Chapter 34 Complementary and Alternative Therapies in Maternity and Pediatric Nursing.

Chapter 34Chapter 34

Complementary and Alternative Complementary and Alternative Therapies in Maternity and Pediatric Therapies in Maternity and Pediatric

NursingNursing

ObjectivesObjectives

• Define complementary and alternative medicine (CAM) therapy.

• Identify the role of the nurse in CAM therapy.

• Describe the involvement of the federal government in CAM therapy.

• Discuss the integration of CAM therapy in nursing practice.

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Objectives Objectives (cont.)(cont.)

• Discuss the impact on nursing care of patients who use CAM therapy.

• State five types of CAM therapy in common use.

• State three herbal products contraindicated in pregnancy.

• State three herbal products commonly used in pediatrics.

• State popular herbs used during menopause.

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Objectives Objectives (cont.)(cont.)

• Discuss the use of hyperbaric oxygen therapy in the care of carbon monoxide poisoning and necrotic ulcer.

• State three herbs that should be discontinued 2 weeks before surgery.

• State the use of meridians, dermatomes, and reflexology lines in CAM therapy.

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Definition of CAM TherapiesDefinition 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

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Alternative Health CareAlternative Health Care

CAM TherapyCAM Therapy

• Also known as – Integrative therapies– Integrative healing– Holistic healing

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CAM PractitionersCAM Practitioners

• Holistic practitioners

• Naturopaths

• Nutritional consultants– Food therapy– Vitamin and mineral supplements

• Herbalist

• Practitioners of acupuncture and acupressure

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Popular Cultural Folk Healers Popular Cultural Folk Healers

• Mexican: Curanderos

• African American: Root doctor

• Asian and Chinese: Herbalist

• Puerto Rican: Espiritistas or santiguadoras

• Navajo: Singers

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Accepted TheoriesAccepted Theories

• Gate control theory of pain relief

• Imagery

• Journaling

• Therapeutic touch

• Humor

• Support groups

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Nurse’s Role in CAM TherapyNurse’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

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Nurse’s Role in CAM Therapy Nurse’s Role in CAM Therapy (cont.)(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

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Cautions in CAM TherapyCautions 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

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Herbs to Discontinue Two Weeks Herbs to Discontinue Two Weeks Before SurgeryBefore Surgery

• Echinacea• Garlic• Ginger• Gingko biloba• St. John’s wort• Ginseng• Kava kava• Feverfew• Ephedra (ma huang)

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Federal RegulationsFederal Regulations

• 1962: Kefauver-Harris Drug Amendment Act required FDA proof of safety and effectiveness for all drugs (not including herbal products) before placing them on the market

• 1992: NIH formed Office of Alternative Medicine to evaluate CAM therapies

• 1994: Dietary Supplement Health and Education Act defined dietary supplement and prohibited claim of medicinal value

• 1994: DSHEA required regulations for labeling and statement that there is no FDA approval

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Overview of Common Alternative Overview of Common Alternative Health Care PracticesHealth Care Practices

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MassageMassage

• 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

• Gentle touch—for premature infants17Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

Massage Massage (cont.)(cont.)

• Massage and manipulative therapy are contraindicated in patients with– Cancer– Osteoporosis– Localized infection– Cardiac and circulatory disorders

• Because of the increased blood flow to the affected areas

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OsteopathyOsteopathy

• 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

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Energy HealingEnergy 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

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ReflexologyReflexology

• Reflex points in the hands and feet thought to correspond to every organ or part of the body

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Acupuncture and AcupressureAcupuncture 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

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HomeopathyHomeopathy

• 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

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AyurvedaAyurveda

• Ancient Hindu healing regimen

• Deals with biological rhythms of nature

• Includes music, herbs, massage, aromatherapy, and a tailored diet

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AromatherapyAromatherapy

• 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

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Nursing TipNursing Tip

• Lavender, chamomile, and sandalwood essential oils are useful in aromatherapy for children with chronic pain

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HypnotherapyHypnotherapy

• 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

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HydrotherapyHydrotherapy

• Promotes relaxation

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Guided ImageryGuided Imagery

• Patient focuses on a specific image which can result in the reduction of stress and increased performance

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BiofeedbackBiofeedback

• A type of relaxation therapy that enables the patient to recognize tension in the muscles via response on an electronic machine

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Chiropractic CareChiropractic Care

• Deals with the relationship between the spinal column and nervous system

• Involves nerve energy thought to be responsible for restoring and maintaining health

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Herbal RemediesHerbal 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

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Common Herbs Contraindicated in Common Herbs Contraindicated in Pregnancy and LactationPregnancy 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

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Herbs Commonly Used in Herbs Commonly Used in PediatricsPediatrics

• Blue-green algae• Chamomile• Ephedra• Echinacea• Evening primrose oil• Fennel seed oil

• Feverfew• Fish oil• Ginger• Ginkgo biloba• Ginseng

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Herbs that Promote MenstruationHerbs 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

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Popular Herbs Used in MenopausePopular Herbs Used in Menopause

• Black cohosh

• Sage

• Dong quai

• Chasteberry

• Motherwort

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Hyperbaric Oxygen TherapyHyperbaric Oxygen Therapy

• Uses an airtight enclosure to provide compressed air or oxygen under increased pressure

• Contraindicated in pregnancy

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Sauna/Heat TherapySauna/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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Question for ReviewQuestion for Review

• What are some CAM therapies that are currently used regularly in the labor unit?

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ReviewReview

• Objectives

• Key Terms

• Key Points

• Online Resources

• Critical Thinking Questions

• Review Questions

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