Nur 397: Complementary And Alternative Therapies

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Common conditions of those seeking CAM

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back and neck problems, cancer, chronic pain, HIV, anxiety/depression, arthritis, fatigue, insomnia, hypertension

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CAM

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a group of diverse medical and health care systems, practices and products that are not presently considered part of conventional medicine in the US

medical interventions not taught widely at US medical schools or those that are not generally available at US hospitals

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Focus of CAM

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maintain and promote health, prevent disease, assist healing, support rehab

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Complementary

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therapies used in conjunction with conventional medicine

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Alternative

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Therapies used instead of conventional medicine

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Integrative

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combination of both conventional medicine and complementary and alternative medicine/therapies that have a strong scientific base for use and safety

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CAM domains

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alternative medical systems, mind/body interventions, biologically based therapies, manipulative and body based methods, energy therapies

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Use of CAM by patients with cancer

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28-85%

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Patients are often..

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reluctant to initate communication regarding CAM to their helathcare provider

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How many patients do not disclose CAM use

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63%

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Homeopathic

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dilution of substances

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Naturopathic

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diet and nutrition, homeopathy, spine and soft tissue manipulation, acupuncture, acupressure, herbs, exercise, counseling, light therapy

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Belief of Naturopaths

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If the body is supporter and barriers to cure are removed, the body will heal itself

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Ayurveda

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seeks to restore harmony and balance, encourages prevention, diet, exercise, meditation, herbs, massage, exposure to sunlight, controlled breathing, detox

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Elements of Ayurveda

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make up all things
space, ether, air, fire, water, earth

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Goal of Ayurveda?

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bring the body into balance: disease is an imbalance

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Ayurveda diagnosis

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symptomatology, not a test

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Acupuncture

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strongest evidence in promoting the flow of chi

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some traditional Chinese medicine

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acupuncture, herbal medicine, massage, meditation, balance of Yin and Yang

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Yin/Yang

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Yin- cold, slow, darkness, passive
Yang- hot, active, excited, stimulates fire

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Yin/Yang belief

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Health is a balance of yin and yang

Disease is an imbalance that impedes the flow of vital energy (chi) and blood along the pathways called meridians

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Mind-body interventions

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prayer, deep breathing, meditation, yoga, biofeedback, guided imagery, tai chi, pet/music therapy, religious tradition

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Best evidence for balance

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tai chi

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Deep breathing commonly used for?

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panic attacks

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Guided imagery commonly used for?

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pain

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Biologically based therapies

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herbs, vitamins, foods, natural therapies, diets

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Vitamin E

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does NOT reduce risk of chronic disease, but may make it worse

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Foods for biological therapy

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apricots, tomatoes, watermelon to decrease risk of certain cancers and heart disease

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Echinacea

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treatment for cough, flu, and colds

may interfere with immunosuppressant drugs, MS, TB, AIDS

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Panax ginseng

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analgesic

may decrease effectivness of warfarin, MAOIs

May increase glucose/ bad for diabetics

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Gingko

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antioxidant
used for bleeding disorders or hyperglycemia

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Garlic supplements

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Vasodilator

May increase bleeding

Does not decrease blood pressure

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Glucosamine

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may stimulate cartilage growth

shellfish allergy

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St. John's Wort

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antidepressant
ETOH and other antidepressives may increase effect

takes at least 6 weeks to work

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Peppermint

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muscle relaxant in the digestive tract

avoid during pregnancy and avoid large doses because it can relax uterine muscles causing spontaneous abortion

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Fish oils

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decrease risk of CAD (no CI identifited)

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Ginger supplements

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antiemetic
inhibits platelets
improves appetite and digestion
*bleeding tendencies or anticoagulant therapy

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Soy supplements

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decrease total cholesterol and LDL

(may increase cancer risks but may protect in br cancer)

decreases hot flashes post menopause

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Manipulative body based methods

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focus on structures and systems of body, osteopathic manipulation, massage therapy, reflexology

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Energy therapies

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music therapy, light therapy

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CAM Nursing interventions

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**be knowledgable about the modalities and increase discussion comfort
cultural associations
**ask about use
why they use
*what they know about side effects/ drug interactions
Good, NON JUDGMENTAL communication
*communicate with other professionals about CAM

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Medical modalities Physician

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chiropractic, acupuncture, TCM

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Pharmacists

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know benefits or potential drug interactions with specific herbs or ingested substances

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Physical and occupational therapist

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tai chi, yoga

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Questions to ask

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what benefits are expected? Has it been used to manage symptom or problem? does literature support it? nursing references? risks? safe? effective? benefits outweigh risks? interfere with other treatment? clinical trial? appropriate for patient? providers who are skilled? does the person expect it to work? health insurance?

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Enough evidence to use acupuncture for?

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migraine headaches, osteoarthritis, chemotherapy induced nausea

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Homeopathy evidence

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abundance of anecdotal evidence exists but rigorous and empirical research not available

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Evidence: Relieve low back pain

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good posture

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Evidence: Aspirin can...

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reduce risk of heart attack (plavix does not increase benefits)

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Yogurt Evidence

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ease diarrhea, bladder infections, and food allergies (probiotics)

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Evidence: Blood pressure

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tamed with mediation

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Boost memory

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walk 3 times a week, reduce stress, relaxation exerices, emotional health

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Walking 3 times a week

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30% less likely to have dementia in 6 year study

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Relaxation exercies for 20 minutes a day, 5 days a week

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reduce stress

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Lower cholesterol

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sunflower seeds, pistachios, pumpkin seeds, pine nuts, whole flaxseeds

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federal lead agency for scientific research in CAM

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National Center for Complementary and Alternative Medicine (NCCAM)

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OCCAM

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cancer related CAM: office of cancer complementary and alternative medicine