Free Nursing Dissertations - He Had Been A Regular Smoker Since Adolescence. The 12 Lead Ecg Indicated A
He had been a regular smoker since adolescence. The 12 lead ECG indicated a non-ST, arterial myocardial infarction that was treated using intravenous heparin and a beta blocker. Subsequently, cardiac catherisation confirmed narrowing of the arteries, but percutaneous coronary intervention was inappropriate for this patient on the basis of the coronary arteriography, so cardiac artery bypass surgery was recommended. The patient was anxious about long term health implications of atherosclerosis and was referred by the cardiologist to the STOP (Smoking Treatment Or Prevention) nurse-led initiative to encourage smoking cessation and identify his support needs.
Assessment of Patient
Upon assessment, this was a patient of normal weight, with a body mass index of 24. Apart from the recently diagnosed cardiovascular disease, he reported no additional medical conditions and had been in good health until his myocardial infarction. He had smoked continuously since the age of 19 years, and had attempted to quit smoking during his 40’s but had been, in his words, unable to kick the habit which he partly attributed to the fact that his wife was also a smoker. Although he had smoked 20 a day since adolescence, he admitted that his recent smoking behaviour had changed on account of occupational stress, and he was currently smoking between 35 and 40 filtered low tar cigarettes per day. He was a light alcohol user, and took regular exercise as he enjoyed daily walks, and ate a balanced diet. It was quickly identified through the nursing health assessment that smoking was the major preventable health problem for this patient. This was an anxious patient and receptive to lifestyle modifications that might improve his long term prognosis. During the consultation it was apparent he was in the preparation for change stage and needed to be encouraged towards the action stage. This was reinforced by providing a carbon monoxide reading on his wife so that the patient could reflect on the effects of smoking at a personal level, and he was provided with a leaflet outlining the specific effect of smoking on the heart.
Implementation/ Planning
The patient indicated he had quit smoking for a brief period in the past without the aid of smoking cessation therapies using willpower alone, but relapsed due to his wife. She was now also keen to quit smoking and aware of the risks of passive smoking for her husband. The patient completed the Fagerstrom tolerance questionnaire (Fagerstrom, 1978) that revealed a moderate level of nicotine addiction. The patient felt that his smoking was a habit, as opposed to a nicotine addiction. A summary of smoking cessation therapies available through the NHS were provided to the patient. It was recommended that he, and his wife, attend the local smoking cessation support group in conjunction with prescriptions of nicotine patches. Nicotine replacement therapy was commenced on the ward.
