NUR 321 Module 6 Flashcards
Immunizations, Screenings, CAM therapies
Complementary therapies are:
therapies used together with conventional treatment recommended by a person’s health care provider.
CAM therapies include:
relaxation, exercise, massage, reflexology, prayer, biofeedback, hypnotherapy, creative therapies (art, music, or dance), meditation, chiropractic therapy, and herbs/supplements.
Integrative therapy
interventions provided by a licensed health care provider.
Alternative therapies
non-pharmacologic therapies are used in place of conventional pharmacologic or other medical procedures.
Holistic nursing
the practice of healing the whole person and not just the body.
Integrative nursing
“a way of being-knowing-doing that advances the health and well-being of persons, families, and communities through caring-healing relationships. Integrative nurses use evidence to inform traditional and emerging interventions that support whole person/whole systems healing”
Relaxation Therapy
Relaxation helps individuals develop cognitive skills to reduce the negative ways in which they respond to situations within their environment.
Cognitive skills include:
- focusing
- passivity (stop unnecessary goal)
- receptivity (tolerate and accept experiences)
Benefits:
- Lowers BP and HR
- Decrease muscle tension
- Improve well-being
- Reduce distress, pain, anxiety, depression, & breathlessness
Limitations:
- Continued intensification of symptoms or the development of altogether new symptoms,
- Active progressive RT requires moderate expenditure and can increase fatigue in Cancer and AIDS pts.
- Passive relaxation or guided imagery is more appropriate for these individuals.
Medication and breathing therapy
Any activity that limits stimulus input by directing attention to a single unchanging or repetitive stimulus so that the person can become more aware of self.
4 components of meditation
- a quiet space
- comfortable position
- receptive attitude
- focus of attention.
Meditation is “mindful,” increasing our ability to live freely and escape destructive patterns of negativity.
Meditation is self-directed
Benefits:
- Reduces BP, HTN risk, relapses in alcohol tx programs
- Less depression, anxiety, & distress
- Better QOL, increases productivity, improves mood, increases identity, and lowers irritability.
Limitations:
- Pt. w/ fear of losing control will perceive it as a form of mind control & be resistant to learning.
- May become hypertensive during meditation & require shorter session than the average 15 to 20 min.
- May increase certain drugs
Imagery
“Visualization” is a mind-body therapy that uses the conscious mind to create mental images to stimulate physical changes in the body, improve perceived well-being, and/or enhance self-awareness.
- Combined with some form of relaxation training.
- Self-directed
- Also include the auditory, proprioceptive, gustatory, and olfactory senses, control or relieve pain, decrease nightmares, and improve sleep, asthma, cancer, sickle cell anemia, migraines, autoimmune disorders, atrial fibrillation, functional urinary disorders, menstrual and premenstrual syndromes, gastrointestinal disorders such as irritable bowel syndrome and ulcerative colitis, and rheumatoid arthritis
Limitations:
- Few side-effects
- Increased anxiety & fear occur when imagery is used to treat PTSD & social anxiety disorders
- Some pts w/ COPD & asthma experience increased airway constriction
Biofeedback
1980s; Uses instruments to teach self-regulation and voluntary self-control over specific physiological responses
- Measure, process, & provide info to pts about their muscle tension, cardiac activity, respiratory rates, brain-wave patterns, & autonomic nervous system activity.
- Feedback is given in physical, physiological, auditory, and/or visual feedback signals that increase a person’s awareness of internal processes that are linked to illness & distress.
- Used to change thinking, emotions, and behaviors, which in turn support beneficial physiological changes, resulting in improved health and well-being.
- May be helpful in stroke recovery, smoking cessation, ADHD, epilepsy, headaches, gastrointestinal and urinary tract disorders
- Lowers BP, HR, & other physiological parameters.
- Pts who adhere to treatment have positive results.
Limitations:
- Psychological or neurological conditions.
- During biofeedback sessions the repressed emotions or feelings for which coping is difficult sometimes surface. - - - HCP who offer biofeedback need to be trained in more traditional psychological methods or have qualified professionals available for referral.
Traditional Chinese Medicine
Began as an ethnic healing system approx 3600 yrs ago
Views health as “life in balance”
- Yin-yang: dynamic equilibrium, cupping, tai chi, qi gong.
- Evidence is limited. Most research studies individual tx components (acupuncture and herbal therapies)
- Some evidence shows that TCM is helpful in treating fibromyalgia and symptoms associated with menopause
Limitations:
- Not regulated in the states w/ exception of acupuncture
- FDA does not regulate herbs; contraindications with drugs
Acupuncture
Regulates/realigns the vital energy (qi), which flows like a river through the body, acupuncturists insert needles along this channel (acupoints)
- Modifies body’s response to pain and how pain is processed by central neural pathways and cerebral function
- Effective for low back pain, myofascial pain, hot flashes, simple/migraine headaches, osteoarthritis, plantar heel pain, and chronic shoulder pain.
- It is also used to treat sinusitis, gastrointestinal disorders, chronic pruritus, perimenstrual symptoms, menopausal symptoms, clinical depression, smoking, and other addictions with varying effectiveness
Limitations:
- Safe w/ appropriate training
- Needle complications are rare
- Reported complications include infections resulting from inadequately sterilized needles or those that are left in place for an extended length of time, broken needles, puncture of an internal organ, bleeding, fainting, seizures, and post-treatment drowsiness.
- Caution with pregnant women and history of seizures
Therapeutic Touch
1770s, affects energy fields that surround and penetrate human body with conscious intent to help or heal.
“Acupressure, healing touch, and reiki”
- It occurs in five phases: centering, assessing, unruffling, treating, and evaluating.
- Evidence supporting is inconclusive. May be effective in in treating pain, dementia, trauma, and anxiety during acute and chronic illnesses.
Limitations:
- Few complications or side effects
- People who are sensitive to human interaction and touch (e.g., those who have been physically abused or have psychiatric disorders) often misinterpret the intent of the treatment and feel threatened and anxious by it.
Chiropractic Therapy
1985, manipulative or body-based therapy
- Chiropractors graduate from well-established post-baccalaureate educational programs
- Belief that when the spine is misaligned, energy flow is impeded, and the innate healing abilities of the body are impaired.
- Use their hands or a device to provide manipulation, which is the application of a controlled, sudden forceful movement to a joint, moving it beyond its passive range of motion.
Limitations:
- Bone and joint infections require pharmaceutical or surgical intervention because the structural integrity of the bone is compromised if excessive force is used.
- Acute myelopathy, fractures, dislocations, rheumatoid arthritis, & osteoporosis.
- Headache, increased pain & stiffness, vertebral arty dissection
Natural Products & Herbal Therapies
Used over 60K years; approx. 25k plant species used medicinally.
- Not regulated by FDA
- Cranberry juice – UTIs, Curcumin – anti-inflammatory and lowering fasting blood sugars
Limitations:
- Natural does not mean safe
- Contamination with pesticides and heavy metals
- Only use reputable manufacturers
- Some herbs contain toxic products linked to cancer
What patient conditions do the College of Physicians recommend these therapies and why?
Complementary therapies accessible to nursing include relaxation, meditation and mindfulness techniques, and imagery.
Evidence supports their use to decrease the effects of stress and improve overall patient well-being.
Screenings
Secondary prevention methods
Primary objective for screenings
identify risk factors, detect disease in early stages, and reduce cost of disease management
Secondary objective for screenings
Reduce cost of disease management by avoiding costly interventions required at later stages. Save money by removing polyps before they get worse.
Advantages of screenings
simple, cost effective, ind. Vs. pop (PKU), one test or multiple, opportunity for health education
Disadvantages of screenings
false positive, false negative
Clinical preventative services include:
screening tests, preventive medication, and counseling
USPSTF grading
A- Recs service. High certainty that net-benefit is substantial. Offer/provide service
B- Recs service. High certainty that net-benefit is moderate. Offer/provide service
C- Recs selective service. High certainty that net-benefit is small. Offer/provide service selectively
D- Does NOT rec service. No net-benefit. Discourage use of service.
I- Current evidence is insufficient. Read clinical considerations. Pt. should understand uncertainty.
Mammogram screenings
Women age 40-49 –> grade C
Women age 50-74 –> grade B, biennial
Colorectal cancer screenings
adults 50-75 –> grade A
Prostate screenings
men 55-69 –> grade C
men 70+ –> grade D
How is Hep B transmitted?
Contact with blood or body fluids of an infected person.
HPV - how is it transmitted, what does it cause, when to vaccinate
- Transmitted sexually
- Asymptomatic and result in no clinical disease therefore are dangerous for cancers they cause
- Vaccinate at 11 or 12 years old. Can be as early as 9.
How is Influenza transmitted?
Influenza type A- moderate to severe, seen in all age groups
Influenza type B- milder disease, primarily affects children
Herpes Zoster
Shingles, cause by varicella zoster virus, manifestations are on 1 side of the body, associated with aging immunosuppression, intrauterine exposure and varicella at younger than 18 months of age
Active Immunity
- Through injection to make immune system react defensively.
- Protection produced by the person’s own immune system
Passive Immunity
- Accomplished by injecting blood from an actively immunized person or animal
- Can be given after an individual has been exposed to a disease to prevent the disease from developing
Attenuated vaccines are
- Live
- Weakened form of the whole germ that causes a disease
- Strong, long lasting immunity response
Examples of attenuated vaccines
- MMR
- Flu Mist
- Rotavirus
- Varicella
Limitations of attenuated vaccines
- Do not give to immunocompromised individuals or pregnant women
- Refrigerate
- Can cause mild infection, symptoms, but NO disease
Inactive vaccines are
Killed version of the germ that causes a disease
Examples of inactivated vaccines include
- Hep A
- Flu
- Polio
- Rabies
Limitations of inactivated vaccines are
- Immunity not as strong
- May need several doses: booster
Subunit, recombinant, polysaccharide & conjugate vaccines
Specific pieces of the germ inserted into the patient and are made of proteins, sugars, or capsid of the causative bug
Limitations to subunit, recombinant, polysaccharide & conjugate vaccines include
May need booster
Examples of subunit
Hep B and acellular pertussis
Examples of recombinant
HPV, can also be Hep B
Examples of polysaccharide
Pneumococcal
Examples of conjugate
Hib
Toxoid vaccines
- diphtheria and tetanus
- a targeted toxin is used
- booster is needed
Examples of passive immunity
- Antibodies from breast milk or placenta, or when a person receives antibodies in the form of an injection.
- Provides immediate protection against an antigen, but does not provide long-lasting protection
Adults over 50 years of age need…
- flu shot annually
- tetanus every 10 yrs.
- zoster or varicella at age 50
- Pneumococcal vaccine recommendation (1 time the PPSV23 at age 65)
Immunization adverse reactions include:
- Local: redness
- Systemic: fever, syncope
- Allergic: anaphylaxis
Management of adverse reactions includes:
- Local: cold compress
- Systemic: Acetaminophen
- Serious: manage anaphylaxis (EpiPen, Oxygen, antihistamines, steroids)
- DO NOT GIVE ASPIRIN FOR FEVER –> associated with rye syndrome
