Chapter 5: Complementary and Alternative Therapies

Chapter 5: Complementary and Alternative Therapies

Overview

  • Complementary and Alternative Therapies: Includes a variety of health practices and products that do not fall under conventional medical approaches.

    • Categories:

    • Botanicals

      • Herbs, plants, and plant-derived/herbal medicine products used for health and therapeutic purposes

    • Nutritional products

      • Vitamins, minerals, probiotics, and dietary supplements used for health promotion and disease prevention

    • Herbal supplements

      • Over-the-counter as dietary supplements and can be taken in various forms: teas, infusions, tinctures, tablets, and dried herbs

  • Effects:

    • Positive effects: May provide benefits for various health conditions.

    • Negative effects: Potential adverse reactions or complications.

    • Interactions: Can interact with both prescription and over-the-counter drugs.

Regulatory Framework

Dietary Supplement Health and Education Act (DSHEA)

  • Purpose: To ensure the safety of products and that labeling is truthful and not misleading.

Current Good Manufacturing Practices (CGMPs)

  • Standards:

    • Require package labels to declare quality and strength of contents.

    • Ensure that products are free from contaminants and impurities.

Herbal Preparations

  • Various methods of preparing herbal remedies include:

    • Decoction: Boiling herbs to extract active ingredients.

    • Infusion: Steeping herbs in hot water.

    • Tinctures: Concentrated liquid extracts made with alcohol or vinegar.

    • Liniment: Liquid made for medicinal topical applications.

    • Poultice: Soft mass of material applied to the body for relief of pain or inflammation.

    • Essential Oils: Concentrated hydrophobic liquids containing volatile aroma compounds.

    • Herb-infused Oils: Oils that have been infused with herbs.

    • Percolation: Gradually passing a solvent through a solid to extract soluble substances.

Commonly Used Herbal Remedies

Chamomile

  • Uses: Relief of anxiety, sleeplessness, digestive complaints, skin conditions, and oral ulcers.

  • Effects: May induce sedative effects.

  • Allergic reactions: Urticaria and bronchoconstriction possible in those allergic to daisies or ragweed.

Cinnamon

  • Uses: Treats bronchitis, gastrointestinal (GI) issues, anorexia, diabetes.

  • Safety: Generally regarded as safe without notable allergic reactions.

  • Effect: May decrease blood clotting.

Echinacea

  • Uses: Commonly for colds, flu, and infections.

  • Effect: Stimulates the immune system.

Garlic

  • Uses: Addresses hypercholesterolemia, hypertension, heart disease, and prevention of stomach and colon cancer.

  • Side effects: Possible heartburn, upset stomach, body odor, and decreased blood clotting.

Ginger

  • Uses: Effective for nausea, motion sickness, diarrhea, and relief of pain/swelling.

  • Side effects: Gas, bloating, heartburn, and nausea.

Ginkgo Biloba

  • Uses: Used for asthma, bronchitis, fatigue, tinnitus, memory enhancement, intermittent claudication, and sexual dysfunction.

  • Side effects: Headache, dizziness, nausea, gastrointestinal upset, increased bleeding, and allergic reactions.

Lavender

  • Uses: Treats anxiety, depression, and digestive symptoms.

  • Side effects: Topical application may cause skin reactions.

Saw Palmetto

  • Uses: Addresses urinary symptoms, chronic pelvic pain, decreased libido, migraines, and hair loss.

  • Side effects: Includes digestive problems and headaches.

St. John's Wort

  • Uses: Helpful for mental disorders, nerve pain, sleep disorders, malaria, and wound healing.

  • Side effects: Include anxiety, dry mouth, dizziness, headache, fatigue, sensitivity to sunlight, gastrointestinal issues, and potential sexual dysfunction.

  • Drug interactions: Can lead to serotonin syndrome when taken with other antidepressants.

Turmeric

  • Uses: Effective for heartburn, stomach ulcers, gallstones, inflammation, and cancer.

  • Side effects: High doses may cause nausea and diarrhea; generally considered safe.

Potential Hazards of Herbs

  • Natural does not mean safe: Not all natural substances are safe via all routes of administration.

  • Patient management:

    • Collect a complete list of a patient's herbal usage.

    • Be vigilant for possible herb-drug interactions.

  • Impact on lab results: Certain herbal products may affect laboratory test results.

  • Impact on medications: Some herbs can interfere with the absorption, breakdown, and excretion of anesthetics, anticoagulants, and other medications used in surgical contexts.

  • Guidance: It is advised to discontinue herbal therapy 2 to 3 weeks prior to surgical procedures.

Guidelines for Herbal Use

  • Consult healthcare provider before taking herbal supplements, especially when on prescription medication.

  • Pregnant and nursing women should avoid herbal products.

  • Do not administer herbs to infants or young children.

  • Avoid consuming large quantities of herbal preparations.

  • Adhere strictly to label instructions.

  • Withdraw usage if side effects are observed, and consult a healthcare provider immediately.

Nursing Process in Herbal Therapy

Assessment

  • Determine and document the baseline of the patient’s use of complementary and alternative therapies.

  • Identify all prescription and over-the-counter (OTC) medications being taken.

Nursing Diagnosis

  • Develop planning and interventions based on the patient's needs.

Interventions

  • Monitor the patient’s response to all therapies, including prescription, OTC, and herbal treatments.

  • Be aware of cultural considerations that may influence herbal therapy usage.

Evaluation

  • Regularly evaluate the effectiveness of the therapies used and adapt care plans accordingly.

Practice Questions

Question #1

  • A patient uses herbal products. Identify at least four guidelines that the nurse should teach the patient for the responsible use of herbs.

Question #2

  • Which statement about St. John’s wort is true?
    A. Current research suggests that it is no more effective than placebo when used by individuals with severe depression.
    B. Side effects include hypotension, breast tenderness, menstrual irregularities, and hypoglycemia.
    C. St. John’s wort has been approved by the U.S. Food and Drug Administration to treat depression.
    D. Users of St. John’s wort should avoid tyramine-rich foods while taking the supplement.

Question #3

  • Which herb is thought by some to decrease memory loss associated with aging?
    A. Ginger
    B. Valerian
    C. Ginkgo biloba
    D. Echinacea

Question #4

  • A patient receives an anticoagulant secondary to previous blood clots. The nurse should reinforce that the patient should not take
    A. Garlic.
    B. Echinacea.
    C. Valerian.
    D. Peppermint.