A.D. Characterized by familial incidence?

be kept as comfortable as possible. SPEAKING OUT ON JOEL FREEDMAN, ACSW, VA Medical NASOGASTRIC FEEDING Center, Canandaigua, NY Institutionalized patients in advanced stages of mental and physical deterioration who are unable to swallow by ordinary means are kept alive by pass- FEEDBACK O N ing a nasogastric feeding tube through P L U S H A N I M A L S the nose, down the throat, and to the At a recent Journal Club meeting, I, Audrey Drake, presented the study of stomach. These tubes remain in place con- "Plush Animals--Do They Make a stantly and frequently cause gagging, Difference?" (GN, May/June 1986). ear aches, sore throats, bleeding, and This led to a lively and enthusiastic extensive ulceration of the digestive discussion of the study and its merits. Some participants were concerned tract. To alleviate such painful side effects, doctors recommend using softer, that giving plush animals to elderly smaller, more pliable tubes (sizes 5- persons would demean their dignity. 12). Here in New York, at the urging of Others countered with reports of midthe Medical Review Board of the State dle-aged friends who had their own Commission of Quality of Care for the Cabbage Patch Dolls and/or plush aniMentally Disabled and the two state mals. senators, the majority of New York's Methodological concerns centered psychiatric and developmental cen- around whether the positive changes ters are now using the smaller tubes or in psychosocial variables resulted another more humane alternative, the from the plush animal, or the party where the animals were distributed. gastrostomy. Several years ago, the U.S. Depart- Questions were also raised about the ment of Health and Human Services fact that all participants were wheeladvised, "We share your concerns chair bound. about potential problems with large What really excited our group, howdiameter tubes. We will, during our ever, was the serendipitous observaregular training programs, alert sur- tion that staff and residents who reveyors to these problems and to the ceived a plush animal seemed to interneed to be alert to the widespread and act m o r e positively and more freprolonged use of these tubes as a po- quently. This led to an intense discustential indicator of problems in quality sion of how to replicate the study in our setting. of care." We want to thank you for publishing Yet these problems persist. Far too often the use of the largest nasogastrie nursing research studies that report tubes (sizes 14-18) is standard proce- findings that are relevant, exciting, dure. Many patients are subjected to and creative for clinicians. KATHLEEN M. NEILL, RN, DNSc these tubes for months Or even years. AUDREY C. DRAKE, RN, MSN, The smaller tubes are more expenNursing Home Care Unit, Veterans sive and require additional stafftrainAdministration, Washington, D.C. ing and supervision when used. Some facilities just don't want to bother with gastrostomy procedures, even though a new gastrostomy procedure using fi- U S E C A R D I A C E M E R G E N C Y ber oPtic endoscopic methods elimi- D R U G S AS A G U I D E nates the need for a surgical incision I am concerned about Betsy Todd's arand general anesthetic. So "cost effec- ticle, "Update: Cardiac Emergency tiveness" often takes priority over hu- Drugs," which appeared in your Sepmaneness. And professionals who tember/October 1986 issue. In several instances, Ms. Todd made reference to know this is wrong fail to speak out. There are honest disagreements when a certain drug was to be used. about using any extraordinary devices The article was presented in a factual to prolong the lives of people in such manner, not allowing the naive reader poor health, but as long as we do use to believe these drugs can be given in a such measures, those affected should different sequence than that which was

presented. Additionally, when describing Verapamil, Ms. Todd indicated its use was for"supraventricular dysrhythmias such as ventricular tachycardia." Ventricular tachycardia originates in the ventricles and therefore is not a supraventricular dysrhythmia. If readers are relying on this informtion to base portions of their nursing practice, please inform them of these errors. MARY ANN KNIGHT, RN University of Missouri-Cohmzbia Hospitals attd Clinics Author's reply: The goal of that partic-

ular article was to update the general medical/surgical nurse's knowledge of critical care drugs. I emphasized that the principles I set forth were general guidelines only, and l agree that simple rules cannot apply in all circumstances. As with any drug, flexibility and individual assessment and monitoring are essentialfor the appropriate use of these drugs. Regarding your second point, it is certainly true that ventricular tachycardia is not supra ventricular! That phrase shouM read, "supraventricular dysrhythmias such as supraventricular tachycardia, ~"and we thank the other readers who picked up this typographical error. I apologize for any resulting confusion. Corrections appeared in the November/December issue. A.D. C H A R A C T E R I Z E D BY FAMILIAL INCIDENCE? Lest your readers be mislead: Dee Ann Gillies made the statement that "it's important to investigate the incidence o fAlzheimer's disease and Huntington's chorea in close relatives, since both disorders are characterized by familial i n c i d e n c e . . . " ("Patients Suffering Memory Loss Can Be Taught Self-Care," GN, SeptemberOctober 1986). Although a biological marker has been identified in Huntington's chorea, none has been found in Alzheimer's disease. In fact, the majority of individuals with presumptive A.D. are sporadic cases and only a small number of cases are classified as "familial." I agree that it is important to investiGeriatric Nursing January/February_J9877

LETTERS

Several investigators have suggested that causation ofAlzheimer's disease is multifactorial, involving a combination of hereditary and environmental factors (Breitner and Folstein, 1984; McLachlan and Lewis, 1985; Whalley Damascus, M D . Buckton, 1978). These references are pertinent: Author's reply:It is true that the exact Breitner, J. and Folstein, M., "Familcauses for Alzheimer's disease have not ial Nature of Alzheimer's Disease," yet been determined. However, several New England Journal of Medicine, researchers havefound that relatives of 1984, 311 (3), p. 192; Heston, L. and persons with proven Alzheimer's dis- Mastri, A., "'The Genetics of Alzheimease (revealing characteristic brain er's Disease:Association with Hematochanges on autopsy) demonstrate high- logic Malignancy and Down's Syner incidence ofA lzheimer's disease that drome, A rchives of General Psechiatre, do members of the general population 1977, 34, p. 976; Heyman, A., and oth(Breitner and Folstein, 1984; Heston ers, "Alzheimer's Disease: Genetic Asand Mastri, 1977; Heyman, and oth- pects and Associated Clinical Disorers, 1983). Apparently, the evidence for ders," Annals of Neurolog3,, 1983, 14 genetic causation of Alzheimer's dis- (5), pp. 507-717; McLachlin, D. and ease is strongest in patients with onset Lewis, P., "Alzheimer's Disease: Erof dementia before 55 years (Zarit, and rors in Gene Expression, '" Canadian. others, 1985). Journal of Neuroscience, 1985, 12, (1),

gate the incidence of A.D. in families in order to identify those who may be at greater risk, but let's not say that A.D. is characterized by familial incidence when it just isn't so! KATHLEEN MUSALLAM,RNC,

Circle

no. 2 on reader

8 Geriatric Nursing January/February 1987

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pp. 1-5; Whalley, L. and Buckton, K., "Genetic Factors in Alzheimer's Disease, "' Alzheimer's Disease: Earle Recognition of Potentially Reversible Defects edited by A. Glen and L. Whalley, New York: Churchill Livingstone, 1978, pp. 36-41; and Zarit, S. and others, The Hidden Victims ofAlzheimer's Disease: Families Under Stress, New York: New York University Press, 1985,pp. 13-14.

REPORT ON GERONTOLOGICAL NURSING CONFERENCE Often when we geriatric nurses meet colleagues with other specialties in the nursing profession, we find ourselves defending the importance of the geriatric nurse. Geriatric nurses frequently find themselves alone in the health care system. Nursing is a large field, and geriatrics has a bad reputation. On September 26, 1986, I attended the first annual Gerontological Nursing Conference in Washington, D.C. I am proud to say there were 850 geriatric nurses in attendance. The convention was two days long and included lectures by many of the most well known nursing leaders--from Dolores Alford to Mary Opal Wolanin--and topics ranged from pharmacological therapies, to urinary incontinence control, to advances in pain assessment and management, to name just a few. Nurses from every area (home care, LTC, hospitals) and every level (directors of nursing, nurse practitioners, staffnurses) were in attendance. It was wonderful to hear that 48 states were represented. John McConnell, president of NGNA, added to our enthusiasm when he announced that the organization had been founded in his living room two years ago by four nurses. The general public may not yet recognize the rapidly growing field of geriatric nursing, but let me be the first to tell you: This conference let me know I'm not alone. This is an area that is exciting, rewarding, and growing. Geriatric nurses are more than nurses in a field--we stand as a family.