Contents
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Library of Congress Cataloging-in-Publication Data
Fundamentals of anatomy and physiology for student nurses / edited by Ian Peate and Muralitharan Nair.
p. ; cm.
Includes bibliographical references and index. ISBN 978-1-4443-3443-2 (pbk. : alk. paper)
1. Human physiology. 2. Human anatomy. 3. Nursing. I. Peate, Ian. II. Nair, Muralitharan. [DNLM: 1. Anatomy-Nurses’ Instruction. 2. Physiology-Nurses’ Instruction. QS 4]
QP34.5.F862 2011
612-dc22
2010040972
Contributors
About the editors
Ian Peate
Professor of Nursing
Head of School
School of Nursing, Midwifery and Healthcare
University of West London
EN(G), RGN, DipN (Lond), RNT, Bed (Hons), MA(Lond), LLM
Ian began his nursing a career in 1981 at Central Middlesex Hospital, becoming an enrolled nurse working in an intensive care unit. He later undertook three years student nurse training at Central Middlesex and Northwick Park Hospitals, becoming a staff nurse then a charge nurse. He has worked in nurse education since 1989. His key areas of interest are nursing practice and theory, men’s health, sexual health and HIV/AIDS. He is currently Head of School.
Muralitharan Nair
Senior Lecturer
School of Nursing, Midwifery and Social Work University of Hertfordshire
SRN, RMN, DipN (Lond) RNT, Cert Ed., BSc (Hons) MSc (Surrey), Cert in Counselling, FHEA
Muralitharan commenced his nursing a career in 1971 at Edgware General Hospital becoming a Staff Nurse. In 1975 he commenced his mental health nurse training at Springfield Hospital and worked as a Staff Nurse for approximately 1 year. He has worked at St Mary’s Hospital Paddington and Northwick Park Hospital returning to Edgware General Hospital to take up the post of Senior Staff Nurse and then Charge Nurse. He has worked in nurse education since 1989. His key interests include physiology, diabetes, surgical nursing and nurse education. Muralitharan has published in journals and written a chapter on elimination and published a textbook on pathophysiology. He is a fellow of the Higher Education Academy.
About the contributors
Louise McErlean
Senior Lecturer
School of Nursing, Midwifery and Social Work
University of Hertfordshire
RGN, BSc(Hons), MA (Herts)
Louise began her nursing career in 1986 at the Victoria Infirmary in Glasgow, becoming a registered general nurse. She later completed the intensive care course for RGNs while working in Belfast as a staff nurse. She then worked as a junior sister at the Royal Free Hospital and has worked in nurse education since 2005. Her key areas of interest are pre-registration nurse education and intensive care nursing.
Janet G Migliozzi
Senior Lecturer
School of Nursing, Midwifery and Social Work Faculty of Health and Human Sciences University of Hertfordshire
RGN, BSc (Hons), MSc (London), PGDEd, FHEA
Janet commenced her nursing career in London becoming a staff nurse in 1988. She has worked at a variety of hospitals across London, predominately in vascular, orthopaedic and high dependency surgery before specialising in infection prevention and control. Janet has worked in nurse education since 1999 and her key interests include microbiology particularly in relation to healthcare associated infections, vascular/surgical nursing, health informatics and nurse education. Janet is currently a senior lecturer and a member of the Infection Prevention Society.
Carl Clare
Senior Lecturer
School of Nursing, Midwifery and Social Work
University of Hertfordshire
RN, DipN, BSc (Hons), MSc (Lond), PGDE (Lond)
Carl began his nursing a career in 1990 as a nursing auxiliary. He later undertook three years student nurse training at Selly Oak Hospital (Birmingham), moving to The Royal Devon and Exeter Hospitals, then Northwick Park Hospital, and finally The Royal Brompton and Harefield NHS Trust as a resuscitation officer and honorary teaching fellow of Imperial College (London). He has worked in nurse education since 2001. His key areas of interest are physiology, sociology, cardiac care and resuscitation. Carl has previously published work in cardiac care, resuscitation and pathophysiology.
Peter S Vickers
Visiting Fellow
School of Nursing and Midwifery
University of Hertfordshire
Cert Ed, Dip CD, SRN, RSCN, BA, PhD, FHEA
Following a career in teaching, Peter commenced his nursing career in 1980 at the York District Hospital, followed shortly afterwards by studying and working at the Hospital for Sick Children, Great Ormond Street, London. He later obtained his first degree in Biosciences and Health Studies and then obtained a doctorate in his specialty, immunology nursing, concentrating on the long- term development of children with SCID in the UK and Germany. He has worked in nurse education for several years, and has recently completed a research study into adult palliative care. The author of books on children’s responses to early hospitalisation, and research methodology/ proposals, he has also written chapters for several nursing bioscience and pathophysiology books, as well as presented papers at many national and international conferences. His key areas of interest are all aspects of immunology and immunology nursing, infectious diseases, genetics, and research. Although officially retired, he continues to work part-time at the University of Hertfordshire, as well as continuing with his writing and presenting at conferences.
Anthony Wheeldon
School of Nursing, Midwifery and Social Work
Faculty of Health and Human Sciences
University of Hertfordshire
MSc (Lond), PGDE, BSc(Hons), DipHE, RN
After qualification in 1995 Anthony worked as a staff nurse and senior staff nurse in the Respiratory Directorate at the Royal Brompton and Harefield NHS Trust. He began teaching on postregistration courses in 2000 before moving into full-time nurse education at Thames Valley University in 2002. Anthony has a wide range of nursing interests including cardiorespiratory nursing, anatomy and physiology, respiratory assessment and nurse education. Anthony has previously published work on respiratory assessment and pathophysiology. He is currently a senior lecturer at the University of Hertfordshire.
Acknowledgements
We would like to thank all of our colleagues and students for their help, support, comments and suggestions.
Muralitharan would like to thank his wife, Evangeline, and his daughters, Samantha and Jennifer, for their continued support and patience.
Ian would like to thank his partner, Jussi Lahtinen, for all of his continued support and encouragement.
Thank you to Anthony Peate who contributed to some of the illustrations.
Copyright acknowledgements
The following figures were produced with the kind permission of the copyright holders.
Tortora, G.J. and Derrickson, B.H. (2009) Principles of Anatomy and Physiology, 12th edn. Hoboken, NJ: John Wiley & Sons.
1.1, 1.4, 1.5, 1.6, 1.7, 1.8, 1.9, 2.1, 2.3, 2.5, 2.6, 2.7, 3.1, 3.2, 3.3, 3.8, 3.10, 3.11, 3.12, 3.13, 4.1, 4.2, 4.3, 4.4, 4.5, 4.6, 4.7, 4.8, 4.9, 4.10, 4.11, 4.12, 4.14, 4.15, 4.16, 5.1, 5.2, 6.2, 6.3, 6.5, 6.6, 6.7, 6.8, 6.9, 6.11, 6.12, 6.14, 6.15, 6.16, 7.1, 7.7, 7.9, 8.1, 8.2, 8.3, 8.5, 8.8, 8.9, 9.1, 9.3, 9.4, 9.5, 9.10, 9.11, 10.1, 10.2, 10.5, 10.6, 10.8, 10.9, 10.11, 11.1, 11.2, 11.3, 11.4, 11.6, 11.11, 11.12, 11.14, 11.15, 12.1, 12.2, 12.5, 12.6, 12.8, 12.9, 12.10, 12.11, 12.12, 12.13, 12.14, 12.16, 12.18, 12.19, 12.21, 12.22, 13.1, 13.2, 13.3, 13.4, 13.5, 13.6, 13.7, 13.8, 13.9, 13.11, 13.12, 13.13, 13.14, 13.15, 14.1, 14.3, 14.4, 14.5, 14.6, 14.7, 14.9, 15.1, 15.2, 15.3, 15.4, 15.5, 15.6, 15.8, 15.9, 15.10, 15.11, 15.13, 16.1, 16.2, 16.3, 16.4, 16.5, 16.6, 16.7, 16.8, 16.9, 16.10, 16.12, 16.13, 16.14, 16.15, 16.16, 16.18, 16.19, 16.20, 17.1, 17.2, 17.3, 17.5, 17.6, 17.7, 17.9, 17.10.
Nair, M. and Peate, I. (2009) Fundamentals of Applied Pathophysiology: An Essential Guide for Nursing Students. Oxford: Wiley-Blackwell.
2.2, 2.4, 2.10, 2.12, 3.4, 5.3, 5.4, 5.5, 5.6, 7.5, 7.10, 7.11, 7.12, 7.13, 11.5, 11.9, 11.10, 13.16, 14.8, 15.12.
Jenkins G.W., Kemnitz C.P. and Tortora G.J. (2007) Anatomy and Physiology: From Science to Life. Hoboken, NJ: John Wiley & Sons.
4.13, Unnumbered illustration from clinical application, Pessary insertion box
Tortora, G.J. (2008) A Brief Atlas of the Skeleton. Hoboken, NJ: John Wiley & Sons.
8.6, 8.7.
Tortora, G.J. and Derrickson, B. (2010) Essentials of Anatomy and Physiology, 8th edn. New York: John Wiley & Sons.
6.4, 13.10.
Lister Hill National Center for Biomedical Communications (2010) Genetics Home Reference: Your Guide to Understanding Genetic Conditions, p.19.
17.4.
National Heart Lung and Blood Institute
Unnumbered illustration in Clinical application: Myocardial Infarction box
Peate, I. (2009) Men’s Health. Oxford: Wiley-Blackwell.
15.7.
Introduction
The contributors to this text are all committed to the provision of high quality care. The authors are all experienced academics working in higher education, with many years of clinical experience, knowledge and skills, teaching a variety of students at various academic levels. We are confident that after you have gained a sound understanding of the anatomy and physiology of the various bodily systems you will be able to understand better the needs of the people you have the privilege to care for. High quality care for all is something we should be striving to provide but it is not possible to do this effectively if we do not fully appreciate the whole being, the whole person. This text has been formulated in such a way that we hope you enjoy reading it, and more importantly that you are hungry to learn more, that you will be tempted to delve deeper and that you grow and develop.
The companion to this book, The Fundamentals of Applied Pathophysiology (Nair & Peate 2009) will aid in your development and understanding. It is essential in any programme of study related to the provision of care that you are confident and competent in this field of study. It is not enough that you remember all of the facts (and there are many of these) that are associated with anatomy and physiology; you must be able to relate these to the people you care for. Some of these people may be vulnerable and at risk of harm; you have a duty to ensure that you are knowledgeable. Fundamentals of Anatomy and Physiology for Student Nurses will help you. The Standards for Pre Registration Nursing Education (Nursing and Midwifery Council, 2010) make it clear that you must be competent in a number of spheres in order to register successfully with the Nursing and Midwifery Council.
The human body is as beautiful on the inside as it is on the outside; the mind and the body when working in harmony is a fantastic machine capable of extraordinary things. Healthcare students work and study both in the hospital and the community setting where they will meet and care for patients with diverse altered anatomical and physiological problems. Using a fundamental approach with a sound anatomical and physiological understanding will provide healthcare students with an essential basis on which to offer care.
Anatomy and physiology
Anatomy can be defined simply as the science related to the study of the structure of biological organisms; many dictionaries use such a definition. Fundamentals of Anatomy and Physiology for Student Nurses focuses on human anatomy, and the definition for the purposes of this text is a study of the structure and function of the human body. This allows for reference to function as well as structure; in all biological organisms structure and function are closely interconnected. The human body operates through interrelated systems.
The term anatomy is Greek in origin and means ‘to cut up’ or ‘to dissect’. While the first scientifically based anatomical studies (attributed to a 16th-century Flemish anatomist, doctor and artist, Vesalius) were based on observations of cadavers (dead bodies), modern approaches to human anatomy differ as they include other ways of observation, for example, with the aid of a microscope and other imaging tools. Subdivisions are now affiliated within the broader field of anatomy; the word anatomy is often preceded with an adjective that identifies the method of observation, for example, gross anatomy (the study of body parts visible to the naked eye, for example, the heart or the bones) or microanatomy (where body parts, for example, cells or tissues are only visible with the use of a microscope).
Living systems can be defined from a number of perspectives:
As anatomy is associated with the function of a living organism it is almost always inseparable from physiology. Physiology can be described as the science which deals with the study of the function of cells, tissues, organs and organisms.
Physiology is concerned with how an organism carries out its many activities, considering how it moves, how it is nourished, how it adapts to changing environments – human and animal, hostile and friendly. It is the study of life.
Physiology is the foundation upon which we build our knowledge of what life is; it can help us to decide how to treat disease as well as helping us to adapt and manage changes imposed on our bodies by new and changing surroundings – internal and external. Studying physiology will help you understand disease (pathophysiology) arising from this; physiologists are able to develop new ways for treating diseases.
Just as there are a number of branches of anatomical study, so too are there a number of physiological branches that can be studied, for example, endocrinology, neurology and cardiology.
The chapters
There are 17 chapters. The text is not intended to be read from cover to cover, but you may find reading the first three chapters will help you come to terms with some of the complex concepts; we encourage you to delve in and out of the book. The chapters use simple and generously sized full colour art work to assist you in understanding and appreciating the complexities associated with the human body from an anatomical and physiological perspective. There are many features contained within each chapter that assist you to build upon and develop your knowledge base; we would encourage you to get the most out of this book.
Getting the most out of your copy of Fundamentals of Anatomy and Physiology for Student Nurses
The text takes the reader from the microscopic to macroscopic level in the study of anatomy and physiology. The contents demonstrate the movement from cells and tissues through to systems. This approach to teaching is a tried and tested approach when helping learners understand a topic area that can sometimes be seen as complex.
This book has been written with these key principles in mind, to help inform your practice as well as your academic work. A number of features are provided to help bring to life the fascinating subject of human anatomy and physiology.
Each chapter begins with several questions that are posed to test your current knowledge and which will allow you to pre-test. Learning outcomes are provided. These will cover the content within the chapter but only you can do the learning; these outcomes are what are expected of you after reading and absorbing the information. This is a minimum of what you can learn; do not be constrained by the learning outcomes, they are only there to guide you. Where appropriate an anatomical map is provided; the anatomical map is related to the chapter you are reading, this allows you to visualise the anatomy being discussed.
Another feature in the chapter that is provided to help you consider people you care for, to help you make clinical links, are the boxes in most of the chapters called Clinical considerations. These boxes demonstrate the application to your learning citing specific care issues that you may come across when working with people in clinical settings.
At the end of the chapter you are provided with a bank of multiple choice questions that are based on the content of the chapter. Some of the answers to the questions are not found in the text; in this case you are encouraged to seek out the answers helping to develop your learning further
Other features provided will help you measure the learning that has taken place, for example, true or false, label the diagram, find out more, crosswords or word searches; they are meant to be fun but they also aim to pull together the content of the chapter.
The feature called Conditions provides you with a list of conditions that are associated with the topics discussed in the chapter. You are encouraged to take some time to write notes about each of the conditions that have been described; this will help you relate theory to practice. You can make notes taken from other textbooks or other resources, for example, people you work with in a clinical area, or you may make the notes as a result of people you have cared for. It is important however that if you are making notes about people you have cared for you must ensure that you adhere to the rules of confidentiality.
A glossary of terms is provided at the end of every chapter. We present this to facilitate the learning of difficult words or phrases; understanding these words and phrases is important to your success as a healthcare student. When you have mastered the words your medical vocabulary will have grown and you will be in an ideal position to develop it further.
Patient notes are provided as an accompaniment to the text as a part of the web resources feature. These notes can be read at the beginning of the chapter as this will enable you to relate the issues being discussed to the people you may care for. We would suggest you revisit the patient notes several times as you work your way through each chapter – making a link from theory to practice and practice to theory. The patient notes are there merely to help you visualise, contextualise and to think about the application of theory to practice.
The use of computers and other electronic resources now play a central role in education as well as the education of nurses and other healthcare students with many universities using virtual learning environments. The electronic resources associated with this book are designed to help enhance your learning; they are varied and informative and are visually stimulating.
The text is accompanied by a raft of electronic resources that will support your learning. These resources can be used in your own place at your own pace. The aim is to encourage further learning and to build upon what you know already. There are also links to other resources. Using the electronic resources alongside the book as well as the human resources you will meet in practice will enhance the quality of your learning. The electronic resources available cannot replace the more conventional face to face learning with other students, lecturers, registered nurses and patients; they complement it.
What’s in a name?
The use of terminology is important. Sometimes the term ‘the patient’ has been used in this text; universally the term is used because it is easier to do so and it is commonly understood. There are some possible dangers with this as it implies the person is in receipt of medical care and this can then mean that the care provider has the upper hand. This suggestion must be avoided at all costs as those in receipt of care are participants and the person offering care should be acting as advocate.
Throughout this text we have chosen to use a multitude of words that may be used to describe the people you care for, for example, patient, person, service user. These words (and many more) are used in everyday practice and you will come across them when you are in clinical and healthcare settings. The most important thing to remember is that the people being cared for are people, not labels or names attached to them. The Patients Association (2009) suggest: ‘Patients not numbers ... People not statistics’.
When you are caring for people on an individual basis you must ask them what they would prefer you to call them. Some people are content with you addressing them by their first name, others may not be and you must, from the beginning of the therapeutic relationship, determine what the individual prefers; this demonstrates respect.
Just because a person becomes ill, prone to illness or vulnerable, they do not lose all their own values and beliefs, their sense of self as mother, father, lover, partner, brother or sister. How a person is addressed can impact on their health and wellbeing.
You may also note that we have used a variety of words to describe you, the reader. We have done this because we know that many people from a variety of backgrounds will read and use this text. All of us are learners and this is the perspective that we have used when writing this text.
The provision of a world-class health and social care service
The National Health Service (NHS) is the main provider (but not the only one) of health care in the United Kingdom (UK); the NHS belongs to all of us. There are thousands of healthcare workers employed by the NHS; most of them provide hands-on care – the NHS aims to deliver world-class care. This includes engaging people cared for and empowering them and their communities; as well as this you are an important part of this aim, you are central to ensuring that this intention is realised.
The provision of care and access to services – how it is provided, where it is provided, when it is provided and who provides it is changing all of the time. Accessibility of services is important, so too is the prevention of illness and disability with the intention of helping people to stay active and healthy – mind and body.
The four countries of the UK have planned the way services are provided in their own countries. The people of these four countries deserve the very best and they should settle for nothing less. You must also strive to deliver world-class care along with other health and social care workers, for example, physiotherapists, speech and language therapists, doctors, midwives, dieticians, paid carers, informal carers, social services and the people you care for themselves.
We wish you much success with your studies be they in the classroom or in the multitude of care areas that you might find yourself working.
References
Nair, M. and Peate, I. (2009) Fundamentals of Applied Pathophysiology: An Essential Guide for Nursing Students. Oxford: Wiley-Blackwell.
Nursing and Midwifery Council (2010) Standards for Pre Registration Nursing Education. London: NMC.
Patients Association (2009) Patients not Numbers. .. People not Statistics. London: Patients Association.