Geriatric Clinical Protocols by L.J. Pearson and M.E. Kotthoff, Philadelphia, J.B. Lippincott Co.
This book of 590 pages is authored by a family nurse practitioner and an adult nurse practitioner with contributing authors who are geriatric nurse practitioners, family health practitioners, adult nurse practitioners, a sociologist, and an audiologist. It is organized in two units. Unit I includes protocols for seven "presenting complaints" of elderly persons. These are: acute monoand poly-articular pain, falls and hip injury, hearing deficit, urinary incontinence, urinary tract infections, peripheral edema, and skin diseases. Unit II includes protocols for chronic conditions common to the elderly. These are: constipation, depression, obesity, dementia, congestive heart failure, and hypertension.
Each protocol takes up an entire chapter. The following facets are included in each chapter: pathophysiology, conditions that cannot be missed when using the protocol, subjective data, objective data, rationale for collecting specific data, assessment section, and planning section. Model forms for collecting the subjective and objective data are included. There are no pictures, however there are several figures that help to explain such things as how to interpret an audiogram. Each chapter is ended with a reference list.
Each protocol is designed in the medical model. That is, the language is very medical: the protocol is designed for the nurse to end up with a medical diagnosis or conditions to be "ruled out" and the lab work to be ordered. The kind of drugs the client should receive are listed. Much detail is presented on various laboratory procedures; when to order them and how to interpret them. Much information on differentia] diagnosis is presented. The book could be used by physicians as well as nurses because the content includes more medical information than nursing information.
While the book is 590 pages in length, all pages are not full pages. Printing on most pages takes up only half the page longitudinally. The left half of the page contains the title of the condition, the laboratory work, anatomy, etc, being presented on that page. The right side of the page is written in narrative including many lists of pertinent data such as: subjective data, objective data, lab work, etc. The book is a reference text and may be used in ambulatory care clinics. It may have minimal use in nursing homes as it does not address the total patient; each protocol addresses one disease entity and it is not within the parameters of holism. The plan of care presented,, in most cases, is very brief and directed toward the nurse working with clients that she may see only on a one-time basis.
Ella Kick, RN, MSN