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With the continued rapid growth of the older adult popu-
lation, there remains an increased demand for health-care
providers to deliver age-specific care and direct disease man-
agement. Advanced Practice Nursing in the Care of Older Adults
will serve as a guide for advanced practice nurses who are
privileged to provide care to older adults. Designed as a text for
students, as well as a reliable source of evidence-based prac-
tice for advanced practice nurses, this book contains informa-
tion on healthy aging, comprehensive geriatric assessment,
and common symptoms and illnesses that present in older
adults. Given the complexity of prescribing for older adults
taking multiple medications, a new chapter on polyphar-
macy is included. The book concludes with a chapter on care
delivery for patients with chronic illnesses who face end-of-
life care.
Throughout the book, case studies are included to provide
further practice and review. An important feature of this
book is the use of the Strength of Recommendation Taxon-
omy (SORT) [Ebell, M. H., Siwek, J., Weiss, B. D., Woolf, S. H.,
Susman, J., Ewigman, B., & Bowman, M. (2004). Strength
of recommendation taxonomy (SORT): A patient-centered
approach to grading evidence in medical literature American
Family Physician, 69(3), 548–556], which provides a direct
reference to evidence-based practice recommendations for
clinicians to consider in the care of older adults.
In Unit I, “The Healthy Older Adult,” the first chapter,
“Changes with Aging,” addresses the normal changes of
aging, expected laboratory values in older adults, presen-
tation of illness, atypical disease presentation, bimodal
conditions, and the impact of chronic illness on functional
capacity. In the second chapter, “Health Promotion,” updated
information pertaining to health promotion and disease pre-
vention strategies for older adults from Healthy People 2020
and the U.S. Preventive Services Task Force (USPSTF) is pro-
vided, including an immunization schedule and information
on the Welcome to Medicare Visit. Also covered is an over-
view of physical activity, sexual behavior, dental health, and
substance use, as well as a section pertaining to the older
traveler. Recommendations for exercise and safe physical
activity are provided in this unit.
Unit II, “Assessment,” opens with a detailed chapter on
comprehensive geriatric assessment. Information on phys-
ical, functional, and psychological health is delineated, and
information on quality of life measures is included. Next is
the fifth chapter, “Symptoms and Syndromes,” which pro-
vides the clinician with a concise description of more than 20
symptoms prevalent in older adults. A rapid reference detail-
ing common contributing factors and associated symptoms
and clinical signs that should be worked up for each present-
ing condition is included. Recommendations for diagnostic
Preface
tests with accompanying results are used to form a differen-
tial diagnosis.
Unit III, “Treating Disorders,” provides 11 chapters of
concise, updated information pertaining to disease manage-
ment of illnesses common in older adults, presented by body
systems. Each chapter opens with an assessment section that
provides the reader with a focused review of systems and the
physical examinations needed to obtain pertinent informa-
tion for diagnosis and treatment of the older adult. Signal
symptoms indicating atypical presentation of illness are
highlighted at the beginning of each condition. The discus-
sion of each problem and disorder follows a consistent mono-
graph format:
■ Signal symptoms
■ Description
■ Etiology
■ Occurrence
■ Age
■ Ethnicity
■ Gender
■ Contributing factors
■ Signs and symptoms
■ Diagnostic tests
■ Differential diagnosis
■ Treatment
■ Follow-up
■ Sequelae
■ Prevention/prophylaxis
■ Referral
■ Education
Unit IV, “Complex Illness,” addresses complex manage-
ment of patients requiring chronic illness management, pal-
liative care, and supportive care at end of life, and includes a
new chapter on polypharmacy. The text concludes with two
appendices—“Physiological Influences of the Aging Process”
and “Laboratory Values in the Older Adult”—both of which
are ready references for the busy practitioner.
In addition to the content of the book, a Bonus Chapter,
Nutritional Support in the Older Adult, selected Refer-
ences, and other online resources to aid the user in practice
and review of the key concepts are available at DavisPlus.
Case studies are provided to support critical thinking and
are available for users to complete on their own or for edu-
cators to incorporate into their course requirements. To
enhance the delivery of competency-based education, the
case studies were mapped to the Adult-Gerontology Primary
Care Nurse Practitioner Competencies (2016).
For the faculty, there are PowerPoint presentations
and a well-developed test bank located on DavisPlus. The
vii
viii Preface
Active Classroom Instructors’ Guide is an online faculty
resource that maps the resources available with the text and
includes lecture notes and additional case studies.
This book is written by and for advanced practice nurses
involved in the care of older adults across multiple settings of
care. While intended as a guide for the management of care
for older adults, clinicians are encouraged to deliver individ-
ualized, patient-centered care considering the latest clinical
practice guidelines on prevention and management of condi-
tions common in older adults.
REFERENCE
National Organization of Nurse Practitioner Faculties. (2016). Adult-
Gerontology Acute Care and Primary Care Nurse Practitioner com-
petencies. Retrieved from http://c.ymcdn.com/sites/www.nonpf.org/
resource/resmgr/competencies/NP_Adult_Geri_competencies_4.pdf.
 Contributors

Sue A. Anderson, PhD, RN, FNP-BC Lisa Byrd, PhD, FNP, GNP, FAANP
Associate Professor, Family Nurse Practitioner Practice Administrator
Program Coordinator Florida Health Care Plans
Saint Mary’s College Nurse Practitioner, Assistant Professor
Notre Dame, Indiana University of South Alabama
Epistaxis; Rhinitis; Asthma Lake Mary, Florida
Bowel Incontinence; Diarrhea; Fatigue; Urinary Incontinence;
Louann Bailey, CRNP Wandering
Nurse Practitioner
Inpatient Medical Services Carol Calianno, RN, MSN, CWOCN, CRNP
Akron, Ohio Nurse Practitioner – Dermatology and Wound Ostomy
Chest Pain Continence Specialist
Philadelphia VA Medical Center
Tracy Ballard, MSN, GNP-BC Philadelphia, Pennsylvania
Nurse Practitioner Skin Cancer
Optum
Greensboro, North Carolina Christina Coletta-Hansen, MSN, ANP-BC, ACHPN
Gastroenteritis Palliative Care Nurse Practitioner
Einstein Medical Center Montgomery
Judith A. Berg, PhD, RN, WHNP-BC, FAANP, FNAP, Norristown, Pennsylvania
FAAN Palliative and End of Life Care
Clinical Professor
The University of Arizona College of Nursing Kristin R. Curcio, DNP, AGPCNP-BC, AOCNP
San Diego, California Nurse Practitioner
Atrophic Vaginitis; Breast Cancer Cone Health Cancer Center at Wesley Long
Greensboro, North Carolina
Sharon Biby, MSN, APRN, ANVP-BC, AGPCNP-BC Lung Cancer; Bladder Cancer; Liver Cancer; Brain Tumor;
Nurse Practitioner, Advanced-Practice Stroke Nurse Pancreatic Cancer
Cone Health
Greensboro, North Carolina Nancy Dirubbo, DNP, FNP-BC, FAANP, Certificate
Stroke in Travel Health
Director
Anna Wentz Boone, PhD, ANP-BC Travel Health of New Hamsphire, PLLC
Adult Nurse Practitioner Laconia, New Hampshire
Rockingham Gastroenterology, Cone Health Medical Travel and Leisure
Group
Reidsville, North Carolina Brenda L. Douglass, DNP, APRN, FNP-BC, CDE,
C. Difficile; Cholecystitis; Peptic Ulcer Disease; Gastritis CTTS
DNP Program Director, Assistant Clinical Professor,
Angela Brown, DNP, FNP-BC, ANP-BC, CDE Family Nurse Practitioner
Clinical Assistant Professor, Family Nurse Practitioner Drexel University
University of Arizona Philadelphia, Pennsylvania
Tucson, Arizona Chronic Obstructive Pulmonary Disease
Cellulitis; Hearing Loss

ix
x Contributors

Janet DuBois, DNP, APRN, FNP-BC, FAANP, FNAP Debra A. Friedrich, DNP, FNP-BC, CLS, BC-ADM,
Associate Professor FNLA, FAANP
Loyola University New Orleans Diplomate, Accreditation Council for Clinical
New Orleans, Louisiana Lipidology
Pneumonia; Upper Respiratory Tract Infection Assistant Professor
University of South Florida College of Nursing
Kristen Tomblin Duffy, CRNP Tampa, Florida
Nurse Practitioner Hyperlipidemia
Lehigh Valley Health Network
Allentown, Pennsylvania Cynthia Gerstenlauer, ANP-BC, GCNS-BC, CDE,
Dysphagia; Hematuria CCD
Nurse Practitioner
Renee E. Edkins, DNP, ANP-C, Fellow, American Troy Internal Medicine
Society of Lasers in Medicine & Surgery Troy, Michigan
Director Laser Surgery Program, UNC Division of Osteoporosis
Plastic & Reconstructive Surgery, Medical Laser
Safety Officer Larry Ryan Gibson, MSN, AGNP-C
University of North Carolina, Department of Surgery Nurse Practitioner
Chapel Hill, North Carolina Alliance Urology Specialists
Burns Greensboro, North Carolina
Cystitis
Vaunette P. Fay, PhD, RNC, FNP, GNP
Director, Continuing Education; Lead Nurse Planner; Eric Gill, DNP, AGNP-C
Professor of Nursing Nurse Practitioner
The University of Texas Health Science Center at Rockingham Gastroenterology Cone Health Medical
Houston, Cizik School of Nursing Group
Houston, Texas Reidsville, North Carolina
Dehydration; Pruritus Cirrohsis; Esophagitis; Gastroesophageal Reflux Disease; Irritable
Bowel Syndrome; Acute Pancreatitis; Chronic Pancreatitis
Carrie Fernald, DNP, AGPCNP-BC
Nurse Practitioner Mary Jane Griffith, RN, MSN, GNP-BC, ACHPN
PACE of Triad Nurse Practitioner
Greensboro, North Carolina LTC Health Solutions
Joint Pain; Osteoarthritis Columbia, South Carolina
Palliative and End of Life Care
Diana Filipek-Oberg, RN, BSN, MSN, AGACNP-BC
Surgery APN Mary Guhwe, DNP, FNP-BC, SCRN
Cooper University Hospital Nurse Practitioner
Camden, New Jersey Duke University Hospital
Clinical Adjunct Faculty Durham, North Carolina
Drexel University Dizziness
Philadelphia, Pennsylvania
Chapter 7 Case Study; Assessment of the Respiratory System; Candace Currie Harrington, PhD, DNP, APRN,
Chapter 8 Case Study AGPCNP-BC, CDP
Clinical Professor
Nancy A. Fisher, RN, MSN, GNP-BC East Carolina University
Nurse Practitioner, Rheumatology Greenville, North Carolina
Cleveland Department of Veterans Affairs Heart Failure
Cleveland, Ohio
Gout; Rheumatoid Arthritis Melodee Harris, PhD, APRN, GNP-BC, AGPCNP-BC
Assistant Professor
University of Arkansas for Medical Sciences College of
Nursing
Little Rock, Arkansas
Delirium; Dementia
 Contributors xi

Theresa C. Hollander, CRNP Donna Behler McArthur, PhD, FNP-BC, FAANP,

Nurse Practitioner FNAP
Jefferson Health Adjunct Clinical Professor
Abington, Pennsylvania Vanderbilt University School of Nursing
Ischemic Heart Disease University of Arizona College of Nursing &
Department of Neurology, College of Medicine
Shelly Jesberger, MSN Tuscon, Arizona
Nurse Practitioner Headache; Seizure Disorders
Veterans Health Administration
Cleveland, Ohio Sincere McMillan, ANP-BC
Hemoptysis Nurse Practitioner
Memorial Sloan Kettering Cancer Center
Carol G. Kelley, PhD, AGPCNP-BC New York, New York
Associate Professor Colorectal Cancer
Frances Payne Bolton School of Nursing, Case
Western Reserve University Laurie Lovejoy McNichol, MSN, RN, CNS, GNP,
Cleveland, Ohio CWOCN, CWON-AP, FAAN
Falls Clinical Nurse Specialist, WOC Nurse
Cone Health
Nanette LaVoie-Vaughan, ANP-C, DNP Greensboro, North Carolina
Nurse Practitioner Pressure Injuries
Geriatric Neuropsychiatry Services
Raleigh, North Carolina Jennifer Mondillo, MSN, MBA, CRNP
Agitation; Constipation; Failure to Thrive Clinical Instructor
Villanova University
Sheree L. Loftus, PhD, MSN, APRN-BC Villanova, Pennsylvania
Nurse Scientist Assessment of the Cardiovascular System
Mount Sinai Union Square
New York, New York LaTroy Navaroli, DNP, FNP-BC, CWS
Investigator Nurse Practitioner Would Specialist
CHEAR Center Navaroli Medical
Bronx, New York Warren, Pennsylvania
Parkinson’s Disease; Restless Legs Syndrome Oral Nutritional Supplementation

William J. Lorman, JD, PhD, MSN, PMHNP-BC, D. Che Navey, A-GNP, MSN, RN
CARN-AP Neurohospitalist, Advanced Practice Clinician
Vice President & Chief Clinical Officer Novant Health Presbyterian Medical Center
Livengrin Foundation Charlotte, North Carolina
Bensalem, Pennsylvania Tremor
Alcohol Abuse; Prescription Drug Abuse
Olivia Faith Ogburn, AGPCNP
Denise Lucas, PhD, FNP-BC, CRNP, FAANP Nurse Practitioner
Chair, Advance Practice Programs Gastroenterology Oncology Clinic
Duquesne University Wake Forest Baptist Medical Center
Pittsburgh, Pennsylvania Winston Salem, North Carolina
Benign Prostatic Hyperplasia; Drug-Induced Impotence; Prostate Gastric Cancer
Cancer; Prostatitis
Loretta Phillips, RN, NP-C, APRN, BC
Rhonda W. Lucas, MSN, AGNPC Nurse Practitioner
House Calls Provider Capital Nephrology Associates
Optum Raleigh, North Carolina
United Healthcare Acute Kidney Injury; Chronic Kidney Disease
Reidsville, North Carolina
Herpes Zoster
xii Contributors

Sabrina Pickens, PhD, RN, ANP-BC, GNP-BC
Assistant Professor – Tenure Track, Faculty
University of Texas Health Science Center at Houston
Cizik School of Nursing
Houston, Texas
Elder Abuse
Allen V. Prettyman, PhD, FNP-BC, FAANP
Associate Professor – College of Nursing
University of Arizona
Tucson, Arizona
Pulmonary Tuberculosis
Catherine R. Ratliff, PhD, GNP-BC, CWOCN, CFN
Nurse Practitioner/Clinical Associate Professor, School
of Nursing
University of Virginia Health System
Charlottesville, Virgina
Peripheral Vascular Disorders
Susan D. Ruppert, PhD, RN, FNP-C, ANP-BC, FNAP,
FCCM, FAANP, FAAN
Professor, Associate Dean of Graduate Studies
Cizik School of Nursing at The University of Texas
Health Science Center at Houston
Houston, Texas
Anemia of Chronic Disease; Anemia; Iron Deficiency
Valerie K. Sabol, PhD, ACNP-BC, GNP-BC, ANEF,
FAANP
Professor and Division Chair, Healthcare in Adult
Populations
Duke University School of Nursing
Adult Acute Care & Gerontology Nurse Practitioner
Department of Medicine, Division of Endocrinology,
Metabolism and Nutrition
Duke University Medical Center
Durham, North Carolina
Obesity

Barbara Reall, MBA, MSN, CRNP Susan Kate Sandstrom, MSN, APRN-BC, ADCN
Senior Clinical Services Manager Nurse Practitioner
Optum University Hospitals, Seidman Cancer Center
Horsham, Pennsylvania Cleveland, Ohio
Hypertension Oral Cancer

Luann Richardson, PhD, DNP Jennifer Serafin, RN, BSN, MS, GNP-BC
Associate Professor Nurse Practitioner
Robert Morris University Kaiser Permanente
Moon Township, Pennsylvania South San Francisco, California
Anxiety; Bipolar Disorder Endometrial Cancer; Ovarian Cancer

Lauren Robbins, DNP, APRN, GNP-BC Terri Setzer, NP-C

Nurse Practitioner Nurse Practitioner
Atlanta VA Healthcare System Reidsville Clinic for GI Diseases, Cone Health Medical
Decatur, Georgia Group
Bowel Obstruction Reidsville, North Carolina
Nonalcoholic Fatty Liver Disease
Mary Ellen E. Roberts, DNP, APN-c, FNAP, FAANP,
FAAN Kate Sheppard, PhD, RN, FNP, PMHNP-BC, FAAN,
Director – Doctor of Nursing Practice Program FAANP
Seton Hall University Clinical Associate Professor, Retired
South Orange, New Jersey PMHNP Specialty Coordinator
Cardiac Arrhythmias; Myocardial Infarction University of Arizona, College of Nursing
Tucson, Arizona
Barbara Rogers, CRNP, MN, AOCN, ANP-BC Depression
Nurse Practitioner
Fox Chase Cancer Center Tracey Sherrod, MSN, ANP-C, GNP BC
Philadelphia, Pennsylvania Adult and Gerontological Nurse Practitioner
Leukemias Vidant Healthplex
Wilson, North Carolina
Nephrolithiasis
 Contributors xiii

Carroll M. Spinks, GNP-BC Jennifer L. Warren, MSN, NP-C

Nurse Practitioner Nurse Practitioner
Triad HealthCare Network Anticoagulation Clinic
Greensboro, North Carolina Wake Forest Baptist Health
Corns and Calluses High Point, North Carolina
Pulmonary Embolism
David V. Strider, DNP, MSB, APRN, CCRN, ACNP-BC
Nurse Practitioner, Clinical Assistant Professor of Tomika Williams, PhD, AGPCNP-C
Nursing Assistant Professor of Nursing
University of Virginia School of Nursing East Carolina University
Charlottesville, Virginia Greenville, North Carolina
Peripheral Vascular Disorders Malnutrition

Ladsine Taylor, MSN, GNP-BC Colleen Wojciechowski, MSN, GNP-BC

Gerontology Nurse Practitioner Nurse Practitioner, Retired
Bill Hefner VA Medical Center Community Living Veteran Administration Durham Health Care System
Center Cary, North Carolina
Salisbury, North Carolina Cough
Peripheral Neuropathy
M. Catherine Wollman, DNP, GNP-BC, CRNP
Barbara A. Todd, DNP, CRNP, FAANP, FAAN Consultant
Director, Graduate Nurse Education Demonstration Ponte Vedra, Florida
Hospital University of Pennsylvania Chronic Illness and the APRN
Philadelphia, Pennsylvania
Valvular Heart Disease

Renee Walters, PhD, RN, CCRN, FNP-BC

Clinical Operations Manager, Clinical Associate
Professor
Boise State University
Boise, Idaho
Restrictive Lung Disease; Immune Thrombocytopenic Purpura
 Reviewers

Wendy Biddle, CFNP Valerie Flattes, APRN, MS, ANP-BC

Program Director MSN-FP program Assistant Professor
South University University of Utah
Savannah, Georgia Salt Lake City, Utah

Joan Blum, MSN, APRN Stacy Harris, DNP, APRN

Assistant Professor Graduate Program Coordinator, Assistant Professor
Clarkson College University of Central Arkansas
Omaha, Nebraska Conway, Arkansas

Sharon Chalmers, PhD, CNE, APRN, FNP-BC Ann McDonald, DNP, MSN
Professor of Nursing Assistant Professor
University of North Georgia Western Carolina University
Dahlonega, Georgia Cullowhee, North Carolina

Claudia M. Chaperon, PhD, RN, APRN, BC Clarice Wasmuth, MSN, NP

Associate Professor Professor
College of Nursing Georgia State University
University of Nebraska Medical Center Atlanta, Georgia
Omaha, Nebraska

xv

The second edition of this book would not be a reality if
not for the kind assistance and guidance of some wonderful
people whom we would like to thank. To Susan R. Rhyner,
our Senior Acquisitions Editor, who believed in the timeli-
ness of updating this edition given the impact that the APRN
consensus model for advanced practice registered nurses has
on nursing education and practice with the required inclu-
sion of gerontology and geriatrics for all advanced practice
nurses taking care of older adults. To Christine M. Abshire,
our Senior Content Project Manager, who kept us on track
and provided us order. To Teresa Wilson for your quick turn-
around editing and to Sharon Y. Lee, Daniel Domzalski, and
Acknowledgments
crew for carrying us over the finish line, without which we
would not have completed the charge. To Ashleigh Lucas,
Amy Daniels, and Tyesha Harvey who assisted in informa-
tion retrieval, thanks for your timely research. We are most
appreciative to our dedicated contributors who believe in the
importance of creating a reference specific to the care of older
adults written by advanced practice registered nurses. We
also would like to acknowledge those who have contributed
to our previous books. We especially want to thank Kathleen
Ryan Fletcher for being a part of the journey over the past
20 years; your expertise and dedication to advanced practice
gerontological nursing will not be forgotten.
xvii
 Contents in Brief

Unit I 12 Musculoskeletal Disorders 305

The Healthy Older Adult 1 13 Central and Peripheral Nervous System

Disorders 328
1 Changes With Aging 2
14 Endocrine, Metabolic, and Nutritional
2 Health Promotion 6 Disorders 361
3 Exercise in Older Adults 19 15 Hematological and Immune System
Disorders 407
Unit II 16 Psychosocial Disorders 428
Assessment 25
4 Comprehensive Geriatric Unit IV
Assessment 26 Complex Illness 469
5 Symptoms and Syndromes 34 17 Polypharmacy 470
18 Chronic Illness and the APRN 474
Unit III
19 Palliative Care and End-of-Life
Treating Disorders 95 Care 485
6 Skin and Lymphatic Disorders 96
appendix A Physiological Influences of the
7 Head, Neck, and Face Disorders 127
Aging Process 499
8 Chest Disorders 152
appendix B Laboratory Values in the Older
9 Peripheral Vascular Disorders 215 Adult 505
10 Abdominal Disorders 225
11 Urological and Gynecological
Disorders 280 Index 507

xix
 Psychological Health 31
Unit I
Socioenvironmental Supports 32
The Healthy Older Adult 1 Quality of Life Measures 32
CHAPTER 1 Changes With Aging 2 Summary 32

Fundamental Considerations 2 CHAPTER 5 Symptoms and

Physiological Changes With Aging 2 Syndromes 34
Laboratory Values in Older Adults 3 Assessment 34
Presenting Features of Illness/Disease in the Older Bowel Incontinence 34
Adult 3 Chest Pain 38
Chronic Illness and Functional Capacity 5 Constipation 41
Summary 5 Cough 43
CHAPTER 2 Health Promotion 6 Dehydration 46
Diarrhea 47
Primary, Secondary, and Tertiary Prevention 7
Dizziness 51
Healthy Lifestyle Counseling 7
Dysphagia 53
Screening and Prevention 9
Falls 55
Immunizations 12
Fatigue 57
Travel and Leisure 12
Headache 59
Summary 17
Hematuria 63
Case Study 17
Hemoptysis 65
CHAPTER 3 Exercise in Older Adults 19 Involuntary Weight Loss 67
Available Resources 19 Joint Pain 72
Barriers and Facilitators to Exercise for Older Peripheral Edema 74
Adults 20 Pruritus 77
Plan for Incorporating Exercise into Patient Syncope 78
Encounter 20 Tremor 81
Key Guidelines for Safe Physical Activity (Physical Urinary Incontinence 83
Activity Guidelines Advisory Committee,
Wandering 88
2008) 21
Case Study 90
Summary 22
Case Study 23
Unit III
Treating Disorders 95
Unit II
CHAPTER 6 Skin and Lymphatic
Assessment 25
Disorders 96
CHAPTER 4 Comprehensive Geriatric Assessment 96
Assessment 26 Burns 97
Physical Health 26 Cellulitis 103
Functional Health 30 Corns and Calluses 104

xxi
xxii Contents

Herpes Zoster 106 Peripheral Vascular Disease 219

Pressure Injuries 109 Venous Disease (Chronic Venous Insufficiency) 221
Psoriasis 113 Case Study 223
Skin Cancer 117
CHAPTER 10 Abdominal Disorders 225
Superficial Fungal Infections 120
Case Study 125 Assessment 225
Acute Kidney Injury 226
CHAPTER 7 Head, Neck, and Face Bladder Cancer 230
Disorders 127 Bowel Obstruction 231
Assessment 127 Cholecystitis 233
Cataract 128 Chronic Kidney Disease 235
Epistaxis 130 Cirrhosis of the Liver 239
Glaucoma, Acute and Chronic 132 Clostridium difficile 242
Glaucoma, Acute (Primary Angle-Closure) 132 Colorectal Cancer 245
Glaucoma, Chronic (Primary Open-Angle) 133 Diverticulitis 249
Hearing Loss 136 Esophagitis 251
Hordeolum and Chalazion 138 Gastric Cancer 253
Age-Related Macular Degeneration 139 Gastritis 256
Oral Cancer 141 Gastroenteritis 258
Retinopathy 144 Gastroesophageal Reflux Disease 260
Rhinitis 146 Hernia 263
Case Study 150 Irritable Bowel Syndrome 265
Liver Cancer 268
CHAPTER 8 Chest Disorders 152
Nephrolithiasis 270
Assessment of the Cardiovascular System 152
Nonalcoholic Fatty Liver Disease 272
Assessment of Risk Factors for Coronary Artery
Peptic Ulcer Disease 274
Disease 152
Case Study 276
Clinical Examination Features 153
Assessment of the Respiratory System 154 CHAPTER 11 Urological and Gynecological
Asthma 155 Disorders 280
Cardiac Arrhythmias 160 Assessment 280
Chronic Obstructive Pulmonary Disease 164 Atrophic Vaginitis 282
Heart Failure 170 Breast Cancer 284
Hypertension 175 Cystitis 289
Ischemic Heart Disease 179 Endometrial Cancer 292
Lung Cancer 185 Ovarian Cancer 293
Myocardial Infarction 187 Benign Prostatic Hyperplasia (Benign Prostatic
Pneumonia 191 Hypertrophy) 295
Pulmonary Embolism 196 Drug-Induced Erectile Dysfunction 297
Pulmonary Tuberculosis 199 Prostate Cancer 299
Restrictive Lung Disease 203 Prostatitis 301
Upper Respiratory Tract Infection 205 Case Study 303
Valvular Heart Disease 207
CHAPTER 12 Musculoskeletal
Case Study 211
Disorders 305
CHAPTER 9 Peripheral Vascular Assessment 305
Disorders 215 Bursitis, Tendinitis, Soft Tissue
Assessment 215 Syndromes 307
Abdominal Aortic Aneurysm 216 Fractures 310
Chronic Lymphedema 218 Gout 312
 Contents xxiii

Osteoarthritis 315 Anxiety 434

Polymyalgia Rheumatica 319 Bipolar Disorder 436
Rheumatoid Arthritis 322 Delirium 439
Case Study 325 Dementia 443
Depression 451
CHAPTER 13 Central and Peripheral Nervous
Elder Abuse 456
System Disorders 328
Grief and Bereavement 459
Assessment 328 Insomnia 461
Brain Tumor 331 Prescription Drug Misuse (Hazardous or Risky
Parkinson’s Disease 333 Users) 463
Peripheral Neuropathy 336 Case Study 466
Restless Legs Syndrome 344
Seizure Disorders 346 Unit IV
Stroke 352
Case Study 359
Complex Illness 469
CHAPTER 17 Polypharmacy 470
CHAPTER 14 Endocrine, Metabolic, and
Pharmacokinetic/Pharmacodynamic Changes 470
Nutritional Disorders 361
Tools to Assist Providers to Avoid PIMs and
Assessment 361 Polypharmacy 472
Acute Pancreatitis 362 Preventing Polypharmacy, Addressing
Chronic Pancreatitis 366 Polypharmacy 472
Diabetes Mellitus, Types 1 and 2 369
Failure to Thrive 377 CHAPTER 18 Chronic Illness and the
Hyperlipidemia 379 APRN 474
Hyperthyroidism 384 Definitions of Chronic Disease and Chronic
Hypothyroidism 387 Illness 474
Malnutrition 389 Demographics of Chronic Illness 474
Obesity 392 Multiple Chronic Conditions 475
Osteoporosis 396 Economic Burden of Chronic Disease 477
Pancreatic Cancer 402 Minorities and Chronic Disease 478
Case Study 404 Function and Frailty 478
Evidence-Based Practice and Chronic Disease 479
CHAPTER 15 Hematological and Immune Chronic Care Model of Quality Improvement 479
System Disorders 407 Legislation and Chronic Disease 480
Assessment 407 Transitions of Care 480
Anemia of Chronic Disease 408 Provider Reimbursement for Chronic Illness
Anemia, Iron Deficiency 410 Care 482
Immune Thrombocytopenic Purpura (Idiopathic The Role of APRNs in Chronic Disease 482
Thrombocytopenic Purpura) 413 Case Study 483
Leukemias 414
CHAPTER 19 Palliative Care and End-of-Life
Acute Lymphoblastic Leukemia 414
Acute Myeloid Leukemia 416
Care 485
Chronic Lymphocytic Leukemia 419 Overview of Palliative Care 485
Chronic Myeloid Leukemia 423 Symptom Management 486
Case Study 426 Delirium 486
Dyspnea 488
CHAPTER 16 Psychosocial Disorders 428 Pain 490
Assessment 428 The Dying Patient 493
Agitation 429 Grief and Bereavement 496
Alcohol Misuse (Hazardous or Risky Drinkers) 431 Case Study 497
xxiv Contents

appendix A Physiological Influences of the

Aging Process 499
appendix B Laboratory Values in the Older Index 507
Adult 505
 unit I
The Healthy
Older Adult
Another random document with
no related content on Scribd:
[264]

Op. cit. 1895, p. 399.

[265]

P. ent. Soc. London, 1880, p. iii.

[266]

Ent. Monthly Mag. xiii. 1877, p. 231.

[267]

Entomologist, xxiii. 1890, p. 92.

[268]

Mem. Ac. Washington, vii. 1895, 290 pp., 49 plates.

[269]

Tr. ent. Soc. London, 1878, p. 121, Pl. v.

[270]

Op. cit. 1889, pp. 1-40, 6 plates.

[271]

Walsingham, Op. cit., 1889. c. p. 21.

[272]

Ent. Zeit. Stettin, lvi. 1895, p. 233.

[273]

Op. cit. li. 1890, p. 261.

[274]

Ent. Zeit. Stettin, li. 1890, p. 263.

[275]

For details as to habits, etc., see Rambur, Ann. Soc. ent. France,
v. 1836, p. 577; and Graslin, op. cit. xix. 1850, p. 396.

[276]

Monograph of European Psychidae, Ann. Soc. ent. Belgique, xxv.

1881, p. 29, etc.

[277]

Heylaerts, op. cit. p. 55.

[278]

Zool. Anz. xx. 1897, p. 473. This is probably Apterona crenulella,

or one of its varieties.

[279]

Bull. U.S. Dep. Agric. Ent. x. 1887, p. 22.

[280]

Ann. New York Ac. viii. 1893, p. 54.

[281]

Kalender, Ent. Zeit. Stettin, xxxv. 1874, p. 203.

[282]

Ent. Tidskr. xvi. 1895, p. 116.

[283]

On larvae of Hepialidae, J. New York ent. Soc. iii. 1895, p. 69,

Plates III. IV.

[284]

Olliff, Australian Hepialidae, Entomologist, xxviii. 1895, p. 114.

[285]

Ent. Mag. xiii. 1876, p. 63; and xxiii. 1886, p. 164.

[286]

Weir, Entomologist, xiii. 1880, p. 249, plate; King, Ent. Record, vii.
1895, p. 111.

[287]

Bertkau, SB. Ver. Rheinland, xxxvi. 1879, p. 288; and Arch.

Naturg. xlviii. i. 1882, p. 362.

[288]

Zool. Anz. iii. 1880, p. 186.

[289]

It is much to be regretted that, as in so many other Lepidoptera, no

satisfactory agreement as to names has been attained; our British
A. testudo is variously styled Limacodes testudo (by Chapman and
most naturalists), Apoda limacodes (by Meyrick), or Apoda
avellana (Kirby, Catalogue of Moths). The family is called either
Limacodidae, Apodidae, Cochliopodidae, or Heterogeneidae.

[290]

See Chapman, Tr. ent. Soc. London, 1894, p. 345, Plate VII., for
our British species; for North American forms, Dyar, Life-histories
of the New York Slug-caterpillars (in progress, with numerous
plates), J. New York ent. Soc. iii. etc., 1895.

[291]

See Packard, P. Amer. Phil. Soc. xxxi. 1893, pp. 83, 108, Plates.
(He uses the term Cochliopodidae instead of Limacodidae); also
Dyar, as above.

[292]

Insects affecting the Orange, Washington, 1885, p. 143.

[293]

Tr. ent. Soc. London, 1894, p. 348.

[294]

Op. cit. 1876, p. 522; and 1877, p. 433.

[295]

P. Amer. Phil. Soc. xxxii. 1894, p. 275.

[296]

Revision of the Thyrididae; Hampson, P. Zool. Soc. London, 1897,

p. 603.

[297]

P. ent. Soc. London, 1891, p. xv.

[298]

This moth is known under several generic names—Psilura, Liparis,

Ocneria, Lymantria; there is now a very extensive literature
connected with it. A good general account by Wachtl may be found
in Wien. ent. Zeit. x. 1891, pp. 149-180, 2 Plates.

[299]

Wachtl and Kornauth, Mitt. forst. Versuchswesen Österreichs, Heft

xvi. 1893.

[300]

Crahay, Ann. Soc. ent. Belgique, xxxvii. 1893, p. 282.

[301]

Amer. Natural. xxix. 1895, p. 801.

[302]

Catalogue of Lepidoptera Heterocera, i. 1892.

[303]

Ann. Soc. ent. France (4), iv. 1864, p. 689.

[304]

P. Zool. Soc. London, 1892, p. 188.

[305]

Tr. ent. Soc. London, 1892, pp. 53-140; for criticism on the
nomenclature, see Rebel, Ent. Zeit. Stettin, liii. 1892, p. 247.

[306]

See Poulton, Tr. ent. Soc. London, 1884, p. 51; op. cit. 1892, p.
293; and Bateson, p. 213; Gould, p. 215.

[307]

Giraud, Ann. Soc. ent. France (4), v. 1865, p. 105; Fauvel, l.c. Bull.
p. liii.

[308]

For a table, see Meyrick, l.c.

[309]

Barrett, "Increasing Melanism in British Geometridae," Ent.

Monthly Mag. 1895, p. 198.

[310]

P. Zool. Soc. London, 1892, p. 192.

[311]

Although this term is widely used in North America, it is not in use

in England, though it may possibly have originated in Scotland.
See Slingerland, Bull. Cornell University Exp. Stat. 104, 1895, p,
555.
[312]

Fourth Rep. U.S. Ent. Commission, 1885, p. 3.

[313]

Insect Life, vi. 1894 p. 6.

[314]

See Chapman, The Genus Acronycta and its Allies, London, 1893.

[315]

Insects Injurious, etc., Ed. 1862, Boston, p. 437.

[316]

See Westwood, Tr. Zool. Soc. London, x. pp. 507, etc., for
discussion of this question and for figures; also E. Reuter, Act.
Soc. Sci. Fenn. xxii. 1896, p. 202.

[317]

Congr. Internat. Zool. ii. 1892, pt. 2, p. 180.

[318]

Ragonot, Ann. Soc. ent. France, 1890 and 1891; and Meyrick, Tr.
ent. Soc. London, 1890, p. 429.

[319]

Ent. Mag. xii. 1876, p. 210, and xvii. 1881, p. 249.

[320]

Zool. Jahrb. Syst. vi. 1892, p. 617.

[321]

Nat. Hist. Aquatic Insects, London, 1895.

[322]
For Bibliographic references connected with the divisions of
Pyralidae see Ragonot, Ann. Soc. ent. France (6), x. 1890, pp.
458, etc.

[323]

Monograph, by Ragonot, in Romanoff, Mem. Lep. vii. 1893.

[324]

Ent. Zeit. Stettin, 1878, p. 230.

[325]

Howard, Insect Life, vii. 1895, p. 402.

[326]

Monograph by Hampson, P. Zool. Soc. London, 1895, p. 897-974.

[327]

Disqué, Ent. Zeit. Stettin, li. 1890, p. 59. Cf. also Rebel, Zool.
Jahrb. Syst. xii. 1898, p. 3.

[328]

Classification; Meyrick, Tr. ent. Soc. London, 1886, p. 1.

[329]

P. Linn. Soc. N. S. Wales (2), vi. 1881, p. 410.

[330]

Handbook Brit. Lep. 1895, p. 493.

[331]

Tr. ent. Soc. London, 1895, p. 495.

[332]

Zool. Anz. v. 1882. p. 262.

[333]

Ann. Soc. ent. France (4), x. 1870, p. 1, pl. vii.

[334]

For table of the larvae, according to number of feet and other

characters, see Sorhagen, Berlin. ent. Zeit. xxvii. 1883, pp. 1-8.

[335]

P. Linn. Soc. N.S. Wales (2) vii. 1892, p. 593.

[336]

Durrant, Ent. Mag., xxxi. 1895, p. 107.

[337]

"The Yucca moth and Yucca Pollination," Rep. Missouri Botanical

Garden, 1892, pp. 99-158.

[338]

The maxillary tentacle is considered by Prof. J. B. Smith to be a

prolongation of the stipes, cf. antea, p. 309; also Insect Life, v.
1893, p. 161.

[339]

Chapman, Tr. ent. Soc. London, 1894, p. 366.

[340]

Walter, Jena. Zeitschr. Naturw. xviii. 1885. He did not distinguish

Eriocephala as a genus, as we have explained on p. 308.

[341]

Amer. Natural. xxix. 1895, pp. 636 and 803.

[342]

Wood, Ent. Mag. xxvi. 1890, p. 148.

[343]

See Chapman, Tr. ent. Soc. London, 1893, p. 255.

[344]

Osten Sacken, Tr. ent. Soc. London, 1884, p. 501, and Berlin. ent.
Zeitschr. xxxvii. 1892, p. 423, etc.

[345]

Osten Sacken has recently discussed the intermediate conditions,

and proposed the name "pseudholoptic" for some of them, Berlin.
ent. Zeitschr. xli. 1896, p. 367.

[346]

Girschner, Berlin. ent. Zeitschr. xxxi. 1887, p. 155.

[347]

It may be well to remark that this name was formerly applied to all
Diptera except Nemocera.

[348]

Zool. Anz. xvii. 1894, p. 35, and Ann. Nat. Hist. (6) xiii. 1894, p.
372; Zeitschr. wiss. Zool. lviii. 1895, p. 475.

[349]

Cf. Osten Sacken, Berlin. ent. Zeitschr. xxxviii. 1893; and Becher,
Wien. ent. Zeit. i. 1882, p. 49. For an account of the condition, with
diagrammatic figures, of the fly emerging from the pupa, cf.
Sasatti, J. Coll. Japan, i. 1887. p. 34, pl. vi.

[350]

It is frequently said that one sex of a single species may be

dimorphic in this respect, but we shall subsequently mention (in
Blepharoceridae) that this is not yet sufficiently established.
[351]

Fluernes Munddele, Copenhagen, 1881, 91 pp. 6 plates; Ent.

Tidskr. i. 1879, p. 150; Becher having given (Denk. Ak. Wien. xlv.
1882, p. 123) an interpretation different from that of Meinert, this
author set forth his general views in Zool. Anz. v. 1882, pp. 570
and 599.

[352]

The reader should not suppose that there are only two views as to
the Dipterous mouth, for actually there are several; our object is
here only to give a general idea of the subject.

[353]

Tr. Linn. Soc. London (2) v. 1892, p. 271.

[354]

Tr. ent. Soc. London, 1884, p. 497.

[355]

Osten Sacken, although making use of the terms tegula and

antitegula, suggested the propriety of using squama and
antisquama, as we have done.

[356]

Zeitschr. wiss. Zool. li. 1891, p. 55.

[357]

Brandt, Horae Soc. ent. Ross. xiv. 1878, p. vii.; xv. 1879, p. 20.
Brauer, Denk. Ak. Wien, xlvii. 1883, pp. 12-16. Künckel, C.R. Ac.
Paris, lxxxix. 1879, p. 491.

[358]

Blow-fly, 1895: in two vols. For Anatomy of Volucella, see Künckel

d'Herculais, Recherches sur l'org. des Volucelles, Paris, 1875 and
1881.
[359]

Tijdschr. Ent. xxxviii. 1895, pp. 65-100.

[360]

Denk. Ak. Wien, xlvii. 1883, pp. 1-100, pls. i.-v.

[361]

Since our brief and imperfect sketch of metamorphosis appeared

in Vol. V. of this series, Packard has treated the subject more fully
in his Text-book of Entomology, New York, 1898; and Pratt has
summarised the state of knowledge as to imaginal discs in
Psyche, viii. 1897, p. 15, etc.

[362]

Monograph of Oestridae, Verh. Ges. Wien, 1863, and other papers

op. cit. 1864, 1867, 1869; also Denk. Ak. Wien, xlii. 1880, xlvii.
1883.

[363]

Becher, Wien. Ent. Zeit. i. 1882, p. 49; for observation on

connecting forms see Brauer, Verh. Ges. Wien, xl. 1890, p. 272.

[364]

The palpi are said to be of only one segment in some genera of

Cecidomyiidae. The Cecidomyiidae are easily distinguished by the
minute size—body not more than a line long—and by there not
being more than six nervules at the periphery of the wing. Aëdes
(Culicidae) has also short palpi.

[365]

It is said by Schiner that in the anomalous genus Nemestrina the

palpi are of three segments.

[366]
For tables of the families of flies the student may refer to Loew,
Smithson-Misc. Coll. vi. Art. i. 1862; to Brauer, Denk. Ak. Wien, xlii.
1880, p. 110 (Orthorrhapha only); to Williston, Manual of N.
American Diptera, 1896; to Schiner, Fauna austriaca, Diptera,
Vienna, 1860, etc.

[367]

Berlin. ent. Zeitschr. xxxvii. 1892, p. 365, and xli. 1897, p. 365.

[368]

Tr. Amer. ent. Soc. iii. 1871, p. 345.

[369]

Bull. Soc. ent. France, 1893, p. lxxx.

[370]

Naturhist. Tidskr. (3) viii. 1874, p. 34, pl. xii.

[371]

Ann. Soc. ent. France (2) vii. 1849, p. 346.

[372]

Trans. New Zealand Inst. xxiii. 1890, p. 48.

[373]

Osten Sacken, Berlin. ent. Zeitschr. xxxvii. 1892, p. 442; and

Perris, Ann. Soc. ent. France (2) vii. 1849, p. 202.

[374]

See Guérin-Méneville, Ann. Soc. ent. France (2) iv. 1846; Bull. p.
8; and Nowicki, Verh. Ges. Wien, xvii. 1867, SB. p. 23.

[375]
For details as to the family cf. Osten Sacken, Berlin. ent. Zeitschr.
xl. 1895, p. 148; and for the larvae F. Müller, Arch. Mus. Rio-Jan.
iv. 1881, p. 47. The name "Liponeuridae" was formerly applied by
some authorities to this family, but it is now generally recognised
that Blepharoceridae is more legitimate.

[376]

Berlin. ent. Zeit. xxv. 1881, p. 61; and cf. Brauer, Wien. ent. Zeit. i.
1882, p. 1.

[377]

Natural History of Aquatic Insects, London, 1895, chap. ii.

[378]

Tr. Linn. Soc. Lond. (2) ii. 1884, p. 367.

[379]

For an extremely interesting account of Chironomus refer to Miall's

book, already cited, and, for the larva, to the valuable work of
Meinert on Eucephalous larvae of Diptera, Danske Selsk. Skr. (6)
iii. 1886, p. 436.

[380]

Ann. Nat. Hist. (4) viii. 1871, p. 31.

[381]

Ibid. (6) xv. 1895, p. 133.

[382]

For metamorphoses of aquatic species of Ceratopogon, see Miall

and Meinert, already quoted: for examples of the terrestrial
species, and their illustrations, refer to Mik, Wien. ent. Zeit. vii.
1888, p. 183.
[383]

Monograph, Eaton, Ent. Mag. xxix. and xxx. 1893, 1894:

supplement op. cit. 1896, etc.

[384]

Tr. ent. Soc. London, 1895, p. 141.

[385]

Tr. ent. Soc. London, 1895, p. 479.

[386]

A Naturalist's Sojourn in Jamaica, London, 1853, p. 284.

[387]

Bull. Illinois Lab., iv. 1895, p. 193.

[388]

Miall's Aquatic Insects, 1895, p. 174.

[389]

"Studies," etc., Berlin. ent. Zeitschr. xxxi. 1887.

[390]

Tr. ent. Soc. London, 1897, p. 362.

[391]

Tr. ent. Soc. London, 1897, pp. 343-361.

[392]

Acta Univ. Lund. xxxiii. (2) No. 7, 1897.

[393]

"Studies," etc., Berlin. ent. Zeitschr. xxx. 1886, p. 153.

[394]

Osten Sacken, Berlin. ent. Zeitschr. xxxvii. 1892, p. 450.

[395]

Entomologist, xiv. 1881, p. 287. This observation has never, we

believe, been confirmed.

[396]

Ann. Soc. ent. France (2) v. 1847, p. 46.

[397]

Perris, in Ann. Soc. ent. France (2) v. 1847, p. 37, pl. i.

[398]

Ann. Soc. ent. France (5) i. 1871, Bull. p. lxvii.

[399]

Rep. Dep. Agric. Ent. Washington, 1886, p. 492.

[400]

Cf. Réaumur, Mem. v. 1740, p. 21; and Perris, Ann. Soc. ent.
France (4) x. 1870, p. 190.

[401]

Verh. Ges. Wien, xxx. 1880, p. 343.

[402]

Arch. Naturges. xli. i. 1875, p. 48.

[403]

Bull. Illinois Lab. iv. 1895.

[404]

Ent. Mag. xxiii. 1886, p. 51.

[405]

Ann. Soc. ent. France, ii. 1833, p. 492.

[406]

Wien. ent. Zeit. ii. 1883, pp. 11 and 24, pl. i.

[407]

Ent. Mag. xiv. 1878, p. 196.

[408]

For figures, etc., cf. Westwood, Tr. ent. Soc. London, 1876, p. 507,
pls. v. vi.

[409]

Verh. Ges. Wien, xix. 1869, p. 737, pl. xiii.

[410]

Tr. ent. Soc. London (3) i. 1862, p. 338, pl. xi.

[411]

Verh. Ges. Wien, xix. 1869, p. 941.

[412]

Ann. Soc. ent. France (4) x. 1870, p. 221.

[413]

SB. Ak. Wien, xci. 1885, p. 392.

[414]

Ent. Mag. xiv. 1877, p. 226; for a discussion of the subject see Mik,
Wien. ent. Zeit. xiii. 1894, p. 273.

[415]

Amer. Natural. xxviii. 1894, p. 35.

[416]

Perris, Ann. Soc. ent. France (4) x. 1870, p. 321, pl. 4; and
Laboulbène, op. cit. (5) iii. 1873, p. 50, pl. v.

[417]

Perris, Ann. Soc. ent. France (4) x. 1870, p. 354.

[418]

Ent. Meddelelser, ii. 1890, p. 213.

[419]

Frauenfeld, Verh. Ges. Wien, xx. p. 37, pl. iii.

[420]

For monograph of Pipunculidae, see Becker, Berlin. ent. Zeitschr.

xlii. 1897, pp. 25-100.

[421]

Ofv. Ak. Forh. xi. 1854, p. 302, pl. v., since confirmed by others,
see Giard, C.R. Ac. Sci. cix. 1889, pp. 79 and 708.

[422]

Natural History of Aquatic Insects, 1895, p. 198.

[423]

Ent. Zeit. Stettin, vi. 1845, p. 384, pl. i.

[424]

Ann. Soc. ent. France (6) iii. 1883, p. 23, pl. i.

[425]

Ent. Nachr. xviii. 1892, p. 13.

[426]
Ann. Soc. ent. France (4) x. 1870, p. 330.

[427]

See on this difficult subject, Becher, Wien. ent. Zeit. i. 1882, p. 49.

[428]

Loudon's Magazine, v. 1832, p. 302; P. ent. Soc. London, 1871, p.

x.

[429]

Baron von Osten Sacken informs the writer that this statement has
since been withdrawn by Portschinsky as being erroneous.

[430]

Ent. Amer. iii. 1887, p. 126.

[431]

J. Coll. Japan, i. 1886, pp. 1-46, plates i.-vi.

[432]

Souvenirs entomologiques, 1879, pp. 246-254.

[433]

A list of the Insects known to be attacked by Dipterous parasites

has been given by Brauer and Bergenstamm, Denk. Ak. Wien, lxi.
1895.

[434]

Berlin. ent. Zeit. xxx. 1886, p. 135.

[435]

Berlin. ent. Zeitschr. xxxi. 1887, p. 17.

[436]
Biol. Centralbl. vii. 1887, p. 521.

[437]

For an account of the habits of this fly, see Kirk, J. Linn. Soc. viii.
1865, pp. 149-156; and for a bibliographic list, Wulp, Tijdschr. Ent.
xxvii. 1884, p. xci. and pp. 143-150.

[438]

Preliminary Report on the Tse-tse Fly Disease, 1895.

[439]

P. Liverpool Soc. xxxiii. 1878, p. 13, note.

[440]

We may specially mention the monograph of Oestridae, published

in 1863 by the K. k. Zool.-Bot. Ges. Wien, and supplements in
Wien. ent. Zeit. v. vi. 1886, 1887; these include copious
bibliographic lists.

[441]

Riley, Insect Life, iv. 1892, p. 302.

[442]

See Blanchard, Ann. Soc. ent. France (7) ii. 1892, pp. 109, 154.

[443]

See Bigot, Ann. Soc. ent. France (6) ii. 1882, p. 21, Brauer,
Monograph, 1863, p. 51, and Wien. ent. Zeit. vi. 1887, p. 75.

[444]

Arch. Naturgesch. lviii. i. 1892, pp. 287-322, pls. xv. xvi.

[445]

Stein, Deutsche ent. Zeit. xxi. 1877, p. 297.

[446]

Abh. Ges. Halle, iv. 1858, p. 145.

[447]

Arch. Naturgesch. lix. i. 1893, p. 151.

[448]

SB. Ak. Wien. cv. 1896, Abtheil. i. p. 400.

[449]

Arch. Naturges. lviii. i. 1892, p. 287.

[450]

Horae Soc. ent. Ross. ii. 1863, p. 90.

[451]

Tr. ent. Soc. London, 1881, p. 360.

[452]

The best general description of the external anatomy of the flea is

to be found in Taschenberg, Die Flöhe, 1880. The morphology is
better elucidated, though still incompletely, in Wagner's valuable
"Aphanipterologische Studien," Horae Soc. ent. Ross. xxiii. 1889,
pp. 199-260, 5 plates, and op. cit. xxxi. 1897, pp. 555-594, 3
plates. Cf. also N. C. Rothschild, Nov. Zool. v. 1898, pp. 533-544,
3 plates.