Case Presentation #2

Mr. C is a 65-year-old male presenting to the Emergency Department with chest pain. His past medical history includes controlled hypertension and Type II diabetes. He started smoking at age 18 and smokes one pack per day. He noticed recently that his legs ache when he walks any distance, and he gets short of breath walking up stairs. His mother and father both smoked until their seventies, and he never worried about how smoking might affect him. He has never had any quit attempts, and is unsure if he can quit now. His wife also smokes one pack per day. What should be suggested?

What are Mr. C's risk factors?

Hypertension, smoker, Type II diabetes, dyspnea and intermittent claudication are his risk factors.

As the nurse in the Emergency Department, what actions should be considered?

What strategies can be implemented to assist him with nicotine withdrawal while hospitalized? What smoking cessation techniques may be helpful to him?

Nicotine replacement therapy is contraindicated in this patient because of chest pain, and should not be initiated until a myocardial infarction has been ruled out. Buproprion HCL may be started, but realize that it takes approximately eight days to raise blood levels sufficiently to reduce/prevent craving.

Ask: Pattern of tobacco use, triggers, support systems, readiness to make changes.

Advise: Address his fear of lifestyle changes in the plan, including his wife in this process, encouraging her that quitting is also important for her, Provide problem solving/skills training to enhance his coping with stress. Emphasize that quitting at any age has positive benefits. Provide motivational information related to his current health status, and self-help literature.

Assist: Teach problem solving/skills training to enhance his coping with stress. Provide specific information related to diagnostic tests that may be ordered (e.g., an exercise stress test).

Arrange: Refer both patient and wife for group support. Follow-up telephone support. Reinforce his short term successes.