Title Advanced Physiology and Pathophysiology
Subtitle Essentials for Clinical Practice
Author Nancy C. Tkacs, Linda L. Herrmann , Randall L. Johnson
ISBN 9780826177070
List price USD 99.00
Price outside India Available on Request
Original price
Binding Paperback
No of pages 840
Book size 216 x 279 mm
Publishing year 2021
Original publisher Springer Publishing Company
Published in India by .
Exclusive distributors .
Sales territory Bangladesh, India, Pakistan, Sri Lanka
Status New Arrival
About the book Send Enquiry


Specifically designed for future healthcare providers who will diagnose, manage, and prescribe

This advanced physiology and pathophysiology text is designed to address the specific learning needs of future nurse practitioners, physician assistants, and other advanced healthcare providers caring for patients across the lifespan. Focusing on practical applications of physiology, it facilitates in-depth understanding of important pathophysiological concepts as they relate to major disorders commonly seen in clinical practice and includes comprehensive pediatric and geriatric considerations. This knowledge is crucial to providing the foundation required to be an informed and confident clinical decision maker.

The author team includes experienced clinicians and educators: nurses and nurse practitioners, physician assistants, doctors of pharmacy, physicians, and basic scientists. This collaboration has produced a text that carefully details and richly illustrates the cellular structure and function of each organ system and mechanisms of associated major clinical disorders. Uniquely interweaving aspects of organ function during healthy states with disease-associated changes, the text emphasizes and extends the basic science foundation to practical clinical applications. The text promotes a deep understanding of cellular function in health and disease that provides the bedrock knowledge required to master pharmacology for prescriptive practice. Equally important, the solid foundation of applied pathophysiological mechanisms offered in this text prepares the student clinician to care for patients with a broad variety of disorders. This resource not only provides a deep dive into pathophysiology, but it also examines why patients often present with particular symptoms, the rationale for ordering specific diagnostic tests and interpretation of results, and common management strategies that proceed from the underlying pathophysiology.

Key Features:

  • Designed explicitly to build a foundation for pharmacology and clinical courses that lead to successful clinical practice and prescribing
  • Includes comprehensive lifespan considerations with key insights from specialists in pediatric and geriatric pathophysiology
  • Provides a complete chapter on the basic principles of genetics and genomics with coverage of genetic variations, assessment, and genomics woven throughout the book
  • Integrates thought questions and case studies to promote discussion and synthesis of information
  • Offers a unique Bridge to Clinical Practice in each chapter to translate science to patient care
  • Includes more than 500 images to illustrate complex scientific concepts
  • Summarizes the contents succinctly with handy key points at the end of each chapter




Case Studies

Foreword by Linda S. Costanzo, PhD



Case Study Contributors


How to Use This Book

Instructor Resources


Chapter 1. The Foundational Concepts of Clinical Practice (Nancy C. Tkacs, Linda L. Herrmann, Randall L. Johnson, and Loretta A. Sernekos) • Pathophysiology and the Process of Clinical Decision-Making • Building From a Basic Science Foundation: Chapters 2 To 4 • Chemistry (Chapter 2) • Biochemistry (Chapter 2) • Molecular Biology and Genetics (Chapter 3) • Cell Biology (Chapter 4) • Advanced Physiology and Pathophysiology: Chapters 5 to 17 • Infectious Disease (Chapter 5) • The Immune System and Leukocyte Function (Chapter 6) • Neoplasia (Chapter 7) • Blood and Clotting (Chapter 8) • Circulation (Chapter 9) • Heart (Chapter 10) • Lungs (Chapter 11) • Kidneys (Chapter 12) • Gastrointestinal Tract (Chapter 13) • Liver (Chapter 14) • Nervous System (Chapter 15) • Musculoskeletal System (Chapter 16) • Endocrine System (Chapter 17) • CONNECTING THE DOTS • Pathophysiology and the Independent Clinician • References


Chapter 2. Chemical and Biochemical Foundations (Gioia Petrighi Polidari) • The Clinical Context • Chemical Foundations of Life • Atomic Structure • The Periodic Table and Families of Elements • Electron Shells and Chemical Reactivity • Thought Questions 1–3 • Ion Formation and Roles in the Body • Acids And Bases • Covalent Bond Structure And Formation • Thought Questions 4 and 5 • Chemical Patterns In Physiology And Pathophysiology • Nonpolar versus Polar Covalent Bonds • Molecular Geometry • Molecular Properties of Water • Hydrogen Bonding and Aqueous Solutions of Polar Molecules and Ions • Hydrophobicity and Hydrophilicity • Thought Questions 6 and 7 • Organic Chemistry Foundations • Carbon-Based Molecules • Major Organic Functional Groups • Major Biochemical Reaction Types • Biomolecules Build From Small To Large • Carbohydrates • Carbohydrate Molecular Formulas • Hydrophillic Nature of Carbohydrates • Function of Carbohydrates • Thought Questions 8 and 9 • Lipids • Types of Lipids • Structure and Function of Lipids • Fatty acids and derivatives • Eicosanoids • Cholesterol and derivatives • Lipoproteins • Thought Questions 10–12 • Amino Acids and Proteins • Amino Acid Structures and Organic Functional Groups • Amino Acid Classes and Their Properties • Nonpolar amino acids • Uncharged polar amino adds • Acidic amino acids • Basic amino acids • Uncharged polar amino acids with a hydroxyl group • Specific Amino Acid Functions • Peptide Bond Formation • Protein Folding • Protein Functions • Thought Questions 13-16 • Nucleotides and Nucleic Acids • Structure of Bases, Nucleosides, and Nucleotides • Individual Nucleotide Contributions to Cell Energy Transfers and Cell Signaling • Structural and Functional Aspects of RNA and DNA • The Principle of Complementary Base-Pairing • Thought Questions 17 and 18 • Conclusion: Phenylketonuria Revisited • Key Points • References • Suggested Resource


Chapter 3. Molecular Biology, Genetics, and Genetic Diseases (Sheila A. Alexander and Michael J. Groves) • The Clinical Context • Information Transmission within Cells and Between Cell and Human Generations • DNA Structure • Molecular Biology of the Cell and DNA Replication • The Cell Cycle • Mitosis • Meiosis • DNA Replication • Exonucleolytic proofreading • RNA Function and Protein Synthesis • Transcription • Post-transcriptional processing • Regulation of Transcription • Translation • The genetic code and reading frame Û The ribosome Translation processes Post- translation processing • Thought Questions 1 and 2 • Concepts In Genetics And Genomics • Chromosome Terminology • Gene Terminology • Gene Variations • Single Nucleotide Polymorphisms • Point Mutations in Coding Regions • Deletion or insertion Mutations • Fromeshift Mutations • Trinucleotide Repeats and Other Copy Number Variants • Copy number variants • Inheritance: Mendelian and Non-Mendelian • Autosomal dominant disorders • Autosomal recessive disorders • Non-Mendelian inheritance • X-linked dominant inheritance • linked recessive inheritance • Mitochondrial inheritance • Phenotypic Variability in Genetic Disorders: Penetrance and Expressivity • Penetrance • Expressivity • Examples of Single Gene and Multifactorial Diseases • Madan syndrome • Hereditary breast and ovarian cancer • Coronary artery disease • Major depressive disorder • Thought Questions 3–5 • Technical Approaches in Genetics and Genomics • Family History and Pedigree Analysis • Obtaining the History • Genetic Red Flags • Karyotyping • Hybridization Arrays and Gene Chips • Whole Genome Sequencing • Research Approaches • Genome-Wide Association Studies • Candidate Gene Association Studies • Direct-to-Consumer Testing • Epigenetics • Thought Questions 6 and 7 • Pediatric Considerations (Theresa Kyle) • Prenatal Identification of Genetic Disorders • Genetic Disorders Identified After Birth • Key Points • References • Suggested Resources


Chapter 4. Cell Physiology and Pathophysiology (Nancy C. Tkacs, Fruzsina K. Johnson, Robert A. Johnson, and Spencer A. Rhodes) • The Clinical Context • Overview • Cell Components • Cell Membrane • Cytoplasm • Nucleus • Ribosomes and Rough Endoplasmic Reticulum • Smooth Endoplasmic Reticulum • Golgi Apparatus • Mitochondria • Lysosomes • Peroxisomes • Cytoskeleton • Mechanisms Of Membrane Transport • Diffusion • Endocytosis and Exocytosis • Endocytosis • Exocytosis • Facilitated Diffusion • Active Transport • Primary Active Transport • Secondary Active Transport • Aquaporins • Ion Channels • Thought Questions 1–3 • Mechanisms of Cell Signaling • Overview of Signal Transduction • Autonomic Nervous System and Signaling by G Protein–Coupled Receptors • G Protein–Coupled Receptors Linked to Adenylyl Cyclase • G Protein–Coupled Receptors Linked to Phospholipase C • G Protein GTPase Activity is a Timing Mechanism • Cell Signaling by Cyclic Guanosine Monophosphate • Cell Signaling by Enzyme-Linked Receptors • Cell Signaling by Cytoplasmic and Nuclear Receptors • Summary of Cell Signaling • Thought Questions 4–6 • Mechanisms of Contractile Cells • Overview of Contractile Cell Structure and Function • The Sarcomere of Skeletal and Cardiac Muscle • Mechanism of Myofibril Crossbridge Formation and Contraction • Comparison of Skeletal Muscle Fibers and Cardiac Muscle Cells • Mechanisms of Smooth Muscle Contraction • Summary of Muscle Cell Function • Thought Questions 7 and 8 • Cell Renewal, Stress, and Cell Death • Overview of Cell Renewal, Maintenance, and Adaptation • Overview of Cell Injury and Death • Tissue Responses to Acute, Severe Ischemia—Necrotic Cell Death • Apoptotic Cell Death • Autophagy • Thought Questions 9 and 10 • Gerontological Considerations (Lori St. John) • Cellular Theories of Aging • Nine Hallmarks of Aging • Frailty • Thought Questions 11 and 12 • Key Points • References • Suggested Resources


Chapter 5. Infectious Disease (Ross S. Johnson, Jennifer Bailey, and Roseann Velez) • The Clinical Context • Overview of Infectious Disease Pathophysiology • Human–Microbe Interactions • Mechanisms of Protection from Pathogens • Portals of Pathogen Entry and Targets of Colonization • Pathogen Virulence Factors • Host Response Factors • Thought Questions 1–3 • Microbial Pathogenicity • Overview • Characteristics of Pathogen Classes • Bacteria • Viruses • Fungi and Yeasts • Protozoa • Thought Questions 4 and 5 • Clinical Concepts in Infectious Disease • Methods of Pathogen Identification • Direct Observation • Culture-Based Methods • Antigen Identification • Molecular Methods • Drug-Resistant Pathogens • Antimicrobial Stewardship • Thought Question 6 • Pathogenesis of Selected Microbes • Streptococcus pyogenes • Methicillin-Resistant Staphylococcus aureus • Mycobacterium tuberculosis • Chlamydia trachomatis • Neisseria gonorrhoeae • Clostridioides difficile • Borrelia burgdorferi • Influenza Virus • Human Immunodeficiency Virus • Plasmodium Species • Thought Question 7 • Pediatric Considerations (Lara Roettger) • Norovirus • Measles, Mumps, and Rubella • Gerontological Considerations (Elizabeth Walsh, Candace Kastner, and Alyssa Bondy) • Community-Acquired Pneumonia • Varicella-Zoster Virus • HIV • Case Study 5.1 A Patient With Acute HIV Infection (Sampath Wijesinghe) • Case Study 5.2 A Child With Hand, Foot, and Mouth Disease (Stephanie L. Carper) • Bridge to Clinical Practice (Ben Cocchiaro) • KEY POINTS • References • Suggested Resources


Chapter 6. The Immune System and Leukocyte Function (Jo Kirman and Raffaela Ghittoni) • The Clinical Context • Role of the Immune System • Introduction to Host Defensess • Overview of Physical and Chemical Barriers • Overview of the Innate Immune Response • Overview of the Adaptive Immune Response • Thought Questions 1 and 2 • Functional Anatomy of the Immune System • Hematopoiesis • Cells and Tissues of the Immune System • B Cells Develop in the Bone Marrow • T Cells Develop in the Thymus • B Cells and T Cells Circulate Through the Lymphatic System • The Spleen • Gut-Associated Lymphoid Tissue • Thought Questions 3 and 4 • Innate Immunity • Acute Inflammation • Innate Immune Cells • Neutrophils • Basophils, Mast Cells, and Eosinophils • Monocytes and Macrophages • Dendritic Cells • Opsonization and Phogocytosis • Innate Lymphoid Cells • Activation of the Innate Inflammatory Response • Recognition of Pathogens and Tissue Damage • Sequence of Inflammation and Inflammatory Mediators • Resolving an Inflammatory Response • The Complement Pathway • Innate Responses to Viral Infection • Chronic Inflammation • Trained Innate Immunity • Transition from Innate to Adaptive Immunity: Antigen Presentation and the Major Histocompatibility Complex • Thought Questions 5–9 • Adaptive Immunity • B Cells are Responsible for Humoral Immunity • Antibody Structure • Antibody Classes • Steps in B-Cell Activation and Maturation • B-Cell Memory • Antibody Production • Clinical Applications of AntIbodies • Thought Questions 10 and 11 • T-Cell Functions • Major Histocompatibility Complex Restriction • CD4 T-Cell Responses • T Helper Subsets • CD8 T-Cell Responses • Unconvention T Cells: yd T Cells, Mucosal-Associated Invariant T; and Invariant Natural Killer T Cells • T CelI Memory • Pathogen–Host Immune Evasion Mechanisms • Vaccination • Hypersensitivity • Type 1: Immediate Hypersensitivity • Type 2: Antibody-Mediated Hypersensitivity • Type 3: Immune Complex-Mediated Hypersensitivity • Type 4 (Delayed): T-Cell-Mediated Hypersensitivity • Autoimmunity • Immunodeficiency • Thought Questions 12–14 • Immune Responses across the Life Span • Pediatric Considerations (Jane Tobias) • Type 1 Hypersensitivity in Children and Adolescents • Atopic Dermatitis • Food Allergies • Gerontological Considerations (Nancy C. Tkacs) • Immune Cellular Senescence and Disease • Inflammaging • Case Study 6.1 A Patient With Allergic Rhinitis (Linda W. Good) • Bridge to Clinical Practice (Ben Cocchiaro) • Key Points • References • Suggested Resources


Chapter 7. Neoplasia (Kolbrun (Kolla) Kristjansdottir, Thomas M. Bodenstine, and Sandhya Noronha) • The Clinical Context • Overview of Cancer Pathophysiology • The Cell Cycle • Interphase • M-Phase (Mitotic Phase) • Exit and Reentry of the Cell Cycle • Control of the Cell Cycle • Checkpoints • Thought Questions 1 and 2 • Properties of Neoplasms • Tumor Terminology • Thought Questions 3 and 4 • Characteristics of a Cancer Cell • Proto-Oncogenes,Oncogenes, and Tumor Suppressor Genes • Uncontrolled Proliferative Signaling • Evading Growth Suppressors • Genomic Instability • Enabling Replicative Immortality • Resisting Cell Death • Promotion of Angiogenesis • Invasive and Metastatic Ability • Recently Identified Cancer Cell Characteristics • Evasion of Immune Destruction • Cancer Cell Metabolic Alterations • Thought Questions 5–7 • Clinical Aspects of Neoplasia • Pathophysiology of Cancer Manifestations and Treatment Sequelae • Biological Aspects of Gene Mutations and Cancer Risk Factors • Viral Causes of Cancer • Thought Questions 8–10 • Genotyping in Cancer Diagnosis and Treatment • Thought Questions 11 and 12 • Pediatric Considerations (Theresa kyle) • Overview of Pediatric Cancer • Leukemias • Bone Tumors • Nervous System Tumors • Gerontological Considerations (Rita M. Jakubowski and Janet H. Van Cleave) • Physiological Processes of Aging that May Promote Cancer Development • Aging and Cancer: Practice Implications • Case Study 7.1 A Patient With Breast Cancer
(Beth Boyer) • Bridge to Clinical Practice (Ben Cocchiaro) • Key Points • References • Suggested Resources


Chapter 8. Blood and Clotting (Allison Rusga, Megan E. Schneider, Daniela Livingston, and Patrick C. Auth) • The Clinical Context • Overview of Blood and Clotting • Red Blood Cells • Erythropoiesis • Thought Questions 1 and 2 • Hemoglobin • Genetic Hemoglobinopathies • Iron • Vitamin B12 and Folate • Thought Questions 3 and 4 • General Concepts in Anemia • Iron-Deficiency Anemia (Microcytic Anemia) • Vitamin B12 Deficiency Anemia (Macrocytic Anemia) • Anemia of Chronic Inflammation • Anemia in Chronic Kidney Disease • Hemolytic Anemia • Glucose-66-Phosphate Deficiency • Autoimmune Hemolytic Anemia • Thought Questions 5 and 6 • Hemostasis • Platelet Structure and Function • Modulation of Clotting and Anticlotting by Products of Arachidonic Acid Metabolism • Thought Questions 7 and 8 • Coagulation Cascade • Laboratory Assessment of Clotting • Control of the Clotting Process • Endothelial Influences on Clotting • Plasmin and the Fibrinolytic Process • Cessation of Clotting Activity • Modulation of Clotting Activity by Anticoagulant Drugs • Thought Questions 9 and 10 • Thromboembolic States • Specific Disorders of Hypercoagulation • Factor V Leiden and Other Genetic Disorders • Antiphospholipid Syndrome • States Of Excess Bleeding • Thrombocytopenia • von Willebrand Disease • Coagulation Cascade–Associated Disorders • Hemophilia A • Cirrhosis-Related Coagulation Dysfunction • Thought Questions 11 and 12 • Pediatric Considerations (Stephanie L. Carper) • Developmental Changes in Red Blood Cell Measures • Iron-Deficiency Anemia • Hyperbilirubinemia • Sickle Cell Disease • Von Willebrand Disease • Gerontological Considerations (Linda L. Herrman) • Anemia • Changes in Bone Marrow • Hypercoagulability • Medication Effects on Blood and Clotting • Case Study 8.1 A Patient With Pernicious Anemia (Allison Rusgo) • Case Study 8.2 A Patient With Deep Venous Thrombosis (Allison Rusgo and Michelle Zappas) • Bridge to Clinical Practice (Ben Cocchiaro) • Key Points • References • Suggested Resources


Chapter 9. Circulation (Fruzsina K. Johnson, Robert A. Johnson, and Spencer A. Rhodes) • The Clinical Context • Overview Of Circulatory Structure and Function • Homeostatic Functions of the Circulatory System • Organizing Principles of the Circulatory System • The Pulmonary Circulation • The Systemic Circulation • Structure and Properties of Blood Vessels • General Structure of Blood Vessels • Comparative Structure of Blood Vessels • Properties and Disorders of Large Arteries • Overview of Large Artery Structure and Function • Biophysics of Vascular Wall Tension (Law of Laplace) • Vascular hypertrophy • Vascular aneurysm • Biophysics of Vascular Compliance • Biophysics of Blood Flow Velocity and Shear Stress • Atherosclerosis: The Most Common Disease of Large Arteries • Overview of Atherosclerosis • Stages of Atherosclerosis Development • Fate of Atherosclerotic Plaques • Stages of plaque growth and vessel narrowing • Plaque growth and aneurysm formation • Risk Factors for Atherosclerosis • Endothelial Vulnerability and Risk Factors Contributing to Atherosclerotic Plaque Development • Endothelial vulnerability • Dyslipidemia: Altered blood lipoprotein levels • Hypertension • Smoking • Diabetes mellitus • Interactions among risk factors • Inflammation • Genetics of familial hypercholesterolemia • Risk reduction • Atherosclerotic Peripheral Arterial Disease • Thought Questions 1–3 • Properties and Disorders of Arterioles • Overview of Arteriole Structure and Function • Biophysical Determinants of Blood Pressure • Determinants of Vascular Resistance • Distribution of Vascular Resistance in the Systemic Circulation • Biophysical Determinants of Blood Pressure • Determinants of Vascular Resistance • Distribution of Vascular Resistance in the Systemic Osculation • Thought Questions 4 and 5 • Regulation of Blood Pressure • Over view of Blood Pressure Control • Maintenance of Vascular Smooth Muscle Tone: Intrinsic, Neural and Local Mechanisms • The cellular basis of vascular smooth muscle control • Vascular autoregulation • Extrinsic vascular regulation • Neural and endocrine mediators that regulate vascular smooth muscle contraction and arteriolar resistance • Local mechanisms of vascular smooth muscle control • Integration of Mediators Regulating Peripheral Resistance • Baroreflexes and Circulatory Control • Long-Term Blood Pressure Control by Hormones That Control Blood Volume and Vascular Tone • Thought Questions 6–8 • Pathophysiology of Elevated Vascular Resistance: Hypertension • Definition and Causes of Hypertension • Hypertension Damages Several Organs • Management of Hypertension • Pathophysiology of Decreased Blood Pressure and Peripheral Resistance: Shock • Definition of Shock • Common Shock Progression • Compensated shock • Decompensated shock • Irreversible shock and circulatory collapse • Forms of Shock • Hypovolemic shock • Distributive shock • Cardiogenic shock • Obstructive shock • Management of Shock • Thought Questions 9–11 • Properties And Disorders of Capillaries • Overview of Capillary Structure and Function • Principles Governing Capillary Fluid Exchange • Lymphatics • Principles Governing Capillary Fluid Movement and Edema Formation • Thought Question 12 • Properties And Disorders Of Veins • Overview of Venous Structure and Function, and Vulnerability to Pressure Elevations • Venous Disorders • Varicose Veins • Deep Venous Thrombosis • Thought Questions 13 and 14 • Pediatric Considerations (Randall L. Johnson) • Embryological Development of the Circulatory System • Blood Pressure and Pediatric Hypertension • Gerontological Considerations (Susan Krekun and Linda L. Herrmann) • Vascular Changes with Aging • Aging-Associated Vascular Disorders • Case Study 9.1 A Patient With Hypertension (David A. Roberts and Michelle Zappas) • Case Study 9.2 A Patient With Edema (David A. Roberts and Michelle Zappas) • Bridge to Clinical Practice (Ben Cocchiaro) • Key Points • References • Suggested Resources


Chapter 10. Heart (Fruzsina K. Johnson, Robert A. Johnson, and Spencer A. Rhodes) • The Clinical Context • Overview of Cardiovascular Structure and Function • Homeostatic Functions of the Heart • Structural Organization of the Heart • Cardiac Chambers and Valves • Membranes Protecting the Heart • Structure of the Heart Wall • Overview of Myocardial Cell Structure • Myocardial Oxygen Supply and Demand • Cardiac Electrophysiology and Pathophysiology • Myocardial Cell Ion Channels and Transporters • Structure of the Cardiac Conduction System • Cardiac Cell Action Potentials • Refractory Periods in Contractile Cardiac Muscle Cells • Supranormal Period in Contractile Cardiac Muscle Cells Supranormal Period in Contractile Cardiac Muscle Cells • Slow-Response Action Potentials in Pacemaker Cardiac Muscle Cells • Thought Questions 1 and 2 • Functional Aspects of Cardiac Action Potentials • Slope of Phase 4 Depolarization In the SA Node Cells Regulates Heart Rate • Pharmacctogical slowing of the heart rate by HCN inhibition • Cardiac Action Potentials Determine Conduction Speed in the Heart • AV node conduction slows action potential propagation to the ventricles • Alterations of fast-response action potentials can also influence action potential corduction • L-Type Ca2+ Channels Play Multiple Roles In Cardiovascular Function • Thought Question 3 • The ECG: Record of Cardiac Electrical Activity • Disorders of Cardiac Electrical Activity (Arrhythmias or Dysrhythmias) • General Mechanisms ol Arrhythmlos • Altered impulse formation: Native and latent pacemakers, escape rhythms • Ectopic pacermakers triggered activity, and premature beats • Conduction blocks and reentry • Bradyarrhythmias • Sinus bradycardia and escape rhythms • AVconduction blocks • tachyarrhythmias • Supraventricular versus ventricular tachycardias • Atrial Fibrillation • Definition • Mechanisms of atrial fibrillation • Functional consequences of atrial fibrillation • Ventricular Arrhythmias • Genetic Disorders Associated With Arrhythmias • Brugada syndrome • Long QT syndromes • Thought Questions 4 and 5 • Cardiac Performance Physiology • Cardiac Muscle • Histology • Parameters of Cardiac Function • Excitation-Contraction Coupling • Contractility, Preload, and Afterload: Determinants of Pump Function and Stroke Volume • Sympathetic activity increases force of contraction and rate of relaxation • Increase in preload increases stroke volume • Increased contractility augments preload effects on performance • Digitalis increases cardiac contractility by increasing intracellular calcium • Increased afterload reduces stroke volume • Summary: Determinants of Cardiac Output • Thought Questions 6-8 • Cardiac Cycle • Viewing the Cardiac Cycle Using Pressure-Volume Loops • Thought Question 9 • Coronary Blood Flow and Ischemic Heart Disease • Cardiac Vasculature • Coronary Arteries • Coronary Veins • Cardiac Oxygen Supply and Demand • Determinants of Cardiac Oxygen Supply • Determinants of Cardiac Oxygen Demand • Coronary Artery Disease • Acute Coronary Syndromes • Non-ST-Elevation Myocardial Infarction and Unstable Angina • ST-Elevation Myocardial Infarction • Patterns of Ischemk Heart Disease in Women • Sequeloe Associated with Myocardial Infarctions • Thought Questions 10 and 11 • Heart Failure • Left-Sided Heart Failure • Left Ventricular Failure With Reduced Ejection Fraction • Heart Failure Stimulates Neurohormonol Compensation • Left-Sided Heart Failure Effect on Lung Vascular Volumes and Pressures • Left Ventricular Failure With Preserved Ejection Fraction • Right-Sided Heart Failure • Management of Heart Failure • Thought Questions 12 and 13 • Structural Cardiac Disorders • Normal Structure of the Heart and Cardiac Valves • Valve Diseases • Types of Cardiac Murmurs • Aortic Valve Dysfunction • Aortic stenosis • Aortic Regurgitation • Mitral Valve Dysfunction • Mitral stenosis • Mitral regurgitation • Mitral valve prolapse • Cardiomyopathies • Hypertrophic Cardiomyopathy • Pediatric Considerations (Fruzsina K. Johnson, Robert A. Johnson, Spencer A. Rhodes, and Mary B. Mehta) • Normal Cardiac Development • Principles of Developmental Cardiac Anomalies • Gerontological Considerations (Susan Krekun) • Age-Related Changes in Cardiac Structure • Age-Related Changes in Cardiac Function • Summary of Age-Related Cardiac Changes • Case Study 10.1 A Patient With Heart Failure Symptoms (Lisa Rathman) • Case Study 10.2 A Patient With Angina (David A. Roberts) • Case Study 10.3 A Patient With Atrial Fibrillation (Linda W. Good) • Bridge To Clinical Practice (Ben Cocchiano) • Key Points • References • Suggested Resources


Chapter 11. Lungs (Nancy C. Tkacs, Charrell S. Porter, and Nicholas A. Barker) • The Clinical Context • Overview Of Lung Structure And Function • Structures of the Respiratory System • Mechanisms of Respiration • Anatomy and Histology of Airways and Alveoli • Mechanisms of Lung Protection • Cystic Fibrosis: A Genetic Disorder that Compromises Lung Protection • Lung Volumes and Capacities • Lung–Chest Wall Interactions • Plueral Effusion • Thought Questions 1–3 • Compliance Of The Lungs And Chest Wall In Health And Disease • Surfactant and Lung Compliance • Diseases of Decreased Lung Compliance • Idiopathic Pulmonary Fibrosis • Chest Wall Compliance • Thought Question 4 • Airway Resistance • Overview of Airway Resistance • Forced Expiratory Maneuvers are Used to Assess Airway Resistance • Airway Resistance • Concepts in Obstructive Lung Disease • Asthma • Chronic Obstructive Pulmonary Disease • Obstructive Sleep Apnea • Thought Questions 5–7 • Gas Exchange in the Lungs • Overview of Gas Exchange • Oxygen–Hemoglobin Dissociation Curve • Effects of partial pressure of arbon dioxide and pH • Effects of 2,3-diphoshogycerate • Effects of temperature • Hypoxia and Hypoxemia • Generalized Hypoventilation • Ventilation/Perfusion (V/O) Mismatch • Shunt • Diffusion Limitation • Thought Questions 8 and 9 • Lung Vascular Considerations • Cardiac Consequences of Pulmonary Disease • Pulmonary Embolism • Pulmonary Edema • Pulmonary Hypertension • Thought Questions 10 and 11 • Pediatric Considerations (Randall L. Johnson) • Lung Development • Respiratory Problems Associated with Preterm Birth • Lung Concerns in Infancy • Childhood Asthma • Gerontological Considerations (Ingrid Deming and Alison Fife) • Pneumonia • Chronic Obstructive Pulmonary Disease (Chronic Bronchitis and Emphysema) • CASE STUDY 11.1 A Child With Asthma (Stephanie L. Carper) • Case Study 11.2 A Patient With Chronic Bronchitis (Linda W. Good) • Bridge To Clinical Practice (Ben Cocchiano) • Key Points • References • Suggested Resources


Chapter 12. Kidneys (Connie B. Scanga and Nancy C. Tkacs) • The Clinical Context • Overview of Kidney Structure and Function • The Kidney and Homeostasis • Water: The Solvent of Body Fluids • Distribution of Fluids in the body • Water Movement Between Fluid Compartments • Overview of Body Fluid Compartments • Kidney Structure • Nephron Structure • Glomerular Function • Glomerular Vascular • Structure and Glomerular, Filtration Barriers • Peritubular Capillary Reabsorption and Secretion • Understanding Renal Clearance and Glomerular Filtration Rote • Thought Questions 1 and 2 • Glomerular Injuries • Glomerular Injury by Immune Mechanisms • Diabetic Nephropathy • Hypertensive Nephropathy • Thought Questions 3 and 4 • Regulation Of Renal Blood Flow And Glomerular Filtration Rate • Autoregulation of Renal Blood Flow • Extrinsic Regulation of RBF and GFR • Importance of eGFR as the Indicator of Renal Function • Factors Reducing RBF and GFR in Disease States • Thought Questions 5 and 6 • Structure And Function Of The Renal Tubule • Tubular Transport Overview • Segmental Tubular Processing • Proximal Tubule • Loop of Henle • Distal Tubule • Late Distal Tubule and Collecting Duct • Thought Questions 7 and 8 • Regional Kidney Function • Corticomedullary Osmolarity Gradient • Production of Concentrated Urine and Homeostatic Regulation of Urine Composition and Osmolarity • Concepts In Fluid, Electrolyte, And Acid–Base Balance • Renal Compensation in States of Hypovolemia and Hypotension • Renal Compensation in States of Hypervolemia and Hypertension • Thought Question 9 • Acute Kidney Injury–Chronic Kidney Disease Continuum • Assessment of Kidney Function • Mechanisms and Manifestations of Acute Kidney Injury • Kidney Stones • Thought Question 10 • Mechanisms and Manifestations of Chronic Kidney Disease • End-Stage Renal Disease • Thought Questions 11–13 • APOL1 and CKD Progression • Pediatric Considerations • Urinary System Development • Pediatric Disorders of Urinary Tract and Kidneys • Gerontological Considerations (Ryan Prince) • Age-Related Changes in the Kidney • Clinical Considerations in Older Adults • Summary of Age-Related Concerns • Case Study 12.1 A Patient With Chronic Kidney Disease (Kim Zuber and Jane S. Davis) • Case Study 12.2 A Patient With a Kidney Stone (Kim Zuber and Jane S. Davis) • Bridge to Clinical Practice (Ben Cocchiano) • Key Points • References • Suggested Resources


Chapter 13. Gastrointestinal Tract (Wilson Crone) • The Clinical Context • Overview of Gastrointestinal Structure and Function • Alimentary Canal Structure and Motor Activity • Neural, Humoral, and Immune Regulation of Gastrointestinal Function • Gastrointestinal Innervation • Gastrointestinal Hormones and Mediaton Modulate Gastrointestinal Function • Gastrointestinal Amine Neurotransmitters and Mediators • Gastrointestinal Immunology • Thought Questions 1–3 • Properties and Disorders of Digestive Tract Organs • Mouth • Salivary Glands • Esophagus • Disorders of the Esophagus • Esophageal obstruction • Esophageal varices • Esophagitis and gastroesophageal reflux disease • Esophageal cancer • Stomach • Disorders of the Stomach • Peptic ulcers • Gastroparesis • Vomiting • Thought Questions 4 and 5 • Small and Large Intestines • Pancreas • Acute pancreatitis • Digestion and Absorption • Overview of Macronutrient Digestion and Absorption • Thought Questions 6 and 7 • Principles of Micronutrient Absorption • Principles of Fluid and Electrolyte Absorption • Immune-Related Gastrointestinal Disorders • Celiac Disease • Inflammatory Bowel Disease • Abdominal Pain Patterns • Irritable Bowel Syndrome • Hemorrhoids • Intestinal Failure and Short Bowel Syndrome • Thought Questions 8 and 9 • Malnutrition and Obesity • Lynch Syndrome • Pediatric Considerations (Randall L. Johnson) • Gastrointestinal Development and Function in Childhood • Gastroenteritis • Gastroesophageal Reflux • Hypertrophic Pyloric Stenosis • Intussusception • Hirschsprung Disease • Gerontological Considerations (Rosanna Reda) • Age-Related Changes of the Gastrointestinal Tract • Age-Associated Alterations in Mastication • Dysphagia • Gastroesophageal Reflux Disease in Older Adults • Altered Digestion • Peptic Ulcer Disease • Constipation • Diverticular Disease • Case Study 13.1 A Patient With Peptic Ulcer Disease (Amanda Chaney and Michelle Zappas) • Case Study 13.2 A Teenage Boy With Celiac Disease (Amanda Chaney and Michelle Zappas) • Bridge To Clinical Practice (Ben Cocchiano) • KEY POINTS • References • Suggested Resources


Chapter 14. Liver (Jennifer Andes, Adam Diamond, Kimberly A. Miller, Nicole E. Omecene, and Dusty Lisi) • The Clinical Context • Overview of Liver Structure and Function • Liver Structure • Liver cells • Thought Questions 1 and 2 • Liver Function • Energy Metabolism • Synthetic Processes of the Liver • Thought Questions 3 and 4 • Liver Clearance Mechanisms • Metabolism of bilirubin • Hormone and drug (xenobiotics) metabolism • Thought Question 5 • Other Functions of the Liver • Reticuloendothelial System • Vitamin and mineral storage • Regenerative capacity • Liver Disorders • Measures of Liver Function and Dysfunction • Acute Liver Disorders • Acute Liver Toxicity and Failure • Acute Cholestasis • Viral Hepatitis • Hepatitis A • Hepatitis B • Hepatits C • Thought Questions 6 and 7 • Chronic Liver Disorders • Alcoholic Liver Disease • Nonalcoholic Fatty Liver Disease • Thought Questions 8 and 9 • Hereditary Hemochromatosis • Pediatric Considerations (Mariah Morris and Nicole E. Omercene) • Fetal and Childhood Liver Development • Hyperbilirubinemia • Other Liver Disorders Presenting in Children • Nonalcoholic Fatty Liver Disease • Gerontological Considerations (Heather Givans) • Aging and Hepatitis C • Alcoholic Liver Disease • Nonalcoholic Fatty Liver Disease • Drug-Induced Liver Injury • Autoimmune Hepatitis • Primary Biliary Cholangitis (Primary Biliary Cirrhosis) • Hepatocellular Carcinoma • Case Study 14.1 A Patient With Hepatitis A Virus Infection (Amanda Chaney and Michelle Zappas) • Case Study 14.2 A Patient With Nonalcoholic Fatty Liver Disease (Amanda Chaney and Michelle Zappas) • Bridge To Clinical Practice (Ben Cocchiano) • Key Points • References • Suggested Resources


Chapter 15. Nervous System (Nancy C. Tkacs, Peggy A. Compton, and Kara Pavone) • The Clinical Context • Overview of Nervous System Function and Neuroanatomy • Nervous System Function • Anatomy of the Nervous System • Cortical Anatomy and Functional Regions • Basal Ganglia and Thalamus • Limbic System • Connections Between the Central Nervous System and the Periphery • Structural Brain Protection • Neurons • The Functional Units of the Brain • Electrically Excitable Cells • Thought Questions 1–3 • Synaptic Transmission • Synapse Structure • Electrical and Chemical Events or Synaptic Transmission • Neurotransmitter Receptors • Termination of Synaptic Transmission • Thought Questions 4-7 • Neurotransmitters • Two Main Transmitter Families • Glutamate • Gamma-Aminobutyic Acid • Epilepsy results from excessive excitation or insufficient inhibition • Thought Questions 8 and 9 • Neuromodulatory Transmitters: Amines • Acetylcholine • Cotecholamines • Dopamine • Norepinephrine • Serotonin • Histamine • Neuromodulatory Transmitters: Peptides • Opiold Peptides • Orexins • Application of Neurotransmitter Concepts • Summary of Neurotransmitter Concepts • Thought Questions 10–12 • Sensory Neurophysiology • Overview of Spinal Cord Anatomy • Somatic Sensory Function • Dorsal Column/Medial Lemniscus System • Spinothalmic Tract System • Pathological States of Sensory Function • Thought Questions 13 and 14 • Pain • Neurophysiology of Pain • Nociceptors • Spinotholomic Tract Neurons • Ascending Pain Pathways: A Site of Pain Modulation • Descending Pain Modulation • Sensitization • Referred Pain • Pharmacological Modulation of Pain • Nonpharmacological Modulation of Pain • Thought Questions 15–17 • Special Senses: Vision and Hearing • Visual System • Auditory System • Motor Activity and Movement Disorders • Motor Neurons and the Neuromuscular Junction • Lower Motor Neuron Lesions • Spinal Cord Reflex Circuits • Motor Pathways from the Pons and Medulla • Motor Pathways from the Cortex and Midbrain • Accessory Systems in Motor Control • The Basal Ganglia • The Cerebellum • Summary of Motor Disorders • Thought Questions 18–20 • Higher Functions of The Nervous System • Functional Anatomy of Cognition and Behavior • Brain Mechanisms of Stress • Neurobiology of Depression, Anxiety, and Substance Use Disorders • Thought Questions 21–24 • Pediatric Considerations (Melissa Assaf) • Overview of Brain Development • Spinal Muscular Atrophy • Pediatric Seizures and Epilepsies • Developmental Delay • Headaches • Concussion • Gerontological Considerations (Linda L. Hermann) • Aging and Structural Changes in Cerebral Cortex • Cognitive Dysfunction • Neurodegenerative Disorders • Vascular Disease • Gait Dysfunction • Aging and Sense Organs • Case Study 15.1 A Teenage Girl With Migraine (Michelle Zappas and Collen Diering) • Case Study 15.2 A Child With a Seizure Disorder (Melissa Assaf and Katherine Edwards) • Case Study 15.3 A Patient With Depression (Linda W. Good) • Bridge to Clinical Practice (Ben Cocchiano) • Key Points • References • Suggested Resources


Chapter 16. Musculoskeletal System (Connie B. Scanga and Joseph J. Curci) • The Clinical Context • Overview of Bones and Skeletal Physiology • Bone Histology • Osteogenesis and Bone Remodeling • Thought Questions 1 and 2 • Bone Fractures • Types of Fractures • Fracture Healing • Recovery from Fracture • Thought Questions 3 and 4 • Joints • Functional Classification • Structural Classification • Fibrous Joints • Cartilaginous Joints • Sinovial Joints • Thought Questions 5 and 6 • Strains and Sprains • Ankle Sprains • Structure and Conditions of the Knee • Anatomy of the Knee • Ligamentous and Meniscal Injuries of the Knee • Medical ligament tears • Lateral ligament tears • Cruciate ligament tears • Meniscal injuries • Thought Questions 7 and 8 • Herniated Disc Disease • Pathophysiology of Disc Herniation • Anatomical Correlations • Clinical Presentation and Management • Cumulative Trauma Disorders • Causes of Cumulative Stress Injury • Clinical Syndromes • Carpal Tunnel Syndrome • Cubital Tunnel Syndrome • Lateral Epicondylitis • Trigger Finger • Hip Bursitis • Thoracic Outlet Syndrome • Thought Questions 9 and 10 • Pediatric Considerations (Theresa Kyle) • Musculoskeletal Development • Youth Sports and Musculoskeletal Injuries • Genetic Musculoskletal Conditions • Gerontological Considerations (Rudy Tassy) • Aging and Muscle Integrity: Sarcopenia and Frailty • Bone Density And Osteoporosis • Joint Disorders In Older Adults • Parkinson Disease and Pisa Syndrome • Case Study 16.1 A Patient With a Sprained Ankle (Allison Rusgo and Michelle Zappas) • Case Study 16.2 A Patient With Acute Gouty Arthritis (Michelle Zappas and Allison Rusgo) • Bridge To Clinical Practice (Ben Cocchiano) • Key Points • References • Suggested Resources


Chapter 17. Endocrine System (Christine Yedinak, Carolina R. Hurtado, Angela M. Leung, Meredith Annon, Hanne S. Harbison, Diane L. Spatz, Gioia Petrighi Polidari, and Victoria Fischer) • The Clinical Context • Principles of Endocrine Function (Christine Yedinak) • Hormone Structures • Cell Signaling by Hormones • Circulating Hormone Levels • Hormone Control Axes • Thought Questions 1 and 2 • Hypothalamus and Pituitary Gland (Christine Yedinak) • Structure of the Hypothalamus • Functions of the Hypothalamus • Thirst and Fluid Balance Control • Regulation of Uterine Contractility • Regulation of Body Energy Balance and Weight • Thought Questions 3–5 • Development of the Hypothalamus and Relationship with the Pituitary Gland • Endocrine Cells of the Anterior Pituitary • Corticotroph Cells: Adrenocorticotrophic Hormone • Corticotroph Dysfunction • Lactotroph Cells: Prolactin • Lactotroph Dysfunction • Somatotroph Cells: Growth Hormone • Somatotroph Dysfunction • Gonadotroph Cells: Luteinizing Hormone and Follicle-Stimulating Hormone • Gonadotroph Dysfunction • Thyrotroph Cells: Thyroid-stimulating Hormone • Thyrotroph Dysfunction • Posterior Pituitary Hormones • Vasopressin: Antidiuretic Hormone • Diabetes Insipidus • Syndrome of Inappropriate Antidiuretic Hormone Secretion • Oxytocin • Thought Questions 6 and 7 • Adrenal Glands (Christine Yedinak) • Development, Structure, and Function of the Adrenal Glands • Adrenal Cortex Zones and Hormones • Zona Glomerulosa: Aldosterone • Hypoaldosteronism • Primary Aldosteronism • Zona Fasciculata: Glucocorticoids and Cortisol Production • Adrenocorticol Dysfunction • Hypocortisoism (Adrenal Insufficiency) • Adrenal hypercortisolism • Zona Reticularis: Androgens • Adrenal Medulla and Catecholamines • Adrenomedullary Dysfunction • Thought Questions 8–10 • Pediatric Considerations: Hypothalamus, Pituitary, and Adrenal Glands (Randall L. Johnson) • Endocrine Control of Growth • Genetic Disorder: Congenital Adrenal Hyperplasia • Gerontological Considerations: Hypothalamus, Pituitary, and Adrenal Glands (Stacy M. Alabastro and Linda L. Hermann) • Decline in Growth Hormone • Adrenal Gland Changes • Key Points: Endocrine Concepts; Hypothalamus, Pituitary, and Adrenal Glands • Thyroid Gland (Carolona R. Hustado and Angela M. Leung) • Structure and Function of the Thyroid Gland • Thyroid Hormone Synthesis • Thyroxine Metabolism • Alterations of Serum Thyroid-Binding Globulin Concentrations • Thyroid Hormone Actions • Screening for Serum Thyroid Dysfunction • Thought Questions 11–13 • Thyroid Disorders • Hypothyroidism • Mechanisms of Hypothyroidism • Laboratory Evaluation of Hypothyroidism • Hyperthyroidism • Mechanisms of Hyperthyroidism • Laboratory Evaluation of Hyperthyroidism • Nonthyroidal Illness with Altered Thyroid Function Tests (Euthyroid Sick Syndrome) • Thought Questions 14 and 15 • Pediatric Considerations: Thyroid Gland  (Randall L. Johnson) • Gerontological Considerations: Thyroid Gland (Stacy M. Alabastro and Linda L. Hermann) • Case Study 17.1 A Patient With Graves Disease (Linda W. Good) • Bridge to Clinical Practice: Thyroid (Ben Cocchiano) • Key Points: Thyroid Gland • The Gonads (Meredith Annon, Hanne S. Harbison, and Diane L. Spatz) • Overview Of The Reproductive System • The Female Reproductive System • Structure and Functions of the Female Reproductive System • Female Hypothalamic-Pituitary-Gonadal Function • Thought Questions 16 and 17 • Abnormalities of the Menstrual Cycle, Ovaries, and Endometrium • Amenorrhea • Abnormal Uterine Bleeding • Polycystic Ovary Syndrome • Endometriosis • Thought Question 18 • Breast Cancer • Menopausal Transition and Aging • Osteoporosis in Postmenopausal Women (and Older Men) • Thought Question 19 • Case Study 17.2 A Patient With Hyperparathyroidism (Nancy C. Tkacs) • The Male Reproductive System • Structures and Functions of the Male Reproductive System • Regulation and Spermatogenesis of the Male Reproductive System • Hypothalamic-Pituitary Gonadal Axis • Spennatogenesis • Erectile Dysfunction • Prostate Disorders • Benign Prostatic Hypetplasla • Prostate Cancer • Thought Questions 20 and 21 • Key Points: The Gonads • Metabolism and the Pancreas (Giona Polidari and Victoria Fisher) • Overview • Review of Metabolism • Metabolic Processes in the Fed State • Liver Processes • Skeletal Muscle Processes • Adipose Tissue Processes • Summary of the Fed State • Metabolic Processes In the Fasting State • Liver Processes • Skeletal Muscle Processes • Adipose Tissue Processes • Ketogenesis is on additional catabolic pathway • Summary of the Fasting State • Thought Questions 22 and 23 • Hormonal Regulation of Metabolism • Insulin • Cellular Mechanisms of insulin Action • Effects of Insulin on the Liver • Effects of Insulin on Muscle • Effect of Insulin on Fat Cells • Effects of Insulin on the Brain • Regulation of Insulin Secretion • Oral Glucose Tolerance Testing • Additional Hormones Regulating Metabolic Homeostasis • Glucagon • Cortisol • Epinephrine • Growth Hansom • Chorionic Soomatomammotropin • Thought Questions 24-26 • Diabetes Mellitus • Diagnostic Criteria • Type 1 Diabetes Mellitus • Pathogenesis • Presentation • Clinical Management • Diabetic Ketoacidosis • Hypoglycemia • Type 2 Diabetes Mellitus • Risk Factors • Diabetes Screening • Pathogenesis • Insulin resistance • ft • Cell Dysfunction • Interrelation of obesity and T2DM • Clinical Management • Lifestyle modifications • Pharmacological interventions • Complications of Diabetes Mellitus • Acute Complications of Type 2 Diabetes Mellitus • Hypoglycemia • Hyperosmolar hyperglycemic syndrome • Chronic Complications of T1DM and T2DM • Hyperglycemia and diabetes complications • Diabetic microangiopathy • Diabetic nephropathy • Diabetic retinopathy • Diabetic neuropathy • Susceptibility to Infections • Other Forms of Diabetes and Diabetes-Related Conditions • Gestational Diabetes • Latent Autoimmune Diabetes in Adults • Polycystic Ovary Syndrome • Obstructive Sleep Apnea • Cognitive Decline and Alzheimer Disease• Summary • Pediatric Considerations: Metabolism and the Pancreas (Randall L. Johnson) • Type 1 Diabetes Mellitus • Type 2 Diabetes Mellitus • Gerontological Considerations: Metabolism and the Pancreas (Stacy M. Alabastro and Linda L. Hermann) • Type 2 Diabetes Mellitus • Case Study 17.3 A Patient With Gestational Diabetes (Kimberly K. Trout) • Bridge to Clinical Practice: Diabetes (Ben Cocchiaro) • Key Points: Metabolism and the Pancreas • Summary: Endocrine Physiology and Pathophysiology • References • Suggested Resources


List of Abbreviations


List of Disorders



About the Editors:

Nancy C. Tkacs, PhD, RN, received her BSN and MSN degrees from the University of Pennsylvania School of Nursing and her PhD in physiology with a focus in neuroscience from Loyola University of Chicago Graduate School at the Stritch School of Medicine. She completed postdoctoral training in neuroendocrinology in the laboratory of Dr. William F. (Fran) Ganong at University of California San Francisco. Dr. Tkacs conducted preclinical research on neuroendocrine responses to physiological stressors in rodent models, particularly pertaining to the diabetes complication hypoglycemia unawareness. Dr. Tkacs has been teaching pathophysiology for advanced nursing practice for over 25 years, drawing on her knowledge of organ systems physiology and pathophysiology to provide a strong basic science foundation for advanced nursing practice. As a master’s-prepared nurse with a doctorate in physiology, she is able to build a bridge between physiology concepts and the pathophysiology of disease. Students learn how findings from the history and physical and diagnostic test results relate to the underlying disease process at the cell and organ level. She taught advanced pathophysiology and neuroscience courses at the University of Medicine and Dentistry of New Jersey and the New Jersey Medical School; she taught advanced pathophysiology and pathogenesis of mental health disorders courses at the University of Pennsylvania; and she directed and taught advanced pathophysiology and advanced pharmacology online courses at the University of Southern California. She also served as assistant dean for Diversity and Inclusivity at the University of Pennsylvania School of Nursing.

Linda L. Herrmann, PhD, RN, AGACNP-BC, GNP-BC, ACHPN, FAANP, is a clinical assistant professor and nurse practitioner with expertise in gerontology, neuroscience, and palliative care. Dr. Herrmann’s clinical and research interests are acute neurological injury in older adults, dementia, stroke, caregivers, palliative care of patients with neurological diseases, and transitional care of older adults. Dr. Hermann teaches advanced pathophysiology and aging at the graduate level. Her research also explores innovative pedagogy using virtual reality and mixed reality to teach advanced pathophysiology and advanced nurse practitioner courses in acute care and aging. Dr. Herrmann earned her BSN, MSN, and PhD from the University of Pennsylvania School of Nursing under the mentoring of Neville E. Strumpf, PhD, RN. She was a John A. Hartford predoctoral scholar and is currently a Fellow of the Hartford Institute for Geriatric Nursing and a Fellow of the American Association of Nurse Practitioners. She is a nationally recognized expert in neuroscience, aging, and advanced pathophysiology; and is known internationally for expertise in patient safety in hospital and clinic settings in Africa.

Randall L. Johnson, PhD, RN, is an associate professor of nursing at the University of Tennessee Health Science Center. He is also a pediatric critical care nurse practitioner. Dr. Johnson has clinical experience in pediatric medical–surgical nursing and pediatric intensive care and trauma. His research interests are in clinical care of hospital-acquired infection reduction. Dr. Johnson has taught pathophysiology in both undergraduate and graduate degree programs. He has also taught various pediatric and pharmacology courses through the course of his academic career. Dr. Johnson earned his BSN from Cedarville University, his MSN from the University of Pennsylvania, and his PhD from the University of Central Florida. Dr. Johnson has held academic appointments since 1999 and has served in a leadership capacity in academics.


Target Audience:

This book is for future nurse practitioners, physician assistants, and other advanced healthcare providers caring for patients across the lifespan.


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