Complementary and Alternative Therapy

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Complementary and Alternative Therapy C. Matthews MSN, RN Marilee Elias, MSN, RN Spring 2012 0 Please make phones silent & visible 

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Reading ™ Required: - Wilkinson-Ch. 40 - Ignatavicius - Ch. 2 ™ Suggested Additional reading: - Lilley - Ch. 8 “Over the counter drugs and Herbal products” Some references in this presentation will be from pages in your textbooks other than required chapters - highly recommended reading. ‎my‏ ات 0 ‏3 ,۱۱ كن 02/2 

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Course Outcomes 1. Identify the roles of the nurse in a variety of community settings to maintain optimal ‏|اعنلا 5ه اعناع|‎ 0655. 2. Client - centered teaching. 3. Apply the nursing process to meet the physiological and psychosocial needs of clients and their families at the end of life. 4. Standards of safe medication administration. ner a 02/2 [OCI 3 

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UNIT OUTCOMES 1. Integrate complementary therapies into health promotion activities for the well client. 2. Assess client need for Complementary or Alternative therapy. 3. Identify use of Complementary or Alternative therapy. 4. Evaluate outcomes of Complementary or Alternative therapy practices. 35 2 non-pharmacological measures for pain Roa 6. Identify quackery or unscrupulous practitioners. ner a 02/2 [OCIS aC moos 5 

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CONTENT FOR ALTERNATIVE THERAPIES = |. Systems of Health Care - Traditional Chinese Medicine - Native American medicine - Homeopathy = Il. Mind-Body Therapies - A. Journaling - B. Imagery - C. Meditation ‏عا‎ ۱۱۱, ۱۵۸۵۱۵۵۷۵۱۵۲۱۷ ۲۲۳۵۲۵0۵165 - D. Massage - E. Tai Chi ner a 02/2 [OCIS aC moos 

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CONTENT FOR ALTERNATIVE THERAPIES = IV. Biologic Based Therapies mer ‏هد‎ ۷ - B. Herbal preparations = V. Energy Therapies - Healing touch - Therapeutic touch - Reiki ner a 02/2 [OCI 

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History of Western Medicine 9 02/2 0 

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Ancients -- Myths & Religion - Basis For Medical Practice ner a 02/2 [OCIS aC moos 

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وت 0۵ 2018و ‎Medicine:‏ ‎elas‏ 1 تك ماما Ippocrates وی 9 02/2 [OCIS aC moos 10 

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History of Western Medicine ™ Early Christian ‏مأ 5اع دنا اع‎ hospitals and health care similar to established Arab Medicine 9 02/2 [OCIS aC moos 11 

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History of Western Medicine ™ Middle Ages - Midwives - Witches - Physicians یت یت ‎[OCIS aC moos 12‏ 02/2 

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History of Western Medicine ™ Renaissance a 02/2 [OCIS aC moos 13 

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History of Western Medicine ۲ - Nightingale Coreen aT 02/2 ‏اننا‎ ase 3 

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History of Western Medicine = 20th and 21st Centuries اد 0162 9 02/2 ‏اننا‎ ase 1s 

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Integrative Health Care is A Concept of Coordinated Health Care that Includes ALL the Treatments (Conventional and CAMs) and Health Practices that Your Patient uses in their Life. How do We get our Patients to Tell us about the CAMs they use? كت 00 16 1۲ ال ان #1 عمممعاناه انوا 

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What is Holism? ™ Concept focused on Relationships among all living things. = Therapeutic Encounters include: - Enhancing Resistance to Illness - Reducing aggravating behaviors - Stress Management - Goal is Optimal state of Wellness for each unique person كت 00 17 1۲ ال ان #1 عمممعاناه انوا 

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RNs must be familiar with C. A. ۷۳ “The 2007 National Health Interview Survey (NHIS), which included a comprehensive survey of CAM use by Americans, showed that approximately 38 percent of adults use CAM.” nccAM retrieved 3/16/11 from http://nccam.nih.gov/health/whatiscam/ كت 00 18 1۲ ال ان #1 عمممعاناه انوا 

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What is CAM? = Complementary modalities (therapies): used in conjunction with conventional medical practice. (wilkinson, p. 1019) = Alternative Modalities(therapies): used instead of traditional care. (Wilkinson, p.1019) كت 19 ال ان ‎Uae}‏ 

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RN must: 1.Be non-judgmental despite personal opinions 2. Build rapport by showing client respect - if not, he may be afraid to tell about CAM use 3. Understand that C.A.M. can be beneficial, when used correctly 4. Be aware that C.A.M. can be dangerous if it interacts or interferes with conventional treatment كت 00 20 خ ا #1 عمممعاناه انوا 

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BN aa Sie 5. Be willing to teach the public about the positive and negative information regarding C.A.M. 6. Be aware that use of C.A.M. is popular and increasing and must be included in the history & physical 7. Know that Herbals, in particular, can have significant effect on prescription drugs and body function كت ‎fem eerste)‏ 21 ا اننا #1 عمممعاناه انوا 

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National Center for Complementary and Alternative Medicine = National Institutes of Health established NCCAM. ™ Purposes: - Fund studies evaluating effectiveness of C.A.M. - Advance health professional knowledge re: C.A.M. - Serve as a clearinghouse for information about these therapies ل 22 1۲ 5۱۲ ,۲۸۸ ان 02/2 

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NCCAM Domains of C.A.M. Ignatavicius pg 8; Wilkinson p. 1020 = National Center for Complementary and Alternative Medicine - 5 categories - Systems of Health Care - Mind-body therapies - Manipulative and body-based ‏لت‎ i - Biologically based therapies - Energy therapies كت ال ان ‎Uae}‏ 

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Mind-Body = Meditation - Stress relief/ reduce anxiety ‏لت واه‎ - Reduced levels of lactic acid - Decreased oxygen consumption - Slowed heart rate - Decreased blood pressure - Improved function of immune system - Reduce pain - Relieve symptoms of psoriasis - Improve health = (References: Ignativicius; Wilkinson) كت 24 خ لکلا را ‎iets ese) [eo‏ 

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Relaxation =™Used post-operatively <ignatavicius, p. 299) | ‏فلت لت دا‎ techniques (ignatavicius, p. 56- - To reduce anxiety, tension & emotional tension which can exacerbate pain ‏ممعد۵/۱ 17 10) ]۵ ا‎ ۷۵۱ 27 p. 967; Vol 1, pg 806-807) ™Progressive muscle relaxation (Cea UI O Ceca neat = Promoting sleep = Can be taught in home setting = Nurses can use for reduction of pain & stress. كت 25 خ لکلا را ‎iets ese) [eo‏ 

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Guided Imagery - Distraction when confronting pain, discomfort or fear - Making decisions and altering behavior - Caution: not recommended for emotionally unstable or cognitively impaired client - Helps reduce pain. - Reduction of nausea & vomiting. - Decreasing anxiety - Promoting comfort during cancer treatment ~ Ignatavicius, 6" ed. p. 9 كت 26 ال ان ‎iets ese)‏ 

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Mind - Body ™ Biofeedback 0 ‏ل‎ 22) = Journaling - Provides a vehicle for expressing feelings = Hypnosis 55 - Advanced training is NECESSARY ™ Humor - Biochemical Responses? - Physiologic Responses? كت 3 ال ان ‎iets ese)‏ 

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Spiritual ™ Life force beliefs found in most Cultures. (witkinson, p 1020) ™ Faith healing (wikinson page 260) ۳۸ ل 3 1۲ 5۱۲ ,۲۸۸ ان 02/2 

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Spiritual = spiritual beliefs - how they affect health = Longer life span = Predictors of health outcomes = Effects on specific diseases - Page 249 Wilkinson كت 3 خ لکلا را ‎iets ese) [eo‏ 

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Prayer ™ Most Widely Used CAM in U.S. (NCCAM, 2004) = C.A.M. interventions (Wilkinson page 257) Lal ele - For Self - For Others - Healing Prayer Services - Prayer Groups كت ‎ase 30‏ اننا ‎iets ese)‏ 

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0101» ۱۱۹20220 prayer - An organized and regular form of prayer in which someone communicates with his or her higher power on behalf of another who is in need. = Healing prayer - Studies showing evidence of improvement * Wilkinson, p 259-260 كت ‎ase 31‏ اننا ‎iets ese)‏ 

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ا »010 ™ Nurses should expect to work in collaboration with others, particularly ministers, pastors and chaplains, to meet the complex spiritual needs of all patients. ™ Potential problem: the nurse and patient have different views of spirituality - Respect patient’s wishes - If patient asks for spiritual intervention that is inconsistent with the nurse’s beliefs, seek assistance from another nurse or chaplain. كت ‎ase 32‏ اننا ‎iets ese)‏ 

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Manipulative and body-based methods ™= Movement & exercise - Strengthens circulatory & respiratory function - Endorphins - Helps regulate metabolism - Enhances Immune system nace my iets ese) ‏اننا‎ ase 33 

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Manipulative and Body-based Therapies = Yoga - “life forces in correct balance and flow - Concentration, strength, flexibility, (1 symbolic movements J - Breathing, movement & posture = Tai Chi - Promotes the flow of q/ or energy throughout the body - Ignatavicius, p. 11 - Reduces sx. of fibromyalgia - Used in cardiac rehab programs, can lower BP كت 34 ا اننا ‎se‏ 000 

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Chiropractic and Osteopathy ™ Chiropractic - Relationship between Body Structure and Function - Subluxation & Adjustment ™ Osteopaths D.O. vs. M.D. 1 - Includes Osteopathic Manipulation 4 ی ‎ase 35‏ اننا ‎iets ese)‏ 

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31 "Massage - Muscles & Soft Tissues - Benefits of Massage - Contraindications for Massage - Can we (nurses) do Massage? iets ace Sed 

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Energy - Based Therapies = “A group of techniques that work with the body’s energy field by the use of the hands to direct or redirect the energy to enhance balance within the ۲۶16۱0۰۳ ‏طمعط۷۷۱ عع6)‎ page 1033-34) Zo alternativecancer.us/aura.jpg كت ‎ase 37‏ اننا ‎iets ace Sed‏ 

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Energy - Based Therapi ™ Energy fields ‎Bait htc ae‏ ل ا ی یا ‎Fer caaea OT‏ ‏حت كاه 15 - ‎Reflexology ‘zones’‏ - ‎ ‎flexology+zones&btnG=S ‎ ‎8 ‎- Traditional Chinese Medicine - 12 Meridians (ignatavicius, 6% ed., page 9) ‎- Acupressure ‘meridians’ (wilkinson figure 40-3 page 1024) - Acupuncture chi/blockages ‎eon Ura NE) iets ese) ‏جرک لکلا ,ال نا‎ 38 ‎ 

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Energy - Based Therapies ™ Therapeutic massage - Precaution ‏ور‎ 3 = Therapeutic touch - Caution for touch - Ignatavicius 6% ed., page 13 ™ Healing touch ™ Reiki ™ Acupressure = Reflexology كت ‎ase 39‏ اننا ‎iets ese)‏ 

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Energy - Based Therapies = TT (Therapeutic Touch) - Integral to assessment - Bonding - Communication - Soothing, calming, comfort - orientation ™ Contraindications - When \\©! to touch - Ignatavicius pg. 13 nace my iets ese) ‏اننا‎ ase 40 

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"Reiki ™ Create Energy Balance = Patient draws Energy ™ Reiki Masters & Training “Reiki is a Japanese technique for ‏کت و یت ی ای ات توت‎ also promotes healing. It is administered by "laying on hands" 300 ‏مة غقطغ قعل عطغ مه معدقط 5أ‎ unseen "life force energy" flows through us and is what causes us to ie cet een 0 600] ‏اقمع جنك 1ي8‎ 01661: 327711 5 خی اه سس 

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Reflexology/Acupressure ™ Reflexology - Ancient Egypt - Energy Zones Top to Bottom - Pressure Points - What conditions benefit from it? ™ Acupressure - Meridians & Pressure Points كت ‎ase‏ اننا ‎iets ese)‏ 

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Acupuncture ™ Derived from traditional Chinese medicine and other countries and alternative systems ®= Qi (chi) Energy travels through 72 Meridians in the body ™ Needles are applied to Acupoints on the Meridians to restore the flow of gi nace my iets ese) ‏اننا‎ ase 43 

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Acupuncture - uses for Migraine headache - Ignatavicius, p. ‏دك‎ Pain and Anesthesia - ‏و‎ ‎5 ‎a‏ ات ‎[OCI 44‏ 02/2 

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بو ( 12[ Mak, MDG es/cancertre 3 0 [UC aS ote 45 

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Biologically Based Therapies ™ Dietary Therapies ™ Herbs omni Taal tals) = Aromatherapy 000 ae ‏كت‎ ‎۱ 1-5 ‏ا اننا‎ 46 

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Dietary Therapies ™ Nutraceuticals and phytonutrients = Protective or healing agents found in plant and animal foods. ™ Free radicals: unstable molecules that alter genetic codes and trigger the development of cancer growth in cells. ™ Antioxidants: react with free radicals, preventing their damaging effects - Sources of antioxidants: vitamin C, beta- carotene, vitamin E 6 3 ,#2 عمعانه ععمی كت 47 ا اننا 1-5 ۱ 

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Dietary Therapies ™ Macrobiotic Diets - Yin/ yang of foods - Balanced foods - Foods to avoid: processed and treated foods, red meat, sugar, dairy products, eggs, caffeine - Caution: children and pregnant women may have deficiency in Vitamins D and 812 6 3 ,#2 عمعانه ععمی كت 48 ا اننا 1-5 ۱ 

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Aromatherapy - Wilkinson page 1030 ™ Essences from oils extracted from plants & flowers. ™ Conditions responsive to aromatherapy: - Stress and anxiety - Muscular and rheumatic pains - Digestive disorders - Skin conditions 6 3 ,#2 عمعانه ععمی كت 3 49 ا اننا 1-5 ۱ 

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Aromatherapy ™ Can be used for sense of smell, but also as compresses, baths or topical nace my 02/2 ‏اننا‎ ase 00 

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Aromatherapy (Ignativicius, p.12) ™ Lavender - promotes relaxation & sleep = Peppermint - stimulation, concentration ™ Sandalwood - ease depression ™ Tea tree - treating MRSA? = Chamomile - relaxation ™ Lemon - promotes sleep/ tx for insomnia and/or digestive disorders 000 ی 3 ‎ase 51‏ اننا 1-5 ۱ 

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داز وتو Cherokee story =“ ..Aumans were without diseases until the animals created them in retribution for the lack of respect humans had shown them. The plants, however, felt that the animals were much too harsh and volunteered themselves to provide a cure for every disease the animals had created.” = Cavendar, p. 55 0000 eee) ‏كت‎ ‎Unit outcomes #1-5 ‏اننا‎ ase 52 

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; HERBALS=what RN needs to— 301۷ ™ Major drawback: May delay important diagnosis and treatment. ۱9/0 ی ‎ARNP is aware of client’s use of herbals.‏ ™ Nursing action: What to assess & instruct pre-op client regarding herbal therapy. 6 3 ,#2 عمعانه ععمی كت 53 ا اننا 1-5 ۱ 

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HERBALS - what RN needs to know ™ FDA categorized herbals as food and nutritional supplements not as drugs = The ‏ا الم‎ Health & Education Act (DSHEA) of 1994 allowed herbs to be sold as dietary supplements as long as there are no health claims written on labels ™ DSHEA requires no proof of safety or efficacy and sets no standards for products labeled as supplements, i.e. no guarantee the herb is properly prepared 000 كت 54 ا اننا 1-5 ۱ 

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Commonly used Herbals Ignatavicius page 12 - table 2-3 ™ Know intended uses for each ™ Know Caution & adverse effects of ‏وفعت‎ ‎- Gingko bilboa - Garlic - Echinacea - Ginseng - St. John’s Wort 000 كت 3 55 ا اننا 1-5 ۱ 

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Ginko Biloba ™ Reduce Memory Problems, Dementia, Peripheral Vascular Disease ™ Antioxidant & Vasodilatory Properties = BUT can cause BLEEDING when used with Anticoagu ® Avoid before a ™ Also cause Headache, GI Upset nace my Vitesse) ‏اننا‎ ase 56 

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Garlic ™ Lowers Cholesterol, Lowers BP, Natural Antibiotic, " Natural Anti-platelet Agent = BUT Causes BLEEDING with other Anti-platelet Drugs = Potentiates Anti-diabetic Drugs ™ Avoid before Surgery \E iy 6 3 ,#2 عمعانه ععمی كت ا اننا 1-5 ۱ 

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Echinacea ™ Builds Immunity, Helps Wound Healing = Use > 8 Weeks & Possible Immune Function Suppression = NOT Recommended for People with Immune Diseases 6 3 ,#2 عمعانه ععمی كت 58 ا اننا 1-5 ۱ 

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Ginseng = Asian Ginseng- Diabetes, Erectile Dysfunction, “Unclear” Thinking = American Ginseng- Diabetes, Prevention of Colds & Flu = Siberian Ginseng- Prevent Colds & Flu, reduce Severity of Herpes Simplex type 2 Infections = BUT, BUT, BUT, BUT... 6 3 ,#2 عمعانه ععمی كت 59 ا اننا 1-5 ۱ 

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Ginseng and the Big Buts Coreen aT 02/2 ‏اننا‎ ase 

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Ginseng & The BIG BUTS ™ Insomnia, Headache, Agitation, Gl Upset, Unusual Menstrual Bleeding, Breast Pain, Dizziness, Increase or Decrease BP, Hypoglycemia, iw ۹0 els Heartbeat; Severe Allergic Reaction = Not with Immune System Disorders, Schizophrenia, Endometriosis, Fibroids ال لا ‎fea‏ ی ‎ie po‏ ‎a‏ تدك 0 20006 

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St. John’s Wort ™ Ease Mild to Moderate Depression " BUT causes Photosensitivity = DO NOT use in Major Depression = DO NOT use with Other Antidepressants 6 3 ,#2 عمعانه ععمی كت 62 ا اننا 1-5 ۱ 

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Herbals =~. “Natural” does not always mean ‏تزور‎ = Plants used improperly can be po sonous. ™ Chemicals within herbs can strengthen the immune system, alter blood chemistry, or protect specific organs against disease علاقط لاقم 15ا3نال ألا أ لطا ت۱۱ ‎allergies‏ 000 كت 3 63 ا اننا 1-5 ۱ 

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۱۱۲۵۵5 ! 1 2 ‏و ره‎ 8 lactating women and children - should not use without physician's ‏م‎ ‎Unpredictable biologic effects Possible allergies Side effects Herbs have chemical composition Little or no regulation of production/ quality Possible herb/drug or herb/herb interaction Possible delay of treatment is dangerous 25250 3 ل 0 64 ا اننا 1-5 ۱ 

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Herbals & the RN = Teach about signs of allerc ۱531105 ™ Teach that herbs can be dangerous even if they are not Rx and are “natural” 6 3 ,#2 عمعانه ععمی كت 65 ا اننا 1-5 ۱ 

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Herbals & the RN = Always ask about use of herbals when getting medication history = “What is the story of why the patient is using the plant medicine or therapy?” ~ Libster, p. 809 ®™ Teach clients to look for products labeled ‘standardized’ - these more likely to have accurate amounts of herb and less likely to have contamination nace my ‏اننا‎ ase 66 

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اه الاو ۹۱۱92 رک 9 ‎use‏ ‎AL)‏ ترایز بات ی ‎ancient times and they also were adopted‏ ‎as medicines for physical ailments.‏ ‎™ In modern Chinese Materia Medica, these two resins are classified as herbs for ‏ای‎ circulation of blood and are utilized for treating traumatic injury, painful swellings, masses, and other disorders related to stasis syndromes. ‎WNP MYL ‏ا‎ UCER OD ‏ل‎ Regs a) ‏6 3 ,#2 عمعانه ععمی كت 3 ‎test!‏ ا لاك اك لاقن ال ل ل ‎sey M. Elias RN, MSN‏ ا ان ‎ ‎ ‎1 ‎ ‎ 

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® Pain in the epigastrum, abdomen, hypochondria, and/or heart due to qi and blood stasis, and stagnation in the viscera and bowels or the channels (jing) and network vessels (/uo). ™ Amenorrhea, dysmenorrhea, or postpartum abdominal pain due to blood stasis. ™ Rheumatic complaints due to wind damp causing qi and blood stagnation and stasis in the network vessels. ™ Wounds, scars, and skin inflammation with blood stasis and necrotic tissue. ™ Traumatic injuries with pain, swelling, and redness due to qi stagnation and blood stasis. SEN yet a ae Led een ascii ta) nace my 02/2 ‏اننا‎ ase 68 

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Folk Medicine (Ignatavicius, 6 ed., page 32-33) = Learned from experience ™ Passed from generation to generation ™ Preservation of heritage/ culture ™ Some have been scientifically proven (ex. Garlic) = Plants/herbs = Hot/cold = “Evil Eye” (Mal de Ojo) 000 كت 69 ا اننا 1-5 ۱ 

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Folk Medicine = Own terminology: (Feel free to ask the meaning) - “high blood” “low blood” “thin blood” - “Thick blood” ‏عانازامء‎ water - “fallout” gimpy ‏جه اكرات‎ - risin’ sugar cut pain - Weeded breasts - “snuffing the mother” = -the iteh7 - Cavendar, 2003 eee ens ۳ كت 71 ا اننا 1-5 ۱ 

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What is Quackery? ™ A pretender ™ Questionable products & services ™ Overpromotion vs fraud = Misinformation " Useful for some purposes, not others ات 0000 73 ا اننا 6 عمممعاناه الملا 

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How to spot Quackery ® Tell only part of the story ™ Overpromotes nutritional insurance ™ Play on fears about chemicals ™ ‘Everyone needs supplements’ = Promise quick, dramatic, miraculous results ™ Anecdotes & testimonials ® Questionable credentials = Claim persecution ™ Promote distrust = Take claims directly to the media, not peers ™ Resist peer review كت 0000 24 ا اننا 6 عمممعاناه الملا 

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Nurses Educate the Public ™ Teach signals of fraudulent practice ™ Avoid ‘healers’ who: - Promise immediate relief or success - State that their way is the only sure therapy - Refuse to work with other health care providers - Claim to have all the answers - Use testimonials that claim amazing results كت 0000 25 ا اننا 6 عمممعاناه الملا 

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One Minute Paper Now is the time to write short answers to: i What is something you heard today that is new to you? 2, How do you plan to approach your clients about CAM? 3, List one thing that surprised you, 4 List one thing that reinforced something you already believed. nace my 02/2 ‏اننا‎ ase 05 

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References ™ Cavender, A.(2003) Folk Medicine in Southern Appalachia. The University of North Carolina Press, Chapel Hill, N.C. ® Ignatavicius, D.D. & Workman, M.L. (2010) Medical- Surgical Nursing. 6 ed. Elsevier Saunders, St. Louis, Missouri. ™ Libster, M.L. (2002) Delmar’s Integrative Herb Guide for Nurses. Delmar Thomson Learning. United SS) ] Ko ® Wilkinson, J.M. & Treas, L.S. (2011) Fundamentals of nursing, 2" ed. FA Davis Company, Philadelphia, PA. nace my 02/2 ‏اننا‎ ase 7