OB Chap 34 the changing health care environment

To promote positive outcomes, nurses must be well informed about the use and validity of complementary and alternative medicine
(CAM) practices and understand the potential interactios with prescribed medications and treatments
Complementary therapies are
treatments used in conjunction with traditional medicine.
Alternative therapies are
treatments that replace traditional medical therapy
the National Center for Complementary and Alternative Medicine part of the
National Institutes of Health was created to conduct and review research concerning the efficacy and dangers of CAM therapy
Many herbal preparations do not have
research based-data to guide determination of safe dosage and use
Many CAM therapies are used
effectively and integrated with traditional Western medicine
Nurses have successfully used
some CAM therapies, such as guided imagery, massage and therapeutic touch for many years.
it is likely that nurses today and in the future
will encounter some form of CAM therapy as part of the health care delivery system
Transcutaneous electrical nerve stimulation
(TENS) is a form of energy therapy used to prevent nausea in labor, after surgery and during chemotherapy
Nurses must use critical thinking
skills to determine the interactions between CAM therapy and traditional prescribed treatments.
coin-rubbing is a type of CAM therapy
that can be mistaken for child abuse because of lingering skin marks after treatment
Meridians are invisible (imaginary) lines running through the body that are thought
to control the health of vital organs. Stimulation of any of the 150 pressure points on the 12 meridian sites is the basis of acupressure and acupuncture
Dermatomes are areas of the skin that are innervated by the dorsal roots of the spinal cord
and affect specific segments of the skin and adjacent structures. These areas are manipulated by chiropractors
Reflexology lines divide the body into 10 zones of longitudinal lines.
Blockage is thought to obstruct energy pathways. This is the basic concept of reflexology
As part of routine history data collection,
nurses should ask all patients if they use a form of CAM therapy; this information should be recorded on the chart.
Traditionally hormone replacement therapy (HRT) has been the most popular approach
to managing menopausal symptoms. Recently , more natural paths of management have developed including exercise; relaxation techniques, a low-fat, high-fiber and soy diet and herbs.
Cao-gio (coin rubbing) is a form of facial manipulation believed to bring the body in alignment with gravity.
It is a form of CAM therapy that can easily be mistaken for child abuse because of the lingering marks on the skin after treatment.
Many medications are related to herbal remedies.
Digitalis originates from foxglove, opiates originate from poppy flowers, quinine originates for the cinchona trees
Kava-Kaa is a commonly used herb
in pediatrics that is thought to reduce anxiety
Some essential oils are contraindicated during pregnancy
because of the effect on the mother or fetus including anise, juniper, thyme, wintergreen, nutmeg, pennyroyal and mugwort.
The nurse’s role is not to promote the acceptance of CAM
therapy but to recognize and respect its use in patients and to use critical thinking skills to determine its interactions with traditional therapy.
When documenting a patient’s health history, the nurse should
ask questions concerning the family’s use of CAM therapies
CAM therapy for obstetrics helps
some women feel a sense of control over their well-being. Because many women view CAM therapy and herbal remedies as natural remedies, they may not be aware of the possible dangers to themselves or their growing fetuses. There are many herbs that are contraindicated during pregnancy
In 1992 the National Institutes of Health created the Office of Alternative Medicine
to evaluate the various CAM therapies. It has since been renamed the National Center for CAM. This center serves as a public clearinghouse and resource for research concerning CAM therapies.
The nurse’s role is not to promote the acceptance of CAM therapy
but to recognize and respect its use in pts and to use critical thinking skills to determine its interactions with traditional therapy.
Rolfing
Fascia pressure, stretching, and manipulation
Federal Food, Drug, and Cosmetic Act
Requires all drugs, including herbs, to be safe before sale
Complementary therapy
Nontraditional therapy used with traditional therapy
Perineal massage
Technique that may prevent the need for an episiotomy during delivery of a child
Energy healing
Repatterning a patient’s own energy field can aid in healing
Dietary Supplement Health and Education Act (DSHEA)
Requires that dietary supplement labels must show they are not FDA approved
Reflexology
Massaging reflex points in hands/feet can relieve specific problems
Light therapy
Uses energy healing in treating people with seasonal affective disorder
Dietary Supplement Health and Education Act
Prohibits claims that dietary supplements had medicinal value
Alternative therapy
Nontraditional therapy that replaces traditional therapy
Neuromuscular massage
Technique to relieve muscle tension
Pressure point therapy
Certain areas of the body are connected to pressure points in the feet, hands, and ears
Complementary therapy
Nontraditional therapy used with traditional therapy
Coin-rubbing
Skin manipulation thought to help bring the body into healthy alignment
Effleurage
Form of massage used during labor that may include stroking the abdomen with the fingertips
Herbs can help manage
Hot flashes, night sweats, insomnia during menopause.
Dietary Supplement Health and Education Act
Prohibits claims that dietary supplements had medicinal value
Identify contraindications for massage therapy.
Cardiac disorders, Down syndrome
Proxmire amendment to the Federal Food, Drug and Cosmetic Act
Prevents the U.S. Food and Drug Administration (FDA) from regulating supplement potency
Chiropractic care
Involves nerve energy and manipulation to restore and maintain health
Coin-rubbing
Skin manipulation thought to help bring the body into healthy alignment
Proxmire amendment to the Federal Food, Drug and Cosmetic Act
Prevents the U.S. Food and Drug Administration (FDA) from regulating supplement potency
Kefauver-Harris drug amendment
Requires proof of drug effectiveness
Acupuncture
Sites that positive or negative energy can be realigned through stimulation
Kefauver-Harris drug amendment
Requires proof of drug effectiveness
Ayurveda
Deals with the biological rhythms of nature; can include music, herbs, massage, aromatherapy, diet
Heat therapy
Speeds up metabolism and inhibits replication of certain pathogens
Aromatherapy
Involves use of concentrated fluid or the essence of specific herbs to relieve certain ailments
Herbal medicines
Megadoses can be harmful
Biofeedback
Uses electronic machines to recognize tension in the muscles
Hyperbaric oxygen therapy (HBOT)
Uses airtight enclosure to provide compressed air or oxygen to correct health problems
Shiatsu
Emphasizes preventing disease rather than treating symptoms
Obstetric use of herbs
Can be harmful to mother or fetus
Herbal medicines
Megadoses can be harmful
Complementary and alternative medicine (CAM) therapy
Recognize and respect use
Dermatome
Specific area of skin supplied by a single spinal nerve root
Guided imagery
Involves focusing on a specific image to reduce stress
Homeopathy
Uses plants, herbs, and earth minerals to manage specific health problems
Pediatric use of herbal medicine has
increased for children with various chronic disorders
Meridians
Imaginary lines thought to carry energy to specific organs/tissues
Hypnotherapy
Involves giving specific, potentially long-lasting suggestions to patient during induced sleep
Definition of CAM Therapies
*Complementary therapy
*Nontraditional therapy that is used with traditional or conventional therapy
*Alternative therapy
*Unconventional or nontraditional that replaces conventional or traditional therapy
CAM Therapy
*Also known as
*Integrative therapies
*Integrative healing
*Holistic healing
* CAM Practitioners
*Holistic practitioners
*Naturopaths
*Nutritional consultants
Food therapy
Vitamin and mineral supplements
*Herbalist
*Practitioners of acupuncture and acupressure
Popular Cultural Folk Healers
*Mexican: Curanderos
*African American: Root doctor
*Asian and Chinese: Herbalist
*Puerto Rican: Espiritistas or santiguadoras
*Navajo: Singers
Accepted Theories
*Gate control theory of pain relief
*Imagery
*Journaling
*Therapeutic touch
*Humor
*Support groups
* Nurse’s Role in CAM Therapy
*Cultural competence is a sensitivity and respect for practices and philosophies different from
one’s own
*The need for nurses to understand CAM therapy, how it can be used, and how it may
interact with or enhance traditional medical and nursing care are important
*Nurses need to understand basic underlying philosophies and beliefs concerning CAM
interventions
Nurse’s Role in CAM Therapy (cont.)
*Is not to promote CAM therapy but to recognize and respect its use
*Use critical thinking skills to determine interactions with traditional therapies
*Work with the patient as a partner in the delivery of health care
* Cautions in CAM Therapy
*Herbs can
*Interact with cardiac drugs
*Affect glucose control in patients with diabetes
*Lower the concentration of some synthetic drugs
*Lower the blood level of some medications for HIV/AIDS
*Polypharmacy should be avoided; the use of some drugs with herbal remedies can be
dangerous
Herbs to Discontinue Two Weeks Before Surgery
*Echinacea
*Garlic
*Ginger
*Gingko biloba
*St. John’s wort
*Ginseng
*Kava kava
*Feverfew
*Ephedra (ma huang)
Overview of Common Alternative Health Care Practices
* Massage
– Thought to bolster immune response
*Rolfing—thought to improve muscle and bone function
*”Cao-gio” (coin rubbing) form of skin manipulation thought to help bring the body into healthy alignment
*Perineal massage in preparation for labor
*Effleurage—pain relief
Massage (cont.)
*Massage and manipulative therapy are contraindicated in patients with
– Cancer
– Osteoporosis
– Localized infection
– Cardiac and circulatory disorders
– Down syndrome
*Because of the increased blood flow to the affected areas
Osteopathy
*Pressure point therapy
*Certain areas of the body are connected to specific identified pressure points such as hands, feet, and ears
*Channels conduct vital energy through the body
Energy Healing
*Belief that electromagnetic flow emerges from the therapist’s hand and can funnel energy
into the patient
*The body, the mind, the spirit, and the emotions are usually involved in this form of therapy
*Light therapy, another form of energy, is used to treat a jaundiced newborn
Reflexology
*Reflex points in the hands and feet thought to correspond to every organ or part of the body
* Acupuncture and Acupressure
*Complex meridians that are pathways to specific organs or parts of the body
*It is at these points that positive or negative energy can be realigned
*”Chi” energy is thought to regulate proper body function
*Points to avoid during pregnancy are
*Bottom of foot
*Inner lower leg
*Base of thumb
*Most areas over abdomen
Homeopathy
*Uses plants, herbs, and earth minerals
*Belief that disease is an energy imbalance and that prescribed remedies assist the body to
reestablish correct balance
*Taken sublingually
*Don’t combine with caffeine, alcohol, or traditional Western medicine
*Only one remedy is administered at a time
*May contain Mercury, Arsenic, or Alcohol
* Ayurveda
*Ancient Hindu healing regimen
*Deals with biological rhythms of nature
*Ayur = Life
*Veda = Knowledge
*Includes music, herbs, massage, aromatherapy, and a tailored diet
* Aromatherapy
*Dates back to 40,000 B.C.
*Involves the use of concentrated fluid or the essence of specific herbs that are combined
with steams or baths to inhale or bathe the skin
*NOTE: Concentrated pure oils can cause burns on the skin if used incorrectly
* Nursing Tip
*Lavender, chamomile, and sandalwood essential oils are useful in aromatherapy for children
with chronic pain
* Hypnotherapy
*Patient enters a hypnotic state of induced sleep
*Under the guidance of a practitioner, specific and potentially long-lasting suggestions are
given to the patient
*Some patients resist the trance state and are not candidates for hypnotherapy
* Hydrotherapy
*Promotes relaxation
Guided Imagery
*Patient focuses on a specific image which can result in the reduction of stress and increased
performance
*What types of children might benefit?
Biofeedback
*A type of relaxation therapy that enables the patient to recognize tension in the muscles via
response on an electronic machine
Chiropractic Care
*Deals with the relationship between the spinal column and nervous system
*Involves nerve energy thought to be responsible for restoring and maintaining health
* Herbal Remedies
*Powerful nutritional agents
*Most are safe to ingest
*Herbal remedies consumed during pregnancy can reach the fetus
*Herbal capsules are about 4 times stronger than herbal teas
*Herbal extracts are about 4 to 8 times stronger than capsules
* Common Herbs Contraindicated in Pregnancy and Lactation
*Aloe vera
*Garlic
*Ginkgo biloba
*St. John’s wort
*Angelica (dong quai)
*Chamomile
*Feverfew
*Flax (flaxseed)
*Ginseng
*Kava kava
*Ma huang (ephedra)
*Nettle
* Herbs Commonly Used in Pediatrics
*Blue-green algae
*Chamomile
*Echinacea
*Evening primrose oil
*Fennel seed oil
*Feverfew
*Fish oil
*Ginger
*Ginkgo biloba
*Ginseng
Herbs that Promote Menstruation
*The following herbs promote menstruation and may cause miscarriage if used during
pregnancy:
*Cascara
*Cohosh
*Goldenseal
*Juniper
*Marjoram
*Motherwort
*Mugwort
*Pennyroyal
*Sage
*Senna
*Wormwood
* Popular Herbs Used in Menopause
*Black cohosh
*Sage
*Dong quai
*Chasteberry
*Motherwort
Hyperbaric Oxygen Therapy
*Uses an airtight enclosure to provide compressed air or oxygen under increased pressure
*Contraindicated in pregnancy
* Sauna/Heat Therapy
*Thought to help eliminate body waste
*Patients should monitor their pulse during this form of treatment
*This type of therapy is contraindicated in pregnancy
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