Textbook of Anatomy and Physiology for Nurses

Specifically targeted for nurses, this book has been written in line with the curriculum prescribed by the Nursing Council of India. The combination of anatomy and physiology in one book will allow the students to understand structure–function relationships of the human body in preparation for their clinical training.

PART A Anatomy

SECTION 1 Introduction to Anatomy

1 What Is Anatomy?, 4

• Introduction, 4
• Role of Anatomy in Health Sciences, 4
• A Brief History of Human Anatomy, 4
• Subdivisions of Anatomy and their Scope, 6

• Introduction, 7
• Anatomical Position, 7
• Planes of the Body, 7
• Sections of the Body, 7
• Terms of Relationship, 7
• Movements of the Body, 8

• Introduction, 11
• Structural Organization of the Human Body, 11
• The Cell Theory, 11
• Classification of Cells, 11
• Ultrastructure of an Animal Cell, 11
• Cell Division, 15
• The Cell Cycle, 16
• Applied Anatomy, 16

• Introduction, 20
• Functions of Epithelial Tissue, 20
• Arrangement of Epithelial Tissue, 20
• Classification of Epithelial Tissue, 20
• Epithelial Cell Junctions, 22
• Applied Anatomy, 22

• Introduction, 23
• General Features of Exocrine Glands, 23
• Classification of Exocrine Glands , 23
• Applied Anatomy, 25

• Introduction, 27
• General Features, 27
• Classification, 28
• Applied Anatomy, 29

• Introduction, 30
• General Features, 30
• Classification and Specific Features, 31
• Applied Anatomy, 31

• Introduction, 36
• Classification of Bones, 36
• Terms Used to Describe the Gross Anatomy of Bones, 38
• General Features of Long Bones, 39
• General Microscopic Features of Bones, 39
• Microstructure of Lamellar Bone, 40
• Growth and Development of Bone, 40
• Applied Anatomy, 40

• Introduction, 43
• The Skull, 43
• Other Bones, 44
• The Vertebral Column, 45
• The Cervical Vertebrae, 45
• The Thoracic Vertebrae, 45
• The Lumbar Vertebrae, 46
• The Sacrum and Coccyx, 46
• The Bony Thorax, 46
• The Sternum, 46
• The Ribs, 46
• Applied Anatomy, 49

• Introduction, 51
• The Upper Limb, 51
• The Lower Limb, 54
• Applied Anatomy, 57

• Introduction, 60
• Classification of Muscles, 60
• Microscopic Features of Muscles, 62
• General Features of Skeletal Muscles, 64
• Nomenclature Used to Name Skeletal Muscles, 64
• Classification of Skeletal Muscles, 65
• Applied Anatomy, 65

• Introduction, 67
• Muscles of the Head and Neck, 67
• Muscles of the Thorax, 71
• Muscles of the Upper Limb, 71
• The Deltoid Muscle, 71
• The Thoracoabdominal Diaphragm, 71
• Applied Anatomy, 71

• Introduction, 78
• Muscles of the Abdominal Wall, 78
• Muscles of the Pelvis and Perineum, 79
• Muscles of the Lower Limb, 80
• The Gluteus Maximus Muscle, 82
• Applied Anatomy, 84

• Introduction, 88
• Definition, 88
• Classification, 88
• Fibrous Joints, 89
• Cartilaginous Joints, 89
• Synovial Joints, 89
• Applied Anatomy, 92

• Introduction, 93
• Joints of the Axial Skeleton, 93
• Joints of the Appendicular Skeleton, 96
• Applied Anatomy, 101

• Introduction, 104
• General Features of Blood Vessels, 104
• Histology of Blood Vessels, 106
• The Arteries of the Body, 108
• The Veins of the Body, 108
• Applied Anatomy, 109

• Blood Supply, 123
• Introduction, 123
• The Pericardium, 123
• The External Features of the Heart, 124
• Blood and Nerve Supply of the Heart, 126
• Applied Anatomy, 128

• Introduction, 130
• Internal Features of the Chambers of the Heart, 130
• The Conducting System of the Heart, 133
• Applied Anatomy, 134

• Introduction, 136
• Lymphoid Organs, 136
• Lymph Nodes, 136
• Lymphatic Vessels, 138
• The Thymus, 138
• The Spleen, 140
• The Tonsils, 140
• Applied Anatomy, 142

• Introduction, 146
• The Nose, 146
• The Paranasal Air Sinuses, 148
• The Pharynx, 149
• The Larynx, 149
• Applied Anatomy, 151

• Introduction, 153
• The Trachea, 153
• The Mediastinum, 154
• The Extrapulmonary Bronchi, 154
• The Lungs, 154
• The Bronchial Tree, 156
• The Pleura, 157
• Applied Anatomy, 158

• 22 The Upper Alimentary Canal, 162
• Introduction, 162
• The Oral Cavity, 162
• The Palate, 163
• The Tongue, 164
• The Salivary Glands, 167
• Applied Anatomy, 287

• Introduction, 290
• General Features of Skin, 290
• Thick and Thin Skin, 292
• Appendages of the Skin, 292
• Applied Anatomy, 292
• The Pharynx, 170
• The Oesophagus, 171
• Applied Anatomy, 173

• Introduction, 176
• The Abdominal Cavity and its Walls, 177
• The Peritoneum and Peritoneal Cavity, 177
• The Stomach, 177
• The Small Intestine, 183
• The Large Intestine, 186
• Applied Anatomy, 192

• Introduction, 196
• The Liver, 196
• The Extrahepatic Biliary Apparatus, 200
• The Pancreas, 200
• Applied Anatomy, 203

• Introduction, 208
• The Kidneys, 208
• Applied Anatomy, 214

• Introduction, 216
• The Ureters, 216
• The Urinary Bladder, 217
• The Urethra, 219
• Applied Anatomy, 221

• Introduction, 224
• The Ovaries, 224
• The Fallopian Tubes, 228
• The Uterus, 228
• The Vagina, 230
• The Breast, 231
• The External Genitalia, 231
• Applied Anatomy, 231

• Introduction, 235
• The Testes, 236
• The Duct System, 237
• The Accessory Glands, 239
• The Penis, 239
• The Scrotum, 241
• Applied Anatomy, 241

• Introduction, 244
• Nervous Tissue, 244
• The Meninges, 248
• The Dural Venous Sinuses, 248
• The Cerebrospinal Fluid, 250
• The Autonomic Nervous System, 251
• Applied Anatomy, 251

• Introduction, 255
• The Spinal Cord, 255
• The Spinal Nerves, 258
• Applied Anatomy, 259

• Introduction, 263
• The Brainstem, 263
• The Cranial Nerves, 265
• The Cerebellum, 265
• The Fourth Ventricle, 265
• Applied Anatomy, 266

• Introduction, 270
• The Thalamus, 271
• The Hypothalamus and Epithalamus, 272
• The Basal Nuclei, 272
• The Cerebrum, 273
• The Third and Lateral Ventricles, 277
• Applied Anatomy, 277

• Introduction, 282
• The Hypothalamus, 282
• The Pituitary Gland, 283
• The Thyroid Gland, 284
• Parathyroid Glands, 284
• Adrenal Glands, 285
• The Pineal Gland, 285
• The Pancreatic Islets, 285
• Applied Anatomy, 287

• Introduction, 290
• General Features of Skin, 290
• Thick and Thin Skin, 292
• Appendages of the Skin, 292
• Applied Anatomy, 292

• Introduction, 296
• The Eyeball and its Accessory Structures, 296
• The Ear, 299
• Anatomy of Taste, 301
• Anatomy of Smell, 301
• Applied Anatomy, 301

• The Cell and Organization of the Human Body, 308
• Regulatory Systems, 308
• Negative Feedback: An Example of Regulatory Control, 310

• Structure of the Cell Membrane, 311
• Transport Across the Cell Membrane, 312
• Applications in Nursing, 313

• Fluid Intake and Output, 314
• Components of Body Water, 315
• Differences in Intracellular Fluid and Extracellular Fluid, 315
• Applications in Nursing, 316

• Stimulus, 317
• The Resting Membrane Potential, 317
• Nernst Potential, 317
• Genesis of the Resting Membrane Potential, 318
• What Happens if a Cell is Stimulated?, 318

• The Local Response, 322
• The Action Potential, 323
• The All-or-None Law, 324
• Refractory Period, 324
• Comparison of the Local Response and Action Potential, 324

• Structure of an Axon, 326
• Types of Nerves, 327
• Synapse, 327
• Transmission (Conduction) of the Nerve Impulse, 327
• Types of Nerve Injury, 328
• Wallerian Degeneration, 328
• Applications in Nursing, 329

• Structure of the Neuromuscular Junction, 330
• Events that Occur at the Neuromuscular Junction, 330
• Drugs/Toxins Acting at the Neuromuscular Junction, 331
• Myasthenia Gravis – A Disease that Affects
• Neuromuscular Transmission, 332
• Applications in Nursing, 332

• Comparison of the Three Muscles, 333

• Structure of Skeletal Muscle, 335
• Excitation–Contraction Coupling, 337
• Molecular Events of Muscle Contraction, 337
• Types of Muscle Contraction, 337
• Quantal Summation, 337
• Effect of Increasing Frequency of Stimulus, 338
• Muscle Fatigue, 339
• Types of Muscle Fibres in Skeletal Muscle, 339
• Applications in Nursing, 339

• What is Muscle Tone, 341
• How Muscle Tone is Regulated, 341
• Hypotonia, 341
• Hypertonia, 341
• Clinical Evaluation of Muscle Tone, 343
• Applications in Nursing, 343

• Types of Reflexes, 347
• Properties of Reflexes, 348
• Applications in Nursing, 348

• Types of Glial Cells, 349
• Functions of Glial Cells, 350
• Disorders of Glial Cells, 351
• Applications in Nursing, 351

• The Forebrain, 352
• The Cerebral Lobes and their Function, 353
• Comparison of Left and Right Cerebral Hemisphere, 354
• Hypothalamus, 354
• The Midbrain, 355
• The Hind Brain, 355
• Applications in Nursing, 355

• Classification of Receptors, 357
• Properties of Receptors, 357
• The Synapse, 358
• Sensory Pathways, 359
• Central Processing of Sensation, 359
• Pain, 360
• Applications in Nursing, 360

• Control of Muscle Length and Tension, 362
• The Motor Cortex, 363
• The Pyramidal Tract, 364
• The Basal Ganglia, 364
• The Cerebellum, 365
• The Vestibular Apparatus, 366
• Applications in Nursing, 367

• Functional Anatomy of the Autonomic Nervous System, 368
• Neurotransmitters and Receptors of the Autonomic
• Nervous System, 369
• Broad Actions of the Sympathetic Nervous System, 369
• Broad Actions of the Parasympathetic Nervous System, 370
• Relationship Between the Sympathetic and
• Parasympathetic Nervous System, 370
• Applications in Nursing, 370

• Peripheral Neuropathies, 372
• Types of Nerve Injuries, 373
• Upper and Lower Motor Neuron Lesions, 373
• Stroke and Hemiplegia, 373
• Transection of the Spinal Cord, 373
• Brown-Sequard Syndrome, 374
• Amnesia, 374
• Alzheimer Disease, 374
• Examination of the Nervous System, 374
• Applications in Nursing, 375

• Plasma and Serum, 379
• Cellular Components of Blood, 379
• Noncellular Components of the Blood, 380
• Response to Bleeding, 380
• Clotting Factors, 381
• Coagulation Cascade, 381
• Anticoagulants, 381
• Thrombocytopenic Purpura: An Example of a Bleeding
• Disorder, 382
• Haemophilia: An Example of a Clotting Disorder, 382
• Blood Groups, 382
• Blood Transfusions, 383
• Incompatible (Mismatched) Transfusion Reactions, 383
• Rh Incompatibility of the Newborn, 383
• Applications in Nursing, 383

• Erythropoiesis, 385
• Haemoglobin, 386
• Anaemia, 387
• Jaundice, 388
• Applications in Nursing, 390

• Factors Governing the Movement of Fluid in the
• Capillary Bed, 391
• Organization of the Lymphatic System, 392
• Functions of the Lymphatic System, 392
• Factors that Affect Lymph Flow, 393
• Lymphoedema, 393
• Applications in Nursing, 393

• Innate Immunity, 394
• Acquired Immunity, 395
• Passive Immunity, 396
• Vaccination (Immunization), 396
• Inflammation, 396
• Immune Deficiency States, 397
• Immunity and Transplantation, 397
• Applications in Nursing, 398

• Blood Vessels of the Circulatory System, 399
• Cells of the Heart, 400
• Functional Features of Cardiomyocytes (Cardiac Muscle
• Cells), 400
• Applications in Nursing, 401

• Introduction, 402
• The Pacemaker of the Heart, 403
• The Conducting System of the Heart, 403
• The Electrocardiogram, 404

• Phases of the Cardiac Cycle, 407
• Summary of the Phases of the Cardiac Cycle, 410
• Pressure Volume Changes During the Cardiac Cycle, 410
• ECG Waves and the Cardiac Cycle, 410
• The Heart Sounds in the Cardiac Cycle, 410
• Jugular Venous Pulse, 411
• Cardiac Output, 412
• Regulation of Cardiac Output, 412
• Venous Return, 412
• Syncope (Fainting), 413
• Applications in Nursing, 414

• Relationship Between Pressure, Flow and Resistance, 415
• Poiseuille’s Law, 415
• Patterns of Blood Flow, 416
• Pressure Pattern Along the Circulatory Tree, 416
• The Microcirculation, 416
• The Arterial Pulse Pressure Curve, 417
• Determinants of Blood Pressure, 417
• Variations in Blood Pressure, 418
• Regulation of Blood Pressure, 418
• Applications in Nursing, 419

• Coronary Circulation, 422
• Coronary Heart Disease, 423
• Cerebral Circulation, 423
• Renal Blood Flow, 424
• Cutaneous Circulation, 425
• Circulation to Skeletal Muscle, 425
• Splanchnic Circulation, 425
• Applications in Nursing, 426

• and Heart Failure, 427
• Shock, 427
• Heart Failure, 428
• Applications in Nursing, 428

• Zones of the Respiratory System, 432
• The Tracheobronchial Tree, 432
• Functions of the Respiratory System, 432
• The Pulmonary Circulation, 433
• Applications in Nursing, 433

• Muscle of Ventilation, 435
• Spirogram, 436
• Timed Vital Capacity, 436
• Ventilation at Rest and During Hyperventilation, 437
• Pressure Changes During Breathing, 438
• Lung Compliance, 438
• Surfactant, 438
• Applications in Nursing, 439

• Gas Laws, 440
• Atmospheric, Alveolar and Expired Air, 441
• The Respiratory Membrane, 441
• Regional Differences in Ventilation and Perfusion, 442
• Applications in Nursing, 443

• Transport of Oxygen in the Blood, 444
• The Oxygen–Haemoglobin Dissociation Curve, 444
• Transport of Carbon Dioxide in Blood, 445
• Blood Gases, 446
• Applications in Nursing, 446

• Chemical Regulation of Respiration, 447
• Location of Chemoreceptors, 447
• Stimuli for the Chemoreceptors, 448
• Response to Stimulation of Chemoreceptors, 448
• Neural Regulation of Respiration, 448
• The Role of the Cerebral Cortex, 448
• Respiratory Reflexes, 449
• Abnormal Breathing Patterns, 449
• Applications in Nursing, 449

• Hypoxia, 451
• Cyanosis, 452
• Dyspnoea, 452
• Assessing Lung Function, 452
• Adaptation to High Altitude, 452
• Breathing During Deep Sea Diving, 453
• Applications in Nursing, 453

• The Function of the Gastrointestinal System, 456
• The Basic Organization of the GI System, 456
• Cross-Sectional Structure of the Gut, 456
• Circulation of the Gut, 458
• Applications in Nursing, 458

• Salivary Secretion, 459
• Gastric Juice Secretion, 460
• Pancreatic Secretion, 461
• Biliary Secretion, 462
• Intestinal Secretion, 463
• Applications in Nursing, 463

• Digestion of Carbohydrates, 465
• Digestion of Proteins, 465
• Digestion of Fats, 466
• Features Which Maximize Absorption, 466
• Absorption of Nutrients in the Git, 466
• Role of the Large Intestine, 467
• Malabsorption Syndromes, 467
• Applications in Nursing, 467

• Deglutition, 469
• Gastric Emptying, 470
• Intestinal Motility, 470
• Gastrointestinal Reflexes, 471
• Applications in Nursing, 471

• Functional Anatomy of the Hepatobiliary System, 473
• Factors Affecting the Secretion of Bile, 474
• Functions of the Liver, 474
• Liver Function Tests, 475
• Applications in Nursing, 475

• Utilization of Glucose, 476
• Storage Form of Glucose, 477
• Gluconeogenesis, 477
• Utilization of Amino Acids, 477
• Utilization of Fats, 477
• Applications in Nursing, 478

• The Nephron, 480
• The Juxtaglomerular Apparatus, 482
• Functions of the Kidney, 482
• The Urinary Bladder, 483
• The Micturition Reflex, 484
• Applications in Nursing, 484

• Glomerular Filtration, 485
• The Proximal Convoluted Tubule, 487
• The Counter-Current Multiplier, 487
• The Counter-Current Exchanger, 487
• The Concept of ‘Clearance’, 490
• Applications in Nursing, 490

• Evaluation of Urine, 491
• Abnormal Constituents of Urine, 492
• Tests of Kidney Function, 493
• Applications in Nursing, 494

• Functions of the Skin, 495
• Protective Role of the Skin, 495
• Thermoregulation, 496
• Sensation, 496
• Excretion, 497
• Endocrine Function, 497
• Applications in Nursing, 497

• Mechanisms of Heat Production (Generation), 498
• Mechanisms of Heat Loss, 499
• Role of the Hypothalamus in Heat Regulation, 500
• Abnormalities of Body Temperature, 500
• Applications in Nursing, 500

• Distribution of Body Water, 502
• Composition of the Fluids in the Different Body
• Compartments, 502
• Fluid Intake, 503
• Loss of Fluids, 503
• Electrolytes in the Body, 503
• Maintenance of Fluid Balance in the Body, 503
• Regulation of Electrolytes, 504
• Applications in Nursing, 505

• The Path of Light in the Eye, 509
• The Retina, 509
• Light and Dark Adaptation, 510
• Accommodation, 510
• Errors of Refraction, 511
• The Visual Pathway, 511
• Testing for Visual Function, 513
• Some Clinical Conditions Affecting the Eye, 514
• Applications in Nursing, 516

• The External Ear, 518
• The Middle Ear, 518
• The Inner Ear, 519
• The Auditory Pathway, 521
• Types of Deafness, 522
• Tests of Hearing, 522
• Hearing Aids, 523
• Applications in Nursing, 523

• Taste, 525
• Smell, 526
• Applications in Nursing, 526

• The Endocrine Role of the Hypothalamus, 528
• How Do the Hypothalamic Hormones Reach the
• Pituitary Gland?, 529
• Hormones of the Anterior Pituitary Gland, 529
• Posterior Pituitary Hormones, 531
• Negative Feedback, 531
• Applications in Nursing, 531

• Hormones of the Thyroid Gland, 533
• Synthesis of T4 and T3, 533
• Comparison of T3 and T4, 534
• Regulation of Secretion of T3 and T4, 534
• Actions of T3 and T4, 534
• Disorders of Thyroid Hormone Secretion, 535
• Applications in Nursing, 535

• Functions of Calcium, 537
• Basic Calcium Metabolism, 537
• Hormones Involved in the Regulation of Calcium, 537
• Sites of Calcium Regulation, 538
• Parathormone, 538
• Vitamin D – 1,25-Dihydroxycholecalciferol, 538
• Calcitonin, 538
• Calcium Phosphate Interrelationships, 539
• Hypocalcaemia, 539
• Disorders of Secretion of Parathormone, 540
• Rickets, 540
• Osteoporosis, 540
• Applications in Nursing, 540

• Hormones Secreted by the Adrenal Gland, 542
• Hormones of the Adrenal Cortex and Associated Clinical
• Conditions, 543
• Cushing Syndrome, 544
• Addison Disease, 545
• Conn Syndrome, 545
• Adrenogenital Syndrome, 545
• Hormones of the Adrenal Medulla, 545
• Pheochromocytoma, 547
• Applications in Nursing, 547

• Insulin, 549
• Glucagon, 549
• Diabetes Mellitus, 549
• Applications in Nursing, 550

• Sex Differentiation in Utero, 552
• Functional Anatomy of the Male Reproductive System, 553
• Testosterone, 554
• Puberty and Secondary Sexual Characteristics in the Male, 554
• Applications In Nursing, 554

• Steps in Spermatogenesis, 555
• Structure of the Spermatozoa, 555
• Role of the Sertoli and Leydig Cells, 557
• Regulation of Spermatogenesis, 557
• Semen Analysis, 557
• Disorders of Sperm Production, 557
• Applications in Nursing, 557

• Internal Reproductive Organs, 559
• External Female Genitalia, 560
• The Reproductive Life Cycle, 560
• Determinants of Menarche, 560
• Determinants of Menopause, 560
• Applications in Nursing, 561

• The Ovarian Cycle, 563
• The Uterine Cycle, 563
• Cervical and Vaginal Changes During the
• Menstrual Cycle, 563
• Hormonal Changes During the Menstrual
• Cycle, 564
• Tests of Ovulation, 564
• Variations/Disorders of the Menstrual Cycle, 565
• Actions of Oestrogen and Progesterone, 565
• Penile–Vaginal Intercourse, 565
• Methods of Contraception, 566
• Applications in Nursing, 566

• Maternal Changes During Pregnancy, 568
• Structure and Function of the Placenta, 568
• Tests of Pregnancy, 569
• Parturition, 569
• Lactation, 570
• Applications in Nursing, 571