Introduction
Nursing is a profession that continually evolves to meet the ever-changing demands of modern healthcare. As a result, the education of student nurses must also evolve so that registrants are equipped to deal with the challenges of being a qualified nurse.
The Nursing and Midwifery Council (NMC) regulates nurses and midwives in the UK, and nursing associates in England. The role of the NMC is to protect the public. To that end, all student nurses enrolled on a programme leading to registration with the NMC have to complete a programme of study informed by the NMC Standards for pre-registration nursing programmes (2018b). According to Article 5 (2) of the Nursing and Midwifery Order (2001) (legislation.gov.uk, 2002), the NMC must identify standards of proficiency required to enter the register. These standards of proficiency are grouped together under seven platforms and two annexes.
The platforms are:
1 Being an accountable professional
2 Promoting health and preventing ill health
3 Assessing needs and planning care
4 Providing and evaluating care
5 Leading and managing nursing care and working in teams
6 Improving safety and quality of care
7 Coordinating care.
(NMC, 2018b, page 6)
Annexe A focuses on communication and relationship management while Annexe B identifies nursing skills and procedures required of a nurse at the point of registration (NMC, 2018b).
The NMC recognises that nurses require a
comprehensive knowledge of the sciences on which general nursing is based, including sufficient understanding of the structure, physiological functions and behaviour of healthy and sick persons, and of the relationship between the state of health and the physical and social environment of the human being.
(NMC, 2018b, page 50)
It is not enough to learn how to undertake tasks by rote. Nurses must be able to understand what is happening within the body so that when a patient develops a high temperature during a blood transfusion (Chapter 9) or a person with asthma becomes breathless when exposed to pollen (Chapter 4), for example, they can make an informed decision on the appropriate action to take. In short, unless we understand what is ‘normal’, we can never truly understand how the disease process affects our minds and bodies, and without this understanding, we cannot deliver appropriate care.
We have specifically written this book to ensure that its readers have the requisite underpinning knowledge and understanding of anatomy and physiology to equip them to assess, plan and deliver safe and effective nursing care. Within each chapter, you will find case studies and activities to encourage you to test and apply your newfound knowledge in relation to ‘real-world’ situations. We have mapped each chapter against the relevant platforms and the procedures in Annexe B to ensure that you have the required knowledge and understanding of anatomy and physiology to meet the NMC Standards for pre-registration nursing programmes (2018a) and achieve proficiency in these standards; see Table 0.1.
Table 0.1
We are confident that you will find this book invaluable as you navigate your way through your nursing degree. One you have qualified as a nurse, this book will continue to provide a useful source of reference as you develop your nursing skills even further on the journey from being a novice to an expert (Benner, 1984).
We sincerely hope you enjoy reading this book and wish you every success in your nursing career.
John Knight
Yamni Nigam
Jayne Cutter
Chapter 1 Cellular physiology and histology
Chapter aims
After reading this chapter, you will be able to:
describe the structure of a typical human cell;
describe the movement of materials into and out of cells;
explain how cells can be used to screen for disease;
provide a description of the major types of human tissue;
explain the difference between eukaryotic and prokaryotic cells.
Introduction
Case study: Josie – breast cancer
Josie was showering when she noticed a small but hard lump in her right breast. Josie was quickly referred to the local breast screening clinic for further investigation where ultrasound sonography revealed a dense mass around the size of a large garden pea. The consultant immediately recommended a needle biopsy which was carried out the same day under local anaesthetic. The tissue collected was sent for histological examination and a week later Josie was diagnosed with breast cancer and her treatment options were discussed.
The collection of a tissue sample from a patient is termed a biopsy. There are many types of biopsy ranging from the collection of a peripheral blood sample from a finger prick to a more invasive needle or surgical biopsy. As we have seen in Josie’s case, study biopsies may be carried out to look for characteristic tissue changes that may be indicative of diseases such as cancer. Biopsies can also be used to check for infection or to monitor a variety of biochemical parameters in patients.
An average adult body is thought to be constructed from around 50 trillion (50 million million) cells, the majority of which have a finite lifespan, and are continually being replaced as they die. This means that most of the tissues and organs of the human body are not static but in a continual state of flux as senescent, aged cells are replaced.
This chapter will begin by examining the internal structure of a human cell. We will explore how deoxyribonucleic acid (DNA) is organised in the nucleus and the nature of human chromosomes and their use in screening for genetic disease. The individual components of the cytoplasm and structure of the plasma (cell) membrane will be described and mechanisms of transporting materials into and out of cells explored. Once you have a good grasp of cell structure, we will examine how cells are organised into the tissues which are used to construct the human body. Since microbes greatly outnumber human cells, we will examine the nature of bacterial cells which are found colonising the body as part of the microbial biome. To reinforce the key points we will explore the use of cells in detecting disease and examine how certain drugs can target specific cell types to treat disease.
Regions of a cell
Human cells are traditionally split into three distinct regions: the nucleus, the cytoplasm and the plasma (cell) membrane (Figure 1.1).