Fundamentals of Applied Pathophysiology THIRD EDITION Fundamentals of Applied Pathophysiology An Essential Guide for Nursing and Healthcare Students EDITED BY IAN PEATE OBE FRCN Head of School School of Health Studies Gibraltar This edition fi rst published 2018 © 2018 John Wiley & Sons Ltd Edition History © 2009, 2013 by John Wiley & Sons Ltd All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by law. Advice on how to obtain permission to reuse material from this title is available at http://www.wiley.com/go/permissions The right of Ian Peate to be identifi ed as the author of the editorial material in this work has been asserted in accordance with law. 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Title: Fundamentals of applied pathophysiology : an essential guide for nursing and healthcare students / [edited by] Ian Peate. Description: Third edition. | Hoboken, NJ : Wiley, 2017. | Includes bibliographical references and index. | Identifi ers: LCCN 2017013384 (print) | LCCN 2017014343 (ebook) | ISBN 9781119219484 (pdf) | ISBN 9781119219491 (epub) | ISBN 9781119219477 (pbk.) Subjects: | MESH: Pathologic Processes | Nursing Care—methods | Physiological Phenomena Classifi cation: LCC RB113 (ebook) | LCC RB113 (print) | NLM QZ 140 | DDC 616.07—dc23 LC record available at https://lccn.loc.gov/2017013384 Cover image: © Science Photo Library/Gettyimages Cover design by Wiley Set in 10/12 pt MyriadPro by Aptara 10 9 8 7 6 5 4 3 2 1 Dedication This text is dedicated to the life of Thomas Webster . A brave young man who died far too early. Contents Preface viii Acknowledgements x Contributors xi About the companion website xiii Chapter 1 Cell and body tissue physiology 1 Chapter 2 Cancer 32 Chapter 3 Infl ammation, immune response and healing 62 Chapter 4 Shock 93 Chapter 5 The nervous system and associated disorders 116 Chapter 6 The heart and associated disorders 148 Chapter 7 The vascular system and associated disorders 178 Chapter 8 The blood and associated disorders 212 Chapter 9 The renal system and associated disorders 247 Chapter 10 The respiratory system and associated disorders 278 Chapter 11 The gastrointestinal system and associated disorders 315 Chapter 12 Nutrition and associated disorders 346 Chapter 13 The endocrine system and associated disorders 371 Chapter 14 The reproductive systems and associated disorders 407 Chapter 15 Pain and pain management 441 Chapter 16 The musculoskeletal system and associated disorders 478 Chapter 17 Fluid and electrolyte balance and associated disorders 506 Chapter 18 The skin and associated disorders 534 Chapter 19 The ear, nose and throat, and eyes, and associated disorders 563 Appendix Reference values in venous serum (adults) 592 Index 595 Preface The third edition I am delighted to be writing the preface to the third edition of this very popular text Fun- damentals of Applied Pathophysiology: An Essential Guide for Healthcare Students. The new edition brings with it a number changes but at the same time it has aimed to preserve its user-friendly approach. Inviting and listening to feedback from readers has allowed me to retain features that have been seen as helpful, to introduce new features and to reorganise some of the chapters. Illustrations are again used in abundance to assist in understanding and appreciating complex disease patterns that are being discussed. Applying a fundamental approach will provide readers with a crucial understanding of applied pathophysiology. I have introduced a series of new activities that are intended to help you learn in an engaged way and to apply your learning when you are in the care setting, wherever this may be. This third edition provides you with an up-to-date overview of pathophysiology and important issues related to care. This edition also considers the wider context of care provision supplementing a nursing focus by broadening the professional base to embrace all healthcare students. In providing care that is contemporary, safe and eff ective an integrated, multidisciplinary approach is an absolutely essential requirement for those who provide care as well those who manage it. The healthcare student is an important member of any multidisciplinary care team, and this edition also emphasises the multidisciplinary approach and acknowledges the fact that care is delivered in ever changing environments to a range of people and communities. As with the fi rst and second editions, this text has also been written with the intention of making the sometimes complex subject of pathophysiology accessible and exciting. Our bodies have an extraordinary ability to respond to disease in a number of physiological and psychological ways; we are able to compensate for the changes that occur as result of the disease process – the pathophysiological processes and the impact they can have on a person. This text will assist you in developing your critical thinking, encouraging innovation and creativity in relation to the health and well-being of the people that you have the privi- lege to care for. The new features that have been added apply to most chapters and most chapters pro- vide two case studies that are related to chapter content. At the end of each chapter there are questions that will trigger refl ection and further thought. In all of the case studies, names that are used are pseudonyms, and these have been used in order to maintain confi denti- ality. Nurses owe a duty of confi dentiality to all those who are receiving care (Nursing and Midwifery Council, 2015). Where appropriate, we have included boxed information that will help you when you are providing care, which include red fl ags that contain signifi cant information alerting you to be cautious in your approach, and information regarding the management of medicines as related to the chapter. The case studies have been developed further and include data concerning the patient’s vital signs and blood analysis. This can help you relate important concepts to care, off ering you more insight into the patient’s condition and therefore needs. One of the case studies includes a NEWS score (national early warning score) where applicable (Royal College of Physicians, 2016). Preface Many of the values cited are a range, and blood pressure in respect of the national early warning score is noted as systolic. Local policy and procedure should be adhered to when ix using the National Early Warning Score. Although an elevated blood pressure is an important risk factor for cardiovascular disease, it is low or falling systolic blood pressure that is most signifi cant in the context of assessing acute illness severity. We have adopted Royal College of Physician’s (2016) stance on this and parameters per- tain to a range of systolic blood pressure. Another new feature is the investigations box. One investigation will be chosen pertinent to one case study in the chapter. This will contain details about the test, the pre-, peri- and post-procedure care that is required. Each chapter begins with and ends with questions that are there to test your pre- and post-knowledge. There are ten multiple choice questions at the end of each chapter along with varied learning activities such as word searches, ten true or false statements, and ‘label the diagram’ activities. Selected chapters provide a list of further resources that the reader may wish to access in order to increase and their advance learning. A glossary of terms is included at the end of each chapter. Pathophysiology considers the cellular and organ changes that take place when disease is present, as well as the eff ects these changes have on the body’s ability to function. When something interrupts the normal physiological functioning of the body, such as disease, this then becomes a pathophysiological issue. It must always be remembered that normal health is not and cannot be exactly the same in any two individuals and as such when using the term normal this has to be treated with caution. An understanding of pathophysiology ‘nor- mal’ and ‘abnormal’ can assist the student to help the patient in a kind, compassionate, caring and safe way. This text is a foundation text that can support the reader to grow personally and profes- sionally in relation to the provision of care, and is primarily intended for nursing students who come into contact with those who may have a number of physically related health- care problems such as coronary heart disease, asthma, dementia and many more diseases, in the hospital and community setting. The text focuses on the adult person. Illness and disease are discussed explicitly, highlighting the fact that people do become ill and they do experience disease. It is not envisaged that you read the text from cover to cover, but you are encouraged to dip in and out of it. The aim is to entice and encourage you, whet the appetite, so you may read further and in so doing I hope to instill a sense of curiosity in you. The fi rst four chapters however, set the scene and you may wish to read these fi rst and the move on to a more spe- cifi c area of interest. References Nursing and Midwifery Council (2015). The Code. Professional Standards of Practice and Behaviour for Nurses and Midwives https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf last accessed September 2016. Royal College of Physicians (2016). National Early Warning Score (NEWS) https://www.rcplondon.ac.uk/ projects/outputs/national-early-warning-score-news last accessed September 2016.