Porth's pathophysiology concepts of altered health states

1690 Pages·2014·140.548 MB·English

by  Sheila C. Grossman, Carol Mattson Porth

PORTH’S PATHOPHYSIOLOGY
Concepts of Altered Health States
Porth9781451146004-FM.indd 1 7/15/2013 1:11:44 PM
Porth9781451146004-FM.indd 2 7/15/2013 1:11:44 PM
PORTH’S
PATHOPHYSIOLOGY
Concepts of Altered Health States
NINTH EDITION
SHEIlA C. GrOSSmAN, PhD, APrN, FNP-BC, FAAN
Professor & FNP Track Coordinator
Fairfield University School of Nursing
Fairfield, Connecticut
CArOl mATTSON POrTH, rN, mSN, PhD (Physiology)
Professor Emeritus
College of Nursing
University of Wisconsin – Milwaukee
Milwaukee, Wisconsin
Porth9781451146004-FM.indd 3 7/15/2013 1:11:55 PM
Acquisitions Editor: David Troy
Product Manager: Katherine Burland
Editorial Assistant: Latisha Oglesby
Production Project Manager: Cynthia Rudy
Design Coordinator: Joan Wendt
Manufacturing Coordinator: Karin Duffield
Prepress Vendor: SPi Global
9th edition
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Copyright © 2009 by Wolters Kluwer Health | Lippincott Williams & Wilkins. Copyright © 2005, 2002 by Lippincott Williams &
Wilkins. Copyright © 1998 by Lippincott-Raven Publishers. Copyright © 1994 by J.B. Lippincott Company. All rights reserved.
This book is protected by copyright. No part of this book may be reproduced or transmitted in any form or by any means, includ-
ing as photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system without
written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials
appearing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by
the above-mentioned copyright. To request permission, please contact Lippincott Williams & Wilkins at Two Commerce Square,
2001 Market Street, Philadelphia, PA 19103, via email at [email protected], or via our website at lww.com (products and
services).
9 8 7 6 5 4 3 2 1
Printed in China
Cataloging-in-Publication Data available on request from the Publisher.
ISBN: 978-1-4511-4600-4

Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices. However,
the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the
information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy
of the contents of the publication. Application of this information in a particular situation remains the professional responsi-
bility of the practitioner; the clinical treatments described and recommended may not be considered absolute and universal
recommendations.
The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are
in accordance with the current recommendations and practice at the time of publication. However, in view of ongoing research,
changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is
urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions.
This is particularly important when the recommended agent is a new or infrequently employed drug.
Some drugs and medical devices presented in this publication have Food and Drug Administration (FDA) clearance for
limited use in restricted research settings. It is the responsibility of the health care provider to ascertain the FDA status of each
drug or device planned for use in his or her clinical practice.
LWW.com
Porth9781451146004-FM.indd 4 7/15/2013 1:11:55 PM
Contributors
Cynthia Bautista, PhD, RN, CNRN, CCNS, ACNS-BC Christine Kurtz, DNP, PMHCNS-BC
Neuroscience Clinical Nurse Specialist Adjunct Assistant Professor
Yale New Haven Hospital Valparaiso University College of Nursing
New Haven, Connecticut Valparaiso, Indiana
(Chapters 17, 18, 19, 20) (Chapter 21)
Jaclyn Conelius, PhD, APRN, FNP-BC Jessie Moore, MS, APRN
Assistant Professor Program Coordinator, Weight Loss Surgery
Fairfield University School of Nursing Yale New Haven Hospital – Saint Raphael Campus
Fairfield, Connecticut New Haven, Connecticut
(Chapters 29, 30, 31, 32, 33, 34) (Chapter 47)
Sally O. Gerard, DNP, RN, CDE Nancy Moriber, PhD, CRNA, APRN
Assistant Professor of Nursing and Coordinator, Nursing Visiting Assistant Professor and Director, Nurse
Leadership Track Anesthesia Track
Fairfield University School of Nursing Fairfield University School of Nursing
Fairfield, Connecticut Fairfield, Connecticut
(Chapters 48, 50) (Chapters 13, 15)
Lisa Grossman, MD, MPH Martha Burke O’Brien, MS, ANP-BC, APRN
Administrative Chief Resident Director of Student Health Services
Obstetrics/Gynecology Trinity College
Columbia University Medical Center Hartford, Connecticut
New York, New York (Chapter 23)
(Chapters 6, 7, 53, 54, 55)
Eileen O’Shea, DNP, RN
Theresa Kessler, PhD, RN, ACNS-BC, CNE Assistant Professor
Professor Fairfield University School of Nursing
Valparaiso University Fairfield, Connecticut
Valparaiso, Indiana (Chapter 2)
(Chapters 21, 40)
Kathleen Wheeler, PhD, APRN, PMHNP-BC, FAAN
Melissa Kramps, DNP, APRN Professor
Nurse Practitioner Fairfield University School of Nursing
Memory Disorders Center Fairfield, Connecticut
New York, New York (Chapter 22)
(Chapter 3)
Zachary Krom, MSN, RN, CCRN
Service Line Educator: Adult Surgery
Yale New Haven Hospital
New Haven, Connecticut
(Chapters 44, 45, 46)
v
Porth9781451146004-FM.indd 5 7/15/2013 1:12:00 PM
Reviewers
Mary Fisler Aebi, RN, MSN Brian H. Kipp, PhD
Associate Professor Associate Professor
Mt. Hood Community College Grand Valley State University
Yachats, Oregon Allendale, Michigan
Beverly Anderson, MSN, RN Lori Knight, CHIM
Associate Professor of Nursing Instructor
Salt Lake Community College Health Information Management Program
West Jordon, Utah SIAST, Wascana Campus
Regina, Canada
Lou Anne Baldree, MD
Clinical Associate Professor of Nursing Kay Luft, MN, CNE, CCRN
College of Nursing Associate Professor
East Carolina University St. Luke’s College of Health Sciences
Greenville, North Carolina Kansas City, Missouri
Karen Chandra, RN, MSN, MBA Dr. Nicholas Lutfi, DPM, MS
Assistant Professor Associate Professor of Anatomy
Harper College Nova Southeastern University
Palatine, Illinois Ft. Lauderdale-Davie, Florida
Dale E. Collins, MS, RT(R)(M)(QM), RDMS, RVT Barbara McGeever, BSN, MSN, PhD
Clinical Coordinator Assistant Professor
University of Arkansas for Medical Sciences Neumann University
Massachusetts General Hospital Aston, Pennsylvania
Imaging Associates of Providence
Little Rock, Arkansas Jack Pennington, PhD
Assistant Professor
Kent Davis, MD Goldfarb School of Nursing
Professor of Biology Barnes Jewish College
Brigham Young University – Idaho St. Louis, Missouri
Rexburg, Idaho
Kathy Sheppard, PhD
Wendy Dusek, BS, DC Chair ADN Program
Natural Science Instructor Associate Professor
Wisconsin Indianhead Technical College University of Mobile
New Richmond, Wisconsin Mobile, Alabama
Kelly L. Fisher, RN, PhD Paula S. Steiert, MS
Dean and Associate Professor of Nursing Instructor of Biology
Endicott College St. John’s College of Nursing
Beverly, Massachusetts Southwest Baptist University
Springfield, Missouri
Catherine Jennings, DNP, MSN, APN-C
Assistant Professor Graduate Nursing
Felician College
Newton, New Jersey
vi
Porth9781451146004-FM.indd 6 7/15/2013 1:12:06 PM
Preface
Over the last 30 years, Carol M. Porth’s text, Pathophysiology: Features that were proven to be effective in previous edi-
Concepts of Altered Health States, has become widely known tions have been retained, and appropriate updates to content
as a seminal text in pathophysiology for nursing and health have been made. The sequencing of units has been updated to
profession students. It is a testament to her extensive knowl- continue to enhance students’ ability to master basic concepts
edge, skills, and commitment that she succeeded in creating and then advance to more complex material. Case studies have
such a student-friendly and, at the same time, state-of-the-art been created for each unit and integrated into relevant chap-
book. It is a great honor to carry forward this tradition as the ters. Reference lists for each chapter have been updated, and
new author of the ninth edition of Porth’s Pathophysiology. selected clinical application content has been incorporated
The goal for this edition has been to retain the text’s solid throughout the text to enhance students’ understanding of the
foundation while updating and incorporating new advances pathophysiology of frequently seen conditions.
in science and technology. Once again, talented clinicians, Attention has been given to the incorporation of the most
researchers, and scholars have contributed their expertise and recent advances from the fields of genetics, immunity, micro-
knowledge to the book. The major emphasis continues to be on biology, and molecular biology. Advances in health care tech-
relating normal body functioning to the physiologic changes nology are presented through the inclusion of international
that occur as a result of disease, as well as on the body’s ability studies, WHO guidelines, and the health variants of diverse
to compensate for these changes through mechanisms of heal- populations. I am pleased to present this new edition and to
ing and those that work to prevent and resist disease. Although play a role in continuing the legacy of this valuable resource
primarily designed as a textbook, the book also serves as a for students, instructors, and health professionals.
reference that students will find useful throughout their edu-
cational program and, eventually, in practice. Sheila C. Grossman
This edition marks the 30th anniversary of Pathophysiology: are interrelated. Selection of content was based on common
Concepts of Altered Health States. From its first edition pub- health problems across the lifespan, and recent advances in the
lished in 1982, it has grown to become a trusted and definitive fields of genetics, immunology, microbiology, and molecular
resource for students, instructors, and health care professionals. biology are included. Concepts are presented in a manner that
The goal for each edition has been to develop a text that is logical and understandable for students, building from basic
is current, accurate, and presented in a logical manner. While to more complex. The chapters are arranged so that common
its vision and objectives have remained the same throughout accompaniments to disease states, such as inflammation and
the editions, the methods used to gather, analyze, present, and repair, genetic control of cell function and inheritance, and
deliver the information have changed. Myriad cultural, politi- immunologic processes, appear in the early chapters before
cal, and technological factors have helped to shape the text, and the specific discussions of particular disease states.
it is now a reflection of the global community. Technology has Proven strengths of the text include the expanded chap-
allowed me to work with contributors from around the world, ters on health and disease; nutrition; sleep and sleep disorders;
to harvest information from a seemingly unlimited reservoir, pediatrics; gerontology; and thought, emotion, and mood dis-
and to deliver the information to an ever-growing audience. orders. Advances in health care are presented through the
With each edition, the task at hand was to create a learn- inclusion of international studies, World Health Organization
ing environment that would, in the words of Chinese scholars, guidelines, and the health variants of diverse populations.
“open the gates of knowledge” to the reader. The art of open- Many “trademark” features and learning aids have been
ing up a subject and generating enthusiasm for that subject developed over the years that inspire students’ enthusiasm and
is what produces autonomy and ultimately, an independent facilitate learning, including more than 700 detailed, full-color
learner. While other physiology-based texts take a “how-to” or illustrations depicting the clinical manifestations of selected
heavily application-oriented approach, that was not the intent disease states and other important visuals. Learning objectives
here. Rather, this text focuses on the scientific basis upon are listed at the beginning of each major section in a chapter,
which the practice components of the health professions are and summary statements appear at the end. Organizing the
based, fostering a practitioner with the knowledge and skills content in this manner encourages students to pause and review
to develop creative solutions within a dynamic profession. important points. Key points boxes within each chapter help
A holistic conceptual framework uses body systems as students develop true understanding by incorporating infor-
an organizing framework and demonstrates how the systems mation within a larger conceptual unit, versus merely asking
vii
Porth9781451146004-FM.indd 7 7/15/2013 1:12:06 PM
viii Preface
them to memorize miscellaneous facts. The Understanding and psychological aspects of altered health. In its very essence,
features that appear in some chapters break physiologic pro- each edition has reflected my desire to share the beauty of the
cesses and phenomena into their sequential parts, providing human body and to emphasize that in disease as in health,
insight into the many opportunities for disease to disrupt the there is more “going right” in the body than is “going wrong.”
processes. Review exercises are included to provide practice Throughout its 30 years, authoring the book has been
in using the c onceptual approach in solving problems related a meaningful endeavor. The preparation of each edition has
to patient scenarios. Other helpful tools include a glossary and been a challenging and humbling task. I have experienced
a table of normal laboratory values. great joy and satisfaction in engaging the reader and shar-
In developing content for the previous editions, my per- ing the excitement and wonder that I have for the physio-
spective as a nurse–physiologist led to an approach based on logic basis of life and altered health. With this ninth edition,
relating normal body functioning to the physiologic changes we welcome a new voice and vision to the enterprise as
that participate in disease production and that occur as a result Dr. Sheila Grossman leads the publishing effort for this new
of disease. I also focused on the body’s remarkable ability to edition and shares in the experience of “opening the gates of
compensate for these changes. The beauty of physiology is knowledge.”
that it integrates all of the aspects of human genetics, molecu-
lar and cellular biology, and anatomy and physiology into a Carol Mattson Porth
functional whole that can be used to explain both the physical
Porth9781451146004-FM.indd 8 7/15/2013 1:12:06 PM