AHE3100 Advanced Exercise Physiology

AHE3100 Advanced Exercise Physiology

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AHE3100 Advanced Exercise Physiology

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AHE3100 Advanced Exercise Physiology

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Course Code: AHE3100
University: Victoria University

MyAssignmentHelp.com is not sponsored or endorsed by this college or university

Country: Australia

Question:

Cardiopulmonary Responses to Exercise
Aim
To examine heart rate and blood pressure responses to static and dynamic exercise
Introduction
During exercise, the cardiovascular system performs a number of important functions:
(1) to increase blood flow and oxygen delivery to contracting skeletal and cardiac muscle
(2) to maintain mean arterial pressure (MAP), thereby ensuring adequate cerebral blood flow, and
(3) to minimize exercise-induced hyperthermia by transporting heat to the skin where it is used to evaporate sweat.
The cardiovascular centre controls cardiovascular function, and is activated in concert with the motor cortical inputs to the contracting skeletal muscle. This “central command” is subject to feedback modification by baroreceptors, chemoreceptors, volume receptors and afferents within contracting skeletal muscle. The cardiovascular response to exercise is influenced by a number of factors including mode of exercise, exercise intensity and active muscle mass. Thus, the responses to different types of exercise can provide a lot of information about the health of the cardiovascular system.
Note
– students with a history of hypertension or a resting diastolic blood pressure of >90 mmHg are excluded from being subjects in this class
Part A: Static Exercise (The Same Volunteer Has To Do Both Parts!)
Getting Started – Baseline Assessment
Record resting heart rate – Palpitation (carotid or radial pulse) is fine
Measure blood pressure a number of times to establish resting values. Record resting blood
pressure
Place a blood pressure cuff on the non-exercising arm (usually your non-dominant arm)
While seated, exert maximum force with the hand-grip dynamometer with your dominant hand. The highest of three trials is to be recorded as the maximum voluntary contraction (MVC)
Procedure: Test 1
Start and maintain a handgrip contraction of the hand-held dynamometer at 30% MVC for 3 minutes, breathing normally
Record heart rate and measure blood pressure each minute during exercise At the end of 3 minutes contracting – Stop contracting
Record heart rate and measure blood pressure during 3 minutes of recovery

Procedure: Test 2
Following a 20 minute rest period, repeat test 1, but with an additional procedure
Place an additional blood pressure cuff over the biceps of the exercising arm (do not inflate)
Start and maintain a handgrip contraction of the hand-held dynamometer at 30% MVC for 3 minutes, breathing normally, and record heart rate and blood pressure as before
During the last 30 seconds of exercise, inflate the cuff on the exercising arm to between 160-200 mmHg in order to occlude the blood supply
Record heart rate and measure blood pressure (in non-exercising arm) for 3 minutes of rest with circulatory occlusion, and then record the same variables for another 3 minutes of recovery with the cuff deflated
Note
– if the subject experiences any discomfort, release the cuff to restore normal circulation
Graph heart rate and mean arterial blood pressure against time for both experimental conditions.

Part B: Dynamic Exercise (The Same Volunteer Has To Do Both Arm And Leg Exercises!)
Getting Started – Baseline Assessment
Place a blood pressure cuff on the arm for blood pressure
Record heart rate and measure blood pressure to establish resting (baseline) values
The subject then exercises for 12 minutes (4 minutes at 3 workloads) in 2 ways (these can be done in any order you like):
(a) leg exercise
– the subject performs step ups at a rate of 1 every 3 seconds, 1 every 2 seconds and then 1 every second
(b) arm exercise
– the subject will “bicep curl” (Both arms) light, medium and heavy loads Record heart rate and measure blood pressure during the last 30 seconds of each workload
Note 1
– as the subject will have to cease exercising for the blood pressure to be accurately taken, pump up the cuff just prior to the subject stopping so that you are ready to take the measurement as soon as the person stops exercising, and ensure that you take no more than 30 seconds to measure blood pressure
Graph heart rate and systolic, diastolic and mean arterial pressure against workload for the two modes of exercise.
Note 2
– the workloads have been designed so that they are equivalent (ie. 1 step up every 2 seconds = bicep curl with medium load. However, since we do not have absolute values for the work performed, simply list the workloads as 1, 2 and 3.
Task:
Instructions
This research is to be completed using the scientific structure (except for the introduction as that is not needed). It must include;

Introduction
Results (including tables, graphs etc)
Discussion
Conclusion
References

Please Graph heart rate and mean arterial blood pressure against time for both experimental conditions.
Please include to answer the following questions in the discussion:

What do the results say about the relative importance of central and peripheral mechanisms for the control of the heart rate and blood pressure during static exercise?
What are the differences in cardiovascular responses between arm and leg exercises, and the possible underlying reasons?

Results
Part A: Static Exercise
Maximum voluntary contraction (MVC) highest of three tries = 496N
Test 1

Exercise

Blood pressure (mmHg)

Heart Rate (BPM)

Pre-test

126/60

65

1 minute

128/62

67

2 minutes

131/63

69

3 minutes

135/65

70

 

Rest

Blood pressure (mmHg)

Heart Rate (BPM)

1 minute

130/63

67

2 minutes

128/62

65

3 minutes

125/60

65

 
Test 2

Exercise with cuffs

Blood pressure (mmHg)

Heart Rate (BPM)

1 minute

127/62

67

2 minutes

132/63

69

3 minutes

136/66

72

 

Rest with cuffs (inflated)

Blood pressure (mmHg)

Heart Rate (BPM)

1 minute

136/66

69

2 minutes

137/67

67

3 minutes

136/66

64

 

Rest with cuffs (deflated)

Blood pressure (mmHg)

Heart Rate (BPM)

1 minute

136/66

64

2 minutes

133/63

63

3 minutes

127/60

63

Part B: Dynamic Exercise

Step up exercise

Blood pressure (mmHg)

Heart Rate (BPM)

Resting

129/70

73

Step up every 3 seconds

135/72

77

Step up every 2 seconds

141/73

85

Step up every 1 second

145/72

95

*Step ups were performed for 4 minutes for each workload and measurements were taken in the final 30 seconds of each workload (3:30)

Bicep curls exercise

Blood pressure (mmHg)

Heart Rate (BPM)

Light weights

138/75

80

Medium weights

150/77

91

Heavy weights

156/78

101

*Bicep curls were performed for 4 minutes for each workload and measurements were taken in the final 30 seconds of each workload.

 
Answer:

Introduction:
The aim of this experiment was to determine how the heart rate and blood pressure changes in response to two different types of exercise. It has been well established from scholarly studies that exercise is beneficial for improving the cardiovascular health (Nystoriak and Bhatnagar 2018). It has also been found that there is an increase in both of the values of blood pressure and heart rate during the exercise (Oh, Hong and Lee 2016). The parameters also returns to the normal range after finishing the activities. This event suggests a presence of a regulatory activity in the body for controlling the heart rate and the blood pressure. The regulation is important for maintaining the oxygen balance inside the body (Romero, Minson and Halliwill 2017). However, this study is based on the assumption that different types of exercise along with different exercising conditions might affect both the heart rate and blood pressure in different ways. This paper will be discussing different effects of static and dynamic exercises on the cardiovascular system along with comparing the results between each other. The effects of static exercises will be considered for determining the comparative importance between the regulatory mechanisms present and the effect of dynamic exercises will be discussed for comparing the cardiovascular response for arm and leg exercises.
Results:
The results can be represented in a tabular format and can be explained via graphical representation.
Part A: Static Exercise
Test 1: Exercise without cuff
Table 1:

Exercise time (Minute)

Systolic blood pressure (mmHg)

Diastolic blood pressure (mmHg)

Heart Rate (BPM)

0

126

60

65

1

128

62

67

2

131

63

69

3

135

65

70

Graph:
 
Interpretation: Heart rate and blood pressure increased with exercise time.
Table 2:

Resting time (Minute)

Systolic blood pressure (mmHg)

Diastolic blood pressure (mmHg)

Heart Rate (BPM)

0

0

0

0

1

130

63

67

2

128

62

65

3

125

60

65

Graph:
 
Interpretation: Heart rate and blood pressure decreased with an increase in the resting time.
Test 2: Exercise with cuffs
Table 3:

Exercise time (Minutes)

Systolic blood pressure (mmHg)

Diastolic blood pressure (mmHg)

Heart Rate (BPM)

0

126

60

65

1

127

62

67

2

132

63

69

3

136

66

72

Graph:
 
Interpretation: Both blood pressure and heart rate increased with exercising time.
Table 4:

Resting time with inflated cuffs (Minutes)

Systolic blood pressure (mmHg)

Diastolic blood pressure (mmHg)

Heart Rate (BPM)

1

136

66

69

2

137

67

67

3

136

66

64

Graph:
 
Interpretation: There was a significant decrease in the heart rate with increased resting time. However, a significant decrease in the blood pressure with increased resting time was absent.
Table 5:

Resting time with deflated cuffs (Minutes)

Systolic blood pressure (mmHg)

Diastolic blood pressure (mmHg)

Heart Rate (BPM)

1 minute

136

66

64

2 minutes

133

63

63

3 minutes

127

60

63

Graph:
 
Interpretation: After deflating the cuff the blood pressure decreased significantly with an increase in the resting time. However, there was no significant decrease in the heart rate.
 
Part B: Dynamic Exercise
Table 6:

Step up exercise interval time (seconds)

Systolic blood pressure (mmHg)

Diastolic blood pressure (mmHg)

Heart Rate (BPM)

0

129

70

73

3

135

72

77

2

141

73

85

1

145

72

95

Graph:
 
Interpretation: The complexity of the exercises increased as the time of interval (y-axis) decreased. Thus, both heart rate and blood pressure increased with an increase in the complexity of the exercises.
Table 7:

Bicep curls exercise

Systolic blood pressure (mmHg)

Diastolic blood pressure (mmHg)

Heart Rate (BPM)

Light weights

138

75

80

Medium weights

150

77

91

Heavy weights

156

78

101

Graph:
 
Interpretation: Exercises using heavy weight are more complex than using medium weight and light weight. Thus, both heart rate and blood pressure increased with an increase in the complexity of the exercises.
Discussion:
Exercises cause an increase in both the blood pressure and the heart rate, which are restored during the resting period. The central mechanism for the control of heart rate and blood pressure involves the central nervous system or CNS (Raven and Chapleau 2014). There is also another mechanism for controlling the blood pressure and heart rate, which is known as peripheral vascular resistance system (Raven and Chapleau 2014). Both of these mechanisms assist in regulation of the two parameters inside the body. In this experiment, during the static exercises, the peripheral mechanism for vascular resistance was made impaired by using cuff in test 2. The first experiment was used as a control. The experiment found a normal rise in the blood pressure and heart rate with increased exercise time. Those parameters were also measured during the resting time. It was found that after 3 minutes of exercising without cuffs the heart rate was only 75 bpm and the blood pressure was 135/65 mmHg. The increase in the heart rate was only 10 bpm and the same in the blood pressure was 9/5 mmHg. According to the results the increased values almost restored to normal after resting for 3 minutes post exercise. In this experiment, both central and peripheral mechanisms were responsible for the regulation. However, in test 2, the experiment was carried out using cuffs or making the normal functioning of the peripheral system impaired. In this experiment both the blood pressure and heart rate increased at a faster rate. However, the resting time of 3 minutes was unable to restore the values into normal range, suggesting a slower recovery. Additionally, it was found that when the cuffs were deflated or the peripheral system was enabled, there was a faster recovery. Thus from this experiment, it can be decided that peripheral system for blood pressure and heart rate regulation is as important as the central system during static exercise.
The next experiment was based on the dynamic exercises. The results found that with an increase in the complexity of the exercises, the heart rate and blood pressure also increased. However, the increase was higher in case of dynamic arm exercises compared to the leg exercises. The possible reason for this result might be the choice of exercise. The exercise that was chosen as the leg exercises was step-up exercise. However, for the arms, the weight lifting exercise. Since the results of this experiment already suggests that the increase in blood pressure and heart rate is a result of increase in the complexity of the exercises, it can be deduced that the step up exercise was less complex than the weight lifting exercise. This was the possible reason for the different cardiovascular response in case of two different exercises.
Conclusion:
Hence, it can be decided from the above discussion that there are two principle regulatory system present for regulating the blood pressure and heart rate, which are CNS and peripheral vascular resistance. In this experiment the peripheral system was affected, which resulted in poor regulation of the parameters. The experiment suggested that the peripheral system is equally important as CNS for maintaining an appropriate regulation.
The results of this study also found that there is an increased cardiovascular response with an increase in the complexity of the exercises. There was also a significant difference between the cardiovascular responses for the arm exercises and leg exercises. The values for the step up exercises were lower compared to the arm exercises. The possible explanation for the event is the higher complexity of the arm exercises compared to the leg exercises.
 
References:
Nystoriak, M.A. and Bhatnagar, A., 2018. Cardiovascular effects and benefits of exercise. Frontiers in cardiovascular medicine, 5, p.135.
Oh, D.J., Hong, H.O. and Lee, B.A., 2016. The effects of strenuous exercises on resting heart rate, blood pressure, and maximal oxygen uptake. Journal of exercise rehabilitation, 12(1), p.42.
Raven, P.B. and Chapleau, M.W., 2014. Blood pressure regulation XI: overview and future research directions. European journal of applied physiology, 114(3), pp.579-586.
Romero, S.A., Minson, C.T. and Halliwill, J.R., 2017. The cardiovascular system after exercise. Journal of Applied Physiology, 122(4), pp.925-932.

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AHE3100 Advanced Exercise Physiology

AHE3100 Advanced Exercise Physiology

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AHE3100 Advanced Exercise Physiology

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AHE3100 Advanced Exercise Physiology

0 Download10 Pages / 2,329 Words

Course Code: AHE3100
University: Victoria University

MyAssignmentHelp.com is not sponsored or endorsed by this college or university

Country: Australia

Question:

Explain the physiology of one of the 5 vital signs.Discuss the importance of professionalism when caring for this patient.
Here you should explain the normal physiology of one of (blood pressure Remember to stay within the normal parameters)  the vital signs and normal parameter.  

Answer:

The Physiology of normal blood pressure
Blood pressure in the major circulation is characterized by the greatest difference – from the maximum value in the left ventricle and in the aorta to the minimum in the right atrium, where at rest it normally does not usually exceed 2-3  mm Hg. Art ., often taking negative values ??in the inspiratory phase. In the left ventricle of the heart, K. d. By the end of diastole is 4-5 mm Hg. Art ., and in the period of systole increases to a value commensurate with the value of systolic K. d. in the aorta. The limits of the normal values ??of systolic K. in the left ventricle of the heart are 70–110 in children and 100–150 mmHg in adults (Klabunde, 2012).
It is noted that in the range of normal values ??in men, blood pressure is higher than in women; higher values ??of blood pressure are recorded in obese subjects, in urban residents, persons of mental labor, lower – in rural residents, in those who are constantly engaged in physical labor and sports. In the same person, blood pressure can clearly change under the influence of emotions, with a change in body position, in accordance with daily rhythms (in most healthy people, blood pressure rises in the afternoon and evening hours and decreases after 2 hours a night) (Klabunde, 2012). All these fluctuations occur mainly due to changes in systolic blood pressure with a relatively stable diastolic.
In children under 8 years of age, blood pressure is lower than in adults. In newborns, systolic blood pressure is close to 70 mmHg. Art., in the coming weeks of life, it rises, and by the end of the first year of the child’s life reaches 80-90 with a diastolic blood pressure of about 40 mm Hg. st . In the subsequent years of life, blood pressure gradually increased, and at 12–14 years old, boys and 14–16 years old boys showed an accelerated increase in indicators of blood pressure to values ??comparable to the blood pressure in adults. In children at the age of 7 years, blood pressure has values ??in the range of 80-110 / 40-70, in children of 8-13 years old – 90-120 / 50-80 mm Hg. Art., and in girls 12 years old, it is higher than in boys of the same age, and in the period between 14 and 17 years of age, blood pressure reaches 90-130 / 60-80 mm Hg. st., and in boys, on average, it is higher than in girls. As in adults, there were differences in blood pressure in children living in the city and in the countryside, as well as fluctuations during different loads. Blood pressure is noticeable (up to 20 mm Hg. Art.) Increases when the child is excited, when sucking (in infants), in conditions of cooling the body; when overheating, for example in hot weather, blood pressure decreases. In healthy children, at the end of the action of the cause of the increase in blood pressure (for example, an act of sucking), it quickly (within about 3-5 minutes) decreases to its initial level (La, 2011).
Professionalism
Based on the texts and articles associated with this course such as the NMC and the NHS Constitution, I have learned many things about professionalism in nursing profession. I have learned that nurses should respect patients. A nurse should always be prepared to provide competent assistance to patients regardless of their age or gender, nature of the disease, social or financial situation, and other differences. When providing care, a nurse should take into account the patient’s personal needs, respect his right to participate in the planning and execution of treatment.  In communicating with patients, one should never forget the following rules: always listen carefully to the patient, asking a question, always be sure to wait for an answer, express your thoughts clearly, simply, and intelligibly (In Scott, 2017).  Manifestations of arrogance, neglect, or degrading treatment of the patient are not allowed. The nurse does not have the right to impose his moral, religious, political beliefs on the patient. When prioritizing the provision of medical care to several patients, a nurse should be guided only by medical criteria, excluding any discrimination. In cases that require, for medical reasons, control over the patient’s behavior, the nurse should limit his intervention in the personal life of the patient to purely professional necessity.
I have also learned that nurse should not do harm. The nurse does not have the right to violate the ancient ethical commandment of medicine “First of all, do no harm!”. The nurse does not have the right to be indifferent to the actions of third parties seeking to bring such harm to the patient. The actions of the nurse for nursing, any other medical interventions involving pain and other temporary negative phenomena are permissible only in his interests. “The medicine should not be worse than the disease!”. When making medical interventions that are fraught with risk, the nurse is obliged to provide for safety measures, for stopping complications that threaten the patient’s life and health.
I also learned that a very important principle in modern health care is the principle of informed voluntary consent. This principle means that the medical worker should inform the patient as fully as possible and give him optimal advice (Standing, 2011). Only after that the patient should choose their own actions. In this case, in our country, the law gives the patient the right to receive all the information.  Providing incomplete information is a hoax. The moral and professional duty of a nurse is to explain to the patient the consequences of refusing a medical procedure to the best of his qualifications (McSherry, McSherry & Watson, 2012). The patient’s refusal should not affect his position and adversely affect the attitude of the nurse and other medical personnel towards him. A nurse is entitled to assist without the patient’s consent (or without the consent of a legal representative of an incompetent patient – a child under 15 or an incapable mentally ill) only in strict accordance with the legislation. When providing care to incompetent patients, a nurse should, as far as the condition of such patients allows, involve them in the decision-making process. If the patient is unable to express her will, the nurse is entitled to carry out the emergency medical intervention shown to him, within her competence, on the basis of her own decision.
Additionally, I learned that a nurse should keep confidential from third parties the information entrusted to her or made known to her by virtue of performing her professional duties about the patient’s health status, diagnosis, treatment, prognosis of her disease, and the patient’s personal life even in the event of the patient’s death (Gallagher & Hodge, 2012). The nurse is obliged to strictly perform their functions to protect confidential information about patients, in whatever form it may be stored. A nurse has the right to disclose confidential information about a patient to a third party only with the consent of the patient. The right to transfer information to a nurse to other specialists and medical professionals who provide medical care to the patient, presupposes his consent. The nurse is entitled to transmit confidential information without the patient’s consent only in cases provided for by law. In this case, the patient should be informed of the inevitability of disclosure of confidentiality of information. In all other cases, the nurse bears personal moral, and sometimes legal, responsibility for the disclosure of professional secrets (Armstrong, 2007).
A nurse should maintain the authority and reputation of her profession. Neatness and personal hygiene are essential qualities of a nurse’s personality. A nurse has a personal moral responsibility to maintain, introduce and improve nursing standards. She should not claim to the degree of competence that does not possess. The right and duty of a nurse is to defend their moral, economic and professional independence. A nurse should refuse gifts and complimentary offers from the patient if the basis is his desire to achieve a privileged position compared to other patients (Crouch, Charters, In Dawood & Bennett, 2016). A nurse has the right to accept gratitude from a patient if she expresses herself in a form that does not destroy the human dignity of both, does not contradict the principles of justice and decency and does not violate legal norms. Intimate relationships with the patient are condemned by medical ethics. The behavior of a nurse should not be an example of a negative attitude towards health.
A nurse should pay tribute of deserved respect to their teachers. In relations with colleagues, a nurse should be honest, fair and fair, recognize and respect their knowledge and experience, their contribution to the treatment process (Mandelstam, 2011). The nurse is obliged to the best of her knowledge and experience to help her colleagues in the profession, counting on the same help from their side, and also to assist other participants in the treatment process, including volunteers (Keown, 2012). The nurse is obliged to respect the long tradition of his profession – to provide medical assistance to a colleague for free. Attempts to gain credibility by discrediting colleagues are unethical. The moral and professional duty of a nurse is to help the patient carry out the treatment program prescribed by the doctor. The nurse is obliged to accurately and efficiently perform the medical manipulations prescribed by the doctor. The high professionalism of the nurse is the most important moral factor of companionship, collegial relations between the nurse and the doctor (Toon & Royal College of General Practitioners 2014). The familiarity, unofficial nature of the relationship between a doctor and a nurse in the performance of their professional duties are condemned by medical ethics. If a nurse doubts the advisability of the doctor’s medical recommendations, she should tactfully discuss this situation first with the doctor himself (Macdonald, Magill-Cuerden & Mayes, 2011).
A nurse, faced with illegal, unethical or incompetent medical practice, should defend the interests of the patient and society. A nurse is required to know the legal regulations governing nursing, the health care system in general and the application of traditional medicine (healing) methods, in particular. A nurse has the right to seek support from state health authorities, the Nurses Association, by taking measures to protect the interests of the patient from questionable medical practice (Peate & Peate, 2012).
In modern conditions, the principle of distributive justice, which means the obligation to provide and equal access to medical care, is especially important. Unfortunately, distributive injustice especially often arises when distributing expensive drugs, using complex surgical interventions, etc (Tingle & Cribb, 2014).  At the same time, enormous moral damage is inflicted on those patients who, for a number of reasons, are deprived of this or that type of medical care. The nurse is obliged to provide the patient with quality medical care that meets the principles of humanity and professional standards. She bears moral responsibility for her work in front of the patient, colleagues and society. The professional and ethical duty of a nurse is to provide, to the extent of her competence, emergency medical care to any person.
The nurse should put compassion and respect for the patient’s life above all else. The nurse is obliged to respect the patient’s right to alleviate suffering to the extent that the current level of medical knowledge allows. A nurse is not entitled to participate in torture, executions and other forms of cruel and inhuman treatment of people (Ballatt & Campling, 2011). The nurse does not have the right to contribute to the suicide of the patient. The nurse is responsible, within her competence, for ensuring the rights of the patient, proclaimed by the World Medical Association, the World Health Organization and enshrined in the legislation
Concerning professional requirements, nurse should utilize many things such as a creative approach to their duties, the ability to quickly navigate information, choose from it the most necessary, constantly improve their knowledge and skills, improve their cultural level (In Peate & In Wild, 2018). A nurse should be competent about the patient’s moral and legal rights. She receives the highest standards in the field of nursing practice, considering real situations, guided by the requirements of the legislation of Ukraine, the principles of professional ethics. A nurse is personally responsible for the performance of her professional duties.
References
Armstrong, A. E. (2007). Nursing Ethics: A Virtue-Based Approach. London: Palgrave Macmillan UK.
Ballatt, J., & Campling, P. (2011). Intelligent kindness: Reforming the culture of healthcare. London: RCPsych Publications.
Crouch, R., Charters, A., In Dawood, M., & Bennett, P. (2016). Oxford handbook of emergency nursing. Oxford: Oxford University Press.
Gallagher, A., & Hodge, S. (2012). Ethics, law and professional issues: A practice-based approach for health professionals. Basingstoke : Palgrave Macmillan
In Peate, I., & In Wild, K. (2018). Nursing practice: Knowledge and care. Hoboken, NJ : John Wiley & Sons, Ltd
In Scott, P. A. (2017). Key concepts and issues in nursing ethics. Cham, Switzerland : Springer
Keown, J. (2012). The law and ethics of medicine: Essays on the inviolability of human life. Oxford, UK: Oxford University Press.
Klabunde, R. E. (2012). Cardiovascular physiology concepts. Lippincott Willams and Wilkins.
La, B. L. (2011). Blood pressure basics. New York, NY: Rosen Central.
Macdonald, S., Magill-Cuerden, J., & Mayes, M. (2011). Mayes’ midwifery. Edinburgh: Baillière Tindall.
Mandelstam, M. (2011). How we treat the sick: Neglect and abuse in our health services. London: Jessica Kingsley Publishers.
McSherry, W., McSherry, R., & Watson, R. (2012). Care in nursing: Principles, values, and skills. Oxford: Oxford University Press.
Peate, I., & Peate, I. (2012). The student’s guide to becoming a nurse. Chichester, U.K: Wiley-Blackwell.
Standing, M. (2011). Clinical judgement and decision making for nursing students. Exeter: Learning Matters.
Tingle, J., & Cribb, A. (2014). Nursing law and ethics. Chichester, West Sussex, UK : John Wiley & Sons Ltd
Toon, P. D., & Royal College of General Practitioners. (2014). A flourishing practice?. London : Royal College of General Practitioners.

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