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Smoking and Withdrawal:

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Title: Smoking and Withdrawal:


1
Smoking and Withdrawal
  • How to be your patients advocate
  • Megan M. Martin
  • DeSales University

2
Nicotine
  • Used as an insecticide and plant spray when in
    liquid form
  • Considered a very poisonous alkaloid colorless,
    oily liquid in its pure state
  • Amount used in cigarettes is not enough to cause
    (immediate, direct) death.
  • Nicotine in tobacco can cause indigestion,
    increase blood pressure, and dull appetite.

3
Action of Nicotine
  • Nicotine is absorbed through the skin, GI tract,
    and respiratory mucous membrane
  • Action of drug is dose-related
  • Temporarily stimulates both sympathetic and
    parasympathetic ganglia also stimulates skeletal
    muscle
  • Following stimulant phase, nicotine causes a
    depressant phase relaxes skeletal muscle

4
Nicotine in cigarettes A powerful addiction
  • Cigarettes are the primary vector of nicotine
    ingestion.
  • Others are chew, cigars, and pipe smoking
  • Cigarettes become addicting after approximately
    two weeks of smoking ten cigarettes per day
  • Initial rush of nicotine initiates a temporary
    feeling of well-being by increasing activity of
    dopamine in the brain
  • Considered as addictive as heroine same action

5
Addiction
  • The DSM-IV criteria for substance dependence are
    shown below
  • Maladaptive pattern of substance use leading to
    clinically significant impairment or distress,
    manifested by three or more of the following
    within a 12-month period
  • Presence of tolerance to the drug presence of
    withdrawal symptom
  • Substance taken in larger amounts/longer period
    of time than intended
  • Unsuccessful or persistent desire to cut down or
    control use
  • Varcarolis, 1998

6
Withdrawal
  • Occurs after a period of continued use
  • Stopping or reducing use results in specific
    physical and psychological signs and symptoms
  • Occurs approximately four hours after last
    cigarette, peaks in 3-5 days, lasts at least two
    weeks

7
Physical and Mental Side Effects of Nicotine
Withdrawal
  • PHYSICAL
  • Tingling in hands and feet
  • Sweating
  • Intestinal disorders, primarily constipation
    and/or upset stomach
  • Headache
  • S/S of colds and respiratory problems initially
  • Weight gain
  • MENTAL
  • Insomnia
  • Mental confusion
  • Vagueness
  • Irritability
  • Tension, perceived unbearable
  • Depression, mimics grief
  • Anxiety

8
First two weeks of withdrawal
  • Critical in determining failure rate
  • If smoker cheats in this period, highly likely to
    return to habit within six months
  • After five days, the smoker is undergoing the
    most severe physical effects of withdrawal
  • Emotional effects are carried for approximately
    1-3 months after quitting

9
Success Rates of Quitting
  • 47 million people in U.S. smoke 28 of males,
    23 of females
  • 3,000 young people start smoking every day
  • Although about 25 of adults smoke, 70 of them
    want to quit
  • 1/3 will try seriously to quit
  • Only 6 will be successful within one year
  • Those who continue to try have 50 success rate

10
Reasons smokers relapse fail to quit permanently
  • Depression Cigarettes relieve minor depression,
    fits of anger, enhance sense of well being,
    enhance concentration
  • Physical effects over long-term seem abstract
    wont happen to me Ill quit
  • Weight gain quitting smoking/withdrawal causes
    bodys basal metabolic rate to drop for 3-6
    months before return to normal.
  • Average weight gain 10-25 lbs.

11
Nursings relation to the smoking patient
  • Patients are ill to begin with withdrawal
    symptoms can exacerbate their sense of illness
  • Be your patients advocate!! If you know youre
    patient is a smoker, call the physician
  • Request some form of nicotine replacement unless
    contraindicated
  • Request an oral replacement/antidepressant, e.g.
    Zyban

12
Nicotine Replacements
  • Nicotine Patch Available in several dosages
    21mg-7mg Dosages should gradually be decreased
    over min. of 6 wks.
  • Absorbed transdermally
  • Should be worn 24hrs/day
  • Adverse SE pruritus/erythema under patch,
    nausea, dizziness, myalgias, coughing, difficulty
    sleeping, nightmares
  • Recommend that patient change sites daily

13
Nicotine Gum
  • Absorbed through buccal mucosa
  • Dosage 2mg, repeated prn up to 30 pieces of
    gum/day.
  • Gum not chewed, rather bitten into and held in
    the cheek
  • Adverse SE injury to mouth, teeth, dental work.
    Rare irregular heartbeat
  • Largest complaint Gum has peppery taste

14
Nicotine Nasal Spray
  • Administers 1 mg/2 sprays to the nasal membrane
  • Faster onset of action than patch or gum
  • Should be used for at least three months, no
    longer than six months
  • Adverse SE belching, tachycardia, mild H/A,
    increased appetite, increased watering of mouth,
    sore mouth or throat

15
Nursing Considerations
  • Instruct client to take exactly as directed
  • Instruct the client of the importance of NOT
    smoking at all while using nicotine replacement
    therapy could lead to nicotine toxicity
  • Give client information of smoking cessation
    support groups relative to their area
  • Instruct family if possible of patient needs and
    support

16
Nursing Diagnoses
  • Anxiety-Nurses teach deep breathing
  • Self-esteem disturbance-Nurses teach coping
    mechanisms
  • Noncompliance-Nurses support patient throughout
    withdrawal process
  • Sleep-pattern disturbance (r/t withdrawal and
    Zyban/ nicotine replacement)-Nurses teach it is
    temporary effect recommend decrease in caffeine,
    increase in exercise
  • Constipation-Nurses teach patient about better
    diet, high in fiber, increase in exercise will
    decrease occurrence

17
Oral agents Zyban
  • Zyban, also Wellbutrin (bupropion HCl) is an oral
    agent used to curb the most severe side effects
    of nicotine withdrawal
  • Only available through prescription
  • Actually an antidepressant, Zyban acts as a weak
    serotonin reuptake inhibitor, also acts on
    dopamine and norepinephrine centers of the brain

18
Zyban...
  • When used on people not previously depressed, has
    no effect on mood
  • Instruct patient that its primary function is to
    prevent depression, not an upper
  • Dosages for smoking cessation differ from dosage
    used for depressive disorders
  • Patient usually starts with 150 mg QD X 3days,
    then 150 mg BID X 7-12 wks.

19
Zyban...
  • Contraindicated in patients with seizure
    disorders, MAOIs, eating disorders
  • Adverse SE Weight loss/weight gain, agitation,
    dry mouth, blurred vision, headache, dizziness,
    tremor, nausea, vomiting, constipation, insomnia,
    vivid dreams
  • SEIZURES with overdose (450mg/day)

20
Zyban...
  • Instruct patient that the full antidepressant
    effect of drug may not be realized for up to 4
    wks
  • Patient is to pick a target date for cessation,
    stick to it.
  • Patient may continue smoking while taking Zyban
    for up to two weeks
  • It is recommended that the patient consider
    nicotine replacement in conjunction

21
Nursing Teaching Points...
  • It is important that the patient be READY to
    quit, otherwise will be unsuccessful
  • NEVER push a patient to quit. This will only hurt
    your relationship with that patient.
  • Respect the patients wishes. Only instruct about
    the effects of smoking, the values of quitting.
    Be a support system to your patient.
  • Remember the effects of Nicotine withdrawal. Be
    empathetic with the patients needs. Be an
    advocate!

22
Stage-of-Readiness Model for Smoking Cessation
23
Physical Response to Quitting
24
Nursing Teaching Diet
  • Encourage your patient to increase the amount of
    fruits, vegetables, whole grains, and fiber-rich
    foods.
  • Encourage the patient to drink large amounts of
    water
  • Teach the patient about oral cravings encourage
    healthy snacks such as carrots, apples, celery.
    Also recommend sugar-free gum.

25
Exercise
  • Quitting may be harder for women than men due to
    body image perceptions
  • Encourage patient to increase levels of activity
    recommend taking walks during times of craving
  • Remind patient that if weight is gained, it will
    most likely come off in time
  • Teach deep breathing exercises. This helps to
    mimic feeling of smoking induces relaxation

26
Conclusion
  • Smoking is a common addiction
  • Nurses must be aware of the effects of nicotine
    both physically and mentally on their patients
  • Nurses MUST be patient advocates.
  • Encourage patient to quit
  • Never push
  • Speak to the physician about possibility of
    smoking cessation aide
  • Continue to have a positive, supportive
    relationship with patient. Nothing helps more
    than understanding

27
References
  • Guthrie, C. (2001). Kick butts now! Online.
    Available http//my.webmd.com/content/article/168
    9.50430
  • Ignatavicius, D.D., Workman, M.L., Mischler,
    M.A. (1999). Medical-Surgical nursing across the
    health care continuum (3rd ed.). Philadelphia
    W.B. Saunders Company.
  • McKenry, L.M. Salerno, E. (1998). Pharmacology
    in nursing. (20th ed.). St. Louis Mosby.
  • Miller, B.F Keane, C.B. (1997). Encyclopedia
    dictionary of medicine, nursing, and allied
    health. (6th ed.). Philadelphia W.B. Saunders
    Company.

28
References (cont)
  • Varcarolis, E.M. (1998). Foundations of
    psychiatric mental health nursing. (3rd Ed).
    Philadelphia W.B. Saunders Company
  • WebMDHealth. (2001). Smoking. Online. Available
    http//my.webmd.com/content/article/1680.51953.
  • Wilson, B.A., Shannon, M.T. Stang, C.L. (2001).
    Nursing drug guide 2001. New Jersey
    Prentice-Hall, Inc.
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