Anatomy and Physiology

Anatomy (from the Greek ἀνατομία anatomia, from ἀνατέμνειν ana: separate, apart from, and temnein, to cut up, cut open) is a branch of biology and medicine that is the consideration of the structure of living things. It is a general term that includes human anatomy, animal anatomy (zootomy) and plant anatomy (phytotomy). In some of its facets anatomy is closely related to embryology, comparative anatomy and comparative embryology,  through common roots in evolution.

Anatomy is subdivided into gross anatomy (or macroscopic anatomy) and microscopic anatomy. Gross anatomy (also called topographical anatomy, regional anatomy, or anthropotomy) is the study of  anatomical structures that can be seen by unaided vision with the naked eye. Microscopic anatomy is the study of minute anatomical structures assisted with microscopes, which includes histology (the study of the organization of tissues), and cytology (the study of cells).

The history of anatomy has been characterized, over time, by a continually developing understanding of the functions of organs and structures in the body. Methods have also improved dramatically, advancing from examination of animals through dissection of cadavers (dead human bodies) to technologically complex techniques developed in the 20th century including X-ray, ultrasound, and MRI imaging.

Anatomy should not be confused with anatomical pathology (also called morbid anatomy or histopathology), which is the study of the gross and microscopic appearances of diseased organs.

Physiology is the science of the function of living systems. It is a subcategory of biology. In physiology, the scientific method is applied to determine how organisms, organ systems, organs, cells and biomolecules carry out the chemical or physical function that they have in a living system. The word physiology is from Ancient Greek: φύσις, physis, "nature, origin"; and -λογία, -logia, "study of".

Human physiology is the science of the mechanical, physical, and biochemical functions of humans in good health, their organs, and the cells of which they are composed. The principal level of focus of physiology is at the level of organs and systems within systems. Much of the foundation of knowledge in human physiology was provided by animal experimentation. Physiology is closely related to anatomy; anatomy is the study of form, and physiology is the study of function. Due to the frequent connection between form and function physiology and anatomy are intrinsically linked and are studied in tandem as part of a medical curriculum.

Psychosocial

Psychosocial refers to one's psychological development in and interaction with a social environment. The individual is not necessarily fully aware of this relationship with his or her environment. It was first commonly used by psychologist Erik Erikson in his stages of social development. Contrasted with social psychology, which attempts to explain social patterns within the individual. It is usually used in the context of "psychosocial intervention," which is commonly used alongside psychoeducational or psychopharmacological interventions and points toward solutions for individual challenges in interacting with an element of the social environment.

Problems that occur in one's psychosocial functioning can be referred to as "psychosocial dysfunction" or "psychosocial morbidity." This refers to the lack of development or atrophy of the psychosocial self, often occurring alongside other dysfunctions that may be physical, emotional, or cognitive in nature.

Psychosocial support is an approach to victims of disaster, catastrophe or violence to foster resilience of communities and individuals. It aims at easing resumption of normal life, facilitate affected people participation to their convalescence and preventing pathological consequences of potentially traumatic situations.

Psychosocial Network is a network of practitioners of psychosocial work and serves the information sharing need of diverse people in the psychosocial field - ranging from grassroots practitioners to UN policy-makers.

Psychological trauma is a type of damage to the psyche that occurs as a result of a traumatic event. When that trauma leads to posttraumatic stress disorder, damage may involve physical changes inside the brain and to brain chemistry, which damage the person's ability to adequately cope with stress.

A traumatic event involves a single experience, or an enduring or repeating event or events, that completely overwhelm the individual's ability to cope or integrate the ideas and emotions involved with that experience. The sense of being overwhelmed can be delayed by weeks, years or even decades, as the person struggles to cope with the immediate circumstances. Psychological trauma can lead to serious long-term negative consequences that are often overlooked even by mental health professionals: "If clinicians fail to look through a trauma lens and to conceptualize client problems as related possibly to current or past trauma, they may fail to see that trauma victims, young and old, organize much of their lives around repetitive patterns of reliving and warding off traumatic memories, reminders, and affects.

Trauma can be caused by a wide variety of events, but there are a few common aspects. There is frequently a violation of the person's familiar ideas about the world and of their human rights, putting the person in a state of extreme confusion and insecurity. This is also seen when people or institutions, depended on for survival, violate or betray or disillusion the person in some unforeseen way.

Psychological trauma may accompany physical trauma or exist independently of it. Typical causes and dangers of psychological trauma are sexual abuse, bullying, domestic violence, the victim of alcoholism, the threat of either, or the witnessing of either, particularly in childhood. Catastrophic events such as earthquakes and volcanic eruptions, war or other mass violence can also cause psychological trauma. Long-term exposure to situations such as extreme poverty or milder forms of abuse, such as verbal abuse, can be traumatic (though verbal abuse can also potentially be traumatic as a single event).

However, different people will react differently to similar events. One person may experience an event as traumatic while another person would not suffer trauma as a result of the same event. In other words, not all people who experience a potentially traumatic event will actually become psychologically traumatized.

Some theories suggest childhood trauma can lead to violent behavior. Some ideas believe such violent behavior can be as extreme as serial murder. For example, Hickey's Trauma-Control Model which suggests "childhood trauma for serial murderers may serve as a triggering mechanism resulting in an individual’s inability to cope with the stress of certain events.

Acute Nursing

Critical care nursing is the field of nursing with a focus on the utmost care of the critically ill or unstable patients. Critical care nurses can be found working in a wide variety of environments and specialties, such as emergency departments and the intensive care units. An acute care nurse practitioner (ACNP) provides advanced nursing care to patients suffering brief but severe illnesses, typically in an emergency department, ambulatory care clinic or other short term stay facility. ACNPs diagnose and treat acute medical conditions, working in collaboration with the physician and other members of the health care team.

The ACNP profession is one of the more fast-paced nursing career choices, and it is loaded with responsibility and variety. This also makes it one of the most challenging and rewarding nursing careers you can choose. In the thriving field of nursing, especially with the increased pressure in emergency rooms and other acute health care settings, the need for ACNPs is enormous.

Training and education

Most critical care nurses in the U.S. are registered nurses. Due to the unstable nature of the patient population the LPN/LVN's are rarely utilized in a primary care role in the intensive care unit. However, with proper training and experience LPN/LVN's can play a significant role in providing exceptional bedside care for the critically ill patient.

Nurses in the US who wish to obtain certification in critical care nursing can do so through a national advisory board, known as the American Association of Critical Care Nurses. This advisory board sets and maintains standards for critical care nurses. The certification offered by this board is known as CCRN. This does not stand for 'Critical Care Registered Nurse' as is popularly believed, but is merely a certification as a critical care nurse for adult, pediatric and neonatal populations.

Registration is a regulatory term for the process that occurs between the individual nurse and the state in which the nurse practices. All nurses in the US are registered as nurses without a specialty. The CCRN is an example of a post registration specialty certification in critical care.

There are also variants of critical care certification test that the AACN offers to allow nurses to certify in progressive care (PCCN), cardiac medicine (CMC) and cardiac surgery (CSC). In addition, Clinical Nurse Specialists can certify in adult, neonatal and pediatric acute and critical care (CCNS). In November, 2007, the AACN Certification Corporation launched the ACNPC, an advanced practice certification examination for Acute Care Nurse Practitioners. None of these certifications confer any additional practice privileges, as nursing practice is regulated by the individual's state board of nursing. These certifications are not required to work in an intensive care unit, but are encouraged by employers, as the tests for these certifications tend to be difficult to pass and require an extensive knowledge of both pathophysiology and critical care medical and nursing practices. The certification, while difficult to obtain, is looked upon by many in the field as demonstrating expertise in the field of critical care nursing, and demonstrating the individual's nurse's desire to advance their knowledge base and skill set, thereby allowing them to better care for their patients.

Intensive care nurses are also required to be comfortable with a wide variety of technology and its uses in the critical care setting. This technology includes such equipment as hemodynamic and cardiac monitoring systems, mechanical ventilator therapy, intra-aortic balloon pumps (IABP), ventricular assist devices (LVAD and RVAD), continuous renal replacement equipment (CRRT/CVVHDF),extracorporeal membrane oxygenation circuits (ECMO) and many other advanced life support devices. The training for the use of this equipment is provided through a network of in-hospital in-services, manufacturer training, and many hours of education time with experienced operators. Annual continuing education is required by most states in the U.S. and by many employers to ensure that all skills are kept up to date. Many intensive care unit management teams will send their nurses to conferences to ensure that the staff is kept up to the current state of this rapidly changing technology.

 

Employment areas

Critical care nurses work in a variety of different areas, with a diverse patient population. There are many critical care nurses working in hospitals in intensive care units, post-operative care and high dependency units. They also work on medical evacuation and transport teams.

In August 2004, to demonstrate the work of critical care nurses Massachusetts General Hospital invited reporter Scott Allen and photographer Michelle McDonald from The Boston Globe to take part in an 'immersion experience' in the Surgical Intensive Care Unit (SICU). The Globe staffers spent eight months shadowing an experienced nurse and a trainee nurse to learn about nursing practice first hand. The result was a four part, front-page series that ran from October 23–-October 26, 2005, entitled Critical Care: The making of an ICU nurse.

 

Subspecialities

Subspecialities of critical care nursing include such areas as Neonatal Intensive Care (also called Nursery ICU), Pediatric Intensive Care (or PICU), and Adult Intensive Care (or ICU). The patient population of these units is generally based on the age of the patient.

The Neonatal ICU has a patient population that primarily consists of newborn and premature infants. The NICU will care for patients up to about one month old, based on gestational age, at which point care will generally be assumed by the Pediatric Intensive Care unit.

The Pediatric Intensive Care unit will generally care for patients of about one month to eighteen years. After eighteen years, most patients will be admitted to an Adult Intensive Care Unit.

These are general guidelines, but all admissions to the intensive care unit are made on a case by case basis. For example, a newborn that was admitted from the Emergency Department will most likely be admitted to PICU, and not to the NICU. A seventeen year old, 235 lb patient may be admitted to the Adult Intensive Care unit. Rarely, adult patients with congenital heart defects will be admitted to the PICU, as their physicians have been treating them since they were children and are familiar with their cardiac defects and treatment plan; however this depends on the skill mix and ability of critical care nurses

Further specialties of care can be found based on the disorder, disease or primary injury of the patient population. For example, a unit that is an Adult Intensive care unit, specialized in the care of trauma patients would be an Adult Trauma Intensive Care Unit. The focus of the unit is generally on either an adult or a pediatric/neonatal population, as the treatment methods differ for the age ranges.

Mental Health Nursing

Mental health nursing or Psychiatric nursing  is the specialty of nursing that cares for people of all ages with mental illness or mental distress, such as schizophrenia, bipolar disorder, psychosis, depression or dementia. Nurses in this area receive more training in psychological therapies, building a therapeutic alliance, dealing with challenging behavior, and the administration of psychiatric medication.

Therapeutic Relationship Aspects of Psychiatric Nursing

The most important duty of a psychiatric nurse is to maintain a positive therapeutic relationship with patients in a clinical setting. The fundamental elements of mental health care revolve around the interpersonal relations and interactions established between professionals and clients. Caring for people with mental illnesses demands an intensified presence and strong a desire to be supportive. Nurse Practioners, Fiona Dziopa, BPsyc, BSN, RN, and Kathy Ahern, Ph.D., RN, have identified nine critical mental health aspects of the psychiatric nursing practicum. These nine aspects include: understanding and empathy, individuality, providing support, being there/being available, being 'genuine', promoting equality, demonstrating respect, demonstrating clear boundaries, and demonstrating self awareness for the patient.

Understanding and Empathy

Understanding and empathy from psychiatric nurses reinforces a positive psychological balance for patients. Conveying an understanding is important because it provides patients with a sense of importance. The expression of thoughts and feelings should be encouraged without blaming, judging or belittling.  Feeling important is significant to the lives of people who live in a structured society, who often stigmatize the mentally ill because of their disorder.  Empowering patients with feelings of importance will bring them closer to the normality they had before the onset of their disorder. When subjected to fierce personal attacks, the psychiatric nurse retained the desire and ability to understand the patient. The ability to quickly empathize with unfortunate situations proves essential. Involvedness is also required when patients expect nursing staff to understand even when they are unable to express their needs verbally.  When a psychiatric nurse gains understanding of the patient, the chances of improving overall treatment greatly increases.

Individuality

Individualized care becomes important when nurses need to get to know the patient. To obtain this knowledge the psychiatric nurse must see patients as individual people with lives beyond their mental illness. Seeing people as individuals with lives beyond their mental illness is imperative in making patients feel valued and respected  In order to accept the patient as an individual, the psychiatric nurse must not be controlled by his or her own values, or by ideas and pre-understanding of mental health patients.  Individual needs of patients are met by bending the rules of standard interventions and assessment. Psychiatric/mental health nurses spoke of the potential to 'bend the rules', which required an interpretation of the unit rules and the ability to evaluate the risks associated with bending them.

Providing Support

Successful therapeutic relationships between nurses and patients need to have positive support. Different methods of providing patients with support include many active responses.  Minor activities such as shopping, reading the newspaper together, or taking lunch/dinner breaks with patients can improve the quality of support provided. Physical support may also be used and is manifested through the use of touch.  Patients described feelings of connection when the psychiatric nurses hugged them or put a hand on their shoulder.  Psychiatric/mental health nurses in Berg and Hallberg's study described an element of a working relationship as comforting through holding a patient's hand.  Patients with depression described relief when the psychiatric nurse embraced them. Physical touch is intended to comfort and console patients who are willing to embrace these sensations and share mutual feelings with the psychiatric nurses.

Being There and Being Available

In order to make patients feel more comfortable, the patient care providers make themselves more approachable, therefore more readily open to multiple levels of personal connections. Such personal connections have the ability to uplift patients’ spirits and secure confidentiality. Utilization of the quality of time spent with the patient proves to be beneficial. By being available for a proper amount of time, patients open up and disclose personal stories, which enable psychiatric/mental health nurses to understand the meaning behind each story. The outcome results in nurses making every effort to attaining a non-biased point of view.  A combination of being there and being available allows empirical connections to quell any negative feelings within patients

Geriatric Nursing

Geriatric nursing is the specialty that concerns itself with the provision of nursing services to geriatric or aged individuals. This page tries to outline the state of art guidelines for geriatric care that are useful to a nurse practitioner and clinical nurse specialist who encounters aging person in practice. Due to their complexity, aged people always deserve personal attention. Nurses address physical, psycho social, cultural and family concerns as well as promoting health and emphasizing successful aging.

Life expectancy is rising at rates which call for the proper preparation of nurses to take good care of the rapidly increasing number of the aged.

It is important to distinguish changes involved with normal aging from changes attributable to pathophysiology. Alterations in the structure and function of multiple body system may affect an older person appearance, mobility and ability to fight off infections. Geriatric medications need to be managed so as to avoid too much use of medicine since this group receives a lot of medication if poor care is taken. Multiple medications can cause a variety of drug interaction in older people. Primary drug reaction occurs when one drug causes one side effect, secondary drug reaction occurs when one medication reacts with another. This is brought about by polypharmacy. Old people should be treated in ways that are of benefit and do no harm or as little harm as possible. Principle of assessment: data regarding biomedical, functional, psychological and social issues are obtained to help in planning and implementation of individual health care.

Pressure injuries

A pressure ulcer is a lesion caused by unrelieved external pressure resulting from occlusion of the blood flow, tissue ischemia and cell death. Pressure ulcers are often viewed as a complication of an acute or chronic illness. The presence of ulcers may also be evidence of poor nursing care. Although pressure ulceration can be prevented, it may also occur despite optimal nursing care and advanced technologies. In order to provide effective nursing care for the older adult with pressure ulcers, the nurse must approach patient care within a holistic frame work. This framework should include an integration of good assessment, use of research-based intervention and methodical intervention of patience outcomes. Some specific issues of prevention, assessment and treatment of adult with pressure ulcers are aging skin: The older people have an aged skin and due to exposure to the sun the skin wrinkles, epidermis thins, blood vessels recede, dermal-epidermal ridges flatten and the skin appears thin and fragile. The age related changes may lead to ulceration. The skin which is the largest organ can help in viewing the overall functioning of the entire body. All clinicians working with older people at risk for, or suffering from pressure ulcers must be mindful of these varying relationships in using the cutaneous "window" of person to plan and implement individualized, comprehensive care.

Ulcers have different stages. Stage one ulcers are characterized by non-blancherble erythema of intact skin. It is important to note that stage one pressure ulcers are difficult to identify in darkly pigmented people and are usually indicated by discoloration, warmth, endyma, indurations and hardness. Stage two ulcers are partial lesions extending into the epidermis and the dermis. Stage three ulcers are defined as the full thickness skin loss. Stage four is characterized by extensive tissue damage which extends to the muscle, bone or the underlying structures.

Through a holistic assessment and evaluation a nurse can build a plan of care for those patients who suffer from pressure injury. When treating an ulcer wound treatment should focus on wound healing. For a chronic, non healing ulcer, comfort should be a top priority. For pressure injury careful positioning padding to reduce the risk of pressure ulceration is critical. Wound healing occurs only if the patience is physiologically able to provide needed substrate; wound cleanliness, moist and infection free and the cause of injury is removed. For older people it takes longer to heal and so extra care should be taken. When customary interventions fail to heal a pressure ulcer, surgical intervention may be the best option.

Cardiovascular disease

This is a disease that affects the heart and the blood vessels. The disease is caused by disruption in the blood circulation secondary to decreased vessel, patently (constriction, spasm and occlusion). Cardiovascular disease is common in 50% of the population over the age of 65, and accounts for 40% of deaths in this group. Because of the changes associated with normal aging and some of the unique aspects of reporting and presenting in old adults, underestimation of the seriousness, cardiac disease often occurs. This can lead to misdiagnosis, under treatment, and even death. There is different kind of heart disease: Atherosclerosis and arteriosclerosis. Arteriosclerosis is a disease of the arteries, characterized by abnormal thickening and hardening of vessel walls, it also leads to atherosclerosis. Due to advance in age the disease easily finds its way to old people and so it should be carefully diagnosed and proper treatment given. When diagnosing look out for cases of fainting, continuous chest pain, nausea, shortness of breath, rapid heart rate, rapid weight gain, pain in the abdomen, swelling of legs among others. Then address the issue of hypertension, high blood cholesterol, diabetes, obesity and overweight, smoking, hereditary issues. Treatment includes medication and physical exercises.

Respiratory issues

The following age related changes may occur in the respiratory system of an old person: diminished muscle strength in the diaphragm and thorax, stiffer chest wall, decreased elastic recoil, decreased elasticity in the alveoli reduced surface area, with diminished capacity for gas exchange, decreased vital capacity, and drier mucous membrane leading to more difficulty in mucous excretion. Tests should be carried out by doing x-ray coupled with physical examination. The following are possible diseases in old people; bronchitis, asthma, pneumonia, tuberculosis, and chronic obstructive pulmonary disease. Some of this disease leads to cardiovascular disease due to effect on the lungs by air pollution. Nurse should draw a plan for treatment which includes working with other specialties like heart experts.

Paediatric Nursing

Paediatric Nursing is a nursing journal which publishes original research and clinical articles relevant to the practice of paediatric nursing. The journal was established in 1989. It is published by RCN Publishing. It is abstracted and indexed in CINAHL, MEDLINE, Scopus, ProQuest, EBSCO databases, and Thomson.

Child health nursing or pediatric nursing is an area of nursing and medical practice with a focus on providing holistic care to infants, children and adolescents. It differs from pediatrics, in that the emphasis in pediatrics is ill-health and the alleviation of symptoms or disease. There are different places Pediatric nurses can work, one is they can work in a pediatric ward at a hospital, and others choose to work in a pediatric doctors office.

One of the major principles of pediatric nursing is the concept of family centered care. Pediatric nurses function to support the family by providing nursing care that the family cannot perform, educating and supporting them to maintain their normal caring activities and actively viewing the parents as partners in the care process.

Ensuring children's health is critical not only for reducing child morbidity and mortality, but also for increasing the likelihood of a healthier adult life. The primary goal of child health services, however, is to prevent the major causes of death, difficulties, and disease during childhood: accidental injuries, infections, education problems, and behavioral problems.

Child health services address environmental risks, problems related to low family income, sociopsychological stress, and traditional medical services. Early detection and treatment of disease and disability requires screening, counseling, and, for high-risk populations, interventions. For children from birth to age ten, screening includes measurements of height and weight, blood pressure, hearing, and vision. Counseling, or anticipatory guidance, relates to injury prevention, diet and exercise, substance use, and dental health. Immunizations for children generally include diphtheria-tetanus-pertussis (DTaP), oral poliovirus, measles-mumps-rubella, H. influenza type B, hepatitis B, and vermicelli. Interventions for high-risk populations are dependent on the population, but range from HIV (human immunodeficiency virus) testing for infants of mothers at risk for HIV to hepatitis A vaccine for children traveling to developing countries.

For children older than age ten, additional screening recommendations include a Pap smear and Chlamydia screening for sexually active females and assessment of problem drinking for all adolescents. Counseling with this age group covers sexual behaviors, smoking, drinking, and other drug use. Immunizations should include a tetanus-diphtheria booster for those aged eleven to sixteen. Hepatitus B and varicella vaccines should be given to those who did not receive them at earlier ages. High-risk populations include those who engage in high-risk sexual behavior or drug use and those with certain medical conditions. Interventions specific to each of these populations are needed.

The U.S. government's Healthy People 2010 objectives provide guidance to those planning for or providing child health services. Central among these is access to care. Unfortunately, certain economic, educational, racial, and ethnic factors, as well as disability status, affect such access. To be of benefit, health care must not only be available, it must also be accessible in an ongoing and routine fashion. The American Academy of Pediatrics recommends six well-child visits during infancy. An additional three such visits are recommended during a child's second year, annual visits are recommended through age six, and visits every other year through the remainder of childhood. Access to care is essential in order to accomplish the screening and preventive care previously noted, as well as to ensure that children receive treatment for both acute and chronic illnesses.

In addition to access to care, Healthy People 2010 address levels and severity of child health-related issues and conditions. Pediatric asthma and diabetes; accidents, violence, and suicide; mental health; tobacco use; and nutrition and physical activity are areas in which little or no improvement has been seen. Equally important aspects of child health include dental exams and oral health; school nursing and health education; environmental hazards (particularly lead); food-borne pathogens; sexuality; alcohol and other drug use; and vision and hearing.