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Complementary and alternative medicines for the postoperative patient.

Case Study

Mrs. Stevens is a 44-year-old married mother of two daughters ages 15 and 11. She was admitted to the medical-surgical unit 3 days ago following bowel resection for an incarcerated ventral hernia. Medical history includes mild anxiety and panic disorder, for which Mrs. Stevens receives 3 mg extended release alprazolam (Xanax[R]) daily. The patient is receiving nothing by mouth and has a nasogastric tube to intermittent low wall suction for postoperative ileus. She has two Jackson-Pratt drains with minimal output. Vital signs are within normal parameters.

Mrs. Stevens receives hydromorphone (Dilaudid[R]) by patient-controlled analgesia pump for pain management. Mrs. Stevens is complaining of overall anxiety and insomnia. "I keep thinking of all the things that need to be done at home. My daughters are having to arrange rides from their practices, or else they miss the practices altogether. My poor husband has so much on his plate right now. I hope he is making sure the girls are getting their homework done. And here I am in the hospital unable to help my family at home! I just can't relax or sleep knowing what chaos must be going on at home."

The following questions relate to the nurse's understanding of complementary and alternative medicine (CAM), as well as pharmacology for pain management.

Questions

1. In assessing CAM options for this patient, the nurse would understand

a. patients may be reluctant to report CAM use to conventional health providers.

b. complementary or integrative therapies are used in combination with conventional Eastern medicine treatments.

c. the concept of group healing is the philosophical foundation of CAM therapy.

d. CAM is least prevalent among women and adults ages 30-69.

2. The nurse would include which of the following statements when instructing the patient about CAM use?

a. "If it is natural, it will be safe to take."

b. "Read the labels to know all the contents."

c. "Herbs are safe to take without supervision of a medical professional."

d. "Self-diagnosis and self-treatment can result in problems."

3. The nurse recognizes alprazolam must be given very cautiously with hydromorphone because of the risk for medication reactions and

a. increased serum creatinine

b. hyponatremia

c. grand mal seizures

d. respiratory depression

Preparing for Certification

4. In speaking with the patient, the nurse notes evidence for CAM therapies includes which of the following?

a. Therapeutic touch and energy therapies accelerate wound healing.

b. Essential oils are thought to work at psychological levels only.

c. Massage may have benefits for chronic neck pain.

d. Evidence indicates conclusively that decreased fat intake lowers cancer risk.

Answers with Rationale

1. A--Patients may be reluctant to report CAM use to conventional health providers (Hill, 2016). Complementary or integrative therapies are used in combination with conventional Western medicine treatments. The concept of self-healing is the philosophical foundation of CAM therapy. CAM is most prevalent among women and adults ages 30-60.

2. D--Self-diagnosis and self-treatment can result in problems (Hill, 2016). Natural does not equate with safe. Labels may not show all the contents. Herbs should be taken under the supervision of a medical professional who has been trained in herbal medicine.

3. D--Respiratory depression is a possible side effect of alprazolam and hydromorphone (Truven Health Analytics, Inc., 2016a, 2016b). Hyponatremia, grand mal seizure, and increased serum creatine are not common side effects of alprazolam and hydromorphone.

4. C--Massage may have benefits for chronic neck pain (Hill, 2016). No current evidence indicates therapeutic touch accelerates wound healing. Essential oils are thought to work at psychological, physical, and cellular levels.

Are You Certified?

Certification shows you have taken that extra step to validate your knowledge and skills. The Academy of Medical-Surgical Nurses (AMSN) and the Medical-Surgical Nursing Certification Board (MSNCB) encourage you to show your colleagues and patients your commitment to excellence in medical-surgical nursing practice. For more information, visit www.amsn.org

Letters Welcome

MEDSURG Nursing welcomes readers' comments and invites readers to share information with their colleagues through Letters to the Editor. Submission of a letter constitutes permission for its copyright and publication in MEDSURG Nursing. Letters are subject to editing.

Please address your correspondence to: MEDSURG Nursing, East Holly Avenue Box 56, Pitman, NJ 08071; E-mail: msjml@ajj.com.

REFERENCES

Hill, B. (2016). Complementary, alternative, and integrative therapies. In H. Craven (Ed.), Core curriculum for medical-surgical nursing (pp. 193-200). Pitman, NJ: Academy of Medical-Surgical Nurses.

Truven Health Analytics, Inc. (2016a). Hydrocodone: Medication safety: Adverse effects. Micromedex. Ann Arbor, Ml: Author.

Truven Health Analytics, Inc. (2016b). Alprazolam: Medication safety: Adverse effects. Micromedex. Ann Arbor, Ml: Author.

Jo Ellen Inman-Puckett, MSN, MBA, RN, CMSRN[R], AHN-BC, CCCTM, is Clinical Nurse Leader, Carolinas Medical Center, Charlotte, NC, and MSNCB CCCTM Examination Committee Member.
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Title Annotation:Preparing for Certification
Author:Inman-Puckett, Jo Ellen
Publication:MedSurg Nursing
Geographic Code:1USA
Date:Jan 1, 2017
Words:784
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