QUIZ 5 REVIEW

complementary and integrative health (CIH)

Approaches health and wellness through a broader lens and is combined with, ideally complementing, conventional medicine.

biological therapies

substances found in nature

* non-prescriptive, herbal (botanical) medicines; often sold OTC
* include herbal therapies, dietary therapies, nutritional therapies, nutritional supplements, vitamins, minerals, and probiotics

manual therapies

hands-on focus on the structures (bones, joints, soft tissue) and systems (circulatory, lymphatic) of the human body

* include massage, chiropractic, osteopathy, manipulative therapies, and reflexology

bioenergetic therapies

practices involving manipulation of human energy fields to affect well-being.

* these fields can be considered either veritable (measurable) or putative (assumed)
* veritable energy relies on electromagnetic fields, like those generated by magnets, or light therapy
* putative energy (biofields) is based on the concept that humans possess subtle forms of energy
* energy therapists influence biofields by acupressure or other hands-on manipulation of these fields in and through the body
* ex: healing touch, therapeutic touch and qi gong

alternative systems of care

are whole medical systems (ex: ayurveda, traditional chinese medicine) that have developed over time and in different cultures, separate from Western or conventional medicine practices

* based on indigenous knowledge, theories, beliefs, and experiences
* homeopathy and naturopathy also evolved as alternative systems of care in recent years as contemporary practices

complementary therapies

used along with conventional medicine

alternative therapies

used as an alternative to conventional medicine

integrative therapies

use conventional, complementary, and alternative therapies to treat the mind, body, and spirit

holistic medicine

Viewing the client as a whole person and assisting in healing not only physically, but mentally, spiritually, and emotionally.

holistic nursing

Nursing practice whose goal is to heal the person and reinforce the body’s innate ability to heal itself.

key holistic nursing concerns

* Proactive promotion of health and wellness
* Honoring the caring–healing relationship
* Respecting the subjective experiences of client wellness, illness, growth, healing, birth, and dying
* Empowerment—that is, encouraging clients to actively participate in, and make informed decisions about, their own care
* Collaboration of cultural values and belief systems, folk and traditional practices, and the use of complementary and integrative practices in the promotion of health and wellness

progressive relaxation

relies on a systematic progression of tensing and relaxing groups of muscles

* ex: relaxation therapy, hypnotherapy, deep breathing, yoga

energy therapies

hands-on techniques involving the channeling of healing energy through a practitioner to the client, for restoration of health and balance of the body's energy.

* ex: therapeutic touch, healing touch

guided imagery

Involves relaxation through visualization of particular images to free the body of specific illnesses, or condition.

biofeedback

A conscious regulation of bodily functions assisted by electronic devices to improve health by reducing stress, eliminating headaches, recondition injured muscles and alleviate pain.

massage precautions

For clients taking anticoagulant medications or those who have a low platelet count, bleeding or bruising may occur with energetic massage. Avoid massaging over areas of tumors, blood clots, and prostheses.

reflexology

using anatomic charts to guide a method of massaging or manipulating the feet and/or hands reflex systems to positively influence the body’s functions regarding pain, stress, or other dysfunctions.

osteopathic medicine

A health care system concentrating on structural and anatomical abnormalities that cause disease.

alexander technique

Is focused on healthy posture and its effects on the body, particularly the spine, neck, and head. Developed by Frederick Mathias Alexander.

structural integration

Developed by Dr. Ida P. Rolf in the 1940 s with influences from yoga, chiropractic and the Alexander Technique.

Feldenkrais Method

Developed by Dr. Moshe Feldenkrais in the early 1970s this technique focuses on mindful movements to improve the physical use of the body.

therapeutic touch and dementia

For clients who have dementia, Therapeutic Touch was found to decrease behavioral manifestations such as restlessness and cortisol variability.

Ayurveda

An ancient Indian medical system based on harmony and balancing the mind, body, spirit to lead to health, contentment, and removing substances from the body that can cause disease.

Kampo

A traditional medicine form the developed in Japan, with origins in Traditional Chinese Medicine.

reiki

A Japanese system of healing where a practitioner directs Ki to restore health. This energy of life is similar to Chinese Qi but is unsupported by scientific evidence to effectively treat illness.

naturopathy

European healthcare and medical practices that evolved from traditional to alternative medical system in the 19th century. The theory is that a healing power, the body, establishes, maintains, and then restores health through the support of diet, supplements, exercise, homeopathy, medicinal plants, and traditional Chinese medicine.

homeopathy

A system of theoretical medical practices that any substance can produce a disease state in a healthy person and that any substance can provide treatment for a person who has the disorder. Ingredients in homeopathic remedies are often derived from plants, animals & minerals.

functional medicine

a biology-based approach whose focus is on the root cause of disease. It systemically identifies the many causes and conditions contributing to dysfunctional health.

prebiotics

A nutrient stimulating the health and growth of bacteria in the large intestine

* Organisms in the colon effect digestive health.

probiotics

Substances that promote a favorable, health-promoting effect on tissues and cells.

* example: Lactobacillus acidophilus inhibits the growth of damaging bacteria in the GI tract, like Salmonella or C. difficile, and can assist with digestive issues, such as lactose intolerance.

omega-3 fatty acids

found in a number of foods, mainly fish

* Fish oil supplements are the most common non-vitamin/non-mineral natural product taken by adults and children.

aloe vera

Plant-based product applied topically to aid in skin repair (burns), or taken orally for bowel discomfort. Aloe’s yellow latex properties can reduce the efficacy of some oral medications

Garcinia cambogia

Supplement used for weight loss, cholesterol reduction, and gastrointestinal problems. Available as a lotion, an extract, and a tea, or in capsules or tablets.

garlic

Oral supplement and topical oil that may be used to reduce cholesterol and high blood pressure

ginger

Fresh root, tea, and supplement used for nausea, especially postoperative nausea and vomiting, and motion sickness.

Ginkgo biloba

No research shows that this popular herb effectively treats symptoms of dementia or enhances memory. It may, however, interfere with medications like anticoagulants

ginseng

Asian red and white ginseng, as well as American roots, are used in teas and tonics for energy, stamina, and general good health. Interactions with anticoagulants are uncertain

Glucosamine/chondroitin

A structural compound similar to that found in cartilage, which is often used, with conflicting results, in osteoarthritis of the hips and knees. Interactions with anticoagulants and the body’s own blood sugar are possible.

Goldenseal

From a native North American plant; commonly used for allergic rhinitis, gastrointestinal upset, and respiratory tract infections, and as an eyewash

green tea

A caffeinated beverage used for weight loss, headaches, and digestion. Though some benefits can be found with heart disease, it has shown reduced efficacy when used in conjunction with nadolol, a beta-blocker

kava

A root used orally, in either powder or liquid form, that has mild effects in relieving anxiety. Kava can cause liver damage

lavender

Mainly used topically. Lavender oil is used to decrease anxiety, improve mood, and decrease restlessness

licorice root

A plant used for digestion, menopausal manifestations, and infections. Caution is warranted in clients with high blood pressure and those taking diuretics, as licorice root can potentiate low potassium levels. Pregnant women should avoid it altogether

melatonin

A natural hormone made by the brain in response to decreased light. It affects the body’s circadian rhythm and is an important component in promoting sleep. Melatonin supplements, made synthetically from animals or micro-organisms, have shown benefits in improving quality of sleep and mitigating jetlag

milk thistle

A plant used for liver disease and diabetes mellitus, research regarding its effectiveness is inconclusive. Can cause allergic reactions in clients who have a similar plant allergy (ragweed, daisy, marigold). Also known as silymarin

peppermint oil

This mint’s leaves commonly help relieve digestive issues, particularly irritable bowel syndrome. Used topically as an oil, peppermint is thought to relieve headaches and muscle pains

saw palmetto

Most often taken for benign prostatic hyperplasia, although it has not been shown to reduce prostate-specific antigen levels. Also taken for chronic pelvic pain, hair loss, and migraine

soy

Although present in many foods, soy is available in powdered form, tablets, and capsules. Using soy protein in place of other protein sources can reduce low-density lipoprotein (LDL) cholesterol. Soy products that contain isoflavones have effects similar to estrogen and can relieve manifestations of menopause, including hot flashes

st. Johns wort

Available in tablet, capsule, extract, or tea form, this herb is most often used for depression and insomnia. Its benefits, however, are mixed. Caution clients that combining St. John’s wort with antidepressants has serious effects on serotonin levels. Taking St. John’s wort in conjunction with medications such as digoxin, cyclosporine, anticoagulants, hormonal contraceptive pills, and some medications for HIV and cancer can reduce the effectiveness of those medications. One of the most common adverse effects is sensitivity to sunlight

tea tree oil

Commonly used topically for integumentary indications like acne, fungal infection, cuts, and insect bites. Tea tree oil can cause an allergic rash in some clients; caution clients that it is toxic if ingested.

valerian

Capsules, tablets, tinctures, and teas are used for reducing anxiety and insomnia. Should not be used in conjunction with alcohol or sedatives due to the potential for increasing drowsiness

chamomile

Used topically for skin conditions, orally for gastrointestinal distress and diarrhea, and as a tea for sleeplessness. Chamomile can trigger allergic reactions and may have negative interactions with cyclosporine and warfarin

cranberry

Oral supplement used in the relief and reduction of urinary tract infections (UTIs). When used in larger quantities, cranberry may interact with anticoagulants

echinacea

Widely believed to help prevent or reduce the effects of colds and infections when taken as supplement. Used topically for skin disorders. Existing research supports the use of echinacea to prevent colds; other uses have not been validated

ephedra

Historically used for respiratory conditions in Indian and Chinese medicine. Banned for use in the United States as a component in weight loss and energy/performance enhancement supplements. Ephedra may potentiate a stroke or other cardiovascular events. Also known as ma huang

evening primrose oil

Oral supplement used for rheumatoid arthritis, eczema, and premenstrual and menstrual conditions. May have some efficacy in diabetic neuropathy. Evening primrose oil may increase bleeding in clients on anticoagulant therapy

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Federal law defines nutritional supplements as products that:

* Are to be taken orally, in the form of a pill/tablet, capsule, powder, or liquid


* Contain one or more nutritional components such as a vitamin, mineral, or herb; a botanical-like product; a plant, algae, fungi, or any combination of those; an amino acid, enzyme, or organ tissue; or any extracts of the previous components
* Must be labeled correctly

pharmacokinetics

study of the absorption, metabolism, distribution, and excretion of drugs in the human body

absorption

the movement of a medication from where it was administered (enters the body) to the circulatory system

* first step in pharmacokinetics and affects the speed and intensity of the medication’s action in the body

factors that affect the rate of absorption

* route of administration: the point where the med enters the body
* ionization: the pH of the med and site of absorption
* dissolution: meds must be dissolved before absorption takes place
* blood flow: meds are absorbed more rapidly where blood flow is high
* lipid solubility: meds formulation can have either high lipid solubility or low lipid solubility
* surface area of the absorptive site: the size of surface area where the meds will be absorbed
* client-specific factors: pathophysiological processes, diseases or injury, age, and so on

ionization

affects the degree of absorption and the rate at which the drug permeates the cell membranes, which ultimately impacts the distribution of a medication

dissolution

the process where a gaseous, liquid, or solid phase dissolved in a solvent to form a solution

* med must be dissolved in solution before absorption takes place; the dissolution of a med is dependent upon its initial state and route of administration

orally disintegrated tablets

drug form that rapidly dissolved on the tongue or oral cavity

* allow for faster absorption

aspirin in its non-ionized form

easily absorbed in the acidic environment of the stomach

* enters small intestine; becomes ionized in the alkaline environment, which slows absorption rate

lipid solubility

if med is highly lipid soluble, it is absorbed more rapidly than a med that has low lipid solubility

* lipids act as carries that convey molecules of a med through membranes of the blood vessels and into the bloodstream - are essential to rate of absorption

protective barriers and lipid solubility

some meds are specifically designed to be more selective in their ability to cross through protective barriers (blood-brain and fetal-placental barriers)

* lipid-soluble meds cross barriers more readily

blood flow

the higher the blood flow to the site of administration, the faster a med will be absorbed

surface area of absorptive site

the larger the surface area available, the more rapidly the absorption will occur

* many oral meds have been designed to be absorbed in the small intestine because the small intestine has a larger surface area than the stomach
* many of these meds are weak bases (ionization) and are absorbed better in small intestine’s alkaline environment

enteral medications

most of the absorption occurs in the small intestines

* some meds may be absorbed from the stomach
* include tablets, capsules, and liquids
* can also be given via enteral feeding tube

enteral route

medications administered via the GI tract including: the mouth, stomach or intestines

* slower rate of absorption
* mucous membranes of the GI tracts delay med movement
* oral and enteral meds must pass through GI membranes to reach circulatory system (GI tract must be functional)

subcutaneous injections

are delivered into the fat layer found immediately under the dermis

* absorption rate may be slower than with an intramuscular injections due to smaller size of blood vessels found in the muscles
* are variable and reflect the blood flow to the site of injection

intramuscular injections

often have a faster absorption rate than subcutaneous injections due to large blood vessels found in the muscles

* are variable and reflect the blood flow to the site of injection

both intramuscular and subcutaneous routes of med admin have a faster rate of absorption than

oral or enteral route

oral meds

pass from the small intestine to the hepatic circulation via the mesenteric and portal veins following into the liver, before reaching systemic circulation

intravenous route

the most rapid rate of absorption because the meds are directly injected into the circulatory system through pt’s vein

* not affected by the same factors that affect absorption of medications administered through the other routes

topical meds

applied directly to the skin or mucous membranes of the eyes, nose, respiratory tract, vagina, rectum, and urinary tract

transdermal patches

transdermal applications allow for med to be absorbed slowly, providing prolonged medication release lasting for several days

* generally applied to the upper torso, chest, upper arms, or back, or behind the ears → absorbed though skin for systemic distribution
* ex: opioids, antidepressants, contraceptives, nicotine, and antinausea medications

dose

the amount of the ordered medication

distribution

the process of medication delivery to the target organ or tissues following absorption into the circulatory system

* affected by pt’s circulatory status or blood flow and the med’s solubility and protein-binding ability

high vascular areas

heart, brain, liver, and kidneys receive the greatest blood supply

low vascular areas

bones, skin, adipose tissue receive lesser amount of blood supply than high vascular areas

metabolism (biotransformation)

then chemical process of converting a meds structure

* can result in amplified med activity, inactivation, or increased excretion via the kidneys and can toxicity levels of meds
* may transform a specific med to another form resulting in a more active or potent form
* ex: codeine is transformed to morphine → increased relief

most meds are metabolized in the

liver

* kidneys and sections of small intestine are responsible for SOME med metabolism

cytochrome P-450

group of liver enzymes that transform meds to active and inactive substances to allow for their excretion

* play a role in med metabolism by regulating the rate at which a med is broken down and the amount of time the med stays in the body

pts with liver and kidney diseases

may have slower rate of med clearance

* important to evaluate the client’s renal(kidney) and hepatic(liver) function before med admin

toxicity

an adverse effect in which the body is unable to metabolize or excrete a medication; it can cause irreversible damage to organs

* develops when the body is unable to metabolize and excrete a med
* med doses may need to be lowered to avoid toxicity or may need to be discontinued
* older adults and pts with impaired cardiac, kidney, and liver function are at higher risk for developing toxicity

prodrugs

contain inactive chemicals that are activated through metabolism to exert their therapeutic effects.

therapeutic effects

the desired effects of a medication.

first-pass effect

can result in a lower concentration (bioavailability) of the med reaching the systemic circulation, if a majority of the med has already been metabolized into and inactive form before it enters the bloodstream

nutrients can influence medication metabolism by

allowing or preventing enzymes of P-450 (CYP) system to function normally

excretion

the process by which a med is removed from the body

which organ is primarily responsible for the excretion of medications

kidneys

*  skin, lungs, exocrine glands, liver, mammary glands, and intestines excrete medications to a lesser extent

the rate of medication excretion is affected by

kidneys, heart, and liver function which influence the meds concentration in the body

* med levels may remain at higher concentrations prior to next scheduled dose for clients with liver, kidney, or heart failure

pharmacodynamics

the study of how a drug works, its relationship to drug concentrations, and how the body responds

therapeutic range

a method used by health care providers to monitor drug concentrations to determine therapeutic dose and avoid toxicity.

* concentration of a medication is considered to be within therapeutic range when the med produces the desired effects

therapeutic drug monitoring (TDM)

method used by health care providers to monitor drug level concentrations.

peak blood level

highest level of a drug in the bloodstream without being at a toxic level

peak medication levels

occur when absorption is complete

trough blood level

is the lowest level of concentration of a medication that correlates to the rate of elimination

* it is measured before administering the next scheduled dose

half-life

time it takes for the drug to fall to half its strength through excretion