Question

C. Your last patient is a 33 years old who has been smoking for 15 years. She has come for her annual well women's examination. When you ask if she is interested in quitting smoking, she says she is ready to quit. She smokes approximately one pack of cigarettes per day. She wants to know how to use the nicotine gum to quit smoking She is otherwise healthy except for exercise-induced asthma. 1. What is the plan of care for Marina? 2. What education does this patient require? Be specific.

Answer 1

Ans) C. 1) Plan of care

• Ask your doctor about medications. Treatments that can lessen cravings include nicotine replacement skin patch, lozenges, gum, inhalers or nasal sprays. These treatments begin on your quit day. Other non-nicotine medication can help reduce nicotine withdrawal symptoms by mimicking how nicotine functions in your body. Treatment with these drugs, such as bupropion (Zyban) and varenicline (Chantix), should begin one to two weeks before your quit day.
• Find a support program.Individual, group or telephone counseling can provide you with needed support and help you develop coping skills. Your doctor may refer you to local resources or support groups. To reach the National Cancer Institute's telephone quit line, call 877-44U-QUIT (877-448-7848). To find your state's quit line, call 800-QUIT-NOW (800-784-8669).
• Identify online tools and apps.Online tools for creating and implementing a quit plan are available from the National Cancer Institute. These programs provide chat services, text messaging or apps for mobile devices to provide support and coping strategies. These and other mobile phone-based services appear to increase smoking cessation success.
• List your smoking triggers and habits. Make a list of your common triggers for smoking or your typical daily smoking habits. Do you smoke when you're stressed? Do you always smoke after a meal? Do you smoke during work breaks? Identifying patterns can help you determine when you will most likely need support or some kind of distraction.
• Tell people. Let family, friends and co-workers know about your quit day. Make them your allies. They can provide moral support. You can ask them to check in with you, help plan activities to get your mind off smoking and be patient with your changes in mood. Ask friends who smoke not to smoke around you or offer you a cigarette.
• Clean house. Rid your home, car, office and other places of your past smoking supplies, including cigarettes, lighters, matches and ashtrays. Wash coats and other clothing items that may have lingering smells of tobacco. Clean upholstered furniture or curtains.
• Stock up on substitutes. Have on hand items that you can substitute for the cigarette you're used to having in your mouth, such as sugarless gum, hard candy, straws, cinnamon sticks or carrot sticks. You can also find items to keep your hands busy, such as a squeeze ball. Keep these substitutes where you would normally leave your cigarettes or ashtray.
• Schedule a dental cleaning. Have your teeth cleaned to remove nicotine stains. The fresh start on your teeth may be a motivation not to smoke.
• Reflect. If you've tried to quit smoking before, but took it up again, think about what challenges you faced and why you started again. What worked and what didn't? Think about what you can do differently this time.

Handling quit day

Getting through your quit day can be emotionally and physically challenging, especially if strong tobacco cravings strike. Try these tips to help manage your quit day:

• Don't smoke, not even "just one."
• Use nicotine replacement therapy if you've chosen that method.
• If you are having strong cravings and withdrawal despite using medication, talk to your doctor about adjusting the medication plan to better control these symptoms.
• Remind self the reasons to stop smoking.
• Drink plenty of water or juice.
• Keep physically active.
• Avoid situations and people that trigger your urge to smoke.
• Attend a support group, counseling session or stop-smoking class.
• Practice stress management and relaxation techniques.
• Keep hands busy with your cigarette substitutes or an activity, such as writing or knitting.
• Keep your mind distracted when necessary with a book or crossword puzzle.

2) Patient education:

1. Try nicotine replacement therapy
2. Avoid triggers
3. Delay
4. Chew on it
5. Don't have 'just one
6. Get physical
7. Practice relaxation techniques
8. Call for reinforcements