Chapter 35 Integrative Care

Select all that apply. A patient reports frequent sleep disturbances. Which interventions could be considered to help improve the patient's sleep pattern? a. Aromatherapy b. Chamomile d. Valerian

ANS: A, B, D Chamomile and valerian have relaxant effects that help sleep. Aromatherapy has sedating properties that may improve sleep. SAM-e may help with mild depression. Vitamin C has no effect on sleep.

A patient asks, "What is the major difference between conventional health care and complementary and alternative medicine (CAM)?" The nurse's best reply is that conventional health care: a. focuses on what is done to the patient, whereas CAM focuses on body-mind interaction with an actively involved patient.

ANS: A Conventional health care focuses primarily on curative actions implemented on a mostly passive patient, whereas CAM focuses more on the mind-body aspects of health, along with the active involvement of the patient. Conventional health care is largely grounded in scientific research, and its various components are heavily regulated; the opposite tends to be true of CAM. Some forms of CAM have their roots in religious or cultural practices, but this is not characteristic of CAM as a whole. Both conventional health care and CAM can focus on health promotion and treatment of illness. Although critics express concern about the role of profit in conventional health care, the profit motive can also apply in CAM.

A nurse plans health education for a patient who will be receiving warfarin (Coumadin) for several weeks after knee-replacement surgery. Which substance should the nurse caution the patient to avoid? a. Ginkgo biloba

ANS: A Ginkgo biloba has anticoagulant effects and can cause bleeding in individuals using anticoagulants and antiplatelet agents. Black cohosh is an herbal treatment for hot flashes. Kava kava is considered to have analgesic properties but would not cause increased risk of bleeding. Valerian has calming, sleep-inducing effects.

During an assessment interview, a patient who reports a high level of anxiety says, "I've been using kava in small doses for about a week." When the nurse assesses mental status, expected findings would be: a. intact cognitive function.

ANS: A Kava relieves anxiety without producing cognitive impairment, reducing mental acuity, or affecting coordination. The patient has taken small doses, so response times would be normal. It does not usually produce the effects cited in the distracters.

For which patient would it be most important for the nurse to urge immediate discontinuation of kava? A patient with a comorbid diagnosis of: a. cirrhosis.

ANS: A Kava should be used with caution in patients with liver disease because of its potentially hepatotoxic effects. The other health problems do not pose immediate dangers.

A patient diagnosed with depression tells the nurse, "I want to try supplementing my selective serotonin reuptake inhibitor with St. John's wort." Which action should the nurse take first? a. Advise the patient of the danger of serotonin syndrome.

ANS: A Research has suggested that St. John's wort is a mild inhibitor of serotonin reuptake and could lead to serotonin syndrome; this risk is increased if the patient is taking other medications that increase serotonin activity. Assessing the depression would be a secondary intervention. Aromatherapy has not been shown to be an effective adjunct or treatment for depression. Although a dosage reduction in her SSRI medication might reduce the risk of serotonin syndrome, this intervention is not in the nurse's scope of practice.

A patient reports good results from taking an herb to manage migraine headache pain. The nurse confirms there are no hazardous interactions between the herb and the patient's current prescription drugs. Select the nurse's best comment to the patient. a. "Thanks for telling me. I'll make a note in your medical record that you take it."

ANS: A The nurse should reinforce the patient for reporting use of the herb. Many patients keep secrets about use of alternative therapies. If it poses no danger, the nurse can document the use. The patient may also get placebo effect from the herb, but it is not necessary for the nurse to point out that information. The distracters are judgmental and may discourage the patient from openly sharing in the future.

Select all that apply. Which important points should the nurse teach a patient about using herbal preparations? a. Check active and inactive ingredients. b. Discontinue use if side or adverse effects occur. c. Avoid herbals during pregnancy and breast-feeding. e. Inform your health care provider about the use of herbals.

ANS: A, B, C, E All of the instruction is correct except regarding purchase of herbals. Herbals should be purchased from a reputable firm. Internet purchasing might not be the best plan, unless the reputation of the firm can be confirmed.

Select all that apply. A patient who emigrated from India is hospitalized. The patient and family use ayurvedic medicine. The nurse wants to alter this patient's care so that it is more comfortable and familiar. What changes from usual Western practice should be considered? a. In preparation for discharge, include a significant focus on preventive practices. b. Spend time exploring the patient's life overall, focusing on broader issues than health. d. Anticipate that because the patient's traditions are steeped in history, there may be distrust in high-tech interventions. e. Provide relevant health-related information and then allow the patient to determine which course of action to pursue.

ANS: A, B, D, E Ayurvedic medicine, an ancient practice that originated in India, stresses individual responsibility for health, is holistic, promotes prevention, recognizes the uniqueness of the individual, and offers natural methods of treatment. Ayurvedic medicine does not require spiritual cleansing or the involvement of family and the treatment team in all decisions.

Select all that apply. A patient in good health and without any major health needs says, "I want to try some nutritional supplements I read about on the Internet." What information would be appropriate for the nurse to include in a response? a. "Most healthy people who eat a balanced diet do not need nutritional supplements." b. "Research has not supported claims that various nutritional supplements create significant benefits in healthy people." e. "Researchers are still studying the benefits and side effects of many supplements. We should know more in the years to come."

ANS: A, B, E Although some supplements do seem to improve certain disorders such as depression, nutritional supplements generally are not needed by persons who eat a balanced diet and are in good health. Claims for clear health benefits from exceeding the recommended intake of nutrients are generally not supported by science. Research is limited to date, and future findings may show more support as our understanding of the body's nutritional needs expands. Taken at levels supported by most health care practitioners, supplements are probably safe. Occasionally, research suggests that supplements thought to be safe can contribute to health problems under some circumstances. There is no evidence that supplements slow aging or prevent cancer. It is important for nurses to caution patients about reliability of information on the Internet.

A patient has tried a variety of complementary and alternative medicine (CAM) approaches to manage health concerns. The nurse asks, "How is going to CAM practitioners different from seeing your medical doctors?" The patient is most likely to respond, "The CAM practitioners: b. spend more time talking with me and not just about my symptoms."

ANS: B CAM practitioners often spend considerable time assessing the person in a holistic way. Visits typically involve lengthy discussions, in contrast to traditional physician visits, where contact is often brief. CAM remedies can sometimes be invasive or slightly painful, but usually they are noninvasive and well-tolerated. Some CAM practices are very spiritually focused, but most do not have overt religious elements. Conventional health care involves more diagnostic testing than CAM.

A patient had a stroke 3 weeks ago and is taking warfarin (Coumadin). When visiting the laboratory for a prothrombin time, the patient reports taking gingko for memory enhancement. Which nursing diagnosis applies? b. Deficient knowledge related to potentially harmful drug interactions

ANS: B Gingko is purported to improve memory, concentration, and mood in patients with dementia. Because it antagonizes platelet-activating factor, it should not be taken by patients who are receiving anticoagulants or who have other potential bleeding problems. Thus, deficient knowledge is an appropriate nursing diagnosis.

A patient tells the nurse, "My memory is not as good as it once was, so I started taking ginkgo biloba." The patient's only other medication is a low-dose aspirin daily. Which potential complication should be the focus of the nursing assessment? b. Spontaneous bleeding

ANS: B Ginkgo interacts with anticoagulants and antiplatelet agents and may cause spontaneous bleeding. Aspirin is such an agent and can predispose the patient to spontaneous bleeding. It would not increase the risk of thromboembolism. Drowsiness and gastrointestinal complaints are common side effects.

Which complementary and alternative medicine (CAM) method is associated with using allergy injections of small amounts of an allergen in solution? b. Homeopathy

ANS: B Homeopathy uses small doses of a substance to stimulate the body's defenses and healing mechanisms to treat illness. Naturopathy emphasizes health restoration rather than disease. Chiropractic uses manipulation of the body to restore health. Shiatsu is a type of massage.

A patient says, "I have taken megadoses of vitamin E for 3 months to improve my circulation, but I think I feel worse." Which action should the nurse take first? b. Assess the patient for symptoms and signs of toxicity from excess vitamin exposure.

ANS: B Megadoses of many vitamins, especially when taken over long periods, may produce dangerous side effects or toxicity. The priority for the nurse is to assess for signs of any dangerous consequences of the patient's use of such a regimen. Secondary interventions would include patient education about research findings related to the practice, along with any benefits and undesired effects associated with the practice.

A patient tells the nurse, "I've been having problems with my memory. I read some information on the Internet and started taking gingko." Select the nurse's best response. b. "More recent studies indicate gingko does not help memory problems."

ANS: B Recent studies indicate gingko is does not help with cognition or memory problems. Valerian is useful for treating mild depression or anxiety. The other distracters are misleading.

Select the best desired outcome for a patient who uses valerian. The patient will report: b. undisturbed sleep throughout the night.

ANS: B Valerian decreases sleep latency, nocturnal waking, and leads to a subjective sense of good sleep. Sleeping through the night is the best indicator the herb was effective. Although the patient's stress level may be lowered by use of valerian, the problem is insomnia; outcomes should relate to the problem. Early morning waking is indicative of depression or anxiety.

A patient reports, "Last night I had several mixed drinks at a party. When I got home, I had difficulty falling sleep. I made two cups of herbal tea with valerian. This morning, I feel very groggy and have a headache." The nurse should explain that: b. valerian may increase sedation from other central nervous system depressants.

ANS: B Valerian has sedative properties that are potentiated when used in combination with other central nervous system depressants. Headaches are another possible side effect of this herbal medicine. The nurse should advise caution in ingesting alcohol and valerian for these reasons. Taking valerian an hour after alcohol will not prevent these interactions, and it is likely that the valerian played a role in her feeling perhaps worse than usual after this episode of drinking. Herbal teas cause headaches in some cases, but it is not characteristic of this group of herbal remedies.

Acupuncture is a traditional Chinese medical treatment based on the belief that: c. insertion of needles modulates the flow of energy along body meridians.

ANS: C Acupuncture involves the insertion of needles to modulate the flow of body energy (chi) along specific body pathways called meridians. Acupressure uses pressure to affect energy flow. Homeopathy involves the use of microdosages of specific substances to effect health improvement. Traditional Chinese medicine is more concerned with energy and life force balance, and acupuncture is not predicated on the removal of toxic energies.

A patient tells the nurse, "I prefer to treat my physical problems with herbs and vitamins. They are natural substances, and natural products are safe." Which response by the nurse would be most appropriate? c. "The word natural can be a marketing term used to imply a product is healthy, but that's not always true."

ANS: C CAM remedies are usually natural substances, but it is a fallacy that products labeled natural are safer than conventional medicines. Some natural products contain powerful ingredients that can cause illness and damage to the body if taken inappropriately and, for some persons, can be dangerous even when used as directed. This is the most important message for the nurse to convey to the patient. So-called natural substances can have a number have significant side effects. Natural substances may give one the belief that he is controlling his own treatment, but that is not the message that most needs to be communicated here. Many patients can safely self-manage minor physical problems.

Which complementary and alternative therapy may be safely combined with traditional Western medicine in the treatment of anxiety disorder? c. Meditative practices

ANS: C Yoga, meditation, and prayer are considered to be beneficial adjuncts to treatment for anxiety disorder. Research supports this with findings of lower catecholamine levels following meditation. Patient self-reports suggest patient satisfaction, with increased ability to relax. Meditation and spiritual practices have no associated untoward side effects. Herbal therapy and megadoses of vitamins have potential associated side effects and interactions. Electroconvulsive therapy is not CAM.

A patient shows a nurse this advertisement: "Our product is a scientific breakthrough helpful for depression, anxiety, and sleeplessness. Made from an ancient formula, it stimulates circulation and excretes toxins. Satisfaction guaranteed or your money back." Select the nurse's best response. c. "Let's do some additional investigation of that product."

ANS: C Helping consumers actively evaluate the quality of information available to them is important. It is important for the nurse to work with the patient and include the patient's preferences regarding management of health. Advertisements indicating scientific breakthroughs or promising miracles for multiple ailments are usually for products that are useless and being fraudulently marketed. Some may even be harmful. Some over-the-counter products can be useful, and patients do not need a prescription for these products. The broader issue is safety and efficacy, rather than whether the patient is trying to self-medicate.

Which patient would most likely benefit from taking St. John's wort? A patient with: c. mild depressive symptoms.

ANS: C Research has found St. John's wort to be effective in treating mild to moderate depression. St John's wort has not been found to be effective in treatment of cyclothymic, bipolar, or anxiety disorders.

A patient diagnosed with depression confidently tells the nurse, "I've been supplementing my paroxetine (Paxil) with St. John's wort. It has helped a great deal." What is the nurse's priority action? c. Educate the patient about the risks of selective serotonin syndrome.

ANS: C Research has suggested that St. John's wort inhibits serotonin reuptake by elevating extracellular sodium; thus, it may interact with medication, particularly selective serotonin reuptake inhibitors, to produce serotonin syndrome. Discussing the patient's birth control method is a secondary priority.

An immigrant from China needs a colonic resection but is anxious and reluctant about surgery. This patient usually follows traditional Chinese health practices. Which comment by the nurse would most likely reduce the patient's anxiety and reluctance? d. "If you would like, we could investigate using acupuncture to help control pain."

ANS: D It would be helpful to incorporate elements of TCM as appropriate, such as acupuncture for pain control. Traditional Chinese medicine (TCM) has the goal of healing in harmony with one's environment and all of creation in mind, body, and spirit, as well as balance of yin and yang energies and a state of transition. However, it would not be helpful to suggest that surgery will balance the yin and the yang, since this is not how balance is achieved in TCM. Transformation is recognized as a stage of healing occurring when mutual, creative, active participation occurs between healers and the patient toward changes in the mind, body, and spirit; but "final transformation" could imply the end of corporeal life and might be perceived as hastening his demise. Appealing to him to trust persons whose practices are foreign to him conflicts with the patient's values and would not likely be effective.

A patient with a history of asthma says, "I've been very nervous lately. I think aromatherapy will help. I am ordering $250 worth of oils from an Internet site that promised swift results." Select the nurse's best action. d. Tell the patient, "Aromatherapy can complicate respiratory problems such as asthma. Let's consider some other options."

ANS: D Safety is paramount, and aromatherapy may cause complications for a patient with asthma. The nurse should view alternative treatments with an open mind and try to recognize the importance of the treatment to the patient while trying to give the patient accurate, reliable information about the treatment. Although efforts to become health literate should be supported, educating the patient about the pitfalls of relying on the Internet is essential. The opinions of others, whether they are positive or negative, lack a scientific basis and are subject to confounding variables such as the placebo effect and individual factors such as age and health history. Admonishing the patient may jeopardize the relationship.

A patient wants to learn more about integrative therapies. Which resource should the nurse suggest for the most reliable information? d. National Center for Complementary and Alternative Medicine (NCCAM)

ANS: D The National Center for Complementary and Alternative Medicine has a clearinghouse from which individuals may request information. The FDA has information, but it is not as extensive as NCCAM. The Internet has many resources but some are unreliable. The ANA does not provide extensive information about this topic.

A patient tells the nurse, "Look at all my bruises. They appeared about a week after I started taking nutritional supplements from the health food store." The nurse should focus assessment questions on the patient's use of supplements containing: d. Vitamin E

ANS: D Vitamin E has anticoagulant properties. Generally, a multiple vitamin tablet contains the minimum daily requirement of each vitamin. Taking nutritional supplements containing additional vitamin E would have the potential for causing bruising and hemorrhage. Excess Vitamin A, B, and C do not produce anticoagulant effects.