Cigarette smoking is globally recognized as a primary preventable cause of mortality and morbidity, impacting nearly every organ system in the body, leading to numerous diseases, and diminishing overall well-being. The detrimental health effects of smoking are extensive and well-documented.
Smoking is linked to a wide array of adverse health outcomes, including:
- Periodontal Disease: Smoking significantly increases the risk of gum disease and tooth loss.
- Vision Impairment: Conditions such as macular degeneration and cataracts are more prevalent in smokers.
- Cancer Development: Smoking is a leading risk factor for various cancers, particularly lung, throat, bladder, and kidney cancer.
- Chronic Cough: Persistent coughing is a common symptom among smokers, often indicative of underlying respiratory issues.
- Chronic Obstructive Pulmonary Disease (COPD): Emphysema and chronic bronchitis, the main components of COPD, are overwhelmingly linked to smoking.
- Cardiovascular Disease: Smoking elevates the risk of heart disease, hypertension, and peripheral artery disease.
- Angina Pectoris: Chest pain due to reduced blood flow to the heart is exacerbated by smoking.
- Stroke: Smoking increases the likelihood of stroke and other cerebrovascular events.
- Infertility: Both male and female fertility are negatively impacted by smoking.
- Pregnancy Complications: Smoking during pregnancy is associated with premature birth, low birth weight, and other complications.
- Erectile Dysfunction: Smoking is a significant contributor to erectile dysfunction in men.
- Compromised Immune System: Smoking weakens the immune system, making individuals more susceptible to infections.
- Blood Clots: Smokers have an increased risk of developing dangerous blood clots.
- Premature Skin Aging: Smoking accelerates skin aging, leading to wrinkles and a dull complexion.
The primary component of cigarettes, tobacco, harbors a multitude of toxic substances, notably carbon monoxide, nicotine, and tar. Carbon monoxide, when inhaled in substantial quantities, is lethal as it diminishes oxygen levels in the blood, causing organ dysfunction. Nicotine, a highly addictive substance in cigarettes, creates temporary mood and behavioral enhancements, driving dependence. Tar, a viscous brown residue, inflicts damage on the lungs and impairs respiratory function.
The Nursing Process and Smoking Cessation
Smoking cessation presents a considerable challenge for many individuals. Nurses are pivotal in delivering counseling and education on pharmacological and behavioral interventions, which are proven effective in aiding smoking cessation.
Nicotine replacement therapy (NRT) products, available in various forms such as patches, gums, lozenges, and sprays, deliver controlled doses of nicotine to alleviate cravings and withdrawal symptoms. Concurrently, behavioral therapies and support systems are crucial in equipping smokers with coping mechanisms and strategies to permanently quit smoking.
Nursing care plans, initiated upon identifying relevant nursing diagnoses associated with smoking, are instrumental in prioritizing assessments and interventions to achieve both immediate and long-term patient care objectives. The subsequent sections will detail nursing care plan examples pertinent to smoking-related issues.
Ineffective Breathing Pattern: Nursing Diagnosis
Cigarette smoking is directly implicated in acute respiratory changes, manifesting as coughing, airway irritation, and reduced airflow resistance. It is a primary etiological factor in chronic respiratory conditions like COPD, chronic bronchitis, and emphysema.
Prolonged exposure to cigarette smoke toxins leads to the degradation of the alveoli, causing them to lose elasticity and efficiency. This alveolar damage impairs the lungs’ ability to effectively exchange oxygen and carbon dioxide, resulting in breathing difficulties.
Nursing Diagnosis: Ineffective Breathing Pattern
Link to Ineffective Breathing Pattern Nursing Diagnosis Care Plan
Related Factors:
- Smoking
- Impaired Gas Exchange
- Complications of Cigarette Smoking
As Evidenced By:
- Decreased Expiratory Pressure
- Decreased Inspiratory Pressure
- Hypoxemia (low blood oxygen levels)
- Hypoxia (oxygen deficiency in tissues)
- Coughing
- Nasal Flaring
- Tachypnea (rapid breathing)
- Bradypnea (slow breathing)
- Hyperventilation (rapid and deep breathing)
- Hypoventilation (slow and shallow breathing)
Expected Outcomes:
- The patient will demonstrate comfortable breathing with respiratory rate and rhythm within normal parameters.
- The patient will not develop preventable smoking-related lung diseases.
Nursing Assessment:
- Assess breathing pattern, rate, and Oxygen saturation (SpO2). Variations in breathing rate, rhythm, and SpO2 levels can indicate respiratory compromise and the potential development of chronic lung diseases.
- Auscultate breath sounds. Adventitious breath sounds such as wheezes and crackles may signify compromised pulmonary function, infections, or established lung damage.
Nursing Interventions:
- Promote optimal oxygenation. Supplemental oxygen therapy can effectively address hypoxemia in smokers experiencing respiratory complications. Continuous oxygen administration may be necessary for patients with advanced COPD or emphysema. Emphasize the critical importance of abstaining from smoking while using or being in proximity to oxygen.
- Facilitate the use of bronchodilators. Inhaled bronchodilators, including corticosteroids, are frequently prescribed to dilate airways and reduce inflammation, improving airflow.
- Encourage and support smoking cessation. Provide ongoing patient education regarding the detrimental effects of smoking on respiratory health and overall well-being. Assess the patient’s readiness to quit smoking and offer appropriate resources and referrals.
- Promote controlled coughing and deep breathing exercises. Cigarette smoke toxins can lead to mucus accumulation in the airways. Controlled coughing and deep breathing techniques facilitate lung expansion and the expectoration of mucus, improving airway clearance.
Ineffective Health Maintenance Behaviors: Nursing Diagnosis
Individuals who smoke often exhibit ineffective health maintenance behaviors, demonstrating a failure to adequately maintain their physical, psychological, spiritual, or emotional well-being. Denial regarding the harmful consequences of their smoking habit is frequently observed.
Nursing Diagnosis: Ineffective Health Maintenance
Link to Ineffective Health Maintenance Nursing Diagnosis Care Plan
Related Factors:
- Competing Demands
- Competing Lifestyle Preferences
- Conflict Between Cultural Beliefs and Health Practices
- Depressive Symptoms
- Difficulty Accessing Community Resources
- Difficulty with Decision-Making
- Inability to Seek or Request Health Information
As Evidenced By:
- Failure to Take Action that Reduces Risks
- Failure to Take Action that Prevents Health Problems
- Inadequate Health Literacy
- Inadequate Commitment to a Plan of Action
- Inadequate Knowledge of Basic Health Practices
- Inadequate Interest in Improving Health
- Pattern of Lack of Health-Seeking Behavior
- Poor Personal Support System
Expected Outcomes:
- The patient will articulate perceived obstacles in adhering to a health regimen and complying with an agreed-upon health maintenance plan.
- The patient will commit to and actively participate in a smoking cessation plan of action.
Nursing Assessment:
- Assess the patient’s feelings and rationale for non-adherence to health maintenance recommendations. Emotional factors significantly influence health behaviors and compliance. Evaluate for underlying issues such as grief, depression, or spiritual distress that may impede health maintenance.
- Determine economic, psychological, emotional, spiritual, and cultural factors impacting adherence to treatment. Patients who smoke may hold beliefs or values that conflict with or challenge their adherence to health maintenance regimens, necessitating culturally sensitive assessment and intervention.
Nursing Interventions:
- Engage the patient in collaboratively developing a suitable smoking cessation plan. Shared decision-making enhances patient ownership and increases the likelihood of adherence to the agreed-upon treatment plan.
- Assist the patient in selecting a quit date. Establishing a quit date is a crucial initial step in the cessation process, providing a tangible goal to work towards. The date should be neither too distant nor too immediate, allowing adequate preparation.
- Explore pharmacological interventions. Discuss and offer information on nicotine replacement therapy options, including gums, lozenges, patches, and sprays, to manage withdrawal symptoms and reduce nicotine cravings effectively.
- Educate on trigger avoidance and reinforcement of benefits. Managing cravings is a significant challenge in smoking cessation. Guide patients to identify and avoid personal triggers, such as specific situations or environments. Encourage them to regularly reinforce their motivations for quitting, such as improved health, financial savings, or personal goals.
Risk-Prone Health Behavior: Nursing Diagnosis
Individuals with nicotine addiction often struggle to modify their lifestyles and unhealthy behaviors, even when aware of the health risks associated with smoking.
Nursing Diagnosis: Risk-Prone Health Behavior
Related Factors:
- Unhealthy Lifestyle
- Addictive Behavior
- Inadequate Understanding of Health Information
- Inadequate Social Support
- Low Socioeconomic Status
- Low Self-Efficacy
- Social Anxiety
- Stressors
As Evidenced By:
- Failure to Achieve an Optimal Sense of Control
- Failure to Take Action that Prevents Health Problems
- Minimizes Perceived Health Status Change
- Continuing to Smoke Despite Health Effects
- Substance Misuse
Expected Outcomes:
- The patient will express acceptance of health status changes and the necessity of smoking cessation.
- The patient will verbalize two effective strategies for quitting smoking.
Nursing Assessment:
- Assess the patient’s perception of health and wellness. Individual perceptions of well-being and illness are unique. Avoid imposing personal beliefs or judgments; patient motivation is paramount for successful behavior change.
- Identify major barriers to health and wellness. Cultural and social beliefs, alongside current mental and emotional states, can significantly impede the adoption of healthy lifestyle modifications. Assess these factors to tailor interventions effectively.
Nursing Interventions:
- Discuss current health goals with the patient. Smoking addiction requires a clear goal for change. Facilitate goal setting to initiate and sustain the cessation process.
- Help the patient recognize external influences. If family members or peers smoke, quitting becomes more challenging. Help patients identify and potentially limit exposure to smoking influences to enhance cessation success.
- Explore previous quit attempts. Discuss past cessation attempts to understand what strategies were employed, their effectiveness, and identify potential areas for improvement and resource utilization.
- Refer the patient to support programs. Recommend and facilitate enrollment in tobacco quit programs, which often provide valuable counseling, resources, and pharmacological support to aid smoking cessation.
References
- 10 Health Effects Caused by Smoking You Didn’t Know About. American Lung Association. Updated: January 26, 2022. From https://www.lung.org/research/sotc/by-the-numbers/10-health-effects-caused-by-smoking
- ACCN Essentials of Critical Care Nursing. 3rd Edition. Suzanne M. Burns, MSN, RRT, ACNP, CCRN, FAAN, FCCM, FAANP. 2014. McGraw Hill Education.
- Cigarette smoking and the adrenergic nervous system. Grassi G, Seravalle G, Calhoun DA, Bolla G, Mancia G. Clin Exp Hypertens A. 1992;14(1-2):251-60. doi: 10.3109/10641969209036186. PMID: 1541039. From: https://pubmed.ncbi.nlm.nih.gov/1541039/
- Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care. 9th Edition. Donna D. Ignatavicius, MS, RN, CNE, ANEF. 2018. Elsevier, Inc.
- Smoking. Cleveland Clinic. Reviewed: October 28, 2020. From: https://my.clevelandclinic.org/health/articles/17488-smoking
- What are the health risks of smoking? NHS. Reviewed: October 9, 2018. From: https://www.nhs.uk/common-health-questions/lifestyle/what-are-the-health-risks-of-smoking/
