DOMAIN	EXAMPLES
Natural products	Neutraceuticals (dietary supplements), such as calcium and magnesium; probiotics, including foods (e.g., yogurt) and supplements (e.g., Lactobacillus)
Mind-body therapies	Imagery, meditation, music, humor, biofeedback, yoga, prayer, pet therapy
Manipulative and body-based therapies	Chiropractic treatment, massage, tai chi
Other CAM therapies	Healing Touch, Therapeutic Touch, Reiki

CAM, Complementary and alternative medicine; NCCAM, National Center for Complementary and Alternative Medicine.

Cam Categories

Natural Products

Most natural products are either neutraceuticals (dietary and herbal supplements) or probiotics. As a group, these products are thought to provide health and medical benefits and are used widely, especially by older adults (Zarowitz, 2010). In the United States, neutraceuticals and probiotics are regulated as food and nutritional supplements by the Food and Drug Administration (FDA). However, these regulations are less strict than those for drug therapy, which has raised increasing concern about their safety. Dietary and herbal supplements do not receive the same stringent oversight in their preparation and use as drugs. Therefore they cause a range of patient responses depending on their nature and how they were prepared. Herbal preparations that are sold as standardized extracts are more likely to contain larger amounts of the herb or nutritional element and less likely to contain inactive ingredients or fillers. Teach patients that because an herb is labeled as “natural,” it does not mean that the herb is safe. Because it may be safe does not mean that it is effective.

Some dietary and herbal supplements have pharmacoactive effects that can be serious or deadly, as in cases of overuse, inappropriate use, supplement toxicities, and supplement-drug and supplement-supplement interactions.

Considerations for Older Adults

Older adults in the community often overuse dietary and herbal supplements to help prevent potentially life-threatening health problems and promote quality of life. For example, older women may take too much calcium because they want to prevent osteoporosis. As a result, excess calcium can deposit in kidneys as renal calculi (stones). Teach women the importance of collaborating with their health care provider to monitor serum calcium levels and kidney function before and during calcium supplementation.

Older adults who live in independent and assisted-living communities often self-administer a variety of supplements without telling their nurses or primary care providers. Nurses working in these settings need to talk with their residents about the safety and efficacy of CAM therapies. To prevent toxicities and supplement-drug interactions, encourage residents to inform the health care team about which supplements they are taking (Moquin et al., 2009).

In some cases, herbal preparations are self-administered to treat a serious health problem that could more effectively be treated by conventional medicine, potentially resulting in a delay of diagnosis and treatment. For example, patients may take St. John’s wort for depression rather than be evaluated for possible psychotherapy and/or drug therapy. In other cases, patients may neglect or choose not to tell their health care providers about their use of supplements. As a result, they may take conventional drugs and natural products to treat the same condition. The resulting drug-supplement interactions may be harmful or life threatening.

Nursing Safety Priority

Drug Alert

When caring for patients in any health care setting, ask them if they use herbs or nutritional supplements and, if so, for what purpose. Ask about the frequency and dose of the products used. To prevent complications, remind patients of the importance of telling all health care providers about dietary supplement or herbal therapy use. For example, to avoid increased risks of bleeding, one should not use ginkgo, ginseng, or garlic for at least 3 days before surgery. Table 2-2 lists several commonly used herbs, their uses, and their precautions. Teach patients about these precautions and how to safely use them.

TABLE 2-2 COMMONLY USED HERBAL PREPARATIONS: DESIRED EFFECTS AND PRECAUTIONS

HERB	DESIRED EFFECTS/USES	HEALTH TEACHING/PRECAUTIONS
Ginkgo biloba	Reduces memory problems, dementia, peripheral vascular disease; has antioxidant and vasodilator properties.	Use with anticoagulants may cause bleeding; rarely dizziness, headache, GI upset.
Garlic	Lowers cholesterol or blood pressure; acts as a natural antibiotic; acts as an antiplatelet agent.	Bleeding can occur when used with other antiplatelet agents; potentiates action of antidiabetic drugs; avoid several days before surgery.
Glucosamine sulfate	Decreases inflammation; effective for knee osteoarthritic pain.	Takes several weeks to be effective; monitor for increased INR in patients taking warfarin; can cause GI upset—take with meals.
Ginseng	Promotes general well-being; anti-aging.	Observe INR with warfarin. Side effects depend on type of ginseng used.
Saw palmetto	Decreases prostatic hyperplasia.	Discontinue 2 weeks before surgery because it inhibits platelet aggregation (clotting).