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THIRD EDITION PPAATTHHOOPPHHYYSSIIOOLLOOGGYY A PRACTICAL APPROACH Lachel Story, PhD, RN Assistant Dean for Research and Evaluation PhD Program Director Associate Professor College of Nursing The University of Southern Mississippi Hattiesburg, Mississippi World Headquarters Jones & Bartlett Learning 5 Wall Street Burlington, MA 01803 978-443-5000 [email protected] www.jblearning.com Jones & Bartlett Learning books and products are available through most bookstores and online booksellers. To contact Jones & Bartlett Learning directly, call 800-832-0034, fax 978-443-8000, or visit our website, www.jblearning.com. Substantial discounts on bulk quantities of Jones & Bartlett Learning publications are available to corporations, professional associations, and other qualified organizations. For details and specific discount information, contact the special sales department at Jones & Bartlett Learning via the above contact information or send an email to [email protected]. Copyright © 2018 by Jones & Bartlett Learning, LLC, an Ascend Learning Company All rights reserved. No part of the material protected by this copyright may be reproduced or utilized in any form, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without written permission from the copyright owner. The content, statements, views, and opinions herein are the sole expression of the respective authors and not that of Jones & Bartlett Learning, LLC. Reference herein to any specific commercial product, process, or service by trade name, trademark, manufacturer, or otherwise does not constitute or imply its endorsement or recommendation by Jones & Bartlett Learning, LLC and such reference shall not be used for advertising or product endorse- ment purposes. All trademarks displayed are the trademarks of the parties noted herein. Pathophysiology: A Practical Approach, Third Edition is an independ- ent publication and has not been authorized, sponsored, or otherwise approved by the owners of the trademarks or service marks referenced in this product. There may be images in this book that feature models; these models do not necessarily endorse, represent, or participate in the activities represented in the images. Any screenshots in this product are for educational and instructive purposes only. Any individuals and scenarios featured in the case studies throughout this product may be real or fictitious, but are used for instructional purposes only. The author, editor, and publisher have made every effort to provide accurate information. However, they are not responsible for errors, omissions, or for any outcomes related to the use of the contents of this book and take no responsibility for the use of the products and procedures described. Treatments and side effects described in this book may not be applicable to all people; likewise, some people may require a dose or experience a side effect that is not described herein. Drugs and medical devices are discussed that may have limited availability controlled by the Food and Drug Administration (FDA) for use only in a research study or clinical trial. Research, clinical practice, and government regulations often change the accepted standard in this field. When consideration is being given to use of any drug in the clinical setting, the health care provider or reader is responsible for determining FDA status of the drug, reading the package insert, and reviewing prescribing information for the most up-to-date recommendations on dose, precautions, and con- traindications, and determining the appropriate usage for the product. This is especially important in the case of drugs that are new or seldom used. 12113–1 Production Credits VP, Executive Publisher: David D. Cella Executive Editor: Amanda Martin Editorial Assistant: Christina Freitas Senior Production Editor: Amanda Clerkin Senior Marketing Manager: Jennifer Scherzay Product Fulfillment Manager: Wendy Kilborn Composition: codeMantra Cover Design: Scott Moden Rights & Media Specialist: Wes DeShano Media Development Editor: Troy Liston Cover Image (Title Page): © Ezume Images/Shutterstock Printing and Binding: LSC Communications Cover Printing: LSC Communications Library of Congress Cataloging-in-Publication Data Names: Story, Lachel, author. Title: Pathophysiology : a practical approach / Lachel Story. Description: Third edition. | Burlington, Massachusetts : Jones & Bartlett Learning, [2018] | Includes bibliographical references and index. Identifiers: LCCN 2016047299 | ISBN 9781284120196 Subjects: | MESH: Pathology | Physiology | Nurses’ Instruction Classification: LCC RB113 | NLM QZ 140 | DDC 616.07–dc23 LC record available at https://lccn.loc.gov/2016047299 6048 Printed in the United States of America 21 20 19 18 17 10 9 8 7 6 5 4 3 2 1 Contents Preface .................................................................. x Acknowledgments ......................................................... xi Reviewers ............................................................... xii Introduction to Pathophysiology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv Chapter 1 Cellular Function .............................................. 1 Basic Cell Function ............................................. 2 Cellular Adaptation and Damage .................................. 9 Neoplasm .................................................... 14 Genetic and Congenital Alterations ................................ 21 Chapter Summary ............................................. 30 References ................................................... 30 Chapter 2 Immunity .................................................... 31 Stress ...................................................... 32 Immunity .................................................... 33 Innate and Adaptive Defenses .................................... 34 Transplant Reactions ........................................... 41 Autoimmune Disorders ......................................... 42 AIDS . ...................................................... 45 Developing a Strong Immune System .............................. 48 Chapter Summary ............................................. 50 References ................................................... 50 Chapter 3 Hematopoietic Function ......................................... 51 Normal Hematopoietic Function .................................. 52 Diseases of the White Blood Cells ................................. 53 Diseases of the Red Blood Cells ................................... 59 Diseases of the Platelets ......................................... 65 Chapter Summary ............................................. 69 References ................................................... 69 Chapter 4 Cardiovascular Function ......................................... 71 Anatomy and Physiology ........................................ 72 Understanding Conditions That Affect the Cardiovascular System ........ 80 Alterations Resulting in Decreased Cardiac Output ........................ 80 Conditions Resulting in Altered Tissue Perfusion ......................... 94 Conditions Resulting in Decreased Cardiac Output and Altered Perfusion ...... 107 Chapter Summary ............................................. 115 References ................................................... 115 vii viii Contents Chapter 5 Respiratory Function ........................................... 117 Anatomy and Physiology ........................................ 118 Understanding Conditions That Affect the Respiratory System .......... 127 Infectious Disorders ................................................ 128 Alterations in Ventilation ............................................ 141 Alterations in Ventilation and Perfusion ................................ 156 Chapter Summary ............................................. 159 References ................................................... 160 Chapter 6 Fluid, Electrolyte, and Acid–Base Homeostasis ....................... 161 Fluid Balance ................................................. 162 Electrolyte Balance ............................................. 167 Acid–Base Balance ............................................. 175 Chapter Summary ............................................. 185 References ................................................... 185 Chapter 7 Urinary Function .............................................. 187 Anatomy and Physiology ........................................ 188 Understanding Conditions That Affect the Urinary System ............. 194 Chapter Summary ............................................. 213 References ................................................... 213 Chapter 8 Reproductive Function .......................................... 215 Anatomy and Physiology ........................................ 216 Congenital Disorders ........................................... 226 Infertility Issues ............................................... 229 Disorders of the Testes and Scrotum ............................... 230 Menstrual Disorders ............................................ 233 Disorders of Pelvic Support ...................................... 235 Disorders of the Uterus ......................................... 236 Disorders of the Ovaries ......................................... 239 Disorders of the Breasts ......................................... 239 Miscellaneous Infections ........................................ 240 Sexually Transmitted Infections ................................... 243 Cancers ...................................................... 251 Chapter Summary ............................................. 257 References ................................................... 257 Chapter 9 Gastrointestinal Function ........................................ 259 Anatomy and Physiology ........................................ 260 Understanding Conditions That Affect the Gastrointestinal System ....... 268 Chapter Summary ............................................. 301 References ................................................... 301 Chapter 10 Endocrine Function ............................................ 303 Anatomy and Physiology ........................................ 305 Understanding Conditions That Affect the Endocrine System ........... 310 Chapter Summary ............................................. 324 References ................................................... 324 Contents ix Chapter 11 Neural Function ............................................... 325 Anatomy and Physiology ........................................ 326 Understanding Conditions That Affect the Nervous System ............. 339 Chapter Summary ............................................. 374 References ................................................... 375 Chapter 12 Musculoskeletal Function ........................................ 377 Anatomy and Physiology ........................................ 378 Understanding Conditions That Affect the Musculoskeletal System ....... 388 Chapter Summary ............................................. 413 References ................................................... 413 Chapter 13 Integumentary Function. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 415 Anatomy and Physiology ........................................ 416 Understanding Conditions That Affect the Integumentary System ........ 417 Chapter Summary ............................................. 438 References ................................................... 438 Chapter 14 Sensory Function .............................................. 439 Anatomy and Physiology ........................................ 440 Understanding Conditions That Affect the Senses ..................... 449 Chapter Summary ............................................. 461 References ................................................... 461 Appendix A Normal Lab Values ............................................. 463 Appendix B Root Words and Combining Forms ................................ 467 Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 481 Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 509 Preface While teaching pathophysiology for more than 13 years (Committee on the Robert Wood Johnson Foundation and nursing for more than 21 years, I noticed a lack of Initiative on the Future of Nursing at the Institute of pathophysiology books that students could relate to, Medicine, 2010), and nursing leaders (Benner, Sutphen, and high student frustration in learning the convoluted Leonard, & Day, 2010), among others, who have sought material. Pathophysiology—while being the foundation to change how nurses are educated to meet the chang- of much of nursing education, from medical–surgical to ing landscape of health care and needs of new pharmacology—is often an insurmountable barrier for generations. students. They are faced with a copious amount of com- The third edition of this text organizes content in a plicated information to weed through. While some stu- conceptual manner to provide students with an under- dents become bogged down in an information marsh, standable and practical resource for learning pathophys- others seek more information than is provided in a iology. New and updated material has been added to skeleton book that has been cut to the bone. Nursing every chapter. An increased focus on pediatric content faculty join the students on this frustrating, Goldilocks and considerations has been threaded throughout. New journey by trying to make the available resources fit. and updated case studies add to students’ understand- Unfortunately, nursing students and faculty often have ing and ability to apply their learning on a practical pathophysiology books available that provide either far level. Instructor resources have been expanded to in- too much information or far too little. clude active learning activities that support the “flipped” This text provides the right fit: it is a practical guide classroom approach. Faculty will appreciate having a to pathophysiology that presents information in a resource that speaks to and engages students. Health student-friendly, understandable way. Here, extraneous professionals will also be able to refer the text to refresh information is omitted, leaving only necessary informa- their memory on concepts in a pragmatic way. tion. The information in this text is also presented in a more accessible manner by considering readability, pro- References viding colorful graphics, and giving the content context and meaning. Benner, P., Sutphen, M., Leonard, V., & Day, L. (2010). Edu- This ground-breaking text will provide a spring- cating nurses: A call for radical transformation. San Francisco, CA: Jossey-Bass. board for faculty and students to come together as co- Committee on the Robert Wood Johnson Foundation Initia- learners to explore this fascinating content. When such tive on the Future of Nursing at the Institute of Medicine. co-learning is stimulated, pathophysiology is no longer (2010). A summary of the February 2010 forum on the just mindlessly deposited into the students in a stifling future of nursing: Education [Chapter 2: What to teach]. manner; rather, learning for the students and the fac- Retrieved from http://www.nap.edu/catalog/12894.html ulty becomes an empowerment pedagogy. This ap- Institute of Medicine. (2011). The future of nursing education: proach has been supported by experts at the Institute of Leading change, advancing health. Washington, DC: National Medicine (2011), the Robert Wood Johnson Foundation Academies Press. x Acknowledgments First, I would like to thank my husband, Tom, and chil- past, present, and future for constantly teaching me dren, Clayton and Mason, for their never-ending love more than I could ever teach them and for all their and encouragement. I would also like to express my feedback—I heard it and I hope this is more what you deepest gratitude to my mom, Carolyn, and dad, had in mind. Finally, I would like to convey my appre- Tommy, because I would not be who I am today without ciation to my colleagues for their gracious mentoring them. I would also like to acknowledge all my students and support. xi Reviewers Judy Anderson, PhD, RN, CNE Christine Henshaw, EdD, RN, CNE Associate Professor Associate Dean, Undergraduate Program School of Nursing School of Health Sciences Viterbo University Seattle Pacific University La Crosse, Wisconsin Seattle, Washington Margaret Hamilton Birney, PhD, RN Patricia R . Keene, DNP, ACNP, CS, BC Associate Professor Associate Professor of Nursing School of Nursing School of Nursing University of Delaware Union University Newark, Delaware Germantown, Tennessee Linda Keilman, DNP(c), MSN, GNP-BC Patsy E . Crihfield, DNP, APRN, FNP-BC Assistant Professor Associate Professor of Nursing and Director of Nurse College of Nursing Practitioner Program Michigan State University School of Nursing East Lansing, Michigan Union University Germantown, Tennessee Barbara McClaskey, PhD, MN, ARNP-CNS Associate Professor Jennifer Donwerth, MSN, RN, ANP-BC, Department of Nursing GNP-BC Pittsburg State University Instructor Pittsburg, Kansas Department of Nursing Tarleton State University Joan Niederriter, PhD, RN Stephenville, Texas Assistant Professor Department of Nursing Julie Eggert, PhD Cleveland State University Associate Professor and Healthcare Genetics Doctoral Cleveland, Ohio Program Coordinator Tanya L . Rogers, APRN, BC, MSN, EdD School of Nursing Associate Professor of Nursing Clemson University School of Nursing and Allied Health Administration Clemson, South Carolina Fairmont State University Fairmont, West Virginia Masoud Ghaffari, MSN/RN, MEd, MT (ASCP), CMA Jennifer K . Sofie, MSN, ANP, FNP Associate Professor Adjunct Assistant Professor College of Nursing College of Nursing East Tennessee State University Montana State University Johnson City, Tennessee Bozeman, Montana Kathleen A . Goei, PhD, RN, MSN Joan Stokowski, MSN Assistant Professor Assistant Professor School of Nursing and Health Professions Department of Health Careers University of the Incarnate Word Illinois Central College San Antonio, Texas Peoria, Illinois xii Reviewers xiii Brenda D . Tilton, RN, MSN, FNP-BC Vickie Walker, DNP, RN Assistant Professor of Nursing Assistant Professor of Nursing School of Nursing School of Nursing Southern State Community College Gardner-Webb University Hillsboro, Ohio Boiling Springs, North Carolina

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