Anne Gonzalez

Delivery of Clinical Care: Table of Holistic Therapeutics

Project Instructions: Using the template provided, develop a comprehensive, holistic therapeutics table for a typical patient in your chosen
population [at least 15 therapeutics] and scientific, evidence-based rationale. The following should be included in this document: traditional &
integrative pharmacologic and non-pharmacologic interventions, physiologic explanation of rationale, potential adverse effects for which patients
should be monitored, and the general cost of the therapeutic. References should include current national standards of care for this population and best
practice literature. All references should be current within the past 5 years. Formatting for table and narrative is single-spaced.
Please include the following:
Introduction to the Table of Therapeutics for the chosen population addressing the goals of care and integration of holistic interventions.
10 pharmacologic interventions [traditional, including oxygen and integrative]. Please do not include more than 2 drugs in a specific
category of drugs. Consider medications which are typically used to treat, and stabilize the chronic illness and management symptoms
typical of a patient with the chronic illness.
5 non-pharmacologic interventions with a specific emphasis on integrative therapies
Perspectives from 2 or more interprofessional colleagues
Summary of application of holistic therapeutics to health of chosen population and expected optimal outcomes of care.
Introduction to Patient Population:
Since 2012, 1.7 million Americans over the age of 20 have been diagnosed as diabetic (Centers for Disease Control and Prevention [CDC],
2014). Diabetes Mellitus (DM) is a disease that does not only affect the United States, it is a pandemic crisis, it is estimated by 2030 over 500
million individuals will be diabetic (Olokoba, Obateru, & Olokoba, 2012). Currently there are 29.1 million Americans diagnosed with diabetes, that
is one out of eleven individuals in the United States (CDC, 2014). There is even an alarming amount of prediabetics, estimated at 86 million; they are
individuals that have multiple risk factors that increase their chance of being diabetic. So, that makes nine out of ten citizens a prediabetic, this is a
very serious disease that can be prevented with the right lifestyle and wellness choices (CDC, 2014).

Population-specific Goals of Care:

NURS660: Clinical Systems Leadership Immersion (Revised 06/29/15)

Page 1

Anne Gonzalez

The goal of treating the diabetic patient is to maintain tight glycemic control to prevent complications related to hyperglycemia. Medications
help control and maintain target glucose but there are also other methods of glycemic control. The patient will need to take action in physical activity,
mindful diet, and stress management; this will support and sustain glycemic balance (Faison, Burns, & Weed, 2016). The healthcare professional will
take into consideration the living environment, food insecurities, spiritual, psychological, and social life of each patient (Faison et al., 2016). Diabetes
requires the patient to participate in self-care and become responsible with the appropriate guidance (Potter, Wallston, Trief, Juth, & Smyth, 2015).
Medication is not a fix all but it is a start to help implement balance, but ultimately the intertwining wellbeing of mind, body and spirit (Potter et al.,
2015).

Name of Therapeutic
+Route
+Safe Dose [maximum
24hr dose; daily
dosing; onset/ peak/
duration]
Classification of
Therapeutic
[therapeutic and
pharmacologic OR
category of nonpharmacologic]
1. Metformin
(Glucophage)
Route: Oral

General Mechanism of
Action
[paraphrase in your own
words the physiologic
and/or psychological
basis for therapeutic
action using current
evidence]

Specific Indication for

this patient population
[explain in your own
words the specific
benefits for health and
wellness using current
evidence]

Outline patient safety issues

associated with this therapy
[adverse drug reactions, drugdrug and drug-food
interactions]

General Mechanism of
Action
Metformin is the first

Specific Indication for

this patient population
The diabetic patient is

Outline patient safety issues

associated with this therapy
Adverse reactions:

NURS660: Clinical Systems Leadership Immersion (Revised 06/29/15)

General Cost
of
Therapeutic
[per dose and
monthly cost]

Outline potential
contraindications for the
therapy

Page 2

General Cost
of
Therapeutic

References
[use in-text APA
style references
including
personal
communication
as appropriate]

References
(Adams,
Holland, &

Anne Gonzalez

Safe dose in 24 hour

period: 850mg three
times a day
Daily dosing: starting
at 500mg titrate to Hgb
A1c
Onset: unknown
Peak: unknown
Duration: 12 hours
Classification of
Therapeutic:
Antidiabetics/
Biguanides

antidiabetic medication
ordered to help with
hyperglycemia. This
medication decreases the
bodys insulin resistance
by increasing the
peripheral glucose
uptake. This is a
beneficial effect to
utilize the glucose
transporters to help
manage hyperglycemia.

unable to transport
glucose to cell for
metabolism. The cells
inability to transport
glucose is related to
increase lipid content in
the blood. Metformin
will help decrease the
amount of unused
glucose in the vascular
system.

NURS660: Clinical Systems Leadership Immersion (Revised 06/29/15)

Common adverse reaction to

Metformin is hypoglycemia.
Patient will need to be aware
of the symptoms of
hypoglycemia. The patient can
experience bloating, diarrhea,
vomiting and nausea. These
gastrointestinal side effects
usually occur at the start of
therapy and will subside.
Lactic acidosis can occur with
alcohol intake.
Drug-drug interaction: The
patient should avoid studies
with contrast to prevent renal
damage. Medications that
should be avoided are calcium
channel blockers and
histamine-2 receptor
antagonist these medications
are eliminated the same
method as metformin and
could cause renal stress or
damage. Tagamet and Lasix
can increase the effects of the
metformin causing more cases
of hypoglycemia.
Drug-food interaction:
Carbohydrates should be
avoided to help prevent excess
amount of glucose.
Page 3

Urban, 2014)
[per dose and
monthly cost]
Metformin
500mg: $0.23
per dose and
$6.99 per
month

(Cefalu, 2016)
(Fortney, 2012)
(Martin &
Talbert, 2013)
(Vallerand,
Sanoski, &
Deglin, 2015)

Anne Gonzalez

If the patient does not have the

proper teaching about the
importance of the medication
and side effects, the patient
can become hypoglycemic or
noncompliant. The patient will
need to know when to take the
medication and how to
monitor blood glucose. Health
literacy will need to be
assessed and addressed for
each new diabetic patient.
Outline potential
contraindications for the
therapy: If diarrhea does not
stop, the medication should be
discontinued to prevent
dehydration and electrolyte
imbalance.
2. Humalog Insulin
Route: injection
subcutaneous
Safe dose in 24-hour
period: A safe does is
based on each patients
metabolic need.
Daily dosing: initial
dose 0.2-0.6
units/kg/day,
maintenance dose 0.5-

General Mechanism of
Action
Humalog insulin is a fast
acting insulin that
controls the metabolism
of glucose and will
stimulate glucose uptake
in muscles and adipose
tissue.

Specific Indication for

this patient population
Patient with a Hgb A1c
above 9% should be
considered for dual
therapy of insulin and
oral medications for
diabetes to promote
maximum effect of
glycemic control.

NURS660: Clinical Systems Leadership Immersion (Revised 06/29/15)

Outline patient safety issues

associated with this therapy
Adverse Drug Reaction:
Failure to monitor glucose
while taking insulin can result
in hypoglycemia. Other
reactions documented are
hypokalemia, lipodystrophy,
edema, and pruritus.
Drug-Drug Interaction:
Medications that can increase
Page 4

General Cost
of
Therapeutic
A 10ml vial of
Humalog cost
$272.00. A
10ml vial of
Humalog
contains
1000units.
Cost per unit

References
(Adams,
Holland, &
Urban, 2014)
(Cefalu, 2016)
(Fortney, 2012)
(Martin &

Anne Gonzalez

1.2 units/kg/da
Onset: within 15
minutes
Peak: one to two hours
Duration: three to four
Classification of
Therapeutic:
antidiabetic/
pancreatics

NURS660: Clinical Systems Leadership Immersion (Revised 06/29/15)

the risk of hypoglycemia

is $0.27.
while injecting Humalog:
other antidiabetic medications,
ACE inhibitors, beta-blockers,
Fibrates, fluoxetine, and
sulfonamide.
Medications that can inhibit
Humalog from working
effectively resulting in
hyperglycemia:
sympathomimetic agents,
thyroid hormones, oral
contraceptives and niacin.
Drug-Food Interaction:
Patients should be instructed
not to eat food high in sugar
and carbohyrates. Food high
in sugar can fluctuate the
glucose violently resulting in
hyperglycemia and follow
with hypoglycemia after
insulin administration if
patient does not eat mindfully.
Outline potential
contraindications for the
therapy: Patient that has
blood sugars that are volatile
should be monitored with
caution and reconsider for
dual therapy with oral
antihyperglycemic. Patient
Page 5

Talbert, 2013)
(Vallerand,
Sanoski, &
Deglin, 2015)

Anne Gonzalez

3. Lisinopril (Zestril)
Route: Oral
Safe dose in 24 hour
period: 40mg daily
Daily dosing: 2.5mg to
40mg daily
Onset: one hour
Peak: six hours
Duration: 24 hours
Classification of
Therapeutic:
Antihypertensive

General Mechanism of
Action
Lisinopril is considered
an angiotensinconverting enzyme
(ACE) inhibitor that
helps prevent
hypertension by stopping
angiotensin I from
becoming angiotensin II.
The increase in the levels
of plasma renin that is
excrete will prevent the
kidneys from retaining
fluid decrease the
volume of fluid in the
body therefore, dropping
blood pressure.

Specific Indication for

this patient population
Diabetic patients that
have uncontrolled blood
pressure can develop
other disease processes
from hypertension. A
common disease from
hyperglycemia and
hypertension is cerebral
vascular accidents and
cardio vascular events.

NURS660: Clinical Systems Leadership Immersion (Revised 06/29/15)

should be monitored for

hypoglycemia and taught the
signs, symptoms and
management.
Outline patient safety issues
associated with this therapy
Adverse reactions: A
trademark side effect of
Lisinopril is a dry cough.
Hypotension can occur with
out proper monitoring of daily
blood pressure. Angioedema
is a serious side effect that can
lead to loss of airway and lead
to death.
Drug-drug interaction:
NSAIDs should be avoided
when taking lisinopril.
Medications like Motrin can
decrease the effect of
lisinopril resulting in
hypertension. Caution should
be considered when
combining lisinopril with
other hypertensive
medication, hypotension can
occur.
Drug-food interactions:
Potassium containing foods
can increase the risk of
hyperkalemia.
Page 6

General Cost
of
Therapeutic:
Cost per dose
of Lisinopril
is $0.99 per
pill and
$29.70 for a
30-day supply.

References
(Adams,
Holland, &
Urban, 2014)
(Cefalu, 2016)
(Fortney, 2012)
(Martin &
Talbert, 2013)
(Vallerand,
Sanoski, &
Deglin, 2015)

Anne Gonzalez

4.Hydrochlorothiazide
Route: Oral
Safe dose in 24 hour
period:
Daily dosing: 50mg per
day
Onset: Two hours
Peak: Three to six
hours
Duration: Six to twelve
hours
Classification of
Therapeutic:
Antihypertensive

General Mechanism of
Action
HCTZ is a medication
that is a diuretic. It stops
the absorption of sodium
and water in the distal
tubuals of the kidneys.
This mechanism will
increase the patients
need to urinate. The
decreased volume of
fluid decreases the
patients blood pressure.

Specific Indication for

this patient population
Diabetic patients can be
hypertensive before
being diagnosed with
diabetes. Uncontrolled
hypertension in
conjunction with
hyperglycemia can
create coronary artery
disease, increase risk for
stroke and impair renal
function.

NURS660: Clinical Systems Leadership Immersion (Revised 06/29/15)

Outline potential
contraindication for the
therapy: Patient with end
stage renal disease should not
take this medication. An
individual with history of
hereditary angioedema can
develop an allergic reaction to
this medication.
Outline patient safety issues
associated with this therapy
Adverse Reactions: A
common adverse reaction to
HCTZ is hypotension,
hypokalemia, dizziness,
cramping and hyponatremia.
Drug-Drug Interaction:
HCTZ in conjunction with
other hypertensive therapies
can result in hypotension.
NSAIDs can decrease the
effectiveness of HCTZ.
Drug-Food Interaction:
Patients should be instructed
to eat food high in potassium
to prevent cramping, chest
pain and arrhythmias.
Outline potential
contraindication for the
therapy: Patients should be
assessed frequently for skin
Page 7

General Cost
of
Therapeutic
Monthly cost
for HCTZ is
$4.00 and cost
per dose daily
is $0.13.

References
(Adams,
Holland, &
Urban, 2014)
(Cefalu, 2016)
(Fortney, 2012)
(Martin &
Talbert, 2013)
(Vallerand,
Sanoski, &
Deglin, 2015)

Anne Gonzalez

irritation. Steven Johnson

Syndrome is a life threating
but is not common. People
with renal and liver
insufficiency should be
reevaluated for drug therapy.
5. Lyrica (Pregabalin)
Route: Oral
Safe dose in 24 hour
period: 100mg PO
three times a day
Daily dosing: Starting
dose at 50mg three
times a day and
increase 100mg three
times a day. Dose will
be titrated for
peripheral neuropathy
pain.
Onset: Unknown
Peak: two to four
weeks
Duration: Unknown
Classification of
Therapeutic:
Analgestics
Gamma Aminobutyric
Acide analogues
Nonopioid Analgesics

General Mechanism of
Action
Lyrica is intended for
patients with peripheral
neuropathy. This
medication is a
nonopioid agent that
does not bind with
bodys opioid receptor.
This medication works
together with the central
nervous system, fusing
with calcium channel
blockers to monitor and
control neurotransmitter
interaction.

Specific Indication for

this patient population
Chronically elevated
glucose can damage the
nerve cells in any part of
the body. Commonly in
diabetic patients they
will experience
numbness and tingling
to hands, feet, toes and
legs. The sensation can
be extremely painful for
some patients and limit
quality of life if left
untreated.

NURS660: Clinical Systems Leadership Immersion (Revised 06/29/15)

Outline patient safety issues

associated with this therapy
Adverse Reaction: Patients
should be educated about
dizziness and drowsiness that
can be experienced while
taking Lyrica. Dry mouth is a
common side effect reported
by patients.
Drug-Drug Reaction: The
combination of Lyrica with
analgesic or benzodiazepine
medication can depress the
central nervous system.
Drug-Food Interaction:
There is not a drug food
interaction listed in the drug
book or website for Lyrica
Outline potential
contraindication for the
therapy: Patients should be
taught about using Lyrica with
other pain medications. It is
recommended starting this
Page 8

General Cost
of
Therapeutic
Cost of dose
for a 30-day
supply is
$369.42. Cost
per dose for
Lyrica is
$12.31.

References
(Adams,
Holland, &
Urban, 2014)
(Cefalu, 2016)
(Fortney, 2012)
(Joy, 2013)
(Martin &
Talbert, 2013)
(Vallerand,
Sanoski, &
Deglin, 2015)

Anne Gonzalez

6. Gabapentin
(Neurontin)
Route: Oral
Safe dose: 100mg oral
three times a day. This
medication can be
titrated weekly
300mg/day to 900 or
2400mg/day
Daily dosing in 24-hour
period: Titrate based on
pain. Maximum
allowed in a 24-hour
period is 3600mg.
Onset: Rapid
Peak: two to four hours
Duration: Eight hours
Classification of
Therapeutic:
Analgesic Adjuncts

General Mechanism of
Action
The action of mechanism
of this medication is
unknown. Research has
speculated it may effect
how amino acids are
transported and crossed
into the central nervous
system.

Specific Indication for

this patient population
Neurontin is a
medication used for
peripheral neuropathy in
diabetic patients to help
manage the pain from
neuron cellular death.

NURS660: Clinical Systems Leadership Immersion (Revised 06/29/15)

medication at night because of

the side effect of dizziness and
drowsiness.
Outline patient safety issues
associated with this therapy
Adverse Reaction: This drug
can cause the patient to feel
confused, lethargic, and
present symptoms of
depression. Anxiety is another
side effect that can occur
while taking this medication.
Drug-Drug Interaction: The
use of antacids can increase
the absorption rate of
Gabapentin causing the
patient to feel an amplified
effect of the medication. Other
pain medication can cause the
patient to become increasingly
lethargic and disorientated.
Drug-Food Interaction: Use
of herbal supplements such as
Kava-kava, valerian root and
chamomile can cause a
depression of the central
nervous system.
Outline potential
contraindication for the
therapy: Patients that present
with a depressed central
Page 9

General Cost
of
Therapeutic
Cost for a
monthly
supply of
Gabapentin is
$42.92 and
per dose
$0.53.

References
(Adams,
Holland, &
Urban, 2014)
(Cefalu, 2016)
(Fortney, 2012)
(Joy, 2013)
(Martin &
Talbert, 2013)
(Vallerand,
Sanoski, &
Deglin, 2015)

Anne Gonzalez

7. Paxil
Route: Oral
Safe dose in 24 hour
period: 50mg
Daily dosing: Start
20mg and increase by
10mg daily maximum
dose is 50mg in a 24
hour period
Onset: one to four
weeks
Peak: unknown
Duration: unknown
Classification of
Therapeutic:
Antianxiety agent
Antidepressant

General Mechanism of
Action
Paxil is a selective
serotonin reuptake
inhibitor that blocks the
central nervous system
from reacting to the
serotonin.

Specific Indication for

this patient population
A newly diagnosed type
2 diabetic can
experience many
different emotions.
About 60% of diabetics
experience depression
and anxiety related to
disease process of T2D.
Paxil is a medication
that can help treat both
depression and anxiety
and would be beneficial
to consult a psychologist
for further therapy.

NURS660: Clinical Systems Leadership Immersion (Revised 06/29/15)

nervous system and

compromised airway should
not take gabapentin or patients
that are hypersensitive to the
medication should not take
gabapentin.
Outline patient safety issues
associated with this therapy
Adverse Reaction: Common
adverse reactions to Paxil are
dizziness, drowsiness or
insomnia, poor libido, and
nausea. Serious adverse events
recorded are suicidal thoughts,
serotonin syndrome, and
neuroleptic malignant
syndrome. Medication should
be discontinued immediately
if reaction occurs.
Drug-Drug Interaction:
MAO-inhibitors should not be
combined with this
medication as it increases the
patients risk of developing
serotonin syndrome. The
patient can be at higher risk
for bleeding while taking
Coumadin, ASA and Paxil
together. Paxil can decrease
the efficiency of Digoxin.
Drug-Food Interaction:
Page 10

General Cost
of
Therapeutic
Monthly cost
of Paxil
$173.61 and
cost per dose
is $5.78.

References
(Adams,
Holland, &
Urban, 2014)
(Cefalu, 2016)
(Fortney, 2012)
(Joy, 2013)
(Martin &
Talbert, 2013)
(Vallerand,
Sanoski, &
Deglin, 2015)

Anne Gonzalez

8. Lipitor
(Atorvastatin)
Route: Oral
Safe dose in 24 hour
period: Starting dose
10mg and increase to
80mg daily depending
on lipid fasting profile
Daily dosing: 10mg to
80mg daily
Onset: Unknown
Peak: Unknown
Duration: 20 to 30
hours
Classification of
Therapeutic: Lipid
Lowering Agent

General Mechanism of
Action
Lipitor is a medication
that will stop HMG-CoA
from communicating
with the liver. The lack
of communication will
prevent the liver from
producing cholesterol
and low-density lipids.

Specific Indication for

this patient population
Type 2 diabetic patient
take Lipitor when
cholesterol and low
density lipids are
elevated. Excess amount
of fat in the vascular
system can prevent the
body from metabolizing
glucose and insulin.
T2D patients are at
higher risk for coronary
artery disease and
cerebral vascular events.
Tight control of lipids in
the body is a method of

NURS660: Clinical Systems Leadership Immersion (Revised 06/29/15)

Vitamins to be avoided
include SAMe, Saint Johns
Wort, and tryptophan. These
vitamins can increase the
patients risk of developing
serotonin syndrome.
Outline potential
contraindication for the
therapy: Patients that are on a
MAO-inhibitor should not
take Paxil and stop Paxil or
MAO-inhibitor for at least
two weeks before starting new
medication therapy.
Outline patient safety issues
associated with this therapy
Adverse Reaction: Common
reported adverse reaction is
muscle weakness and
cramping. Leveled liver
enzymes and medicationinduced hepatitis or
pancreatitis can occur and be
monitored for.
Drug-Drug Interaction:
Lipitor can enhance the effect
of Coumadin and Digoxin
causing the patient to become
toxic and lead to death.
Drug-Food Interaction:
Rhabdomyolysis can occur
Page 11

General Cost
of
Therapeutic
Cost per
month is
$115.64 and
the cost per
dose is $3.85.

References
(Adams,
Holland, &
Urban, 2014)
(Cefalu, 2016)
(Fortney, 2012)
(Martin &
Talbert, 2013)
(Vallerand,
Sanoski, &
Deglin, 2015)

Anne Gonzalez

HMG-CoA Reductase
Inhibitors

inhibiting myocardial
infarction and cerebral
accidents.

when taking Lipitor with

grapefruit juice.
Outline potential
contraindication for the
therapy: Patients with a
history of liver disease or
pancreatitis should be
reevaluated for the use of
Lipitor. Hyper sensitivity can
occur while taking this
medication.
9. Lovastatin
General Mechanism of Specific Indication for Outline patient safety issues
Route: Oral
Action
this patient population associated with this therapy
Safe dose in 24 hour
Lovastatin works the
T2D patients with
Adverse Reaction: Muscle
period: 80mg
same as Lipitor. This
elevated lipid profile are cramping and weakness that
Daily dosing: Start at
medication is second in
at higher risk for
can lead to rhabdomyolysis.
20mg and titrate per
choice for a diabetic
vascular disease.
Liver failure from medication
lipid panel profile and
patient to use if patient
Treating the
induced hepatitis. Can
patient tolerance.
cannot tolerate Lipitor.
dyslipidemia is a method increase blood glucose.
Maximum dosing 80mg Lovastatin will prevent
of preventing any type
Drug-Drug Interaction:
per day.
the liver from producing of event that can be life
Patients on Coumadin and
Onset: two weeks
and distributing
altering.
Digoxin should be monitor for
Peak: four to six weeks cholesterol and lowincreased bleeding and
Duration: six weeks
density lipids. A negative
toxicity to those medications
Classification of
effect of this medication
while taking lovastatin.
Therapeutic
can cause the high
Drug-Food Interaction:
Lipid Lowering Agent
density lipids (HDLs) to
Eating before taking this
HMG-CoA Reductase
lower as well, the HDLs
medication can increase the
Inhibitors
are the positive lipids of
effects of the lovastatin.
the human body that help
Grapefruit juice should not be
keep cells functional.
consumed while taking this
NURS660: Clinical Systems Leadership Immersion (Revised 06/29/15)

Page 12

General Cost
of
Therapeutic
Cost of
medication
per month is
$5.00 and per
dose $0.16.

References
Adams,
Holland, &
Urban, 2014)
(Cefalu, 2016)
(Fortney, 2012)
(Martin &
Talbert, 2013)
(Vallerand,
Sanoski, &
Deglin, 2015)

Anne Gonzalez

10. Aspirin (ASA)

Route: Oral
Safe dose in 24 hour
period: 81mg to
1000mg daily
Daily dosing: 325mg
Onset: Five minutes to
30 minutes
Peak: one to three
hours
Duration: three to six
hours
Classification of
Therapeutic:
Antiplatelet Agent

General Mechanism of
Action: ASA will
prevent micro clots from
forming in capillaries
from abnormal epithelial
cell formation for
hyperglycemia. The
mechanism of ASA will
inhibit platelets from
aggregating creating
blockages in the vascular
system.

medication
Outline potential
contraindication for the
therapy: Individuals with
liver disease should not be
started on lovastatin.
Discontinue if muscle
weakness or cramping occurs
to prevent rhabdomyolysis.
Specific Indication for Outline patient safety issues
this patient population: associated with this therapy
The morphology of
Adverse Reactions:
platelets changes when
Individuals with a history of
the patient becomes
gastrointestinal bleeding or
diabetic. A daily dose of ulcers should use ASA with
ASA will help in
caution. Inappropriate use of
preventing
ASA can lead to GI bleeding,
microvascular
liver disease and renal disease.
complications in organ
Drug-drug interaction:
systems of the body.
There is an increase risk of
bleeding with combining ASA
in dual therapy with Plavix,
Heparin and Effient.
Drug-food interaction:
Foods that can cause increase
risk of bleeding is garlic and
ginger. Herbal supplements
that can cause bleeding are
chamomile, clove, and
feverfew.
Outline potential

NURS660: Clinical Systems Leadership Immersion (Revised 06/29/15)

Page 13

General Cost
of
Therapeutic

References
Adams,
Holland, &
Urban, 2014)
(Cefalu, 2016)

The cost per

pill is $0.49
and $14.70 for (Fortney, 2012)
a months
(Martin &
supply of
Talbert, 2013)
Aspirin.
(Vallerand,
Sanoski, &
Deglin, 2015)

Anne Gonzalez

contraindication for the

therapy: Toxicity to ASA can
be presented as anemia,
hematuria and epigastric
crisis. Laryngeal edema is a
common reaction to ASA and
is treated as a medical
emergency. Common?
11. Massage
Route: Touch. Can be
done at home or spa
Safe dose: starting at
30 minutes and 60
minutes
Daily Dose:
recommended weekly
or as needed per
individual.
Maintenance Dose:
Up to three times a
week or weekly

General Mechanism of
Action
Massage is a
combination of touch
and applied pressure to
the muscles and soft
tissues of the body. It
will decrease tension and
allow the body to relax
to allow blood to flow
freely.

Specific Indication for

this patient population
Massage is an
integrative therapy that
will help the T2D
patient to relax and
decrease anxiety related
to the diagnosis. Touch
can help decrease blood
pressure and allow
vessels to dilate to
promote blood flow to
organs and extremities.

12. Essential Oils

Route: Topical
Safe Dose: three to five
drops

General Mechanism of
Action:
Essential oils work on
the olfactory gland of the

Specific Indication for

this patient population
Essential oils will help
promote relaxation.

NURS660: Clinical Systems Leadership Immersion (Revised 06/29/15)

Adverse Reaction:
Allergic reactions to products
used such as essential oils.
Injury from too much pressure
or discomfort.
Drug-Drug Interaction:
N/A
Drug-Food Interaction:
N/A
Outline potential
contraindication for the
therapy: Massage is not for
all patients. Some patients do
not enjoy the sensation of
touch from strangers. Injury
can occur from a non-licensed
individual performing the
massage.
Adverse Reaction: A skin
reaction to the oil can occur.
Redness or hives can be
presented and should be
Page 14

General Cost
of
Therapeutic
Range from
$40 to $100
per session

(Cefalu, 2016)

General Cost
of
Therapeutic
Vial $10.00 to

(Cefalu, 2016)

(Nahas, 2012)

(Nahas, 2012)

Anne Gonzalez

Daily Dosing: As
needed
Maintenance Dose:
Daily use to create the
calming effect desired.

brain. This will trigger

the brain to send a
message to the limbic
system to relax
emotions.

Bringing peace to mind

body and spirit.
Decreasing stress to
prevent the body from
producing cortisol from
daily stress.

13. Personal
Trainer/Physical
Fitness Expert
Route: Physical
Safe Dose: Twice a day
for one hour
Daily Dosing: Daily
for 45 minutes to one
hour
Maintenance Dose:
Three times a week for
one hour

General Mechanism of
Action:
Physical activity will
increase the heart rate
and motivate the body to
burn stored energy to
meet the demand of the
body to burn calories.

14. Yoga
Route: Physical
movement
Safe Dose: Three times

General Mechanism of
Action: Purposeful
movements that stretch
and use all muscles of

Specific Indication for

this patient population
T2D is a lifestyle
disease from inactivity
and poor food choices.
Personal trainers can
help the diabetic patient
develop an exercise
routine and how to eat
healthy. Weight loss will
help the body
metabolize glucose and
lessen the severity of the
diabetes.
Specific Indication for
this patient population
Physical activity and
mindfulness of yoga will

NURS660: Clinical Systems Leadership Immersion (Revised 06/29/15)

washed off immediately.

Nightmares are not a common
side effect but are possible,
rendering this therapy
nontherapeutic.
Drug-Drug Interaction: N/A
Drug-Food Interaction: N/A
Outline potential
contraindication for the
therapy: Previous reaction to
oils and sensitivity to smell of
the oils. Some oils are strong
and have an offensive odor.
Adverse Reaction: Injury can
occur if the trainer is not
aware of previous injury or is
not a certified personal trainer.
Drug-Drug Interaction: N/A
Drug-Food Interaction: N/A
Outline potential
contraindication for the
therapy: Physical limitations
can interfere with desired
effects of weight loss

$25.00
depending on
the oil
purchased

Adverse Reaction: Injury

from prior event can prevent
proper form for yoga poses.
Injury can occur if participant

General Cost
of
Therapeutic

Page 15

General Cost
of
Therapeutic
Per session
$25 to $40

(Anderson,
2014)
(Cefalu, 2016)
(Nahas, 2012)

(Anderson,
2014)
(Cefalu, 2016)

Anne Gonzalez

a week or daily
Daily Dosing: 30
minutes to two hours
Maintenance Dose:
Ideally daily for
physical and mental
wellbeing

the body. Meditation is

part of yoga that will
allow the mind to relax
and promote inner peace.

help motivate the patient

to become active in a
positive environment.

15. Smoking cessation

Route: Educational
class/ listening skills
Safe Dose: As many
times it is needed to
help quit smoking
tobacco
Daily Dosing: Classes
are offered twice a
week from local
hospital and
community center.
Maintenance Dose: As
needed to prevent
smoking habit from
forming again

General Mechanism of
Action: Participants are
guided on how to quit
smoking with will power
and knowledge. Patients
are taught healthy
techniques to stop the
oral fixation of smoking.

Specific Indication for

this patient population
Smoking can increase
the stickiness of blood.
T2D patients are already
compromised with
hyperglycemia and
dyslipidemia. The tar
from nicotine can create
blockages in blood
vessels decreased
vascular perfusion,
leading to vascular
events.

NURS660: Clinical Systems Leadership Immersion (Revised 06/29/15)

does not communicate with

yogi about limitation
Drug-Drug Interaction: N/A
Drug-Food Interaction: N/A
Outline potential
contraindication for the
therapy: Injury to any
participant that does not
verbalize limitations and
previous injury
Adverse Reaction:
Participate can lose
motivation and/or become
defensive about smoking
cessation information
Drug-Drug Interaction: N/A
Drug-Food Interaction: N/A
Outline potential
contraindication for the
therapy: Lack of motivation
can make this therapy a poor
option. Unable to pay for the
class. Barriers to learning such
as language and funding.

Page 16

Per class
$9.00

(Nahas, 2012)

General Cost
of
Therapeutic
Programs can
vary form $35
to $100 for
four weeks.

(Anderson,
2014)
(Cefalu, 2016)
(Nahas, 2012)

Anne Gonzalez

Summary of application of holistic therapeutics to health of chosen population and expected optimal outcomes of care:
The five integrative therapies chosen for this population are massage, essential oil therapy, personal trainer, yoga, and smoking cessation. T2D
is ultimately triggered from lifestyle habits of physical inactivity, stress, and poor dietary decisions (Cefalu, 2016). Taking control of ones life and
becoming active with a fitness expert to establish an exercise routine is crucial. A fitness expert has valuable knowledge on meal planning and can
help establish a healthy diet. Networking with fitness experts will help the diabetic patient develop a support team and a motivator to help the
participant push ones self to over come challenges and obstacles. Stress management with yoga, essential oils, and massage will help prevent
depression and anxiety (Fortney, 2012). Uncontrolled emotions can lead to over eating and making wrong lifestyle choices. Smoking is dangerous for
everyone but in a diabetic patient it accelerates the growth of vascular complications (Cefalu, 2016). Learning to cope with stress will decrease the
participants need to smoke and help to prevent poor food selections. These integrative therapies are essential to becoming healthy and will work well
with the medications ordered by the primary care provider.

Reference

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Adams, M. P., Holland, L. N., & Urban, C. Q. (2014). Pharmacology for nurses: A pathophysiologic approach (4th ed.). Retrieved from
https://online-statref-com.ezproxy1.library.arizona.edu/Document.aspx?FxId=198&SessionID=227ED2BGKLPKMXNB
Anderson, J. (2014). Healthy coaching: A partnership on the journey to wellbeing. In M. Kreitzer, & M. Koithan (Eds.), Integrative nursing (pp. 171183). New York, NY: Oxford University Press.
Bagheri-Nesami, M., Shorofi, S. A., Nikkhah, A., Espahbodi, F., & Koolaee, F. (2016). The effects of aromatherapy with lavender essential oil on
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Cefalu, W. T. (Ed.). (2016). Standards of medical care in diabetes-2016 [Entire issue]. Diabetes Care, 39(1). http://dx.doi.org/10.2337/dc16-S004
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Fortney, L. (2012). Recommending meditation. In D. Rakel (Ed.), Integrative medicine (3rd ed., pp. 873-881). Retrieved from https://wwwclinicalkey-com.ezproxy2.library.arizona.edu/#!/content/book/3-s2.0-B9781437717938000820
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Joy, M. S. (2013). Genomics and the kidney. In J. S. Bertino, C. DeVane, U. Fuhr, A. D. Kashuba, & J. D. Ma (Eds.), Pharmacogenomics: An
introduction and clinical perspective. Retrieved from http://accesspharmacy.mhmedical.com.ezproxy4.library.arizona.edu/content.aspx?
bookid=511&sectionid=40849387
Martin, C. P., & Talbert, R. L. (2013). Pharmacotherapy: Bedside guide. Retrieved from Arizona Health Science Library
Nahas, R. (2012). Type 2 Diabetes. In D. Rakel (Ed.), Integrative medicien (3rd ed., pp. 297-311). Retrieved from https://www-clinicalkeycom.ezproxy4.library.arizona.edu/#!/content/book/3-s2.0-B9781437717938000327
Olokoba, A. B., Obateru, O. A., & Olokoba, L. B. (2012). Type 2 diabetes mellitus: A review of current trends. Oman Medical Journal , 27(4), 269273. http://dx.doi.org/10. 5001/omj.2012.68
Potter, L., Wallston, K., Trief, P., Juth, V., & Smyth, J. (2015). Attributing discrimination to weight: Associations with well-being, self-care, and
disease status in patients with type two diabetes mellitus. Journal of Behavioral Medicine , 38(6), 863-875. http://dx.doi.org/10.1007/s10865015-9655-0
Vallerand, A. H., Sanoski, C. A., & Deglin, J. H. (2015). Davis drug guide for nurses (14th ed.). Retrieved from https://online-statrefcom.ezproxy1.library.arizona.edu/Document.aspx?
FxId=58&SessionID=227ED2BGKLPKMXNB#H&1&ChaptersTab&N6Gco_9BBDOQaaQ0KDh78Q%3d%3d&&58

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