Cigarette smoking, a leading cause of preventable death all over the world, affects nearly all organs in the body, results in various diseases, and reduces overall well-being.
Smoking can cause the following adverse health effects:
- Gum disease
- Vision problems
- Cancer development
- Persistent cough
- COPD
- Heart disease
- Angina
- Stroke
- Infertility
- Pregnancy complications
- Erectile dysfunction
- Weakened immune system
- Blood clots
- Premature skin aging
Tobacco, which is the primary material used in cigarettes, contains toxic substances including carbon dioxide, nicotine, and tar. Carbon dioxide is fatal when inhaled in large doses as it will decrease oxygen concentrations in the blood. Without oxygen, organs cannot function properly. Nicotine is a highly addictive substance in cigarettes that temporarily improves behavior and mood. Tar is a sticky brown substance that damages the lungs and causes breathing problems.
Nursing Process
Smoking cessation is difficult to achieve. Nurses play an important role in providing counseling and education on medications as these are proven effective methods in smoking cessation.
Nicotine replacement therapy products contain varying amounts of nicotine and are effective in reducing nicotine cravings as well as withdrawal symptoms. Behavioral therapy and support are essential in helping smokers develop skills to give up cigarette smoking for good.
Nursing Care Plans
Once the nurse identifies nursing diagnoses related to smoking, nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. In the following section, you will find nursing care plan examples related to smoking.
Ineffective Breathing Pattern
Cigarette smoking is associated with acute changes in respiratory function, including coughing, airway irritation, and impaired airflow resistance. It can cause health conditions like COPD, chronic bronchitis, and emphysema.
Over time, the toxins from cigarette smoke will start to build up and cause thinning of the alveoli. When this happens, the air sacs in the lungs will become less efficient, making it difficult to breathe in oxygen and expel carbon dioxide.
Nursing Diagnosis: Ineffective Breathing Pattern
Related to:
- Smoking
- Impaired gas exchange
- Complications of cigarette smoking
As evidenced by:
- Decreased expiratory pressure
- Decreased inspiratory pressure
- Hypoxemia
- Hypoxia
- Coughing
- Nasal flaring
- Tachypnea
- Bradypnea
- Hyperventilation
- Hypoventilation
Expected Outcomes:
- The patient will be able to breathe comfortably with respiratory rate and rhythm with normal parameters
- The patient will not develop preventable lung diseases
Assessment:
1. Assess breathing pattern, rate, and O2 saturation.
Alterations in the normal breathing rate, rhythm, and O2 sat can indicate physiological respiratory complications and the development of incurable diseases.
2. Auscultate breath sounds.
Abnormal lung sounds like wheezes and crackles can indicate impaired pulmonary function, infections, and long-term lung damage.
Interventions:
1. Promote adequate oxygenation.
Providing supplemental oxygen can help correct hypoxemia in smokers with respiratory complications. Continuous oxygen may be needed for end-stage COPD and emphysema. Remind the patient never to smoke when using or around oxygen.
2. Promote the use of bronchodilators.
Inhaled corticosteroids are often needed to open airways and reduce inflammation.
3. Encourage and support the patient to stop smoking.
Continue to educate the patient on the effects of smoking on their body and lungs. Ask the client if they are ready to quit smoking and provide resources if applicable.
4. Encourage controlled coughing and deep breathing exercises.
Mucus accumulation can occur in the air sacs due to toxins from cigarette smoking. Controlled coughing and deep breathing allow adequate lung expansion and expulsion of mucus from the lungs.
Ineffective Health Maintenance Behaviors
Patients who smoke exhibit ineffective health maintenance behaviors as they fail to maintain their physical, mental, spiritual, or mental health. They are often in denial that this unhealthy behavior is causing them harm.
Nursing Diagnosis: Ineffective Health Maintenance
Related to:
- 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
- A pattern of lack of health-seeking behavior
- Poor personal support system
Expected Outcomes:
- The patient will discuss perceived barriers in following a health regimen and adhering to the agreed health maintenance plan
- The patient will agree to and participate in a place of action to quit smoking
Assessment:
1. Assess the patient’s feelings and reasons for not following the health maintenance regimen.
Emotions play an important role in how we act and comply with appropriate healthcare behaviors. Assess for issues such as grief, depression, or spiritual distress.
2. Determine economic, mental, emotional, spiritual, and cultural patterns affecting compliance with the treatment regimen.
Patients who smoke may have beliefs and values that challenge their adherence to a healthcare maintenance regimen.
Interventions:
1. Involve the patient in planning an appropriate regimen to promote smoking cessation.
Patients who are involved in shared decision-making have a higher chance of adhering to the treatment plan.
2. Help the patient pick a quit day.
One of the first steps in quitting is having a plan and picking a day. It shouldn’t be a date too far or soon. This allows the patient to mentally prepare.
3. Explore pharmacologic interventions.
Nicotine replacement therapy comes in the form of gums, lozenges, patches, and sprays to prevent withdrawal symptoms and reduce cravings.
4. Teach to avoid triggers and remind themselves of the benefits.
Resisting cravings is one of the hardest parts of quitting smoking. Discuss avoiding triggers such as going for a walk instead of smoking, or avoiding certain places where others smoke. In time, cravings will become less. When cravings occur, have the patient remind themselves of their reason for quitting such as traveling or saving money.
Risk-Prone Health Behavior
Patients who are addicted to smoking and nicotine will find it difficult to modify their lifestyle and unhealthy behaviors even if they are aware that these behaviors are putting their health at risk.
Nursing Diagnosis: Risk-Prone Health Behavior
Related to:
- 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 health status change
- Continuing to smoke despite health effects
- Substance misuse
Expected Outcomes:
- The patient will verbalize acceptance of health status changes and the need to quit smoking
- The patient will verbalize two strategies to quit smoking
Assessment:
1. Assess the patient’s perception of health and wellness.
Every person has a unique and individual perception of concepts of well-being and illness. Do not push personal perceptions or judgments onto the patient. They must have their own motivation to quit or they will not be successful.
2. Assess major barriers to health and wellness.
The patient’s cultural and social beliefs and current mental and emotional state can be a major hindrance in promoting and adapting to healthy lifestyle modifications.
Interventions:
1. Discuss with the patient current health goals.
Smoking is addictive and without an established goal to change this unhealthy behavior, smoking cessation cannot be achieved.
2. Help the patient recognize the influence of others.
If the patient’s family and peers also smoke, it can make quitting much more difficult. Help the patient recognize who they spend their time with and how they may be able to limit interactions to reduce the influence of smoking.
3. Explore previous attempts to quit.
Discuss what the patient has tried in the past if they attempted quitting. This can help the nurse offer tips and resources to successfully quit smoking.
4. Refer the patient to support programs.
Many states have tobacco quit programs that provide free counseling, resources, and medications to quit smoking.
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/
