iy nig Cee RST A ee ttain your @ Lippincott Williams & Wilkins a Wolters Kluwer businessSTAFF Executive Publisher Judith A. Schilling McCann, es, ess Editorial Director David Moreau Clinical Director Joan M, Robinson, ss ss Art Director Mary Ludwicki Senior Managing Editor Jaime Stockslager Buss, 5 Editorial Project Manager Coleen ME. Stern Clinical Project Manager Beverly Ann Tscheschlog, nx 35, Editors “Margaret Eckman, Diane M. Labus, Gale Thompson Clinical Editor Marcy S. Caplin, Rx. Ms Copy Editors Kimbery Bilotta (supervson), ‘Tom DeZego, Amy Furman, Shana Harrington, Lisa Stockslager, Pamela Wingrod Designer Matie Anne Patterson Digital Composition Services Diane Faluba (manages), Joyce Rossi Biletz, Donna S, Morris Associate Manufacturing Manager Beth J. Welsh Editorial Assistants Megan L. Aldinger, Karen J. Kirk, linda K. Kuht Indexer Karen C. Comerford ‘The linia treatments described and recornmendedin this publication are based on research and consultation ‘with nursing, medica and legl authorities, othe best of our knowledge, these procedures reflect curently ac- cepted practice. Nevertheless, they can’t be corsidered absclute and wniversl recommendations For individ applications, all recemmendations must be corsidered In ight of the patient’ clinical condition and, before ad~ ministration of new or infrequently used drugs in light ‘ofthe latest package-insert information, The authors and publisher disclaim ary responsibilty for ary adverse ‘effects resulting from the suggested procedures, rom ny undetected errors, or from the reader’ misundes standing of the text (© 2007 by Lippincot Willams & Witkin, Al rights re- served. This book is protested by copyright. Nopart of it may be reproduced, stored in a retrieval system, or transmitted n any form or by ny means-—eletrone, ‘mechanical, photocopy, recording, or otherwise—with- cout prior wailten permission ofthe publisher, except for brie! quotations embodied incitical articles ard reviews analtesting and evakation materials provided by pub- lisher to instructors whose schools have adopted itsac- companying textbook. Printed in the United States of “America For information writs Lippincott Willams & Wilkins, 323 Norristown Road, Suite 200, Ambler, PA 19002-2756, STRAGPDILNG Library of Congress Cataloging: in-Publication Data Straght ’s in anatomy end physodogy. pcm. Includes bibiographical references and index. 1. Human piysiciogy—Outines, syllabi, ete 2 Human anatomy—Outlines, lab ete.3. Human physiology—Beaminations questions, et. 4. Human anatomy—Esaminations, questions, et. Nuses— Licenses—Unted States—Examinations—Study guides, [Lippincott Williams & Wilkins, IDNLM: 1. Anatomy-Esamination Questions, 2. Anstomy—Nurses' Instruction. 3, Physislogy—Exari- nation Questions 4. Physiology—Nurses’ Instruction (QS 182 $896 2007} (QP51.$895 2007 61497 rsp ISBNI0 1-58255-562-1 ak. paper) 2006024927eeveaaren a a =6 2 13 4 6 7 Advisory board vi Contributors and consultants vii How to use this hook ix Foreword x Overview of anatomy and physiology 1 Chemical organization 13 Cell organization 26 Tissue organization 41 Genetics 52 Integumentary system 63 Skeletal system 75 Muscular system 100 Nervous system 126 Sensory system 159 Cardiovascular system 182 Respiratory system — 210 Hematologic system 231 Lymphatic system 257 Gastrointestinal system — 279 Urinary system 305 Fluid, electrolyte, and acid-base balance 327 Endocrine system 345 Reproductive system 366 Reproduction and lactation 385 Glossary 410 Selected references 422 Index 423Ivy Alexander, rho, cane Assistant Professor Yale University "New Haven, Conn, Susan E. Appling, nx, ss,cxnr Assistant Professor, Johns Hopkins University School of Nursing Baltimore Paul M. Arnstein, rho, arky-sc, ENC Assistant Professor, Boston College Bobbie Berkowitz, rip, oxaa,rAan (Chair & Professor, Psychosocial &¢ Community Health University of Washington Seattle Karla Jones, av. usw ‘Nursing Faculty, Treasure Valley Community College ‘Ontario, Ore. ‘Manon Lemonde, x, pho Associate Professor, University of Ontario (Oshawa) Institute of Technology Sheila Sparks Ralph, nv, pxsc, ran Director & Professor, Division of Nursing & Respiratory Care Shenandoah University Winchester Va. Kristine Anne Scordo, ny, Pho, cs, acNP Director, Acute Care Nurse Practitioner Program Wright State University Dayton, Ohio Robin Wilkerson, rw.nc. ho Associate Professor, University of Mississippi Jackson(Comtributorsyam| Consultants Rita Bates, rs. ssw ‘Team Leader, Fundamentals of Nursing, ADN University of Arkansas Fort Smith Lynn Cherry, ew, usw Education Specialist Henry Ford Hospital Detroit Kim Cooper, ax, ssn Nursing Department Program Chairperson Ivy Tech Community College Terre Haute, Ind. Lillian Craig, wy, nex, rvr-c Adjunct Faculty ‘Oklahoma Panhandle State University ‘Goodwell Diane J. Lane, ex, sw Instructor, Vocational Nursing Silva Health Magnet High School Paso, Tex. Virginia Lester, wv, ws Assistant Professor in Nursing ‘Angelo State University, San Angelo Tex. Linda Ludwig, ws ns, tea Practical Nursing Instructor Canadian Valley Technology Center E1Reno, Okla William J. Pawlyshyn, es, nsw Ms, my, n.bIV, APRN-BC, ANC Nurse Practitioner ‘Cape Cod Ear, Nose & Throat Specialists Hyannis, Mass.AND CONSULTANTS ‘Maria Elsa Rodriguez, wi Clinical Educator Kindred Hospital San Diego Janis Simpson, wasn, ma, Eds Practical Nursing Coordinator ‘Tennessee Technology Center ‘Athens Betty E. Sims, nx, sow ‘Nurse Consultant ‘Board of Nurse Examiners Austin Tex Kimberly Such-Smith, ay, 5sv,1Nc ‘President, Healtheare Advocate ‘Narsing Analysis & Review, LLC Allison J-Terry, ny, ws, 40 ‘Nurse Consultant ‘Alabama Board of Nursing, ‘Montgomery Copyrighted materialSue is a multivolume study guide series developed especially for nursing students. Each volume provides essential course material in a unique two- column design. The easy-to-read interior outline format offers a succinct review of key facts as presented in leading textbooks on the subject The bulleted exterior columns provide only the most crucial information, allowing for quick, efficent review right before an important quiz or test. Special features appear in every chapter to make information accessible and easy to remember. Learning objectives encourage the student to evaluate knowledge before and after study. The Chapter overview highlights major concepts. The NCLEX®-style questions found in the NCLEX checks atthe end of each chapter offer additional opportunities to review material and assess knowledge gained before ‘moving on to new information. Other features appear throughout the book to facilitate learning, Clinical alerts appear in color to bring the reader's attention to important, potentially life- threatening considerations that could aifect patient care. Time-out for teaching. highlights key areas to address when teaching patients. Go with the flow charts promote critical thinking, Last. Windows-based software program (see CD-ROM ‘on inside back cover) poses more than 250 multiple-choice and alternate-format NCLEX-style questions in random order to assess your knowledge. ‘The Straight As volumes are designed as learning tools, not as primary informa. tion sources. When read conscientiously as a supplement to class attendance and textbook reading, Straight 4's can enhance understanding and help improve test scores and final grades.san experienced family nurse practitioner who has taught prelicensure regis tered nursing students and graduate nursing students, I'm always appreciative ‘of texts that provide a straightforward review of complex material. Stucents often dontt keep their textbooks from anatomy and physiology and, therefore, have no ba is on which to conduct a teview. In addition, tests are scarce that contain anatomy ‘and physiology material that’s succinct yet detailed and, most importantly, that are reader friendly. That’s why Straight A's in Anatomy & Physiology is a must have for your reference shelf ‘This review text not only presents the basic concepts of anatomy and physiology but azo reviews each body system in an innovative format that makes the learning process easy. Each chapter begins with clearly stated learning objectives and a chap ter overview that summarizes the topics featured within. The book's unique two column design presents a simple-to-follow outline in the main text along with on ‘outer column highlighting key points, so students can retrieve important facts light ning fast and study more efficiently for an exam. Perhaps most important to prelicensure registered nursing students are the NCLEX-style questions, including alternate-format types, at the end of each chapter, ‘which provide the comect ansvrers and rationales for correct and incorrect answer choices. In addition to the 200 end-of chapter questions, students can continue to test themselves with the more than 250 NCLEX-style questions on the CD-ROM in the back of the book. Straight A in Anatomy & Physiology isn’t just for prelicensure registered nursing students, i's also useful for any registered nurse or advanced practice nurse who ‘wishes to review anatomy and physiology. Even more-experienced clinicians will find that the lear diagrams and succinct, bulleted information are a quick-and-2asy ‘way to brush up on their knowledge of anatomy and physiology. And once you learn the Straight 4's way, you'll reach for other books in the series when it's time to study! Nancy M. George, PhD, APRN, BC Assistant Professor (Clinical) ‘Wayne State University College of Nursing Detoitaa You have either reached a page that is unavailable for viewing or reached your viewing limit for this book.6 OVERVIEW OF ANATOMY AND PHYSIOLOGY ‘Types of anatomy # Gross: studies structures vi to the eye ‘ Regional: studies limited regions of the body ‘* Developmental: studies struc- tural changes occurring aver time © Microanatomy: studies struc- tures using a microscope * Applied: applies anatomic find- ings to medical diagnosis and treatment * Pathologic: studies diseased or injured tissue ible ‘Types of physiology Cell: studies cell functions ‘ Systems: studies operation of ‘organ systems Pathophysiology: studies changes caused by disease or aging # Exercise: studies cell and organ function during activity '* Neurophysiology: studies nerve cell functions ‘© Endocrinology: studies effects of hormones on body functions Immunology: studies body's de- fense mechanisms @ Anatomy + Anatomy: study of the body's structure and the relationship of its arts . Faas several subdivisions that address specific aspects of struc- ture ~ Gross anatomy (macroscopic anatomy) is the study of anatomic structures visible to the unaided eye ~ Regional anatomy is the study of limited portions or regions of the body, such as the head and neck ~ Developmental anatomy is the study of structural changes from conception through old age ~ Microanatomy (microscopic anatomy) is the study of anatomic structures using a microscope ~ Applied anatomy is the application of anatomic findings to the diagnosis and treatment of medical disorders ~ Pathologic anatomy (morbid anatomy) is the study of abnormal, diseased, or injured tissue @ Physiology + Physiology: study of how body parts function, including their chemical and physical processes + Includes several subdivisions that address specific aspects of func- tion ~ Cell physiology is the study of cell functions ~ Systems physiology is the study of organ system operation — Pathophysiology is the study of functional changes caused by disease and aging ~ Exercise physiology is the study of cell and organ functions dur- ing skeletal muscle activity — Neurophysiology is the study of nerve cell functions ~ Endocrinology is the study of the effects of hormones on body functions ~ Immunology is the study of the body’s defense mechanisms * Can also be subdivided according to the function of specific struc~ tures ~ Cardiovascular physiology is the study of the heart and blood vessels ~ Respiratory physiology is the study of air passageways and lungs ~ Renal physiology is the study of kidneys = Reproductive physiology is the study of reproductive structures + Also covers complementarity, or how the functions of a body part reflect (complement) its structure; for example, the structure of the heart valves controls the direction of blood flow through the heartBODY ORGANIZATION AND FUNCTION eo @ Anatomic and directional terms « Used by clinicians and throughout health science fields to describe Koy cnatomsdo tereer exact location of body structures; terms are derived mainly from s:Atsiinoa poskion: bea wee Greek or Latin facing forward, arms at sides + Anatomical position: position of the body when erect and facing for- and palms forward ward, with arms at the sides and palms turned forward * Superior: toward the head e Inferior: toward lower part of the body © Antorior: toward the front ‘* Superior (cranial): toward the head + Inferior (caudal): toward the tail or lower part of the body + Anterior (ventral): toward the front of the body eee tread te ack » Posterior (dorsal): toward the back of the body ‘¢ Medial: toward the midiine + Medial: toward the midline of the body « Lateral: away from the midline + Lateral: away from the midline of the body Proximal: closest to the trunk + Proximal: closest to the trunk, point of origin of a part, or center of Distal: farthest from the trunk the body ‘© Superficial toward or at the Distal farthest from th f origin of : Paes + Distal farthest from the trunk, point of origin of a part, or center oF i Dees tarts none boo the body surface + Superficial: toward or at the body surface + Deep: farthest from the body surface @ Body reference planes ; | Key body reference + Imaginary lines that divide the body and its organs into sections pes + Used to describe the body's structural plan and the anatomic rela- a s ® Sagittal: right and left regions tionship of its parts ¢ Frontal: anterior and posterior + Includes three major body reference planes— sagittal, frontal, and regions transverse —which lie at right angles to one another (see Body ¢ Transverse: superior and inferior reference planes, page 4) regions 3 ~ Sagittal plane runs longitudinally (lengthwise), dividing the ie Objique: slanted; between hors nto right and left regions zontal and longitudinal planes + Called the median sagittal plane or midsagittal plane when exactly midline + Called the parasagittal plane when not exactly midline — Frontal plane (coronal plane) runs longitudinally but at a right angle to the sagittal plane, dividing the body into anterior and posterior regions ~ Transverse plane runs horizontally at a right angle to the vertical axis, dividing the body into superior and inferior regions + Also includes the oblique plane, which is slanted and lies between horizontal and longitudinal planes PITS RTT a © Structural organization + Characteristic of the body and all its parts + Each higher level is increasingly more complex than the previous level@o OVERVIEW OF ANATOMY AND PHYSIOLOGY Body reference planes Body reference planes are directional terms used to locate body structures This illustration shows the median sagittal, rontal, and transverse planes, which le atright ancles to one another. — Chemical level includes the atoms and molecules needed to pay acts aoe ‘maintain life oe eee = Cellular level consists of cells—the body's basic structural and ‘© Chemical level: most basic level; functional unit Consists of atoms and molecules _Etyetalilebed ~Tissue level combines similar cells and surrounding substances and functions; consists of cells into groups that work together ie Tite level colls end ecco ~ Organ level organizes different kinds of tissues — usually in ing eubstances work together recognizable shapes—to perform a special function © Organ level: diferent tissues ~ Systems level consists of different kinds of organs arranged to Beare ont neces ceed peter complex tmcions ar comncane CRS ~ Organismic level (highest level) brings together all lower level ‘© Organismic level: highest level structures into a functioning, living being + Changes gradually ~ Structures typically grow and develop until young adulthood ~ After young adulthood, body structures typically age and atrophyaa You have either reached a page that is unavailable for viewing or reached your viewing limit for this book.@6 OVERVIEW OF Key structures of the mediastinum ‘* Hoart and ite large vessels Trachea + Esophagus © Thymus e Lymph nodes ‘© Other vessels and nerves Key abdominal regions ‘© Umbilical (navel) ‘© Epigastric (stomach) ‘¢ Hypogastric (pubic region) ‘Inguinal Gliac regions) ‘* Lumbar (Join regions) ‘¢ Hypochondriac (lateral to epi- gastric) ANATOMY AND PHYSIOLOGY + Divided into thoracic and abdominopelvic cavities - Thoracic cavity is superior to the abdominopelvic cavity (separated by the diaphragm, a large dome-shaped mus- cle), surrounded by the ribs and chest muscles, and divid- ed into the pleural cavities and mediastinum ~ Tivo lateral pleural cavities each contain a lung (serosa in these cavities is called the pleura) + Mediastinum contains the heart (enclosed in a mem- branous serosal sac called the pericardium, which forms the pericardial cavity), large vessels of the heart, tra- chea, esophagus, thymus, lymph nodes, and portions of other vessels and nerves ~ Aldomiinopelvic cavity is subdivided into the superior por tion (abdominal cavity) and inferior portion (pelvic cavi- ty), which aren't separated by muscle or membrane (Serosa in these cavities is called the peritoneum) Abdominal cavity contains the stomach, spleen, liver, small intestine, most of the large intestine, and other organs + Pelvic cavity contains the bladder, some of the large in- testine, some reproductive organs, and the rectum + Also includes other cavities: oral, nasal, orbital, tympanic, and syn- ovial — Oral cavity (mouth) contains the teeth and tongue and is con- tinuous with other GI structures — Nasal cavity (nose) is divided medially and is continuous with the respiratory tract — Orbital cavities house the eyes ~ Tympanic cavities (temporal bone) contain the auditory ossicles (small bones of the middle ear) ~ Synovial cavities are enclosed within fibrous capsules that sur- round freely movable joints @ Body regions + Specific areas of the body with a particular nerve, vascular supply, or special function + Used to describe the anatomic locations of body structures, + Abdominal regions are most widely used body region terms (see ‘Abdominal regions) — Umbilical region (navel) surrounds the umbilicus; prominent structures include sections of the small and large intestines, in ferior vena cava, and abdominal aorta — Epigastric region (stomach) is superior to the umbilical region; prominent structures include the pancreas and portions of the stomach, liver, inferior vena cava, abdominal aorta, and duode- num