Caring for the older woman: Current topics in obstetrics and gynecology

ore sometimes invasive. that vimI testing wiil wovide mforkxpe~e, and, perhaps, painful. matior that sig&anhy adds to a From the #andmint of readabilitv. careful histologic analysis of th,? lethere is one &ous omission. P& sion. stgniftcance of WV DNA glossary exists for quick reference to in the absence of cytologic or h,stoterms that wrll be lessfamiliar to many I@ abnomv&ies is unknown” (page 219). They do make several simple clinicians. A clear understanding of fine distinctions in specific vocabulaw recanmr~dations to clinicians. &r for vtrolcgy and pathology is essential example, use of the cytobrush to address the fundamental weakness of to understanding this highly specialized bwk. ‘lo the nonspecialist. this false-negativecytology smears. In summay, this reviewer recomreviewer would susst having a medicaldictionarynearbywhile readmends this book as an avalable refing. Although the titing is often quite erence text for any clinician involved in th 1 managementof pahenk with technical,usually there. is clarity. OcHPV. The individual clinicianwithout casionallapses into excessively cumready accessto an extensive medical bersome verbiage can be found: for example,“Moreover, this dichotomy library is continually challenged to mav be awrectated at the molecular evaluate acceptedPrentice standards &I, be&we lesion groups that can ultbout the benefit of criacally examining the derivation of such pracbe distinsuished bv biolwkal fin&ding &pholo&l or &phomtices This baok is an excellent reebic) parameters generally associate source that will encourage such a ctitique of clinical practiceand allow with different HPV tvpes” cliniciansto examine carefully the reAlthough the authors do an excellent job of revieu;.ng and summatilationship of an extremely prevalent sexuatly transmitted YINS and :ts rote ing relevant literature, there is no real in the development of genital neoattempt et meta-zwziyds. As a result, the rader is oc&onaUy confused PIesme. about how to interpret seemingly contradlckxy results. Research techREFERENCE niques are seldcm cited, and methcdolcgtes are generally not titiqued. 1. ‘&xl CL. Laryngeal pap,llamas in infantsand children.relationshipto mathe asociaternalvenerealwar@ J Nurse Midwfer, tion between WV and laryngeal pap1991; 3&297302. Ufomasin the pedtabic population recentfy (1). this ,tiewer read the caring for the Older Woman: CUP chapter on “Papibmavlms fnfec. rent Topics in Obstetrks and Gyna tio& in the Pedtthic Population” with co@,. Edited bjr Morton A. Steagreat interest. ft was with relief that chever and George A. Aagaard. New reviewerno&d the concurrence York: FJseCer, 1991. 230 pa*. of these two experts with so many of $59.00. hardcover. her own opinions. In addkkm to spetific epidemic!c& details, a tief Reviewed by: Jeanne L. Brinkley, 0ve~Iew of the significance of sexa-m MPH, cansdhnt. Eastern uaflv transmitted disease In children Sbors Re+n. Maryland Dee;urtment k presented as a context for dtagwis of Health and Mental t!ygiene. Raand treatment. timore. :&yland. Although these authors are clearly both fam&r end comfortablewith the The editors state that this book “IS level of technolw that has brought designedto r&e issues of current inti typing to its present degree of terest to obst&icians and gynemlo spectficity, they do not support the @a and o&r physicians and profesuse of technology for its wm sake: sionais involved in the care of “However, there is no clear evidence

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women.” Thq further addthat to care properly for wcmlen as they age “physicians. must learn to pdodU7.ehealth &sues impor%mt to this cfass of women.” In this reviewer’s opmion, the editors have done a fine jab of prioriting the placement and organization of chapters, as well as the content and length of chapters throughout the book. The final sentence of the preface sums up the edit& atttb.& toward the okler woman: “Older women deserve excellent and sped&id care POthat they may eontinue to enjoy fife to the fullest measure of their physic-4 and emotional capabilities.” The editors dacdbe themselves as ewedenced mactitioners in the care of older women; one is a gynecolc& (Stenchever) and the other is an internist IAacwd) with a cavp9r interest m hywtenskm and its b~&ment. Thebookcontains Eshoti- !:sven pages) to modemto- i&3 pages) length chapters. It begins with an intrcduction 0” the role of the yynecoto!& in which the.at&a notesiha~ in many cases, nurse clinicians will be able to address many of the c:iant’s needs. as weU. It then continues through the epidemtolosy of aging and ends with five chapters disu&ng specific direa5e states. The second chauter is a discussion of ethical issues and the geriatr:c patient Thii chatier is one of the best in the Lwoh Tfie authors, Jecker and Jonsen, discuss how to work through ethical dilemmas or qwstions by exam!nim wwsite o* comwthw ethical pdnciples. For read& tiih minimal understandins of p~I:nci~fesof ethics. the case dkcuslons are clea:, informatie. and easy to understand. The authors examine how attitudes of both physictans and patients toward r&g have a “pernicious influence on clinical decisions ” They also explore and discuss the ethiil implications of negative conceptions of the elderly, ageism, and age&t attitudes. These are the only authors listing any references from the nudng Utelatwe.

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The chapter on the biology of aging discussesa vartety of theoties The reader is encouraged to think in terms of multiple processes of aging rather than one single mechanism. Throughout the first half of this book. the reader is remtnded IO individualiie care. There is repeated emphasis to personalize plans of care based on each ciient’s medical. social. .md emotional needs, as weli as the reminder that old age Is otten associated with Ionelin&,

economic dep-

livatton, and social isolation. This re-

viewer wishes that these sentiments were repeated more often throughout the later chapters dealing with the very technical aspects of managting ~yoecdogic m&@a”d-. Instead, the reader finds phrases such as “the managemert of :~rurren2 diseaa mu?t be taken in the context of tine of stitival and quality of life.” OrBe is left to wonder, who is it that determines quality? The chap:eron “Preventive He& Care of Older Women” 1s an excellent application of elder care to basic epidemiology This chapter, as well as the one on pharmacothempeutks, contiins useful information for both clients an-I providers. This reviewer found th- “Practical Sugee*tions for Opbmal Drug Therapy in Older Women” to be a wondelful piece of basic cormnon sense; for example, “give the patient written inshucttons, txy to fit the drug treatment plan into the patient’s daily schedule, prescribe a drw

o&J if there is a clear need ”

There-Is a!&a sample

“Annual Kealth Questionnaire” that includes questions on almost all relevant topics. Unfortunately, the only reference lo sexuality in thii questionnaire is the “yes or “no” au&on that asks the dientwhether o; she has had my sfxmlly transmitted diseases.This reviewer would add questions that permit clients to discuss thci: sexuzi activlty and their level of satisfactton. The chapter on hypertension is complete and well documenred, and it contains useful information. After

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the documentatton of the dtagnosis. the initial recommendations for treatment include weight loss, salt resbtcBon, and Inaeased recreational exerctse rather than cm immediate mhaaon of medeahon. Udnary incontinence and loss of pelvic support are discussed in separate chapters, both of which lean toward the technlcal aswzcb of treatment In his chapter on genitounnaty changes and incontinence, Stenchev& supports using the combination of Kegel exerdses and estrogen replacement as a treatment for milder fomls of genuine stxss incontinence. This reviewer Is pleased that Kegel’s work is discussed and referenced and that = pr*c*ce CNMS ~“erally encourage and see work 1s recommended. The final chapter addresses the issue of hormone replacement therAmy. The author dexribes rneno~aususe, the effects of estrogen withdrawal on all organ systems. and the philosophy of &ro+r, replacement, including related problems. He afw, discusses other therapies; however, all of these additional therapies are prescription dogs. Thts revtewer recommends this book as a useful addition to thz mussrnid;uib’s libray. All of the chapters are well referenced with current dtations. The tables are readable and the line drawings are excellent. The few cri~cisrm discussed above do not detract from the positive aspeck of this text. Although the entire volume is recommended: the chapters of special interest to the CNM include the ones on ethical kaues, preventive health care, biology of the aging woman, and pharmacothempsutics.

Clinical OB/GYN and Reproductive S&x~car. Universitv of Texas Health Science t&tar at Houston, Houston, Te%Zls. Barbara Bates’ textbook has become s:andard reading for most programs teaching physical assessment&Us, and it is a wonderful reference book as well. As with previous editions. the first three cha;teers cover how to obBin a history. how to approach syrnptarns.and assessme”iof me!&! stahis. Next, separate chapters review each body re@on and system, including the anatomy and physiology, techniques of examinatton, and abnormalities for each. The last chapters assist ths

A Guide to Pb~sical Examhmiton and History Taking. Rftii Edition. By Barbara Bates. Philadelphia: J. B. Lippincott. 1991.714pages. $44.95, hardcover. Reviewed

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thinking and documentation. How to manage data. formulate assessmenh, and organize the Information in a logical format is included. ThereisalsoachaPteronthephysicai examination of infanb and children. A new chapter has been added to thii edition. It is entitled “The Pregnant Woman” and is authored by Joyce Thompwn. CNM. LXPH. Like other chapters, this one be(pns with basic anatomy and physiology, revtews sign&ant historical information to be obtained, and then desutbes techniques of examination of a pregnant woman. A tabie is included that lists common complain6 of pregnancy and an explanation of their etloloyy. In the techniques of examination ~;rrt, each L&y synem is reviewed. Normal chanqes at various gestationa ages and some common abr~ornmlities are emphasized As would be expected, more emphasis is placed on abdominal and pelvic a$Sessrnent. Dr. Thomrrson exnlains that the purpose of t&s chapter ir to as&t the primary health care provider with an initial assessment of the pregnant woman. It is not the author’s intent to provide enough rnformalon for a month by month assessment throughout a pregnancy. However, because the initial assessment may clittcJ

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Vol. 37, No. 1, JanuurylFebmary 1992