Peripheral Vascular Dilemma

Here are the discussion topics I mentioned in my e-mail, they are others response to the topic on Peripheral Vascular Dilemma. I need you to respond to numbers 1, 2, 3, & 4 as to whether you agree or disagree to what they are saying and if you agree or disagree state why. Please number your response according to the numbering below: 1) As the RN working with Mrs.Jefferson first of all I would let her know that smoking is very bad for her health and everyone elses.I would make sure she is well educated on the risks if she continues to smoke and how much higher the risk are after a MI.I would give her several options that are avaliable to help stop smoking and encourage her to try one of the methods such as the medication,fake electric cig. and make sure she is fully educated on the different ways to help her quit.I would also let her know that I will be informing my supervisor of employees coming in smelling like smoke.Since this is the follow up visit,first I would check her vitals,pain levels, and check to see how often she is having to take nitro for chestpain relief and how often she is having to use O2 if any.I would make sure she was still taking her medications to help prevent stroke or another MI.She should be taking a beta blocker,ace inhibitor, possible antiplatelet , and possible tx for hyperlipidemia if needed.I would also educate the patient on the importance of a cardiac excercise rehabilitation progroam and make sure she has all the information to get started if she hasn't already.I will also evaluate patient knowledge of community resources and when to seek medical attention. 2) I think the first thing to address with Mrs.. Jefferson is smelling smoke on other nurses in the office. I would be honest, its hard to quit smoking. You would think with being a nurse and knowing the health risks that go along with smoking they would quit. But, unfortunately sometimes even nurses need a life changing event to help them realize how scary the effects of smoking can be. (Stroke, heart attack, cancer). Now lets talk about your history with smoking have you tried to quit in the past? (I would like to assume she has) What were your reasons then and are they the same as now? Then I would have the more serious discussion about her health, she has already suffered from a MI and she is at high risk for having another one. I would talk to her about what can happen if she survives a stroke or another heart attack. She could loose the ability to talk, swallow, move one side of her body (sometimes living with the results can be worse than death itself). Then I would leave time for her to discuss her feelings on this. I would hope after this, she is willing to try to quit smoking and we can work on a plan Since she is such a heavy smoker and for so long I would discuss our options for medications to help decrease the cravings. There are many types of over the counter medicines to help with cravings throughout the day. Then we can talk about what to do when experiencing an urge to smoke. Take a walk, grab a friend to talk to or knit (sometimes it helps to replace smoking with another activity). During these times think of how healthy your body will be, how you will be able to enjoy friends and family longer. Think of the wonderful vacation you promised yourself after saving over $7,000 this year from not buying cigarettes. I would also refer her to websites that can help with ideas to stay smoke free. And help her understand its OK to have a slip up, it doesn't mean you can't keep trying to stay smoke free. The last step would be to schedule and appointment 6 weeks from now to check up and see how our plan is working. Also let her know if at anytime she feels the over the counter medicine is not helping she can come in and we can discuss prescription medicine to help quit. 3) A 40 year old female with a diagnosis of coronary artery disease (CAD) and history of myocardial infarction (MI) 6 months prior to her follow up visit responds to her physician's directive to stop smoking by expressing her enjoyment of smoking and goes on to question why she should quit. The patient also mentions that she has smelled smoke on the clothing of the healthcare staff, attempting to justifying her smoking by deferring to the actions of others and using this as a basis for ignoring the physicians directive. When Mrs. Jefferson asks why should she quit smoking she has given me, the RN, the perfect opportunity to provide her with evidence based data that clearly and simply states the negative effects of smoking and how it relates to CAD and other co-morbidities. According to The Centers for Disease Control, coronary heart disease is the leading cause of death in the United States. Smoking can cause coronary heart disease. Smoking is known to reduce blood flow by narrowing the blood vessels which can also lead to peripheral vascular disease and by weakening the aorta can lead to abdominal aortic aneurysms. The American Heart Association estimates that 30% of all coronary heart disease deaths in the United States annually can be linked to smoking. In conjunction with basic information related to health risks associated to smoking, Mrs. Jefferson will be referred to a multi-component program such as the one developed by Debusk and colleagues which is a case managed program primarily telephone based for coronary risk modification post MI. This program showed a smoking cessation rate jump from 53% at one year to 70%. As her smoking habit consumes more than 15 cigarettes per day, a nicotine patch could be offered by the physician or nicotine gum if her habit was oral fixation based. As this follow up visit is occurring in a physicians office, there may be a program available through the office which would provide counseling with treatment algorithms negating the need for a formal outpatient case managed multi-component program. As far as her smelling cigarette smoke on healthcare staff I would propose that the poor healthcare decisions of others should not impact her choice to lead a healthier life with reduced modifiable risks 4) Cigarette smoking is the most preventable cause of illness and death. Cigarettes are filled with nicotine, which acts like a poison in your body. You may have breathing problems that make it difficult for you to do daily activities or play sports. You have a higher risk of bone fractures because smoking can cause osteoporosis (brittle bones). If you fall asleep with a lit cigarette, you can start a fire. Cigarette smoking can also cause the following health problems: Cancer: Smoking increases your risk of many kinds of cancer. The most common cancers are lung, lip, mouth, or throat cancer. Heart and blood vessel disease: The nicotine in tobacco causes an increase in your heart rate and blood pressure. Nicotine also causes your blood vessels to narrow. This can lead to blood clots in your heart or brain and caused a heart attack or stroke. Cigarette smoke has carbon monoxide in it. This can decrease the amount of oxygen flowing to your heart and other organs. Lung disease: The chemicals in cigarette smoke can damage your lungs. This causes a buildup of dirt and waste products in your lungs. Many people who smoke have a long-term cough as a result. Cigarette smoking may also cause long-term lung infections or diseases, such as asthma, emphysema, or chronic bronchitis. You are also at higher risk for respiratory illnesses, such as colds or pneumonia. Gastrointestinal disease: Cigarette smoking increases the amount of acid in your stomach. This can cause an ulcer or gastric reflux. When A person quits smoking their health will improve and the risks for many diseases will decrease. Their breath, clothes, and hair will no longer smell like smoke. Tobacco will no longer stain teeth. Tobacco smoke is dangerous to others. By quitting will decrease the risks to those around you, such as your children or family members. General health improves – tiredness and headaches can be linked to smoking. Your sense of taste and smell improve. Your heart will be less strained and work more efficiently. You will feel healthier and stronger Some pharmacological and non-pharmacological aids are: Nicotine replacement therapy, Zyban, Champix, Varenicline, behavior modification programs, and alternative therapies like acupuncture and hypnosis. I would apologize for the healthcare staff that smells of smoke. They are also doing damage to their bodies, and could eventually have the same adverse health effects as Mrs. Jefferson. I would then tell her that with her health conditions she has to take responsibility on her own health and empower herself to make positive healthy changes. The best thing for her health right now is to quit smoking. She can change the amount of damage being done at the age of 40 and possibly reverse any other complications that may arise. I would assess, educate, and be a listener to her worries/fears/concerns. I would assist and give referrals to smoking cessation groups, etc. I would also stress that more serious health effects can occur if she continues on her current path. I would be understanding, but at the same time show care and concern for her well-being.