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.
Tracy Terrones NURS660
Introduction to Patient Population: It is estimated that in the United States there are 6.5 million adult cerebral vascular accident (CVA) survivors.
More then half of CVAs are caused by uncontrolled hypertension and 80 percent of these CVAs are preventable with proper medical treatment.
Population-specific Goals of Care: Immediate treatment and appropriate interventions help minimize the long-term deficits of a CVA survivor and
improve recovery outcomes. The patients optimum healthy lifestyle post CVA and prevention of a recurrent stroke are the objectives to be
accomplished.
Name of Therapeutic
+Route
+Safe Dose [maximum
24hr dose; daily
dosing; onset/ peak/
duration]

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

Specific Indication for

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

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

Outline patient safety issues

associated with this therapy
[adverse drug reactions, drugdrug and drug-food
interactions]
Outline potential
Page 1

General Cost
of
Therapeutic
[per dose and
monthly cost]

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

Classification of
Therapeutic
[therapeutic and
pharmacologic OR
category of nonpharmacologic]
#1 Aspirin (ASA)
Route: Oral
Safe Dose: 160-325 mg
QD within 48 hours of
a CVA, 81-325 mg QD
thereafter
Onset: 5-30 minutes
Peak: 1-3 hours
Duration: 3-6 hours
Classification of
Therapeutic
Analgesic, Nonnarcotic
Anti-inflammatory
Agent
Antiplatelet Agent
Antipyretic
Nonsteroidal Antiinflammatory Drug
(NSAID)
Salicylate

evidence]

General Mechanisms of
Action
Decreasing the platelets
ability to aggregate and
to form a clot in narrow
blood vessels. This
mechanism also helps
decrease the amount of
inflammation
experienced by the blood
vessels. Preventing
inflammation will less
the chances of blood
clots from forming.

contraindications for the

therapy

Specific Indication for

this patient population
ASA is used to help
prevent a CVA victim
from having a
reoccurring stroke. This
will prevent ischemic
strokes and could
increase the patients
risk for having a
hemorrhagic stroke.
ASA is recommend by
the American Stroke
Association to help
prevent strokes as a front
line defense.

Outline patient safety issues

associated with this therapy
Adverse reactions:
There are many adverse
reactions noted with taking
ASA Gastrointestinal
complications are the highest
occurring reactions.
Drug-drug interactions:
Dual platelet therapy ASA and
Plavix can increase the
patients risk for bleeding
ASA can increase risk of
gastrointestinal bleeding and
discomfort.
There are drug-food
interactions that can occur
while taking this medication.
Patients should avoid some
herbal medications such as
clove, feverfew, garlic, and
chamomile. Theses herbs can
increase the risk of bleeding.
Outline potential

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

Page 2

General Cost
of
Therapeutic
[per dose and
monthly cost]

(Adams, Holland,
& Urban, 2014)
("ASA," 2014)
(CreutzfeldtR,
Holloway, &
Walker, 2012)
(Gengo &Rainka,
2013)

Aspirin 325
mg:
(Vallerand,
$0.49 per dose
Sanoski, &
and $14.70
Deglin, 2015)
per month

#2 Clopidogrel
(Plavix)
Route: Oral
Safe Dose: 75 mg QD
Onset: Within 24 hours
Peak: 3-7 days
Duration: 5 days
following
discontinuation
Classification of
Therapeutic
Antiplatelet Agent

General Mechanisms of
Action
Clopidogrel works as an
inhibitor of platelet
aggregation. This
medication creates a
slippery surface of the
platelet blocking the
receptor site from
activating the GPIIb/IIIa
receptor complex of the
clotting cascade. Thus,
preventing the platelets
from sticking together
and forming a clot.

Specific Indication for

this patient population
Clopidogrel or Plavix is
an antiplatelet
medication used to
reduce atherosclerotic
events in patients at risk
from a recent ischemic
CVA.

contraindications for the

therapy
ASA should be used with
caution with patients
diagnosed with bleeding
conditions, hepatic, and renal
disease.
Outline patient safety issues
associated with this therapy
Adverse reactions:
A common adverse reaction
with Clopidogrel is bleeding
because of the change of the
platelet surface. A prolonged
amount of time will need to
allocate to achieve hemostasis
once bleeding occurs. GI
bleeding, neutropenia, and
thrombotic thrombocytopenia
purpura can all occur while
taking this medication and can
potentially be life threatening.
Drug-drug interactions:
This drug combine with other
anticoagulation therapy can
increase the effects of the
medication such as ASA or
Heparin. This medication can
also make other therapies such
as phenytoin ineffective by

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

Page 3

General Cost
of
Therapeutic
[per dose and
monthly cost]
Clopidogrel
75 mg: $6.96
per dose and
$208.80 per
month
Plavix 75mg:
$7.73 per dose
and $232.03
per month

(Adams et al.,
2014)
("ASA," 2014)
(CreutzfeldtR et
al., 2012)
(Gengo &
Rainka, 2013)
(Martin &
Talbert, 2013)
(Vallerand et al.,
2015)

decrease the bodys ability to

metabolize and absorb the
medication.
Drug-food interactions:
Food that should be avoid are
chamomile, clove, garlic and
ginger increasing the patients
chances of developing a bleed
of some form.
Outline potential
contraindications for the
therapy
Some patients are found to be
hypersensitive to clopidogrel
developing GI bleeding and
intracranial bleeding.

#3 Lisinopril (Prinvil
or Zestril)
Route: Oral
Safe Dose: 10 mg QD,
may be increased up to
20-40 mg QD
Onset: 1 hour
Peak: 6 hours
Duration: 24 hours
Classification of

General Mechanisms of
Action
Lisinopril is an
aggressive inhibitor of
angiotensin-converting
enzyme (ACE) that
prevents
vasoconstriction.
Preventing the hormone

Specific Indication for

this patient population
Lisinopril is used for the
treatment of
hypertension either
alone or in combination
with other anti
hypertensive agents.

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

Outline patient safety issues

associated with this therapy
Adverse reactions:
There are many adverse
reactions associated with this
medication a common effect is
hypotension and a dry cough.
A more serious reaction noted
is angioedema.
Drug-drug interactions:
Page 4

General Cost
of
Therapeutic

(Adams et al.,
2014)

[per dose and

monthly cost]

(CreutzfeldtR et
al., 2012)

Lisinopril 10
mg: $0.99 per
dose and

(Gengo &
Rainka, 2013)

("ASA," 2014)

Therapeutic
Antihypertensive

angiotensin I from
becoming angiotensin II
will prevent the blood
vessel from constricting.

When this medication is

conjoined with other anti
hypertensives, the patient is at
higher risk for a hypotensive
episode. Patient should use
caution when taking the
medication and using a
potassium replacement. The
patient can be become
hypokalemic and cause
decrease renal function.
Taking NSAIDs can decrease
the drugs desired effect to
decrease the blood pressure.
Drug-food interactions:
Foods high in potassium
should be avoided
Outline potential
contraindications for the
therapy

$29.70 per
month

(Martin &
Talbert, 2013)
(Vallerand et al.,
2015)

Hypersensitivity to lisinopril,
any component of the
formulation, or other ACE
inhibitors and ARBs can be
related to the development
angioedema.

#4 Atorvastatin
(Lipitor)

General Mechanisms of
Action

Specific Indication for

this patient population

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

Outline patient safety issues

associated with this therapy
Page 5

General Cost
of

(Adams et al.,
2014)

Route: Oral
Safe Dose: 10-20 mg
QD, may increase
every 2-4 weeks up to
80 mg QD
Onset: unknown
Peak: unknown
Duration: 20-30 hours
following
discontinuation
Classification of
Therapeutic
Lipid Lowering Agent

Lipitor blocks the 3hydroxy-3methylglutaryl coenzyme

A (HMG-CoA) reductase
from starting the
production cholesterol.
That enzyme is made in
the liver and that
produced the LDL. This
will decrease the amount
of LDL that is made by
the body and preventing
plaque build up in
vessels causing
occlusions that lead to a
CVA.

Lipitor is administered
for primary and
secondary levels of
prevention for a CVA.
Plaque build up in
vessels can lead to
narrowing of arties and
eventually no blood
flow. It is recommended
by the American Stroke
Association that a
cholesterol medication
be added to therapy as a
preventive measure.

Adverse reactions:
Adverse reaction consist of
muclse cramps/weakness,
medication induced hepatitis,
increased liver enzymes, and
pancreatitis
Drug-drug interactions:
This medication can increase
levels of digoxin and the
patient can become toxic.
Warfarins effect can be
amplified by taking Lipitor at
the same time. Increasing the
patients risk for bleeding.
Drug-food interactions:
Grapefruit juice may increase
levels and risk of
rhabdomyolysis
Outline potential
contraindications for the
therapy
Hypersensitivity to
atorvastatin can cause acute
medication induced hepatitis
and pancreatitis.

Therapeutic

#5 Labetalol
Route: Oral or IV

General Mechanisms of
Action

Specific Indication for

this patient population

Outline patient safety issues

associated with this therapy

General Cost
of

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

Page 6

("ASA," 2014)
[per dose and
monthly cost]

(CreutzfeldtR et
al., 2012)

Lipitor 10 mg: (Gengo &

$3.85 per dose Rainka, 2013)
and $115.64
(Martin &
per month
Talbert, 2013)
(Vallerand et al.,
2015)

(Adams et al.,
2014)

Safe Dose:
Oral 100 mg BID up to
400-800 mg QD in
divided doses
IV 20 mg initially,
additional doses 40-80
Q 10 minutes as needed
(not to exceed 300 mg
total dose) or 2 mg/min
infusion (range 50-300
mg total dose required)
Onset:
Oral: 20 min-2 hours
IV: 2-5 minutes
Peak:
Oral: 1-4 hours
IV: 5 minutes
Duration:
Oral: 8-12 hours
IV: 16-18 hours

Labetalol blocks alpha-,

beta1 (myocardial), and
beta2 (pulmonary,
vascular) receptor sites.
There is a reduction of
elevated renins.
Allowing the smooth
muscle of the blood
vessel to relax to
decrease blood pressure
and help heart rate
control.

Labetalol is
administered to the CVA
patient for the treatment
of mild-to-severe high
blood pressure and IV
Labetalol is for severe
hypertension or
hypertensive crisis.

Classification of
Therapeutic
Antianginal,
Antihypertensive

Adverse reactions:
Hypotension, dizziness,
bronchospasms, and anxiety
are possible reactions from
Labetalol. These are side
effects that can be noticed
with patients status post CVA.
Drug-drug interactions:
This medication combined
with other heart rate control
medication and anti
hypertensive can lead to heart
blocks and serious
hypotension. Can also
decrease the desired effect of
anti depressive medications
causing hypertention from as
MAOI therapies.
Drug-food interactions:
Administer with food as
Labetalol serum
concentrations may be
increased if taken with food
Outline potential
contraindications for the
therapy
Hypersensitivity to labetalol is
severe bradycardia or heart
block. Bronchospasms with

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

Page 7

Therapeutic
("ASA," 2014)
[per dose and
monthly cost]
Labetalol 100
mg tablet:
$0.56 per dose
and $16.98
per month
Labetalol
5mg/ml
solution for
IV: $0.14 per
ml

(CreutzfeldtR et
al., 2012)
(Gengo &
Rainka, 2013)
(Martin &
Talbert, 2013)
(Vallerand et al.,
2015)

asthmatic patients.

General Mechanisms of
#6 Ativan
Action
(Lorazepam)
Ativan depresses the
Route: Oral, IV, IM
central nervous system
Safe Dose:
by an inhibitory
Oral: 1-3 mg 2-3x QD, neurotransmitter. By
up to 10 mg/day
attaching specific
IV: 44 mcg (0.044
benzodiazepine to
mg)/kg (not to exceed 2 receptors of the central
mg)
nervous system creating
IM: 50 mcg (0.05
a calming effect.
mg)/kg (not to exceed 4
mg)
Onset:
Oral: 15-60 min
IV: 15-30 min
IM: 30-60 min
Peak:
Oral: 1-6 hr
IV: 15-20 min
IM: 1-2 hr
Duration:

Specific Indication for

this patient population
CVA survivors are prone
to anxiety post CVA;
Ativan is used for shortterm management of
anxiety post CVA.
Length of time that is
indicated for treatment
with Ativan is less than
four months.

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

Outline patient safety issues

associated with this therapy
Adverse reactions: side effects
include lethargy, confusion,
increase depressed feeling of
hopelessness and slurred
speech.
Drug-drug interactions:
Combination of Ativan with
other benzodiazepines can
amplify the desired effect and
lead to respiratory depression.
Alcohol should be avoided to
prevent CNS disturbance.
Drug-food interactions:
Herbal medication kava-kava,
valerian root, or chamomile
can add a depression like
feeling to the central nervous
system.
Outline potential
Page 8

General Cost
of
Therapeutic

(Adams et al.,
2014)

[per dose and

monthly cost]

(CreutzfeldtR et
al., 2012)

Ativan 1 mg
tablet: $21.64
per dose and
$694.20 per
month.
Lorazepam 1
mg tablet:
$0.88 per dose
and $264.48
per month

(Gengo &
Rainka, 2013)

Ativan
2mg/ml
injection:

("ASA," 2014)

(Martin &
Talbert, 2013)
(Vallerand et al.,
2015)

Oral, IV, IM: 8-12 hr

Classification of
Therapeutic
Anesthetic Adjuncts,
Antianxiety Agents,
Sedative Hypnotics

#7 Gabapentin
(Neurontin)
Route: Oral
Safe Dose: 100 mg 3x
QD, titrate weekly by
300 mg/day up to 9002400 mg/day
(maximum: 3600
mg/day)
Onset: rapid
Peak: 2-4 hr
Duration: 8 hr

General Mechanisms of
Action
Mechanism of action is
not known. May affect
transportation of amino
acids to cross and to
steady neuronal
membranes.

Specific Indication for

this patient population
Gabapentin used for
seizures and restless leg
syndrome, also
unlabeled use for
administration to CVA
survivors for pain
associated with
neuralgia, anxiety, and
migraine headache.

Classification of
Therapeutic
Analgesic Adjuncts,
Anticonvulsants, Mood
Stabilizers
NURS660: Clinical Systems Leadership Immersion (Revised 06/29/15)

contraindications for the

therapy
Hypersensitivity to Ativan can
lead to sever respiratory
dysfunction such as apnea and
poor perfusion causing
respiratory distress.

$2.08 per dose

Outline patient safety issues

associated with this therapy
Adverse reactions: Confusion,
depression, sedation, and
anxiety are common adverse
reactions with patient that
have suffered from a CVA.
Drug-drug interactions:
Patients should use caution
while taking this medication
with antacids such as tums
because it can increase the
medications absorption.
Increase the effects of the
medication leading to the
patient to becoming lethargic.
Drug-food interactions:
Kava-kava, valerian, or
chamomile can increase CNS

General Cost
of
Therapeutic

(Adams et al.,
2014)

[per dose and

monthly cost]

(CreutzfeldtR et
al., 2012)

Gabapentin
100mg tablet:
$0.53 per dose
and $47.92
per month

(Gengo &
Rainka, 2013)

Page 9

Lorazepam
2mg/ml
injection:
$0.90 per dose

("ASA," 2014)

(Martin &
Talbert, 2013)
(Vallerand et al.,
2015)

depression
Outline potential
contraindications for the
therapy
Hypersensitivity to gabapentin
for the patient can lead to
depression to the CNS and
respiratory system.

#8 Lasix (Furosemide)
Route: Oral
Safe Dose: 40mg BID
Onset: 30-60 min
Peak: 1-2 hr
Duration: 6-8 hr
Classification of
Therapeutic
Diuretic

General Mechanisms of
Action
Lasix stops reabsorption
of sodium and chloride
in the ascending loop of
Henle. It increases renal
excretion of fluid and
electrolytes. This
mechanism makes the
patient void large
volumes of fluid.

Specific Indication for

this patient population
Lasix is used in the
antihypertensive regime
for the CVA survivor

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

Outline patient safety issues

associated with this therapy
Adverse reactions:
Dehydration, electrolyte
imbalance, renal failure, and
hypotension are the common
adverse reactions with the
CVA population
Drug-drug interactions:
Increased risk of hypotension
is noted with a combination of
other antihypertensives.
Drug-food interactions:
Food that should be avoid
while taking Lasix is high
sodium.

Page 10

General Cost
of
Therapeutic

(Adams et al.,
2014)

[per dose and

monthly cost]

(CreutzfeldtR et
al., 2012)

Lasix 20 mg
tablet: $0.59
per dose and
$17.74 per
month

(Gengo &
Rainka, 2013)

("ASA," 2014)

(Martin &
Talbert, 2013)

(Vallerand et al.,
2015)
Furosemide
20 mg tablet:
$0.14 per dose
and $4.29 per
month

Outline potential
contraindications for the
therapy
Hypersensitivity to
furosemide can lead to poor
renal function and elevated
levels of creatinine and BUN

#9 Alteplase (t-PA)
Route: IV
Safe Dose: 0.9 mg/kg
(not to exceed 90 mg),
given as an infusion
over 1 hr, with 10% of
the dose given as a
bolus over the 1st min
Onset: 30 min
Peak: 60 min
Duration: unknown

General Mechanisms of
Action
t-PA initiates local
fibrinolysis by attaching
to a fibrin thrombus and
dissolves the clot.

Specific Indication for

this patient population
Acute Ischemic Stroke
with onset of stroke
symptoms within 3
hours of treatment

Classification of
Therapeutic
Thrombolytic

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

Outline patient safety issues

associated with this therapy
Adverse reactions:
Hemostasis is affected,
bleeding is the major adverse
effect associated with
alteplase, intracranial
hemorrhage, GI bleeding,
epistaxis, gingival bleeding,
ecchymoses.
Drug-drug interactions:
Patients that are on other
anticoagulation therapies
should be monitored for
excessive bleeding.
Drug-food interactions:
Increased bleeding effect with
over the counter medications
such as clove, garlic, dong
quai and licorice. These herbal
Page 11

General Cost
of
Therapeutic

(Adams et al.,
2014)

[per dose and

monthly cost]

(Gengo &
Rainka, 2013)

Alteplase
50mg IV:
$4566.16

(Martin &
Talbert, 2013)

("ASA," 2014)

(Vallerand et al.,
2015)

medications should be
avoided.
Outline potential
contraindications for the
therapy
Active internal bleeding and
prior history of bleeding
complication, hemorrhagic
stroke or GI bleeding. High
INR levels or supra
therapeutic level of Heparin.

(Adams et al.,
2014)
#10 Prozac
(Fluoxetine)
Route: Oral
Safe Dose: 10mg QD in
AM, not to exceed
60mg QD
Onset: 1-4 weeks
Peak: unknown
Duration: 2 weeks
Classification of
Therapeutic
Antidepressant

General Mechanisms of
Action
Prozac inhibits the
neuron serotonin
reuptake in the central
nervous system. Prozac
is known as a selective
serotonin reuptake
inhibitor. This will help
the CVA survivor from
feeling depressed.

Specific Indication for

this patient population
Prozac is prescribed for
a major depressive
and/or panic disorder
following a CVA

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

Outline patient safety issues

associated with this therapy
Adverse reactions:
Anxiety, drowsiness,
headache, insomnia,
nervousness, abnormal dreams
are adverse effects that are
commonly noted with CVA
survivors.
Drug-drug interactions:
Can increase the effectiveness
of other essential medication
such as Plavix and ASA.
Page 12

General Cost
of
Therapeutic
[per dose and
monthly cost]
Prozac 10mg
capsules:
$10.45 per
dose and
$313.56 per

("ASA," 2014)
(CreutzfeldtR et
al., 2012)
(Gengo &
Rainka, 2013)
(Martin &
Talbert, 2013)
(Vallerand et al.,
2015)

Increasing the patients risk for

bleeding.
Drug-food interactions:
St. John's wort and SAMe
should be avoided increasing
the patients risk for serotonin
syndrome.

month
Fluoxetine
10mg
capsules:
$2.60 per dose
and $77.95
per month

Outline potential
contraindications for the
therapy
Hypersensitivity can lead to
cardiac complications and can
potentially increase the
patients depression cause the
patient to lead to suicidal
ideations.

#11 Acupuncture
Route: In home,
hospital based, or
acupuncture center
Safe Dose: 20 minutes
2x/week initially
Maximum 24 hr dose:

General Mechanisms of
Action
The ancient Chinese
acupuncture therapy
helps CVA patients using
needlepoints on energy
pathways to correct or

Specific Indication for

this patient population
Asian cultures believe
acupuncture helps to
stimulate your body's
nerves and muscles. This
form of therapy is a

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

Outline patient safety issues

associated with this therapy
Adverse reactions: Risk of
skin damage and infection
Drug-drug interactions: N/A
Drug-food interactions: N/A
Page 13

General Cost
of
Therapeutic
[per dose and
monthly cost]

(CreutzfeldtR et
al., 2012)
(Wayne, 2013)

20 minutes
Maintenance dosing:
1x/week or every other
week

improve imbalances.

#12 Meditation
Route: In home,
hospital based, yoga
center mindful class
Safe Dose: 5 minutes
Daily dose: 15 -20
minutes
Maintenance dosing:
Daily

General Mechanisms of
Action
The goal of meditation is
to focus on the present
moment without
thinking. This allows the
body to relax and center
ones self. As a stroke
survivor, accepting the
present moment can be
very difficult and by
silencing internal chatter,
negative thoughts can be
removed.

standard treatment in
China for CVA patients.
It is utilized to assist the
CVA patient with
complications in
language and
swallowing.

Specific Indication for

this patient population
Meditation significantly
helps stroke survivors
reduce mental fatigue
during stroke recovery.
With this side effect
minimized, stroke
survivors can devote
more energy to
rehabilitation exercises
and boost motor
recovery. More energy
also means more
opportunity to engage in
social activities, which
can help reduce
depression and anxiety.
A specific type of
meditation can help you

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

$75-150/ visit
Outline potential
contraindications for the
therapy
Fear of needles, financial
status, transportation

Outline patient safety issues

associated with this therapy
Adverse reactions: Possible
vasovagal response
Drug-drug interactions: N/A
Drug-food interactions: N/A
Outline potential
contraindications for the
therapy
Non fostering environment,
embarrassment, or feeling
judged by family members

Page 14

General Cost
of
Therapeutic
[per dose and
monthly cost]
In home: Free
Yoga Center:
$15/session

(CreutzfeldtR et
al., 2012)
(Fortney, 2012)

calm your mind and

body, which is especially
beneficial for stroke
survivors.

#13 Aromatherapy
Route: Topical
Safe Dose: 2-3 drops
Daily dose: PRN
Maintenance dosing:
As desired

#14 Massage
Route: In home,
hospital, or massage
spa
Safe Dose: 30-60
minutes
Daily Dose: N/A
Maintenance Dose:
3x/ week

General Mechanisms of
Action
Essential oils are used
for the CVA patient for
the enhancement of the
body, spirit, and soul.
The special effects of
aromatherapy, is the
attachment of chemical
factors in the oils to the
receptors in the olfactory
gland stimulating the
emotional part of the
brain to help relax.

Specific Indication for

this patient population
A recent study on the
use of aromatherapy for
stroke treatment resulted
in evidence that the CVA
patients pain had
enhanced relief when
combined with
acupressure.

Outline patient safety issues

associated with this therapy
Adverse reactions: Allergic
reaction, headache, skin
irritation
Drug-drug interactions: N/A
Drug-food interactions: N/A
Outline potential
contraindications for the
therapy
Asthmatic, COPD, CVA
patients with multiple allergies

General Cost
of
Therapeutic

General Mechanisms of
Action
Massage therapy is the
technique of applying
compression to the
muscles and other soft
tissues to help heal and
comfort. It decreases
pain, relaxes muscles,

Specific Indication for

this patient population
Research studies have
shown that massage can
help decrease feelings of
depression and
emotional hopelessness
in CVA survivors.
Massage will help keep

Outline patient safety issues

associated with this therapy
Adverse reactions: allergic
reaction to massage oils,
injury, or pain
Drug-drug interactions: N/A
Drug-food interactions: N/A
Outline potential
contraindications for the

General Cost
of
Therapeutic

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[per dose and

monthly cost]

(Bagheri-Nesami,
Shorofi, Nikkhah,
Espahbodi, &
Koolaee, 2016)
(CreutzfeldtR et
al., 2012)

Essential oil:
$0.064 per
drop and
$0.19 per 3
drops

[per dose and

monthly cost]

Massage: $

(CreutzfeldtR et
al., 2012)
(Lamas, Hagar,
Lindgren, Wester,
& Brulin, 2016)

#15 Herbal Medicines

Route: Oral
Safe Dose: Herb
specific per
consultation
Daily Dose: Herb
specific per
consultation
Maintenance Dose:
N/A

and maximizes
perfusion.

blood pressure and heart

rate under control.

therapy
Patients that do not like to be
physically touched, financial
status

50-100/ hour
session

General Mechanisms of
Action
Herbal medicines can
help the CVA survivor
with relaxation,
depression, and promote
cerebral reperfusion.

Specific Indication for

this patient population
Chinese herbs help
promote the blood flow
to the brain and prevent
another CVA from
occurring. Chinese herbs
combined with other
holistic therapeutics can
help maximize recovery
and serve as a level of
prevention.

Outline patient safety issues

associated with this therapy
Adverse reactions: Allergic,
nausea, vomiting, diarrhea
Drug-drug interactions: N/A
Drug-food interactions: N/A
Outline potential
contraindications for the
therapy
Multiple herb-drug
contraindications, and further
research is needed on its
efficacy.

General Cost
of
Therapeutic

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

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[per dose and

monthly cost]

Herb
consultation:
$30-60 and
Herb cost:
$30-60/ month

(CreutzfeldtR et
al., 2012)
(Gardiner & Low
Dog, 2012)

Summary of application of holistic therapeutics to health of chosen population and expected optimal outcomes of care:
Alternative therapies, such as acupuncture, meditation, aromatherapy, massage, and Chinese herbs can support a CVA survivor patient achieve
optimal healing. Patients and caregivers, surrounding themselves with carefully formulated scents, rejuvenating massages, meditation, and
acupuncture could actually assist a CVA survivors recovery in conjunction with traditional stroke treatment and therapy. Alternative therapy provides
additional benefits and encouragements in patients recovery/rehabilitation from a CVA. As one recovers from a stroke, a life changing event, it is
considerable to explore the world of ancient and modern alternative treatments, if your physician deems it safe. Educating our patients about all the
options and treatments for a CVA survivor will hopefully decrease the reoccurrence of another CVA.

References
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American Stroke Association stroke target: Phase two. (2014). Retrieved from http://www.strokeassociation.org/idc/groups/heartpublic/@wcm/@gwtg/documents/downloadable/ucm_470730.pdf
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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