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The synthesis of art and science is lived by the nurse in the nursing act
Josephine G Paterson
Genetics, mitosis and meiosis
McLafferty E et al (2012) Genetics, mitosis and meiosis.
Nursing Standard. 26, 48, 35-42. Date of acceptance: March 29 2012.
Abstract
As part of the life sciences series, this article describes the role of
deoxyribonucleic acid and ribonucleic acid, genes and chromosomes.
The processes of mitosis and meiosis are discussed and some genetic
disorders outlined. Possible strategies for future management of
genetic disorders are introduced.
Authors
Ella McLafferty
Retired, was senior lecturer, School of Nursing and Midwifery,
University of Dundee.
Charles Hendry
Retired, was senior lecturer, School of Nursing and Midwifery,
University of Dundee.
Alistair Farley
Lecturer in nursing, School of Nursing and Midwifery,
University of Dundee.
Correspondence to: a.h.farley@dundee.ac.uk
Keywords
Cell division, genetics, life sciences, meiosis, mitosis
Review
All articles are subject to external double-blind peer review and
checked for plagiarism using automated software.
Online
Guidelines on writing for publication are available at
www.nursing-standard.co.uk. For related articles visit the archive
and search using the keywords above.
In the previous article, the cell was identified
as the smallest living structure in the body. All
cells in the body, with the exception of mature
erythrocytes (red blood cells), have a nucleus
containing the genetic code or blueprint for the
individual. In different cells, various sections of
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this genetic code are active and therefore direct
the cell to different functions – however, each
cell contains the entire blueprint for the person.
This is why it is possible to take the nucleus from,
for example, a skin cell and place it within an
enucleated ovum and produce a new individual
who is identical in almost every respect to the
original nuclear donor. This is called cloning.
To date, no human beings have been artificially
cloned and in most countries the ethical concerns
surrounding this are such that even if it were
technically possible it would be illegal. This article
examines the structures that carry the genetic code
from one generation of cells to the next, as well as
the nature and mechanisms of cell division, namely
mitosis and meiosis. Gene inheritance and what
can go wrong when abnormalities occur in the
genetic code are also discussed.
Deoxyribonucleic acid and ribonucleic acid
The genetic code is contained within the
nucleic acids deoxyribonucleic acid (DNA) and
ribonucleic acid (RNA) found in cells. Nucleic
acids contain carbon, hydrogen, oxygen, nitrogen
and phosphorus. DNA forms the genetic material
that is responsible for passing on inherited
characteristics from one generation to the next.
RNA relays instructions from genes to direct the
synthesis of proteins from amino acids within
the cell. Specific genes contain the code for the
synthesis of specific proteins.
Deoxyribonucleic acid
DNA is a double-stranded helical molecule
made up of four chemical bases or nucleotides
(Figure 1). There are four bases, or nucleotides,
in human DNA. These are adenine (A), thymine
(T), cytosine (C) and guanine (G). Each strand of
DNA contains a backbone made up of sugar and
phosphate to which the nucleotides are attached.
 
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 Art & science life sciences: 3

As a result of their chemical structure, adenine FIGURE 2

can only pair with thymine, and cytosine can
Deoxyribonucleic acid replication
only pair with guanine. This specific pairing
means that knowledge of the sequence of bases on
one strand of DNA can enable prediction of the
sequence of bases on the complementary strand
(Tortora and Derrickson 2009).
When cell division takes place the double helix
unwinds and separates and each strand acts as a
template for the production of its partner strand
(Figure 2). Sometimes during DNA replication a
change in the base sequence can occur – known
as mutation. Some mutations can lead to a greater
or lesser change in protein synthesis and may lead
to reduced function, cancer or cell death. Genetic
defects in future individuals can arise if the mutation
occurred in the cells that form ova or sperm.
sequence coded for in the mRNA. In this way, a
Ribonucleic acid protein is assembled.
RNA differs from DNA in a number of important A sequence of three DNA nucleotides or bases
ways. RNA is a single-stranded molecule made up is known as a base triplet. The mirror image of
of the sugar ribose, and includes uracil (U) instead such a sequence in mRNA is called a codon. A
of thymine. codon codes for a specific amino acid. With four
There are three different types of RNA nucleotides available to make up a 3 codon amino
including messenger RNA (mRNA), ribosomal acid, it is possible to produce 64 distinct codons,
RNA (rRNA), and transfer RNA (tRNA). that is 43. There are more than enough possible
mRNA is produced when a gene or genes in the combinations to code for the 20 amino acids which
DNA are expressed or activated, thus generating are used to form a wide range of proteins in the
a copy of the gene. Ribosomes in the cytoplasm body. Humans can make 12 amino acids from
then read coding information in the mRNA. simple organic molecules found in the diet, and the
Ribosomes are composed of rRNA and proteins. remaining eight which must be ingested are known
tRNA transports amino acids to the ribosome, as essential amino acids (Vanputte et al 2009).
which selects the appropriate ones that match the

Genes
FIGURE 1 The nucleus in each cell of the body contains
Deoxyribonucleic acid molecule genes from both biological parents. Each gene is
made up of a segment of DNA. It is estimated that
humans have about 20,000-30,000 genes (Tortora
and Derrickson 2009, Patton and Thibodeau
2010). This accounts for about 3% of total DNA
in humans; the remaining 97% does not code
for anything (Saladin 2011). This ‘junk’ DNA
has been accumulated over the course of human
Nucleotides
evolution, with no known purpose. Genes can vary
in length, with most being 20,000-40,000 base
pairs long; however, some are one million base
pairs long (Kumar and Clark 2009). Because vast
amounts of information have to be carried in each
nucleus, every strand of DNA has to be carefully
and precisely packaged. When tightly packaged,
Sugar the DNA is found in the form of chromosomes.
phosphate
backbone
Chromosomes
In every cell in the body (with the exception of the
gametes or sex cells (ova and sperm)) the nucleus

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 contains 46 chromosomes arranged in pairs.
In both males and females there are 23 pairs of
chromosomes: 22 identical (homologous) pairs
called autosomes and one pair of sex chromosomes
(Figure 3). In females the 23rd pair is also identical,
consisting of a pair of X chromosomes, whereas
in the male the pair of sex chromosomes is made
up of two different chromosomes, one X and
one Y chromosome.
The classic image of human chromosomes is
usually one of the chromosome in a condensed,
tightly coiled state. Most of the time – that is,
when the cell is not undergoing cell division – the
chromosome is relaxed and partially unwound.
In this state, it is known as chromatin and makes
DNA more easily accessible for DNA replication
and subsequent protein synthesis.
Cell division
Cell division is the process whereby the cell
reproduces itself (a parent cell divides into two or
more daughter cells). It consists of a nuclear division
and a cytoplasmic division. Two types of nuclear
cell division are recognised: mitosis and meiosis. In
mitosis, the number of chromosomes is maintained,
that is, the daughter cells contain the same number
of chromosomes as the parent cells. In meiosis, the
final daughter cells (or gametes) only contain half
the number of chromosomes found in the parent cell
– this is known as a reduction division.
Mitosis and the cell cycle
Mitosis involves duplication of the parent cell.
Before the cytoplasm of a cell divides to form
FIGURE 3
Human chromosones
ALAMY
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p35-42w48.indd 37
FIGURE 4
Mitosis
Prophase
Metaphase
Anaphase
Telophase
two cells, the cell undergoes nuclear division
or mitosis, whereby the cell separates the
chromosones in its nucleus into two identical sets
in two separate nuclei. When the cytoplasm of
the parent cell divides to form two cells, each new
cell contains the identical number and types of
chromosomes that were present in the parent cell
(46 chromosomes in 23 pairs) (Figure 4).
Before onset of cell division by mitosis, a cell
replicates its DNA and other intracellular material
such as organelles, in preparation for this division.
At the end of this phase each chromosome consists
of two distinct, but genetically identical, strands of
chromatin known as chromatids. These chromatids
are linked by a part of the chromosome known as
the centromere.
The cytoplasm, cell membrane and other cell
structures are also being replicated in anticipation of
cell division. The phase between active cell divisions
is known as interphase – a period of high metabolic
activity. It is during this phase that much of a cell’s
growth takes place (Tortora and Derrickson 2012).
Mitosis follows on from interphase and can be
divided into four stages: prophase, metaphase,
anaphase and telophase.
Prophase
During prophase the nuclear envelope begins to
disintegrate as the chromatin in the nucleus coils
up to form dense, compact chromosomes. Each
chromosome is made up of one pair of identical,
double-stranded chromatids. At the end of
prophase there are 46 double-stranded chromatids.
As the chromatids are forming, two centrioles
(which derive from the centrosome, an organelle
close to the nucleus) move towards opposite ends
of the parent cell. As they prepare to migrate, an
 
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 Art & science life sciences: 3

arrangement of microtubules called spindle fibres meiosis. Cells produced by meiosis each have
is constructed between the centrioles. By the end 23 chromosomes. During fertilisation, the sperm
of prophase the nucleolus and nuclear envelopes contributes 23 chromosomes and the secondary
completely disappear. oocyte contributes another 23 chromosomes.
Therefore the zygote (fusion of the nuclear
Metaphase material of the ovum and sperm) receives half its
The chromatids are arranged along the centre of chromosomes from each parent, giving a total of
the cell midway between the centrioles located at 46 chromosomes.
opposite ends of the cell. They line up centrally Meiosis involves two cell divisions in succession
along the spindle fibres. One strand of each with the production of four haploid daughter cells
chromatid faces one pole of the cell, and the other (Figure 5) (Vanputte et al 2009). Each daughter cell
strand faces the opposite pole. has half the number of chromosomes of the parent
cell. The different stages involved in meiosis are:
Anaphase Prophase
 I.
At the beginning of anaphase the centromere of Metaphase
 I.
each of the 46 chromatids divides, separating the Anaphase
 I.
two parts of each chromatid. One chromatid is Telophase
 I.
now pulled towards one pole of the cell, while the Interkinesis.

other is pulled towards the opposite pole of the cell. Prophase
 II.
Once separated, the chromatids are referred to as Metaphase
 II.
chromosomes (Tortora and Derrickson 2012). Anaphase
 II.
Telophase
 II.
Telophase During prophase I the chromatin condenses to form
During telophase the chromosomes at opposite ends pairs of chromosomes, each of which is composed
of the cell begin to unravel and lengthen (Tortora of two chromatids joined by a centromere. It is
and Derrickson 2012). The spindle fibres disappear worth highlighting that one chromosome originates
and a new nuclear envelope appears around from the male and the other from the female
both sets of chromatin and the chromosomes are
organised to form two separate nuclei at opposite
ends of the cell (Vanputte et al 2009). The cell now FIGURE 5
cleaves down the midline and divides into two parts. Meiosis
Each nucleus is now surrounded by cytoplasm and
the organelles are equally divided between the two
new genetically identical cells. Each cell now enters
interphase where there is much metabolic activity
and cellular growth takes place.

Clinical note
Nerve cells or neurones lose the capacity to undergo Cell
mitosis. This means that if neurones are damaged division 1
or destroyed, such as occurs in stroke patients,
then new nerve cells are not produced to repair the
damage. The functions that those nerve cells were
responsible for will be lost, although other areas of
the brain may be able to compensate for some or all
of the lost function.

Meiosis
Sexual reproduction necessitates the fusion of a
sperm cell from the male with a secondary oocyte
Cell
(an immature egg cell) from the female. To ensure division 2
that the number of chromosomes remains constant
from generation to generation, the number of
chromosomes in the sex cells must be half that
present in the somatic cells (Watson 2011). This
requires a special form of cell division known as

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 parent. The centrioles produce spindle fibres during
prophase I and the nuclear membrane begins to
disintegrate. In metaphase I, the chromosomes
are arranged along the equator of the cell with
their centromeres attached to the spindle fibres.
During anaphase I each of the paired chromosomes
separate and are pulled to opposite poles of the
cell. However, this separation does not involve the
splitting of the centromere nor do the chromatids
separate from each other. Rather, each chromosome
separates from its ‘twin’ (Saladin 2011). In telophase
I the cell divides to form two new daughter cells
each with double-stranded chromosomes. However,
each cell contains 23 unpaired chromosomes. New
nuclear membranes form around the chromosomes
and the cytoplasm divides.
The period of interkinesis is similar to interphase
in mitosis and is a brief rest period in the cell
division process.
The daughter cells now enter prophase II
during which the nuclear membrane of the two
daughter cells disintegrates and new spindle
fibres are produced. Metaphase II involves the
arrangement of chromosomes along the equator
of the cell with their centromeres attached to
spindle fibres. The centromeres divide during
anaphase II and single chromatids are pulled
to opposite poles of the cell. Each chromatid is
composed of a single-stranded chromosome.
During telophase II nuclear envelopes develop
around the chromosomes, the cytoplasm divides
and the two daughter cells from telophase I
divide to form four daughter cells, each with
23 single-stranded chromosomes. As previously
mentioned, when fertilisation of an ovum by a
sperm occurs each contributes 23 chromosomes
giving the new cell a total of 46 chromosones.
Genetic inheritance
Humans have genetic material from both
biological parents. The genes carry information
that codes for various characteristics. The total
of all genetic material contained within a cell is
known as the genotype of that individual. The
total of all characteristics that can be observed
as a result of the actions of the genotype is called
the phenotype.
Each individual receives half of his or her DNA
from each parent. Some genes are said to be
dominant for a given characteristic; only one copy
of the gene needs to be present for the characteristic
to be evident. A good example of this would be
the gene that codes for facial dimples – only one
copy of the gene needs to be present for dimples to
be present. Other characteristics require the gene
to be present on each of the chromosomes. If only
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p35-42w48.indd 39
present on a single chromosome, the characteristic
will not be expressed. This means that the gene is
not activated and therefore the characteristic will
not be seen. These genes are therefore said to be
recessive. An example of a recessive gene would be
the gene that causes cystic fibrosis. If only one copy
of the gene is present then disease will not arise.
However, if two copies of the gene are present then
the person will have cystic fibrosis.
Genetic mutations
Each time a cell divides the DNA double helix
unwinds and each strand acts as a template for
the production of a new strand of DNA – DNA
replication. The enzyme DNA polymerase enables
this process. However, errors can occur during
replication. Some errors are of no consequence. For
example, ACC and ACG both code for threonine,
so if the third nucleotide ‘C’ is replaced by a ‘G’ the
end result would be the same. However, a different
error may lead to the failure of the gene to code for
a protein properly, such that the effectiveness of the
protein is reduced or it is not produced at all.
To minimise the number of errors that may
occur during replication, another enzyme, also a
polymerase, scans the newly replicated strand of
DNA for errors and corrects them. This reduces
significantly the number of errors that occur, but
does not eliminate them completely.
While some mutations are of no consequence,
others may lead to the cell functioning less
efficiently. If the mutation is severe enough the
daughter cell may not survive. Some mutations go
on to cause cancers. Carcinogens – environmental
agents that cause mutations in the DNA – also
cause cancer.
Mutations that occur in the formation of the sex
cells, gametes, can go on to cause genetic defects in
future generations.
Genetic disease
Several disorders result from the inheritance of
a faulty gene or chromosome. Table 1 highlights
some genetic and chromosomal disorders. It should
be noted that conditions such as hypertension,
coronary heart disease and diabetes involve the
complex interaction of several genes with a range
of environmental factors.
Gene therapy
Gene therapy is a form of treatment that aims to
correct the underlying genetic defect. Its potential
is still being explored in laboratory and clinical
trials. This technique may allow doctors to treat
 
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 TABLE 1
Examples of inherited disorders
p35-42w48.indd 40
Disorder Gene of chromosome involved
Haemochromatosis A mutation known as C282Y
of the HFE gene. Another
mutation, H63D, on the same
HFE gene can also cause
this disorder. It is autosomal
recessive.
Cystic fibrosis Mutation of the CFTR gene
40  august 1 :: vol 26 no 48 :: 2012
located on chromosome 7. It is
autosomal recessive.
Breast cancer Variations of the BRCA1,
BRCA2, CDH1, PTEN, STK11
and TP53 genes increase
the risk of developing breast
cancer.
Huntington’s disease Mutation of the HTT gene. It is
autosomal dominant.
Down’s syndrome Trisomy 21 – an affected
individual has three copies of
chromosome 21 instead of the
usual two. This accounts for
© NURSING STANDARD / RCN PUBLISHING
about 94% of all cases. Other
27/07/2012 12:21
Prevalence
One in 200 people in northern Europe
has haemochromatosis. More than one
in ten carries a single gene mutation
for this disorder.
Around one in 25 people carry a single
recessive gene for cystic fibrosis.
There are approximately 8,000 people
with cystic fibrosis in the UK.
An estimated 5-10% of all breast
cancers are hereditary.
It is estimated that 6,000-10,000
people in the UK have Huntington’s
disease. Approximately 3% of cases
have no previous family history of the
disease, which suggests that it has
arisen as a new mutation.
Affects about one in 1,000 infants
born in the UK each year. The
likelihood of having a baby with
Down’s syndrome increases with
maternal age.
Effect
Iron overload resulting in damage to a
wide range of tissues and organs, including
but not restricted to type 2 diabetes,
heart failure, arthritis, liver damage and
impotence.
Production of abnormally thick and sticky
mucus affecting primarily the respiratory
and gastrointestinal systems. This leads
to repeated chest infections, culminating
in respiratory failure. It also causes
malnutrition. Cystic fibrosis-related diabetes
may occur secondary to pancreatic damage.
Cancer.
This is a disorder of the central nervous
system affecting men and women. Onset is
usually between 30 and 50 years. Clinical
features include motor effects, diminished
cognitive function and mood changes. As
the disease progresses features may include
involuntary movements, difficulty in speech
and swallowing, and weight loss.
Characteristic facial appearance with small
ears, protruding tongue, small stature.
Heart defects, gastrointestinal problems,
constipation, thyroid problems as well as
hearing and sight difficulties.
Treatment
Regular venesection. Reduction
in the amount of iron ingested
in the diet.
A range of healthcare
professionals is involved
in caring for people with
cystic fibrosis. These include
Art & science life sciences: 3
physiotherapists to help clear
the chest of mucus and to
assist the person in taking
exercise. Dietitians assist
with maintaining adequate
nutrition. Drugs used include
bronchodilators and antibiotics,
DNase to help break down
mucus and pancreatic enzymes
to help with digestion.
A range of treatment options
are available for breast cancer.
Some women now choose
preventive mastectomy should
they have a gene for hereditary
breast cancer.
Symptomatic treatment,
for example speech therapy
to improve speech and
communication difficulties, and
a high calorie diet to prevent
weight loss.
N/A.
 types include translocation
p35-42w48.indd 41
of chromosome 21 where the
extra chromosome is attached
to another chromosome; and
mosaic Down’s syndrome
when only some of the cells in
the individual carry the extra
chromosome – these individuals
usually have a milder
presentation and account for
about 2% of all cases.
Retinoblastoma Mutations in the RB1 gene
cause most cases of
retinoblastoma. Approximately
40% of cases are germinal,
that is the mutation is present
© NURSING STANDARD / RCN PUBLISHING
in the sex cells, and is therefore
inherited. It is an autosomal
dominant condition.
Sickle cell anaemia Mutations in the HBB gene
cause a range of blood
disorders, including sickle cell
disease and beta thalassaemia.
It is an autosomal recessive
condition.
Muscular dystrophy Mutations in the DMD gene
on the X chromosome cause
Duchenne’s muscular dystrophy.
This is one of 20 different
forms of muscular dystrophy. It
is X-linked recessive.
august 1 :: vol 26 no 48 :: 2012  41 
(Adapted from the National Library of Medicine 2012)
27/07/2012 12:21
About 40-50 children develop
retinoblastoma each year in the UK.
More than 12,500 people in the UK
have sickle cell anaemia. People with
sickle cell anaemia are mostly of
African or Caribbean origin although
it can also affect those from Asia,
the Middle East and the eastern
Mediterranean. There are about
240,000 carriers (people who only
have one copy of the faulty gene) in
the UK. They are said to have sickle
cell trait.
One in 3,500 male births is at risk of
developing muscular dystrophy. There
are approximately 1,500 boys living
with the disease in the UK at any given
time.
Susceptibility to infection is also common.
Later in life, leukaemia and Alzheimer’s
disease are more prevalent. Individuals may
have moderate to severe learning disabilities.
Autistic spectrum disorders are more
common.
Visual defect may range from slight to
severe. Occasionally, surgical removal of the
eye is required. There is also an increased
lifetime risk of other cancers, notably
osteosarcoma, soft tissue cancers and
melanoma.
People with sickle cell anaemia have an
abnormal form of haemoglobin (HbS as
opposed to HbA) in their red blood cells.
This causes their red blood cells to assume
an abnormal shape and to be more rigid.
These cells can become lodged in blood
capillaries preventing oxygen from reaching
the tissues and causing damage and pain.
These cells also break up easily leading to
anaemia.
Characterised by progressive muscle
weakness in skeletal muscle. It may also
affect cardiac muscle leading to dilated
cardiomyopathy. Muscular atrophy is also
a feature of certain types of muscular
dystrophy.
Depending on location and
extent of tumour – cryotherapy,
laser therapy, radiotherapy and
chemotherapy may be possible.
There is no cure, but the
frequency and severity of
so-called sickle cell ‘crises’
can be reduced by prompt
recognition and treatment.
Regular checks should be
made to assess end organ
damage. Treatment can include
prophylactic antibiotics,
supplemental oxygen, and
pain-relieving measures
including analgesics. Anaemia
may require repeated blood
transfusions that can then
lead to iron overload. As iron
overload is toxic this must be
dealt with by administration of
an iron-chelating agent.
There is no cure for this
condition, but medication,
exercise and physiotherapy can
help in symptom management.
Physical aids can assist patient
mobility.
 Art & science life sciences: 3

POINTS FOR PRACTICE a disorder by inserting a gene into a patient’s

Consider the patients with whom you are currently working. Is there a
genetic component to any of their health problems? In what way does
this genetic element result in ill health?
What carcinogens might you be exposed to in your everyday life? What
cancers might they trigger? How might you lessen the risk?
Consider how you might use your knowledge and understanding of
genetics and inheritance in your everyday practice?
GLOSSARY
Autosome
Any chromosome other than a sex chromosome.
Chromosomes
Deoxyribonucleic acid (DNA) is packaged within the cell as a tightly
wound substance known as a chromosome. There are 23 pairs of
chromosomes in human body (somatic) cells and 23 chromosomes in
human sex cells or gametes.
Deoxyribonucleic acid (DNA)
A molecule which stores genetic information. It is located in the nucleus
of the cell although a small amount is contained within the mitochondria.
Gamete
This term refers to the germ cells or sex cells of an organism, for example
sperm cells in males and ova in females.
Genes
A section of DNA which codes for the production of a specific protein.
Meiosis
A form of cell division that produces daughter cells with only half the
number of chromosomes. Meiosis produces the sex cells, sperm and ova,
within the body.
Mitosis
A form of cell division where the parent cells replicate to produce two
daughter cells, which are genetically identical to the parent.
Ribonucleic acid (RNA)
Three molecules (mRNA, rRNA, tRNA) found in the cell which converts
the genetic information from DNA into a particular protein.
cells. Researchers are testing several different
approaches to gene therapy. These include:
Replacing
 the mutated gene with a healthy copy
of the gene.
Inactivating
 the gene that is functioning
improperly.
Introducing
 a new gene into the body to help
combat a specific disease.
Work is ongoing to make sure that such therapy
will be safe and effective.
Conclusion
Knowledge of genetics and inheritance is often
key to understanding how individuals become ill.
Several disorders have clear patterns of inheritance,
such as cystic fibrosis or haemochromatosis,
others such as coronary heart disease or diabetes
have a genetic element, but the way in which
the disease finds expression in any individual
is often complicated and varied. Genes also
interact in many instances with the environment
in which we live and as no two individuals live
in identical environments then this can also alter
the outcome of diseases with a genetic element.
An understanding of genetics can help healthcare
professionals communicate more effectively with
patients and assist in planning and delivering
appropriate care. In this article the authors have
tried to explain information in such a way to allow
the nurse to appreciate the complexity of genetics
and to apply that information to his or her area
of practice NS

References
Kumar P, Clark M (Eds) (2009)
Kumar & Clark’s Clinical Medicine.
Seventh edition. Saunders
Elsevier, London.
National Library of Medicine
(2012) Genetics Home Reference.
Your Guide to Understanding
Genetic Conditions. http://ghr.
nlm.nih.gov (Last accessed:
July 12 2012.)
Patton KT, Thibodeau GA (2010)
Anatomy and Physiology.
Seventh edition. Mosby Elsevier,
St Louis MO.
Saladin KS (2011) Anatomy and
Physiology: The Unity of Form and
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Hill, Boston MA.
Tortora GJ, Derrickson BH (2009)
Principles of Anatomy and
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Control Systems of the Human
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Tortora GJ, Derrickson BH (2012)
Essentials of Anatomy and
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Vanputte C, Regan J, Russo AF
(2009) Seeley’s Essentials of
Anatomy and Physiology. Seventh
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Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.