inner of the three layers of the endometrial cancer, a carcinoma of the endometrium
embryo and the epithelial lining of the respiratory system, of the uterus. It is the most prevalent gynecological malig-
the digestive tract, and other tissues. Also spelled entoder- nancy, most often occurring in the fifth or sixth decade of
mal. See also endoderm. life. Although the cause of endometrial cancer is not clear,
endodermal cloaca, a part of the cloaca in the developing some of the risk factors associated with an increased inci-
embryo that lies internal to the cloacal membrane and gives dence of the disease are a medical history of infertility,
rise to the bladder and urogenital ducts. Compare ectoder- anovulation, late menopause (52 years), administration of
mal cloaca. See also urogenital sinus. unopposed exogenous estrogen, uterine polyps, and a com-
endodermal sinus tumor, yolk sac tumor. bination of diabetes, hypertension, and obesity. Abnormal
endodontics [Gk, endon, within, odous, tooth], the vaginal bleeding, especially in a postmenopausal woman, is
branch of dentistry that specializes in the diagnosis and the cardinal symptom. Lower abdominal and low back pain
treatment of diseases of the dental pulp, tooth root, and may also be present; a large, boggy uterus is often a sign of
surrounding tissues and in the associated practice of root advanced disease. Fewer than half the patients with endome-
canal therapy. Also called endodontia, endodontology, trial cancer have a positive finding on Papanicolaou’s (Pap)
pulpodontia. test of the cervix and vagina because the tumor cells rarely
endodontist /-don′tist/ [Gk, endon, within, odous, exfoliate in early stages of the lesion. A Pap test of cells
tooth], a dentist who specializes in endodontics. removed from the endometrium obtained from jet washings
endodontology. See endodontics. of the uterine cavity provides more accurate data. Vacuum
endogenous /endoj′ənəs/ [Gk, endon + genein, to pro- curettage is also used to extract endometrial cells for study,
duce], 1. growing within the body. 2. originating from but the diagnostic technique most frequently recommended
within the body or produced from internal causes, such as is dilation and curettage, in which each section of the uterus
a disease caused by the structural or functional failure of an is examined and curetted for biopsy specimens. Adenocar-
organ or system. Compare exogenous. —endogenic, adj. cinomas constitute roughly 90% of all endometrial tumors;
endogenous carbon dioxide, carbon dioxide produced the remaining 10% comprise mixed carcinomas, sarcomas,
within the body by metabolic processes. and benign adenoacanthomas. Endometrial lesions may
endogenous hypertriglyceridemia. See hyperlipidemia spread to the cervix but rarely invade the vagina. They
type IV. metastasize to the broad ligaments, fallopian tubes, and
endogenous infection, an infection caused by the reactiva- ovaries so frequently that bilateral salpingo-oophorectomy
tion of previously dormant organisms, as in coccidioidomy- with abdominal hysterectomy is the usual treatment. Radio-
cosis, histoplasmosis, and tuberculosis. Compare germinal therapy is usually administered before and after surgery.
infection, mixed infection, retrograde infection, second- High doses of a progestogen may be prescribed for pallia-
ary infection. tion in advanced or inoperable cases. Chemotherapy may
endogenous iritis. See primary iritis. also be used.
endometrial cyst 615 endometriosis
Endometrial polyp (Finkbeiner, Ursell, and Davis, 2009)
who undergo pelvic laparotomy for other indications. The

Endometrial cancer (Kumar, Cotran, and Robbins, 2003/Courtesy average age of women found to have endometriosis is 37
Dr. Kyle Molberg, Department of Pathology, University of Texas years. Pregnancy may have an influence in preventing or
Southwestern Medical Center) ameliorating the disease. The causes of endometriosis are
unknown; evidence suggests that the ectopic endometrium
endometrial cyst [Gk, endon, within, metra, womb, kys- of endometriosis develops from vestigial tissue of the wolff-
tis, bag], 1. an endometrial tumor. 2. an ovarian cyst that ian or müllerian duct. Other evidence strongly suggests that
develops as a distension of an endometrial gland. fragments of endometrium from the lining of the uterus are
endometrial hyperplasia, an abnormal condition char- refluxed during menstruation backward through the fallopian
acterized by overgrowth of the endometrium resulting from tubes into the peritoneal cavity, where they attach, grow, and
sustained stimulation by estrogen (of endogenous or exog- function. The tissue is microscopically similar to or identi-
enous origin) that is not opposed by progesterone. Estrogen cal with endometrium, having glands or glandlike structures,
acts as a growth hormone for the endometrium. Through a stroma, and areas of hemorrhage. Fragments may be found
complex intercellular mechanism, endometrial cells bind in the wall of the uterus or on its surface; in or on the tubes,
estrogen preferentially and undergo changes characteristic ovaries, rectosigmoid, or pelvic peritoneum; or occasion-
of the proliferative phase of the menstrual cycle. If estrogen ally in remote extrapelvic areas. Foci of endometriosis have
stimulation continues for 3 to 6 months without periodic ces- been found in surgical scars, the umbilicus, the bowel, the
sation or counteractive progesterone stimulation, as occurs in lung, the eye, and the brain. When endometriosis occurs in a
anovulatory or perimenopausal women and in those receiv- critical location it may cause grave dysfunction of the organ
ing replacement estrogen without added progestogen, the involved or, rarely, death; intestinal obstruction is a common
endometrium becomes abnormally thickened and glandu- complication. The lesions of pelvic endometriosis are typi-
larized. Unremitting estrogen stimulation eventually causes cally small cystic structures a few millimeters in diameter
cystic or adenomatous endometrial hyperplasia. The latter is that appear individually or in clusters as black nodules on the
a premalignant lesion that undergoes malignant degeneration visceral and parietal peritoneum.
in approximately 25% of cases. The causative relationship
between estrogen and endometrial hyperplasia is well estab-
lished; there is some indication but no proof that estrogen Endometriosis
also provokes the change from hyperplasia to neoplasia and
malignancy. Endometrial hyperplasia often results in abnor-
mal uterine bleeding. Such bleeding, particularly in older
women, constitutes an indication for biopsy or curettage of

the endometrium to establish histopathological diagnosis
and to rule out malignancy. A functioning estrogen-secret-
ing tumor is suspected if the woman is not taking estrogen
medication. Progestogen therapy is effective in reversing the
abnormal histopathological changes of endometrial hyper-
plasia. If hyperplasia is adenomatous, hysterectomy is com-
monly performed.
endometrial polyp, a pedunculated overgrowth of endo-
metrium, usually benign. Polyps are a common cause of
vaginal bleeding in perimenopausal women and are often
associated with other uterine abnormalities, such as endo-
metrial hyperplasia or fibroids. They may occur singly or in
clusters and are usually 1 cm or less in diameter, but they
may become much larger and prolapse through the cervix.
Treatment for the condition includes surgical dilation and
curettage.
endometriosis /en′dōmē′trē·ō′sis/ [Gk, endon + metra,
womb, osis, condition], an abnormal gynecological condi-
tion characterized by ectopic growth and function of endo-
metrial tissue. Precise incidence of the disease is unknown, Common sites of endometriosis
but evidence of it is found in approximately 15% of women (Leonard, 2009)
endometriosis interna 616 endorsement
endometriosis interna. See primary endometriosis. in which the primary signs are decreased vision, vitritis, and
endometritis /en′dōmitrī′tis/ [Gk, endon, within, + metra, development of a hypopyon. Patients usually complain of
womb, itis, inflammation], an inflammatory condition of pain. Other symptoms include erythema and edema. It may
the endometrium or decidua, with extension into the myome- result from bacterial or fungal infection or from trauma.
trium and parametrial tissues. It is usually caused by bacterial Depending on the cause, therapy requires surgical interven-
infection, commonly by gonococci or hemolytic streptococci. tion or administration of an intraocular antibiotic. Also called
The condition is characterized by fever, abdominal pain, endophthalmia.
tachycardia, malodorous discharge, tenderness, and enlarge-
ment of the uterus. It occurs most frequently after childbirth
or abortion and is associated with the use of an intrauterine
contraceptive device. It can also be the result of caesarean
delivery. Diagnosis may be made by physical examination,
history, laboratory analysis revealing an elevated white blood
cell count, ultrasound, and bacteriological identification of
the pathogen. Treatment includes antibiotics, rest, analgesia,
adequate fluid intake, and, if necessary, surgical drainage of
a suppurating abscess, hysterectomy, or salpingo-oophorec-
tomy. Endometritis may be mild and self-limited, chronic or
acute, and unilateral or bilateral. It may cause sterility if scar
formation occludes the passage of the fallopian tubes. Septic
abortion and puerperal fever are forms of endometritis that Bacterial endophthalmitis (Stone and Gorbach, 2000/Courtesy
caused many deaths before asepsis and antibiotics became Dr. Jay Duker, New England Medical Center)
commonly available. A kind of endometritis is decidual
endometritis. See also pelvic inflammatory disease. endophthalmitis phacoanaphylactica /fak′ō·an′əfilak′-
endometrium /en′dōmē′trē·əm/ [Gk, endon + metra, təkə/. See phacolytic glaucoma.
womb], the mucous membrane lining of the uterus, consist- endophytic /en′dōfit′ik/ [Gk, endon + phyton, plant], per-
ing of the stratum compactum, the stratum spongiosum, and taining to the tendency to grow inward, such as a tumor that
the stratum basale. The endometrium changes in thickness and grows into the wall of a hollow organ.
structure with the menstrual cycle. The stratum compactum endoplasm /en′dōplaz′əm/ [Gk, endon, within, plasma,
and the stratum spongiosum constitute the pars functionalis plasm], the inner portion of cytoplasm.
and are shed with each menstrual flow. The pars functionalis endoplasmic reticulum /-plaz′mik/ [Gk, endon + plassein,
is known as the decidua during pregnancy, when it underlies to mold], an extensive network of membrane-enclosed
the placenta. Compare myometrium, parametrium. tubules in the cytoplasm of cells. The structure functions in
endomorph /en′dəmôrf′/ [Gk, endon + morphe, form], a the synthesis of proteins and lipids and in the transport of
person whose body build is characterized by a soft, round these metabolites within the cell.
physique with a large trunk and thighs, tapering extremities, endoprosthesis /-prosthē′sis, -pros′thəsis/ [Gk, endon +
an accumulation of fat throughout the body, and a predomi- prosthesis, addition], a prosthetic device installed within
nance of structures derived from the endoderm. Compare the body, such as an internal cardiac pacemaker.
ectomorph, mesomorph. See also pyknic. endopyelotomy /en′dopi′ělot′äme/, an incision procedure
endomyocardial fibrosis [Gk, endon, within + mys, muscle to correct a stenosed ureteropelvic junction by cutting from
+ kardia, heart; L, fibra, fiber + osis, condition], idiopathic within with an instrument inserted through an endoscope.
myocardiopathy occurring endemically in various parts of endoreduplication (end) /en′dōridoo′plikā′shən/ [Gr,
Africa and rarely in other areas, characterized by cardiomeg- endon + L, re-, again, duplicare, to duplicate], replication
aly; marked thickening of the endocardium with dense, white of the chromosomes without subsequent cell division.
fibrous tissue that frequently extends to involve the inner end-organ [AS, ende + Gk, organon, instrument], a
third or half of the myocardium; and congestive heart failure. nerve ending in which the terminal nerve filaments are
endomyocarditis /-mī′ōkärdī′tis/ [Gk, endon, within, mys, encapsulated.
muscle, kardia, heart, itis, inflammation], an inflammation endorphin /endôr′fin/ [Gk, endon + morphe, shape], one
of the lining of the heart. of the three groups of endogenous opioid peptides composed
endoneurial nerve sheath. See nerve sheath. of many amino acids, elaborated by the pituitary gland and
endonuclease, an enzyme that cleaves or hydrolyzes phos- other brain areas, and acting on the central and the periph-
phodiester bonds within a polynucleotide chain. Compare eral nervous systems to reduce pain. There are three known,
exonuclease. designated alpha, beta, and gamma. Beta-endorphin has been
endoparasite /en′dōper′əsīt/ [Gk, endon + parasitos, isolated in the brain and in the GI tract and seems to be the
guest], (in medical parasitology) an organism that lives within most potent of the endorphins. Beta-endorphin is composed
the internal organs or tissues of the host, such as a tapeworm. of 30 amino acids that are identical to part of the sequence
endopathy /endop′əthē/, any disease originating within the of 91 amino acids of the hormone beta-lipotropin, also pro-
person. duced by the pituitary gland. Behavioral tests indicate that
endopeptidase /en′dōpep′ti·dās/ [Gk, endon, within + Gk, beta-endorphin is a powerful analgesic in humans and ani-
peptein, to digest + ase, enzyme suffix], any peptidase that mals. Brain-stimulated analgesia in humans releases beta-
catalyzes the cleavage of internal peptide bonds in a polypep- endorphin into the cerebrospinal fluid. Compare enkephalin.
tide or protein. Endopeptidases are divided into subclasses endorsement /endôrs′mənt/ [Gk, en + L, dorsum, the
on the basis of catalytic mechanism and comprise the serine back], a statement of recognition of the license of a health
endopeptidases, cysteine endopeptidases, aspartic endopep- practitioner in one state by another state. An endorsement
tidases, metalloendopeptidases, and other endopeptidases. relieves the health practitioner of the necessity of completing
endophthalmitis /endof′thalmī′tis/ [Gk, endon + ophthal- the full licensing procedure of the state in which practice is
mos, eye, itis], an infectious condition of the internal eye to be undertaken.
endoscope 617 endothelial-derived relaxing factor
endoscope /en′dəskōp′/ [Gk, endon + skopein, to look], an endoscopy /endos′kəpē/, the visualization of the interior
illuminated optic instrument for the visualization of the inte- of organs and cavities of the body with an endoscope. The
rior of a body cavity or organ. Instruments are available in GI structures that can be examined through this procedure
varying lengths. The fiberoptic endoscope has great flex- include the esophagus, stomach, duodenum, colon, and pan-
ibility, reaching previously inaccessible areas. Although the creas and the biliary tract with the aid of x-ray film and fluo-
endoscope is generally introduced through a natural open- roscopy. Endoscopy can also be used to obtain samples for
ing in the body, it may also be inserted through an incision. cytological and histological examination and to follow the
Instruments for viewing specific areas of the body include course of a disease, such as the assessment of the healing
the bronchoscope, cystoscope, gastroscope, laparoscope, of gastric and duodenal ulcers. See also abdominoscopy,
otoscope, and vaginoscope. See also fiberoptics. —endo- bronchoscopy, cystoscopy, gastroscopy, laparoscopy.
scopic, adj.
Eyepiece Focus
Light Air
Endoscopy (Black and Hawks, 2005)

Tip of
endoscope
on entry into endoskeletal prosthesis /-skel′ətəl/ [Gk, endon + skel-
stomach etos, dried up, prosthesis, addition], a lower-limb support
consisting of an internal pylon usually covered with a light-
weight material, such as plastic foam. See also pylon.
endoskeleton, the internal network of bones, to which
muscles are attached. Compare exoskeleton.
endosteal hyperostosis /endos′tē·əl/, an inherited bone
disorder characterized by an overgrowth of the mandible and
brow areas. The excessive bone growth can lead to entrap-
ment of cranial nerves, causing facial palsy and loss of hear-
ing. Also called van Buchem’s syndrome.
Tip turned
Tip progressed clockwise and
endosteal implant [Gk, endon, within + osteon, bone], a
to within antrum progressed
dental implant made of metal, ceramic, or polymeric mate-
rial, consisting of a blade, screw, pin, or vent, inserted into
Flexible endoscope (Monahan et al, 1998) the jaw bone through the alveolar or basal bone, with a post
protruding through the mucoperiosteum into the oral cavity
endoscopic laser cholecystectomy. See cholecystectomy. to serve as an abutment for dentures or orthodontic appli-
endoscopic retrograde cholangiopancreatography ances, or to serve in fracture fixation.
(ERCP), an endoscopic test that provides radiographic endostomy therapist. See enterostomal therapist.
visualization of the bile and pancreatic ducts. A flexible fiber- endothelial /en′dōthē′lē·əl/ [Gk, endon, within, thele, nip-
optic duodenoscope is placed into the common bile duct. A ple], pertaining to endothelium.
radiopaque substance is instilled directly into the duct, and endothelial cell [Gk, endon, within, thele, nipple; L, cella,
serial x-ray films are taken. It is useful in identifying partial storeroom], a lining cell of a body cavity or of the cardio-
or total obstruction of these ducts, as well as stones, benign vascular system. It is usually seen as a flat, nucleated cell.
strictures, cysts, ampullary stenosis, anatomical variations,
and malignant tumors. See also cholangiography.
Endothelial cells (Carr and Rodak, 2008)
endothelial-derived relaxing factor (EDRF), nitric

Endoscopic retrograde cholangiopancreatogram oxide or related substances produced by the endothelial cells
(Kowalczyk and Mace, 2009) lining blood vessels. Its vasodilatory effect on neighboring
endothelial myeloma 618 endotracheal tube
vascular smooth muscle cells is an important regulator of
local blood flow.
endothelial myeloma. See Ewing’s sarcoma.
endothelin (ET) /-thē′lin/, any of a group of vasoconstric-
tive peptides produced by endothelial cells. Three known
endothelins, designated ET-1, ET-2, and ET-3, are chemi-
cally related to asp venom. ET-1 is the most potent vaso-
constrictor yet discovered, being 10 times stronger than the
second-most potent vasoconstrictor known, angiotensin II.
-endothelioma, suffix meaning “a tumor of endothelial tis-
sue”: hemendothelioma, lymphendothelioma.
endothelium /en′dōthē′lē·əm/ [Gk, endon + thele, nip-
ple], the layer of simple squamous epithelial cells that lines
the heart, the blood and lymph vessels, and the serous cavi-
ties of the body. It is highly vascular, heals quickly, and is
derived from the mesoderm. Endotracheal intubation
endothoracic fascia /-thôras′ik/, a sheet of connective tis- (Image used by permission from Nellcor Puritan Bennett LLC, Boulder,
sue within the thorax; the outer boundary of the thoracic cav- Colorado, doing business as Covidien)
ity. It separates the parietal pleura from the chest wall and the
diaphragm. A thickened portion also attaches to the medial
border of the first rib. (dyspnea, gurgling, respirations, activation of ventilator
endotoxin /en′dōtok′sin/ [Gk, endon + toxikon, poison], a pressure alarms). If so ordered, the trachea is irrigated with
toxin contained in the cell walls of some microorganisms, normal saline solution. The patient is usually on intermit-
especially gram-negative bacteria, that is released when the tent positive-pressure breathing (IPPB) or a volume respi-
bacterium dies and is broken down in the body. Fever, chills, rator with the cuff of the endotracheal tube inflated. If the
shock, leukopenia, and a variety of other symptoms result, patient can breathe independently, the trachea and mouth are
depending on the particular organism and the condition of suctioned, the cuff is deflated, and the respiratory rate and
the infected person. Compare exotoxin. quality are checked hourly. The patient is turned every 1 to
endotoxin shock [Gk, endon, within, toxikon, poison; Fr, 2 hours, and the blood pressure and pulse checked every
choc], a septic shock in response to the release of endotox- 2 to 4 hours or according to institutional protocol. Parenteral
ins produced by gram-negative bacteria. The toxin is released fluids are administered as ordered. Nothing is given orally.
on the death of the bacterial cell, especially Escherichia coli. Fluid intake and output are measured and recorded. The
endotracheal /en′dōtrā′kē·əl/ [Gk, endon + tracheia + patient’s level of consciousness is determined hourly, and, if
arteria, airpipe], within or through the trachea. he or she is sufficiently conscious, a method of communica-
endotracheal anesthesia, general anesthesia that includes tion is established.
an endotracheal tube or a supraglottic airway such as a laryn- n nursing orders: The nurse monitors the position and
geal mask airway (LMA) as a method for controlling ven- patency of the endotracheal tube, performs the necessary
tilation. Anesthesia may be maintained using inhalational suctioning, inflates and deflates the cuff at appropriate
anesthetic agents or a combination that includes intravenous times, and administers IPPB or support with the volume
agents. respirator. The nurse checks the vital signs at specified
endotracheal extubation, a nursing intervention from intervals and provides emotional support and physical care
the Nursing Interventions Classification (NIC) defined as for the patient, who is usually acutely ill, unable to com-
purposeful removal of the endotracheal tube from the naso- municate, and suffering from the discomfort of an endotra-
pharyngeal or oropharyngeal airway. See also Nursing cheal tube.
Interventions Classification. n outcome criteria: Meticulous assessment of the patient
endotracheal intubation, the management of the patient with an endotracheal tube can promote the survival of a criti-
with an airway catheter inserted through the mouth or nose cally ill person.
into the trachea. An endotracheal tube may be used to main- endotracheal tube, a large-bore catheter inserted through
tain a patent airway, to prevent aspiration of material from the mouth or nose and into the trachea to a point above the
the digestive tract in the unconscious or paralyzed patient, bifurcation of the trachea. It is used for delivering oxygen
to permit suctioning of tracheobronchial secretions, or to under pressure when ventilation must be totally controlled
administer positive-pressure ventilation that cannot be given and in general anesthetic procedures. See also endotracheal
effectively by a mask. Endotracheal tubes may be made of intubation.
rubber or plastic and usually have an inflatable cuff to main-
tain a closed system with the ventilator.
n method: With the aid of paralytic agents to ease the
passage, the endotracheal tube is inserted via the mouth or
nose through the larynx into the trachea. If the oral route
is used, a bite block may be required to prevent the patient
from biting and obstructing the tube. Breath sounds are aus-
cultated immediately after insertion and every 1 or 2 hours
thereafter to make certain the tube is properly positioned
and is not obstructing one of the mainstem bronchi. Once
the tube is correctly positioned, it is taped securely in place
and checked for patency and slippage every 15 to 60 min-
utes or per institutional protocol. The trachea is suctioned
every hour and as needed, as indicated by patient assessment Endotracheal tube (Lewis et al, 2011)
endovasculitis 619 enema
endovasculitis /-vas′kyəlī′tis/, inflammation of the tunica arterial carbon dioxide tension. A significant difference may
intima of a blood vessel. indicate a change in ventilation/perfusion matching.
endoxin /endok′sin/, an endogenous analog of digoxin that end-to-end anastomosis. See anastomosis.
occurs naturally in humans. It is a hormone that may regulate end-to-side anastomosis, an anastomosis connecting the
the excretion of salt. end of one vessel with the side of another one.
end plate [AS, ende + ME, plat], the motor end plate in the endurance1 /endy ˘ oor′əns/, the ability to continue an activ-
nervous system, located at the terminal membrane of an axon ity despite increasing physical or psychological stress, as in
and the postjunctional membrane of the adjoining muscle tis- the effort to perform additional numbers of muscle contrac-
sue. Also called myoneural junction. tions before the onset of fatigue. Although endurance and
strength are different qualities, weaker muscles tend to have
less endurance than do strong muscles.
endurance2, a nursing outcome from the Nursing Out-
comes Classification (NOC) defined as the capacity to sus-
Excitatory transmitter vesicles tain activity. See also Nursing Outcomes Classification.
Enduron, a trademark for a thiazide diuretic (methyclo-
Sarcolemma thiazide) used to treat hypertension.
Axon Enduronyl, a trademark for a fixed-combination cardio-
vascular drug containing a diuretic (methyclothiazide) and
E
an antihypertensive (deserpidine).
-ene, suffix used for naming hydrocarbons: ethidene,
ACh
Mitochondrion
xanthene.
enema /en′əmə/ [Gk, enienai, to send in], the introduc-
A Ch
tion of a solution into the rectum for cleansing or thera-

h peutic purposes. Enemas may be commercially packed
Synaptic cleft AC disposable units or reusable equipment prepared just before
use.
ACh receptors n method: The equipment is assembled. If disposable
equipment is to be used, an 18- to 20-French catheter, a 2-
to 3-foot length of tubing, an enema bag, the solution, and
a clamp are collected and taken to the bedside. If a dispos-
able set is to be used, no other equipment is necessary. The
Sarcolemma folds
patient is positioned in the left lateral or dorsal position.
End plate (Phipps et al, 2003) After air is expelled from the tubing, the tip of the catheter
is lubricated. (Disposable units usually have prelubricated
tips.) The patient is asked to bear down, as if to defecate,
end point, 1. (in chemistry) the point at which the condi- and the tip of the catheter is gently inserted 3 to 4 inches
tion of equivalence is reached during a titration. This may into the rectum, depending on the size of the patient and
be indicated by reaching a maximum value in the slope the purpose of the enema. The solution is allowed to flow
of a titration curve, for example. 2. the point or time at from a height of 18 to 20 inches above the level of the hips.
which an activity is finished. 3. the point at which a chemi- The tip of the catheter or squeeze bottle is withdrawn when
cal indicator changes color, for example, in an acid-base most of the solution has been administered. Some solution
titration. is left in the tubing to prevent air from entering the rectum.
end-positional nystagmus, a horizontal rhythmic Light pressure is applied over the anus with toilet tissue or
oscillation of the eyes on extreme lateral gaze. It occurs a gauze pad. The fluid is held in by the patient for the pre-
in normal eyes when the fixation point is outside the scribed length of time. It is then expelled as the patient sits
binocular field. Also called deviational nystagmus, on the toilet.

pseudonystagmus. n interventions: The reasons for performing the proce-
end product /endprod′əkt/, the chemical compound result- dure and the steps to be taken are explained to the patient.
ing from completion of a sequence of metabolic reactions. The solution is warmed to 99° F to 105° F (37.8° C to 40.6°
end-stage disease [AS, ende + OFr, estage + L, dis + Fr, C) to reduce the stimulation of intestinal peristalsis by
aise, ease], a disease condition that is essentially terminal a sudden temperature change in the colon. The patient is
because of irreversible damage to vital tissues or organs. warned that some discomfort may occur because the colon
Kidney or renal end-stage disease is defined as a point at tends to contract when distended by the fluid. The enema
which the kidney is so badly damaged or scarred that dialysis is given slowly to prevent sudden distension that would
or transplantation is required for patient survival. cause peristalsis or spasm and greater discomfort. A call
end-tidal capnography /end′tīdəl/, the process of continu- bell is kept within reach of the patient during expulsion of
ously recording the level of carbon dioxide in expired air. the enema because the discomfort of the procedure and the
The percentage of carbon dioxide at the end of expiration can effort required to expel the enema may cause faintness. The
be estimated and gives a close approximation of the alveolar color, consistency, and amount of material evacuated are
carbon dioxide concentration. The process, which requires evaluated. If nondisposable equipment is used, it is rinsed
the use of infrared spectroscopy, is used to monitor critically in cold water before being washed with warm, soapy water
ill patients and in pulmonary function testing. The data are and sterilized.
typically recorded automatically on a strip of graph paper on n outcome criteria: A thorough explanation to the patient
a bedside patient monitor. of all aspects of the procedure, careful observation of the
end-tidal CO2. See capnometry. patient during the procedure, slow and gentle administration
end-tidal CO2 determination, the concentration of car- of the enema, and evaluation of the results of the procedure
bon dioxide in a patient’s end-tidal breath, assumed to reflect are important to achieve the desired effect.
energy 620 enkephalin
en face /äNfäs′, enfās′/, “face-to-face”; a position in which
the mother’s face and the infant’s face are approximately 8
inches apart and on the same plane, as when the mother holds
the infant up in front of her face or when she nurses the child.
Studies of maternal and infant bonding have shown that moth-
ers seek eye-to-eye contact and that they will instinctively
move the baby to an en face position. In addition, infants have
been shown to prefer a human face to other visual stimuli and
to be best able to focus at a distance of 8 to 10 inches.
enflurane /en′fl ˘ oorān/, a halogenated volatile liquid; a
nonflammable anesthetic gas of the ether family. Its use has
almost entirely been supplanted by newer, shorter-acting
agents.
enfuvirtide, an antiretroviral.
n indications: This drug is used in combination with other
antiretrovirals to treat HIV-1 infection.
n contraindication: Known hypersensitivity to this drug
prohibits its use.
n adverse effects: Adverse effects of this drug include
anxiety, peripheral neuropathy, taste disturbance, insom-
nia, depression, abdominal pain, anorexia, constipation,
pancreatitis, injection site reactions, influenza, cough, con-
junctivitis, lymphadenopathy, myalgia, hyperglycemia, and
Positioning for enema administration pneumonia. Life-threatening side effects include glomerulo-
(Harkreader, Hogan, and Thobaben, 2007) nephritis, renal failure, Guillain-Barré syndrome, thrombo-
cytopenia, and neutropenia.
energy /en′ərjē/ [Gk, energia], the capacity to do work or engagement /engāj′mənt/ [Fr, a bonding], 1. fixation of
to perform vigorous activity. Energy may occur in the form the presenting part of the fetus in the maternal true pelvis.
of heat, light, movement, sound, or radiation. Human energy The largest diameter of the presenting part is at or below the
is usually expressed as muscle contractions and heat produc- level of the ischial spines. 2. fixation of the fetal head in the
tion, made possible by the metabolism of food that originally maternal midpelvis with the biparietal diameter of the head
acquired the energy from sunlight. Chemical energy is that level with the ischial spines.
released as a result of a chemical reaction, as in the metabo- English position. See lateral recumbent position.
lism of food. Compare anergia. —energetic, adj. engorged /in·gôrjd′/ [Fr, engorger, to fill up], distended or
energy conservation1, a principle that energy cannot swollen with fluids.
be created or destroyed although it can be changed from engorgement /engôrj′mənt/ [Fr, engorger, to fill up], dis-
one form into another, as when heat energy is converted to tension or vascular congestion of body tissues, such as the
light energy. It is now superseded by the special relativ- swelling of breast tissue caused by an increased flow of
ity equation E = mc2, but it is still applicable to chemical blood and lymph before true lactation.
changes. engram /en′gram/, 1. a hypothetical neurophysiological
energy conservation2, a nursing outcome from the Nurs- storage unit in the cerebrum that is the source of a particular
ing Outcomes Classification (NOC) defined as personal memory. 2. an interneuronal circuit involving specific neu-
actions to manage energy for initiating and sustaining activ- rons and muscle fibers that can be coordinated to perform
ity. See also Nursing Outcomes Classification. specific motor activity patterns. Thousands of repetitions
energy cost of activities, the metabolic cost in calories or may be needed to establish an engram. 3. the permanent
kilojoules of various forms of physical activity. For example, trace left by a stimulus in nerve tissue.
the average metabolic equivalent (MET) of walking at a rate engrossment. See bonding.
of 3 km/hr is 2 METs per minute, and the energy cost of enhancement /enhans′mənt/ [ME, enhauncen, to
walking at a speed of 6 km/hr is 5 METs per minute. See also raise], the act of improving, heightening, or augmenting.
metabolic equivalent of task. enkephalin /enkef′əlin/ [Gk, enkepalos, brain, in,
energy field, the flow of energy surrounding a person. within], one of two pain-relieving pentapeptides produced
energy management, a nursing intervention from the in the body, located in the pituitary gland, brain, and GI
Nursing Interventions Classification (NIC) defined as regu- tract. Axon terminals that release enkephalins are concen-
lating energy use to treat or prevent fatigue and optimize trated in the posterior horn of the gray matter of the spinal
function. See also Nursing Interventions Classification. cord, in the central part of the thalamus, and in the amygdala
energy output, the amount of energy expended by work or of the limbic system of the cerebrum. Enkephalins function
activity by the body per specified period. as neurotransmitters or neuromodulators and inhibit neu-
energy-protein malnutrition. See protein-energy rotransmitters in the pathway for pain perception, thereby
malnutrition. reducing the emotional as well as the physical impact of
energy subtraction, a radiographic technique in which pain. Methionine-enkephalin and isoleucine-enkephalin are
two different x-ray beams are used alternately to provide a each composed of five amino acids, four of which are identi-
subtraction image resulting from differences in photoelectric cal in both compounds. These two neuropeptides can depress
interaction. neurons throughout the central nervous system. Although it
enervation /en′ərvā′shən/ [L, enervare, to weaken], is not known exactly how these neuropeptides function, the
1. reduction or lack of nervous energy; weakness; lassi- enkephalins are natural pain killers and may be involved,
tude; languor. 2. removal of a complete nerve or a section with other neuropeptides, in the development of psycho-
of nerve. pathological behavior in some cases. Compare endorphin.
enkephalinergic neuron 621 enteral tube feeding
enkephalinergic neuron /enkef′əlinur′jik/, a nerve abdominal distress, dry mouth, flatulence, bitter taste, diar-
cell that releases the peptide neurotransmitter enkepha- rhea, constipation, dyspepsia, and orthostatic hypotension.
lin. Such neurons are widespread in the central nervous ental /en′tal/ [Gk, entos, within], central or inner; interior
system. or inside.
enol /ē′nol/, an organic compound with an alcohol or Entameba, any ameba of the genus Entamoeba.
hydroxyl group directly attached (bonded) to a double bond. entamebiasis. See amebiasis.
By transfer of the hydrogen atom from oxygen to carbon, the Entamoeba /en′təmē′bə/ [Gk, entos, within, amoibe,
enol form becomes the (usually more stable) keto form. Such change], a genus of intestinal amebic parasites of which
compounds usually exist as enol-keto tautomers. several species are pathogenic to humans. See also Ent-
enophthalmos /en′əfthal′məs/ [Gk, en, in, ophthalmos, amoeba histolytica.
eye], backward displacement of the eye in the bony Entamoeba coli, a common nonpathogenic amebic para-
socket, caused by traumatic injury or developmental defect. site found in the intestines of humans and other mammals. It
Ptosis may cause an incorrect diagnosis of enophthalmos. is similar to and sometimes confused with E. histolytica, the
—enophthalmic, adj. causal agent of amebic dysentery. However, E. coli organ-
enoxacin /ĕ-nok′säsin/, an antibacterial effective against isms tend to be slightly larger, have more pseudopods, and
many gram-positive and gram-negative bacteria, adminis- be sluggish in movement.
tered orally in the treatment of gonorrhea and urinary tract Entamoeba gingivalis, a temperature-resistant species of
infections. ameba found in the mouth of humans and other mammals. As
enoxaparin /e-nok′säpar′in/, a low-molecular-weight hep- a causal agent of gingivitis, it is associated with poor dental
arin used as the sodium salt to prevent pulmonary embolism hygiene.
and deep venous thrombosis after hip or knee replacement Entamoeba histolytica /his′təlit′ikə/, a pathogenic species
or high-risk abdominal surgery, administered subcutane- of ameba that causes amebic dysentery and hepatic ame-
ously as the sodium salt. It is also used together with warfa- biasis in humans. See also amebiasis, amebic dysentery,
rin in the treatment of deep venous thrombosis and together hepatic amebiasis.
with aspirin in the prevention of coronary thrombosis asso-
ciated with unstable angina or certain kinds of myocardial
infarction.
enoximone /enok′sĭmōn/, a vasodilator similar to
inamrinone, used as a cardiotonic in the short-term man-
agement of congestive heart failure. It is administered
intravenously.
enriched, 1. (in nutrition) pertaining to foods to which
vitamins or minerals have been added within limits speci-
fied by the U.S. Food and Drug Administration, usually
to replace nutrients lost during processing. For example,
enriched grain products have four B vitamins (B1, B2,
B3, and folic acid) and iron added. 2. (in chemistry) per-
taining to a substance containing a proportion of isotope
greater than that found in the naturally occurring form of
the same element. 3. (in chemistry) pertaining to a com-
pound containing a greater proportion of one of two pos-
Entamoeba histolytica in the colon (Kumar et al, 2007)
sible forms.
enrollee, an individual who has signed up to receive health
care under a particular type of plan. Not applicable in Can- entamoebiasis. See amebiasis.
ada. Also called beneficiary member, participant. entecavir, an antiviral.
ensiform cartilage, ensiform process. See xiphoid n

indication: This drug is used to treat chronic hepatitis B.
process. n
contraindication: Known hypersensitivity to this drug
ensulizole /ensul′ĭzōl/, a water-soluble absorber of ultravio- prohibits its use.
let B radiation, used topically as a sunscreen. n adverse effects: Adverse effects of this drug include
Ensure, a trademark for a lactose-free nutritional supple- fatigue, dizziness, insomnia, nausea, vomiting, and diar-
ment containing protein, carbohydrates, fat, vitamins, and rhea. Life-threatening side effects include lactic acidosis and
minerals. severe hepatomegaly with stenosis. Common side effects
ENT, abbreviation for ear, nose, and throat. See ENT include headache and dyspepsia.
specialist. enter-. See entero-.
entacapone, an antiparkinson agent. enteral /en′tərəl, enter′əl/ [Gk, enteron, bowel], within
n indications: It is used to treat parkinsonism in patients the small intestine, or via the small intestine.
who are experiencing end-of-dose decreased effect. enteral feeding, a mode of feeding that uses the GI tract,
n contraindication: Known hypersensitivity to this drug such as oral or tube feeding.
prohibits its use. enteral nutrition, the provision of nutrients through the GI
n adverse effects: Serious adverse effects include psy- tract when the client cannot ingest, chew, or swallow food
chosis, hallucination, hypomania, severe depression, dizzi- but can digest and absorb nutrients.
ness, gastritis, GI disorders, alopecia, dark urine, back pain, enteral tube feeding1 [Gk, enteron, bowel; L, tubus + AS,
dyspnea, purpura, fatigue, asthenia, and bacterial infection. faedan], the introduction of nutrients directly into the GI
Common side effects include involuntary choreiform move- tract by feeding tube. Routes include both nonsurgical and
ments, hand tremors, fatigue, headache, anxiety, twitching, surgically placed: nasogastric, nasoduodenal, nasojejunal,
numbness, dyskinesia, hypokinesia, hyperkinesia, weakness, esophagostomy, gastrostomy, and jejunostomy. See also drip
confusion, agitation, nightmares, nausea, vomiting, anorexia, gavage, tube feeding.
enteral tube feeding 622 enteric infection
d elivering nutrients and water through a gastrointestinal
tube. See also Nursing Interventions Classification.
enterectomy /en′tərek′təmē/ [Gk, enteron, intestine,
ektomē, excision], the surgical removal of a portion of
Nasogastric intestine.
tube
Esophagostomy enteric /enter′ik/ [Gk, enteron, bowel], pertaining to the
intestinal tract.
enteric coating, a layer added to oral medications that
allows the medication to pass through the stomach and be
absorbed in the intestinal tract. The coating protects against
the effects of stomach juices, which can interact with,
destroy, or degrade these drugs.
enteric cytopathogenic human orphan virus. See
ECHO virus.
enteric fever. See typhoid fever.
Nasoduodenal Gastrostomy enteric infection, a disease of the intestine caused by any
or nasojejunal infection. Symptoms similar to those caused by pathogens
may be produced by chemical toxins in ingested foods and by
allergic reactions to certain food substances. Among bacteria
commonly involved in enteric infections are Escherichia
coli, Vibrio cholerae, and several species of Salmonella,
Jejunostomy Shigella, and anaerobic streptococci. Enteric infections are
characterized by diarrhea, abdominal discomfort, nausea and
Common placement locations for enteral feeding vomiting, and anorexia. A significant loss of fluid and elec-
tubes (Lewis et al, 2007)
trolytes may result from severe vomiting and diarrhea. Oral
rehydration therapy with clean water and electrolyte solution
enteral tube feeding2, a nursing intervention from the may be given. Medication for sedation and relief of abdomi-
Nursing Interventions Classification (NIC) defined as nal cramps may be prescribed. Antibiotics may be recom-
Common problems of patients receiving tube feedings

Problems and possible causes Corrective measures
Vomiting and/or Aspiration

Improper placement of tube Replace tube in proper position. Check tube position before beginning feeding and every
8 hr if continuous feedings.
Delayed gastric emptying, increased If gastric residual volume is ≥250 mL after second gastric residual check, a promotility agent
residual volume should be considered.
If gastric residual volume is >500 mL, hold enteral nutrition and reassess patient tolerance.
Potential for aspiration Keep head of bed elevated to 30- to 45-degree angle. Have patient sit up on side of bed or in
chair. Encourage ambulation unless contraindicated.
Diarrhea
Feeding too fast Decrease rate of feeding. Change to continuous drip feedings.
Medications Check for drugs that may cause diarrhea (e.g., antibiotics).
Low-fiber formula Change to formula with more fiber.

Tube moving distally Properly secure tube before beginning feeding. Check before each feeding or at least every
24 hr if continuous feedings.
Contamination of formula Refrigerate unused formula and record date opened. Discard outdated formula every 24 hr.
Discard formula left standing for longer than manufacturer’s guidelines: 8 hr for ready-to-
feed formulas (cans), 4 hr for reconstituted formula, or 24-48 hr for closed-system enteral
formulas. Use closed system to prevent contamination. Use sterile water for flushes.
Constipation
Formula components Consult health care provider for change in formula to one with more fiber content. Obtain
laxative order.
Poor fluid intake Increase fluid intake if not contraindicated. Give free water, as well as formula. Give total
fluid intake of 30 mL/kg body weight.
Drugs Check for drugs that may be constipating.
Impaction Perform rectal examinations to check and manually remove feces if present.
Dehydration
Excessive diarrhea, vomiting Decrease rate or change formula. Check drugs that patient is receiving, especially antibiotics.
Take care to prevent bacterial contamination of formula and equipment.
Poor fluid intake Increase intake and check amount and number of feedings. Increase amount of intake if
appropriate.
High-protein formula Change formula.
Hyperosmotic diuresis Check blood glucose levels frequently. Change formula.
From Lewis SL et al, Medical surgical nursing: assessment and management of clinical problems, ed 8, St Louis, 2011, Mosby.
enteric intussusception 623 enteroclysis
mended, depending on the specific microorganism causing enterobacterial /-baktir′ē·əl/ [Gk, enteron + bakterion,
the infection. small staff], pertaining to a species of bacteria found in the
digestive tract.
enterobiasis /en′tirōbī′əsis/ [Gk, enteron + bios, life, osis,
condition], a parasitic infestation with Enterobius vermic-
ularis, the common pinworm, causing a crawling sensation
and pruritus. The nematodes infect the large intestine, and
the females deposit eggs in the perianal area, causing pruri-
tus and disturbed sleep. Reinfection commonly results from
transfer of eggs to the mouth by contaminated fingers. Air-
borne transmission is possible because eggs remain viable for
2 weeks in contaminated clothing, bedding, or objects. Five
hundred million cases are reported annually worldwide, and
50% of children will be infected at some point in their lives.
Diagnosing enterobiasis requires the sticky side of an adhe-
Colonic mucosa in enteric infection sive cellophane tape swab to be pressed against the perianal
(Kumar, Abbas, and Fausto, 2005) skin and examined for eggs under a microscope. Therapy for
the whole family may be necessary. Effective anthelmintics
enteric intussusception, intussusception involving two include pyrantel pamoate, mebendazole, albendazole, and
segments of the small intestine. thiabendazole. Personal hygiene, including handwashing, is
entericoid fever /enter′ikoid/ [Gk, enteron + eidos, the best preventive measure. There appears to be little ben-
form], a typhoid-like febrile disease characterized by intes- efit derived from disinfection procedures for the home. Also
tinal inflammation and dysfunction. See also enteric infec- called oxyuriasis.
tion, typhoid fever. Enterobius vermicularis /en′tərō′bē·əs/ [Gk, enteron +
enteric orphan virus [Gk, enteron, bowel, orphanos, bereft; bios, life; L, vermiculus, small worm], a common para-
L, virus, poison], an enterovirus isolated from humans and sitic nematode that resembles a white thread between 0.5
other animals that was not originally associated with the dis- and 1 cm long. Also called oxyuris vermicularis, pinworm,
ease. See also ECHO virus. seatworm, threadworm. See also enterobiasis.
enteritis /en′tərī′tis/, inflammation of the mucosal lining of
the small intestine, resulting from a variety of causes—bac-
terial, viral, functional, and inflammatory. Involvement of
both small and large intestines is called enterocolitis. Com-
pare gastroenteritis.
Fungal enteritis (Damjanov and Linder, 2000)
entero-, enter-, prefix meaning “intestines”: enteric, enter-

obiliary, enteroptosis.
Enterobacter cloacae /en′tirōbak′tər klō·ā′kē, klō·ā′sē/ [Gk,
enteron + bakterion, small staff; L, cloaca, sewer], a com-
mon species of gram-negative rod-shaped bacteria of the fam- Pinworms (Enterobius vermicularis) (arrows) found
ily Enterobacteriaceae found in human and animal feces, dairy on screening colonoscopy of an institutionalized
products, sewage, soil, and water. E. cloacae and E. aerogenes man (Feldman, Friedman, and Brandt, 2010)
are important nosocomial pathogens responsible for a number
of infections such as bacteremia, lower respiratory tract infec-
tions, urinary tract infections, and septic arthritis. Also called enterocele /en′tirōsēl′/, 1. a hernia of the intestine. 2. pos-
Aerobacter aerogenes, Enterobacter aerogenes. terior vaginal hernia. Compare enterocoele.
Enterobacteriaceae /en′tirōbaktir′ē·ā′si·ē/ [Gk, enteron + enterochromaffin cell. See argentaffin cell.
bakterion, small staff], a family of aerobic and anaerobic enteroclysis /en′tərok′lisis/, a radiographic procedure in
gram-negative bacteria that includes both normal and patho- which a contrast medium is injected into the duodenum to per-
genic enteric microorganisms. Among the significant gen- mit examination of the small intestine. To improve visualiza-
era of the family are Escherichia, Klebsiella, Proteus, and tion of the bowel wall, air is sometimes injected into the small
Salmonella. intestine after the contrast medium has reached the cecum.
enterococcemia 624 entropion
enterococcemia /en′terokokse′meä/, blood infection by enterostomal therapy to provide care for persons with sto-
enterococci. mas, draining wounds, fistulae, incontinence, and actual or
Enterococcus /en′terokok′us/ pl. enterococci [Gk, enteron potential alterations in tissue integrity. Also called endos-
+ kokkos, berry], a genus of gram-positive, facultatively tomy therapist. See also Wound, Ostomy and Continence
anaerobic bacteria of the family Streptococcaceae, formerly Nurses Society.
classified in the genus Streptococcus. E. faecalis and E. fae- enterostomy /en′təros′təmē/ [Gk, enteron + stoma,
cium are normal inhabitants of the human intestinal tract that mouth], a surgical procedure that produces an artificial
occasionally cause urinary tract infections, infective endocar- anus or fistula in the intestine through an incision in the
ditis, bacteremia, and life-threatening nosocomial infections abdominal wall. Compare colostomy.
(vancomycin-resistant enterococci infection). E. avium is enterotoxigenic /-tok′sijen′ik/, producing an enterotoxin.
found primarily in the feces of chickens and may be associ- enterotoxigenic Escherichia coli (ETEC), a strain of E.
ated with appendicitis, otitis, and brain abscesses in humans. coli that is a frequent cause of diarrhea in travelers. See also
enterocoele, the abdominal cavity. Compare enterocele. traveler’s diarrhea.
enterocolitis /-kōlī′tis/ [Gk, enteron + kolon, bowel, enterotoxin /-tok′sin/, a toxic substance that causes an
itis], an inflammation involving both the large and small adverse reaction by cells of the intestinal mucosa. Most
intestines. Also called coloenteritis. enterotoxins are produced by certain species of bacteria,
enterocutaneous fistula, a cutaneous fistula connecting such as Staphylococcus.
the body surface and some parts of the intestine. enterovesical fistula, a fistula connecting some part of the
enterocystoplasty /en′terosis′toplas′te/, the most common intestine with the urinary bladder. Also called vesicoenteric
type of augmentation cystoplasty, using a portion of intestine fistula.
for the graft. Common types include ileocystoplasty, ileoce- Enterovirus /-vī′rəs/ [Gk, enteron + L, virus, poison], a
cocystoplasty, and sigmoid cystoplasty. genus of Picornaviridae that preferentially replicates in the
enterodynia /-din′ē·ə/, intestinal pain. mammalian intestinal tract. Kinds of Enteroviruses are cox-
enteroenterostomy /en′tərō·en′təros′təmē/, the surgical sackie virus, ECHO virus, and poliovirus. —enteroviral,
creation of an artificial connection between two segments of adj.
the intestine. enthesitis /en′thəsī′tis/, an inflammation of the insertion of
enterogastritis. See gastroenteritis. a muscle with a strong tendency toward fibrosis and calcifi-
enteroglucagon /-gloo′kəgon/, any of a group of glucagon- cation. It is usually only painful when the involved muscle
like hyperglycemic peptides, released by cells in the mucosa is activated.
in the upper intestine in response to the ingestion of car- enthesopathy /en′thəsop′əthē/, an arthritic condition affect-
bohydrates and fat and stimulating intestinal epithelial cell ing tendons and ligaments rather than joint membranes.
preparation and renewal. Enteroglucagons are similar to pan- ento-. See endo-.
creatic glucagons but immunologically different. Glicentin entodermal. See endodermal.
and oxyntomodulin are the principal enteroglucagons. entomophthoromycosis basidiobolae, a chronic infec-
enterohemorrhagic Escherichia coli (EHEC) tion caused by Basidiobolus ranarum, a filamentous fungus,
/-hem′ôraj′ik/, a strain of E. coli that causes hemor- in which gradually enlarging granulomas form in the subcu-
rhage in the intestines. The organism produces shiga toxin, taneous tissues of the arms, chest, and trunk. Multiple puru-
which damages bowel tissue, causing intestinal ischemia lent ulcers may develop. The infection is seen in children and
and colonic necrosis. Symptoms are stomach cramping adolescents in tropical areas of Indonesia, India, and Africa.
and bloody diarrhea. An infectious dose may be as low as Also called subcutaneous chronic zygomycosis.
10 organisms. Spread by contaminated beef, unpasteurized entopic /entop′ik/, occurring in the proper place. Compare
milk and juice, sprouts, lettuce, and salami, as well as con- ectopic.
taminated water, the infection can be serious although there entopic phenomena, sensations perceived for mechanical
may be no fever. Treatment consists of antibiotics and main- reasons within the eye, such as floaters or flashes caused by
tenance of fluid and electrolyte balance. In advanced cases, retinal changes.
surgical removal of portions of the bowel may be required. entrainment /entrān′mənt/ [Fr, entrainer, to drag along], a
enterohepatic circulation /en′tərōhəpat′ik/, a route by phenomenon observed in the microanalysis of sound films in
which part of the bile produced by the liver enters the intes- which the speaker moves several parts of the body and the
tine, is resorbed by the liver, and then is recycled into the listener responds by moving in ways that are coordinated with
intestine. The remainder of the bile is excreted in feces. the rhythm of the sounds. Infants have been observed to move
enterokinase /en′tirōkī′nās/ [Gk, enteron + kinesis, move- in time to the rhythms of adult speech but not to random noises
ment, ase, enzyme], an intestinal juice enzyme that acti- or disconnected words or vowels. Entrainment is thought to be
vates the proteolytic enzymes in pancreatic juice as they an essential factor in the process of maternal-infant bonding.
enter the duodenum. entrance block [Fr, entrer, to enter; AS, blok], a theoretic
enterolith /en′tərōlith′/ [Gk, enteron + lithos, stone], a zone that surrounds a pacemaker focus and protects it from
stone consisting of ingested material found within the intes- discharge by an extraneous impulse that might trigger ecto-
tine. See also calculus. pic ventricular contractions.
enterolithiasis /en′tərōlithī′əsis/, the presence of entero- entrance exposure, the skin dose of radiation as the beam
liths in the intestine. enters the patient. It may be expressed in milliroentgens or C/kg.
enteron. See digestive tract, small intestine. entrapment neuropathy /entrap′mənt/ [OFr, entraper, to
enteropathic Escherichia coli (EPEC) /-path′ik/, a strain catch in a trap; Gk, neuron, nerve, pathos, disease], injury
of E. coli that is the cause of epidemic infantile diarrhea. See or inflammation of single nerves caused by pressure from
also epidemic diarrhea in newborns. surrounding tissues, such as ligaments and fascia.
enteropathy /en′tərop′əthē/, a disease or other disorder of entropion /entrō′pē·on/ [Gk, en + tropos, a turning], turn-
the intestines. ing inward or turning toward, usually a condition in which
enterostomal therapist /-stō′məl/, a registered nurse the eyelid turns inward toward the eye. In either the upper or
who is qualified by education in an accredited program in lower eyelid, cicatricial entropion can result from scar tissue
entropy 625 environmental management: safety
formation. Spastic entropion results from an inflammation or enucleator /inoo′klē·ā′tər/ [L, e, without, nucleus, nut], a
other factor that affects tissue tone. An inflammation of the eye- procedure or device for removing a nucleus from a cell.
lid may be the result of an infectious disease or irritation from enuresis /en′y ˘
oorē′sis/ [Gk, enourein, to urinate], inconti-
an inverted eyelash. Compare ectropion. See also blepharitis. nence of urine, especially nocturnal bed-wetting.
envenomation /enven′əmā′shən/, the injection of snake,
arachnid, or insect venom into the body.
environment [Gk, en, in; L, viron, circle], all of the many
factors, both physical and psychological, that influence or
affect the life and survival of a person. See also biome, cli-
mate. —environmental, adj.
environmental carcinogen /envī′rənmen′təl/, any of the
natural or synthetic substances that can cause cancer. Such
agents may be divided into chemical agents, physical agents,
hormones, and viruses. Some environmental carcinogens are
arsenic, asbestos, uranium, vinyl chloride, ionizing radiation,
ultraviolet rays, x-rays, and coal tar derivatives. Carcino-
genic effects of chemicals may be delayed for as long as 30
years. Other carcinogens produce more immediate effects.
Some studies indicate that the carcinogens in cigarette smoke
Entropion (Kanski and Nischal, 1999) are involved in 80% of all lung cancer. Most carcinogens
are unreactive or secondary carcinogens but are converted to
entropy /en′trəpē/ [Gk, en + tropos, a turning], the ten- primary carcinogens in the body. Numerous factors, such as
dency of a system to change from a state of order to a state heredity, affect the susceptibilities of different individuals to
of disorder, expressed in physics as a measure of the part cancer-causing agents.
of the energy in a thermodynamic system that is not avail- environmental control unit (ECU), an apparatus for
able to perform work. According to the principles of evolu- individuals with functional limitations that controls devices
tion, living organisms tend to go from a state of disorder to a such as lamps, television, radio, telephone, and alarm sys-
state of order in their development and thus appear to reverse tems. Similar to television remote control devices, they are
entropy. However, maintaining a living system requires the typically switches manipulated by the lips, chin, or other
expenditure of energy, leaving less energy available for body movements.
work, with the result that the entropy of the system and its environmental health, the total of various aspects of sub-
surroundings increases. stances, forces, and conditions in and about a community
ENT specialist. See otolaryngologist. that affect the health and well-being of the population.
enucleation /inoo′klē·ā′shən/ [L, e, without, nucleus, environmental health technician, a health care profes-
nut], 1. removal of an organ or tumor in one piece. sional who performs technical assistance under professional
2. removal of the entire eyeball, performed for malignancy, supervision in monitoring environmental health hazards such
severe infection, extensive trauma, or control of pain in glau- as radioactive contamination, air and water pollution, and
coma. Local or general anesthesia is used. The optic nerve and disposal of chemical wastes of industry.
muscle attachments are cut; if possible, the surrounding layer environmental management, a nursing intervention from
of fascia is left with the muscles. A round implant of hydroxy- the Nursing Interventions Classification (NIC) defined as the
apatite (coralline or syntetic) is inserted, and the muscles are manipulation of the patient’s surroundings for therapeutic
sutured around it, providing a permanent stump to give support benefit, sensory appeal, and psychological well-being. See
and motion to an artificial eye, or an implant of porous poly- also Nursing Interventions Classification.
ethylene is inserted, allowing the rectus muscle to be sutured environmental management: attachment process, a
directly to the implant. After surgery, pressure dressings are nursing intervention from the Nursing Interventions Classi-
kept in place for 1 or 2 days to prevent hemorrhage. Other pos- fication (NIC) defined as manipulation of the patient’s sur-
sible complications include thrombosis of nearby blood ves- roundings to facilitate the development of the parent-infant
sels, which may lead to infection, including meningitis. relationship. See also Nursing Interventions Classification.
environmental management: comfort, a nursing inter-
vention from the Nursing Interventions Classification (NIC)
defined as manipulation of the patient’s surroundings for pro-
motion of optimal comfort. See also Nursing Interventions
Classification.
environmental management: community, a nursing
intervention from the Nursing Interventions Classification
(NIC) defined as monitoring and influencing of the physi-
cal, social, cultural, economic, and political conditions that
affect the health of groups and communities. See also Nurs-
ing Interventions Classification.
environmental management: home preparation, a
nursing intervention from the Nursing Interventions Clas-
sification (NIC) defined as preparing the home for safe and
effective delivery of care. See also Nursing Interventions
Classification.
environmental management: safety, a nursing interven-
tion from the Nursing Interventions Classification (NIC)
Enucleation (Swartz, 2009/Courtesy Ben Serar, MA, CRA) defined as monitoring and manipulation of the physical
environmental management: violence prevention 626 eosinophil
environment to promote safety. See also Nursing Interven- The inducer may be a substance that inactivates a repressor
tions Classification. chemical in the cell.
environmental management: violence prevention, a enzyme-linked immunosorbent assay (ELISA), a labo-
nursing intervention from the Nursing Interventions Clas- ratory technique for detecting specific antigens or antibodies
sification (NIC) defined as monitoring and manipulation of by using enzyme-labeled immunoreactants and a solid-phase
the physical environment to decrease the potential for violent binding support, such as a test tube. A number of different
behavior directed toward self, others, or environment. See enzymes can be used, including carbonic anhydrase, glu-
also Nursing Interventions Classification. cose oxidase, and alkaline phosphatase. Labeling is done by
environmental management: worker safety, a nursing covalently binding the enzyme to the test substance through
intervention from the Nursing Interventions Classification an enzyme-protein coupling agent such as glutaraldehyde.
(NIC) defined as monitoring and manipulation of the work- Products of the reaction may be detected by fluorometry or
site environment to promote safety and health of workers. photometry. ELISA is nearly as sensitive as radioimmunoas-
See also Nursing Interventions Classification. say and more sensitive than complement fixation, agglutina-
environmental medicine, a practice of medicine in which tion, and other techniques.
the major focus is on cause-and-effect relationships in enzyme therapy, in complementary medicine, the oral
health. Evaluations are made of such factors as eating and administration of proteolytic enzymes for the purpose of
living habits and types of air breathed. Testing in the patient’s improving immune system function, used for a wide variety
own environment is performed to determine what precipi- of disorders, including trauma, inflammation, autoimmune
tators are present that may be related to disease or other diseases, and viral infection, and as adjunctive therapy in
health problems. A treatment protocol is developed from this cancer treatment.
information. enzymology /en′zīmol′əjē/, the study of enzymes and their
environmental risk protection, a nursing intervention actions.
from the Nursing Interventions Classification (NIC) defined enzymolysis /en′zīmol′isis/ [Gk, en, in, zyme, ferment,
as preventing and detecting disease and injury in populations lysis, loosening], destruction or change of a substance
at risk from environmental hazards. See also Nursing Inter- caused by means of enzymatic action.
ventions Classification. enzymopenia /en′zīmōpē′nē·ə/, the deficiency of an
environmental services, a functional unit of a health care enzyme.
facility. It has the responsibility for laundry, liquid and solid enzymuria /en′zīm ˘ oor′ē·ə/, the presence of enzymes in
waste control, safe disposal of materials contaminated by urine.
radiation or pathogenic organisms, and general maintenance EOA, abbreviation for esophageal obturator airway.
of safety and housekeeping. EOMs, 1. abbreviation for extraocular muscles. 2. abbre-
enzacamene /en′zah-kam′ēn/, an absorber of ultraviolet viation for extraocular movement.
radiation, used topically as a sunscreen. eosin /ē′əsin/, a group of red acidic xanthine dyes often used
enzygotic twins. See monozygotic twins. in combination with a blue-purple basic dye such as hema-
enzymatic debridement /en′zīmat′ik/, the use of nonir- toxylin to stain tissue slides in the laboratory.
ritating, nontoxic vegetable enzymes to remove dead tissue eosin-, prefix meaning “a rose, red, or dawn color”: eosino-
from a wound without destroying normal tissue. penia, eosinophil, eosinophilic.
enzymatic detergent asthma, an allergic reaction expe- eosinoblast. See myeloblast.
rienced by persons who have become sensitized to alcalase, eosinopenia /ē′əsinəpē′nē·ə/, an abnormally low number of
an enzyme contained in some laundry detergents. Alcalase eosinophil leukocytes in the blood.
is produced by the bacterium Bacillus subtilis, and persons eosinophil /ē′əsin′əfil/ [Gk, eos, dawn, philein, to love], a
sensitive to the enzyme are also usually allergic to the bac- granulocytic bilobed leukocyte characterized by large num-
terium. Asthmatic symptoms may progress in severe cases bers of regular refractile cytoplasmic granules that stain
to an allergic alveolitis. The most serious cases were origi- bright orange with the acid dye eosin. Eosinophils constitute
nally among workers in plants that manufacture laundry 1% to 3% of the white blood cells in peripheral blood films.
detergents. They increase in number with allergy and some parasitic

enzyme /en′zīm/ [Gk, en, in, zyme, ferment], a protein conditions and decrease with steroid administration. Com-
produced by living cells that catalyzes chemical reactions in pare basophil, neutrophil. —eosinophilic, adj.
organic matter. Most enzymes are produced in tiny quanti-
ties and catalyze reactions that take place within the cells.
Digestive enzymes, however, are produced in relatively large
quantities and act outside the cells in the lumen of the diges-
tive tract. The substance that is acted upon by an enzyme is
called a substrate.
Enzyme Commission (EC), the International Commis-
sion on Enzymes, a committee established in 1956 by the
International Union of Biochemistry to standardize enzyme
classification and nomenclature.
enzyme deficiency anemia, a deficiency of enzymes in
the pathways that metabolize glucose and adenosine triphos-
phate (Embden-Meyerhof and pentose phosphate shunt path-
ways), which frequently leads to premature red blood cell
destruction.
enzyme induction [Gk, en + zyme, ferment; L, inducere,
to lead in], the increase in the rate of a specific enzyme
synthesis from basal to maximum level caused by the pres-
ence of a substrate or substrate analog that acts as an inducer. Eosinophil (Carr and Rodak, 2008)
eosinophilia 627 ependymoma
eosinophilia /ē′əsin′ōfil′yə/, abnormal increase in blood cerebrospinal fluid. It usually results from infection with
film eosinophils, accompanying an allergic response or para- Angiostrongylus cantonensis.
sitic infestation. eosinophilic myeloencephalitis, a complex of neurologi-
eosinophilia-myalgia syndrome, tryptophan-induced, cal symptoms produced by invasion of the central nervous
a potentially fatal disorder resulting from ingestion of tryp- system by Gnathostoma spinigerum, including severe nerve
tophan. It is characterized by a symptom complex of severe root pain, followed by paralysis of extremities and sudden
muscle pain, tenosynovitis, muscle edema, and skin rash sensorial impairment, accompanied by increased number of
lasting several weeks. eosinophils in the cerebrospinal fluid, which is often bloody
eosinophilic /ē′əsin′əfil′ik/, 1. the tendency of a cell, tissue, or yellowish.
or organism to be readily stained by the dye eosin. 2. per- eosinophilic pneumonia, inflammation of the lungs, char-
taining to an eosinophilic leukocyte. acterized by infiltration of the alveoli with eosinophils and
eosinophilic adenoma. See acidophilic adenoma. large mononuclear cells, pulmonary edema, fever, night
eosinophilic cellulitis. See Wells’ syndrome. sweats, cough, dyspnea, and weight loss. The disease may
eosinophilic cholangitis, a rare type of cholangitis result- be caused by a hypersensitivity reaction to fungi spores;
ing from eosinophilic infiltration and characterized by mul- plant fibers; wood dust; bird droppings’ porcine, bovine, or
tiple strictures in the bile ducts. The cause is unknown. piscine proteins; Bacillus subtilis enzyme in detergents; or
eosinophilic enteropathy, a rare form of food allergy that certain drugs. Treatment consists of removal of the offending
is characterized by nausea, crampy abdominal pain, diar- allergen and symptomatic and supportive therapy. Compare
rhea, urticaria, an elevated eosinophil count in the blood, and bronchopneumonia. See also asthmatic eosinophilia.
eosinophilic infiltrates in the intestine. Diagnosis is made by -eous, suffix meaning “like” or “composed of ” or “relating
an elimination diet. Symptoms usually disappear when the to” something specified: cutaneous, osseous.
offending food is removed from the diet. EP, abbreviation for evoked potential.
eosinophilic fasciitis, inflammation of fasciae of the limbs, ep-. See epi-.
associated with eosinophilia, edema, and swelling. The cause EPA, abbreviation for Environmental Protection Agency.
is unknown, but the condition often occurs after strenuous epaxial muscles, the intrinsic muscles of the back.
exercise. Also called Shulman’s syndrome. EPEC, abbreviation for enteropathic Escherichia coli.
ependyma /ipen′dimə/ [Gk, an upper garment], a layer of
ciliated epithelial membrane that lines the central canal of
the spinal cord and the ventricles of the brain. —ependymal
/ipen′diməl/, adj.
Ependymal
cells
Eosinophilic fasciitis (Callen et al, 2000)
eosinophilic gastroenteritis, a disorder marked by infil-

tration of the mucosa of the small intestine by eosinophils,
with edema but without vasculitis, and by eosinophilia of
the peripheral blood. Symptoms, including abdominal pain, Ependymal cells (Herlihy, 2011)
diarrhea, nausea, fever, and malabsorption, depend on the
site and extent of the disorder. The stomach is also frequently ependymal glioma, a large vascular fairly solid tumor in
involved. The disorder is commonly associated with intoler- the fourth ventricle, composed of malignant glial cells.
ance to specific foods. ependymitis /ipen′dimī′tis/, an inflammation of the epen-
eosinophilic granuloma. 1. a simple or multiple growth dymal tissue, the epithelial lining of the ventricles of the
in the bone or lung characterized by numerous eosinophils brain and of the canal of the spinal cord.
and histiocytes. Eosinophilic granulomas occur most fre- ependymoblastoma /ipen′dimōblastō′mə/, a malignant
quently in children and adolescents. 2. See anisakiasis. neoplasm composed of primitive cells of the ependyma. Also
eosinophilic leukemia, a malignant neoplasm of the called malignant ependymoma.
blood-forming tissues in which eosinophils are the predomi- ependymoma /ipen′dimō′mə/ [Gk, ependyma, an upper
nant cells. The disease resembles chronic myelocytic leuke- garment, oma, tumor], a neoplasm composed of differen-
mia but may have an acute course, even when no blast forms tiated cells of the ependyma. The tumor, which is usually
are present in the peripheral blood. a benign pale, firm, encapsulated, somewhat nodular mass,
eosinophilic leukocyte. See eosinophil. commonly arises from the roof of the fourth ventricle and
eosinophilic meningitis, meningitis with an increase in may extend to the spinal cord. Primary lesions may also
lymphocytes and a high percentage of eosinophils in the develop in the spinal cord. Also called ependymocytoma.
ephapse 628 epicranius
lacrimation, joint pains, tremor, and stiffness. Also called
phlebotomus fever.
EPI, abbreviation for echo planar imaging.
epi-, ep-, prefix meaning “on, upon”: epicanthus, epicostal,
epidural.
epiblast /ep′iblast′/ [Gk, epi, upon, blastos, germ], the
primordial outer layer of the blastocyst or blastula, before
differentiation of the germ layers, that gives rise to the ecto-
derm and contains cells capable of forming the endoderm
and mesoderm. See also ectoderm. —epiblastic, adj.
epicanthus /ep′ikan′thəs/ [Gk, epi + kanthos, lip of a ves-
sel], a vertical fold of skin over the angle of the inner
canthus of the eye. It may be slight or marked, covering
the canthus and the caruncle. It is a hereditary trait in Asian
people and is of no clinical significance. Some infants with
Down syndrome have marked epicanthal folds. Also called
epicanthal fold, epicanthic fold. —epicanthal, epicanthic,
adj.
Ependymoma (Kumar et al, 2010) epicardia /-kär′dē·ə/ [Gk, epi, above, kardia, heart], the
part of the esophagus that lies between the cardiac orifice of
ephapse /ef′aps/ [Gk, ephasis, a touching], a point of lat- the stomach and the esophageal opening of the diaphragm.
eral contact between nerve fibers across which impulses may epicardial. See epicardium.
be transmitted directly through the cell membranes rather epicardial pacing. See pacing.
than across a synapse. Compare synapse. —ephaptic, adj. epicardium /ep′ikär′dē·əm/ [Gk, epi + kardia, heart], the
ephaptic transmission /ifap′tik/, the passage of a neural outermost of the three layers of tissue that form the heart
impulse from one nerve fiber, axon, or dendrite to another wall. It is composed of a single sheet of squamous epithelial
through the membranes. The mechanism may be a factor in cells overlying delicate connective tissue. The epicardium
epileptic seizures. Compare synaptic transmission. is the visceral portion of the serous pericardium and folds
ephebiatrics /ēfeb′ē·at′riks/ [Gk, ephebos, puberty, iatros, back on itself to form the parietal portion of the serous peri-
physician], a branch of medicine that specializes in the cardium. Compare myocardium. See also pericardium.
health of adolescents. —epicardial, adj.
ephedra, an evergreen herb found throughout the world. epicondylar. See epicondyle.
Also called ma huang. epicondylar fracture /-kon′dilər/, any fracture that
n uses: The sale of ephedra was banned in the U.S. by the involves the medial or lateral epicondyle of a specific bone,
FDA in December of 2003 because of safety concerns (e.g., such as the humerus.
highlighted by death of baseball pitcher Steve Bechler), epicondyle /ep′ikon′dəl/ [Gk, epi + kondylos, knuckle], a
making it the first over-the-counter nutritional supplement projection on the surface of a bone above its condyle.
to be banned. This herb was used for seasonal and chronic —epicondylar, adj.
asthma, nasal congestion, and cough. epicondylitis /ep′ikon′dilī′tis/, a painful and sometimes dis-
n contraindications: People cultivating their own ephe- abling inflammation of the muscle and surrounding tissues
dra should be aware that it is contraindicated in those with of the elbow, caused by repeated strain on the forearm near
known hypersensitivity to sympathomimetics, women who the medial or lateral epicondyle of the humerus. The strain
are pregnant or lactating, children less than 12 years of age, may result from violent extension or supination of the wrist
and people with narrow-angle glaucoma, seizure disorders, against a resisting force, such as may occur in playing tennis
hyperthyroidism, diabetes mellitus, prostatic hypertrophy, or golf, twisting a screwdriver, or carrying a heavy load with
arrhythmias, heart block, hypertension, psychosis, tachycar- the arm extended. Treatment usually includes rest, injection
dia, and angina pectoris. of procaine with or without hydrocortisone, stretching and
epHEDrine /ef′ədrēn/, an alpha- and beta-adrenergic ago- strengthening of the muscle, and, in some cases, surgery to
nist that also promotes the release of norepinephrine from release part of the muscle from the epicondyle. See also golf-
sympathetic nerve terminals. er’s elbow, lateral humeral epicondylitis.
n indications: It is prescribed in the treatment of asthma epicranial. See epicranium.
and bronchitis and is used topically as a nasal decongestant. epicranial aponeurosis /-krā′nē·əl/ [Gk, epi + kranion,
The drug is historically important, but its use is now limited skull, apo, away, neuron, tendon], a fibrous membrane that
because of the availability of more selective beta-2 agonists covers the cranium between the occipital and frontal muscles
for treating asthma. of the scalp. Also called galea aponeurotica.
n contraindications: Concomitant administration of epicranium /-krā′nē·əm/ [Gk, epi + kranion, skull], the
monoamine oxidase inhibitors, hypertension, cardiac artery complete scalp, including the integument, the muscular
disease, cardiac arrhythmia, or known hypersensitivity to sheets, and the aponeuroses. Compare epicranius. —epi-
this drug prohibits its use. cranial, adj.
n adverse effects: Among the more serious adverse epicranius [Gk, epi + kranion, skull], the broad muscular
effects are nervousness, insomnia, anorexia, and increased and tendinous layer of tissue covering the top and sides of
blood pressure. the skull from the occipital bone to the eyebrows. It consists
ephemeral /ifem′ərəl/ [Gk, epi, above, hemera, day], per- of broad, thin muscular bellies, connected by an extensive
taining to a short-lived condition, such as a fever. aponeurosis. Innervation of the epicranius by branches of the
ephemeral fever, an infection of cattle caused by the facial nerves can draw back the scalp, raise the eyebrows,
bovine ephemeral fever virus. It is characterized by respira- and move the ears. Compare epicranium. See also epicra-
tory symptoms including increased oropharyngeal secretions, nial aponeurosis, occipitofrontalis, temporoparietalis.
epicritic 629 epidermal nevus
epicritic /-krit′ik/, pertaining to the somatic sensations epidemic myositis. See epidemic myalgia, epidemic
of fine discriminative touch, vibration, two-point dis- pleurodynia.
crimination, stereognosis, and conscious and unconscious epidemic parotitis. See mumps.
proprioception. epidemic pleurodynia, an acute infectious disease caused
epidemic /-dem′ik/ [Gk, epi + demos, people], 1. adj, by strains of enterovirus Coxsackie, type B, mainly affect-
affecting a significantly large number of people at the same ing children. It is characterized by severe intermittent pain
time. 2. n, a disease that spreads rapidly through a demo- in the abdomen or lower chest, fever, headache, sore throat,
graphic segment of the human population, such as everyone malaise, and extreme myalgia. The symptoms may continue
in a given geographic area, a military base, or similar popu- for weeks or subside after a few days and recur for a period
lation unit, or everyone of a certain age or sex, such as the of weeks. Transmission is through the fecal-oral route. Treat-
children or women of a region. 3. n, a disease or event whose ment is symptomatic; complete recovery is usual. Also called
incidence is beyond what is expected. Compare endemic, Bornholm disease, devil’s grip, epidemic myalgia, epi-
epizootic, pandemic. demic myositis.
epidemic cerebrospinal meningitis. See meningococcal epidemic typhus, an acute severe rickettsial infection
meningitis. characterized by prolonged high fever, headache, and a
epidemic diarrhea in newborns [Gk, epi, above, demos, dark maculopapular rash that covers most of the body. The
the people, dia, through, rhein, flow; ME, newe + beren], causative organism, Rickettsia prowazekii, is transmitted
any severe gastroenteritis epidemic among a community of indirectly as a result of the bite of the human body louse or
newborns, as may occur in a hospital nursery. squirrel flea or louse; the pathogen is contained in feces of
epidemic encephalitis, any diffuse inflammation of the the louse and enters the body tissues as the bite is scratched.
brain occurring in epidemic form. Two kinds of epidemic Disease is manifested by the abrupt onset of an intense head-
encephalitis are Japanese encephalitis and St. Louis ache and a fever reaching 40° C (104° F) beginning after an
encephalitis. Also called von Economo’s encephalitis. See incubation period of 1 week. The rash follows on the fifth
also encephalitis. day of onset. Complications may include vascular collapse,
epidemic hemoglobinuria. See hemoglobinuria. renal failure, pneumonia, or gangrene. Mortality rate is as
epidemic hemorrhagic conjunctivitis [Gk, epi, above, high as 40% depending on preexisting clinical conditions.
demos, the people, haima, blood, rhegnynei, to gush; L, Treatment may include antipyretics and supportive symp-
conjunctivus, connecting; Gk, itis, inflammation], a highly tomatic care. Health care workers are at risk of acquiring this
contagious infection, commonly involving an enterovirus, infection from louse bites or louse feces. Also called classic
that begins with eye pain accompanied by swollen eyelids typhus, European typhus, jail fever, louse-borne typhus.
and hyperemia of the conjunctiva. It is a self-limiting disor- Compare murine typhus. See also Brill-Zinsser disease,
der that has no specific remedy. Rickettsia, typhus.
epidemic hemorrhagic fever, a severe viral infection epidemic vomiting, an episode of sudden vomiting by
marked by fever and bleeding. The disorder develops rapidly members of a group of people in close contact. The vomiting,
and is characterized initially by fever and muscle ache, pos- caused by ribonucleic acid Norwalk virus infection, usually
sibly followed by hemorrhage, peripheral vascular collapse, begins without previous signs or symptoms of illness and
hypovolemic shock, and acute kidney failure. The arbovirus may continue for several hours, ending abruptly. The vomit-
or other pathogen is believed to be transmitted by mosqui- ing may be accompanied by headache, abdominal pain, and
toes, ticks, mites, or rodents. The pathophysiological charac- diarrhea. The patients are frequently children who are attend-
teristics of the hemorrhagic effect are uncertain, although it is ing the same school.
assumed the disease organism causes damage to the lining of epidemiological. See epidemiology.
the capillaries. Among the various forms of epidemic hemor- epidemiologist /-dē′mē·ol′əjist/, a physician or medical
rhagic fevers are Argentine hemorrhagic fever, Bolivian scientist who studies the incidence, prevalence, spread,
hemorrhagic fever, dengue fever, Lassa fever, and yellow prevention, and control of disease in a community or a
fever. See also specific viral infections. specific group of individuals. In a hospital a physician
epidemic hysteria. See major hysteria. may be assigned as a staff epidemiologist with responsi-
epidemic keratoconjunctivitis (EKC) [Gk, epi, above, bility for directing infection control programs within the
demos, the people, keras, horn; L, conjunctivus; Gk, itis, facility.
inflammation], an adenovirus infection consisting of an epidemiologist nurse, a registered nurse with special
acute, severely painful conjunctivitis followed by keratitis. education and experience in the control of infections in the
In the western world, EKC strikes predominantly in selected health care facility and community.
environments: industry eye clinics, emergency rooms, nurs- epidemiology /-dē′mē·ol′əjē/ [Gk, epi + demos, people,
ing homes, schools, camps, and child-care centers. The virus logos, science], the study of the determinants of disease
is often found on the hands of people with active EKC. events in populations. —epidemiological, adj.
Hand-to-eye transmission is felt to be a common method of epiderm-, epidermo-, prefix meaning “epidermis”: epi-
spread, especially in the medical setting. Swimming pools dermoid, epidermolysis, epidermolytic.
and schools have been implicated in transmission, and it epidermal growth factor (EGF) /ep′idur′məl/, a mito-
can spread through inanimate objects. In the eye clinic and genic polypeptide produced by many cell types and made
emergency room, instruments and contaminated eye drops in large amounts by some tumors. It promotes growth and
can transmit the virus. EKC is quite contagious and prone to differentiation, is essential in embryogenesis, and is also
epidemics that may be quite large. It is treated by lubrication important in wound healing. It has been found to be part
with artificial tears. of a family of compounds that includes also transforming
epidemic myalgia, a disease caused by coxsackie B virus. growth factor.
It is characterized by sudden acute chest or epigastric pain epidermal nevus /-dur′məl/ [Gk, epi + derma, skin; L,
and fever lasting 3 to 14 days, followed by complete sponta- naevus, birthmark], a discrete discolored congenital lesion
neous recovery. Also called devil’s grip, epidemic myositis, caused by an overgrowth of epidermis. It may be seen in
epidemic pleurodynia. newborns. Also called epithelial nevus, hard nevus.
epidermis 630 epidural anesthesia/analgesia
Epidermal nevus (Callen et al, 2000)
epidermis /ep′idur′mis/ [Gk, epi + derma, skin], the super- Junctional epidermolysis bullosa
ficial avascular layers of the skin, made up of an outer dead, (Weson, Lane, and Morelli, 2007)
cornified part and a deeper living, cellular part. Each layer is
named for its unique function, texture, or position. The deepest epididym-, prefix meaning “epididymis”: epididymectomy,
layer is the stratum basale. It anchors the more superficial layers epididymitis.
to the underlying tissues, and it provides new cells to replace epididymal appendix, a cystic structure sometimes found
those lost by abrasion from the outermost layer. The cells of on the head of the epididymis. It represents a remnant of the
each layer migrate upward as they mature. Above the stratum mesonephros. Also called appendix epididymidis.
basale lies the stratum spinosum. As the cells migrate to the next epididymis /ep′idid′imis/ pl. epididymides [Gk, epi + didy-
layer, the stratum granulosum, they become flat, lying parallel mos, pair], one of a pair of long, tightly coiled ducts that
with the surface of the skin. Over this layer lies a clear, thin band carry sperm from the seminiferous tubules of the testes to
of homogenous tissue called the stratum lucidum. The outer- the vas deferens.
most layer, the stratum corneum, is composed of scaly, squa- epididymitis /ep′idid′imī′tis/ [Gk, epi + didymos + itis,
mous plaques of dead cells that contain keratin, a waterproofing inflammation], acute or chronic inflammation of the epi-
protein that hardens over several days. This horny layer is thick didymis. It may result from venereal disease, urinary tract
over areas of the body subject to abrasion, such as the palms of infection, prostatitis, prostatectomy, or prolonged use of
the hands, and thin over other more protected areas. Altogether indwelling catheters. Symptoms include fever and chills;
these layers are between 0.5 and 1.1 mm in thickness. Also pain in the groin; and tender, swollen epididymides. Treat-
called cuticle. See also skin. —epidermal, epidermoid, adj. ment includes bed rest, scrotal support, antiinflammatory
epidermitis /ep′idurmī′tis/, an inflammation of the epider- medications, and antibiotics, as appropriate.
mis, the outer layer of the skin. epididymoorchitis /ep′idid′imō′ôrkī′tis/ [Gk, epi +, didy-
epidermoid carcinoma /-dur′moid/ [Gk, epi + derma + mos + orchis, testis, itis], inflammation of the epididymis
eidos, form], a malignant neoplasm in which the tumor and of the testis. See also epididymitis, orchitis.
cells tend to differentiate in the manner of epidermal cells, epididymovesiculography /ep′idid′imōves′ikyəlog′rəfē/,
then form horny cells called prickle cells. the radiographic examination of the seminal ducts. It is usu-
epidermoid cyst, a common benign cavity lined by kera- ally performed in cases of sterility, cysts, tumors, abscesses, or
tinizing epithelium and filled with a cheesy material com- inflammation. The contrast medium may be injected through
posed of sebum and epithelial debris. The cyst is in the skin, a catheter in the urethra or placed directly in the ducts through
connected to the surface by a pore. Treatment is surgical a surgical incision in the upper part of the scrotum.
excision. Also called epidermal inclusion cyst, sebaceous epidural /ep′id ˘ oor′əl/ [Gk, epi + dura, hard], outside or
cyst. Compare pilar cyst. above the dura mater.
epidermolysis bullosa /ep′idərmol′isis/ [Gk, epi + derma + epidural abscess, a disorder characterized by inflamma-
lysis, loosening], a group of rare hereditary skin diseases in tion and a collection of pus between the dura mater of the
which vesicles and bullae develop, usually at sites of trauma. brain and skull, or between the dura mater of the spinal cord
Severe forms may also involve mucous membranes and may and the vertebral canal. It is called an intracranial epidural
leave scars and contractures on healing. Basal cell and squa- abscess if the infection is inside the skull. The infection is
mous cell carcinomas sometimes develop in the scar tissue. usually caused by a bacterium such as Staphylococcus, but
epidermolytic hyperkeratosis [Gk, epi + derma, skin + it can also be secondary to a fungal or viral infection, which
lysis, loosening; Gk, hyper, excess + keras, horn + osis, con- can occur secondary to a chronic ear or sinus infection, a
dition], a rare autosomal-dominant form of ichthyosis with penetrating head injury, or mastoiditis. Fever, headache, and
a high frequency of spontaneous mutations. Present at birth, neurological symptoms are common.
it is characterized by generalized erythroderma and severe epidural anesthesia/analgesia, a type of anesthesia block in
hyperkeratosis with small wartlike scales over the entire which a local anesthetic is injected into the epidural space sur-
body, especially in body folds, and sometimes on the palms rounding the dural sack which contains CSF and the spinal cord.
and soles. There are also recurrent bullae on the lower limbs. Epidurals are most commonly performed in the lumbar area by
If sepsis and electrolyte imbalances are not treated correctly an injection of medication through a catheter placed in the epi-
in neonates, morbidity can occur. Also called bullous con- dural space. Analgesia is maintained by either intermittent dos-
genital ichthyosiform erythroderma. See also ichthyosis. ing or a continuous infusion into the catheter. Close monitoring
epidermomycosis. See dermatophytosis. of vital signs, respirations, pain, and sensation is important. Epi-
epidermophytosis /ep′idur′mōfītō′sis/, a superficial fungus durals have a wide application in anesthesia and pain manage-
infection of the skin. ment because of their safety and versatility. Epidural anesthesia
epidural blood patch 631 epiglottitis
Spinal cord
Pia mater
Dura mater
Epidural catheter
Epidural space in position
Subarachnoid space
Epidural anesthesia (Monahan et al, 2007)
or analgesia can be tailored to affect an area of the body from four nodes along the caudal portion of the inferior epigastric
the lower extremities to the upper abdomen. Epidurals are often vessels. See also lymph, lymphatic system, lymph node.
used for labor and birth and in postoperative pain management. epigastric pain [Gk, epi, above, gaster, stomach; L, poena,
The most common adverse effects include unintentional dural penalty], pain in the upper middle part of the abdomen.
membrane puncture, postdural puncture headache, and hypoten- epigastric reflex [Gk, epi, above, gaster, stomach; L,
sion from sympathetic nerve block and vascular dilation. Severe reflectere, to bend back], a contraction of the rectus
complications may include intravascular injection of local anes- abdominis muscle that occurs when the skin surface in the
thetic and seizures, hematoma of the epidural space. See also upper and middle abdominal region is stimulated. The reflex
epidural hematoma, regional anesthesia. also may be induced by stimulation of the axillary region of
epidural blood patch (EBP), a treatment for postdural the fifth and sixth dorsal nerves.
puncture headache in which 15 to 20 mL of a patient’s autol- epigastric region, the part of the abdomen in the upper zone
ogous blood is injected into the epidural space at or near the between the right and left hypochondriac regions. Also called
location of a dural puncture. The volume injected displaces antecardium, epigastrium. See also abdominal regions.
cerebrospinal fluid (CSF) from the lumbar CSF space into epigastric sensation, a weak, sinking feeling of undefined
the area surrounding the brain, often yielding immediate nature that is usually localized in the pit of the stomach but
relief. When the blood clots, it seals the dural puncture, pro- may occur throughout the abdominal region. See also sensa-
hibiting further leakage of CSF from the subarachnoid space. tion, def. 1.
epidural hematoma, accumulation of blood in the epidu- epigastrium. See epigastric region.
ral space, caused by damage to and leakage of blood from the epigenesis /ep′ijen′əsis/ [Gk, epi + genein, to produce], (in
middle meningeal artery, producing compression of the dura embryology) a theory of development in which the organism
mater and thus of the brain. Unless evacuated, it may result grows from a simple to more complex form through the pro-
in herniation through the tentorium and death. gressive differentiation of an undifferentiated cellular unit.
epidural hemorrhage, a hemorrhage that produces a col- Compare preformation. —epigenesist, n., epigenetic, adj.
lection of blood outside the dura mater of the brain or spinal epiglott-, prefix meaning “epiglottis”: epiglottitis.
cord. It usually results from tearing of the middle meningeal epiglottic vallecula, a depression between the lateral and
artery and may be rapidly life threatening. Also called extra- median glossoepiglottic folds on each side.
dural hemorrhage. epiglottiditis. See epiglottitis.
epidural space, the space immediately above and sur- epiglottis /ep′iglot′is/ [Gk, epi + glossa, tongue], the thin,
rounding the dura mater of the brain or spinal cord, beneath leaf-shaped cartilaginous structure that overhangs the larynx
the endosteum of the cranium and the spinal column. like a lid and prevents food from entering the larynx and the
epifascial /ep′ifash′ē·əl/ [Gk, epi + L, fascia, band], on a trachea while swallowing.
fascia. epiglottitis /ep′iglotī′tis/ [Gk, epi + glossa, tongue, itis,
epifolliculitis /ep′ifolik′yəlī′tis/, an inflammation of the hair inflammation], an inflammation of the epiglottis. Acute
follicles of the head. See also folliculitis. epiglottitis is a severe form of the condition, which primar-
epigastric /-gas′trik/ [Gk, epi, above, gaster, stomach], per- ily affected children 2 to 7 years of age before a significant
taining to the epigastrium, the area above the stomach. decrease in the occurrence of the disease resulting from
epigastric arteries, the arteries (superficial, superior, and the introduction of the Haemophilus influenzae B vaccine
inferior) that supply the medial abdominal wall. in 1985. It is characterized by fever; sore throat; drooling;
epigastric hernia, the protrusion of an internal organ stridor; croupy cough; and an erythematous, swollen epiglot-
through the linea alba. tis. The patient may become cyanotic and require an emer-
epigastric node [Gk, epi + gaster, stomach; L, nodus, gency tracheostomy to maintain respiration. The causative
knot], a node in one of the seven groups of parietal lymph organism is usually Haemophilus influenzae, type B, but it
nodes serving the abdomen and the pelvis, comprising about can also be caused by Streptococcus, groups A, B, and C;
epilating forceps 632 epilepsy
S. pneumoniae; Klebsiella pneumoniae; Candida albicans; with cerebral trauma, intracranial infection, brain tumor, vas-
Staphylococcus aureus; Neisseria meningitides; Varicella cular disturbances, intoxication, or chemical imbalance. See
zoster; and other viruses. Antibiotics, rest, oxygen, and sup- also absence seizure, focal seizure, psychomotor seizure,
portive care are usually included in treatment. Also called tonic-clonic seizure.
epiglottiditis. See also acute epiglottitis. n observations: The frequency of attacks may range from
many times a day to intervals of several years. In predisposed
individuals, seizures may occur during sleep or after physi-
cal stimulation, such as by a flickering light or sudden loud
sound. Emotional disturbances also may be significant trig-
gers. Some seizures are preceded by an aura, but others have
no warning symptoms. Most epileptic attacks are brief. They
may be localized or general, with or without clonic move-
ments, and are often followed by drowsiness or confusion.
Diagnosis is made by observation of the pattern of seizures
and abnormalities on an electroencephalogram. Diagnosis is
also aided by a system of classification of the criteria that
characterize the different types of epileptic seizures. One
major category in the classification scheme encompasses
the partial seizures, which often begin focally, then spread
to other brain areas. A second major category includes the
generalized seizures, which usually begin deep in the brain
and impair consciousness.
n interventions: The kind of epilepsy determines the
selection of preventive medication. Correctable lesions and
metabolic causes are eliminated when possible. During a
seizure the patient should be protected from injury without
being severely restrained.
n nursing considerations: In addition to protecting the
Acute epiglottitis (Marx, 2010) patient from injury, a nurse observing an epileptic seizure
should carefully note and accurately describe the sequence of
epilating forceps /ep′ilā′ting/ [L, e + pilus, without seizure activity. The patient and family must be fully informed
hair], a kind of small spring forceps, used for removing and counseled about the disorder; the importance of regularly
unwanted hair. taking prescribed medication, never discontinuing treatment
epilation. See depilation. without professional advice, and using a medical identifica-
epilepsy /ep′ilep′sē/ [Gk, epilepsia, seizure], a group of tion tag; the toxic effects of medication; and the maintenance
neurological disorders characterized by recurrent episodes of the most normal life-style possible. Nurses also have a
of convulsive seizures, sensory disturbances, abnormal responsibility to help improve the public’s attitude toward epi-
behavior, loss of consciousness, or all of these. Common to lepsy and to correct misunderstanding that limits educational
all types of epilepsy is an uncontrolled electrical discharge and occupational opportunities for individuals affected by this
from the nerve cells of the cerebral cortex. Although most condition. See also anticonvulsant, aura, central nervous
epilepsy is of unknown cause, it is sometimes associated system stimulant, clonus, ictus, tonic. —epileptic, adj., n.
Childhood absence epilepsy: typical EEG pattern (Goldman et al, 2004)
epileptic cry 633 epirubicin
epileptic cry /ep′ilep′tik/, a loud vocalization by a person epiphyseal /ep′ifiz′ē·əl, ipif′əsē′əl/ [Gk, epi, above, phyein,
with epilepsy, often immediately before onset of a seizure. to grow], pertaining to or resembling the epiphysis. Also
epileptic dementia [Gk, epilepsia, seizure; L, de + mens, spelled epiphysial.
mind], a loss of cognitive and intellectual functions that epiphyseal fracture [Gk, epi + phyein, to grow, fractura,
develops in some cases of incompletely controlled epilepsy. break], a fracture involving the epiphyseal plate of a long
Symptoms include slowness and circumstantiality of speech bone, which causes separation or fragmentation of the plate.
and narrowed attention span. Also called Salter fracture.
epileptic march. See cortical march. epiphyseal plate [Gk, epi, above, phyein, to grow, platys,
epileptic stupor, the state of unawareness and unrespon- flat], a thin layer of cartilage between the epiphysis, a sec-
siveness that follows an epileptic seizure or postepileptic ondary bone-forming center, and the bone shaft. The new
state. bone forms along the plate. Epiphyseal plates remain open
epileptic vertigo [Gk, epilepsia, seizure; L, vertigo, dizzi- until late adolescence. Also called growth plate.
ness], an aura of dizziness that may precede, accompany, epiphysial. See epiphyseal.
or follow an epileptic seizure. epiphysis /epif′isis/ pl. epiphyses [Gk, epi + phyein, to
epileptogenic /ep′ilep′tōjen′ik/, causing epileptic seizures. grow], the enlarged proximal and distal ends of a long bone.
epiloia. See tuberous sclerosis. See also epiphyseal plate. —epiphysial /ipif′əsē′əl/, adj.
epimysium /ep′imiz′ē·əm/ [Gk, epi + mys, muscle], the epiphysis cerebri. See pineal body.
outermost fibrous sheath that covers a muscle, continuous epiphysitis /ipif′isī′tis/, an inflammation of the epiphysis,
with the perimysium. It is sturdy in some areas but more deli- usually of a long bone, such as the femur or humerus. The
cate in others, such as those areas where the muscle moves disorder mainly affects children.
freely under a strong sheet of fascia. The epimysium may epipial /ep′i·pi′əl/ [Gk, epi + L, pia, soft or tender], situ-
also fuse with fascia that attaches a muscle to a bone. ated on the pia mater.
epINEPHrine /ep′ənef′rin/ [Gk, epi + nephros, kid- epiploic /ep′iplō′ik/, pertaining to the omentum.
ney], an endogenous adrenal hormone and synthetic adren- epiploic appendix, one of the fat pads, 2 to 10 cm long,
ergic agent. It acts as an agonist at alpha-1, alpha-2, beta-1, scattered through the peritoneum along the colon and the
and beta-2 receptors. Also called adrenaline. upper part of the rectum, especially along the transverse and
n indications: It is prescribed to treat anaphylaxis, acute sigmoid colon.
bronchial spasm, and nasal congestion and to increase the epiploic foramen [Gk, epiploon, caul; L, foramen, a
effectiveness of a local anesthetic. hole]. See omental foramen.
n contraindication: Known hypersensitivity to this drug epipygus. See pygomelus.
prohibits its use. epiretinal /ep′iret′inal/, overlying the retina.
n adverse effects: Among the most serious adverse epiretinal membrane, a pathological membrane partially
effects are arrhythmias, increases in blood pressure, rebound covering the surface of the retina, probably originating from
congestion (when it is used as a decongestant), tachycardia, the retinal pigment epithelial and glial cells. Membranes
and nervousness. peripheral to the macula are generally asymptomatic, but
epiotic /ep′ē·ot′ik/, 1. pertaining to the portion of the tem- those involving the macula or adjacent to it may cause reduc-
poral bone that is the ossification center for the mastoid. tion in vision, visual distortion, and diplopia.
2. above the ear. epirubicin, an antibiotic antineoplastic.
epipastic /ep′ipas′tik/ [Gk, epipassein, to sprinkle n indications: It is used as an adjuvant therapy to treat
about], dusting powder. breast cancer with axillary node involvement following
epiphora. See tearing. resection.
Classification of seizures
Type of seizure Effect on consciousness Signs and symptoms Postictal state
Partial seizures
Simple partial (focal) Not impaired Focal twitching of extremity No
Speech arrest
Special visual sensations (e.g., seeing lights)
Feeling of fear or doom
Complex partial (formerly Impaired May begin as simple partial and progress to complex Yes
psychomotor or temporal Automatic behavior (e.g., lip smacking, chewing, or
lobe seizures) picking at clothes)
Complex partial progressing Impaired Begins as complex partial as above, then progresses to Yes
to generalized tonic-clonic tonic-clonic as described below
Generalized seizures
Absence (formerly petit mal) Impaired Brief loss of consciousness, staring, unresponsiveness No
Tonic-clonic (formerly grand Impaired Tonic phase involving rigidity of all muscles, followed by Yes
mal) clonic phase involving rhythmic jerking of muscles, and
possibly tongue biting and urinary and fecal incontinence
May be any combination of tonic and clonic movements
Atonic Impaired for only a Brief loss of muscle tone, which may cause patient to fall No
few seconds or drop something; referred to as drop attacks
Myoclonic Impaired for only a few Brief jerking of a muscle group, which may cause patient No
seconds or not at all to fall
From Monahan FD et al: Phipps’ medical-surgical nursing: health and illness perspectives, ed 8, St Louis, 2007, Mosby.
episcleritis 634 epispadias
Articular cartilage
Epiphyseal line
Epiphysis
Spongy bone
(contains red marrow)
Compact bone
Medullary cavity
(contains yellow marrow)
Blood vessel
Episcleritis (Moll, 1997)

Nutrient artery
Diaphysis
Periosteum
of the baby, or to prevent stretching of perineal muscles and
connective tissue thought to predispose to subsequent abnor-
malities of pelvic outlet relaxation, as cystocele, rectocele,
and uterine prolapse. Its prophylactic efficacy is debated. It
is usually required for a forceps delivery. The incision into
the vaginal and perineal tissue is closed with absorbable
sutures that need not be removed. Deep incisions require clo-
sure in two or more layers. Immediate complications include
hemorrhage and extension of the incision along the vaginal
sulcus or into the anal sphincter or rectum. Delayed compli-
cations include hematoma and abscess. Application of cold
packs to the perineum for several hours immediately after
delivery minimizes swelling. Later alternating applications
of heat and cold and warm sitz baths reduce discomfort, but
Epiphysis sitz baths longer than 10 minutes soften tissue and prolong
healing time. A mediolateral episiotomy is an episiotomy cut
at an angle of approximately 45 degrees with the midline.
Epiphysis (Leonard, 2009) Although it affords wide exposure for delivery, it is pain-
ful after delivery and is prone to hematoma and infection. A
n contraindications: Factors that prohibit its use include median or midline episiotomy is an incision in the perineum
severe hepatic disease, baseline neutrophil count less than in the midline; although less painful after delivery, it affords
1500 cells/mm3, severe myocardial insufficiency, recent less exposure for delivery and may extend into or through the
myocardial infarction, pregnancy, lactation, systemic infec- anal sphincter and into the rectum.
tions, and known hypersensitivity to this drug, anthracy- episode /ep′isōd/ [Gk, episodion, coming in besides], an
clines, or anthracenediones. incident or event that stands out from the continuity of every-
n adverse effects: Life-threatening effects are thrombo- day life, such as an episode of illness or a traumatic event in
cytopenia, leukopenia, anemia, neutropenia, secondary acute the course of a child’s development. —episodic, adj.
myelocytic leukemia, sinus tachycardia, premature ven- episode of hospital care, the services provided by a hospi-
tricular contractions, bradycardia, and extrasystoles. Other tal in the continuous course of care of a patient with a health
serious adverse effects include increased blood pressure condition. It may cover a sequence from emergency through
and chest pain. Common side effects include nausea, vomit- inpatient to outpatient services.
ing, anorexia, mucositis, diarrhea, amenorrhea, hot flashes, episodic. See episode.
hyperuricemia, rash, necrosis at the injection site, reversible episodic care /-sod′ik/, a pattern of medical and nursing
alopecia, infection, febrile neutropenia, lethargy, fever, and care in which services are provided to a person for a par-
conjunctivitis. ticular problem, without an ongoing relationship being estab-
episcleritis /ep′isklərī′tis/, inflammation of the outermost lished between the person and health care professionals.
layers of the sclera and the tissues overlying its posterior Emergency departments provide episodic care.
parts. episome /ep′isōm/ [Gk, epi + soma, body], an extrachro-
episcope, a skin surface microscope that uses the technol- mosomal replicating unit that exists autonomously or func-
ogy of epiluminescence microscopy (the application of oil tions with a chromosome. See also colicinogen, conjugon,
to produce translucence of the epidermis on a skin lesion). F factor, plasmid, R factor.
The episcope is placed gently over the lesion to observe its epispadias /ep′ispā′dē·əs/ [Gk, epi + spadon, a rent], a
general appearance, surface, pigment pattern, border, and congenital defect in which the urethra opens on the dorsum
depigmentation. of the penis at any point below the internal sphincter. Other
episi-, prefix meaning “vulva”: episioplast, episiotomy. pelvic abnormalities may be present. Treatment focuses on
episiotomy /epē′zē·ot′əmē/ [Gk, episeion, pubic region, correcting or managing urinary incontinence, which occurs
temnein, to cut], a surgical procedure in which an inci- because the urinary sphincters are defective, and on permit-
sion is made in a woman’s perineum to enlarge her vaginal ting sexual function. The corresponding defect in women, in
opening for delivery. It is performed most often electively to which the urethra opens by the separation of the labia minora
prevent tearing of the perineum, to hasten or facilitate birth and a fissure of the clitoris, is quite rare.
epistasis 635 eponym
epithelial cell, any one of several cells arranged in one or
more layers that form part of a covering or lining of a body
surface. The cells usually adhere to one other along their
edges and surfaces. One surface is free, and the other rests on
a noncellular basement membrane. See also epithelial tissue.
epithelial cuff. See junctional epithelium.
epithelial cyst, 1. any cyst lined by keratinizing stratified
squamous epithelium, found most often in the skin. 2. epi-
dermal cyst.
epithelial débridement [Gk, epi, above, thele, nipple; Fr,
débridement, incision], the removal of the entire inner
lining and the attachment from the gingival or periodontal
pocket with a gingival curettage. Also called canal débride-
Epispadias (Monahan et al, 2007) ment, deepithelialization.
epithelialization /-thē′lē·al′izā′shən/ [Gk, epi, above, thele,
nipple; L, ization, process], the regrowth of skin over a
epistasis /epis′təsis/ [Gk, a standing], 1. suppression of a wound.
secretion or excretion, as of blood, menses, or lochia. 2. an epithelial nevus. See epidermal nevus.
interaction between genes at different loci in which one gene epithelial peg [Gk, epi + thele, nipple], any of the papillary
masks or suppresses the expression of the other. Epistasis, projections of the epithelium that penetrate the underlying
which is nonallelic and therefore different from dominance, stroma of connecting tissue and normally develop in mucous
may be caused by the presence of homozygous recessive membranes and dermal tissues. Also called rete peg.
alleles at one gene pair, as occurs in the Bombay phenotype, epithelial rest. See embryonic rest.
or by the presence of a dominant allele at one locus that epithelial tissue [Gk, epi, above, thele, nipple; OFr, tissu], a
counteracts the expression of a dominant allele at the other closely packed single or stratified layer of cells covering the
locus. Compare dominance. —epistatic, adj. body and lining its cavities, with the exception of the blood
epistaxis /ep′istak′sis/ [Gk, a dropping], bleeding from and lymph vessels.
the nose caused by local irritation of mucous membranes, epithelioblastoma /ep′ithē′lē·ō′blastō′mə/, a tumor com-
violent sneezing, fragility or manipulation of the mucous posed of epithelial cells.
membrane, chronic infection, trauma, hypertension, coagu- epitheliofibril. See tonofibril.
lopathy, vitamin K deficiency, or, thrombocytopenia. Also epithelioid leiomyoma /ep′ithē′lē·oid/ [Gk, epi + thele
called nosebleed. + eidos, form], an uncommon neoplasm of smooth mus-
n observations: Epistaxis may result from the rupture of cle in which the cells are polygonal in shape. It usually
tiny vessels in the anterior nasal septum. This occurs most develops in the stomach. Also called bizarre leiomyoma,
frequently in early childhood and adolescence. In adults leiomyoblastoma.
it occurs more commonly in men than in women; may be epithelioma /-thē′lē·ō′mə/ [Gk, epi + thele + oma,
severe in elderly persons; may be accompanied by respira- tumor], a neoplasm derived from the epithelium.
tory distress, apprehension, restlessness, vertigo, and nausea; -epithelioma, suffix meaning a “tumor of epithelial tissue”:
and may lead to syncope. inoepithelioma, periepithelioma, trichoepithelioma.
n interventions: The patient suffering epistaxis is epithelioma adamantinum. See ameloblastoma.
instructed to breathe through the mouth, to sit quietly with epithelioma adenoides cysticum. See trichoepithelioma.
the head tilted slightly backward. The bleeding may be con- epithelium /-thē′lē·əm/ [Gk, epi + thele, nipple], the
trolled by inserting a cotton ball soaked in a topical vasocon- covering of the internal and external organs of the body and
strictor and applying pressure to the skin on both sides of the the lining of vessels, body cavities, glands, and organs. It
nose, occluding the blood supply to the nostrils; or by plac- consists of cells bound together by connective material and
ing an ice compress over the nose. The nasal mucosa may be varies in the number of layers and the kinds of cells. The
anesthetized with topical lidocaine, cauterized with a silver stratified squamous epithelium of the epidermis comprises
nitrate stick or an electrical cautery, and then sprayed with five different cellular layers. —epithelial, adj.
epinephrine. Severe bleeding, especially from the posterior epitope /ep′itōp/ [Gk epi + topos, place]. See antigenic
nasal septum, may be treated by packing, which is left in determinant.
place for 1 to 3 days. Persistent or recurrent profuse epistaxis epitympanic recess /-timpan′ik/ [Gk, epi + tympanon,
may be treated by ligating an artery supplying the nose, such drum], the area of the tympanic cavity cranial to the tym-
as the external carotid, ethmoid, or internal maxillary artery. panic membrane. It contains the upper half of the malleus
episternal /ep′istur′nəl/, situated on or over the sternum. and greater part of the incus. Also called attic.
epistropheus. See axis. epizootic /ep′izō·ot′ik/, a disease or condition that occurs at
epithalamus /ep′ithal′əməs/ [Gk, epi + thalamos, cham- about the same time in many individuals of the same species
ber], the uppermost portion of the diencephalon. It includes in a geographic area.
the trigonum habenulae, the pineal body, the posterior com- eplerenone, an antihypertensive agent.
missure, and the medullary layers of thalamus. Compare EPO, 1. abbreviation for erythropoietin. 2. abbreviation
hypothalamus, metathalamus, subthalamus, thalamus. for Exclusive Provider Organization.
—epithalamic, adj. eponychium. See cuticle, def 3.
epithelial /-thē′lē·əl/ [Gk, epi, above, thele, nipple], per- eponym /ep′ənim/ [Gk, epi, above, onyma, name], a
taining to or involving the outer layer of the skin. name for a disease, organ, procedure, or body function that
epithelial cancer [Gk, epi, above, thele, nipple; L, cancer, is derived from the name of a person, usually a physician
crab], a carcinoma that develops from epithelium or related or scientist who first identified the condition or devised the
tissues in the skin, hollow viscera, and other organs. Also object bearing the name. Examples include fallopian tube,
called epithelioma. Parkinson’s disease, and Billing’s method.
epoophoron 636 eptifibatide
Types of
Cell Shapes: Cell Layers:
Squamous Simple Stratified
Ovary surface:
Simple cuboidal
Cuboidal
Digestive tract:
Simple columnar
Respiratory airways:
Pseudostratified columnar
Columnar
Classification of epithelium (Herlihy, 2011)
epoophoron /ep′ō·of′əron/ [Gk, epi + oophoron, ovary], a immunodeficient patients such as posttransplantation patients
rudimentary structure that is situated in the mesosalpinx on immunosuppressive therapy. It is also thought to cause oral
between the ovary and the uterine tube. The epoophoron is a hairy leukoplakia. One of the most common human viruses,
persistent portion of the embryonic mesonephric duct. Also it resides in the salivary glands, is transmitted with saliva,
called parovarium. and continues to be shed. EBV is ubiquitous. By 40 years of
epoprostenol /e′popros′tĕnol/, name for prostacyclin when age 99% of the U.S. population has serological evidence of
used pharmaceutically. It is used in the form of the sodium EBV infection. Infection is often asymptomatic. There is no
salt as an inhibitor of platelet aggregation for blood contact- specific treatment. No antiviral drugs are available.
ing nonbiological systems, as in renal dialysis; as a pulmo- Epstein-Barr virus (EBV) titer, a blood test to indicate
nary antihypertensive; and as a vasodilator. chronic EBV and associated illnesses.
epoxy, an organic chemical substructure consisting of a Epstein’s pearls [Alois Epstein, Czechoslovakian physi-
three-membered ring derived from the union of an oxygen cian, 1849–1918; L, perla, a mussel], small, white pearl-
atom and two carbon atoms. Epoxy resins are used as bond- like epithelial cysts that occur on both sides of the midline of
ing agents. the hard palate of the newborn. They are normal and usually
eprosartan /ep′rosar′tan/, an angiotensin II antagonist that disappear within a few weeks. Compare Bednar’s aphthae,
causes vasodilatation and decreases the effects of aldoste- thrush.
rone, used as an antihypertensive, administered orally. e.p.t., a trademark for a human pregnancy test kit that uses
EPS, abbreviation for electrophysiological study. monoclonal antibody technology to detect the presence of
EPSDT, abbreviation for Early and Periodic Screening human chorionic gonadotropin in urine.
Diagnosis and Treatment. EP test, abbreviation for erythrocyte protoporphyrin test.
epsilon /ep′silon/, Ε, ε, the fifth letter of the Greek alphabet. eptifibatide, an antiplatelet agent.
Epsom salt. See magnesium sulfate. n indications: It is used to treat acute coronary syndrome,
EPSP, abbreviation for excitatory postsynaptic potential. including patients with percutaneous coronary intervention.
Epstein-Barr virus (EBV) /ep′stīnbär′/ [Michael A. n contraindications: The following factors prohibit
Epstein, b. 1921, English pathologist; Yvonne M. Barr, its use: known hypersensitivity to this drug, active internal
twentieth-century English virologist; L, virus, poison], the bleeding, history of bleeding, stroke within 1 month, major
herpesvirus that causes infectious mononucleosis and is surgery with severe trauma, severe hypotension, history of
associated with nasopharyngeal sarcoma, Hodgkin’s dis- intracranial bleeding, intracranial neoplasm, arteriovenous
ease, B cell lymphoma, leukoplakia, central nervous system malformation/aneurysm, aortic dissection, and dependence
lymphoma in AIDS, and Burkitt’s lymphoma, especially in on renal dialysis.
epulis 637 equivalent weight
n adverse effects: Life-threatening effects of this drug with those of the past in the psychological development of
are stroke and bleeding. Hypotension is another serious an individual.
adverse reaction. equilibrium /ē′kwilib′rē·əm/ [L, aequilibrium], 1. a state
epulis /epyoo′lis/ pl. epulides [Gk, epi + oulon, gum], any of balance or rest resulting from the equal action of opposing
tumor or growth on the gingiva. forces such as calcium and phosphorus in the body. 2. (in
psychiatry) a state of mental or emotional balance. 3. (in
radiotherapy) a point at which the rate of production of a
daughter element is equal to the rate of decay of the par-
ent element and the activities of parent and daughter are
identical.
equilibrium reaction, automatic, reflexive, compensatory
movements of body parts that restore and maintain the center
of gravity over the base of support when the center of gravity
of the supporting surface is displaced. Equilibrium reactions
begin to develop around 6 months of age. See also general
adaptation syndrome, local adaptation syndrome. Also
called equilibrium responses.
Epulis (Zitelli and Davis, 2007) equilin /ek′wəlin/, an estrogen isolated from the urine of
pregnant horses. See also conjugated estrogen.
equin-, equino-, prefix meaning “characteristic of a horse”:
epulosis /ep′yəlō′sis/, a healing process by scar formation, equinovarus.
resulting in the production of a cicatrix. equine antitoxin, an antitoxin derived from the blood of
Equagesic, a trademark for a fixed-combination central healthy horses immunized against a specific bacterial toxin.
nervous system drug that contains an analgesic (aspirin) and equine encephalitis /ē′kwīn, ek′win/ [L, equus, horse;
a sedative (meprobamate). Gk, enkephalon, brain, itis, inflammation], an arbovirus
equal cleavage /ē′kwəl/ [L, aequare, to make alike; AS, infection with a member of the Togaviridae family, Alpha-
cleofan], mitotic division of the fertilized ovum into blas- virus, characterized by inflammation of the nerve tissues of
tomeres of identical size, as occurs in humans and most other the brain and spinal cord. Other characteristics include high
mammals. Compare unequal cleavage. fever, headache, nausea, vomiting, myalgia, and neurologi-
equal distribution, a capitation method in which income cal symptoms, such as visual disturbances, tremor, lethargy,
is distributed equally among providers. It is used when the and disorientation. The virus is transmitted by the bite of
patient population is geographically and clinically homoge- an infected mosquito. Horses are the primary host of the
neous. Not applicable in Canada. See also capitation. viruses that cause the infection; humans are secondary hosts.
Equal Employment Opportunity Commission Because horses are deadend hosts, they are not a significant
(EEOC), a body appointed by the president of the United risk factor for human infection. Eastern equine encephali-
States to administer the Civil Rights Act of 1964, particularly tis (EEE) is a severe form of the infection, with a mortality
to investigate complaints of discrimination in employment rate of 33%. The main EEE transmission cycle is between
in businesses engaged in interstate commerce. Discrimina- mosquitoes and birds, specifically the mosquito Culiseta
tion based on race, color, creed, or national origin is forbid- melanura. EEE occurs primarily along the eastern seaboard
den, but certain kinds of employers and certain conditions of of the United States and lasts longer and causes more deaths
employment allow exceptions to the act. and residual morbidity than western equine encephali-
Equanil, a trademark for a sedative (meprobamate). tis (WEE), which occurs throughout the United States and
equation [L, aequare, to make equal], an expression in produces a mild, brief illness, as does Venezuelan equine
symbols of equality or equivalence. encephalitis (VEE), which is common in Central and South
equator /ē·kwā′tər/ [L, aequator, equalizer], an imagi- America, Florida, and Texas. There is no specific treatment
nary line encircling a globe, equidistant from the poles, used for EEE; care of patients is supportive. See also encephali-
in anatomical nomenclature to designate such a line on a tis, encephalomyelitis.
spherical organ, dividing the surface into two approximately equine gait [L, equus, horse; ONorse, gate, a way], a man-
equal parts. Also spelled aequator. ner of walking characterized by footdrop. The condition is
equatorial plane /ēk′wətôr′ē·əl/ [L, aequare, to make the result of damage to the peroneal nerve, which causes the
alike; Fr, flat + vessel], the plane at the center of the spindle foot to hang in a toes-downward position.
in which the chromosomes are arranged during metaphase of equinovarus. See clubfoot.
mitosis and meiosis. equinus /ēkwī′nəs/ [L, horse], a condition characterized
equi-, prefix meaning “equal” or “equality”: equilibrate, by tiptoe walking on one or both feet. It is usually associated
equilibrium. with clubfoot.
equianalgesic dose /ē′kwē·an′əljē′sik/, a dose of one anal- equipotential, 1. (in physics) indicating bodies that have
gesic that is equivalent in pain-relieving effects to that of the same electrical potential. 2. pertaining to lines of force
another analgesic. This equivalence permits substitution of that have the same electrical potential.
medications to prevent possible adverse effects of one of the equity model /ek′witē/, an organizational model for medi-
drugs. The term is also applied to equivalent alternative dose cal providers that offers the provider equity in the company
sizes and routes of administration. instead of cash payments. Not applicable in Canada.
equilbrium responses, complex postural reactions that equivalence /ikwiv′ələns/, a state of being equal in value.
involve righting reactions with rotation and diagnol patterns equivalent weight [L, a + aequus + valere, equal value;
and are essential for volitional movement and mobility. Also AS, gewiht], 1. the weight of an element in any given unit
called equilibrium reaction. (such as grams) that will displace a unit weight of hydrogen
equilibration /ē′kwilibrā′shən/ [L, aequus, equal, libra, from a compound or combine with or replace a unit weight of
balance], the balancing and integrating of new experiences hydrogen. 2. the weight of an acid or base that will produce
equivocal symptom 638 ergometry
or react with 1.008 grams of hydrogen ion. 3. the weight of the clavicle. Electrical stimulation at Erb’s point causes con-
an oxidizing or reducing agent that will produce or accept tractions of the biceps, deltoid, and other arm muscles.
one electron in a chemical reaction. ERCP, abbreviation for endoscopic retrograde
equivocal symptom [L, aequus, equal, vocare, to call; Gk, cholangiopancreatography.
symptoma, that which happens], a symptom that may be erectile /irek′til, -tīl/ [L, erigere, to erect], capable of
attributed to more than one cause or that may occur in several being erected or raised to an erect position. The term is usu-
diseases. ally used to describe spongy tissue of the penis or clitoris
Er, symbol for the element erbium. that becomes turgid and erectile when filled with blood. It
ER, E.R., abbreviation no longer in common usage also may be used when referring to the epidermal tissue
for emergency room, now referred to as the emergency involved in the appearance of “goose bumps” (piloerection)
department. in response to fear, anger, cold, or other stimuli.
eradication /irad′ikā′shən/, the process of completely erectile dysfunction, failure by a male to attain or main-
removing or destroying something. tain erection until completion of sexual relations on an ongo-
Eraxis, a trademark for anidulafungin. ing basis. The cause may be physical or psychological in
Erb-Duchenne paralysis. See Erb’s palsy. nature. See impotence.
Erbitux, a trademark for cetuximab. erectile myxoma, an angioma that contains areas of myxo-
erbium (Er) /ur′bē·əm/ [Ytterby, Sweden], a metallic matous tissue.
rare earth element. Its atomic number is 68; its atomic mass erection /irek′shən/ [L, erigere, to erect], the condition of
is 167.26. hardness, swelling, and elevation observed in the penis and
Erb’s muscular dystrophy [Wilhelm H. Erb], a form of to a lesser degree in the clitoris, usually caused by sexual
muscular dystrophy that first affects the shoulder girdle and arousal but also occurring during sleep or after physical
later often involves the pelvic girdle. It is a progressively stimulation. It results when additional blood enters the organ
crippling disease with onset in childhood or adolescence and and blood pressure within the organ increases, and it is influ-
is usually inherited as an autosomal-recessive trait. It affects enced by psychic and nerve stimulation. Erection enables the
both sexes. In males, differential diagnosis of Erb’s muscu- penis to enter the vagina and to emit semen. See also ejacu-
lar dystrophy and Duchenne’s muscular dystrophy may be lation, nocturnal emission, priapism.
difficult. Also called scapulohumeral muscular dystrophy. erector spinae. See sacrospinalis.
Erb’s palsy [Wilhelm H. Erb, German neurologist, 1840– erector spinae reflex [L, erigere, to erect, spina, spine,
1921], a kind of paralysis caused by traumatic injury to the reflectere, to bend back], a reflex characterized by contrac-
upper brachial plexus. It occurs most commonly as a result tion of the sacrospinalis and other back muscles when the
of forcible traction during childbirth, with injury to one or overlying skin is stimulated. Also called dorsal reflex, lum-
more cervical nerve roots. The signs of Erb’s palsy include bar reflex.
loss of sensation in the arm and paralysis and atrophy of the ERF, abbreviation for edge response function.
deltoid, the biceps, and the brachialis muscles. The arm on erg /urg, erg/, a unit of energy in the centimeter-gram-
the affected side hangs loosely with the elbow extended and second system equal to the work done by a force of 1 dyne
the forearm pronated. Treatment initially requires that the through a distance of 1 cm. 1 erg |m= 10−7J. See also joule.
arm and shoulder be immobilized to allow the swelling and -erg-, combining form denoting an ergot alkaloid derivative.
inflammation of the associated neuritis to resolve. Physical ergastoplasm /ərgas′təplaz′əm/ [Gk, ergaster, worker,
therapy and splinting may be necessary to improve muscle plassein, to mold], a network of cytoplasmic structures that
function and to prevent flexion contracture of the elbow. Also show basophilic staining properties; granular endoplasmic
called Erb-Duchenne paralysis. reticulum. See also endoplasmic reticulum.
-ergic, -ergetic, suffix meaning an “effect of activity”:
allergic, pathergic, telergic.
ergo-, prefix meaning “work”: ergodermatosis, ergoma-
niac, ergotropy.
ergocalciferol. See calciferol.

ergogenic /ur′gōjen′ik/, a tendency to increase work output.
ergogenic aid, a substance, such as a steroid, used by athletes
with the expectation that it will provide a competitive edge.
ergoloid mesylate /ur′gōloid/, an ergot alkaloid prepara-
tion with psychotropic actions but lacking significant vaso-
constrictor or vasodilator effects.
n indications: It is occasionally prescribed in the treat-
ment of symptomatic age-related decline in mental capacity
with an unknown cause, as in senile dementia, but its efficacy
is not well established.
n contraindications: Psychosis or known sensitivity to
this drug prohibits its use.
n adverse effects: Among the most serious adverse
effects are sublingual irritation, transient nausea, and gastric
Erb’s palsy (Hockenberry and Wilson, 2011) disturbance.
Ergomar, a trademark for an ergot alkaloid (ergotamine
Erb’s point [Wilhelm H. Erb], a landmark of the brachial tartrate).
plexus on the upper trunk, located about 1 inch (2.5 cm) ergometer. See dynamometer.
above the clavicle at about the level of the sixth cervical ergometrine maleate. See ergonovine maleate.
vertebra. The point is the location of an angle between the ergometry /ərgom′ətrē/, the study of physical work activ-
posterolateral border of the sternocleidomastoid muscle and ity, including that performed by specific muscles or muscle
ergonomics 639 erogenous
groups. The studies may involve testing with equipment such n indications: It is prescribed to abort or prevent vascular
as stationary bicycles, treadmills, or rowing machines. headaches such as migraines.
ergonomics /ur′gōnom′iks/ [Gk, ergon, work, nomos, n contraindications: Pregnancy, peripheral vascular dis-
law], a scientific discipline devoted to the study and analy- ease, infectious disease, or known hypersensitivity to this
sis of human work, especially as it is affected by individual drug prohibits its use.
anatomical, psychological, and other human characteristics. n adverse effects: Among the more serious adverse
—ergonomic, adj. effects are vomiting, diarrhea, thirst, tingling of fingers and
ergonovine maleate /ur′gōnō′vēn/, an oxytocic ergot alka- toes, and increased blood pressure. Fetal death may occur if
loid. Also called ergometrine maleate. it is used during pregnancy.
n indications: It is prescribed to contract the uterus in the ergotherapy /ur′gōther′əpē/ [Gk, ergon, work, therapeia,
treatment or prevention of postpartum or postabortion hem- treatment], the use of physical activity and exercise in the
orrhage caused by uterine atony. treatment of disease. By extension the therapy includes any
n contraindications: Pregnancy, peripheral vascular dis- procedure that increases the blood supply to a diseased or
ease, elevated blood pressure, or known hypersensitivity to injured part, such as massage or various types of hot baths.
this drug prohibits its use. —ergotherapeutic, adj.
n adverse effects: Among the more serious adverse ergotism /ur′gətiz′əm/ [L, argota, a grain fungus], 1. an
effects are hypertension, nausea, headache, blurred vision, acute or chronic disease caused by excessive dosages of
and hypersensitivity reactions. Fetal death may result from medications containing ergot. Symptoms may include cere-
use of the drug in pregnancy. brospinal manifestations such as spasms, cramps, and dry
ergosome. See polysome. gangrene. 2. a chronic disease caused by ingestion of cereal
ergosterol /ərgos′tərôl/, an unsaturated hydrocarbon of products made with rye flour contaminated by ergot fungus.
the vitamin D group isolated from yeast, mushrooms, ergot, ergot poisoning [L, argota, a grain fungus; L, potio,
and other fungi. When treated with ultraviolet irradiation it drink], the toxic effects of ingesting food or medications
is converted into vitamin D2. See also calciferol, viosterol, containing ergot alkaloids, particularly ergotamine. See also
vitamin D. ergotism.
ergot /ur′gət/ [L, ergota, a grain fungus], a fungus struc- ergotropic /ur′gōtrop′ik/, 1. pertaining to an activity or
ture that replaces the seed of rye and other cereal grasses work state involving somatic muscle, sympathetic nervous
infested with the parasitic fungus Claviceps purpurea. Ergot system, and cortical alpha rhythm activity. 2. pertaining to
contains ergot alkaloids, the agents responsible for what was the administration of medications or other therapies to ener-
known as St. Anthony’s fire in people who consumed the gize the power of the body’s blood and other tissues to resist
contaminated grain in the Middle Ages. Effects included hal- infections.
lucinations and such intense vasoconstriction in the extremi- -ergy, 1. suffix meaning an “action”: leukergy, synergy.
ties that portions of the limbs often developed gangrene and 2. suffix meaning an “effect or result”: allergy, anabolergy,
fell off before the person died. pathergy.
ergot alkaloid, one of a large group of alkaloids derived from -eridine, suffix denoting an analgesic of the meperidine
a common fungus, Claviceps purpurea. The alkaloids comprise group.
three groups: the amino acid alkaloids typified by ergotamine, Erikson, Erik, a psychologist who described the develop-
the dihydrogenated amino acid alkaloids such as dihydroergot- ment of identity of the self and the ego through successive
amine, and the amine alkaloids such as ergonovine. stages that naturally unfold throughout the lifespan. The eight
n indications: Ergotamine and dihydroergotamine are less stages are trust vs. mistrust (infancy); autonomy vs. shame
effective oxytocics than ergonovine. Therefore ergonovine, and doubt (toddlerhood); initiative vs. guilt (preschool);
given orally or intravenously, is currently used in obstetrics industry vs. inferiority (middle childhood); identity vs. role
to treat or prevent postpartum uterine atony and to complete confusion (adolescence); intimacy vs. isolation (young adult-
an incomplete or missed abortion. Ergotamine is prescribed hood); generativity vs. stagnation (middle adulthood); and
to relieve migraine headache. It acts by reducing the ampli- ego integrity vs. despair (older adulthood).
tude of arterial pulsations in the external carotid branches Eriksson, Katie, a nursing theorist who developed the
of the cranial arteries resulting from stimulation of vasocon- Theory of Caritative Care, which distinguishes between car-
strictive alpha receptors, and it may also act as a serotonin ing ethics, the practical relation between the patient and the
antagonist. See also missed abortion. nurse, and nursing ethics, the ethical principles and rules that
n contraindications: Peripheral vascular disease, coro- guide decision-making. Caritative caring consists of love and
nary artery disease, hypertension, renal or hepatic dysfunc- charity, or caritas, and respect and reverence for human holi-
tion, and sepsis are contraindications for ergot alkaloids. ness and dignity. Suffering related to lack of caritative care
Pregnancy prohibits their use because they may cause con- violates human dignity.
tractions of the uterus, decreased blood flow to the fetus, and ERISA, abbreviation for Employment Retirement
fetal death. Income Security Act.
n adverse effects: Ergot poisoning may result from pro- erlotinib, a miscellaneous antineoplastic.
longed or excessive use of the drug or accidental ingestion n indication: This drug is used in the treatment of non–
of contaminated grain. Signs of toxicity are thirst, diarrhea, small cell lung cancer.
dizziness, chest pain, abnormal and variable rate of cardiac n contraindications: Pregnancy and known hypersensi-
contraction, nausea and vomiting, digital paresthesia, severe tivity to this drug prohibit its use.
cramping, and seizures. Tissue anoxia and gangrene of the n adverse effects: A life-threatening side effect of this drug
extremities may occur as a result of prolonged vasoconstric- is interstitial lung disease. Common side effects include nau-
tion if poisoning is severe. sea, diarrhea, vomiting, anorexia, mouth ulceration, rash, con-
ergotamine tartrate /ərgot′əmēn/, a vasoconstrictor that junctivitis, eye pain, fatigue, infection, cough, and dyspnea.
binds to several receptor populations (e.g., alpha-adrenergic, erogenous /iroj′ənəs/ [Gk, eros, love, genein, to pro-
dopamine, serotonin) and, depending upon the receptor, can duce], pertaining to the production of erotic sensations or
be an agonist or antagonist. sexual excitement. Also erotogenic /irot′ōjen′ik/.
erogenous zones 640 erysipelas
erogenous zones, areas of the body in which sexual ten- some countries as a vegetable oil for salad dressings, mar-
sion tends to become concentrated and can be relieved by garines, and mayonnaise. Canola oil is a rapeseed oil from
manipulation of the region. The areas include the mouth, which virtually all erucic acid has been removed through
anus, nipples, and genitals. breeding.
Eros /ir′os, er′os/ [Gk, mythic love-inciting son of Aphro- eructation /ē′ruktā′shən/ [L, eructare, to belch], the act
dite], a Freudian term for the drive or instinct for survival, of drawing up air from the stomach with a characteristic
including self-preservation and continuation of the species sound through the mouth. Also called belching.
through reproduction. eruption /irup′shən/ [L, eruptio, bursting forth], the
erosion /irō′zhən/ [L, erodere, to consume], the wear- appearance of rapidly forming skin lesions, especially of a
ing away or gradual destruction of a surface. For example, viral exanthem, or of a rash that commonly accompanies a
a mucosal or epidermal surface may erode as a result of drug reaction.
inflammation, injury, or other causes, usually marked by eruptive fever /irup′tiv/ [L, eruptio, bursting forth;
the appearance of an ulcer. See also necrosis. The action febris], a febrile disease of Mediterranean regions, Africa,
of acid (low pH) substances dissolving tooth structure. Can the Crimea, and India, caused by infection with Rickettsia
be due to habitual sucking on citrus fruits such as lemons, conorii.
from acidic swimming pool water, or gastroesophageal eruptive gingivitis, inflammation of the gums that may
reflux. occur when the secondary teeth (adult dentition) break
erosive gastritis /irō′siv/, an inflammatory condition through. Compare desquamative gingivitis.
characterized by multiple erosions of the mucous mem- eruptive xanthoma, a skin disorder associated with ele-
brane lining the stomach. Nausea, anorexia, pain, and vated triglyceride levels in the blood. Numerous erythema-
gastric hemorrhage may occur. Acute erosive gastritis tous or pale, raised papules suddenly appear on the trunk,
involves erosions of the full thickness of the stomach legs, arms, and buttocks.
mucosa, usually with some degree of hemorrhaging; it
may be either localized or diffuse. Chronic erosive gas-
tritis is a type of chronic gastritis with mild symptoms,
characterized by multiple punctate or aphthous ulcers,
found by endoscopy. Some patients have nausea and vom-
iting, but others are symptom free. Complications include
perforation, penetration into a surrounding organ, and
hemorrhage. The cause may be a reaction to nonsteroidal
antiinflammatory drugs, a complication of Crohn’s dis-
ease or a viral infection, or an unknown factor. Also called
varioliform gastritis. See also chemical gastritis, cor-
rosive gastritis.
erosive osteoarthritis. See Kellgren’s syndrome.
-erotic, suffix meaning “sexual love or desire”: anterotic,
homoerotic, hysteroerotic.
eroticism /irot′isiz′əm/ [Gk, erotikos, sexual love], 1. sex-
ual impulse or desire. 2. the arousal or attempt to arouse the
sexual instinct through suggestive or symbolic means. 3. the Eruptive xanthoma (Callen et al, 2000)
expression of sexual instinct or desire. 4. an abnormally per-
sistent sexual drive. Also called erotism. See also anal eroti-
cism, oral eroticism. ERV, abbreviation for expiratory reserve volume.
eroto- /irot′ə-/, prefix meaning “sexual love or desire”: ero- erysipelas /er′isip′ələs/ [Gk, erythros, red, pella, skin], an
togenic, erotopath, erotophobia. infectious skin disease characterized by redness, swelling,
erotogenic. See erogenous. vesicles, bullae, fever, pain, and lymphadenopathy. It is

erratic /irat′ik/ [L, erraticus, wandering], deviating from caused by a species of group A beta-hemolytic streptococci.
the normal but with no apparent fixed course or purpose. Predisposing conditions include diabetes, HIV, and nephrotic
error [L, errare, to wander], (in research) a defect in the syndrome, as well as immunocompromised conditions. It is
design of a study, in the development of measurements or also seen in those with vagrant life-styles. Treatment includes
instruments, or in the interpretation of findings. antibiotics, analgesics, and packs or dressings applied locally
error message, a brief statement delivered by a computer to the lesions.
by means of a peripheral device, such as a monitor or printer,
that a procedure has been done incorrectly.
error of the first kind. See type I error.
error of the second kind. See type II error.
error theory of aging, a stochastic theory of aging that
ascribes aging to the accumulation of errors in the process
of information flow from genes to proteins. The errors cre-
ate faulty proteins that do not function normally, resulting in
impaired cell function and death. See also theories of aging.
ERT, abbreviation for external radiation therapy.
ertapenem, an antiinfective agent to treat adults with mod-
erate to severe infections, complicated skin and skin struc-
ture infections, and complicated urinary tract infections.
erucic acid /eroo′sik/, a fatty acid that has been associated
with heart disease. It is present in rapeseed oil that is used in Erysipelas (Conlon and Snydman, 2000)
erysipeloid 641 erythema multiforme
erysipeloid /er′isip′əloid/ [Gk, erhthros + pella + eidos,
form], an infection of the hands characterized by blue-red
patches and occasionally by erythema. It is acquired by han-
dling meat or fish infected with Erysipelothrix rhusiopath-
iae. The disease is self-limited, lasting about 3 weeks, but
responds to penicillin. Also called fish-handler’s disease.
Compare erysipelas.
Erythema marginatum (Weston, Lane, and Morrelli, 2007)
erythema migrans (EM), a disease that begins as small

Erysipeloid (Conlon and Snydman, 2000) papules that spread peripherally, characterized by a raised,
red margin and clearing in the center. It may mark the site
of a tick bite and is a diagnostic sign of Lyme disease. Also
erythema /er′ithē′mə/ [Gk, erythros, red], redness or called bullseye rash.
inflammation of the skin or mucous membranes that is the
result of dilation and congestion of superficial capillaries.
Examples of erythema are nervous blushes and mild sun-
burn. See also erythroderma, rubor. —erythematous, adj.
erythema infectiosum, 1. an acute benign infectious
disease, mainly of childhood, characterized by fever and
an erythematous rash that begins on the cheeks and later
appears on the arms, thighs, buttocks, and trunk. As the rash
progresses, earlier lesions fade. Sunlight aggravates the
eruption, which usually lasts about 10 days but may recur
in 1 to 3 weeks or longer after exposure to sunlight or heat.
For a period the rash may reappear whenever the skin is
irritated. It is caused by parvovirus B19. Morbidity is more
significant in adults, immunocompromised patients, preg-
nant women, and those with uremia. 2. a virus that lives
only in humans. No treatment is necessary, and prognosis is
excellent. Isolation of patients is not required. Also called
fifth disease.
Erythema migrans in Lyme disease (Callen et al, 2000)
erythema multiforme (EM) /mul′tifôr′mē,

m ˘ool′tēfôr′mā/, any of three major clinical syndromes
characterized by lymphocytic infiltrates in the skin that
cause keratinocyte necrosis. The patient may experience
polymorphous eruption of skin and mucous membranes.
Macules, papules, nodules, vesicles or bullae, and target
(bullseye-shaped) lesions are seen. The three major classi-
fications of erythema multiforme are EM minor, EM major,
and pure plaque toxic epidermal necrosis. EM minor is an
acute form of the disease, characterized by three-ring tar-
get lesions on the extremities. Symptoms often follow an
infection of herpes simplex. The patient may have raised
lesions but no fever and no blistering. EM major, also
called Stevens-Johnson syndrome, is characterized by the
Erythema infectiosum (Callen et al, 2000) presence of target lesions, blistering, and detachment of the
skin and mucous membranes. EM major also tends to fol-
low herpes simplex virus infections. Plaque toxic epider-
erythema marginatum, a skin disorder seen in acute mal necrolysis may not be associated with target lesions.
rheumatic fever characterized by temporary disk-shaped However, the condition is associated with detachment of
nonpruritic reddened macules that fade in the center, leaving large sheets of skin. It is generally drug induced. Definitive
raised margins. and preventive treatment depends on finding the specific
erythema neonatorum 642 erythroblastoma
cause. Use of topical or systemic corticosteroids is helpful
in most cases.
Erythema multiforme (Callen et al, 2000)
erythema neonatorum, a common skin condition of neo-

nates characterized by a pink papular rash frequently super-
imposed with vesicles or pustules. The rash appears within
24 to 48 hours after birth and disappears spontaneously after
several days. A smear of the papules that reveals the presence
of eosinophils rather than neutrophils differentiates the con-
dition from neonatal pustular melanosis. Also called toxic
erythema of the newborn.
Erythema nodosum (From Habif TP: Clinical Dermatology, 5th edi-

tion, St. Louis, 2010, Mosby/Elsevier. (Fig. 18-11, p. 720))
erythema perstans, a persistent local redness of the skin,

characteristically annular.
erythematous. See erythema.
erythematous pemphigus [Gk, erythros, red, pemphix, bub-
ble], a skin disorder characterized by bullous eruptions on
the trunk and a facial eruption that resembles that of lupus
erythematosus. The condition may be accompanied by seb-
orrheic dermatitis. Also called pemphigus erythematosus.
erythemo-, combining form meaning “red”: erythematous,
erythemogenic.
erythemogenic /er′ithe′mojen′ik/, producing or causing
erythema.
erythralgia /er′ithral′jə/ [Gk, erythros, red, algos, pain], a
skin disorder characterized by a painful burning sensation,
raised skin temperature, and redness, generally of the lower
limbs.
erythrasma /er′ithraz′mə/ [Gk, erythros, red], a bacterial
skin infection common in the axillary or inguinal region, char-
Erythema neonatorum (Zitelli and Davis, 2007) acterized by irregular reddish-brown areas. An asymptomatic
disease, it is more common in diabetics and responds quickly
to oral erythromycin. Compare intertrigo, tinea cruris.
erythema nodosum, a hypersensitivity reaction character- erythremia /er′ithrē′mē·ə/ [Gk, erythros + haima,
ized by reddened, tender subcutaneous nodules on the exten- blood], an abnormal increase in the number of red blood
sor aspects of the extremities, such as the shins. The nodules cells. See polycythemia.
last for several days or weeks, never ulcerate, and are often erythro-, prefix meaning “red”: erythroblast, erythroclast,
associated with mild fever, malaise, and pain in muscles and erythrocyte.
joints. This condition may accompany streptococcal infec- erythroblast /erith′rəblast′/, a nucleated immature form of
tions, tuberculosis, sarcoidosis, drug sensitivity, ulcerative a red blood cell found only in bone marrow.
colitis, and pregnancy. The prognosis is good with appropri- erythroblastoma /-blastō′mə/ [Gk, erythros, red, blastos,
ate treatment of the underlying condition. A course of corti- germ, oma, tumor], a myeloma tumor (osteolytic neo-
costeroids is usually effective in diminishing the symptoms. plasm) in which the cells resemble erythroblasts.
erythroblastosis 643 erythromelalgia
erythroblastosis /-blastō′sis/, the presence of abnormally activity in rheumatic diseases and, when performed with a
large numbers of erythroblasts in the peripheral blood. white blood cell count, can indicate infection. Certain non-
erythroblastosis fetalis /-blastō′sis/ [Gk, erythros + blas- inflammatory conditions, such as pregnancy, are also char-
tos, germ, osis, condition; L, fetus, bringing forth], a type acterized by high sedimentation rates. The Westergren ESR
of hemolytic anemia in newborns that results from mater- is determined with a 200-mm Westergren tube. Values are
nal-fetal blood group incompatibility, specifically involving higher for women in both methods and vary according to the
the Rh factor and the ABO blood groups. The condition is method used. Normal findings by the Westergren method are
caused by an antigen-antibody reaction in the bloodstream up to 20 mm/hr for females and up to 15 mm/hr for males.
of the infant resulting from placental transmission of mater- Other diseases which alter blood proteins can also be called
nally formed antibodies against the incompatible antigens abnormal ESRs. Also called (informal) sedimentation rate.
of the fetal blood. In Rh factor incompatibility, the hemo- See also inflammation.
lytic reaction occurs only when the mother is Rh negative erythrocythemia /erith′rōsīthē′mē·ə/ [Gk, erythros + kytos
and the infant is Rh positive. The isoimmunization process + haima, blood], an increase in the number of erythrocytes
rarely occurs in the first pregnancy, but there is increased risk circulating in the blood.
with each succeeding pregnancy. See also hydrops fetalis, erythrocytopenia /-sī′təpē′nē·ə/ [Gk, erythros, red, kytos,
hyperbilirubinemia of the newborn, Rh factor, hemolytic cell, penes, poor], a condition characterized by a deficiency
disease of the fetus and newborn (HDFN) or decrease in number of erythrocytes.
erythrochromia /-krō′mē·ə/, 1. a red coloration or stain. erythrocytosis /erith′rōsītō′sis/ [Gk, erythros + kytos +
2. red pigmentation in spinal fluid caused by the presence osis, condition], an abnormal increase in the number of cir-
of blood. culating red cells. See also polycythemia.
Erythrocin, a trademark for an antibiotic (erythromycin). erythroderma /erith′rōdur′mə/ [Gk, erythros + derma,
erythrocyanosis /-sī′ənō′sis/, a condition characterized by skin], an abnormal redness of the skin. Compare ery-
bluish-red discoloration of skin, accompanied by swelling, thema, rubor.
burning, and itching. erythroderma desquamativum. See Leiner’s disease.
erythrocyte /erith′rəsīt′/ [Gk, erythros + kytos, erythroderma polyneuropathy. See acrodynia.
cell], mature red blood cell; a biconcave disk about 7 μm in erythrogenesis, the creation of red blood cells. See also
diameter that contains hemoglobin confined within a lipoid erythropoiesis.
membrane. It is the major cellular element of the circulating erythroid /erith′roid/, 1. reddish in color. 2. pertaining to
blood and transports oxygen as its principal function. The erythrocytes.
number of red blood cells per microliter of blood is 4.5 to erythroleukemia /-lookē′mē·ə/ [Gk, erythros + leukos,
5.5 million in men and 4.2 to 4.8 million in women. The red white, haima, blood], a malignant blood disorder character-
blood cell count varies with age, activity, and environmental ized by a proliferation of erythropoietic elements in bone mar-
conditions. An erythrocyte normally survives for 110 to 120 row, erythroblasts with bizarre lobulated nuclei, and abnormal
days, when it is removed from the bloodstream and broken myeloblasts in peripheral blood. The disease may have an
down by the reticuloendothelial system. New erythrocytes acute or chronic course. Also called Di Guglielmo’s disease,
are produced at a rate of slightly more than 1% a day; thus Di Guglielmo’s syndrome, erythromyeloblastic leukemia.
a constant level is usually maintained. Acute blood loss,
hemolytic anemia, or chronic oxygen deprivation may cause
erythrocyte production to increase greatly. Erythrocytes orig-
inate in the marrow of the flat bones or at the end of long
bones. Maturation proceeds from the pronormoblast to the
basophilic polychromatophilic normoblast to the basophilic
polychromatophilic normoblast, and orthochromic normo-
blast the final stage before the mature adult cell develops.
Also called red blood cell (RBC), red cell, red corpuscle.
Compare normoblast, reticulocyte. See also erythropoi-

esis, hemoglobin, red cell indexes.
erythrocyte reinfusion, the process of injecting into an
individual’s bloodstream red blood cells previously taken
from that individual and preserved temporarily by freezing.
The process is managed in the same manner as when an indi-
vidual donates his or her own blood for later retransfusion
(autologous transfusion).
erythrocyte sedimentation rate (ESR), the rate at which
red blood cells settle out in a vertical column of anticoagu-
lated whole blood, expressed in millimeters per hour. Blood
is collected in an anticoagulant and allowed to form a sedi-
ment in a calibrated glass column. At the end of 1 hour the Erythroleukemia (Carr and Rodak, 2008)
laboratory technician measures the distance the erythrocytes
have fallen in the tube. Elevated sedimentation rates are not
specific for any disorder but most commonly indicate the erythroleukosis, an abnormal increase in numbers of gran-
presence of inflammation. Inflammation causes an alteration ulocytes and red blood cells.
of the blood proteins, which makes the red blood cells aggre- erythromelalgia /erith′rōmilal′jə/ [Gk, erythros + melos,
gate, becoming heavier than normal. The speed with which limb, algos, pain], a rare disorder characterized by a parox-
they fall to the bottom of the tube corresponds to the degree ysmal dilation of the peripheral blood vessels. It occurs bilater-
of inflammation. Serial evaluations of erythrocyte sedimenta- ally, usually in the extremities, and is associated with burning,
tion rate are useful in monitoring the course of inflammatory redness of the skin, and pain. —erythromelalgic, adj.
erythromycin 644 Esmarch’s bandage
erythromycin /erith′rōmī′sin/, an antibiotic (of the macro- or longer than the duration of its normal cycle. Escape beats
lide type). function as safety mechanisms, and anything that produces a
n indications: It is prescribed in the treatment of many long pause in the prevailing heart cycle may allow an escape
bacterial and mycoplasmic infections, particularly those that to occur. Pauses in which escape beats occur may be caused
cannot be treated by penicillin. by sinoatrial block, atrioventricular (AV) block, or sinus bra-
n contraindications: Liver disease or known hypersensi- dycardia. Escape beats may arise from the atria, the AV junc-
tivity to this drug prohibits its use. tion, or the ventricles.
n adverse effects: The more serious adverse effects result escape rhythm [OFr, escaper + Gk, rhythmos, beat], a
from its effects on the metabolism of other drugs, which have sustained heartbeat that occurs when the sinus or atrioven-
led to fatalities (e.g., with Seldane [terfenadine]). Cholestatic tricular (AV) node is depressed or blocked. Under such con-
hepatitis, hypersensitivity reactions, and GI discomfort are ditions, the heart rate is controlled by the AV junction or the
other adverse effects associated with its use. His-Purkinje system.
erythromyeloblastic leukemia. See erythroleukemia. escarronodulaire. See Marseilles fever.
erythron /erith′ron/, the total mass of circulating red blood -escent, suffix meaning “beginning to be”: alkalescent,
cells (RBCs) and the RBC-forming tissues from which they convalescent, turgescent.
are derived. eschar /es′kär/ [Gk, eschara, scab], a scab or dry crust
erythropathy /er′ithrop′əthē/, any disease involving the that results from trauma, such as a thermal or chemical burn,
red blood cells (erythrocytes). infection, or excoriating skin disease. —escharotic, adj.
erythropenia. See hypocythemia. escharonodulaire. See Marseilles fever.
erythrophage /erith′rəfāj/, a phagocyte that ingests red escharotic. See eschar.
blood cells or blood pigment. escharotomy /es′kärot′əmē/, a surgical incision into
erythrophobia /-fō′bē·ə/ [Gk, erythros + phobos, necrotic tissue resulting from a severe burn. The procedure is
fear], 1. an anxiety disorder characterized by an irrational sometimes necessary to prevent edema from generating suf-
fear of blushing or of displaying embarrassment. 2. a symp- ficient interstitial pressure to impair capillary filling, causing
tom manifested by blushing at the slightest provocation. 3. a ischemia.
morbid fear of or aversion to the color red. —erythropho-
bic, adj.
erythrophthisis /erith′rōtī′sis/, grave damage to the restor-
ative power of red corpuscles. See also anemia.
erythroplasia of Queyrat /erith′rōplā′zhə/ [Gk, erythros
+ plasis, forming; Louis A. Queyrat, French dematologist,
1856–1933], a premalignant lesion on the glans or corona
of the penis. It is a shiny, velvety, well-circumscribed reddish
patch on the skin. It is usually excised surgically. See also
Bowen’s disease.
erythropoiesis /erith′rōpō·ē′sis/ [Gk, erythros + poiein, to
make], the process of erythrocyte production in the bone
marrow involving the maturation of a nucleated precursor
into a hemoglobin-filled, nucleus-free erythrocyte that is reg-
ulated by erythropoietin, a hormone produced by the kidney.
Compare erythrogenesis. See also erythrocyte, erythropoi-
etin, hemoglobin, leukopoiesis. —erythropoietic, adj.
erythropoietic porphyria. See porphyria. Escharotomy (Monahan et al, 2007)
erythropoietic protoporphyria (EPP), an autosomal-
dominant disorder, a form of erythropoietic porphyria, Escherichia coli (E. coli) /eshirī′kē·ə kō′lī/ [Theodor
characterized by increased levels of protoporphyrin in the Escherich, German physician, 1857–1911; Gk, kolon,
erythrocytes, plasma, liver, and feces and a wide variety of colon], a species of coliform bacteria of the family
photosensitive skin changes, ranging from a burning or pru- Enterobacteriaceae, normally present in the intestines and
ritic sensation to erythema, plaquelike edema, and wheals. common in water, milk, and soil. E. coli is the most frequent
erythropoietin (EPO) /erith′rōpō·ē′tin/ [Gk, erythros + cause of urinary tract infection and is a serious gram-neg-
poiein, to make], a glycoprotein hormone synthesized ative pathogen in wounds. E. coli septicemia may rapidly
mainly in the kidneys and released into the bloodstream in result in shock and death through the action of an endotoxin
response to anoxia. The hormone acts to stimulate and to released from the bacteria. See also enterohemorrhagic
regulate the production of erythrocytes and thus increases Escherichia coli.
the oxygen-carrying capacity of the blood. See also escitalopram, an antidepressant, selective serotonin reup-
erythropoiesis. take inhibitor used to treat major depressive disorders.
erythropoietin (EPO) test, a blood test measuring the Escobar’s syndrome. See multiple pterygium syndrome.
hormone erythropoietin, used in the diagnosis of anemia and escutcheon /eskuch′ən/ [L, scutum, shield], the pattern of
polycythemia. distribution of coarse, adult pubic hair, rhomboid in the male
Erythrovirus /e-rith′rōvi′rus/, a genus of parvoviruses con- and triangular in the female.
taining viruses that infect erythrocyte progenitor cells. It -esis, suffix meaning an “action, process, or result of ”:
includes the species B19 virus. enuresis, oxydesis, synthesis.
Es, symbol for the element einsteinium. Eskalith, a trademark for a medication used to treat bipolar
ESADDI, abbreviation for Estimated Safe and Adequate affective disorders (lithium carbonate).
Daily Dietary Intake. Esmarch’s bandage /es′märks/ [Johann F. A. von Esmarch,
escape beat [ME, escapen, to flee; beten, to beat], an auto- German surgeon, 1823–1908], a broad, flat elastic bandage
matic beat of the heart that occurs after an interval equal to wrapped around an elevated limb to force blood out of the
ESO 645 esophagectomy
limb. It is used before certain surgical procedures to create a esophageal dysfunction, any disturbance, impairment, or
blood-free field. abnormality that interferes with the normal functioning of
ESO, abbreviation for electric spinal orthosis. the esophagus, such as dysphagia, esophagitis, or sphincter
eso-, prefix meaning “within”: esogastritis, esotropia, incompetence. The condition is one of the primary symptoms
esophagus. of scleroderma.
esomeprazole /es′omep′räzōl/, a proton pump inhibitor esophageal feeding. See tube feeding.
administered orally as the magnesium salt in treatment of esophageal function studies, manometric tests used
gastroesophageal reflux disease and in the treatment of duo- to assess esophageal function. These include tests for acid
denal ulcer associated with Helicobacter pylori infection. reflux, acid clearing, and acid perfusion.
esophageal. See esophagus. esophageal lead /lēd/, 1. an electrocardiographic conduc-
esophageal atresia /əsof′əjē′əl, es′ofā′jē·əl/ [Gk, oisopha- tor in which the exploring electrode is placed within the lumen
gos, gullet], an abnormal esophagus that ends in a blind of the esophagus. It is used to detect sizable atrial deflections
pouch or narrows to a thin cord and thus does not provide as an aid in identifying cardiac arrhythmias. 2. (informal) a
a continuous passage to the stomach. It usually occurs as a tracing produced by such a lead on an electrocardiograph.
congenital anomaly. Thoracotomy can affect repair. esophageal obturator airway (EOA), an emergency
esophageal cancer, a rare malignant neoplastic disease of device that consists of a large tube that is inserted into the
the esophagus that peaks at about 60 years of age, occurs three mouth through an airtight face mask. Holes in the tube open
times more frequently in men than in women, and is found into the oropharynx when properly placed. The esophagus is
more often in Asia and Africa than in North America. Risk blocked by inflating a balloon at the end of the tube. Because
factors associated with the disease are heavy consumption of of the design, air passes only into the trachea.
alcohol, tobacco smoking, betel-nut chewing, Plummer-Vin- esophageal peristalsis, strong, uncoordinated nonpropul-
son syndrome, Barrett’s esophagus, and achalasia. Aflatoxin sive contractions of the esophagus evoked by swallowing,
in moldy grain and peanuts or a dietary deficiency, especially especially in the elderly. On barium radiography, the lumen
of molybdenum, may be involved. Esophageal cancer does of the esophagus appears as a series of concentric narrowings
not often cause any symptoms in the early stages but in later or as a spiral coil. Also called esophageal spasm.
stages produces painful dysphagia, chest pain, anorexia, esophageal speech. See alaryngeal speech.
weight loss, regurgitation, cervical adenopathy, and, in some esophageal varices, a complex of longitudinal tortu-
cases, persistent cough. Left vocal cord paralysis and hemop- ous veins at the lower end of the esophagus, enlarged and
tysis indicate an advanced state of the disease. Esophageal swollen as the result of portal hypertension. These vessels
cancer metastasizes rapidly and thus has a poor prognosis. are especially susceptible to hemorrhage. Conditions that
The tumor may spread locally to invade the trachea, bron- can cause portal hypertension include cirrhosis and chronic
chi, pericardium, great blood vessels, and thoracic vertebrae hepatitis.
or may metastasize to lymph nodes, the lungs, and the liver.
Diagnostic measures include barium swallow, fiberoptic
esophagoscopy, and biopsy and cytological examination
of the primary lesion and regional nodes. Most esophageal
tumors are poorly differentiated squamous cell carcinomas;
adenocarcinomas occur less frequently and are usually found
in the lower third of the esophagus. Surgical treatment may
require total or partial esophagectomy. Radiotherapy may
eradicate early local tumors and may effectively palliate the
symptoms of an advanced lesion. Chemotherapy may be
used in palliation of advanced disease or as an adjuvant to
surgery or radiation therapy. See also esophagectomy.
Esophageal varices: endoscopic view

(Goldman et al, 2008/Courtesy Dr. Pankaj Jay Pasricha)
esophageal web, a thin membrane that may develop

across the lumen of the esophagus, usually near the level of
the cricoid cartilage. The abnormal condition is generally
associated with iron deficiency anemia and usually disap-
pears when the underlying problem is resolved. See also
Plummer-Vinson syndrome.
Esophageal cancer (Fletcher, 2007) esophagectomy /esof′əjek′təmē/ [Gk, oisophagos +
ektomē, excision], a surgical procedure in which all or part
esophageal dilator, a bougie or similar instrument for of the esophagus is removed, as may be required to treat
dilation of an esophageal stricture or the lower esophageal severe recurrent bleeding, esophageal varices, or esophageal
sphincter. cancer. Also spelled oesophagectomy.
esophagitis 646 esotropia
esophagogastroscopy /-gastros′kəpē/ [Gk, oisophagos,
gullet, gaster, stomach, skopein, to watch], the examina-
tion with an endoscope of the esophagus and stomach.
Interposed esophagogastrostomy /-gastros′təmē/, an artificial anasto-
segment of colon mosis of the esophagus to the stomach.
Diaphragm
Stomach
Stomach
Diaphragm
Esophagectomy with colon interposition

(Monahan et al, 2007)
esophagitis /esof′əjī′tis/ [Gk, oisophagos + itis], inflam-

mation of the mucosal lining of the esophagus, caused by
infection, irritation from a nasogastric tube, or, most com-
monly, backflow of gastric juice from the stomach. Also Esophagogastrostomy for esophageal cancer
spelled oesophagitis. See also gastroesophageal reflux. (Monahan et al, 2007)
esophagojejunostomy /-jij′oonos′təmē/ [Gk, oisophagos,

gullet; L, jejunum, empty, stoma, mouth], the surgical cre-
ation of a direct passage from the esophagus to the jejunum,
Erosion/inflammation bypassing the stomach. The procedure is used after total
of esophageal gastrectomy.
mucosa esophagomyotomy /-mī′ot′əmē/, a longitudinal incision in
the lower part of the esophageal muscle made to treat esoph-
ageal achalasia, an obstruction to the passage of food.
esophagoscopy /esof′əgos′kəpē/ [Gk, oisophagos +
skopein, to look], examination of the esophagus with an
endoscope. Also spelled oesophagoscopy.
esophagospasm /esof′əgōspaz′əm/ [Gk, oisophagos, gul-
let, spasmos], spasmodic contractions of the walls of the
esophagus. The symptoms are substernal chest pain similar
to angina pectoris and dysphagia for both liquids and solid
food.
esophagostomy /esof′əgos′təmē/, a surgical opening into
Bleeding the esophagus for enteral tube feeding.
Severe esophagitis: endoscopic view esophagus /esof′əgəs/ [Gk, oisophagos], the musculo-
(Black and Hawks, 2009) membranous canal, about 24 cm long, extending from the
pharynx to the stomach. It begins in the neck at the inferior
border of the cricoid cartilage, opposite the sixth cervical
esophagocele /esof′əgōsēl′/, a hernia of the mucous mem- vertebra, and descends to the cardiac sphincter of the stom-
brane through a weakened area in the wall of the esophagus. ach in a vertical path with two slight curves. The esophagus
esophagogastroduodenoscopy (EGD) /ə·sof′əgōgas′ is composed of a fibrous coat, a muscular coat, and a submu-
trōdoo′odənos′kəpe/, an endoscopic test that permits direct cous coat and is lined with mucous membrane. Also spelled
visualization of the upper GI tract. Insertion of a long, flex- oesophagus. Also called gullet. —esophageal, adj.
ible, fiberoptic-lighted scope allows examination of tumors, esophoria /es′əfôr′ē·ə/ [Gk, eso, inward, pherein, to
varices, mucosal inflammations, hiatal hernias, polyps, bear], the latent medial deviation of the visual axis of one
ulcers, and obstructions. This test evaluates patients with eye in the absence of visual stimuli for fusion. Also called
dysphagia, weight loss, early satiety, upper abdominal pain, cross-eye. Compare esotropia, exophoria. —esophoric, adj.
ulcer symptoms, or dyspepsia and is also used therapeuti- esotropia /es′ətrō′pē·ə/ [Gk, eso + tropos, turning], a
cally for electrocoagulation, laser coagulation, or injection of medial deviation of one eye relative to the other fixating
sclerosing agents. eye such that fusion is not maintained. Also called conver-
esophagogastronomy /esof′əgō′gastron′əmē/ [Gk, oisoph- gent squint, convergent strabismus, internal strabismus.
agos, gullet, gaster, stomach, stoma, mouth], the surgical Compare esophoria, exotropia. See also strabismus.
creation of a passage between the esophagus and the stomach. —esotropic, adj.
ESP 647 established name
of the body. EFAs are prostaglandin precursors that play
important roles in metabolism. They are also necessary for
the normal functioning of the reproductive and endocrine
systems and the breaking up of cholesterol deposits on arte-
rial walls. The best dietary sources are natural vegetable
oils, such as soy and corn oils; margarines blended with
vegetable oils; wheat germ; edible seeds, such as pump-
Soft palate kin, sesame, and sunflower; and fish oils, especially cod
liver and other fish body oil. Although rare, a deficiency
Nasopharynx of EFAs causes changes in cell structure and enzyme func-
Mouth tion, resulting in decreased growth and other disorders.
Oropharynx
Tongue Symptoms include brittle and lusterless hair, nail problems,
Laryngo- dandruff, allergic conditions, and dermatoses, especially
Epiglottis pharynx eczema in infants. Also excessive amounts may reduce
Esophagus the level of vitamin E in tissues and cause other metabolic
(digestive disturbances.
Glottis passage) essential fever, fever occurring in absence of a known
Trachea
infectious disease.
(respiratory essential hypertension, an elevated systemic arterial pres-
passage) sure for which no cause can be found. It is often the only
significant clinical finding. Individuals with elevated blood
pressure are at risk for cardiovascular disease. In examin-
ing patients with essential hypertension, clinicians consider
Esophagus (Herlihy, 2011) the complex mechanisms that control blood pressure, such
as the arterial baroreflex, body fluid regulators, the renin-
angiotensin system, and vascular autoregulation. Also called
primary hypertension. See also benign hypertension,
malignant hypertension.
essential mixed cryoglobulinemia, a rare condition char-
acterized by deposition of type II cryoglobulins without a
detectable cause, inducing cutaneous vasculitis, synovitis,
and glomerulonephritis. See also cryoglobulin.
essential nutrients, the carbohydrates, proteins, fats,
minerals, vitamins, and water necessary for growth, normal
function, and body maintenance. These substances must be
supplied by food because most are not synthesized by the
body in the quantities required for normal health.
essential oils, a class of generally aromatic volatile oils;
the essences extracted from plants for use in flavoring foods,
perfumes, and medicines. Some essential oils have been used
Esotropia (Kliegman et al, 2011) therapeutically for thousands of years.
essential pruritus [L, essentia, quality, prurire, to
ESP, abbreviation for extrasensory perception. itch], localized or general pruritus that begins without a
espundia /espun′dē·ə/ [Sp, cancerous ulcer], a cutaneous preexisting skin disorder.
form of American leishmaniasis most common in Brazil, essential thrombocythemia, A myeloproliferative
caused by Leishmania brasiliensis. The primary lesion often neoplasm characterized by extreme thrombocytosis.
disappears spontaneously, followed by mucocutaneous Approximately 50% of essential thrombocythemia cases
lesions that destroy the mucosal surface of the nose, phar- are characterized by presence of the JAK2 mutation. See
ynx, and larynx. If the condition is untreated, potentially fatal thrombocytosis.
secondary bacterial infections and disfigurement may occur. essential tremor, an involuntary fine shaking of the hand,
Also called Breda’s disease. the head, and the face, especially during routine body move-
ESR, abbreviation for erythrocyte sedimentation rate. ments. It is a familial disorder inherited as an autosomal-
essential /esen′shəl/, a necessary part of a thing without dominant trait and appears during adolescence or in middle
which it could not exist. age, slowly progressing as a more pronounced disorder. The
essential amino acid [L, essentia, quality], an organic precise cause of this condition is not known. Essential tremor
compound not synthesized in the body that is essential for is aggravated by activity and emotion and can be reduced
protein synthesis in adults and optimal growth in infants and in some patients by the administration of mild sedatives,
children. Adults require isoleucine, leucine, lysine, methio- such as propranolol and diazepam, or with alcohol consump-
nine, phenylalanine, threonine, tryptophan, and valine. tion. Also called benign essential tremor, familial tremor.
Infants need these amino acids plus arginine and histidine. Compare parkinsonism.
Cysteine and tyrosine are derived from methionine and phe- essential vertigo [L, essentia, quality, vertigo, dizziness], a
nylalanine, respectively, and are considered semiessential. form of vertigo for which no organic cause has been found.
See also amino acid, nonessential amino acid. EST, abbreviation for electric shock therapy, electro-
essential convulsion, central convulsion. shock therapy. See electroconvulsive therapy.
essential fatty acid (EFA), a polyunsaturated acid, such established name, the name assigned to a drug by the U.S.
as linoleic, alpha-linolenic, and arachidonic acids, essential Adopted Names Council. The established name, generally
in the diet for proper growth, maintenance, and functioning shorter than the chemical name, is the name by which the
Estar 648 estrone
drug is known to health practitioners. Also called generic estramustine /es′trämus′tēn/, an antineoplastic agent con-
name. See also chemical name, trademark. taining estradiol joined to mechlorethamine, administered
Estar, a trademark for a coal tar preparation used to treat orally for palliative treatment of metastatic or progressive
eczema and psoriasis. carcinoma of the prostate. It is used as estramustine phos-
estazolam /estaz′olam/, a benzodiazepine used as a sedative phate sodium.
and hypnotic in treatment of insomnia, administered orally. estramustine phosphate sodium /es′trəmus′tēn/, an anti-
ester /es′tər/ [Ger, Essigäther, acetic ether], a class of neoplastic agent.
chemical compounds formed by the bonding of an alcohol n indications: It is prescribed for palliative treatment of
and one or more organic acids, with the loss of a water mol- metastatic or progressive carcinoma of the prostate.
ecule for each ester group formed. Fats are esters, produced n contraindications: Thromboembolytic disorders or
by the bonding of fatty acids with the alcohol glycerol. known hypersensitivity to this drug prohibits its use.
esterase /es′tərās/, any enzyme that splits esters. n adverse effects: The most serious adverse effects are
esterification, the process of combining an organic acid cerebrovascular accident, myocardial infarction, thrombo-
(RCOOH) with an alcohol (ROH) to form an ester (RCOOR) phlebitis, pulmonary emboli, and congestive heart failure.
and water. estrangement /estrānj′mənt/ [L, extraneus, not belong-
esterified estrogen /ester′ifīd/, an ester of natural estrogen. ing], 1. a psychological effect of the separation of a mother
n indications: It is prescribed for menstrual irregularities, from her newborn required when the infant is ill or prema-
contraception, and menopausal symptoms. ture or has a congenital defect, thereby diverting the mother
n contraindications: It should not be used in anticipation from establishing a normal relationship with her child. 2. the
of cardiovascular benefits because results from a clinical trial feeling that external objects have a strange, unfamiliar, or
(HERS) found that its use was associated with an increased unreal quality, caused by a failure of cathexis of the external
risk of unstable angina and myocardinal infarction. Preg- ego boundary, one of whose functions is to identify external
nancy, known or suspected breast cancer, thrombophlebitis, objects as real and familiar.
vaginal bleeding of unknown origin, or known hypersensi- Estratab, a trademark for esterified estrogens.
tivity to this drug prohibits its use. estrin. See estrogen.
n adverse effects: Among the more serious adverse estriol /es′trē·ôl/, a relatively weak, naturally occurring
effects are gallbladder disease, thromboembolic disease, and human estrogen found in high concentrations in urine. Also
a possible increase in risk of cancer. spelled oestriol. See also estrogen.
esterify, to convert into an ester. estrogen /es′trojən/ [Gk, oistros, gadfly, genein, to pro-
ester local anesthetic, a class of local anesthetics with an duce], one of a group of hormonal steroid compounds that
ester chemical group that differentiates it from the amide promote the development of female secondary sex charac-
group of local anesthetics. Ester local anesthetics include teristics. Human estrogen level is elaborated in the ovaries,
benzocaine, chloroprocaine, cocaine hydrochloride, pro- adrenal cortices, testes, and fetoplacental unit. During the
caine hydrochloride, Nesacaine, and tetracaine and are menstrual cycle, estrogen renders the female genital tract
metabolized primarily by pseudocholinesterase. Because suitable for fertilization, implantation, and nutrition of the
of rapid metabolism, most ester local anesthetics have a early embryo. Pharmaceutic preparations of estrogen are
relatively short duration of action with the exception of used in oral contraceptives to prevent pregnancy, palliate
tetracaine. certain types of postmenopausal breast cancer and prostatic
esthesia /esthē′zhə/, 1. capacity for perception. 2. sensi- cancer, inhibit lactation, and treat threatened abortion and
tivity or feeling. 3. any disorder of the nervous system that ovarian disease. Estrogen replacement therapy may be pre-
affects perception or sensitivity. Also spelled aesthesia. scribed to relieve the vasomotor symptoms of menopause.
esthesio-, prefix meaning “feeling or perceptive faculties”: Its long-term continued use increases the risk of endome-
esthesiogenic, esthesioneure, esthesioscopy. trial carcinoma. Kinds of estrogen are conjugated estrogen,
esthesiophysiology /esthē′zē·ōfiz′ē·ol′əjē/, the study of esterified estrogen, estradiol, estriol, and estrone. Also
sense organ function. spelled oestrogen. Formerly called estrin. —estrogenic,
-esthetic, -esthetical, -esthes, -aesthetic, -aesthetical, adj.

suffix meaning “a person’s consciousness of a sensation or estrogen fractions test, a 24-hour urine or blood test that
something”: anesthesia, cenesthetic, photoesthetic. measures levels of the three major estrogens. Test results
esthetics /esthet′iks/ [Gk, aisthetikos, sensitivity], the aid in the evaluation of menopausal status, sexual maturity,
branch of philosophy dealing with the forms and psychologi- gynecomastia or feminization syndromes, certain ovarian
cal effects of beauty. In medicine, esthetics may be applied tumors, and placental function and fetal normality in high-
to dental reconstruction and plastic surgery. Also spelled risk pregnancies.
aesthetics. estrogen receptor assay, a microscopic examination of
estimated hepatic blood flow (EHBF), an estimate of the breast tumor tissue used to determine the probable response
rate of blood flow through the liver in a liver function test, of a tumor to endocrine therapy.
such as by calculating indocyanine green clearance. estrogen replacement therapy, administration of an
Estimated Safe and Adequate Daily Dietary Intake estrogen to treat estrogen deficiency, such as that occurring
(ESADDI), nutrient intake recommendations, made after menopause. There are a number of indications, includ-
by the National Academy of Sciences’ Food and Nutrition ing the prevention of postmenopausal osteoporosis and
Board, that give what is considered a safe range of intake for coronary artery disease and the prevention and treatment of
some nutrients because not enough information is available vasomotor symptoms, such as hot flashes, and of thinning of
to set recommended dietary allowance values for them. the skin and vaginal epithelium, atrophic vaginitis, and vul-
Estinyl, a trademark for an estrogen (ethinyl estradiol). var atrophy. In women with a uterus, a progestational agent
estr-, prefix for the name of an estrogen, a female hormone. is usually included to prevent endometrial hyperplasia. Also
Estrace, a trademark for an estrogen (estradiol). called hormone replacement therapy.
estradiol /es′trədī′ôl/, the most potent naturally occurring estrone /es′trōn/, a relatively potent endogenous estrogen.
human estrogen. Also spelled oestrone.
estropipate 649 ethionamide
estropipate /es′trəpip′āt/, an estrogen. n
indication: It is prescribed in the treatment of pulmo-
n indications: It is prescribed in the treatment of vaso- nary tuberculosis in combination with other drugs.
motor symptoms of menopause, atrophic vaginitis, krau- n contraindications: Optic neuritis or known hypersen-
rosis vulvae, female hypogonadism, female castration, and sitivity to this drug prohibits its use. It is not recommended
primary ovarian failure. Estrogens should be used topically for small children.
whenever possible for treating symptoms of menopause n adverse effects: Among the most serious adverse
(e.g., vaginal atrophy). effects are diminished visual acuity and allergic reactions,
n contraindications: Should not be used to prevent cor- such as rashes.
onary vascular disease. Known or suspected cancer of the ethanedioic acid. See oxalic acid.
breast or estrogen-dependent neoplasia, pregnancy, throm- ethanoic acid. See acetic acid.
bophlebitis or thromboembolic disorders, undiagnosed ethanol /eth′ənol/, ethyl alcohol. See also alcohol.
abnormal genital bleeding, or complications of previous ethanolamine, an amino alcohol formed by the decarbox-
administration of estrogen prohibit its use. ylation of serine. It is a component of certain cephalins and
n adverse effects: Among the most serious adverse phospholipids and is used as a surfactant in pharmaceutic
effects are a possible increased risk of cancer, gallbladder products. Also called monoethanolamine.
disease, and thromboembolic disorders. ethanol test, a blood, urine, gastric, or breath test usually
estrus /es′trəs/, the cyclic period of sexual receptivity in performed to evaluate alcohol-impaired drivers or those with
mammals other than primates, marked by intense sexual urge alcohol overdose.
and coinciding with the time that fertilization can take place. ethaverine hydrochloride /eth′əver′ēn/, a smooth muscle
estrus cycle [Gk, oistros, gadfly, kyklos, circle], the peri- relaxant.
odic changes in the female body that occur under the influ- n indications: It is prescribed to relieve spasm of the GI
ence of sex hormones. or genitourinary tract, arterial vasospasm, cerebral insuffi-
ESWL, abbreviation for extracorporeal shock-wave ciency, and peripheral and cerebrovascular insufficiency.
lithotripsy. n contraindications: Liver disease, atrioventricular dis-
ET, abbreviation for endothelin. sociation, or known hypersensitivity to this drug prohibits
eta /ē′tə, ā′tə/, H, η, the seventh letter of the Greek alphabet. its use. It is prescribed with caution to patients who have
etanercept, a biological agent. glaucoma.
n indication: It is used to treat acute, chronic rheumatoid n adverse effects: Among the more serious adverse
arthritis that has not responded to other treatments. effects are hypotension, abdominal distress, cardiac arrhyth-
n contraindications: Known hypersensitivity and sepsis mia, and headache.
prohibit its use. ethene. See ethylene.
n adverse effects: Adverse effects include abdominal ether /ē′thər/ [Gk, aither, air], 1. any of a class of organic
pain, dyspepsia, headache, asthenia, dizziness, injection site compounds in which two hydrocarbon groups are linked
reaction, cough, upper respiratory infection, non-upper respi- by an oxygen atom. 2. a nonhalogenated volatile liquid no
ratory infection, and sinusitis. Common side effects include longer used in clinical practice as a general anesthetic. Also
rash, pharyngitis, and rhinitis. called diethyl ether, ethyl oxide.
-etanide. See -eridine. ethereal /ithir′ē·əl/ [Gk, aither, air], pertaining to or
état criblé /ātä′ krēblā′/ [Fr, sievelike state], a condition resembling ether.
or state of multiple sievelike perforations in swollen lym- ether screen. See anesthesia screen.
phatic nodules in the intestine. It is a frequently fatal compli- ethics /eth′iks/ [Gk, ethikos, moral duty], the science
cation of untreated typhoid fever. or study of moral values or principles, including ideals of
etching /ech′ing/, the cutting of a hard surface, such as autonomy, beneficence, and justice. —ethical, adj.
metal or glass, by a corrosive chemical, usually an acid, to Ethics in Patient Referrals Act, a federal law, the Stark
create a design. Law, enacted in 1989, that prohibits referrals by a physician
ETEC, abbreviation for enterotoxigenic Escherichia coli. to a clinical laboratory in which the physician has a finan-
ETF, abbreviation for electron transfer flavoprotein. cial interest. A 1994 amendment includes other services and
ethacrynate sodium. See ethacrynic acid. equipment such as physical and occupational therapy; radi-
ethacrynic acid /eth′əkrin′ik/, a loop diuretic. ology and other diagnostic services; radiation therapy; par-
n indications: It is prescribed as a treatment for severe enteral and enteral nutrients, equipment, and supplies; and
edema, such as nephrotic syndrome, hepatic cirrhoses, and home health services.
ascites of malignancy. Unlike many other diuretics, ethac- ethinyl estradiol /eth′inil/, an estrogen.
rynic acid is not a sulfonamide derivative and can therefore n indications: It is prescribed in the treatment of post-
be tolerated by some people who develop hypersensitivity menopausal breast cancer, menstrual cycle irregularities,
reactions to other diuretics. prostatic cancer, and hypogonadism and for contraception
n contraindications: Pregnancy, anuria, or known and relief of menopausal vasomotor symptoms.
hypersensitivity to this drug prohibits its use. It is not given n contraindications: Thrombophlebitis, abnormal genital
to infants. bleeding, known or suspected pregnancy, or known hyper-
n adverse effects: Among the more serious adverse sensitivity to this drug prohibits its use.
effects are tetany, muscle weakness, cramps, and excessive n adverse effects: Among the more serious adverse
diuresis. Hearing loss may occur. effects are thrombophlebitis, embolism, and hypercalcemia.
ethambutol /etham′butol/, an antibacterial agent specifi- See also estrogen.
cally effective against Mycobacterium tuberculosis. It is ethionamide /eth′ē·ənam′īd/, a tuberculostatic antibacterial.
administered orally as the hydrochloride salt, in conjunction n indication: It is prescribed for the treatment of tubercu-
with one or more other antituberculous drugs, in the treat- losis in conjunction with other drugs when frontline therapy
ment of pulmonary tuberculosis. has failed.
ethambutol hydrochloride /eth′əmbyoo′təl/, a tuberculo- n contraindications: Existing liver damage or known
static antibiotic. hypersensitivity to this drug prohibits its use.
ethmocarditis 650 ethylene dichloride poisoning
n adverse effects: Among the more serious adverse effects ethnocentrism /eth′nōsen′trizm/ [Gk, ethnos, nation, ken-
are skin rash, jaundice, mental depression, and GI side effects. tron, center], 1. a belief in the inherent superiority of the
ethmocarditis /eth′mōkärdī′tis/, a chronic inflammation of “race” or group to which one belongs. 2. a proclivity to con-
the cardiac connective tissue. sider other ethnic groups in terms of one’s own racial origins.
ethmoid /eth′moid/ [Gk, ethmos, sieve, eidos, ethnography /ethnog′rəfē/ [Gk, ethnos, nation, graphein,
form], 1. pertaining to the ethmoid bone. 2. having a large to record], a branch of anthropology that is concerned with
number of sievelike openings. the history of nations and ethnic populations.
ethmoidal air cell /ethmoi′dəl/ [Gk, ethmos, sieve, eidos, ethoheptazine /eth′o-hep′tah-zēn/, an analgesic used as the
form], one of the numerous small thin-walled cavities in the citrate salt to control mild to moderate pain, administered
ethmoid bone of the skull. The cavities are lined with mucous orally.
membrane continuous with that of the nasal cavity and lie ethology /ethol′əjē/ [Gk, ethos, character, logos, sci-
between the upper part of the nasal cavities and the orbits. ence], 1. (in zoology) the scientific study of the behavioral
Compare frontal sinus, maxillary sinus, sphenoidal sinus. patterns of animals, specifically in their native habitat. 2. (in
ethmoidal process, an outgrowth on the superior border of psychology) the empiric study of human behavior, primarily
the inferior concha that articulates with the uncinate process social customs, manners, and mores. —ethologic, ethologi-
of the ethmoid. cal, adj., ethologist, n.
ethmoid bone, the very light, sievelike, and spongy bone ethosuximide /eth′ōsuk′simīd/, an anticonvulsant.
at the base of the cranium, also forming the roof and most of n indication: It is prescribed in the treatment of absence
the walls of the superior part of the nasal cavity. It consists of seizures.
four parts: a horizontal plate, a perpendicular plate, and two n contraindications: Known hypersensitivity to this
lateral labyrinths. drug or to any succinimide medication prohibits its use.
n adverse effects: Among the more serious adverse
effects are blood dyscrasias, GI disturbance, and hematopoi-
Cribriform etic complications.
(horizontal) plate Crista galli ethotoin /eth′ōtō′in/, an anticonvulsant.
n indications: It is prescribed in the treatment of general-
ized tonic-clonic and complex-partial seizures.
Ethmoid n contraindications: Liver disease, hematologic disor-
sinus ders, or known hypersensitivity to this drug or to any hydan-
toin prohibits its use. It is not recommended for use during
pregnancy or lactation.
n adverse effects: Among the more serious adverse effects
Orbital are blood disorders, nausea, fatigue, skin rash, alopecia, ery-
(lateral)
thema multiforme, exfoliative dermatitis, and chest pain.
Ethrane, a trademark for an inhalational general anesthetic
plate
(enflurane).
ethyl alcohol. See alcohol.
ethyl aminobenzoate. See benzocaine.
ethyl chloride /eth′il/, a topical anesthetic used in short
operations.
n indications: It is prescribed in the treatment of skin irri-
tations and in minor skin surgery; the skin is sprayed until the
Perpendicular plate
surface turns white with frost.
Ethmoid bone drug prohibits its use. It is not used on broken skin or on
mucous membrane.
ethmoid cells, paranasal sinuses occurring in groups within n adverse effects: Among the more serious adverse
the ethmoid bone and communicating with the ethmoidal effects are pain, muscle spasm, and, as a result of excessive
infundibulum and bulla and the superior and highest meatus. use, frostbite.
They are often subdivided into anterior, middle, and posterior n note: It is highly flammable.
ethmoid cells, groups of air cells named according to where ethylene /eth′əlēn/ [Gk, aither, air, hyle, stuff], a colorless
they open into the nasal meatus. Also called ethmoid sinuses. flammable gas that is just lighter than air and has a slightly
Compare frontal sinus, maxillary sinus, sphenoidal sinus. sweet odor and taste. It was previously used as an inhaled
ethmoidectomy. See sinus surgery. general anesthetic and is slightly more potent than nitrous
ethmoidofrontal suture /ethmoi′dōfron′təl/, a line in the oxide. It is now used in the food industry for control of fruit
skull between the cribriform plate of the ethmoid and the ripening, flower opening, and the shedding of leaves. Also
orbital plate and posterior margin of the nasal process. Also called ethene, olefiant gas.
called frontoethmoidal suture. ethylenediamine /eth′əlēndi·am′ēn/, a clear thick liquid
ethmoidolacrimal suture /-lak′riməl/, a line in the skull having the odor of ammonia. It is used as a solvent, an emul-
between the orbital plate of the ethmoid and the posterior sifier, and a stabilizer with aminophylline injections.
margin of the lacrimal bone. ethylene dibromide (EDB), a volatile liquid used as an
ethmosphenoid suture /eth′mōsfē′noid/, a line in the skull insecticide and gasoline additive. Because it has been found
between the crest of the sphenoid bone and the perpendicular to be a cause of cancer in animals, the Environmental Protec-
and cribriform plates of the ethmoid. Also called sphenoeth- tion Agency has restricted the use of EDB to control insect
moidal suture. pests in grains and fruits intended for human use.
ethnic group /eth′nik/, a population of individuals orga- ethylene dichloride poisoning, the toxic effects of expo-
nized on the basis of an assumed common cultural origin. sure to ethylene dichloride, a hydrocarbon solvent, diluent,
ethylene glycol poisoning 651 eugenics
and fumigant, which is one of the most abundant of all chlo- n
contraindications: It should not be used if there is an
rinated organic chemicals. It is an eye, ear, nose, throat, and allergy to etoposide or podophyllum. There is a potential
skin irritant and has produced cancers in laboratory animals. adverse effect to the fetus if used by a pregnant patient, and
Inhalation or ingestion can lead to serious illness or death. The the drug should not be used if breastfeeding.
compound is metabolized into 2-chloroethanol and mono- n adverse effects: The side effects most often reported
chloroacetic acid, both more toxic than the original chemical. include chills, rapid heartbeat, painful or difficult breathing,
ethylene glycol poisoning, the toxic reaction to ingestion decreased blood pressure, hair loss, rash, itching, skin discol-
of ethylene glycol or diethylene glycol, chemicals used in oration, and digestive disorders.
automobile antifreeze preparations. Symptoms in mild cases etoposide phosphate, the phosphate salt of etoposide,
may resemble those of alcohol intoxication but without the having the same actions and uses as the base, administered
breath odor produced by alcoholic beverages. Vomiting, car- intravenously.
popedal spasm, lumbar pain, renal failure, respiratory dis- Etrafon, a trademark for a central nervous system fixed-
tress, convulsions, and coma may also occur. combination drug containing an antipsychotic (perphen-
ethylene oxide (CH2CH2O), a highly flammable gas used azine) and an antidepressant (amitriptyline hydrochloride).
to sterilize surgical instruments and other supplies; the sim- etretinate /etret′ināt/, a synthetic derivative of vitamin A
plest epoxide. used as an oral drug to treat psoriasis.
ethylestrenol, an anabolic steroid. n indications: It is prescribed for severe recalcitrant psoria-
ethyl oxide. See ether. sis, including generalized pustular and erythrodermic psoriasis.
ethyne. See acetylene. n contraindications: It is contraindicated for women who
ethynodiol diacetate and ethinyl estradiol, an oral are of childbearing age unless a pregnancy test within 2 weeks
estrogen-progestin combination contraceptive. of the start of therapy has negative results. Because of the
n indication: It is prescribed for prevention of pregnancy. risk of hyperostosis, the drug should not be given to children
n contraindications: Thrombophlebitis, cardiovascu- unless all alternative therapies have been exhausted. Intoler-
lar disease, breast or reproductive organ cancer, or known ance to vitamin A derivative is another contraindication.
hypersensitivity to either ingredient prohibits its use. n adverse effects: Adverse effects may include benign
n adverse effects: Among the more serious adverse intracranial hypertension, hepatitis, visual abnormalities
effects are thrombophlebitis, uterine fibroma, gallbladder including corneal damage, skeletal hyperostosis, peeling
disease, embolism, and hepatic lesions. skin, alopecia, muscle cramps, and headache.
-etic, suffix used as the equivalent of -ic in forming adjec- etymology [Gk, etymos, base; L, logos, words], the study of
tives: enuretic, genetic, kinetic. the origin and development of words.
etidocaine, an amide local anesthetic that has fallen out of etymon (pl. etyma), an earlier form of a word. See also
use because it is more likely to block motor nerves than sen- etymology.
sory nerves. See also amide local anesthetic. Eu, symbol for the element europium.
etidronate disodium /etid′rənāt/, a regulator of calcium eu-, prefix meaning “well, easily, good, true”: euangiotic,
metabolism. Also called sodium etidronate. eucrasia, euthyroid.
n indications: It is prescribed in the treatment of Paget’s Eubacterium /yoo′baktir′ē·əm/, a large genus of nonsporu-
disease and heterotopic ossification caused by injury to the lating gram-positive anaerobic rod-shaped bacteria normally
spinal cord and after total hip replacement. found in soil and water. The organisms are also found in the
n contraindication: There are no known contrain skin and cavities of humans and other mammals, where they
dications. may cause soft-tissue infections. One species has been found
n adverse effects: Among the more serious adverse in dental tartar; another synthesizes vitamin B12. Eubacterium
effects are bone pain both at pagetic sites and at previously is susceptible to penicillin, cliridamycin, and metronidazole.
asymptomatic sites, GI disturbances, and elevated serum eubiotics /yoo′bī·ot′iks/ [Gk, eu, well, bios, life], the sci-
phosphate concentrations. ence of healthy living.
etio-, prefix meaning “causation”: etiology. eucalyptol /yoo′kəlip′tol/, a substance with an aromatic
etiology /ē′tē·ol′əjē/ [Gk, aitia, cause, logos, sci- odor obtained from the volatile oil of Eucalyptus and used in
ence], 1. the study of all factors that may be involved in nasal emollients. Also called cajeputol.
the development of a disease, including the susceptibility of eucaryocyte. See eukaryocyte.
the patient, the nature of the disease agent, and the way in eucaryon. See eukaryon.
which the patient’s body is invaded by the agent. 2. the cause eucaryosis. See eukaryosis.
of a disease. Compare pathogenesis. —etiological, adj. eucaryote, eucaryotic. See eukaryote.
etodolac /etodo′lak/, a nonsteroidal antiinflammatory drug eucholia /yookō′lyə/ [Gk, eu, well, chole, bile], the nor-
used as an analgesic and antiinflammatory agent, especially mal state of the bile as to the quantity secreted and the condi-
to treat arthritis. It is administered orally. tion of the constituents.
etomidate /etom′idāt/, a short-acting, hypnotic nonbarbitu- euchromatin /yookrō′mətin/ [Gk, eu + chroma, color], the
rate IV agent used for induction of general anesthesia. It has part of a chromosome that is active in gene expression. It
minimal adverse cardiovascular and respiratory effects, thus stains most deeply during mitosis, when it is in a coiled,
providing a greater margin of safety in patients with or at risk condensed state during each repetition of the cell cycle, it
for heart disease. Adverse effects include transient reduction alternates between condensation and dispersion. Compare
in adrenal gland cortisol release, pain on injection, and invol- heterochromatin. See also chromatin. —euchromatic, adj.
untary muscle movements. euchromosome. See autosome.
etoposide, an antineoplastic or chemotherapeutic agent and eugamy /yoo′gəmē/ [Gk, eu + gamos, marriage], the
mitotic inhibitor. union of gametes that contain the same haploid number of
n indications: It is prescribed in the treatment of several chromosomes. —eugamic, adj.
forms of cancer, including lymphomas, cancer of the testicles eugenics /yoojen′iks/ [Gk, eu + genein, to produce], the
and prostate, and small-cell lung cancer, to prevent tumor study of methods for controlling the characteristics of popu-
cells from dividing and spreading. lations through selective breeding.
euglobulin 652 evaluating
euglobulin /yooglob′yəlin/ [Gk, eu + L, globulus, small euploidy /yoo′ploidē/, the state or condition of having a
sphere], that fraction of serum globulin that is insoluble variation in chromosome number that is an exact multiple
in distilled water but soluble in saline solutions. This is one of the characteristic haploid number. Compare aneuploidy.
of a number of different properties used to classify proteins. eupnea /yoop·nē′ə/ [Gk, eu, well, pnein, to breathe], nor-
Compare albumin, cryoglobulin. See also electrophoresis, mal, quiet breathing at a rate of 12 to 20 breaths per minute
plasma protein. in adults.
euglobulin lysis time test, a blood test used to identify Eurax, a trademark for a scabicide (crotamiton).
primary and secondary systemic fibrinolysis and to moni- European blastomycosis. See cryptococcosis.
tor streptokinase or urokinase therapy in patients with acute European typhus. See epidemic typhus.
myocardial infarction. europium (Eu) /yoorō′pē·əm/ [Europe], a metallic rare
eugnathia /yoona′thē·ə/ [Gk, eu, well + gnathos, jaw], an earth element. Its atomic number is 63; its atomic mass is
abnormality of the oral cavity that is limited to the teeth and 151.96.
their immediate alveolar supports and does not include the eury-, prefix meaning “wide, broad”: eurycephalic, euryg-
jaws. Compare dysgnathic anomaly. nathic, euryopia.
eugnathic anomaly /yoonath′ik/ [Gk, eu + gnathos, jaw; Eustachian cushion. See torus tubarius.
anomalia, irregularity], an abnormality of the teeth and eustachian salpingitis, an inflammation of the eustachian
their alveolar supports. Compare dysgnathic anomaly. tube.
eukaryocyte /yooker′ē·ōsīt′/ [Gk, eu + karyon, nut, kytos, eustachian tube /yoostā′shən/ [Bartolomeo Eustachio,
cell], a cell that has a true nucleus, found in all organisms Italian anatomist, 1524–1574; L, tubus], a tube lined with
except bacteria. Also spelled eucaryocyte. mucous membrane that joins the nasopharynx and the middle
eukaryon /yooker′ē·on/ [Gk, eu, good, karyon, nut], a ear cavity. It is normally closed but opens during yawning,
cell nucleus that is highly complex and organized and is chewing, and swallowing to allow equalization of the air
surrounded by a double membrane. Also spelled eucaryon. pressure in the middle ear with atmospheric pressure.
Compare prokaryon. eustress /yoo′stres/, 1. a positive form of stress. 2. a bal-
eukaryosis /yooker′i·ō′sis/ [Gk, eu + karyon, nut, osis, condi- ance between selfishness and altruism through which an indi-
tion], the state of having a eukarykon. Compare prokaryosis. vidual develops the drive and energy to care for others.
eukaryote /yooker′ē·ot/ [Gk, eu + karyon, nut], an organ- euthanasia /yoo′thənā′zhə/ [Gk, eu, good; thanatos,
ism whose cells contain a true nucleus. All organisms except death], 1. also called mercy killing, the deliberate causing
bacteria are eukaryotes. Also spelled eucaryote. Eukary- of the death of a person who is suffering from an incurable
otic, adj. disease or condition. It may be active, such as by adminis-
eukaryotic cell, a cell with a true nucleus. See also cell. tration of a lethal drug, or passive, such as by withholding
Eulexin, a trademark for an antiandrogen antineoplastic of treatment. Legal authorities, church leaders, philosophers,
agent (flutamide). and commentators on ethics and morality usually distinguish
eunuch /yoo′nək/ [Gk, eune, couch, echein, to guard], a passive euthanasia from active euthanasia. 2. an easy, quiet,
male whose testicles have been destroyed or removed. If this painless death.
occurs before puberty, secondary sex characteristics fail to euthenics /yoothen′iks/ [Gk, eu + tithenai, to place], the
develop, and symptoms such as a feminine voice and absence science that deals with improvement of the human species
of facial hair can result from the reduced level of male hor- through the control of environmental factors, such as pollu-
mones in the blood. See also secondary sex characteristic. tion, malnutrition, disease, and drug abuse. Compare eugenics.
eunuchism /yoo′nəkiz′əm/, the condition of being a eunuch, euthymia, 1. a pleasant, relaxed state of tranquility. 2. sta-
with the lack of male hormones caused by castration. ble mood.
eunuchoidism /yoo′nəkoidiz′əm/, a condition resulting euthymic, pertaining to a normal mood in which the range
from a deficiency in the production or effectiveness of male of emotions is neither depressed nor highly elevated.
hormones. The deficiency leads to sterility, abnormal tall- euthymism /yoothī′mizəm/ [Gk, eu + thymos, thyme flow-
ness, small testes, and impaired development of secondary ers], the characteristic of normal mood responses.
sexual characteristics, libido, and sexual potency. euthyroid /yoothī′roid/ [Gk, eu, well, thyreos, oblong
euphoretic /yoo′fəret′ik/ [Gk, eu + pherein, to shield], pertaining to a normal thyroid gland and normal
bear], 1. adj, (of a substance or event) tending to produce a thyroid gland function.
condition of well-being or elation. 2. n, a substance tending eV, abbreviation for electron volt.
to produce a feeling of well-being or elation, such as lysergic evacuant /ivak′yoo·ənt/ [L, evacuare, to empty], any
acid diethylamide, mescaline, marijuana, and other halluci- medicine or other agent that causes an organ to discharge its
nogenic drugs. contents, such as an emetic or laxative.
euphoria /yoofôr′ē·ə/ [Gk, eu + pherein, to bear], 1. a evacuate /ivak′yoo·āt/ [L, evacuare, to empty], 1. v, to dis-
feeling or state of well-being or elation. 2. an exaggerated charge or to remove a substance from a cavity, space, organ,
or abnormal sense of physical and emotional well-being or tract of the body. 2. n, a substance discharged or removed
not based on reality or truth, disproportionate to its cause, from the body, such as evacuation of stool. —evacuation, n.
and inappropriate to the situation, as commonly seen in the evacuator /ivak′yoo·ā′tər/, an instrument for emptying a
manic stage of bipolar disorder, some forms of schizophre- cavity, such as removing a calculus from the urinary bladder.
nia, organic mental disorders, and toxic and drug-induced evagination /ēvaj′inā′shən/, the turning inside out or pro-
states. Compare ecstasy. trusion of a body part or organ.
euploid /yoo′ploid/ [Gk, eu + ploos, multiple], 1. n, an evaluating /ival′yoo·ā′ting/ [L, ex, away, valare, to be
individual, organism, strain, or cell whose chromosome strong], (in five-step nursing process) a category of nursing
number is an integral multiple of the normal haploid num- behavior in which the extent to which the established goals of
ber characteristic of the species. Euploids may be as diploid, care have been met is determined and recorded. To make this
triploid, tetraploid, or polyploid. 2. adj, pertaining to such an judgment, the nurse estimates the degree of success in meet-
individual, organism, strain, or cell. —euploidy, n. Compare ing the goals, evaluates the implementation of nursing inter-
aneuploid. ventions, investigates the patient’s adherence to therapy, and
evaluation 653 evoked potential
records the patient’s response to therapy. The nurse evaluates evidence-based dentistry, a systematic practice of den-
effects of the interventions used, the need for change in goals tistry in which the dentist finds, assesses, and implements
of care, the accuracy of the implementation of nursing inter- methods of diagnosis and treatment on the basis of the best
ventions, and the need for change in the patient’s environment available current research, the dentist’s clinical expertise,
or in the equipment or procedures used. The impact of the and the needs and preferences of the patient.
care or treatment on the patient, the patient’s family, and the evidence-based medicine, the practice of medicine in
staff is evaluated; the accuracy of tests and measurements is which the physician finds, assesses, and implements methods
checked; and the patient’s and family’s understanding of the of diagnosis and treatment on the basis of the best available
information given them is evaluated. The patient’s expressed current research, the physician’s clinical expertise, and the
and observed response to care is recorded. Although evalu- needs and preferences of the patient.
ation is considered the final step of the five-step nursing evidence-based nursing, the practice of nursing in which
process, in practice it is integral to effective nursing prac- the nurse makes clinical decisions on the basis of the best
tice at all steps of the process. See also analyzing, assessing, available current research evidence, the nurse’s clinical
implementing, nursing process, planning. expertise, and the needs and preferences of the patient.
evaluation, assessment of performance against an estab- evidence-based pharmacy, the practice of pharmacy in
lished set of goals or objectives. which the pharmacist makes decisions, taking into account
Evans blue [Herbert Evans, American anatomist, 1882– the best available current research evidence, the pharmacist’s
1971], a nontoxic blue-green dye used to determine blood expertise, and the needs and preferences of the patient.
and plasma volumes. evidence-based practice, the practice of health care in
evaporate. See evaporation. which the practitioner systematically finds, appraises, and
evaporated milk /ivap′ərā′tid/, homogenized whole milk uses the most current and valid research findings as the basis
from which 50% to 60% of the water content has been evap- for clinical decisions. The term is sometimes used to denote
orated. It is fortified with vitamin D, canned, and sterilized. evidence-based medicine specifically but can also include
When it is diluted with an equal amount of water, its nutri- other specialties, such as evidence-based nursing, pharmacy,
tional value is comparable to that of fresh whole milk. and dentistry.
evaporation /ivap′ərā′shən/ [L, ex + vapor, steam], the evisceration /ivis′ərā′shən/ [L, ex + viscera,
change of a substance from a liquid state to a gaseous state. entrails], 1. the removal of the viscera from the abdomi-
The process of evaporation is hastened by an increase in nal cavity; disembowelment. 2. the removal of the contents
temperature and a decrease in atmospheric pressure. See also from an organ or an organ from its cavity. 3. the protrusion
boiling point. —evaporate, v. of an internal organ through a wound or surgical incision,
evening primrose oil, an oil produced by cold extraction especially in the abdominal wall. —eviscerate, v.
from the ripe seeds of Oenothera biennis, the evening prim-
rose, used internally in the treatment of mastalgia, premen-
strual syndrome, and atopic eczema.
eventration /ē′vəntrā′shən/, the protrusion of the intestines
from the abdomen.
event-related potential (ERP) [L, evenire, to happen, rela-
tus, carry back, potentia, power], a type of brain wave that
is associated with a response to a specific stimulus, such as
a particular wave pattern observed when a patient hears a
clicking sound. See also evoked potential.
evergreen contract, a health care contract that is automati-
cally renewed for the term of the contract unless it is renego-
tiated. Not applicable in Canada.
eversion /ivur′zhən/, a turning outward or inside out, such
as a turning of the foot outward at the ankle.
Small bowel evisceration (NAEMT, 2011)
evocation /ev′ōkā′shən/ [L, evocare, to call forth], a spe-

cific morphogenetic change within a developing embryo that
results from the action of a single hormone or other chemi-
cal. See also induction.
evocator /ev′ōkā′tər/ [L, evocare, to call forth], a specific
30° chemical substance or hormone that is emitted from the orga-
nizer part of the embryonic tissue and acts as a morphoge-
netic stimulus in the developing embryo.
20° evoked potential (EP) /ivōkt′/ [L, evocare, to call forth,
potentia, power], an electrical response in the brainstem
0° or cerebral cortex that is elicited by a specific stimulus. The
Eversion Inversion stimulus may affect the visual, auditory, or somatosensory
pathway, producing a characteristic brain wave pattern. The
Eversion and inversion of the foot activity and function of the system may be monitored during
(Seidel et al, 2011/Courtesy Patrick Watson) surgery while the patient is unconscious. The surgeon is thus
evoked potential (EP) studies 654 Exchange Lists for Meal Planning
able to prevent damage to the nerves during operative proce- from bone marrow, usually in long bones or the pelvis. It
dures. Evoked potentials are also used to diagnose multiple occurs most frequently in adolescent boys and is character-
sclerosis and various disorders of hearing and of sight. Kinds ized by pain, swelling, fever, and leukocytosis. The tumor, a
of evoked potentials include brainstem auditory evoked soft, crumbly grayish mass that may invade surrounding soft
response, somatosensory evoked potential, and visual- tissues, may be difficult to distinguish histologically from a
evoked potential. See also brain electric activity map. neuroblastoma or a lymphoma. Surgery, chemotherapy, and
evoked potential (EP) studies, an electrodiagnostic test radiotherapy are often used in treatment. Also called endo-
indicated for patients with suspected sensory deficit who are thelial myeloma, Ewing’s tumor. See also neuroblastoma,
unable to indicate or unreliable in indicating stimulus recog- histiocytic malignant lymphoma.
nition. Evoked potential studies are used to evaluate areas of ex-, prefix meaning “away from, outside, without”: excoria-
the cortex that receive incoming stimulus from the eyes, ears, tion, exfoliatio, exocrinous.
and lower/upper extremity sensory nerves; to monitor natu- exa-, prefix of a Standard International unit that indicates
ral progression or treatment of deteriorating neurological 1018.
diseases; and to identify histrionic or malingering patients exacerbation /igzas′ərbā′shən/ [L, exacerbare, to pro-
with sensory deficit complaints. These studies include visual voke], an increase in the seriousness of a disease or disor-
evoked responses, auditory brainstem evoked potentials, and der as marked by greater intensity in the signs or symptoms
somatosensory evoked responses. of the patient being treated.
evoked response audiometry, a method of testing hear- examination, a critical inspection and investigation, usu-
ing ability at the level of the brainstem and auditory cortex. ally following a particular method, performed for diagnostic
Evoked response audiometry is useful in diagnosing possible or investigational purposes.
defects in the vestibulocochlear nerve and brainstem audi- examination assistance, a nursing intervention from the
tory pathways. Nursing Interventions Classification (NIC) defined as provid-
evolution /ev′əloo′shən/ [L, evolvere, to roll forth], 1. a ing assistance to the patient and another health care provider
gradual, orderly, and continuous process of change and during a procedure or exam. See also Nursing Interventions
development from one condition or state to another. It Classification.
encompasses all aspects of life, including physical, psycho- exanthem /ig′zan′thəm/ [Gk, eruption], a rapidly erupt-
logical, sociological, cultural, and intellectual development, ing rash that may have specific diagnostic features of an
and involves a progressive advancement from a simple to a infectious disease. Chickenpox, measles, roseola infantum,
more complex form or state through the processes of modifi- and rubella are usually characterized by a particular type of
cation, differentiation, and growth. 2. a change in the genetic exanthem. Also called exanthema. Compare enanthema.
composition of a population of organisms over time. 3. the —exanthematous, adj.
appearance over long periods of time of new taxonomic exanthema subitum. See roseola infantum.
groups of organisms from preexisting groups. Kinds of evo- exanthematous /ig′zənthem′ətəs/ [Gk, ex, out, anthema,
lution are convergent evolution, determinant evolution, blossoming], pertaining to an eruptive disease (such as
emergent evolution, organic evolution, orthogenic evolu- measles) or the skin rash that accompanies it.
tion, and saltatory evolution. —evolutionist, n. exanthem subitum, exanthema subitum. See roseola
evolution of infarction, the normal healing process after infantum.
a myocardial infarction, as demonstrated on successive excavatio rectouterina. See Douglas’s cul-de-sac.
electrocardiograms. excavator /eks′kəvāt′ər/ [L, ex, out + cavus, hol-
evulsed tooth. See avulsed tooth. low], 1. an instrument for hollowing out something by
Ewing’s sarcoma /yoo′ingz/ [James Ewing, American removing the center or inner part, or for making a hole or
pathologist, 1866–1943], a malignant tumor that develops cavity such as the removal of caries or granulation tissue.
2. a scoop, spoon, or gouge for surgical use.
exceptional education need, the determination that a
disability or condition exists and interferes with the child’s
or adolescent’s ability to participate in an educational

program.
excess /ek′ses/, an amount more than is normal or necessary.
excessive sweat /ikses′iv/ [L, excedere, to go out; AS,
swaeaten], perspiration greater than normal for the ambi-
ent environment. It is usually a sign of septic fever, pulmo-
nary tuberculosis, hyperthyroidism, chronic renal disease, or
malaria. Abnormal sweating of the hands and feet is often a
sign of nervous irritability or other emotional stress.
excess mortality /ikses′/ [L, excedere, to go out, mortalis,
mortal], a premature death, or one that occurs before the
average life expectancy for a person of a particular demo-
graphic category.
Exchange Lists for Meal Planning, a grouping of foods
in which the carbohydrates, fats, proteins, and calories are
similar for the serving sizes listed. The lists, published by
the American Dietetic Association and the American Dia-
betes Association, are used in meal planning for various
diseases as well as for weight reduction. Foods are divided
into three different groups or lists: carbohydrates, meat and
meat substitutes, and fats. The carbohydrate group is sub-
Ewing’s sarcoma (Fletcher, 2007) divided into lists of starch, fruit, milk, other carbohydrates,
exchange transfusion 655 excoriation
and vegetables. A dietitian can create an appropriate dietary Fluid intake and output are measured, and ongoing care is
program prescribing the number of calories and units of each provided as for all high-risk infants.
exchange category to be consumed daily, as well as a plan n interventions: The nurse prepares the equipment and
for when they should be eaten. The patient selects preferred infant for the exchange transfusion, assists the physician in
foods from the lists. Other countries such as Canada use sim- the insertion of the umbilical venous line, and monitors the
ilar lists, for example, Food Choices. baby during and after the procedure.
exchange transfusion, the removal of all or most of a n outcome criteria: An exchange transfusion is usu-
patient’s diseased blood and its simultaneous replacement ally administered only to a high-risk infant, but the proce-
with an equal volume of normal blood. dure often effectively counteracts the hemolytic anemia
exchange transfusion in the newborn /iks·chāng′/ [L, ex and hyperbilirubinemia associated with erythroblastosis
+ cambire, to change], the introduction of whole blood in neonatorum.
exchange for 75% to 85% of an infant’s circulating blood excimer laser /ek′simər/, one of a class of lasers with out-
that is repeatedly withdrawn in small amounts and replaced put in the ultraviolet range of the electromagnetic spectrum.
with equal amounts of donor blood. The procedure is per- The name is derived from the symbol formed by the combi-
formed to improve the oxygen-carrying capacity of the blood nation of xenon atoms (Xe) and halogen atoms (X) to yield
in the treatment of erythroblastosis fetalis by removing Rh xenon-halide compounds as XEX.
and ABO antibodies, sensitized erythrocytes that produce excision /iksish′ən/ [L, ex + caedere, to cut], 1. the pro-
hemolysis, and accumulated bilirubin. cess of cutting out or off. 2. (in molecular genetics) the pro-
n method: A radiant heat warmer, a pacifier, and cardiac cess by which a genetic element is removed from a strand of
and respiratory monitors are prepared, and resuscitative deoxyribonucleic acid. Compare resection. —excise, v.
equipment and drugs, including oxygen, a mask, a bag, excitability /iksī′təbil′itē/ [L, excitare, to arouse], the
suction apparatus, glucose, calcium, and sodium bicarbon- property of a cell that enables it to react to irritation or stimu-
ate, are made readily available. The results of laboratory lation, such as the ability of a nerve or muscle cell to react to
studies of the infant’s bilirubin, hemoglobin, and calcium an electric stimulus.
levels; hematocrit; blood culture; random blood glucose excitant /eksī′tənt/, a drug or other agent that arouses the
test; and the donor blood culture are checked. The donor central nervous system or other body system in a particular
blood is checked to make certain that it is not more than 48 manner. Excitants may be drugs or other substances, such as
hours old. If fresh whole blood is not used, stored blood is caffeine, or visual or auditory stimuli.
mixed in amounts as ordered with frozen plasma or human excitation /ek′sitā′shən/ [L, excitare, to arouse], nerve or
plasma protein fraction (Plasmanate). Before exchange muscle action as a result of impulse propagation; a state of
transfusion nothing is administered by mouth for 3 to 4 mental or physical excitement.
hours or the contents of the infant’s stomach are aspirated. excitatory amino acids /eksī′tətôr′ē/, one of a group of
The baby’s extremities are restrained; the blood is warmed amino acids that affect the central nervous system by act-
as ordered, and the physician is assisted with the insertion ing as neurotransmitters and in some cases as neurotoxins.
of an umbilical venous line, if one is not in place. The phy- Examples include glutamate and aspartate, which cause
sician may administer albumin with the donor blood. The depolarization but may also trigger the death of neurons.
procedure may be carried out under phototherapy lights. Some excitatory amino acids are produced by plants and
Unless contraindicated, the infant’s parents may be pres- fungi and may be responsible for hypoxic or hypoglycemic
ent. During the procedure the young patient is observed for brain damage.
bradycardia with less than 100 beats a minute, cyanosis, excitatory impulse, a sudden force that stimulates activity.
hypothermia, vomiting, aspiration, apnea, an air embolus, excited state /eksī′tid/ [L, excitare, to rouse, status], (in
abdominal distension, or cardiac arrest. The respiratory chemistry and physics) an energy level of a system that
and cardiac rates are checked every 5 minutes; the axil- is higher than the ground state. The system decays to the
lary temperature is checked every 15 to 30 minutes. The ground state and emits the energy difference, usually in the
integrity of all blood tubing connections is inspected peri- form of photons.
odically. The amount of blood withdrawn and infused is excitement /eksīt′mənt/, (in psychiatry) a pathological state
recorded, and the physician is notified when each 100 mL marked by emotional intensity, impulsive behavior, anticipa-
of blood has been exchanged. A repetition of laboratory tion, and arousal. Excitement in schizophrenic patients tends
studies is requested as ordered for the last amount of blood to result from blocked communications and hostile feelings
removed from the infant. After the procedure the infant is between the patients and the hospital staff.
observed for signs of tachycardia or bradycardia, tachypnea exciting eye, (in sympathetic ophthalmia) the eye that sus-
or bradypnea, hypothermia, lethargy, jitteriness, increasing tains a penetrating injury and causes an inflammatory reac-
jaundice, cyanosis, edema, dark urine, bleeding from the tion in the fellow eye. Also called inciting eye.
cord, convulsions, or complications, such as hemorrhage, exclusion from base price, a health care contract provi-
hypocalcemia, heart failure, hypoglycemia, sepsis, aci- sion in which high-cost variable items beyond the control of
dosis, hyperkalemia, thrombus formation, or shock. The the provider, such as organ procurement costs, are excluded
infant is maintained in a neutral thermal environment and from the base price. Not applicable in Canada.
is handled gently and minimally for the next 2 to 4 hours. Exclusive Provider Organization (EPO), a type of
The cardiac and respiratory rates are monitored every 15 managed health care organization in which no coverage
minutes for 4 hours, then every 30 to 60 minutes for 24 to is typically provided for services received outside the
48 hours or as ordered. The axillary temperature is checked EPO. However, some EPOs incorporate the primary care
every 1 to 3 hours for 48 hours, and the cord is observed physician gatekeeper concept along with prospective
for bleeding every 5 to 15 minutes for 1 to 2 hours after approval of referrals to specialists of providers outside
the procedure. Feeding by gavage or a bottle with a soft the EPO.
nipple with a large enough hole to ensure adequate intake is excoriation /ekskôr′ē·ā′shən/ [L, excoriare, to flay], an
initiated 4 to 6 hours after the transfusion, as ordered. The injury to a surface of the body caused by trauma, such as
infant is fed slowly and repositioned after each feeding. scratching, abrasion, or a chemical or thermal burn.
excrement 656 exercise promotion: stretching
n
indications: This drug is given in combination with met-
formin or a sulfonylurea to treat type 2 diabetes mellitus.
drug prohibits its use.
n adverse effects: Adverse effects of this drug include
feeling jittery, restlessness, weakness, nausea, vomiting,
diarrhea, dyspepsia, anorexia, gastroesophageal reflux, and
weight loss. A life-threatening side effect is hypoglycemia.
Common side effects include headache and dizziness.
exencephaly /ek′sənsef′əlē/ [L, ex, out + Gk, enkephalos,
brain], a developmental anomaly characterized by lack of
all or part of the skull, so that the brain is exposed.
exenteration /eksen′tera′shun/, 1. surgical removal of the
inner organs; evisceration. 2. in ophthalmology, removal of
the entire contents of the orbit.
exercise /ek′sərsiz/ [L, exercere, to exercise], 1. n, the
Excoriations from tree branch scratches performance of any physical activity for the purpose of
(Lemmi and Lemmi, 2000) conditioning the body, improving health, or maintaining fit-
ness or as a means of therapy for correcting a deformity or
excrement /eks′krəment/, any waste matter, particularly restoring the organs and body functions to a state of health.
feces, discharged from the body. 2. n, any action, skill, or maneuver that causes muscle exer-
excreta /ekskrē′tə/ [L, excernere, to separate], any waste tion and is performed repeatedly to develop or strengthen
matter discharged from the body. the body or any of its parts. 3. v, to use a muscle or part
excrete /ekskrēt′/ [L, excernere, to separate], to evacuate of the body in a repetitive way to maintain or develop its
a waste substance from the body, often via a normal secre- strength. Exercise has a beneficial effect on each of the body
tion; for example, a drug that may be excreted in breast milk. systems, although in excess it can lead to the breakdown of
excretion /ekskrē′shən/, the process of eliminating, shed- tissue and cause injury. Kinds of exercise are active assisted
ding, or getting rid of substances by body organs or tissues, exercise, active exercise, active resistance exercise, aero-
as part of a natural metabolic activity. Excretion usually bic exercise, anaerobic exercise, isometric exercise, iso-
begins at the cellular level, where water, carbon dioxide, and tonic exercise, muscle-setting exercise, passive exercise,
other waste products of cellular life are emptied into the cap- progressive resistance exercise, range of motion exercise,
illaries. The epidermis excretes dead skin cells by shedding therapeutic exercise, and underwater exercise.
them daily. exercise amenorrhea, a suppression of ovulation and thus
excretory /eks′krətôr′ē/ [L, excernere, to separate], relat- menstration that affects some women who participate in
ing to the process of excretion, often used in combination high-intensity athletics. See also stress amenorrhea.
with a term to identify an object or procedure associated with exercise electrocardiogram (ECG), a record of the elec-
excretion, such as excretory urography. trical activity of the heart taken during graded increases in
excretory duct, a duct that is conductive but not secretory. the rate of exercise. It is important in the diagnosis of coro-
excretory organ, an organ that is concerned primarily with nary artery disease. Abnormal changes in cardiac function
the production and discharge of body wastes. that are absent during rest may occur with exercise. See also
excretory urography [L, excernere, to separate; Gk, ouron, stress test.
urine, graphein, to record], the radiographic examination exercise-induced anaphylaxis, a rare severe allergic reac-
of the urinary tract. It is accomplished with the use of con- tion brought on by strenuous exercise. Cessation of physical
trast medium that is injected into the blood, filtered by the activity usually results in immediate improvement. See also
kidneys, and passed through the tract. Also called intrave- anaphylaxis.
nous pyelography (IVP). exercise-induced asthma /-indyoost′/, a form of asthma

excursion /ikskur′zhən/ [L, ex, out, currere, to run], a that produces symptoms after strenuous exercise. The condi-
departure or deviation from a direct or normal course. tion usually occurs in persons who already have asthma, hay
execute /ek′səkyoot/, (of a computer) to follow a set of fever, or related hypersensitivity reactions. The effect may be
instructions to complete a program or specified function. acute but is reversible.
executive physical /iksek′yətiv/, a physical examination exercise prescription [L, exercere + prae + scribere, to write],
that includes extensive laboratory, radiographic, and other an individualized schedule for physical fitness exercises.
tests that may be provided periodically to management level exercise promotion, a nursing intervention from the Nurs-
personnel at employer expense. Such examinations may be ing Interventions Classification (NIC) defined as the facilita-
detailed, expensive, and overly complete. tion of regular physical activity to maintain or advance to a
exemestane, an antineoplastic. higher level of fitness and health. See also Nursing Inter-
n indication: It is used to treat advanced breast cancer in ventions Classification.
postmenopausal patients whose cancer is unresponsive to exercise promotion: strength training, a nursing inter-
other therapies. vention from the Nursing Interventions Classification (NIC)
n contraindications: Its use is prohibited in premeno- defined as facilitating regular resistive muscle training to
pausal women, pregnant women, and clients with known maintain or increase muscle strength. See also Nursing
hypersensitivity to this drug. Interventions Classification.
n adverse effects: Adverse effects include fatigue, diar- exercise promotion: stretching, a nursing intervention
rhea, constipation, abdominal pain, increased appetite, from the Nursing Interventions Classification (NIC) defined
hypertension, depression, insomnia, anxiety, cough, and as facilitation of systematic slow-stretch-hold muscle exer-
dyspnea. Common side effects include nausea, vomiting, hot cises to induce relaxation, to prepare muscles/joints for more
flashes, and headache. vigorous exercise, or to increase or maintain body flexibility.
exenatide, an antidiabetic drug. See also Nursing Interventions Classification.
exercise therapy: ambulation 657 exogenous
exercise therapy: ambulation, a nursing intervention exhalation. See expiration.
from the Nursing Interventions Classification (NIC) defined exhale. See expire.
as promotion and assistance with walking to maintain or exhaustion /igzôs′chən/ [L, exhaurire, to drain away], a
restore autonomic and voluntary body functions during treat- state of extreme loss of physical or mental abilities caused
ment and recovery from illness or injury. See also Nursing by fatigue or illness.
Interventions Classification. exhaustion delirium, a delirium that may result from pro-
exercise therapy: balance, a nursing intervention from longed physical or emotional stress, fatigue, or shock associ-
the Nursing Interventions Classification (NIC) defined as the ated with severe metabolic or nutritional problems. See also
use of specific activities, postures, and movements to main- delirium.
tain, enhance, or restore balance. See also Nursing Inter- exhaustion psychosis [L, exhaurire, to drain out; Gk,
ventions Classification. psyche, mind, osis, condition], an abnormal mental condi-
exercise therapy: joint mobility, a nursing intervention tion attributable to physical exhaustion. The main symptom,
from the Nursing Interventions Classification (NIC) defined as a delirious state, may develop in some explorers, mountain
use of active or passive body movement to maintain or restore climbers, persons lost in the wilderness, and terminally ill
joint flexibility. See also Nursing Interventions Classification. patients. See also exhaustion delirium.
exercise therapy: muscle control, a nursing intervention exhibitionism /ek′sibish′əniz′əm/ [L, exhibere, to
from the Nursing Interventions Classification (NIC) defined exhibit], 1. the flaunting of oneself or one’s abilities to
as use of specific activity or exercise protocols to enhance or attract attention. 2. (in psychiatry) a psychosexual disor-
restore controlled body movement. See also Nursing Inter- der that occurs primarily in men in which the repetitive act
ventions Classification. of exposing the genitals in socially unacceptable situations
exercise tolerance, the level of physical exertion an indi- is the preferred means of achieving sexual excitement and
vidual may be able to achieve before reaching a state of gratification. See also paraphilia, scopophilia. —exhibi-
exhaustion. Exercise tolerance tests are commonly performed tionist, n.
on a treadmill under the supervision of a health professional eximer laser /ek′simir/, a small laser designed to break up
who can stop the test if signs of distress are observed. organic molecules, such as cholesterol deposits, without pro-
exeresis /ekser′əsis/ [Gk, ex + eresis, removal], the surgi- ducing intense heat.
cal excision of a part, organ, or body structure. existential humanistic psychotherapy. See humanistic
exertional headache /igzur′shənəl/ [L, exserere, to stretch out; existential therapy.
AS, heafod + acan, headache], an acute headache that occurs existential psychiatry /eg′zisten′shəl/ [L, existere, to
during strenuous exercise. It usually recedes when the level of spring forth; Gk, psyche, mind, iatreia, medical care], a
effort is reduced, when an analgesic medication is taken, or both. school of psychiatry based on the philosophy of existential-
exfoliation /eksfō′lē·ā′shən/ [L, ex + folium, leaf], peeling ism that emphasizes an analytic, holistic approach in which
and sloughing off of tissue cells. This is a normal process mental disorders are viewed as deviations within the total
that may be exaggerated in certain skin diseases or after a structure of an individual’s existence rather than as results of
severe sunburn or may be be done deliberately, such as with any biologically or culturally related factors.
microdermabrasion. See also desquamation, exfoliative existential therapy, a kind of psychotherapy that
dermatitis. —exfoliative, adj. emphasizes the development of a sense of self-direction
exfoliative cytology /eksfō′lē·ətiv/, the microscopic exam- through choice, awareness, and acceptance of individual
ination of desquamated cells for diagnostic purposes. The responsibility.
cells are obtained from lesions, sputum, secretions, urine, exit block [L, exire, to depart; Fr, bloc], the failure of an
and other material by aspiration, scraping, a smear, or wash- expected impulse to emerge from its focus of origin and
ings of the tissue. Compare aspiration biopsy cytology. cause depolarization of cardiac muscle.
exfoliative dermatitis, any inflammatory skin disorder char- exit dose, the amount of radiation at the surface of the body
acterized by excessive peeling or shedding of skin. The cause opposite that to which the radiation is directed.
is unknown in about half of cases. Known causes include drug Exjade, a trademark for deferasirox.
reactions, scarlet fever, leukemia, lymphoma, and generalized exo-, prefix meaning “outside, outward”: exocataphoria,
dermatitis. Treatment is individualized, but care is essential to exohysteropexy, exotoxin.
prevent secondary infection, avoid further irritation, maintain exocoelom. See extraembryonic coelom.
fluid balance, and stabilize body temperature. exocrine /ek′səkrin/ [Gk, exo, outside, krinein, to
secrete], pertaining to the process of secreting outwardly
through a duct to the surface of an organ or tissue or into a
vessel. See also exocrine gland. Compare endocrine sys-
tem. See also eccrine.
exocrine gland, a gland that discharges its secretions
through ducts opening on internal or external surfaces of the
body. An example is the lacrimal gland. See also gland.
exocytosis /ek′sōsītō′sis/ [Gk, exos, outside + kytos, a hol-
low vessel], discharge from a cell of particles that are too
large to diffuse through the wall. Compare endocytosis.
exodondist. See dental surgeon.
exoenzyme /ek′sō·en′zīm/, an enzyme that does not func-
tion within the cells from which it is secreted.
exogenous /igzoj′ənəs/ [Gk, exo + genein, to pro-
duce], 1. outside the body. 2. originating outside the
body or an organ of the body or produced from external
causes, such as a disease caused by a bacterial or viral agent
foreign to the body. Compare endogenous. —exogenic,
Exfoliative dermatitis (Callen et al, 2000) adj.
exogenous hypertriglyceridemia 658 exotropia
exogenous hypertriglyceridemia. See hyperlipidemia exophthalmic goiter /ek′softhal′mik/, exophthalmos that
type I. occurs in association with goiter, as in Graves’ disease.
exogenous infection [Gk, exo, outside, genein, to produce; exophthalmometer /ek′səfthalmom′ətər/ [Gk, exo + oph-
L, inficere, to infect], an infection that develops from bac- thalmos, eye, metron, measure], an instrument used for
teria normally outside the body that have gained access to measuring the degree of forward displacement of the eye in
the body. exophthalmos. The device allows measurement of the for-
exogenous obesity, obesity caused by a caloric intake ward distance of the lateral orbital rim to the front of the
greater than needed to meet the metabolic needs of the body. cornea.
Compare endogenous obesity. See also obesity. exophthalmos. See exophthalmia.
exogenous uric acid [Gk, exo, outside, genein, to produce, exophthalmos-macroglossia-gigantism syndrome. See
ouron, urine; L, acidus], the accumulation of uric acid in EMG syndrome.
the body produced by the metabolism of purine-rich foods. exophytic /ek′səfit′ik/ [Gk, exo + phyton, plant], pertain-
exon /ek′son/ [Gk, exo + genein, to produce], the part of a ing to the tendency to grow outward, such as a tumor that
DNA molecule that contains the code for the final messenger grows into the lumen of a hollow organ rather than into the
RNA. Compare intron. wall.
exonuclease /ek′sōnoo′klē·ās/ [Gk, exo + L, nucleus, nut; exophytic carcinoma, a malignant epithelial neoplasm
ase, enzyme], an enzyme that digests DNA or RNA from that resembles a papilloma or wart.
the ends of the strands. Compare endonuclease. exoskeletal prosthesis /ek′səskel′ətəl/ [Gk, exo + skeletos,
Exophiala /ek′sofī′ə·lə/, a widespread genus of saprobic dried up, prosthesis, addition], a prosthetic device in which
Fungi Imperfecti. E. jeanselmei is commonly found in soil support is provided by an outside structure (not an implant),
and sewage and causes mycetoma and opportunistic infec- such as an artificial limb. See also prosthesis.
tions in humans. Hortae werneckii (formerly classified as exoskeleton /ek′səskel′ətən/ [Gk, exo, outside, skeletos,
E. werneckii) is the cause of tinea nigra. Because it is so dried up], the hard outer covering of many invertebrates,
variable, some authorities have proposed dividing it into such as crustaceans, which lack the bony internal skeleton of
more than one species. Infection usually results from trau- vertebrates. Compare endoskeleton.
matic implantation and is associated with local or systemic exostosis /ek′sostō′sis/ [Gk, exo + osteon, bone], an
immunosuppression. abnormal benign growth on the surface of a bone. Also called
exophoria /ek′səfôr′ē·ə/ [Gk, exo + pherein, to bear], the hyperostosis. —exostosed, exostotic, adj.
latent lateral deviation of the visual axis of one eye out-
ward. It occurs in the absence of visual stimuli for fusion.
Also called divergent strabismus. Compare exotropia.
—exophoric, adj.
exophthalmia /ek′softhal′mē·ə/ [Gk, exo + ophthalmos,
eye], an abnormal condition characterized by a marked
protrusion of the eyeballs (exophthalmos, exophthalmus),
usually resulting from the increased volume of the orbital
contents caused by a tumor; swelling associated with cere-
bral, intraocular, or intraorbital edema or hemorrhage; paral-
ysis of or trauma to the extraocular muscles; or cavernous
sinus thrombosis. It may also be caused by endocrine disor-
ders such as hyperthyroidism and Graves’ disease, varicose
veins within the orbit, or injury to orbital bones. Visual acu-
ity may be impaired in exophthalmia; keratitis, ulceration,
infection, and blindness may also occur. Treatment depends
on the underlying cause. Acute advanced exophthalmia is
often irreversible. Also called protrusio bulbi. See also

proptosis. —exophthalmic, adj.
Exostosis (Swartz, 2009)
exostosis cartilaginea [Gk, ex, out, osteon, bone; L, carti-

lago, cartilage], an outgrowth of cartilage at the ends of
long bones. Also called cartilage capped exostosis.
exostotic. See exostosis.
exoteric /ek′səter′ik/ [Gk, exoterikos, external], lying out-
side an organism.
exothermic, indicating a chemical process accompanied by
the release of heat, such as the loss of body surface heat.
exotoxin /ek′sətok′sin/ [Gk, exo + toxikon, poison], a
toxin that is secreted or excreted by a living microorganism.
Compare endotoxin.
exotropia /ekstrō′fēə/, a deviation of the lines of sight
between the two eyes in which the nonfixating eye is pointed
outward. The eye has defective vision. Also called divergent
Exophthalmia (Goldman et al, 2012) squint, divergent strabismus.
expanded function dental assistant 659 experimental epidemiology
expected date of delivery (EDD), the predicted date of a
pregnant woman’s delivery. Pregnancy lasts approximately
266 days, or 38 weeks from the day of fertilization, but is con-
sidered clinically to last 280 days, or 40 weeks, or 10 lunar
months, or 9⅓ calendar months from the first day of the last
menstrual period (LMP). The EDD is usually calculated on
the basis of 9⅓ calendar months, but if a woman is certain
that coitus occurred only once during the month and if she
knows the date on which it occurred, the EDD may be calcu-
lated as 38 weeks from that date. In the absence of a special
calendar or device for calculating the EDD, it is arrived at by
counting back 3 months from the first day of the LMP and then
adding 7 days and 1 year; thus, if the first day of a woman’s
LMP was July 18, 1997, one counts back 3 months to April
18, 1997, then adds 7 days and 1 year to arrive at an EDD
of April 25, 1998 (Nägele’s rule). Because calendar months
Exotropia (Albert et al, 2008/ Courtesy David Walton, MD) differ in length, this calculation may give a date that is a few
days more or less than 280 days from the first day of the LMP,
but it provides a very close approximation, and a trivial error
expanded function dental assistant, a dental assistant will not be of clinical significance because of the variability
with training beyond basic dental assisting, who has passed of the actual durations of normal pregnancies. The expectant
a competency examination, and who has state-granted per- mother is advised that the EDD is only an estimate and that
mission to perform certain dental procedures other than the the chances are that she will give birth within 2 weeks before
removal, altering, or shaping of human tissue. Examples of or, more commonly, after the calculated date. Also called
some expanded functions are placement of post-extraction expected date of birth, expected date of confinement.
and sedative dressings; placing periodontal dressings; siz- expectorant /ikspek′tərənt/ [Gk, ex, out, pectus,
ing stainless steel crowns; placing and condensing amalgam breast], 1. pertaining to a substance that promotes the ejec-
for Class I, V, and VI restorations; carving amalgam; plac- tion of mucus or other exudates from the lung, bronchi, and
ing composite for Class I, V, and VI restorations; polishing trachea. 2. an agent that promotes expectoration by reducing
the coronal surfaces of teeth; minor palliative care of dental the viscosity of pulmonary secretions or by decreasing the
emergencies (placing sedative filling); preliminary bend- tenacity with which exudates adhere to the lower respiratory
ing of archwire; removal of orthodontic bands and bonds; tract. Expectorant drugs include acetylcysteine, guaifenesin,
final cementation of any permanent appliance or prosthesis; and terpin hydrate. Also called mucolytic. —expectorate, v.
minor palliative care of orthodontic emergencies (bend/clip expectoration /ekspek′tərā′shən/, the ejection of mucus, spu-
wire, remove broken appliance); making impressions for tum, or fluids from the trachea and lungs by coughing or spitting.
the fabrication of removable prosthesis; placement of tem- experience rating /ikspir′ē·əns/ [L, experientia, testing,
porary soft liners in a removable prosthesis; place retrac- rata, proportion], a system used by insurance companies in
tion cord in preparation for fixed prosthodontic impressions; the United States to set the premium to be paid by the insured
making impressions for the fabrication of fixed prosthesis; on the basis of the risk to the company of providing the insur-
extra-oral adjustment of fixed prosthesis; extra-oral adjust- ance. Experience rating may lead to very high malpractice
ment of removable prosthesis during and after insertion; and premiums in some medical specialties, for the insurance
placement and cementation of orthodontic brackets and/or company calculates the premium on the basis of settlements
bands. made in related malpractice cases during a specified period.
expanded role [L, expandere, to spread out; OFr, rolle, an Experience rating is also used to set annual membership
assumed character], the functions of a nurse that are not speci- health maintenance fees in organizations in which the cost
fied in the traditional limits of nursing practice legislation. Com- of providing the services in a previous accounting period is
mon roles are primary nurse and nurse practitioner, necessitating used to determine the premiums for the next fiscal year.
legal coverage through the establishment of standardized proce- experiment, an investigation in which one or more vari-
dures or amendments or changes in nursing practice acts. ables may be altered under controlled circumstances to study
expansion /ekspan′shən/ [L, expandere, to spread the effects of altering variables.
out], 1. the process or state of being increased in extent, sur- experimental design /eksper′imen′təl/ [L, experimentum +
face, or bulk. 2. a region or area of increased bulk or surface. designare, to mark out], (in research) a study design used
expectant treatment /ekspek′tənt/ [L, exspectare, to wait to test cause-and-effect relationships between variables. The
for; Fr, traitment], application of therapeutic measures to classic experimental design specifies an experimental group
relieve symptoms as they arise in the course of a disease, and a control group. The independent variable is administered
rather than treatment of the cause of illness. Some kinds of to the experimental group and not to the control group, and
expectant treatment are amputations for gangrene in a patient both groups are measured on the same dependent variable.
with diabetes, coronary bypass procedures in a patient with Subsequent experimental designs have used more groups
generalized atherosclerosis, and transplantation of tendons in and more measurements over longer periods. True experi-
a patient with severe rheumatoid arthritis. Compare defini- ments must have control, randomization, and manipulation.
tive treatment, palliative treatment, treatment. experimental embryology, the study and analysis through
expectation /eks′pektā′shən/ [L, exspectare, to wait experimental techniques of the factors, mechanisms, and rela-
for], 1. (in nursing) anticipation by the staff of a patient’s tionships that determine and influence prenatal development.
behavior that is based on a knowledge and understanding of the experimental epidemiology, a type of epidemiological
person’s abilities and problems. 2. anticipation of the perfor- investigation that uses an experimental model for studies
mance of the nursing staff in defined roles, as role expectation. to confirm a causal relationship suggested by observational
expectation of life. See life expectancy. studies.
experimental group 660 exposure unit
experimental group, a set of items or people under study for control of respiration. It is a subregion specifically
to determine the effect of an event, a substance, or a tech- involved in carrying out the activity of expiration.
nique. Compare control group. expiratory phase, the portion of the respiratory cycle that
experimental medicine, a branch of the practice of medi- involves exhalation, or moving air out of the lungs. In normal
cine in which new drugs or treatments are evaluated for circumstances, it is passive. In a ventilated patient the expiratory
safety and efficacy in a clinical laboratory setting by using phase may be passive, depending on the recoil of elastic tissues
animals or, in certain cases, human subjects. in the lung to move air out, or active, applying positive pressure
experimental pathology, the study of diseases deliber- to the abdominal area or negative pressure to the upper airway.
ately induced in laboratory animals. expiratory reserve volume (ERV), the maximum vol-
experimental physiology, a branch of the study of physi- ume of gas that can be exhaled after a resting volume exhala-
ology in which the functions of various body systems are tion. See also vital capacity.
evaluated in a clinical laboratory setting by using animals or, expiratory retard, (in respiratory care) a mode of mechan-
in some cases, human subjects. ical ventilation that mimics the prolonged expiratory phase
experimental psychology, the study of mental processes and pursed-lip breathing of emphysema. The method adds
and phenomena by observation in a controlled environment some resistance to expiration. Low levels of positive end-
using various tests, manipulations, and experiments. Com- expiratory pressure may produce a similar effect. Also called
pare analytic psychology. expiratory resistance.
experimental variable. See independent variable. expire /ikspī′ər/ [L, expirare, to breathe out], 1. also
expertise /eks′pərtēz′/ [L, experiri, to try], special skills called exhale, to breathe out. 2. to die.
or knowledge acquired by a person through education, train- expired gas (E), any gas exhaled from the lungs.
ing, or experience. explantation /ex-plan-ta′shun/, the removal of an implant.
expert panel, a group convened for the purpose of providing exploratory /iksplôr′ətôr′ē/ [L, explorare, to search
specialized expertise related to a specific topic or area of interest. out], pertaining to investigation, as in exploratory surgery.
expert witness /ikspurt′, ek′spərt/ [L, experiri, to try; AS, exploratory operation [L, explorare, to search out, operari,
witnes, knowledge], a person who has special knowledge to work], surgical intervention to find the cause of a disorder
of a subject about which a court requests testimony. Special by opening a body cavity or organ and examining the interior.
knowledge may be acquired by experience, education, obser- explosion, 1. a sudden and violent decomposition of a
vation, or study but is not possessed by the average person. chemical compound. 2. a sudden radical breakout.
An expert witness provides testimony or informed opinions explosive personality /iksplō′siv/ [L, ex, out, plaudere, to
on evidence. This evidence often serves to educate the court clap], behavior characterized by episodes of uncontrolled
and the jury in the subject under consideration. rage and physical abusiveness in reaction to relatively minor
expiration /ik′spirā′shən/ [L, expirare, to breathe stressors.
out], 1. also called exhalation. breathing out, normally a explosive speech, abnormal speech characterized by slow,
passive process, depending on the elastic qualities of lung jerky articulation interspersed with sudden loud enunciation
tissue and the thorax. Compare inspiration. 2. termination of words, often seen in brain disorders. The term is less often
or death. —expiratory, adj. used by speech-language pathologists.
exponent /ikspō′nənt/, a superscript on a number that indi-
cates how many times a number is to be multiplied by itself
Exhalation (for example, 34 = 3 × 3 × 3 × 3 = 81). In medical or scientific
reports, powers of 10 are commonly used to indicate very large
Nose (or mouth) or very small numbers, such as in the examples 106 representing
1,000,000 or 10−6 representing 1/1,000,000. Exponents also are
indicated by prefixes, such as mega- for 106 and micro- for 10−6.
Pharynx exposed pulp [L, exponere, to lay out, pulpa, flesh], den-
tal pulp that becomes exposed to the oral environment and
potential bacterial infection. Causes include fracture of the

crown through trauma and loss of a tooth crown, the advance
Larynx of dental caries to the pulp chamber, or penetration through
the dentin during restorative preparation or caries excavation.
exposure /ikspō′zhər/ [L, exponere, to lay out], 1. a mea-
Trachea sure of the ionization of air produced by a beam of radiation.
It is expressed as coulombs per kilogram of air. 2. a state of
being in the presence of or subjected to a force or influence
(e.g., viral exposure, heat exposure).
Bronchi
exposure angle, the angle of the arc described by the move-
ment of a radiographic tube and film during a tomographic
exposure. It is usually less than the tomographic angle. The
Air containing exposure angle influences the thickness of the tomographic
carbon dioxide section: smaller angles produce thicker sections.
leaves the lungs Diaphragm relaxes exposure switch, (in radiology) a control device designed
(Expiration) to interrupt the power automatically when pressure by the
operator’s hand or foot is released. The purpose is to prevent
Expiration (LaFleur Brooks and LaFleur Brooks, 2012,
and Leonard, 2009)
accidental continuing exposure of the patient to radiation. A
common exposure switch is a foot pedal.
exposure unit, any of the conventional or SI units used to
expiratory center [L, expirare, to breath out; Gk, kentron, measure radiation exposure: roentgen, rad, rem, curie, gray,
center], one of several regions of the medulla, responsible sievert, and becquerel.
expression 661 extensor digiti minimi
expression /ikspresh′ən/ [L, exprimere, to express], 1. the exstrophy-epispadias complex, a group of congenital
indication of a physical or emotional state through facial defects of the anterior abdominal wall, including exstrophy
appearance or vocal intonation. 2. the act of pressing or of the bladder, exstrophy of cloaca, and epispadias, under the
squeezing to expel something, such as milk from the breast theory that they are all expressions of the same developmen-
when lactating or the fetus from the uterus by exertion of tal anomaly.
pressure on the abdominal wall. 3. (in genetics) the detect- exstrophy of the bladder, a developmental anomaly
able effect or appearance in the phenotype of a particular trait marked by absence of part of the lower abdominal wall and
or condition. See also expressivity. —express, v. the anterior wall of the urinary bladder, with eversion of the
expressive aphasia. See motor aphasia. posterior wall of the bladder through the defect, as well as an
expressive language disorder, a communication disorder open pubic arch and widely separated ischia connected by a
in children and adults, characterized by problems with expres- fibrous band.
sion of language, either oral or signed. It includes difficulties extended arm. See reacher.
such as limited speech or vocabulary, vocabulary errors, dif- extended care facility (ECF) [L, extendere, to stretch], an
ficulty or hesitation in word selection, oversimplification of institution devoted to providing medical, nursing, or custo-
grammatical or sentence structure, omission of parts of sen- dial care for an individual over a prolonged period, such as
tences, unusual word order, and slowed acquisition of language during the course of a chronic disease or the rehabilitation
skills. Two types are recognized, acquired and developmental. phase after an acute illness. Kinds of extended care facilities
expressivity /eks′presiv′itē/ [L, exprimere, to make are intermediate care facility and skilled nursing facility.
clear], the variability with which basic patterns of inheri- Also called convalescent home, nursing home.
tance are modified, both in degree and in variety, by the extended family, a family group consisting of the biologi-
effect of a given gene in people of the same genotype. For cal or adoptive parents, their children, the grandparents, and
example, polydactyly may be expressed as extra toes in one other family members. The extended family is the basic fam-
generation and extra fingers in another. ily group in many societies. Among its characteristics are
expulsive stage of labor /ikspul′siv/ [L, expellere, to drive exchange of information from experienced older members
out, stare, stand, labor, work], the second stage of labor, to less experienced younger ones, care of the older fam-
during which the mother’s uterine contractions are accompa- ily members in the home by the younger ones, and care of
nied by a bearing-down reflex. It begins after full dilation of younger members’ children by older members. Compare
the cervix and continues to the complete birth of the infant. nuclear family.
exsanguinate /eksang′gwināt/ [L, ex, sanguis, blood], to extended insulin-zinc suspension, a long-acting insulin
drain away or deprive an organ of blood. that is slowly absorbed and slow to act.
exsanguination /eksang′gwinā′shən/, a massive loss of extended-wear contact lens, a refractive index device
blood. that fits over the cornea, designed to permit air permeation.
exsiccant. See desiccant. Oxygen may pass between the lens and the cornea, thereby
exsiccate. See desiccate. reducing the risk of corneal irritation.
exstrophy /ek′strōfē/ [Gk, ekstrephein, to turn inside extender, something that causes an increase in time or size,
out], a congenital malformation in which a hollow organ such as a substance added to a medication to stretch the time
has its wall turned inside-out, establishing a communication required for the drug to be absorbed, such as a plasma vol-
with the exterior. An example is exstrophy of the bladder ume extender.
with eversion of the posterior bladder wall, which causes Extendryl, a trademark for a fixed-combination nasal
urine to drain to the exterior. decongestant drug containing an adrenergic (phenyleph-
rine hydrochloride), an antihistaminic (chlorpheniramine
maleate), and an anticholinergic (methscopolamine nitrate).
extension /iksten′shən/ [L, extendere, to stretch], a
“straightening” movement allowed by certain joints of the
skeleton that increases the angle between two adjoining
bones, such as extending the leg, which increases the poste-

rior angle between the femur and the tibia. Compare flexion.
extension partial denture. See partial denture.
extensor /iksten′sər/ [L, extendere, to stretch out], any
muscle that extends a body part, such as the extensor indicis,
which extends the index finger.
extensor carpi radialis brevis [L, extendere + Gk, karpos,
wrist; L, radius, ray, brevis, short], one of the muscles of the
posterior forearm. It inserts into the dorsal surface of the third
metacarpal bone and functions to extend the hand and forearm.
extensor carpi radialis longus, one of the seven superfi-
cial muscles of the posterior forearm. It inserts into the dorsal
surface of the second metacarpal bone and serves to extend
the hand and flex the forearm.
extensor carpi ulnaris, one of the muscles of the lateral
forearm. It inserts by a tendon into the ulnar side of the fifth
metacarpal bone and functions to extend and adduct the hand.
extensor digiti minimi, an extensor muscle of the poste-
rior forearm. It is a slender muscle that arises from the com-
mon extensor tendon and joins the expansion of the extensor
Exstrophy of the bladder (Kumar, Abbas, and Fausto, 2005/ digitorum tendon on the back of the first phalanx of the little
Courtesy Dr. Hardy Hendren, Surgeon-in-Chief, Children’s Hospital) finger. It functions to extend the little finger and hand.
extensor digitorum 662 external aperture of canaliculus of cochlea
support reflex and consists of an uncontrolled extension of a
flexed leg when the sole of the foot is stimulated.
extern /eks′turn/ [L, externus, outward], a medical or
Medial epicondyle dental student who lives outside the institution but provides
of humerus
Extensor digitorum medical or dental care to patients as an extracurricular activ-
(cut and reflected) ity under the professional supervision of hospital staff mem-
bers. Compare intern.
Extensor carpi
Supinator (deep) external /ikstur′nəl/ [L, externus, outward], 1. being on
ulnaris (cut) Extensor carpi the outside or exterior of the body or an organ. 2. acting
radialis longus from the outside, such as an external influence or exogenous
factor. 3. pertaining to the outward or visible appearance.
Extensor carpi
Compare internal.
radialis brevis external abdominal oblique muscle, one of a pair of
muscles that are the largest and the most superficial of the
Abductor pollicis five anterolateral muscles of the abdomen. It is a broad, thin
longus four-sided muscle that acts to compress the contents of the
Extensor pollicis abdomen and assists in micturition, defecation, emesis, par-
longus turition, and forced expiration. Both sides acting together
Extensor pollicis serve to flex the vertebral column, drawing the pubis toward
brevis the xiphoid process. One side alone functions to bend the
vertebral column laterally and to rotate it, drawing the shoul-
der of the same side forward. Also called obliquus externus
Cut tendons of
abdominis. Compare internal abdominal oblique muscle.
extensor digitorum
Extensor carpi radialis (Patton and Thibodeau, 2010)
extensor digitorum, a muscle of the posterior forearm. It

divides distally into four tendons that pass under the extensor
retinaculum and diverge on the back of the hand, inserting
into the second and third phalanges of the medial four fin- External
gers. It functions to extend the phalanges and, by continued abdominal
action, the wrist. Also called extensor digitorum communis. oblique
extensor digitorum brevis, a muscle that flexes the three
middle toes and the proximal metatarsophalangeal joint of
the great toe.
extensor digitorum longus, a penniform muscle located

at the lateral part of the anterior leg. It is one of four anterior
crural muscles. It extends the proximal phalanges of the four
small toes and dorsiflexes the foot.
extensor hallucis longus, a muscle that extends the great External abdominal oblique muscle
toe and dorsiflexes the foot at the ankle joint. (Thibodeau and Patton, 2003)
extensor indicis. See extensor.
extensor lag, the amount of drooping at a weakened joint external abdominal region. See lateral region.
that can extend only passively, no longer actively. external absorption, the taking up of substances through
extensor pollicis brevis, a muscle that extends the meta- the mucous membranes or the skin.
carpophalangeal and carpometacarpal joints of the thumb. external acoustic meatus, the canal of the external ear,
extensor pollicis longus, a muscle that extends all the composed of bone and cartilage, extending from the auricle
joints of the thumb. to the tympanic membrane. Also called external auditory
extensor retinaculum of the ankle, either of two thick lay- canal.
ers of fascia holding dorsiflexor tendons in place in the ankle. external aperture of aqueduct of vestibule, an external
extensor retinaculum of the hand, the thick band of ante- opening for the small canal extending from the vestibule of
brachial fascia that wraps tendons of the extensor muscles of the inner ear, located on the internal surface of the petrous
the forearm at the distal ends of the radius and the ulna. Also part of the temporal bone lateral to the opening for the inter-
called retinaculum extensorum manus, superficial dorsal nal acoustic passage.
carpal ligament. external aperture of canaliculus of cochlea, an external
extensor thrust, a spinal-level reflex present in a human in opening of the cochlear channel on the margin of the jugular
the first 2 months of life. It is an exaggeration of the positive opening in the temporal bone.
external aperture of tympanic canaliculus 663 external shunt
external aperture of tympanic canaliculus, the lower external iliac artery, the larger, more superficial division
opening of the tympanic channel on the inferior surface of of the common iliac artery, which descends into the thigh and
the petrous part of the temporal bone. becomes the femoral artery. The external iliac supplies the
external auditory canal, external auditory meatus. See lower limb. Compare internal iliac artery.
external acoustic meatus. external iliac node, a node in one of the seven groups of
external beam radiotherapy, treatment by radiation parietal nodes serving the lymphatic system in the abdomen
emitted from a source located at a distance from the body. and the pelvis. Compare common iliac node, iliac circum-
Also called beam therapy, external beam therapy. flex node, internal iliac node. See also lymph, lymphatic
external carotid artery, one of a pair of arteries with eight system, lymph node.
major temporal or maxillary branches, rising from the com- external iliac vein, one of a pair of veins in the lower body
mon carotid arteries. It supplies various parts and tissues of that join the internal iliac veins to form the two common iliac
the head and neck. veins. Compare internal iliac vein.
external carotid plexus, a network of nerves around the external jugular vein, the more superficial and lateral of
external carotid artery, formed by the external carotid nerves a pair of large vessels on each side of the neck that receive
from the superior cervical ganglion. It supplies sympathetic most of the blood from the exterior of the cranium and the
fibers associated with branches of the external carotid artery. deep tissues of the face. Compare internal jugular vein.
Compare common carotid plexus, internal carotid plexus. external locus of control. See locus of control.
external cervical os, an external opening of the uterus that external malleolus /male′ōlas/ [L, externus, outward,
leads into the cavity of the cervix. Compare internal cervi- malleolus, little hammer], a rounded bony prominence on
cal os. either side of the ankle joint. Also called malleolus fibulae.
external conjugate, the distance measured with obstetric external occipital crest, a ridge extending downward
calipers from the depression below the lowest lumbar ver- from the external occipital protuberance.
tebra posteriorly to the upper border of the symphysis ante- external occipital protuberance, a midline projection of
riorly (usually about 21 cm). Also called Baudelocque’s the occipital bone with curved lines extending laterally from
diameter. it.
external counterpulsation, a noninvasive technique for external pacemaker [L, externus, outward, passus, step;
providing counterpulsation (assisted heart pumping). In one ME, maken, to make], 1. a device used to stimulate the
technique the limbs are placed in inflatable trousers. Inflation heartbeat electrically by means of impulses conducted
and deflation are synchronized with the cardiac cycle, gen- through the chest wall, as used in emergency care of sig-
erating augmented blood flow during diastole and assisted nificant bradyarrhythmias. 2. a device in which the impulse
ejection during systole. generator is outside the chest but is connected with the heart
external cuneiform bone. See lateral cuneiform bone. by wires that pass under the skin. The wires are placed during
external ear, the outer structure of the ear, consisting of the open-heart surgery and are removed after surgery, when the
auricle and the external acoustic meatus. Sound waves are risk of bradycardia has diminished.
funneled through the external ear to the middle ear. Compare external perimysium. See epimysium.
internal ear, middle ear. external phase. See continuous phase.
external fertilization, the union of male and female gam- external pin fixation, a method of holding together the
etes outside the bodies from which they originated, such as fragments of a fractured bone by means of pins that are
occurs in frogs and most fish. attached to the bone and that protrude from the skin. See also
external fistula, an abnormal passage between an internal skeletal fixation.
organ or structure and the cutaneous surface of the body. It external pterygoid muscle, one of the four short, thick,
can be surgically created or caused by delayed wound heal- somewhat conical muscles of mastication that function to
ing or necrotizing tumors. open the jaws, protrude the mandible, and move the man-
external fixation, a method of holding together the frag- dible from side to side. Also called pterygoideus lateralis.
ments of a fractured bone by using transfixing metal pins external radiation therapy (ERT), the therapeutic
through the fragments and a compression device attached application of ionizing radiation from an external beam of
to the pins outside the skin surface. Nursing care includes a kilovoltage radiographic machine; a megavoltage cobalt
regular cleansing of the skin around the pins and, in certain 60 machine; or a supervoltage linear accelerator, cyclotron,
cases, application of antibiotic solutions or ointments. The or betatron. ERT is used most frequently in the treatment of
pins are removed in a later procedure when the fracture is cancer but also in the therapy of keloids and some derma-
healed. Compare internal fixation. tological conditions and in counteracting the body’s physi-
ological rejection of transplanted organs.
external resorption, dissolving of the tooth structures pro-
gressing from the outside of the tooth to the inside of the
tooth, not related to caries and often idiopathic in nature.
external respiration, the part of the respiratory process
that involves the exchange of gases in the alveoli of the lungs.
external rotation, turning outwardly or away from the
midline of the body, such as when a leg is externally rotated
with the toes turned outward or away from the body’s
midline.
external secretion. See exocrine gland.
external shunt, a device for the passage of body fluid from
one compartment to another. It consists of a tube or catheter
(or a series of such containers) that passes from one compart-
ment or cavity to another over the body surface rather than
External fixation (Courtesy Zimmer, Inc.) inside the body. See also hemodialysis, hydrocephalus.
external sphincter of female urethra 664 extradural hemorrhage
external sphincter of female urethra, a sphincter muscle matrix secreted by chondroblasts, for example, is responsible
that compresses the central part of the urethra in females. It for the properties of cartilage.
originates in the ramus of the pubis and is innervated by the extracellular space. See extracellular.
perineal nerves. extrachromosomal /-krō′məsō′məl/, occurring without
external sphincter of male urethra, a sphincter muscle direct involvement of the chromosomes. See epigenesis.
that compresses the membranous part of the urethra in males. extracoronal /eks′trəkor′ənəl/ [L, extra + corona,
It originates in the ramus of the pubis and is innervated by crown], outside the crown of a tooth.
the perineal nerves. extracoronal retainer /-kôr′ənəl/ [L, extra + corona, crown,
external urethral orifice. See urinary meatus. retinere, to hold], 1. a dental anchor that incorporates a cast
external ventricular drain, a ventricular catheter con- restoration lying largely external to the coronal portion of a
nected to a drainage system and a closed collection bag. It tooth and complements the contour of the tooth crown. Resis-
allows the clinician to control fluid flow and, to some extent, tance to displacement is developed between the inner surfaces
pressure in the cranial vault. of the casting and the external walls of the prepared tooth.
external version, an obstetric procedure in which a fetus The restoration incorporating an extracoronal retainer may
is turned, usually from a breech to a vertex presentation, by be a complete or partial crown. 2. a direct clasp-type retainer
external manipulation through the abdominal wall. Compare that engages an abutment tooth on its external surface, used to
version and extraction. retain and stabilize a removable partial denture. 3. a manufac-
exteroceptive /ek′stərōsep′tiv/ [L, externus, outside, reci- tured direct retainer, the protruding portion of which is attached
pere, to receive], pertaining to stimuli that originate from to the external surface of a cast crown on an abutment tooth.
outside the body or to the sensory receptors that they acti- extracorporeal /ek′strakôr′pôr′ē·əl/ [L, extra + corpus,
vate. Compare interoceptive, proprioception. body], something that is outside the body, such as extracor-
exteroceptor /ek′stərōsep′tər/ [L, externus, outside, reci- poreal circulation in which venous blood is diverted outside
pere, to receive], any sensory nerve ending, such as those the body to a heart-lung machine and returned to the body
located in the skin, mucous membranes, or sense organs, through a femoral or other artery.
that responds to stimuli originating outside the body, such as extracorporeal membrane oxygenator (ECMO), a
touch, pressure, or sound. Compare interoceptor, proprio- device that oxygenates a patient’s blood outside the body and
ceptor. See also chemoreceptor. returns the blood to the patient’s circulatory system. The tech-
extinction /iksting′shən/, a state of being lost or destroyed. nique may be used to support an impaired respiratory system.
extirpation /ek′stərpā′shən/ [L, extirpare, to root out], the extracorporeal oxygenation, the use of an artificial mem-
total removal of a diseased organ or body part. brane outside the body to provide for oxygenation of the
extra-, extro-, prefix meaning “outside, beyond, in addi- blood in a patient with severe lung disease.
tion to”: extrabronchial, extradural, extramarginal. extracorporeal photochemotherapy, a procedure for
extraarticular /ek′strə·ärtik′yələr/ [L, extra, outside, artic- treating pemphigus vulgaris by treating the patient’s blood
ulare, to divide into joints], pertaining to the area outside a outside the body. Certain drugs are first administered to the
joint or within the joint. patient. Some of the patient’s blood is then removed tem-
extra beat [L, extra, outside; AS, beatan], an extra heart porarily for exposure to ultraviolet light outside the body.
contraction. It is indicated by a premature atrial, junctional, The blood, after treatment, is returned to the patient. See also
or ventricular complex on an electrocardiogram. photochemotherapy.
extracapsular /-kaps′yələr/ [L, extra, outside, capsula, extracorporeal shock-wave lithotripsy (ESWL) [L,
little box], pertaining to something outside a capsule, such extra, outside, corpus, body; Fr, choc + AS, wafian + Gk,
as the articulare capsule of the knee joint. lithos, stone, tribein, to wear away], use of vibrations of
extracapsular ankylosis. See false ankylosis. powerful sound waves to break up calculi in the urinary tract
extracapsular dendrite [L, extra + capsula + Gk, dendron, or gallbladder. Also called shock wave lithotripsy.
tree], pertaining to dendrites of some autonomic nerves extracorporeal technician. See perfusion technologist.
that penetrate the capsule boundary and extend some dis- extracranial /-krā′nē·əl/ [L, extra, outside; Gk, kranion,
tance from the cell body. skull], pertaining to something outside or unconnected
extracapsular fracture [L, extra + capsula, little box], any with the skull.
fracture that occurs near a joint but does not directly involve extract [L, ex, out, trahere, to draw], 1. /ek′strakt/ n, a sub-
the joint capsule. This type of fracture is extremely common stance, usually a biologically active ingredient, prepared by
in the hip. the use of solvents or evaporation to separate the substance
extracellular /-sel′yələr/ [L, extra + cella, store- from the original material. 2. a concentrated form of an herb
room], occurring outside a cell or cell tissue or in cavities that is derived when the crude herb is mixed with water, alco-
or spaces between cell layers or groups of cells. See also cell, hol, or another solvent and distilled or evaporated. Extracts
edema, interstitial. may be either fluid or solid. 3. /ikstrakt′/ v, to remove a tooth
extracellular fluid (ECF), the portion of the body fluid from the oral cavity by means of elevators or forceps or both.
comprising the interstitial fluid and blood plasma. The adult —extraction, n.
body contains about 11.2 L of interstitial fluid, constituting extractor /ikstrak′tər/, a medical instrument, such as a for-
about 16% of body weight, and about 2.8 L of plasma, con- ceps, used to remove a foreign body, tissue sample, or medi-
stituting about 4% of body weight. Plasma and interstitial cal device placed in a body cavity.
fluid are very similar chemically and, in conjunction with extradural /ek′trəd ˘ oor′əl/ [L, extra + dura, hard], outside
intracellular fluid, help control the movement of water and the dura mater.
electrolytes throughout the body. Some of the important ion- extradural anesthesia, anesthetic nerve block achieved
ized components of extracellular fluid are protein, magne- by the injection of a local anesthetic solution into the space
sium, potassium, chlorine, calcium, and certain sulfates. in the spinal canal outside the dura mater of the spinal cord,
extracellular matrix, a substance containing collagen, as in caudal anesthesia, epidural anesthesia/analgesia, or
elastin, proteoglycans, glycosaminoglycans, and fluid, pro- paravertebral block.
duced by cells and in which the cells are embedded. The extradural hemorrhage. See epidural hemorrhage.
extradural space 665 extrasensory
extradural space, the space between the cranial cavity and extraperitoneal cesarean section, a method for sur-
the outer layer of dura mater. gically delivering a baby through an incision in the lower
extraembryonic blastoderm /-em′brē·on′ik/ [L, extra uterine segment without entering the peritoneal cavity. The
+ Gk, en, in, bryein, to grow], the area of the blastoderm uterus is approached through the paravesical space. This pro-
outside the embryo that gives rise to the membranes that sur- cedure is performed most often to prevent spread of infection
round the embryo during gestation. Compare embryonic from the uterus into the peritoneal cavity. It takes longer to
blastoderm. See also allantois, amnion, chorion, yolk sac. perform than the low cervical or classic cesarean operation.
extraembryonic coelom, a cavity external to the develop- Compare classic cesarean section, low cervical cesarean
ing embryo that forms between the mesoderm of the chorion section. See also cesarean section.
and that covers the amniotic cavity and yolk sac. Also called extrapleural /-pl ˘oor′əl/, outside the pleural cavity.
exocoelom. extrapleural pneumothorax, a condition in which
extraembryonic mesoderm [L, extra, outside; Gk, en + a pocket of air or gas forms between the endothoracic
bryein, to grow, mesos, middle, derma, skin], any meso- fascia-pleura layer and the adjacent chest wall. See also
derm in the uterus that is not involved with the embryo itself. pneumothorax.
Included are mesoderms in the amnion, chorion, yolk sac, extrapsychic conflict /-sī′kik/ [L, extra + Gk, psyche,
and connecting stalk. mind; L, confligere, to strike together], an emotional con-
extrahepatic cholestasis, cholestasis occurring outside flict that usually occurs when one’s inner needs and desires
the liver, caused by blockage of a bile duct or ducts. It may do not coincide with the restrictions of the environment or
be caused by a tumor or stricture, a gallstone or other damage society. Compare intrapsychic conflict. See also conflict.
in the duct, pancreatitis, or other causes. extrapulmonary /-pul′məner′ē/, outside of or unrelated to
extramammary Paget’s disease /-mam′ərē/ [L, extra, the lungs.
outside, mamma, breast; James Paget, English surgeon, extrapulmonary small cell carcinoma, a primary small
1814–1899; L, dis + Fr, aise, ease], a gradually spreading cell cancer with a histological diagnosis of small cell carci-
red, scaly, and crusted lesion resembling that of Paget’s dis- noma but located in body areas outside the lungs. It occurs
ease but not occurring on the breast. A common area is the most frequently around the head and neck; in the pancreas,
vulva. The lesions give rise to carcinoma in approximately colon, and rectum; and in the genitourinary tract.
50% of the cases. extrapyramidal /ek′strəpiram′ədəl/ [L, extra + Gk, pyra-
extramarital /-mer′itəl/, happening outside a marriage, mis, pyramid], 1. pertaining to the tissues and structures
such as an extramarital affair. outside the cerebrospinal pyramidal tracts of the brain that
extramedullary /-med′yəler′ē/ [L, extra + medulla, mar- are associated with movement of the body, excluding motor
row], pertaining to something outside or unrelated to any neurons, the motor cortex, and the corticospinal and corti-
medulla. cobulbar tracts. 2. pertaining to the function of these tissues
extramedullary myeloma [L, extra + medulla, marrow], a and structures.
plasma cell tumor that occurs outside the bone marrow, usu- extrapyramidal disease, any of a large group of condi-
ally affecting the visceral organs or the nasopharyngeal and tions affecting the extrapyramidal tracts and characterized by
oral mucosa. Also called extramedullary plasmacytoma, involuntary movement, changes in muscle tone, and abnor-
peripheral plasma cell myeloma, plasma cell tumor. mal posture. Examples include tardive dyskinesia, chorea,
extramedullary myelopoiesis, the formation and devel- athetosis, and Parkinson’s disease.
opment of myeloid tissue outside the bone marrow. Also extrapyramidal side effects, side effects that mimic
called ectopic myelopoiesis. extrapyramidal disease and are caused by drugs that block
extramedullary plasmacytoma. See extramedullary dopamine receptor sites in the extrapyramidal system tract.
myeloma. See also parkinsonism.
extraneous /exstrā′nē·əs/ [L, strange], originating or extrapyramidal system, the part of the nervous system
entering from outside the organism. that includes the basal nuclei (substantia nigra, subthalamic
extraocular /-ok′y ˘ oolər/ [L, extra + oculus, eye], outside nucleus, etc.), part of the midbrain, and the motor neurons of
the eye. the spine. See also extrapyramidal tracts.

extraocular movement. See cardinal position of gaze. extrapyramidal tracts, the uncrossed tracts of motor
extraocular muscle palsy, an abnormal condition character- nerves from the brain to the anterior horns of the spinal cord,
ized by paralysis of the extrinsic muscles of the eye, such as the except the crossed fibers of the pyramidal tracts. Within the
superior, inferior, medial, and lateral rectus muscles, and the brain, extrapyramidal pathways comprise various relays
superior and the inferior oblique muscles. See also strabismus. of motoneurons between motor areas of the cerebral cor-
extraocular muscles (EOMs), the six sets of muscles that tex, the basal nuclei, the thalamus, the cerebellum, and the
control movements of the eyeball. They are the superior rec- brainstem. The extrapyramidal pathways are functional
tus and inferior rectus, which move the eye up and down; rather than anatomical units, comprising the nuclei and the
the medial rectus and the lateral rectus, which move the eye fibers and excluding the pyramidal tracts. They especially
to either side; and the superior oblique and inferior oblique, control and coordinate the postural, static, supporting, and
which move the eye downward and inward, and upward and locomotor mechanisms and cause contractions of muscle
inward, respectively. groups sequentially or simultaneously. The extrapyrami-
extraoral anchorage /-ôr′əl/ [L, extra + oralis, mouth, dal pathways include the corpus striatum, the subthalamic
ancora, hook], an orthodontic holding device outside the nucleus, the substantia nigra, and the red nucleus, together
mouth, typically linking dental attachments to a wire bow or with their interconnections with the reticular formation, the
to hooks extending between the lips and attached by elastic cerebellum, and the cerebrum. Compare pyramidal tract.
to a cap, neck strap, or other device outside the mouth. Also extrarenal uremia. See prerenal uremia.
called extraoral orthodontic appliance. extrasensory /-sen′sərē/ [L, extra + sentire, to feel], per-
extraperitoneal /-per′itənē′əl/ [L, extra + Gk, peri, near, taining to alleged awareness of events that cannot be
around, teinein, to stretch], occurring or located outside observed by any of the five basic senses. It includes telepa-
the peritoneal cavity. thy, clairvoyance, and psychokinesis.
extrasensory perception 666 exudate
extrasensory perception (ESP) [L, extra + sentire, to feel, Superior oblique
percipere, to perceive], alleged awareness or knowledge Medial rectus Trochlea
acquired without using the physical senses. See also clair- Superior rectus
voyance, parapsychology, telepathy.
extrasystole. See ectopic beat. Optic nerve
extrauterine /-yoo′tərin/ [L, extra + uterus, womb], occur-
ring or located outside the uterus, as an ectopic pregnancy.
extravasation /ikstrav′əsā′shən/ [L, extra + vas, ves-
sel], 1. a passage or escape into the tissues, usually of
blood, serum, lymph or infusion. Compare bleeding. 2. pas-
sage or escape into tissue of antineoplastic chemotherapeutic
drugs. Signs and symptoms may be sudden onset of localized
pain at an injection site, sudden redness or extreme pallor at
an injection site, or loss of blood return in an IV needle. Tis-
sue slough and necrosis may occur if the condition is severe.
Treatment depends on the causative agent. Nursing responsi- Levator palpebrae
Inferior oblique
superioris (cut)
bilities include maintaining the patient IV line, elevating the Lateral rectus
affected area, applying ice packs, and notifying the physi-
cian of the need for antidote injections, if applicable. See also
exudate, transudate. —extravasate, v. Superior view
extravascular fluid /-vas′kyələr/ [L, extra, outside, vascu-
lum, small vessel, fluere, to flow], fluid in the body that Superior oblique
is outside the blood vessels. Examples include lymph and Trochlea
Superior rectus
cerebrospinal fluid. Levator palpebrae
extraventricular hydrocephalus. See hydrocephalus. superioris (cut)
extraversion. See extroversion.
extravert. See extrovert.
extraverted personality. See extroverted personality.
extremity /ikstrem′itē/ [L, extremitas], a limb or append-
age. The arm may be identified by the layperson as an upper
extremity and the leg as a lower extremity.
extrinsic /ikstrin′sik/ [L, extrinsecus, on the outside], per-
taining to anything external or originating outside a structure
or organism, including parts of an organ that are not wholly
contained within it, as an extrinsic muscle. Inferior rectus
extrinsic allergic alveolitis. See hypersensitivity
pneumonitis.
extrinsic allergic pneumonia. See diffuse hypersensi- Lateral rectus Inferior oblique
tivity pneumonia.
extrinsic asthma. See allergic asthma.
extrinsic factor. See cyanocobalamin. Inferior view
extrinsic muscle (em) [L, extrinsecus, on the outside], 1. a
muscle that is outside the organ it controls, as the extraocular Extrinsic muscles of the eye (Patton and Thibodeau, 2010)
muscles that control eye movements. 2. a muscle that links a
limb to the trunk of the body. directed to a greater degree toward the outer world of people
extrinsic pathway of coagulation, the mechanism that and events rather than the subjective inner world experience.
produces fibrin after tissue injury, beginning with forma- Also called extraverted personality.
tion of an activated complex between tissue factor and acti- extrude /ekstrōod′/ [L, extrudere, to push out], to thrust
vated factor VII and leading to activation of factor X, which out from a surface or from alignment.
induces the reactions of the common pathway of coagula- extrusion /ek·stroo′zhən/ [L, extrudere, to push
tion. Compare intrinsic pathway of coagulation. See also out], 1. thrusting or pushing out; expulsion by force.
coagulation cascade, common pathway of coagulation. 2. the overeruption or movement of a tooth beyond its nor-
extro-. See extra-. mal occlusal plane in the absence of opposing occlusal force.
extroversion /-vur′zhən/ [L, extra + vertere, to turn], 1. the 3. an orthodontic technique for the elongation or elevation of
tendency to direct one’s interests and energies toward external a tooth. Compare intrusion.
values or things outside the self. 2. the state of being totally or extrusion reflex /ekstroo′zhən/ [L, extrudere, to push out,
primarily concerned with what is outside the self. Also spelled reflectere, to bend back], a normal response in infants to force
extraversion. Compare introversion. the tongue outward when it is touched or depressed. The reflex
extrovert /ik′strəvurt′/, 1. a person whose interests are begins to disappear by about 3 or 4 months of age. Constant
directed away from the self and concerned primarily with protrusion of a large tongue may be a sign of Down syndrome.
external reality and the physical environment rather than extubation /iks′t(y)oobā′shən/ [L, ex, out, tuba, tube], the
with inner feelings and thoughts. This person is usually process of withdrawing a tube from an orifice or cavity of the
highly sociable, outgoing, impulsive, and emotionally body. —extubate, v.
expressive. 2. a person characterized by extroversion. Also exuberant callus. See heterotopic ossification.
spelled extravert. Compare introvert. exudate /eks′y ˘ oodāt/ [L, exsudare, to sweat out], fluid,
extroverted personality /-vur′tid/ [L, extra, outside, cells, or other substances that have been slowly exuded, or
vertere, to turn, personalis, of a person], a persona that is discharged, from cells or blood vessels through small pores
exudation 667 eye memory
or breaks in cell membranes. Perspiration, pus, and serum are eye bank [AS, eage + It, banca, bench], a facility for col-
sometimes identified as exudates. lecting and storing corneas and other ocular tissues for trans-
exudation /eks′yədā′shən/ [L, exudare], the oozing of plantation to recipients.
fluid, pus, or serum. The exudate may or may not contain eyebrow [AS, eage + bru], 1. the supraorbital arch of the
fibrous or coagulated material. frontal bone that separates the orbit of the eye from the fore-
exudative /igzoo′dətiv/, relating to the oozing of fluid and head. 2. the arch of hairs growing along the ridge formed by
other materials from cells and tissues, usually as a result of the supraorbital arch of the frontal bone.
inflammation or injury. eye care, a nursing intervention from the Nursing Interven-
exudative enteropathy, diarrhea that occurs in diseases tions Classification (NIC) defined as prevention or minimi-
characterized by inflammation or destruction of intestinal zation of threats to eye or visual integrity. See also Nursing
mucosa. Crohn’s disease, ulcerative colitis, tuberculosis, Interventions Classification.
and some lymphomas cause an increased amount of plasma, eye-closure reflex. See wink reflex.
blood, mucus, and protein to accumulate in the intestine, eyecup, a small vessel or cup that is shaped to fit over the
adding to fecal bulk and frequency. See also diarrhea. eyeball and used to bathe the exposed surface of the eye.
exudative inflammation [L, exudare, to sweat out, inflam- eye deviation [AS, eage + L, deviare, to turn aside], 1. a
mare, to set afire], an inflammation of a serous or raw cav- movement of one or both eyes, singly or jointly, from the
ity in which fluid is released from the inflamed surface. median line or from the original direction of fixation. Mani-
exudative retinopathy, a condition marked by masses of fest deviation is the number of degrees by which the visual
white or yellowish exudate in the posterior part of the fun- axis of one eye deviates from that of the other in cases of
dus oculi, with deposits of cholesterol and blood debris from squint, when both eyes are open. 2. (in strabismus) the
retinal hemorrhage, that leads to destruction of the macula departure of the foveal line of sight of one eye from the point
and blindness. Also called Coats’ disease, Coats’ retinitis, of fixation.
exudative retinitis. eye dominance, an unconscious preference to use one eye
eye [AS, eage], one of a pair of organs of sight, contained rather than the other for certain purposes, such as sighting a
in a bony orbit at the front of the skull, with retrobulbar fat, rifle or looking through a telescope.
and innervated by four cranial nerves: optic, oculomotor, eyedrops, a liquid medicine that is administered by allow-
trochlear, and abducens. Associated with the eye are certain ing it to fall in drops onto the conjunctival surface.
accessory structures, such as the muscles, the fasciae, the eye-
brow, the eyelids, the conjunctiva, and the lacrimal gland. The
bulb of the eye is composed of segments of two spheres with
nearly parallel axes that constitute the outside tunic and one
of three fibrous layers enclosing two internal cavities sepa-
rated by the crystalline lens. The smaller cavity anterior to the
lens is divided by the iris into two chambers, both filled with
aqueous humor. The posterior cavity is larger than the anterior
cavity and contains the jellylike vitreous body that is divided
by the hyaloid canal. The outside tunic of the bulb consists
of the transparent cornea anteriorly, constituting one fifth
of the tunic, and the opaque sclera posteriorly, constituting
five sixths of the tunic. The intermediate vascular, pigmented
tunic consists of the choroid, the ciliary body, and the iris. The
internal tunic of nervous tissue is the retina. Light waves pass-
ing through the lens strike a layer of rods and cones in the ret-
ina, creating impulses that are transmitted by the optic nerve
to the brain. The transverse and the anteroposterior diameters
Eyedrop administration (Potter et al, 2011)

of the eye bulb are slightly greater than the vertical diameter;
the bulb in women is usually smaller than the bulb in men.
Eye movement is controlled by six muscles: the superior and eye glasses, transparent lenses held in metal or plastic
inferior oblique muscles and the superior, inferior, medial, frames in front of the eyes to correct refractive errors or to
and lateral rectus muscles. Also called bulbus oculi, eyeball. protect the eyes from harmful electromagnetic waves or fly-
ing objects.
Sclera eyeground, the fundus of the eye as revealed by ophthal-
moscopic examination.
Bulbar conjunctiva eyelash [AS, eage + ME, lasche], one of many stiff hairs
Palpebral conjunctiva like cilia growing in double or triple rows along the border of
Upper eyelid the eyelids in front of a row of ciliary glands that are in front
Iris of a row of meibomian glands.
Cornea
eyelid [AS, eage + hlid], one of two movable folds of pro-
tective thin skin over the eye, with eyelashes and ciliary
Pupil
and meibomian glands along its margin. It consists of loose
connective tissue containing a thin plate of fibrous tissue
Lower eyelid lined with mucous membrane (conjunctiva). The orbicularis
Lens oculi muscle and the oculomotor nerve control the open-
ing and closing of the eyelid. The upper and lower eyelids
are separated by the palpebral fissure. Also called palpebra
Retina
/pal′-pəbrə/.
Cross section of the eye (Potter et al, 2011) eye memory. See visual memory.
eye patching 668 ezetimibe
eye patching, 1. placement of a soft patch over a closed eye wash, an apparatus for irrigating the eyes after expo-
eye to restrict lid movement during corneal reepithelializa- sure to dust or other debris or chemical contamination. The
tion or a similar healing procedure in progress. 2. occlu- shower directs one or two streams of water so that they flush
sion of the better eye by patch placement in young patients over the eyes and lids. The patient should blink the eyes and
with amblyopia to force greater use of the amblyopic eye. move the head in different directions with the eyes open,
3. patching used in cases of diplopia (double vision). continuing the irrigation as needed.
eye reanimation, microsurgical restoration of function of a eye worm. See Loa loa.
paralyzed eye sphincter. ezetimibe, an antilipemic agent used to treat hypercholes-
eye shielding, protection of an injured eye by securing a terolemia, homozygous low-density lipoprotein receptor dis-
metal or plastic eye shield or a disposable cup to prevent fur- order, and homozygous sitosterolemia.
ther injury.

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Mosby&#39;s Medical Dictionary (E)

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e-, prefix meaning “out from”: ebonation, egesta, emollient.

E transmit vibrations caused by sound waves reaching the tym-

External ear (not to scale) Middle ear Inner ear

Auricle External acoustic Temporal Tympanic

Structures of the ear (Patton and Thibodeau, 2010)

scu on 2018-01-21 21:41:10. 579

for sensitivity, serological tests, radiological evidence of

organism of any specific disease. ECHO stands for enteric,

Ectropion (Kanski, 2007/Courtesy A. Pearson)

those that are formed webbed so as to appear fused. Also

n indications: It is prescribed to reverse neuromuscular

Before Early Complete Complete

develops defense mechanisms against anxiety. See also id,

elbow bone. See ulna.

Electroencephalogram: normal awake adult (Goldman et al, 2012)

Clinical manifestations of electrolyte imbalance

ance. See also Nursing Interventions Classification.

state of being lengthened or extended. Embden-Meyerhof pathway. See glycolysis.

emergency readiness, a state of having made advance plans

for coping with an unexpected natural disaster, civil distur-

bance, or military attack that may threaten death and injury to a

local population. The planning includes educating the popula-

aid, including cardiopulmonary resuscitation; ensuring that

adequate sources of food, water, basic medical supplies, and

bedding materials will be available; arranging for the disposal

of human wastes when toilets are not functional; and establish-

children, and women who may be pregnant. Plans for com-

munication systems also may be part of emergency readiness.

emergency room (ER, E.R.), obsolete. See emergency

emergent /imur′jənt/ [L, emergens, emerging], arising, often

from the total rearrangement of existing elements so that

from pain, tender care, and continued attention through all

Walls of alveoli are

Emphysema (Patton and Thibodeau, 2010)

emphysematous /em′fisem′ətəs/ [Gk, en, in, physema, a

anatomical crown of a tooth. It contains no nerves or blood germ.

Encephalocele (Cohen and Lemire, 1982)

encephalomeningocele. See meningoencephalocele.

Endometrial polyp (Finkbeiner, Ursell, and Davis, 2009)

who undergo pelvic laparotomy for other indications. The

women, constitutes an indication for biopsy or curettage of

Endoscopy (Black and Hawks, 2005)

Endothelial cells (Carr and Rodak, 2008)

endothelial-derived relaxing factor (EDRF), nitric

tion of a solution into the rectum for cleansing or thera-

binocular field. Also called deviational nystagmus, on the toilet.

ensiform cartilage, ensiform process. See xiphoid n

Common problems of patients receiving tube feedings

Vomiting and/or Aspiration

Low-fiber formula Change to formula with more fiber.

Fungal enteritis (Damjanov and Linder, 2000)

entero-, enter-, prefix meaning “intestines”: enteric, enter-

detergents. They increase in number with allergy and some parasitic

Eosinophilic fasciitis (Callen et al, 2000)

eosinophilic gastroenteritis, a disorder marked by infil-

Epidermal nevus (Callen et al, 2000)

Epidural anesthesia (Monahan et al, 2007)

Childhood absence epilepsy: typical EEG pattern (Goldman et al, 2004)

Episcleritis (Moll, 1997)

Squamous Simple Stratified

Classification of epithelium (Herlihy, 2011)

ergocalciferol. See calciferol.

erotogenic. See erogenous. vesicles, bullae, fever, pain, and lymphadenopathy. It is

Erythema marginatum (Weston, Lane, and Morrelli, 2007)

Mosby's Medical Dictionary (E)

Mosby's Medical Dictionary (E)