Chapter 34 Complementary and Alternative Therapies in Maternity

Chapter 34 Complementary and Alternative Therapies in Maternity and Pediatric Nursing

Objectives • 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. Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 2

Objectives (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. Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 3

Objectives (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. Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 4

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 Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 5

Alternative Health Care Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 6

CAM Therapy • Also known as – Integrative therapies – Integrative healing – Holistic healing Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 7

CAM Practitioners • Holistic practitioners • Naturopaths • Nutritional consultants – Food therapy – Vitamin and mineral supplements • Herbalist • Practitioners of acupuncture and acupressure Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 8

Popular Cultural Folk Healers • • • Mexican: Curanderos African American: Root doctor Asian and Chinese: Herbalist Puerto Rican: Espiritistas or santiguadoras Navajo: Singers Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 9

Accepted Theories • • • Gate control theory of pain relief Imagery Journaling Therapeutic touch Humor Support groups Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 10

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 important • Nurses need to understand basic underlying philosophies and beliefs concerning CAM interventions Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 11

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 Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 12

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 Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 13

Herbs to Discontinue Two Weeks Before Surgery • • • Echinacea Garlic Ginger Gingko biloba St. John’s wort Ginseng Kava kava Feverfew Ephedra (ma huang) Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 14

Federal 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 Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 15

Overview of Common Alternative Health Care Practices Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 16

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 • Gentle touch—for premature infants Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 17

Massage (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 Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 18

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 Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 19

Energy Healing • Belief that electromagnetic flow emerges from therapist’s hand 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 Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 20

Reflexology • Reflex points in the hands and feet thought to correspond to every organ or part of the body Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 21

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 Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 22

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 Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 23

Ayurveda • Ancient Hindu healing regimen • Deals with biological rhythms of nature • Includes music, herbs, massage, aromatherapy, and a tailored diet Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 24

Aromatherapy • Involves the use of concentrated fluid or the essence of specific herbs that are combined with steams or baths to inhale or bathe skin • NOTE: Concentrated pure oils can cause burns on the skin if used incorrectly Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 25

Nursing Tip • Lavender, chamomile, and sandalwood essential oils are useful in aromatherapy for children with chronic pain Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 26

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 Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 27

Hydrotherapy • Promotes relaxation Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 28

Guided Imagery • Patient focuses on a specific image which can result in the reduction of stress and increased performance Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 29

Biofeedback • A type of relaxation therapy that enables the patient to recognize tension in the muscles via response on an electronic machine Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 30

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 Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 31

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 Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 32

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 Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 33

Herbs Commonly Used in Pediatrics • • • Blue-green algae Chamomile Ephedra Echinacea Evening primrose oil Fennel seed oil • • • Feverfew Fish oil Ginger Ginkgo biloba Ginseng Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 34

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 Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 35

Popular Herbs Used in Menopause • • • Black cohosh Sage Dong quai Chasteberry Motherwort Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 36

Hyperbaric Oxygen Therapy • Uses an airtight enclosure to provide compressed air or oxygen under increased pressure • Contraindicated in pregnancy Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 37

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 Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 38

Question for Review • What are some CAM therapies that are currently used regularly in the labor unit? Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 39

Review • • • Objectives Key Terms Key Points Online Resources Critical Thinking Questions Review Questions Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 40