Please review the video on the assignments page under the discussion section as it will provide you with an
opportunity to immerse yourself in the role of a nurse addressing tobacco use during routine patient care. In
doing so, reflect on what you have learned about tobacco use and the role that nurses and other
interdisciplinary team members play in helping to assist tobacco users with quitting. While viewing, it is also
important to keep in mind that tobacco users move through stages of change in the process of quitting. They
move from pre-contemplation to contemplation, contemplation to preparation; preparation to abstinence;
abstinence to maintenance. Every stage requires a different strategy by a nurse.
After watching the video, and reflecting on the information presented, address each of the following
questions.
1. What are the common symptoms associated with an exacerbation of COPD?
2. What assessment techniques will you use to assess Mary?
3. Identify smoking strategies that would be appropriate for each of the encounters that Mary
had with the nurse throughout the video that could have been used to assist Mary in quitting
smoking.
4. Find a resource in your community that could assist Mary. Start by searching the Internet for
your local health department's website. What services are available to Mary? Briefly describe
the services that the state quit line provides. Does it meet the 4 As? Is it accessible,
acceptable, affordable, or available for Mary?
5. What will you do to follow-up on Mary's smoking cessation process?
According to Jarvis (2016), most individuals know they should quit and they need
encouragement and education to modify their daily smoking activities, identify what triggers
their desire to smoke, and need help to manage the withdrawal. Assessing the As can help
determine the stages of quitting. Ask about current tobacco use at every visit and record what the
patient says. Advise why quitting is I their best interest. Assess readiness and interest in quitting
smoking. Assist with finding the right plan including smoking cessation programs and
medications that may help modify the behavior. Arrange follow up appointments and starting the
quitting process over again if unsuccessful the first few tries.
Common symptoms of COPD exacerbation include increased trouble breathing or
shortness of breath, noisy breathing, out of breath with light activity or at rest, irregular
breathing, worsening cough, trouble sleeping, swollen ankles, or changes in skin or nail color.
Spirometry is needed to diagnose COPD. Once diagnosed the COPD Assessment Tool (CAT)
would be an assessment technique used for Mary. This is a short questionnaire that provides
framework for the discussions to ease the impact of COPD on one’s life. This will help to
determine the health status of Mary but does not replace rehabilitation or smoking cessation.
When assessing Mary, it is important to be nonjudgmental and understanding. Does she
smoke because she is stressed? Has she tried other stress relievers? Is she interested in heathy
substitutes for this habit such as exercise or a new hobby? After asking her thoughts and how she
feels about smoking, I would begin a physical assessment, paying close attention to respiratory
status, lung sounds, and asking about her cough. I would assume that she understands the
correlation between smoking and her previous heart attack, but to be sure, I would review that
with her and see where her knowledge is at.
If Mary is contemplating or considering quitting, I would provide her with positive
reasons to quit. First and foremost, for improved over all health. Smoking cessation also
decreases potential health risks, may make her feel less isolated, save her money, improve her