Complementary and alternative therapies:

Approaches to health-related modalities and practice outside of western medicine. They include various approaches, including traditional chinese medicine, mind-body interventions (imagery, biofeedback, hypnosis, meditation); herbal therapy, manipulative and body-based practice (chiropractic, acupressure, pressure points, massage, biofield therapies); massage therapy, energy therapies (therapeutic touch, healing touch), and so forth.

Safety concerns: lack of research, reliability of information available, unknown efficacy of therapies, questionable or absent regulation of practitioners, interactions of herbs or other oral treatments with pharmaceutical medications or body systems.

Note: Alternative therapies are those used in lieu of modern medicine while complimentary are used in conjunction with modern medicine. 

Inflammation and wound healing review

The inflammatory response: neutralizes and dilutes inflammatory agents, removes waste and necrotic tissue from site of injury or trauma, establishes healing environment.

Healing: Vascular response (increased filtration pressure related to vasodilation causing hyperemia). Cellular response (neutrophils eat up pathogens and necrotic tissue; monocytes marginate and diapedesis to tissue -> macrophages; eat pathogens and present them to immune cells; active immunity process). Regeneration is the replacement of lost cells or tissue with same cells/tissue. Repair is the replacement with alternate cells (i.e. production of scar tissue).

• Primary intention edges are well-approximated. 
• Secondary intention healing after ulceration, trauma, infection, wide or irregular wound margins, extensive tissue loss or no approximation.
• Tertiary intention (delayed primary) two layers of granulation or sutured together

Inflammation is considered acute if it is less than 3 weeks with no residual damage, subacute lasts longer, while chronic inflammation lasts a few weeks to years.

Nursing management: reduce risk of infection, trauma, management of surgical interventions, or contact with harmful agents, appropriate wound care, encouraging proper diet and hydration.

Arthritis and Connective Tissue Diseases 

Osteoarthritis non-inflammatory, progressive disorder of diarthrodial joints (synovial joints). Due to cartilage damage, fissuring and erosion of articular surfaces.
Risk factors include advanced age, genetics, body weight, occupation, lack of exercise.
S&S  Asymmetrical pain that is often worse in the mornings and decreases as the day goes on or decreases with movement.
Diagnostics CT scan, MRI, Bone scan, X-rays.
Labs Erythrocyte Sedimentation rate (ESR) increased, C-reactive protein is normal.
Nursing Foci  pain, self care deficit, inflammation, knowledge deficit, impaired body image, impaired mobility.
Treatment  NSAIDs, Injections, Voltaren, Methotextrate, joint replacement

Rheumatoid Arthritis: A chronic, systemic inflammatory, auto-immune disease affecting the connective tissues of synovial membranes and joints.
S&S  Symmetrical pain, stiffness, joint swelling, dry mucous membranes, fatigue/malaise, paresthesia distal to affected joints, paint that stays and does not improve with movement, can lead to joint deformity. Affects at times all joints. Rheumatoid nodules, Sjogren’s syndrome, and Felty’s syndrome.
Diagnostics blank.
Labs increased ESR (Erythrocyte Sedimentation Rate), increased C-reactive protein, positive rheumatoid factors.
Nursing Foci Chronic pain, impaired mobility, self care deficit, body image deficit
Treatment  NSAIDS, Parafin Wax, hot therapy, physical therapy, prevent/correct deformity. 

Septic Arthritis Microbial infection of the synovial membrane.
S&S Pan, swelling, erythema, fever.
Diagnostics Joint aspiration, MRI (?), Cat scan (?).
Labs Increased c-reactive protein, increased lactic acid, blood cultures, increased WCBs
Nursing Foci pain, impaired mobility, knowledge deficit, infection, self care deficit, confusion
Treatment NSAIDs, IV antibiotics, positioning, hot or cold therapy.

Systemic Lupus Erythematosis: Chronic inflammatory, multi-system autoimmune disease. Mostly idiopathic with interactions between hormones, environment, genetics, and immunological factors.”
S&S Butterfly rash, polyarthrasia, tachypnea, lupus nephritis (leaking protein in the urine), seizures, anemia, leukopenia.
Diagnostics Blank
Labs eGFR, Buns/creatinine, C&S, U/A, leukopenia, thrombocytopenia, antinuclear antibody tests (ANA).
Nursing Foci Fatigue, chronic inflammation, risk of infection, may have pericarditis
Treatment NSAIDS, Corticosteroids, immunosuppressive therapy, chemo in extreme cases.

Systemic Sclerosis (scleroderma): Disease of all connective tissue that is autoimmune in origin and can cause inflammation. Fibrotic, degenerative, and at times inflammatory changes in the skin. Can affect organs. Result of overproduction or accumulation of collagen in body tissues. Can affect function of lungs, heart, GI tract, kidneys, etc.
S&S Tightening of patches of skin, thickening skin, changes to vasculature, synovium, skeletal muscles, and internal organs.  NSAIDs CREST Calcinosis, Raynaud’s, Esophageal dysfunction, Sclerodactyl, Telangiectasia. Loss of facial expression. Contractors of joints.
Diagnostics MRI, EMG, Muscle biopsy, serum enzyes.
Labs Antinuclear antibody (ANA), anticentromere antibody, increased ESR, hemolytic anemia, kidney function.
Nursing Foci impaired body image, pain, immobility, preserve muscle strength
Treatment blood pressure medication for vasodilation, prostacyclins, ACE-inhibitors.