Pages: 22

The physiology of heat production at cellular level, including the dietary sources of heat energy: glucose, fats and proteins. The cellular metabolic processes that create body heat. Blood as a distribution of heat to all parts of the body. The homeostatic control of heat gain and heat loss, the thermoregulatory role of the hypothalamus and the difference between core and peripheral temperatures are explained. The importance of maintaining normal body temperature despite adverse environmental temperatures. The methods of temperature measurement and the dangers of high and low body temperatures, especially in vulnerable children and the elderly are considered in detail. Abnormal body temperatures such as pyrexia, fever, febrile convulsions in the young, heat exhaustion and heat stroke, hypothermia and frostbite are discussed. Antipyretic drugs are explained in detail.

Pages: 19

An overview of the anatomy and physiology of the heart, the chambers and valves identified. The cardiac cycle and blood flow through the heart is described and the two circulations, systemic and pulmonary, are identified. The definition of cardiac output (CO) as stroke volume (SV) multiplied by heart rate (HR) is given as CO=SV x PR. Definition of a pulse is given with sites where and how the pulse can be taken identified, including apex beat and pedal pulses. Electrical activity of the heart involving the conduction system is discussed. Introduction to electrocardiogram (ECG) is given, including sinus rhythm, the QRST complex and cardiac axis. Heart sounds and auscultation are described. Pulses and ECG in children are discussed. Arrhythmic disorders, notably asystole, supraventricular tachycardia, extra systoles, and heart block, are described. Myocardial infarction is defined including ECG changes identified. An introduction to anti-arrhythmic drugs is given.

Pages: 23

The physiology of blood pressure (BP) is reviewed highlighting that blood pressure is equal to cardiac output (CO) multiplied by the peripheral resistance (PR), i.e. (BP=CO x PR). The concept of systolic pressure, i.e. the maximum pressure of the blood leaving the heart during a systole, and diastolic pressure, i.e. the arterial pressure during diastole, is identified. The mean arterial pressure (MAP) and pulse pressure are defined. The vasomotor centre (VMC) in the brain is shown as the control over blood pressure. The normal average blood pressure is stated for the systemic and pulmonary circulations. High blood pressure (hypertension) and low blood pressure (hypotension) are discussed. The original and new methods of measuring blood pressure are reviewed in adults and children. Anti-hypertensive drugs and their mechanism of action are discussed.

Pages: 32

The major functions and components of blood, i.e. blood plasma and cells, are explained, with the various blood cell types; red, white and platelets identified. Blood tests on plasma include proteins, vitamins, fats, cholesterol, chemistry, enzymes, hormones, clotting factors, immunity, blood gases and toxins. Normal test results are stated in both conventional units and standard international (SI) units. Tests for a range of blood chemistry components are discussed, including glucose, iron, ketones, uric acid, cholesterol, and others. Drugs related to lowering cholesterol, i.e. statins, are briefly described. Tests for blood enzymes includes the angiotensin converting enzyme (ACE) and lipase. Hormone tests include cortisol, antidiuretic hormone (ADH), and insulin. Tests for clotting factors are followed by a brief discussion on anticoagulation drugs, notably warfarin and heparin. Blood tests on cells include erythrocytes, leukocytes and thrombocytes. These tests include blood groups (ABO and Rhesus factor) for compatibility, cellular counts, and haemoglobin. The main disorders resulting from abnormal levels of any component, e.g. diabetes with abnormal blood glucose levels, is discussed where relevant.

Pages: 24

The respiratory system is described, involving the upper airway and lungs. The need for oxygen as a mechanism for waste disposal is explained. The gas exchange mechanism in the alveoli is driven by concentration gradients is described. Air volumes in the respiratory tract; i.e. alveolar air, dead space, residual volume, tidal volume, pulmonary ventilation rate (PVR), inspiratory and expiratory reserve volumes and vital capacity are all explained. The mechanism of breathing involving ribs, diaphragm and intercostal muscles is described for the respiratory cycle. Neurological control from the respiratory centres in the brain stem is explored. Lung function tests and spirometry are explained. Blood gas tensions and the oxygen saturation curve are discussed. Abnormalities in breathing are explained: respiratory sounds, cough, stridor, bronchitis, dyspnoea and pneumonia. Childhood breathing and the Apgar score are identified. Drugs affecting respiration, especially bronchodilators, are discussed.

Pages: 14

Water is discussed to emphasise its many qualities and functions in the body. Three water compartments, intracellular, extracellular and blood, are discussed. Osmosis is described as the process of water movement between compartments. Water gain and loss forms the basis of fluid balance. The 24-hour fluid balance chart is described. The mechanism by which the kidneys cope with excessive or inadequate water balance is described. Fluid balance can be disturbed by special circumstances, e.g. nil by mouth, intravenous infusion and excessive vomiting. Central venous pressure (CVP) and fluid balance in children are discussed. The pathophysiology of oedema and dehydration are discussed in detail. Definition of electrolytes is given along with a discussion of the major electrolytes, especially sodium, potassium, chloride and magnesium, and the consequences of their imbalance.

Pages: 20

The concept of neutral energy balance in the body is discussed along with the consequences of positive or negative energy balance, e.g. marasmus. The main dietary components, protein, carbohydrates, fats, vitamins, minerals and fibre are discussed in detail. The role of amino acids, glucose and fatty acids in the body is described. The concept of kwashiorkor, a condition of protein lack with stress, is considered as a possibility for some patients in the hospital setting. Saturated and unsaturated fats are defined with the omega 3 and omega 6 explained. Different sugars, e.g. monosaccharides, disaccharides and polysaccharides are described. Vitamins and minerals are identified in detail, with deficiencies and excesses highlighted. Dietary fibre and nutrition in the young and elderly are discussed. Disorders of nutrition, e.g. anorexia, bulimia and obesity are discussed in detail, with definitions of body mass index (BMI) and basal metabolic rate (BMR). The neurobiology of eating control and the concept of total parental nutrition (TPN) are described.

Pages: 25

The renal system, the structure of the kidney and the nephron are all described along with the physiology of normal urine formation. The urinary system in children is discussed. Urinary observations of volume, colour, smell, deposits and specific gravity, and urine tests for glucose, pH, protein, blood, bilirubin, urobilinogen, ketones, nitrite, leukocytes and vitamin C are all discussed in detail. The conditions of polyurea (diuresis), oliguria, anuria, acute and chronic renal failure are all discussed. Diabetes, in its several forms, is described as a possible consequence of detecting glycosuria and ketonuria. Hypoglycaemia and hyperglycaemia are discussed. Mature onset diabetes of the young (MODY) and latent autoimmune disease in adults (LADA) are discussed. Urine colour, smell and deposits are identified. Midstream urine (MSU) sample, 24-hour urine collection, renal calculi and pregnancy testing are all discussed along with the concept of when to test urine. Drugs active on the urinary system, notably diuretics, are described.

Pages: 17

The anatomy and physiology of digestion is described with the concepts of catabolic enzyme activity and intestinal flora examined. Fibre as a major component of faeces and the physiological mechanism of defecation are discussed. Disorders of digestion, i.e. diverticular disease, inflammatory bowel disease (IBD), Crohn’s disease and ulcerative colitis are explained. Symptoms of digestive conditions, i.e. constipation and the various causes of diarrhoea are described. Blood, mucus and fat in the stools are explained. The different types of laxatives, as a treatment for constipation, are discussed. The reasons and locations of stomas are described, and stoma observations discussed. The physiological mechanism for vomiting is described, including the vomit reflex centres of the brain stem. Causes of vomiting, such as vertigo, Meniere’s disease and the gag reflex are explained. Observations of vomit include any undigested food, blood, bile and faeces present. Drugs that induce vomiting, i.e. emetics, are explained.

Pages: 22

The anatomy of the skin are explored in depth, discussing the epidermis, dermis and hypodermis. Various sensory nerve ends and their functions, the blood supply and different tissue structures involved are described. The functions of skin as a barrier against infection, a heat loss organ (part of temperature homeostasis), as a sensory organ, as an excretory organ and as a producer of vitamin D are discussed. Observations of the skin include variations in colour that indicate a pathology, lesions and rashes and the trauma of wounds and burns. The stages of wound healing, i.e. inflammation, proliferation and maturation, are discussed in detail. Pressure sores: the causes and means of prevention, are discussed. Burns: the causes, pathology, complications, treatment and healing are described. The pathology of major skin diseases are described, including acne, eczema, psoriasis and malignant melanoma,

Pages: 28

The anatomy of the brain involved in consciousness is explored, identifying areas of the cerebral cortex and the subcortical regions that influence consciousness. Neurons and neurotransmitters are described. Brain stem reflexes are discussed. Connectivity of brain areas responsible for maintaining consciousness is introduced. Altered states of consciousness, or states of awareness, are discussed, highlighting the different levels from full consciousness through to coma. Reasons for measuring the state of consciousness and the different method employed to achieve this are discussed. The electroencephalogram and coma scales are introduced, with a detail examination of the Glasgow Coma Scale. The major causes of unconsciousness are discussed, including epilepsy, strokes (cerebrovascular accidents, CVA) and fainting. Head injury is explored in depth, including a review of the meninges and cerebrospinal fluid (CSF), types of head injury, local and general symptoms and raised intracranial pressure. The anaesthetic drugs are discussed.

Pages: 21

The different physiological types of pain, nociception, neuropathic and nociplastic pain, are described. The differences between acute, chronic, inflammatory and intractable pain is given. Pain mediators and pain receptors are identified. The sensory nervous system pain pathways, from source to brain, are described, involving ‘A’ and ‘C’ fibres, the Gate Control Theory, the spinal cord, thalamus and cerebral cortex. Pain observations, signs and symptoms, are described in adults and children. Pain assessment scales are described. A gene directly linked to pain is described. Pain management includes opioid and non-steroidal anti- inflammatory (NSAI) analgesic drugs, adjuvant therapy, the analgesic ladder and surgical interventions. Patient controlled analgesia (PCA) is discussed.

Pages: 19

Anatomy of the eye is explained, including the nerve supply (e.g. cranial nerves) controlling muscles inside and outside the eye, pupil size, the lens (accommodation) and the optic nerve (sensory nerve of vision). The brain pathways from the retina to the visual cortex are also described. Cataracts and glaucoma are discussed. Pupil size and reaction to light are explained as basic eye observations. Abnormalities of the pupil, pin-point pupils and drugs used to dilate the pupils for the purpose of fundoscopy are explained. The pathology of raised intracranial pressure (RIP) as a cause of abnormal pupils is discussed. The neurobiology of visual gaze, saccades, and the pathology of nystagmus, ptosis and papilloedema are all discussed.

Pages: 24

The neurobiology of movement is explained from early development to maturity, including the pyramidal system, motor cortex of the cerebrum and extrapyramidal system. The concept of upper motor neuron and lower motor neurons is discussed. The motor component of cranial nerves is introduced. Muscle tone is described, including the brain areas which control it. The motor functions of the cerebellum are discussed. Reflexes are described. Muscles are discussed including types of muscle; smooth, cardiac and skeletal. Abnormalities of movement are discussed as movement losses and movement excesses. The various paralysis disorders, apraxia, multiple sclerosis (MS) and motor neuron disease is all discussed. Muscle diseases, including muscular dystrophy and myopathies are described. Parkinson disease is explored. Motor excesses, as seen in Huntington disease is described. The immobile patient is discussed with what to observe when caring for an immobile patient.

Pages: 25

The chapter defines and introduces the various terms, such as pharmacology, pharmacodynamics, pharmacotherapeutics and pharmacokinetics. Each are discussed in detail, developing the concepts of bioavailability, half-lives, first-pass metabolism, metabolite, pro-drug and therapeutic window. The way drugs work involves definition of other terms, e.g. ligands, antagonists and agonists, all of which are defined in relation to receptor binding. Drug side effects are discussed in relation to the various body systems, notably the gastro-intestinal system and central nervous system. Antimuscarinic and extra-pyramidal side effects are explored. Common side effects, e.g. skin rashes and vertigo are discussed. Different mechanisms of drug interactions, both pharmacokinetic and pharmacodynamic, are described. Four types of immune responses are described in relation to drug interactions, i.e. types I to IV.

Pages: 10

The stages of pregnancy are defined in terms of trimesters; first second and third. Cardiovascular changes are discussed in relations to the heart and electrocardiogram (ECG), blood volumes, blood pressure and blood clotting factors. Respiratory changes involving oxygen consumption are described. Hormonal changes are discussed in detail including why the unborn child is protected against the maternal immune system. The importance of folate, iodine, vitamin B12, iron, glucose, protein, lipids and calcium in the diet are discussed. Relaxin, endothelin, ET-receptors and renal blood flow are described in detail. Antidiuretic hormone (ADH) changes and the effects of sodium retention during pregnancy are described. Pre-eclampsia and eclampsia are discussed.