Fundamentals of Nursing (Ch. 11, 18, 19, 20)

holism

relationships among all living things

holistic care emphasizes

uniqueness of each individual

interaction among mind, body, and spirit

multiple factors as causes of illness and disease

patient’s participation in treatment and healing 

alternative therapy

used instead of conventional treatment

complementary therapy

used along with conventional treatment

reasons patients use complementary alternative medicine (CAM)

cost

access

self-determination

personal touch

western medicine

prescribe drugs or treatments to kill foreign invaders

tends to see health as absence of disease, pain, or other symptoms of illness

approach is correct medications and surgery will make you well

allopathic

traditional, conventional, or western medicine

eastern and alternative health care

awareness of bioenergy

illness and disease are viewed as disharmony, imbalance, or defect of energy in body

symptoms are warning signs that the body is trying to heal itself but needs help

cause of illness is anything that interferes with balance and movement of bioenergy

personal responsibility is key to health

major emphasis is prevention of illness

HCPs are viewed as assistants to help cultivate life and vitality

in eastern medicine, illness progress further by:

energy imbalance causes functional changes that can initiate progression of chronic illness preceding pathological changes in tissue

types of complementary and alternative medicine

chiropractic

massage therapy

acupuncture and acupressure

yoga

herbal supplements

chiropractic

done by hand

manipulation of spine to relieve pressure on nerves; nervous system plays major role

treat people with neuromuscular complaints, arthritis, tendonitis, sprains, and strains; neck and joint pain

pt with osteoporosis and cancer or has undergone back surgery should share info with practitioner to make any modifications to treatment

massage therapy

application of stroking, pressure, kneading, and friction to muscles and other soft tissues to relax muscles and decrease stress

ability to relieve muscle tension and stress without using medications that may produce side effects

stimulates circulatory system; produces endorphins

types of massages

Swedish

shiatsu

reflexology

deep tissue

sports

Swedish massage

long, flowing strokes, kneading, vibration, and compression

hot stone massage (don’t place hot stone directly on skin)

shiatsu massage

Japanese-style massage; uses thumb pressure to work along energy meridians

reflexology massage

uses thumb and fingers to stimulate pressure points on feet

deep tissue massage

more vigorous, strenuous massage with focused pressure applied to tightened muscle areas and trigger points

sports massage

targets muscles and muscle groups maybe strained or injured during sports and vigorous exercise; targeting muscle-tendon junctions

acupuncture

inserting fine needles into carefully selected points located along meridians (energy pathways)

stimulates body’s healing ability and correct dysfunction

reduces chemotherapy nausea

inform acupuncturist if you’re taking anticoagulants

acupressure

blend of acupuncture and pressure; part of traditional Chinese medicine

applying needles to parts of body to affect meridians’ flow of energy, pressure is used

inform acupuncturist if you are taking anticoagulants

yoga

mind-body intervention used to decrease negative effects of stress through use of breathing exercises, physical postures, and meditation

invokes ideas of harmony, health, and balance

types of yoga

hatha

ashtanga

power

iyengar

bikram

hatha yoga

prepares and conditions body so mind can practice meditation without obstacles; slow-paced and gentle

ashtanga yoga

more fast-paced and intense; change poses quickly

power yoga

similar principles to ashtanga; not same set of poses

iyengar yoga

use of props; prevent injuries and assist body to obtain maximum benefit from exercise

bikram yoga

“hot yoga” in 90-minute sessions and 26 postures; increases heart rate and involves vigorous muscle use; causes heat-related illness

herbal supplements

preventative treatment for potential health problems

some herbs can interfere with medications and interfere with surgery and its outcomes

not regulated by FDA

aloe vera

uses: used alone and in many products for skin; people drink it for overall health

caution: laxative effects; causes cramping or diarrhea

capsaicin

uses: used in medicated creams and lotions for tenderness and pain of osteoarthritis; also used for fibromyalgia, diabetic neuropathy, and shingles

caution: burning sensation when applied

CoQ10

uses: replaces naturally occurring coenzyme in heart, liver, kidney, and pancreas; help heart damage caused by cancer treatment

caution: interaction with anticoagulants drugs (warfarin)

chamomile

uses: treat anxiety, induce sleep, and relieve upset stomach

caution: causes allergic reaction if you’re sensitive to ragweed

cranberry

uses: reduces urinary tract infections in pregnant women

caution: interaction with anticoagulants will result in bruising and bleeding

garlic

uses: reduce total blood cholesterol and reduce lipoproteins; 4 to 12 weeks

caution: blood thinners, anti-platelet drugs, and HIV antiviral medication

ginger

uses: relieve nausea and vomiting of pregnancy (doses in short period, larger dose will affect baby); motion sickness

caution: interaction with blood thinners

ginkgo biloba

uses: memory enhancement and dementia; help increase blood flow to brain

caution: medications who interact with liver; not be used with seizure medicines, NSAIDs, diabetic drugs, and blood thinners

st. john worts

uses: used for mild to moderate depression; least effective than prescription drugs

caution: anti anxiety medications; not taken with valerian or muscle relaxers

vasodilation

local application of heat

purpose for heat therapy

allows increased flow of oxygenated blood and nutrient-rich blood to tissues

pores in capillary walls become more permeable; allows increased passage of plasma, oxygen-carrying RBCs, nutrients, and WBCs

indications for heat therapy

relaxation of muscle spasms

pain relief

support healing process

reduction of edema

elevation of body temperature in cases of hypothermia

contraindications to heat applications

suspected appendicitis: result to ruptured appendix

bleeding wound or injury: dilated vessels; will increase bleeding

newly injured joints: increases edema; makes joint mobility difficult

large areas of body in certain cardiac patients: result in massive vasodilation to superficial skin

methods of heat applications

• dry heat

  • commercial heat packs

  • heating pads

  • aquathermia pads

  • warming blankets

• moist heat

  • hot compresses

  • socks 

  • sitz baths

  • whirlpool baths

vasoconstriction

application of cold

purposes of cold therapy

pores in capillary walls become less permeable to fluid passing from vessels to interstitial spaces

systemic cold use lowers body temperature, slowing metabolism, decreasing tissue oxygen demand, and decreasing chance of ischemia

indications for cold therapy

prevention of edema

control or stoppage of bleeding (hemostasis)

pain relief

numbing sensation

reduction of muscle spasm

reduction of fever

methods of cold application

refreezable commercial cold packs

chemical cold packs

cold compresses

tepid baths

gate control theory

transmission of pain impulse to central nervous system is controlled by “gate”; opens and closes in response to sensory input

classification of pain

acute

chronic

intermittent

intractable

referred

radiating

acute pain

comes suddenly, short duration

chronic pain

lasts longer; could be life long

intermittent pain

comes and goes at intervals

intractable pain

cannot be relieved

referred pain

felt in another area from original spot

radiating pain

specific site and shoots out

neuropathic pain

destruction of peripheral nerves or central nervous system itself

may extend beyond local region

phantom limb

pain from extremity that has been amputated

nociceptive pain

stimulation of pain receptors; 3 different types

cutaneous: more superficial (paper cut)

visceral (soft tissue pain): experienced from stimulation of deep internal pain receptors; traumatic injury or surgery

deep somatic (osteogenic pain): bone, ligament, tendon, and blood vessel pain

factors affecting pain

ethnic and cultural beliefs

developmental stage

individual values

previous pain experience

personal support system

emotions and fatigue

management and treatment of pain

level or extent of pain

site of pain

characteristics of pain

acute or chronic pain

what elicits pain

patient’s desire in relation to pain

nonpharmaceutical methods

hot and cold packs

massage and effleurage

transcutaneous electrical nerve stimulation

acupressure and acupuncture

relaxation

distraction

pharmaceutical methods

nonopioid

NSAIDs

opiate/opioids

adjuvant

patient controlled analgesia

nonopioid

acetaminophen (max 3,000 mg)

NSAIDs

ibuprofen, naproxen (Aleve); risk for bleeding and ulcers

opiate/opioids

codeine (Tylenol #3)

hydromorphone (dilaudid)

hydrocodone (Norco)

oxycodone (Percocet)

morphine

fentanyl (Duragesic)

adjuvant

gabapentin, alprazolam

patient controlled analgesia

loading dose or bolus

patient presses button when they need a dose

lock out feature

patient feels more in control of pain

newborns (required sleep)

16 to 18 hours per day

infants up to age 2 (required sleeping)

12 to 14 hours per day

children 3 to 6 years (required sleep)

12 hours per day

children 7 to 12 years (required sleep)

10 hours per day

adolescents (required sleep)

8.5 to 9 hours per day

young adults (required sleep)

7.5 to 8 hours per day

older adults (required sleep)

decreases gradually to 5.5 to 6 hours per day

factors affecting rest and restorative sleep

lifestyle

stress and anxiety

environment

illness and health problems

sleep disorders

interventions to promote restorative sleep

comfort

relaxation

pain relief

sleep medications

environment

stage 1 of sleep

lightest sleep occurs lasting a few minutes; easily aroused; feels like daydreaming

stage 2 of sleep

sound sleep, but arousal is still relatively easy; lasts 10 to 20 minutes

stage 3 of sleep

deep sleep begins; lasts 15 to 30 minutes; arousal is more difficult

stage 4 of sleep

very difficult arouse; lasts 15 to 30 minutes; body rests and is restored during this deep sleep

REM sleep

occurs at end of each NREM cycle; occurs about 90 minutes after sleep begins; vivid dream and can recall dreams after waking up

bruxism

grinding teeth during sleep

insomnia 

chronic inability to fall asleep or stay asleep

narcolepsy

condition causing uncontrollable, recurrent daytime episodes of sleepiness

night terror

nightmares in children that cause awakening and fear

restless leg syndrome

intolerable crawling sensation in legs; results in an irresistible urge to move legs

sleep apnea

inability to maintain breathing while sleeping; can be life-threatening

somnambulism

sleepwalking; potential for serious consequences

sundowning

confusion and disorientation in older adults that occurs in evening hours; patient is at higher risk for injury

echinacea

uses: antiviral agent to prevent colds, flu, and other infections

caution: slows metabolism of coffee; allergic reaction

ginseng

uses: lower bad cholesterol and protect heart; lower blood sugar in type 2 diabetes; boost immune system

caution: blood thinners, blood pressure medicines, and diabetic medications

peppermint

uses: treating heartburn; improve irritable bowel syndrome; decease spasms of GI tract before and after endoscopic procedures

caution: antibiotics or antifungals; iron supplements; medicines to reduce stomach acid

saw palmetto

uses: enlarged prostate in men; improve symptom of difficult urination; doesn’t shrink prostate

caution: don’t take finasteride (Proscar); warfarin, estrogen replacement therapy, birth control pills

soy

uses: decrease cholesterol and low-density lipoproteins; improve diarrhea in infants; decrease menopausal symptoms (hot flashes)

caution: anticoagulants, antiplatelets medicines, and anti-inflammatory medicines; blood pressure and diabetes medicines

valerian

uses: treat insomnia; improve quality of sleep and decrease amount of time it takes to fall asleep

caution: prescription medications (muscle relaxers, sleeping medicines, pain medicines, and antidepressants)

feverfew

uses: anti-inflammatory; migraine headaches, fever suppression, and menstrual cramps

caution: anticoagulants and antiplatelet medicines, leads to bleeding and bruising

additional forms of complementary and alternative medicine

aromatherapy

meditation

biofeedback

relaxation therapy and imagery

therapeutic touch 

homeopathy

phytonutrients

free radicals and antioxidants

pet therapy

music therapy

play therapy

aromatherapy

essential oils used to affect a person’s mood or health; some oils might cause irritation if applied directly to skin

meditation

mind is focused on an object of thought or awareness; practiced more than 5,000 years; turning attention to single point of reference

biofeedback

monitoring devices to help person become aware of changes in heart rate, blood pressure, and muscle contraction

relaxation therapy and imagery

uses conscious awareness and visual images to relax muscles, lower respiration, and promote calm; ease stress and lower blood pressure