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John Knight. Understanding Anatomy and Physiology in Nursing
Understanding Anatomy & Physiology in Nursing
Contents
About the authors
Introduction
Chapter 1 Cellular physiology and histology. Chapter aims
Introduction. Case study: Josie – breast cancer
Regions of a cell
The nucleus
Appearance of chromosomes during cell division
Activity 1.1 Reflection
The cytoplasm and cytoplasmic organelles
The Golgi apparatus
Mitochondria
The plasma (cell) membrane
The glycocalyx
Case study: Jack – organ transplant rejection
Membrane transport
Simple diffusion
Activity 1.2 Team working
Facilitated diffusion
Active transport
Osmosis
Isotonic, hypertonic and hypotonic
Activity 1.3 Evidence-based practice and research
Dehydration
Activity 1.4 Evidence-based practice and research
Water intoxication (water toxaemia)
Other forms of membrane transport
Phagocytosis
Exocytosis
Pinocytosis
Histology
The nature of epithelial tissue
The simple epithelia. Simple squamous epithelium
Simple cuboidal epithelium
Simple columnar epithelium
Stratified epithelium. Stratified squamous epithelium
Pseudostratified epithelium
Transitional epithelium
Prokaryotic cells
Case study: Mary – sepsis evidence-based practice
Cells as targets for drugs
Case study: Josie revisited – breast cancer evidence-based practice
Activity 1.5 Multiple-choice questions
Activities: Brief outline answers. Activity 1.1: Reflection (page 8)
Activity 1.2: Team working (page 14)
Activity 1.3: Evidence-based practice and research (page 18)
Activity 1.4: Evidence-based practice and research (page 19)
Activity 1.5: Multiple-choice questions (pages 28–30)
Further reading
Useful websites
Chapter 2 Homeostasis. Chapter aims
Introduction. Case study: Ian – type II diabetes
Homeostasis
Negative feedback mechanisms
Requirements for negative feedback
Homeostatic control of blood glucose
Hyper and hypo prefixes
Activity 2.1 Evidence-based practice and research
Regulation of body temperature: thermoregulation
Increased body temperature (hyperthermia)
Low body temperature (hypothermia)
Case study: Grace – hypothermia
Activity 2.2 Evidence-based practice and research
Pyrexia: the fever response
Case study: Prisha – tonsillitis
Positive feedback
Activity 2.3 Multiple-choice questions
Activities: Brief outline answers. Activity 2.1: Evidence-based practice and research (page 36)
Activity 2.2: Evidence-based practice and research (page 40)
Activity 2.3: Multiple-choice questions (pages 43–4)
Further reading
Useful websites
Chapter 3 The cardiovascular system. Chapter aims
Introduction. Case study: George – myocardial infarction
Overview of the cardiovascular system
Heart structure and function. Position of heart within the thorax
The pericardium
Pericarditis, pericardial effusions and cardiac tamponade
Layers of the heart
Internal structure of the heart
Atria
Ventricles
Pulmonary and systemic circuits of blood
Activity 3.1 Research and revision
The beating heart
Bradycardia and tachycardia
Systole and diastole
The cardiac cycle
Cardiac muscle
The cardiac conductive system of the heart
The ECG (electrocardiogram)
Electrical waves and time intervals viewable on an ECG
Clinical uses of ECG machines
Cardiac arrhythmias
Changes to the cardiac conductive system
Ectopic beats
Atrial fibrillation (AF)
Case study: Gerald – atrial fibrillation
Activity 3.2 Communication
Ventricular fibrillation (VF)
Blood vessels: the vasculature
Arteries
Capillaries
Haemodynamics of the capillary bed: filtration and the formation of interstitial (tissue) fluid
The role of lymphatic vessels
Veins
Immobility and hospital bed rest
Peripheral oedema
The coronary circulation
Coronary artery disease (CAD)
CAD and angina pectoris
CAD and myocardial infarction (MI)
Case study: Gloria – peripheral oedema
Activity 3.3 Critical thinking
Blood pressure
Control of BP
Neural control of BP
The baroreceptor responses
Case study: Janet – postural hypotension
Activity 3.4 Evidence-based practice and research
Hormonal control of blood pressure
Antidiuretic hormone (ADH)
Physiological actions of ADH
Atrial natriuretic peptide (ANP)
Adrenaline (epinephrine)
Cardiovascular effects of adrenaline
The renin angiotensin aldosterone system (RAAS)
Biochemical steps in the RAAS
Activity 3.5 Multiple-choice questions
Activities: Brief outline answers. Activity 3.1: Research and revision (page 55)
Activity 3.2: Communication (page 63)
Activity 3.3: Critical thinking (page 70)
Activity 3.4: Evidence-based practice and research (page 73)
Activity 3.5: Multiple-choice questions (pages 77–9)
Further reading
Useful websites
Chapter 4 The respiratory system
Chapter aims
Case study: Jake – asthma
Introduction
Functions of the respiratory system
Overview of the respiratory system
The upper respiratory tract. The nose and nasal cavity
The paranasal sinuses
The pharynx
Case study: Jack – obstructive sleep apnoea
The larynx (voice box)
Case study: Phillip – dysphagia
The lower respiratory tract. The tracheobronchial tree
The trachea
The carina
The primary bronchi
Bronchioles
The conduction zone
The respiratory zone
Alveoli
The lungs and pleural membranes
Pneumothorax, chest drain and underwater seal
Activity 4.1 Pneumothorax – evidence-based practice and research
Pulmonary ventilation (breathing)
A bit of simple physics
Activity 4.2 Understanding Boyle’s law
Inspiration
Expiration
Accessory muscles of respiration
Lung volumes and capacities
Gas exchange
Oxygen transport
Pulse oximetry
Activity 4.3 Oxygen therapy – evidence-based practice and research
Carbon monoxide (CO) poisoning
Carbon dioxide transport. In the tissues
In the alveoli
The respiratory system and acid base balance. Respiratory acidosis
Activity 4.4 Hyperventilation and respiratory alkalosis – evidence-based practice and research
Control of ventilation
Peripheral and central chemoreceptors
Modifications to the normal breathing pattern
Activity 4.5 Multiple-choice questions
Activities: Brief outline answers. Activity 4.1: Pneumothorax – evidence-based practice and research (page 94)
Activity 4.2: Understanding Boyle’s law (page 95)
Activity 4.3: Oxygen therapy – evidence-based practice and research (page 99)
Activity 4.4: Hyperventilation and respiratory alkalosis – evidence-based practice and research (page 101)
Activity 4.5: Multiple-choice questions (pages 103–4)
Further reading
Useful websites
Chapter 5 The endocrine system. Chapter aims
Introduction. Case study: Sharma – hypothyroidism
Overview of the endocrine system
The nature of hormones
The hypothalamus and pituitary gland
Hormones of the hypothalamus and posterior pituitary
Antidiuretic hormone (vasopressin)
Case study: Paul – diabetes insipidus
Oxytocin
Origin of the anterior pituitary
Hormones of the anterior pituitary
The anterior pituitary and somatotropin
The pars intermedia and melanocyte-stimulating hormone (MSH)
The thyroid gland
The thyroid gland and metabolism
Role of T3 and T4
Hypothyroidism and hyperthyroidism
Activity 5.1 Communication
The thyroid and parathyroid roles in calcium homeostasis
The parathyroid glands
The thymus gland
The endocrine pancreas: the islets of Langerhans
The pancreas and appetite
The pancreas and blood glucose
The insulin response
Case study: Lucy – type I diabetes mellitus (DM)
Diabetes mellitus (DM)
Activity 5.2 Evidence-based practice and research
Glucagon: the between-meals hormone
The adrenal glands
The adrenal medulla
The adrenal cortex
The anterior pituitary and the release of glucocorticoids
Overview of the HPA axis
Physiological actions of cortisol
Cortisol, metabolism, appetite and fat deposition
Cortisol and immune responses
Case study: Cathy – Cushing’s syndrome
Aldosterone and sodium/potassium homeostasis
Activity 5.3 Multiple-choice questions
Activities: Brief outline answers. Activity 5.1: Communication (page 116)
Activity 5.2: Evidence-based practice and research (page 122)
Activity 5.3: Multiple-choice questions (pages 129–31)
Further reading
Useful website
Chapter 6 The nervous system
Chapter aims
Introduction. Case study: Ahmed – subarachnoid haemorrhage
Overview of the nervous system
Divisions of the PNS. The sensory division
The motor division
The somatic nervous system (SNS) (soma = body)
The autonomic nervous system (ANS)
Cells of the nervous system
Neurons
Types of neuron
Neuroglial cells
Neuroglial cells of the CNS
Neuroglial cells of the PNS
Activity 6.1 Reinforcing key information
Action potentials (nerve impulses)
The sodium potassium pump and resting potential
Action potentials
The role of the myelin sheath
Synapses and synaptic transmission
Electrical and chemical synapses
Brain structure and function
The brain stem
The medulla oblongata
The pons
The midbrain
Cerebellum
Diencephalon
Thalamus
Hypothalamus
Epithalamus
Cerebral cortex
The cranial nerves
Sensory, motor and parasympathetic functions of the cranial nerves
Knowledge of cranial nerves in clinical diagnosis
Activity 6.2 Designing learning tools
Physical structure of the cerebral cortex
Spinal cord and spinal nerves
Spinal cord structure
Ascending and descending information
Dermatomes and referred pain
The autonomic nervous system (ANS)
The sympathetic division
The parasympathetic division
Protection of the CNS
The meninges
The subarachnoid space, CSF and lumbar puncture
Activity 6.3 Assessing the cushioning effect of CSF
Case study: Claire – meningitis
The special senses. Vision
Accessory structures of the eye
Structure of the eye
Hearing and balance
Structure of the ear
Sense of hearing
Sense of balance (equilibrium)
Activity 6.4 Multiple-choice questions
Activities: Brief outline answers. Activity 6.2: Designing learning tools (page 154)
Activity 6.4: Multiple-choice questions (pages 169–70)
Further reading
Useful websites
Chapter 7 The skin. Chapter aims
Introduction. Case study: Rema – infected surgical wound site
Overview of the skin
Skin structure and function
The epidermis
Keratinocytes
Stratum basale (basal/germinal cell layer)
Stratum spinosum (squamous cell layer)
Between skin cells (intercellular substance)
Stratum granulosum (granular cell layer)
Stratum corneum (outer cornified or horny layer)
Melanocytes
Case study: Isabel – malignant melanoma
Merkel cells
Langerhans cells
The basement membrane
Sweat glands
Eccrine sweat glands
Apocrine sweat glands
Skin accessory structures
Hair
Hair structure
Sebaceous glands
Case study: Ali – acne
Nails
Skin microbes
Activity 7.1 Reflection
The dermis
Cells of the dermis
Dermal macrophages
Mast cells
Activity 7.2 Arm slapping!
Fibroblasts
Structure of the dermis
Layers of the dermis
Papillary layer
Reticular layer
Sensory receptors
Mechanoreceptors
Skin capillaries
Lymphatic vessels
The hypodermis
Inflammation and wound healing
The inflammatory phase
The proliferative phase
The maturation phase
Common skin disorders and diseases
Eczema
Psoriasis
Case study: Finley – impetigo
Activity 7.3 Multiple-choice questions
Activities: Brief outline answers. Activity 7.1: Reflection (page 184)
Activity 7.2: Arm slapping! (page 185)
Activity 7.3: Multiple-choice questions (pages 194–6)
Further reading
Useful websites
Chapter 8 The musculoskeletal system. Chapter aims
Introduction. Case study: Nikki – bone fracture
The skeleton
Bone composition
Activity 8.1 Practical experiment
Changes in bone composition
Case study: Indra – osteogenesis imperfecta
Diet and bone health
Long and flat bones
Long bones
Long-bone fractures
Simple fractures
Compound fractures
Flat bones
Flat-bone fractures
Bone formation
Bone growth
Maintaining bone density
Osteoporosis
Secondary osteoporosis
Joint structure and function
Arthritis
Rheumatoid arthritis
Case study: Edward – septic arthritis
Activity 8.2 Evidence-based practice and research
Types of muscle
Cardiac muscle
Smooth muscle
Skeletal muscle
The sliding filament mechanism
Activity 8.3 Practical analogy
Control of muscular contraction
The neuromuscular junction
Muscle relaxants
Muscle groups and injection sites
Activity 8.4 Multiple-choice questions
Activities: Brief outline answers. Activity 8.1: Practical experiment (page 201)
Activity 8.2: Evidence-based practice and research (page 212)
Activity 8.4: Multiple-choice questions (pages 217–19)
Further reading
Useful websites
Chapter 9 Blood, immunity and the lymphatic system. Chapter aims
Introduction. Case study: Erika – secondary anaemia
Overview of blood, lymphatics and immunity
Blood
Blood constituents. Plasma
Plasma proteins
Functions of the plasma proteins. Transport
Clotting
Viscosity and osmotic pressure
Immunity
Other plasma components
The formed elements of blood: blood cells. Erythrocytes
Formation of red blood cells (erythropoiesis) and the role of erythropoietin
Anaemia
Case study: Alan – iron-deficiency anaemia
Polycythaemia
Haematocrit
Destruction of red blood cells (haemolysis)
Case study: Martha – cirrhosis of the liver
Blood groups
Antigens
ABO blood grouping
Case study: Michael – transfusion reaction
Rhesus blood group
White blood cells
Platelets
Platelet count
Blood clotting
Formation of the platelet plug
Formation of the fibrin clot
The extrinsic pathway
The intrinsic pathway
Haemophilia
Thrombosis
Factors preventing thrombosis
Septicaemia
Sepsis
Anticoagulants
Dissolution of the fibrin clot
Immunity. White blood cells (leukocytes)
The immune system
The innate immune system
Immune cells
Granulocytes
Neutrophils
Basophils
Case study: Hongyi – anaphylaxis
Eosinophils
Agranular leukocytes
Monocytes and macrophages
Inflammation
Lymphocytes
Natural killer cells
The adaptive immune system
T-lymphocytes
Dendritic cells
Differentiation of T-cells
TC (cytotoxic T-cells)
TH (helper T-cells)
Ts (suppressor cells)
B-lymphocytes (B-cells)
Memory B-cells
Activity 9.1 Decision making
The lymphatic system
Lymph and the lymphatic vessels
The lymphoid glands and organs
Immune function of the lymphatic system
Primary lymphatic organs
The thymus
The role of the thymus in T-cell maturation
Secondary lymphatic organs
Lymph nodes
Structure of a lymph node
Lymph node swelling
Case study: Dylan – swollen cervical lymph nodes
The spleen
Function of the spleen
Other lymphatic components
The lymphatic system and the metastatic spread of malignancy
Activity 9.2 Evidence-based practice and research
Lymphomas
Autoimmunity
Oedema
Activity 9.3 Multiple-choice questions
Activities: Brief outline answers. Activity 9.1: Decision making (page 253)
Activity 9.2: Evidence-based practice and research (page 261)
Activity 9.3: Multiple-choice questions (pages 262–4)
Further reading
Useful websites
Chapter 10 The digestive system. Chapter aims
Introduction. Case study: Janet – acute cholecystitis
Overview of the digestive system
Why do we need a digestive system?
Digestion of carbohydrates, proteins and fat
Carbohydrates
Proteins
Fats
Anatomy of the digestive tract (GI tract)
The mouth
Control of salivation
Activity 10.1 Reflection
Control of swallowing
The oesophagus
Hiatus hernia and GORD
The stomach
Secretions of the stomach
Activity 10.2 Evidence-based practice and research
Regulation of gastric juice production
Hunger and satiety
The small intestine
The pancreas
Pancreatitis
The liver and bile
The gall bladder and gall stones
Intestinal enzymes
Control of secretion of pancreatic juice, bile and intestinal enzymes
Mechanical digestion
Absorption by the small intestine
Absorption of carbohydrates
Absorption of proteins
Absorption of fats
Absorption of ions
Absorption of vitamins
Malabsorption
Case study: Michael – Crohn’s disease
The large intestine
Appendicitis
Case study: Tom – appendicitis
Absorption and secretion by the large intestine
Transport of faeces in the large intestine
Microbial activity in the large intestine
Fermentation
Activity 10.3 Evidence-based practice and research
Vitamin synthesis by gut
The rectum and anus
Diarrhoea and constipation
Faecal incontinence
Activity 10.4 Multiple-choice questions
Activities: Brief outline answers. Activity 10.1: Reflection (page 273)
Activity 10.2: Evidence-based practice and research (page 279)
Activity 10.3: Evidence-based practice and research (page 292)
Activity 10.4: Multiple-choice questions (pages 294–6)
Further reading
Useful website
Chapter 11 The urinary system
Chapter aims
Introduction. Case study: Zubeyde – kidney stones
Overview of the urinary system
The major functions of the urinary system
External kidney anatomy
Renal blood supply. Renal arteries
Renal vein
Protection of the kidneys
Case study: Ali – benign prostatic hyperplasia
Internal kidney anatomy and histology
The nephron
Nephron structure
Blood supply to the nephron
The formation of urine
Stages of urine production
Filtration
Glomerular filtration rate (GFR)
Tubular re-absorption and secretion
Re-absorption in the proximal convoluted tubule
Re-absorption in the loop of Henle
Re-absorption in the distal convoluted tubule and collecting duct
Fine-tuning of urine volume, concentration and composition. Antidiuretic hormone (ADH)
ADH mechanism of action
Atrial natriuretic peptide (ANP)
The juxtaglomerular apparatus
The renin-angiotensin aldosterone system (RAAS)
Tubular secretion
Activity 11.1 Evidence-based practice and research
The collecting ducts and renal pelvis
Ureters
The urinary bladder
Micturition
The urethra
The female urethra
Case study: Diane – urinary tract infection (UTI)
The male urethra
Activity 11.2 Reflection
Normal urine composition
Activity 11.3 Multiple-choice questions
Activities: Brief outline answers. Activity 11.1: Evidence-based practice and research (page 312)
Activity 11.2: Reflection (page 316)
Activity 11.3: Multiple-choice questions (pages 318–20)
Further reading
Useful websites
Chapter 12 The reproductive systems. Chapter aims
Introduction. Case study: Ahmed – prostate cancer
Introduction
The male reproductive tract
Structure of the testes
The spermatic cords and testicular blood supply
Case study: William – testicular torsion
Activity 12.1 Evidence-based practice and research
Thermoregulation of the testes
Activity 12.2 Evidence-based practice and research
Testosterone
Biosynthesis of testosterone
Biological roles of testosterone
The andropause
Accessory glands of the male reproductive tract: production of semen
Benign prostatic hyperplasia (BPH) and prostate cancer
The penis
Physiology of erection and ejaculation
Case study: David – erectile dysfunction
The female reproductive tract
Structure of the ovaries
The fallopian tubes
Case study: Sarah – chlamydia and ectopic pregnancy
The uterus
The cervix
Case study: Samia – cervical cancer
Activity 12.3 Evidence-based practice and research
The vagina
The vulva
The menstrual cycle
The ovarian cycle
The follicular phase (day 1–14)
Ovulation (typically around day 14)
Luteal phase (day 14–28)
The uterine (menstrual) cycle
Menses (day 1–5)
Proliferative phase (day 5–14)
Secretory phase (day 14–28)
Activity 12.4 Multiple-choice questions
Activities: Brief outline answers. Activity 12.1: Evidence-based practice and research (page 326)
Activity 12.2: Evidence-based practice and research (page 327)
Activity 12.3: Evidence-based practice and research (page 337)
Activity 12.4: Multiple-choice questions (pages 342–4)
Further reading
Useful websites
Chapter 13 Genetics and inheritance. Chapter aims
Introduction. Case study: Christopher – albinism
Deoxyribonucleic acid (DNA)
Complementary base pairing
Cell division
DNA replication and the role of DNA polymerase
Activity 13.1 Consolidation of learning
Types of cell division
Interphase
Mitosis
Prophase
Metaphase
Anaphase
Telophase
The dynamic nature of human tissues
Meiosis
Prophase I
Metaphase I
Anaphase I
Telophase I
Gametes and non-disjunction
DNA and protein synthesis
Transcription of the genetic code from DNA into RNA
The nature of the genetic code
Translation of the genetic code into proteins
Transfer RNA (tRNA)
Activity 13.2 Consolidation of learning
Post-translational modification
Mutations
DNA and inheritance
Single-gene defects
Inheritance of cystic fibrosis
Activity 13.3 Consolidation of learning
Activity 13.4 Multiple-choice questions
Activities: Brief outline answers. Activity 13.1: Consolidation of learning (page 349)
Activity 13.2: Consolidation of learning (page 360)
Activity 13.3: Consolidation of learning (page 362)
Activity 13.4: Multiple-choice questions (pages 363–5)
Further reading
Useful websites
Glossary
References
Index
