NSG 6001nsg 6001 week 2.
Smoking cessation ch 33
• Tobacco use is the leading preventable cause of disease, disability, and death in
the United States, particularly from cardiovascular disease, cancer, and lung
disease.
• nicotine affects the transmission of nervous system signals by
mimicking acetylcholine. It occupies receptor sites at the synapses and
prevents the transmission of nerve impulses from neuron to neuron
and from neuron to muscle cells.
• About 25% of the nicotine is immediately carried to the brain, where it
easily crosses the blood–brain barrier and affects normal brain
biochemistry.
Cardiovascular Effects
• Increased myocardial oxygen consumption
• Increased heart rate
• Increased systemic vascular resistance
• Decreased myocardial inotropic activity
• Decreased myocardial oxygen supply
• Increased carboxyhemoglobin (reduced available hemoglobin)
• Coronary artery vasospasm
• Oxyhemoglobin dissociation curve shifted to the left
• Respiratory
Bronchospas
m
• Cough
• Sputum accumulation
• Decreased circulating immunoglobulin levels
• Decreased neutrophil chemotaxis
• Decreased pulmonary macrophage count and adherence
• Altered T-lymphocyte immunoregulatory activity
• Decreased natural killer lymphocyte activity
• Decreased function of alpha1-antitrypsin
• Chronic effects of nicotine use include the development of tolerance and
chemical dependence.
• Nicotine withdrawal symptoms include a dysphoric or depressed mood, insomnia,
irritability, frustration, anger, anxiety, poor concentration, restlessness,
decreased heart rate, and increased appetite.
• Women who smoke are at increased risk for early menopause,
decreased bone density, and osteoporosis.
• The patient may also have lumps in the jaw or neck area, color change in lumps
inside the lips, or white, smooth or scaly patches in the mouth or throat or on the
lips or tongue.
• A productive cough, dyspnea, wheezing, and fatigue should alert the clinician to
respiratory problems related to smoking.
• Frequent bouts of pneumonia, influenza, and bronchitis, as well as chronic
diseases such as emphysema, interstitial lung disease, or chronic airway
obstruction,
, NSG 6001nsg 6001 week 2.
• Cardiovascular signs of smoking including tachycardia, cardiac dysrhythmias,
increased blood pressure, decreased peripheral blood flow, and angina
• 48 to 72 hours later, and return to baseline within 3 to 4 weeks of quitting.
Criteria for nicotine dependence disorder are published in the Diagnostic and
Statistical Manual of Mental Disorders. They include dysphoric or depressed
mood, insomnia, irritability or anger, frustration, anxiety, concentration
difficulties, decreased heart rate, and increased appetite or weight gain.
• moking-related biochemical compounds such as thiocyanate, cotinine, nicotine,
and COHb in urine, blood, breath, or saliva can be performed to verify smokers’
reports of smoking status or abstinence
• To measure CO, the patient is instructed to inhale deeply and to hold his or her
breath for 10 to 15 seconds before expiring with full force through the inflow
valve of the monitor
• for every patient at every clinic visit, tobacco-use status is queried and
documented.
• cause of a smoker’s cough and dyspnea must be explored to rule out other
explanatory causes, such as lung cancer, interstitial lung disease, allergies, and
infections.
• Smokers tend to have unique laboratory findings, such as increases in HCT, total
white blood cell count, and platelet count
• the five A’s: Ask, Advise, Assess, Assist, and Arrange. A treatment flowchart for
smoking cessation
• five stages of behavioral change in their attempts at cessation (1)
precontemplation, (2) contemplation, (3) preparation, (4) action, and
(5)
maintenance.
• Smokers in the precontemplation stage have no desire to quit in the next 6 to 12
months. These individuals usually benefit from motivational interventions
• Smokers who seriously thinking about and express interest in quitting but are not
yet ready to do so are in the contemplation stage. These smokers also benefit
from motivational counseling emphasizing the negative effects of smoking.
• Smokers who are serious about quitting and have taken the initial steps toward
cessation are in the preparation stage. Individuals in this stage benefit from
interventions that assist them in quitting.
• the action stage, the smoker quits smoking. The action stage lasts from several
weeks to 6 months after cessation,
• smoker has abstained from cigarettes for 6 months, the maintenance stage
begins. Most successful quitters relapse and recycle through these stages three
or four times before attaining long-term abstinence;
• Such strategies include deep breathing and relaxation exercises, chewing gum,
exercise, drinking water, sucking on a piece of sugarless candy, and eating
carrots or celery sticks.
• hypnosis in smoking cessation is to enable the smoker to achieve an altered
state of consciousness that enhances the ability to quit
• Aversion conditioning is based on the premise that smoking is a learned
response that can be extinguished by creation of an association between
smoking and a
negative sensation. electric shock, nausea-inducing drugs, hot and smoky air
treatments, and rapid smoking.
• DRUG DOSAGE ADVANTAGES DISADVANTAGES
• Transdermal Patch Continuous Delivery Expensive NicoDerm CQ (worn 24
h/day) 21 mg/day for 4–6 weeks, then 14 mg/day for 2–4 weeks, then 7
mg/day for 2–4
weeks Consider starting with 14-mg patch if smoking less than 10 cigarettes/day
Smoking cessation ch 33
• Tobacco use is the leading preventable cause of disease, disability, and death in
the United States, particularly from cardiovascular disease, cancer, and lung
disease.
• nicotine affects the transmission of nervous system signals by
mimicking acetylcholine. It occupies receptor sites at the synapses and
prevents the transmission of nerve impulses from neuron to neuron
and from neuron to muscle cells.
• About 25% of the nicotine is immediately carried to the brain, where it
easily crosses the blood–brain barrier and affects normal brain
biochemistry.
Cardiovascular Effects
• Increased myocardial oxygen consumption
• Increased heart rate
• Increased systemic vascular resistance
• Decreased myocardial inotropic activity
• Decreased myocardial oxygen supply
• Increased carboxyhemoglobin (reduced available hemoglobin)
• Coronary artery vasospasm
• Oxyhemoglobin dissociation curve shifted to the left
• Respiratory
Bronchospas
m
• Cough
• Sputum accumulation
• Decreased circulating immunoglobulin levels
• Decreased neutrophil chemotaxis
• Decreased pulmonary macrophage count and adherence
• Altered T-lymphocyte immunoregulatory activity
• Decreased natural killer lymphocyte activity
• Decreased function of alpha1-antitrypsin
• Chronic effects of nicotine use include the development of tolerance and
chemical dependence.
• Nicotine withdrawal symptoms include a dysphoric or depressed mood, insomnia,
irritability, frustration, anger, anxiety, poor concentration, restlessness,
decreased heart rate, and increased appetite.
• Women who smoke are at increased risk for early menopause,
decreased bone density, and osteoporosis.
• The patient may also have lumps in the jaw or neck area, color change in lumps
inside the lips, or white, smooth or scaly patches in the mouth or throat or on the
lips or tongue.
• A productive cough, dyspnea, wheezing, and fatigue should alert the clinician to
respiratory problems related to smoking.
• Frequent bouts of pneumonia, influenza, and bronchitis, as well as chronic
diseases such as emphysema, interstitial lung disease, or chronic airway
obstruction,
, NSG 6001nsg 6001 week 2.
• Cardiovascular signs of smoking including tachycardia, cardiac dysrhythmias,
increased blood pressure, decreased peripheral blood flow, and angina
• 48 to 72 hours later, and return to baseline within 3 to 4 weeks of quitting.
Criteria for nicotine dependence disorder are published in the Diagnostic and
Statistical Manual of Mental Disorders. They include dysphoric or depressed
mood, insomnia, irritability or anger, frustration, anxiety, concentration
difficulties, decreased heart rate, and increased appetite or weight gain.
• moking-related biochemical compounds such as thiocyanate, cotinine, nicotine,
and COHb in urine, blood, breath, or saliva can be performed to verify smokers’
reports of smoking status or abstinence
• To measure CO, the patient is instructed to inhale deeply and to hold his or her
breath for 10 to 15 seconds before expiring with full force through the inflow
valve of the monitor
• for every patient at every clinic visit, tobacco-use status is queried and
documented.
• cause of a smoker’s cough and dyspnea must be explored to rule out other
explanatory causes, such as lung cancer, interstitial lung disease, allergies, and
infections.
• Smokers tend to have unique laboratory findings, such as increases in HCT, total
white blood cell count, and platelet count
• the five A’s: Ask, Advise, Assess, Assist, and Arrange. A treatment flowchart for
smoking cessation
• five stages of behavioral change in their attempts at cessation (1)
precontemplation, (2) contemplation, (3) preparation, (4) action, and
(5)
maintenance.
• Smokers in the precontemplation stage have no desire to quit in the next 6 to 12
months. These individuals usually benefit from motivational interventions
• Smokers who seriously thinking about and express interest in quitting but are not
yet ready to do so are in the contemplation stage. These smokers also benefit
from motivational counseling emphasizing the negative effects of smoking.
• Smokers who are serious about quitting and have taken the initial steps toward
cessation are in the preparation stage. Individuals in this stage benefit from
interventions that assist them in quitting.
• the action stage, the smoker quits smoking. The action stage lasts from several
weeks to 6 months after cessation,
• smoker has abstained from cigarettes for 6 months, the maintenance stage
begins. Most successful quitters relapse and recycle through these stages three
or four times before attaining long-term abstinence;
• Such strategies include deep breathing and relaxation exercises, chewing gum,
exercise, drinking water, sucking on a piece of sugarless candy, and eating
carrots or celery sticks.
• hypnosis in smoking cessation is to enable the smoker to achieve an altered
state of consciousness that enhances the ability to quit
• Aversion conditioning is based on the premise that smoking is a learned
response that can be extinguished by creation of an association between
smoking and a
negative sensation. electric shock, nausea-inducing drugs, hot and smoky air
treatments, and rapid smoking.
• DRUG DOSAGE ADVANTAGES DISADVANTAGES
• Transdermal Patch Continuous Delivery Expensive NicoDerm CQ (worn 24
h/day) 21 mg/day for 4–6 weeks, then 14 mg/day for 2–4 weeks, then 7
mg/day for 2–4
weeks Consider starting with 14-mg patch if smoking less than 10 cigarettes/day
