1. The client/caregiver can describe physical changes caused by tobacco.
   1. Tobacco products include cigarettes, cigars, pipe tobacco, and chewing tobacco.
   2. All tobacco products contain tar, carbon monoxide, and nicotine.
   3. Tar in tobacco increases the risk of lung cancer, emphysema, and other bronchial problems.
   4. The carbon monoxide in tobacco smoke increases the chance of cardiovascular diseases. The Environmental Protection Agency has done studies that indicate second-hand smoke can cause lung cancer in adults and greatly increases the risk of respiratory illnesses in children and sudden infant death.
   5. Nicotine is the drug in tobacco that causes addiction. Nicotine restricts blood vessels, causing increased blood pressure and circulatory problems. Nicotine can reach the brain within 8 seconds after inhalation.
   6. The Centers for Disease Control and Prevention states this:
      1. The use of tobacco products is the leading preventable cause of death in the United States.
      2. More than $75 billion dollars have been used for direct medical costs related to smoking in 1 year.
2. The client/caregiver can list the ill effects of tobacco abuse.
   1. Coughing, shortness of breath, bad breath, and stained teeth
   2. Financial problems (heavy smokers can spend $1,000 per year on cigarettes).
   3. Addiction
   4. Disease
      1. Cancer (all tobacco contains tar, a cancer-causing substance)
      2. Vascular diseases (nicotine causes blood vessels to constrict)
      3. Heart disease
      4. Stroke
      5. A constant oxygen deficiency in the body
      6. Chronic bronchitis
      7. Gum disease
      8. Stomach ulcers
   5. Women who smoke increase the risk of
      • Earlier menopause
      • Stillborn or premature infants
      • Having low birth weight infants
   6. Nutritional problems. Smokers use vitamin C twice as fast as nonsmokers. Vitamin C is one of the useful antioxidants.
3. The client/caregiver can list signs and symptoms of withdrawal.
   1. Anxiety
   2. Nervousness and possibly anger
   3. A loss of concentration
   4. Headaches
   5. An intense craving for nicotine
   6. A rise in blood pressure
   7. Stomach pain
4. The client/caregiver can list methods to stop smoking.
   1. Counseling or behavioral training. Do not exchange one addiction for another, such as eating.
   2. Nicotine-replacement products
      • Gum
      • Inhaler
      • Patch
   3. Nonnicotine medications as prescribed by a physician
   4. Realistic goals because repeated attempts to stop smoking may be needed.
   5. Many community programs assist in smoking cessation. They offer group and personal support.
   6. Keep busy. Find new things to do. Avoid situations or activities that can tempt you to smoke.
   7. The Centers for Disease Control and Prevention has an online program (www.smokefree.gov) to help. It has a five-step plan to use when you decide to quit smoking.
      • S = Set a quit date.
      • T = Tell family, friends, and co-workers that you plan to quit.
      • A = Anticipate and plan for the challenges you will face while quitting.
      • R = Remove cigarettes and other tobacco products from your home, car, and work.
      • T = Talk to your doctor about getting help to quit.
   8. Explore complementary treatments such as
      • Acupuncture or acupressure
      • Hypnosis, meditation, or guided imagery
      • Aromatherapy
5. The client/caregiver can list methods to avoid weight gain.
   1. Eat low-calorie foods, including plenty of fresh fruits and vegetables.
   2. Increase exercise. Take a walk. Seek activities that interest you, such as gardening.

Resources

Health care professionals

American Cancer Society
www.cancer.org

American Lung Association
www.lungusa.org

American Heart Association
www.americanheart.org

Government Internet sites
www.surgeongeneral.gov/tobacco
www.cdc.gov/tobacco/how2quit.htm
www.smokefree.gov
wsw.nlm.nih.gov/medlineplus/smokingcessation

References

Ackley, B. J., & Ladwig, G. B. (2006). Nursing diagnosis handbook: A guide to planning care. St. Louis: Mosby Elsevier.
Canobbio, M. M. (2006). Mosby’s handbook of patient teaching . St. Louis: Mosby Inc.
Hitchcock, J. E., Schubert, P. E., & Thomas, S. A. (2003). Community health nursing: Caring in action. Clifton Park, NY: Thomson Delmar Learning.
Hunt, R. (2005). Introduction to community based nursing. Philadelphia: Lippincott Williams & Wilkins.
Varcarolis, E. M. (2006). Manual of psychiatric nursing care plans. St. Louis: Saunders Elsevier.
You can quit smoking. (2007). Available from: www.cdc.gov/tobacco/quit_smoking/you_can_quit/index.htm. Washington, DC: Centers for Disease Control and Prevention.