CORD: Care of the Geriatric Patient (videotape) Consultants: Mario Cornacchione, Margaret Slusser & Georgia Narsavage, 1996, Shavertown, PA: Geriatric Video Production, Incorporated, 30 minutes, $245
This videotape uses a case discussion to provide an overview of the care required by older adults with chronic obstructive pulmonary disease (COPD). Although described as a multidisciplinary approach, the primary audience is nurses. The program begins with a review of pathophysiology, and differentiation of the terms asthma, chronic bronchitis, and emphysema. A brief discussion of the resident's pulmonary examination and diagnostic findings follows with an explanation of the diagnostic implications of pulmonary function testing.
Although the authors present information regarding symptomatology, the information is limited. Physical assessment findings and clinical manifestations of the disease process could have been presented in greater depth. One segment of the video discusses nursing interventions and lists desired patient outcomes. There are helpful guidelines for improving airway clearance, interesting information regarding pulmonary rehabilitation, and a detailed "how to" description of diaphragmatic and pursed lip breathing. Components of care are highlighted, including smoking cessation, oxygen, nutrition, drug therapy, bronchodilators, anti-inflammatory therapy, mucolytics, expectorants, environmental considerations, and immunizations.
One area of concern, from an educational perspective, is the limited mention of cautious oxygen use in persons with emphysema. The authors comment that, it is "important to make sure that the patient's oxygen flow rate never exceeds that ordered by the physician." As thinking clinicians, nurses need to understand the clinical implications of high oxygen flow rates in persons with COPD. A discussion of the impact of long-standing hypercapnia would have been helpful. The fact that giving unspecified or unmonitored doses of oxygen may depress ventilation, cause apnea, or risk oxygen-induced hypoventilation is critical to know when caring for persons with COPD.
A nutrition segment presents pragmatic suggestions for dealing with the fatigue and dyspnea caused by eating, and introduces the topic of aerophagia. Drug therapy is discussed only briefly, although the information concerning bronchodilators and metered-dose therapy inhalers is very detailed. Antiinflammatory therapy, mucolytics, and expectorants are addressed briefly. The authors include a review of the symptoms and causes of acute exacerbations of COPD, with a brief overview of appropriate treatment.
A segment on end stage COPD explores the clinical and psychological issues encountered at this stage of the disease. The use of psychotropic drugs for older adults warrants further discussion than the information provided in the video. Some mention also needs to be made of the ability of narcotics, tranquilizers, and sedatives to depress the respiratory center. Clinicians need to be reminded of this when treating persons with chronic airway limitation.
The final topic of the video touches on ethical issues and terminal care. The authors present interesting predictors of mortality for the geriatric COPD patient which could be used as clinical criteria for end-of-life decision-making. These ethical issues could be a program in themselves. In fact, during the video, the audience is referred to a full video presentation on ethical issues related to advance directives.
As an educational tool, this program gains its merit from the use of a case study format for learners. It also provides pragmatic, easy-tounderstand information. The inclusion of a pre- and post-test provides the opportunity to establish knowledge competency. Continuing education credits are awarded. This video best meets the needs of the nurse generalist in providing a preliminary plan of care for the older adult with COPD. Further education would be needed for auscultation of breath sounds, clinical assessment of the person with COPD, and drug therapy.