Complementary and Alternative Therapy in Maternity And Pediatric Nursing PDF 2023

**CRM LESSON PLAN REPORT** **Complementary and Alternative Therapy in Maternity and Pediatric Nursing** **NP03L010 ELO D · Version 2.0** **Analysis** **September 2023** **Effective Date: N/A** **SCOPE:** This lesson focuses on the complementary and alternative therapies available for use with...

**CRM LESSON PLAN REPORT** **Complementary and Alternative Therapy in Maternity and Pediatric Nursing** **NP03L010 ELO D · Version 2.0** **Analysis** **September 2023** **Effective Date: N/A** **SCOPE:** This lesson focuses on the complementary and alternative therapies available for use with a maternity and pediatric nursing. **Distribution Restriction:** Distribution authorized to the DOD and DOD Contractors only FD review is required prior to release for national disclosure policy (NDP) compliance and the protection of operational data associated with US tactics, techniques, and procedures (TTPs). 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INTRODUCTION** +-----------------------+-----------------------+-----------------------+ | **Motivator** | Complementary and | | | | alternative medicine | | | | therapies are also | | | | known as integrative | | | | therapy, integrative | | | | healing, and holistic | | | | healing. Although CAM | | | | therapy is used | | | | throughout the life | | | | span, this lecture | | | | will focus only on | | | | the common | | | | gynecological, | | | | obstetric, and | | | | pediatric practices. | | +=======================+=======================+=======================+ | **Terminal Learning | **NOTE:** Inform the | | | Objective** | students of the | | | | following Terminal | | | | Learning Objective | | | | requirements. | | | | | | | | At the completion of | | | | this lesson, you | | | | \[the student\] will: | | +-----------------------+-----------------------+-----------------------+ | **Terminal Learning | **Action:** | | | Objective** | | | | | | | | **Safety | | | | Requirements** | | | +-----------------------+-----------------------+-----------------------+ | | **Conditions:** | | +-----------------------+-----------------------+-----------------------+ | | **Standards:** | | +-----------------------+-----------------------+-----------------------+ | | None | | +-----------------------+-----------------------+-----------------------+ | **Risk Assessment | Low | | | Level** | | | +-----------------------+-----------------------+-----------------------+ | **Environmental | **NOTE:** It is the | | | Considerations** | responsibility of all | | | | Soldiers and DA | | | | civilians to protect | | | | the environment from | | | | damage. | | | | | | | | None | | +-----------------------+-----------------------+-----------------------+ | **Evaluation** | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ **SECTION III. PRESENTATION** **D. ENABLING LEARNING OBJECTIVE** ----------------- ------------------------------------------------------------------------------------------------------------------------ **ACTION:** Determine nursing care approaches **CONDITIONS:** In a clinical setting, given a scenario of a patient requiring non-traditional therapy **STANDARDS:** Determine nursing care approaches for a patient requiring complementary and alternative therapies without further harm ----------------- ------------------------------------------------------------------------------------------------------------------------ 1 Learning Step / Activity 1 Complementary and Alternative Therapy --- ------------------------------ --------------------------------------- Method of Instruction: Large group discussion Instructor to Student Ratio: 1:30 Time of Instruction: mins Media: Large group discussion a\. Define complementary and alternative therapy 1\) Complementary therapy refers to nontraditional therapy that is used **in conjunction** with traditional or conventional therapy a\) Example: Treatment for hypertension with medication plus relaxation or biofeedback 2\) Alternative Therapy refers to unconventional or nontraditional therapy that **replaces** conventional or traditional therapy 3\) These therapies are also known as integrative therapy or healing 4\) This lecture will focus on common gynecologic, obstetric, and pediatric practices a\) Pediatric use of these therapies is relatively new, and the American Academy of Pediatrics have developed resources both to educate professional and consumer and to review legal and ethical considerations b\) More research is being completed to develop evidence-based practice in pediatrics b\. Role of the Nurse in CAM therapy 1\) CAM therapies are based on accepted theories, such as the gate control theory of pain relief 2\) Knowledge concerning CAM therapy expand knowledge about the health care practices used in many cultures, which requires cultural competency a\) Mexican: Curanderos b\) African American: Root doctor c\) Asian and Chinese: Herbalist d\) Puerto Rican: Espiritistas or Santiguadoras e\) Navajo: Singers f\) Cultural competence is a sensitivity and respect for practices and philosophies different from one's own 3\) Increasingly, nurses encounter some alternative health care practices by patient who: a\) Want increasing control over their health care b\) Need to be a part of the decision-making process c\) Want to incorporate cultural beliefs and traditions into their care 4\) Nurses need to understand CAM therapy a\) How it can be used b\) How it may interact with or enhance traditional medicine or nursing care c\) Not all alternative therapists are licensed d\) Not all alternative medicines are regulated e\) Much of the practice may not be evidence-based 5\) Some CAM practices have filtered into accepted nursing practice a\) Massage b\) Imagery c\) Acupressure d\) Aromatherapy 5\) Nurses' role is not to promote the acceptance of CAM therapy, but to recognize and respect its use by patients and to use critical thinking to determine interactions with traditional therapy 6\) When documenting a patient's health history, the nurse should ask questions concerning the family's use of CAM therapies c\. Involvement of the federal government in CAM therapy 1\) Food and Drug Administration a\) Regulations that require proof of the effectiveness for a medication before it could be placed on the market for sale b\) Manufacturers of herbal products can circumvent these regulations by declaring their products to be "dietary supplements" c\) For this reason, many dietary supplement and herbal remedies vary in their strengths and ingredients 2\) National Center for Complementary and Integrative Health a\) Serve as a clearinghouse and resource for research concerning CAM therapies b\) More popular herbs and oils have been the first to be researched in many medical center around the United States 3\) Dietary Supplement Health and Education Act a\) Requires that herbal medications has a label that claims regarding the medication are not approved by the FDA **Check on Learning** **Question:** Discuss specific herbs that should be discontinued at least 2 weeks before surgery and the reason for the contraindication. What herbs can be taken up to the date of surgery? **Summary:** **In this section, we discussed complementary and alternative medicine.** 2 Learning Step / Activity 2 Use of CAM Therapy --- ------------------------------ ------------------------ Method of Instruction: Large group discussion Instructor to Student Ratio: 1:30 Time of Instruction: mins Media: Large group discussion a\. Common Alternative Health Care Practices 1\) Mind-Body Therapies a\) Deep breathing, guided imagery, biofeedback, hypnosis, Chi and yoga are commonly used in OB and Peds b\) Research has shown their value in many aspects of health care delivery 2\) Massage a\) The body is thought to have a self-healing ability that can be aided by spinal or energy manipulation b\) Soft tissue massage is thought to bolster the immune response c\) Examples 1\. Rolfing uses fascia pressure, stretching and manipulation to improve muscle and bone function 2\. Cao-gio or coin rubbing is a form of skin manipulation thought to help bring the body into healthy alignment \(a) Can easily be mistaken as child abuse because of the lingering marks on the skin after treatment 3\. Neuromuscular massage helps to relieve muscle tension and the trigger points of pain and generally improves circulation 4\. OB use \(a) Perineal massage during pregnancy and before delivery may prevent the need for episiotomy. \(b) Effleurage is a form of massage used during labor \(c) Foot massage, can stimulate preterm labor in susceptible women \(d) Nipple, breast stimulation and sexual intercourse are CAM methods to induce labor 5\. Peds use \(a) Used for treatment asthma, arthritis and eating disorders \(b) Gentle touch has shown to have a positive effect on premature Infants, by calming them and promoting bonding \(c) Contraindicated in patients with cancer, osteoporosis, localized infection and cardiac disorders because of the increase it causes in blood flow to the affected area \(d) Down Syndrome children with cervical spine anomalies my be injured with manipulation \(e) Children of sexual abuse do not usually respond favorable to touch Therapy 3\) Osteopathy a\) Combines manipulative therapy with traditional medicine b\) Pressure point therapy is believed that pressure on certain point of the body will open channels in the body to conduct vital energy through the body c\) OB Use: Guiding a woman with previous back problems to select a birthing position that will not aggravate the problem 4\) Energy Healing a\) Involve the belief that an electromagnetic flow emerges from the therapist's hand and can funnel energy into the patient, which is believe to repattern a patient's own energy field to aid healing b\) TENS, shen, reiki, and the use of magnets are other forms of energy therapy c\) OB Use 1\. TENS wristband can prevent nausea and vomiting during pregnancy 2\. Magnets should not be used over the abdominal area d\) Peds Use 1\. Light therapy or sunlight used to treat jaundice in infants and also used in treating seasonal affective disorder 5\) Reflexology a\) Reflex point in the hands and feet that are though to correspond to every organ or part of the body b\) Reflexology lines divide the body into 10 zones of longitudinal line. Blockage of these lines are thought to obstruct vital energy patient way. c\) Massing these reflex points can relieve specific problems c\) OB Use: Stimulating the area around the anklebone can affect he uterus and pelvic organs and relieve pain during labor 6\) Acupuncture and Acupressure a\) Works on the complex meridian, which are imaginary lines that are thought to be pathways carrying energy (Chi) to specific organs or parts of the body 1\. The meridian surface at specific locations called acupuncture points 2\. 150 points on the 12 meridian sites that positive or negative energy can be realigned through stimulation to restore a balance of CHI energy b\) Dermatome is a specific area of the skin that is supplies by a sensory neuron that originates from a specific single spinal nerve root. 1\. Obstructing the dermatome line can anesthetize that area of the skin 2\. These area can be manipulated by chiropractors c\) OB Use 1\. To control nausea, backache, constipation, and pain 2\. Areas to avoid are bottom of the feet, the inner lower leg, base of the thumb and most areas over the abdomen because these areas can cause premature labor d\) Shiatsu is finger pressure used with an emphasis on preventing disease rather than treating symptoms e\) Acupuncturists are licensed to practice in many states and practices are accepted in many pain treatment centers 7\) Ayurveda a\) Ancient Hindu healing regimen that deals with the biological rhythms of nature. b\) Includes music, herbs, massage, aromatherapy, and diet 8\) Aromatherapy a\) Involves concentrated fluid or the essence of specific aromatic plants that are combined with steams or baths to inhale or bathe the skin b\) Concentrated oils are volatile and must be freshly prepared and stored properly c\) Compounds may be antibacterial, antiviral, antifungal and anti-inflammatory d\) OB Use: 1\. Anise, juniper, thyme, wintergreen, nutmeg, pennyroyal and mugwort are contraindicated during pregnancy because of the effect on the mother or fetus 2\. Jasmine, citrus, clary sage, lavender and peppermint has been useful during labor and delivery to relieve anxiety, reduce nausea and improve the general feeling of well-being e\) Peds Use: 1\. Placing a piece of clothing with mother's natural body odor near the newborn has a soothing and consoling effect on the newborn 2\. Peppermint has been used as a respiratory stimulant 3\. Chamomile regulates circadian rhythm 4\. Brazilian guava is used as an analgesic for preterm newborns 5\. Lavender, chamomile, and sandalwood 9\) Hypnotherapy a\) Patient enters a hypnotic state of induced sleep and under the guidance of the practitioner, specific and potentially long-lasting suggestions are given to the patient b\) Used for smoking cessation and pain control 10\) Hydrotherapy a\) Therapeutic use of water to promote relaxation b\) OB Use: 1\. During labor in the form of a shower 2\. Under the direction of a certified midwives, delivery can be accomplished under water 11\) Guided Imagery a\) Based on ancient Greek belief that the mind can influence the body. b\) OB Use: 1\. Focusing on a specific image can results in the reduction of stress and increase performance, when combined with breathing techniques to manage the discomforts of labor 12\) Biofeedback a\) Relaxation therapy that enables the patient to recognize tension in the muscles via responses on an electronic machine and visual electromyography responses b\) Uses: drug addiction, chronic pain control and experimentally with ADHD 13\) Sauna/Heat Therapy a\) Overheating the body has long been used to speed up metabolism and inhibit the replication of viruses and bacteria b\) Sweating is thought to eliminate waste c\) Contraindicated in pregnancy 14\) Chiropractic Care a\) Concerns the relationship between the spinal column and the nervous system and involves nerve energy thought responsible for restoring and maintaining health b\) OB Use: 1\. Circulating hormones such as relaxin increase the mobility of joint capsules and pelvic joint structures, so vigorous manipulation should be avoided between the 12^th^ and 16^th^ weeks because of chance for stimulating a miscarriage or premature labor 15\) Homeopathy a\) Uses plants, herbs and earth minerals that are thought to stimulate the body's immune system to manage specific health problems. b\) Prescribed remedies assist the body to reestablish correct energy balance c\) Accounts for 25% of pediatric visits to alternative health practitioners d\) Remedies are taken sublingually and should not be combined with caffeine, alcohol, or traditional Western medications e\) Some medicines are alcohol based, and some contain mercury or arsenic bases that can cause toxicity or allergic responses in children f\) Only one remedy at a time in the smallest dose is the principle of most practitioners. **Check on Learning** **Summary:** **In this section, we discussed the different complimentary therapies.** 3 Learning Step / Activity 3 Products Used in CAM Therapy --- ------------------------------ ------------------------------ Method of Instruction: Large group discussion Instructor to Student Ratio: 1:30 Time of Instruction: mins Media: Large group discussion a\. Herbal medicine has been used for thousands of years in many countries. 1\) World Health Organization reports that herbal remedies are often used worldwide and are the first-line treatment for most children in developing countries b\. Herbs are made of plant, and most are safe to ingest. c\. Allergic type reactions encountered may be because of processing or storing the product d\. Herbs are sold everywhere, but the processes of growth, processing, storage, and contents are not regulated by the FDA. 1\) Dietary supplement labels may not accurately reveal the content of the ingredients and some supplements may be unintentionally contaminated with pesticides, mercury or other harmful ingredients 2\) General guidelines for their use, including dosages, and the recommendation that herbal mixtures are preferred to single herb products to avoid overdosing on a single ingredient 3\) Drug-drug and drug-herbal interactions can occur a\) Herbs can interact with cardiac drugs b\) Herbs can affect glucose control in patient with diabetes c\) Herbs can lower blood levels of some medications used for HIV/AIDS d\) Polypharmacy should be avoided e\. Herbs that are safe for adults may be harmful for infants and young children, especially when combined with some prescription medication 1\) Peppermint found in after dinner mints relaxes GI spasms, but can exacerbate gastric reflux 2\) St. John's wort may enhance the elimination of many drugs, such as oral contraceptive and antibiotics, causing them to be ineffective f\. Herbs have proven their effectiveness 1\) Fennel, chamomile, licorice, and baby mine are used for colic 2\) Ginger for nausea 3\) Probiotics for diarrhea and constipation g\. Many current medications are related to herbal remedies 1\) Digitalis originates from foxglove 2\) Opiates originates from poppy flowers 3\) Quinine originates from the cinchona tree h\. Most practitioners emphasize that herbal dosages is determined by body weight 1\) Herbal capsules are about 4X stronger than herbal teas 2\) Herbal extracts are about 4-8X stronger than capsules and should be taken more that 6 consecutive days 3\) Herbal tinctures contain a high amount of alcohol and are not often recommended 4\) Herbal baths are relaxing and soothing 5\) Herbal salves, oils, compresses, and poultices use the skin as the body's organ of ingestion i\. Herbs and obstetrics 1\) Many women view CAM therapy and herbal remedies as natural remedies, they may not be aware of the possible dangers to themselves or their growing fetus. (Table 34.2, page 786) 2\) Herbs that promote menstruation should be avoided during pregnancy (Box 34.2, page 786) 3\) Tannic acid (tea) and bran reduce the absorption of iron from food and could lead to anemia 4\) Use of herbal product for neonates is contraindicated, and high levels of vitamin C in a breastfeeding newborn can cause colic j\. Common Herbs used in Pediatrics 1\) CAM therapy has increased for children with various chronic diseases (Table 34.3, page 787- 788) a\) Chiropractic, biofeedback, homeopathy, and herbal-food supplements are popular 2\) Parents prefer "natural remedies" instead of prescribed medications 3\) Herbal treatment focus on improving cognition, producing sedation, or alleviating anxiety 4\) Parents often don't discuss CAM therapy for their children unless they are asked by the nurse k\. Herbs and menopause 1\) Menopause is not approached as a disease or illness but a stage of life and as a normal healthy process. 2\) The physiological alterations that occur as a woman reaches and enter menopause result in minor discomforts a\) Hot flashes, night sweats and insomnia 3\) Hormone replacement therapy has been the most popular approach to managing these symptoms 4\) More "natural" paths of management have been developed a\) Exercise (weight bearing, water aerobics) b\) Relaxation techniques (deep breathing, biofeedback, hypnosis) c\) Low-fat, high-fiber, soy diet d\) Herbs (Table 34.4, page 789) l\. Hyperbaric Oxygen Therapy 1\) Uses an airtight enclosure to provide compressed air or oxygen under increase pressure. 2\) Uses include: a\) Revive children with carbon monoxide poisoning b\) Aid wound healing c\) Treat the diving syndrome known as decompression illness d\) Diabetic wound healing e\) CAM therapy in private centers 3\) Contraindicated in pregnancy because the increase oxygen saturation can cause the ductus arteriosus to close resulting in fetal death **Check on Learning** **Question:** What patient education is appropriate for the following scenarios? A woman has recently given birth and now wants to use Ayurvedic herbs to restore balance to her body. A woman who is 8 months' pregnant asks about using aromatherapy during labor and delivery to relieve anxiety. A pregnant woman asks whether she can drink chamomile tea before bed. A postmenopausal woman asks about natural therapies for managing menopausal symptoms. **Summary:** **In this section, we discussed products that are used in CAM therapy.** **SECTION IV. SUMMARY** +-----------------------------------+-----------------------------------+ | | Determine if the students have | | | learned the material presented by | | | soliciting student questions and | | | explanations. Ask the students | | | questions and correct | | | misunderstandings. | +===================================+===================================+ | **Review / Summarize Lesson** | Review of main points | | | | | | A. CAM Therapy | | | | | | B. Use of CAM Therapy | | | | | | C. Products Used in CAM Therapy | +-----------------------------------+-----------------------------------+ | **SECTION V.** | **STUDENT EVALUATION** | +-----------------------------------+-----------------------------------+ | **Testing Requirements** | **NOTE:** Describe how the | | | student must demonstrate | | | accomplishment of the TLO. Refer | | | student to the Individual Student | | | Assessment Plan. | +-----------------------------------+-----------------------------------+ | | The Individual Student Assessment | | | Plan, which is posted in the | | | Blackboard classroom, provides | | | detailed information about the | | | testing an evaluation processes | | | used in this course. Depending on | | | the type of training objectives | | | contained in this lesson, you may | | | be tested in a number of | | | different ways to ensure that you | | | can perform to the standard | | | stated for each objective. The | | | typical evaluation methods used | | | in this course include, but are | | | not specifically limited to, the | | | following: written, oral, | | | simulated performance exercises, | | | and clinical performance. | +-----------------------------------+-----------------------------------+ | **Feedback Requirements** | **NOTE:** Feedback is essential | | | to effective learning. Schedule | | | and provide feedback on the | | | evaluation and any information to | | | help answer students\' questions | | | about the test. Provide remedial | | | training as needed. | +-----------------------------------+-----------------------------------+ | | Feedback on evaluations is | | | provided in follow - up lesson | | | plans that clarify previous | | | instruction and reinforce | | | effective learning. Errors in | | | learning and performance are | | | corrected. Questions from | | | students are answered. Remedial | | | training is provided \"after | | | hours\" and prior to any | | | reevaluation | +-----------------------------------+-----------------------------------+ **APPENDIX A** **Learning Activity** **A massage therapist is pregnant with her first baby and asks a friend, who is a nurse, what natural remedies she should use to promote a healthy pregnancy and a positive labor and delivery experience. How should the nurse respond?** The mother of a patient with sickle cell anemia is concerned about her child having negative effects from chronic use of opioid narcotics. She asks the nurse whether there are other pain management methods that she can use during a sickle cell crisis. How should the nurse respond? **The nurse is reviewing preoperative instructions with her patient who is scheduled for a hysterectomy. The nurse instructs her to take nothing by mouth beginning at midnight before her surgery and to discontinue her daily aspirin to prevent increased bleeding during surgery. The patient asks if it is OK for her to continue taking her herbal supplements with a few sips of water. What is the nurse's appropriate response?** **APPENDIX A** **Learning Activity - Key** **A massage therapist is pregnant with her first baby and asks a friend, who is a nurse, what natural remedies she should use to promote a healthy pregnancy and a positive labor and delivery experience. How should the nurse respond?** **Discussion Guidelines:** The nurse should explain that some complementary and alternative medicine (CAM) therapies, such as saunas or certain herbal supplements, are unsafe for a fetus and can lead to premature labor, but other therapies, such as transcutaneous electrical nerve stimulation, are safe treatments for pregnancy related symptoms such as nausea. Effleurage and hydrotherapy are techniques that can be used during labor to reduce the pain and anxiety associated with dilation and contractions. Encourage the massage therapist to enroll in a prenatal class. The nurse should emphasize that any CAM therapies the massage therapist considers should first be discussed with her obstetrician or nurse midwife to prevent interactions or contraindications. The mother of a patient with sickle cell anemia is concerned about her child having negative effects from chronic use of opioid narcotics. She asks the nurse whether there are other pain management methods that she can use during a sickle cell crisis. How should the nurse respond? **Discussion Guidelines:** The nurse should support the mother's interest in exploring complementary methods of pain management and her goal of minimizing the negative effects related to medication. The nurse should identify comfort measures that are safe for pediatric patients, such as guided imagery; relaxation through music, art, and play therapy; and healing touch. The nurse should also inform the mother that some CAM therapies can increase bleeding and may interact negatively with other conventional therapies. Therefore, it is important for the mother to consult with her child's pediatrician regarding all treatment modalities, including natural products and therapies. The nurse should answer any questions the mother has regarding prescribed conventional therapy, such as analgesics and hydration, and reinforce the concept that giving pain medication on a schedule before the pain becomes intense will reduce the dosage necessary for relief. The nurse should also instruct the mother to keep a record of the time and doses of pain medication given to the child. A referral to a pain management center may be indicated and should be discussed with the child's pediatrician. **The nurse is reviewing preoperative instructions with her patient who is scheduled for a hysterectomy. The nurse instructs her to take nothing by mouth beginning at midnight before her surgery and to discontinue her daily aspirin to prevent increased bleeding during surgery. The patient asks if it is OK for her to continue taking her herbal supplements with a few sips of water. What is the nurse's appropriate response?** **Discussion Guidelines:** The nurse should assess and document all medications, including herbs, in the patient's chart and communicate the information to the surgeon. The nurse should then instruct the patient to withhold all supplements because they may interfere with other medications given to her during and after surgery, and they could increase bleeding.