nurses: help your patients stop smoking...smoking is a part of the smoker’s life. to stop smoking,...

NATIONAL INSTITUTES OF HEALTHNational Heart, Lung, and Blood Institute

Nurses: Help Your Patients Stop Smoking

Nurses Can Help Smokers Quit

Most Smokers Are Ready to Hear from You

How You Can Help

The Facts: Smoking Causes Death, Disease, and Disability

Benefits of Quitting

Challenges to Quitting

Withdrawal Symptoms

Nicotine Replacement Therapy

Steps for Nurses' Smoking Intervention

National Heart, Lung, and Blood Institute Smoking Education Program P.O. Box 30105 Bethesda, Maryland 20824-0105

Y ou can help your patients This guide contains:stop smoking. How? Talkto patients about their

smoking, provide some simplebut effective quit smokingadvice, and ask other healthprofessionals to do the same.This concise guide will help youdo this successfully.

Information you can use toconfidently talk aboutquitting smoking

A quick and easy-to-useteaching guide: “Steps forNurses’ SmokingIntervention”

Smoking is a proven healthhazard, and there are clearbenefits to quitting. There is nosafe cigarette and no safe levelof smoking. Nurses have aresponsibility, as healthprofessionals, to talk to all theirpatients who think aboutquitting. This is true whetheryou work in a hospital, healthdepartment, worksite, school,physician’s office, patient’s home,or any other setting.

A pocket summary of theteaching guide

Five handouts that can becopied and given topatients.

Begin to use this teaching guidethis week or, better yet, today.

Role-play the steps of thesmoking intervention with afriend or colleague beforetalking with patients.

Take every opportunity topractice and make it part ofyour routine.

If you smoke, use thisbooklet to help yourself quit.

Nurses Can Help Smokers Quit


How You Can Help




Withdrawal Symptoms

Nicotine Replacemeat Therapy


T hree out of foursmokers say they wantto quit.

Most smokers know that smokingcauses lung cancer,emphysema, and heart disease.

Seven out of ten smokers havetried to quit smoking.

Ninety percent of formersmokers quit on their ownwithout participation in formalprograms. Smokers can quit withyour advice.

Smokers expect to hear concernabout their smoking in healthsettings. When you use theSteps for Nurses’ SmokingIntervention listed later, you willnot be seen as nagging orpreaching. Your advice will beseen as good nursing practice.


How You Can Help




Withdrawal Symptoms



One Nurse’s Experience“When I first started talking topatients about their smoking, Iwas hesitant. I thought patientswould think their smoking wasnone of my business. I found justthe opposite. Many patients werewilling to talk about theirsmoking and plans to stop. Sometried to quit, and a smaller groupdid so. I feel good knowing I ammaking a difference in thehealth of my patients.”

Four Stages of QuittingSmokingYou will see smokers at each ofthe four stages of quittingsmoking. With the Steps forNurses’ Smoking Intervention,you can help smokers throughthese stages of breaking thehabit:

Stage 1. Not seriouslythinking aboutquitting(Precontemplation)

Thinking about thepros and cons ofquitting(Contemplation)

Intending to quitand taking actionsto do so (Action)

Remaining offsmoking orreturning to it(Maintenance orrelapse).

Stage 2.

Stage 3.

Stage 4.

You are successful when youhelp smokers move closer totaking action and stoppingsmoking. Even if they don’t quit,they are further on their way toquitting-because of you.

Most smokers will be in the firsttwo stages, not quite ready toquit. They often need an outsideprompt to start them thinkingseriously about quitting. Useevery clinical opportunity, suchas a patient’s persistent cough orrecent illness, to personalize theneed to stop smoking. Youradvice can encourage them tothink more seriously aboutquitting (stage 2) or to set aquit date (stage 3). See theChallenges to Quitting sectionfor ways to help those in stages 3and 4.

Ask Other Health Professionalsto Help Smokers QuitIn addition to talking to patientsyourself, remind other membersof the health team to do thesame. When you learn that apatient smokes, ask thephysician to talk to him or herabout quitting.

Encourage other nurses,respiratory care practitioners,dietitians, physician assistants,and other health care providersto talk to smokers, also.Repetition of the same no-smoking message by severalsources will encourage smokersto think more seriously aboutquitting smoking.

Document on the patient recordor chart the person’s smokinghistory, desire to quit, and quitdate. Use notes in the planningportion of the record to promptothers to discuss stoppingsmoking with the patient.

How You Can Help




Withdrawal Symptoms

Nicotine Replesement Therapy


W hat would happen if twofully loaded jumbo jetscrashed every day with

no survivors? What if a newvirus killed 1,000 Americansevery day? You’d see fast actionto stop this loss of life.

Cigarette smoking now causes1,000 Americans to die each day.

Cigarette smoking is the singlemost important preventablecause of death in the UnitedStates. One of every six deaths inthe United States is related tosmoking. As of 1990, 25.5 percentof (or about 45.8 million)Americans smoked cigarettes.Many of these people are yourpatients.

How Much Greater Is Smokers' Risk of Dying from MajorDiseases?*

Smokers increase their risk ofdeath from many major diseasesbecause they smoke. The tableon this page shows, for example,that smokers have double therisk of dying from coronary heartdisease as do those who neversmoked.

They also greatly increase theirrisk of lung cancer and severalother cancers-mouth, throat,bladder, pancreas, and kidneys.Stomach and duodenal ulcersare more likely to occur, lesslikely to heal, and more likely tocause death in smokers thannonsmokers. The risk ofdeveloping occupational lungdiseases is also increased insmokers.

More Risk Factors, More RiskPatients with diabetes, highblood cholesterol, or high bloodpressure at least double theiralready increased risk for heartdisease by smoking. Otherproblems are also more prone tooccur. For example, diabeticswho smoke greatly increase- therisk of poor circulation to theirhands and feet. This conditioncan lead to gangrene.

Pregnant women who smokeincrease their chances of havinglow birth weight infants by 50percent. Also, smoking increasesthe risk of miscarriage,premature birth, and stillbirth.Children regularly exposed tothe cigarette smoke of others(passive smoking) have moreupper respiratory and inner earinfections. Women who smokeand take birth control pillsincrease their risk of a heartattack 10 times. Their risk of astroke also increases.

Stroke2 times risk

Mouth Cancer6 times riskLarynx Cancer10 times risk

Chronic ObstructivePulmonary Disease10 times risk

Lung Cancer12 times risk

Coronary Heart Disease2 times risk

*Estimated increased risks for male and female smokers age 35 or older. Adapted from:US. Department of Health and Human Services, Reducing the Health Consequences ofSmoking: 25 Years of Progress. A Report of the Surgeon General. Rockville, Office ofSmoking and Health, 1989.




Withdrawal Symptoms



What to Say to Smokers About the Benefits of Quitting

Ask patients what they think their benefits of quitting would be.Share some of the benefits listed below.

Some Reasons Smokers Give forQuitting

Reduced risk of heart attack,cancer, and stroke

Feeling more in control oflife

Better smelling hair, breath,clothes, house, and car

More stamina whenwalking or exercising

Less coughing, colds, andflu

Benefits to People AroundSmokers Who Quit

Infants with mothers whodo not smoke have half thebronchitis, pneumonia, ear



Withdrawal Symptoms



and lower respiratory tractinfections as do infants withmothers who smoke.

Spouses of nonsmokershave half the lung cancerrisk of spouses living withsmokers.

Benefits of Quitting StartWithin Days

As the carbon monoxidelevel in the blood decreases,the oxygen level increasesto normal.

The heartbeat slows tonormal.

The lungs begin to clearand repair themselves.

Long-Term Benefits of Quitting

After 1-2 years of notsmoking, the ex-smoker’srisk of a heart attack dropssharply and graduallyreturns to normal afterabout 10 years.

After quitting smoking, therisk of lung, bladder,laryngeal, oral, andesophageal cancer isgradually reduced whencompared with continuedsmoking. However,cessation may not reducethe former smoker’s risklevel to that of an individualwho never smoked.

Help Your Patients ReduceTheir Risk and Get TheseBenefitsWhen you see a smoker, think ofpatients who have heart disease,cancer, stroke, or emphysema.You don’t want this smoker, yourcurrent patient, to develop one ofthese diseases. You will savesome of your smokers from theseproblems by talking to themabout quitting.

If smokers want to quit, whydon’t they? Here are a fewreasons or challenges

smokers must overcome to quit.

Addiction:Most smokers are addicted tonicotine and will cravecigarettes.

Habit:Smokers smoke automatically inspecific situations every day.

Reward:Some smokers relax or obtainpleasure from smoking.

Stimulant:Some smoke when they are tiredand want to feel more energetic.

Weight gain:Many smokers gain weight afterquitting.

Social:Most smokers have friends orrelatives who smoke.

Time filler:Many smokers smoke when theyare bored or have nothing to do.

Coping:Most smokers smoke when theyfeel worried, upset, sad, or mad.

Smoking is a part of the smoker’slife. To stop smoking, smokersmust first decide to quit. Toremain smoke-free, smokers mayuse two techniques: 1) avoidtempting situations and 2) dosomething else when the urgeto smoke arises.

To help smokers quit andremain off smoking (stages 3and 4), discuss the followingthree points:

Ask about specifictempting situations. Askcurrent smokers about timeswhen they smoke. Askrecent ex-smokers aboutwhen they feel the urge tosmoke.

Discuss ways to avoidthese situations. Can theyavoid the location (e.g.,bars) or friends who smokefor a few weeks? (See thepatient handout.)

Help them find somethingelse to do instead ofsmoking in each situation.Suggest sipping water,breathing deeply, movingaround, and keeping theirhands busy. Remind themthat the urge will soon fade.

The key to quitting for smokers isnot gritting their teeth to resistthe urge to smoke. That doesn’twork. The key is to be active indistracting themselves fromthinking about smoking usingthe techniques listed in the firstcolumn. You don’t need toprovide “answers” to eachsmoking situation. Ask thesmoker to think of activities thatthey think will work.

Address any concerns aboutweight gain. Tell smokers thatmany gain weight afterquitting, although some do not.The average weight gain for ex-smokers found in most studies isabout 5-10 pounds. Some gainmore, some less, and some donot gain any weight. Suggestthat patients focus on quittingsmoking now and then tackleany weight gain later. Tell themthey can help prevent weightgain or keep it small by eatinglow-fat foods and exercising.

Remember that many smokerswill hesitate and want to put offquitting. And, many of those whotry will not quit for good with thisattempt. Encourage those whoreturn to smoking to learn fromthe attempt and try again. Referto the patient handout on thispoint. Never give up on apatient. Nearly half of all adultswho ever smoked have quit forlife. Often it takes a few attemptsbefore smokers quit for life.


Withdrawal Symptoms



What to Say to Smokers About Withdrawal SymptomsThere will be withdrawal symptoms after quitting. Giveexamples such as lack of concentration, feeling tired, or beingrestless.

The withdrawal symptoms may come and go, get stronger orweaker, or remain the same. Tell the smoker to be preparedfor these changes.

The withdrawal symptoms should last 2 to 4 weeks.

Withdrawal symptoms usually last much longer. All smokers dooccur within 24 hours of stopping not experience the samesmoking or reducing the number withdrawal symptoms.of cigarettes smoked per day.These symptoms are signs that Below is a list of withdrawalthe body is recovering form symptoms and tips to help yousmoking. Tell smokers this fact. answer many of the questions

smokers may ask you. If patientsMost symptoms end within 2 to have trouble with these4 weeks. Some symptoms symptoms, refer them to adecrease sharply after the first physician.few days. The urge to smoke will

Ways to Cope with Withdrawal Symptoms

Withdrawal Symptom

Craving for cigarettes

Anxiety

Irritability

Trouble sleeping

Lack of concentration

Tiredness

Dizziness

Headaches

Coughing

Tightness in chest

Constipation

Hunger

Things You Might Do

Do something else; take slow deep breaths; tellyourself, "don't do it."

Take slow deep breaths; don't drink caffeine drinks; doother things.

Walk; take slow deep breaths; do other things.

Don't drink caffeine drinks in the evening; don't take naps duringthe day; imagine something relaxing like a favorite sport.

do something else; take a walk.

Exercise; get plenty of rest.

sit or lie down when needed; know it will pass.

Relax; take mild pain medication as needed.

Sip water.

Know it will pass.

Drink lots of water; eat high-fiber foods like vegetables and fruits.

Eat well-balanced meals; eat low-calorie snacks; drink cold water.

Withdrawal Symptoms



How Nicotine ReplacementTherapy Can HelpNicotine replacement therapymay help smokers stay offsmoking by reducing theirwithdrawal symptoms so thepatient can concentrate morefully on the behavioral aspects ofsmoking cessation. Nicotine fromany source is addictive.Therefore, nicotine replacementshould be used carefully. It is notdesigned to be usedalone. It should be used withother smoking cessationprograms and materials.

What to Say to Smokers About Nicotine ReplacementTherapy

Nicotine gum or the nicotine patch may be useful—check with thedoctor or dentist. If either one is to be used, help the patient get aprescription and teach the patient how to use the gum or thepatch correctly.

Two nicotine replacementtherapy options are available.They are nicotine gum (nicotinepolacrilex medication) and thenicotine patch (transdermalnicotine). Both nicotine gum andthe nicotine patch replace thenicotine from cigarettes with alower, more even dose. Thus,nicotine replacement therapy isonly used when all smoking hasstopped—on quit day andbeyond. Anyone interested inmaking nicotine replacementtherapy a part of their smokingcessation process should discusswith their physician whichoption is best for them—the gumor the patch.

When used with a stop smokingprogram, nicotine replacementtherapy may help smokersremain off cigarettes. These stopsmoking programs includegroup sessions, individualinstruction, and self-helpbooklets that teach habit-breaking techniques.

Nicotine gum and the nicotinepatch may be most helpful tosmokers who smoke more thanone pack a day. Lighter smokersmay find them helpful, too. Bothare available only with aprescription.

Health professionals shouldteach patients how to use

nicotine gum or the nicotinepatch correctly, Some importantinformation about nicotine gumand the nicotine patch ispresented below. Completeinformation about nicotine gumor a particular nicotine patch isprovided in the package insert.

Nicotine GumHow It WorksNicotine gum contains nicotinein a gum base. When chewedbriefly until softened, and thenplaced between the cheek andgum, the nicotine from the gumis absorbed into the bloodthrough the lining of the mouth.Once in the bloodstream,nicotine travels to the brainwhere it binds to nicotinicreceptors to gradually reducewithdrawal symptoms.

How It Is UsedThe amount of nicotine gumeach patient uses will vary.Encourage patients to discusswith their physician thefollowing information:—how many pieces per day they

should use,—when they should use the gum

during the day, and—when they should be weaned

off the gum.

Specific information on howmuch to use is provided in thepackage insert. If nicotine gum isprescribed for the hospitalizedpatient, make the gum easilyavailable to the patient asordered. You may wish to keep alimited supply of nicotine gum atthe bedside for easy patientaccess.

Warnings/PrecautionsPATIENTS SHOULD NOTSMOKE WHILE USINGNICOTINE GUM!! Smokingwhile using nicotine gumcould result in an overdose ofnicotine.

Children, pregnant women, orlactating women should notuse nicotine gum.

Nicotine gum should not beused by patients who havelife-threatening cardiacarrhythmias, severe angina, orwho have had a recentmyocardial infarction.

Patients with medical con-ditions such as hypertension,cardiac arrhythmias, oral/pharyngeal inflammation,history of esophagitis, pepticulcer disease, hyper-thyroidism, insulin-dependentdiabetes, or cardiovasculardisease, should consult theirphysician before usingnicotine gum.



Patients should consult withtheir physician or dentist ifthey have dentures, bridges,or dental problems beforeusing nicotine gum. Patientswith active temporo-mandibular joint diseaseshould not use nicotine gum.

Side EffectsSide effects may include a sorejaw, a sore mouth, excessivesalivation, dyspepsia, nausea,and/or hiccups.

Nicotine PatchHow It WorksThe nicotine patch delivers asteady dose of nicotine throughthe skin of the person wearingthe patch. Once absorbedthrough the skin, the nicotine isdelivered to the bloodstreamwithin a few hours ofapplication, where it travels tothe brain. In the brain, thenicotine binds to nicotinicreceptors to reduce withdrawalsymptoms.

How It Is UsedThe nicotine patch is appliedeach day on the upper arm,back, or chest and is used forseveral weeks at a time. Theamount of nicotine in each patchand the dose delivered over a 24hour period vary with eachbrand of transdermal nicotine.The physical size andappearance and the length oftime the patch should be wornvary among brands as well.Encourage patients to discusswith their physician thefollowing information:—When to put the patch on

(usually first thing in themorning),

—What dose or size of patch touse,

—How long to keep it on eachday,

—How many weeks to use thepatch,

—How to wean off the patch.

Each brand allows gradualdecreases in the amount ofnicotine delivered by providingsmaller patches over time untilthe patient has no need fornicotine replacement. Specificinformation on each brand isprovided in the package insert.Patients should consult with theirphysician to determine whichbrand is best for them.

Warnings/PrecautionsPATIENTS SHOULD NOTSMOKE WHILE USING THENICOTINE PATCH!! Smokingwhile using the nicotine patchcould result in an overdose ofnicotine.

Pregnant women or lactatingwomen should consult withtheir physician before usingthe nicotine patch.

Children should not use thenicotine patch; women inlabor or delivery should notuse the nicotine patch.

The nicotine patch should notbe used by patients with lifethreatening cardiac arrhyth-mias, severe or worseningangina, or a recent myo-cardial infarction.

Patients with medicalconditions such ashypertension, renal or hepaticinsufficiency, cardiacarrhythmias, active pepticulcer disease, hyper-thyroidism, insulin-dependentdiabetes, peripheral vasculardisease, or cardiovasculardisease should consult theirphysician before using thenicotine patch.

Patients with atopic oreczematous dermatitis shouldconsult with their physicianbefore using the nicotinepatch.

Side EffectsSide effects may include skinirritation, sweating, abnormaldreams, insomnia, nervousness,diarrhea, dyspepsia, dry mouth,arthralgia, and/or myalgia.

Instructions for patients usingnicotine gum and the nicotinepatch are provided on thepatient education handout atthe end of this guide. Ifnicotine replacement therapyis indicated for a particularpatient, give them the handouton nicotine gum or thenicotine patch provided in thisguide. Complete informationon nicotine gum or aparticular nicotine patch isprovided in the packageinsert.

Y ou can make a differencewith your smokingpatients in just a short

time. Here are some importanttips:

Start today. To start, just askpatients about their smokingand advise them to quit.Within a week or so, add the“prepare” and “followup”steps. If time is short, simplydo the “ask” and “advise”steps. Soon, this smokingintervention will be aflexible part of your nursingroutine.

Keep your objectives inmind. Patients will:—Set a quit date and begin

to prepare to quit,—Or think more during the

next week about thereasons for quitting andthe possibility of doing soin the next year.

Convey warmth, under-standing, acceptance, andrespect for patients.Express concern about theirsmoking.

1. Ask All Patients if TheySmoke

For smokers, ask how muchthey smoke.

Congratulate smokers whohave quit.

Document patients’ smokingor nonsmoking status inyour notes or other forms.

2. Advise All Smokers ToQuit

Ask the patients what theythink the benefits of theirquitting would be.

Show the patient thehandout and review a fewbenefits you feel would bemeaningful.

Give a firm, simple no-smoking message such as,“I am concerned aboutyour smoking. I musthighly recommend that youquit.”

Repeat your recommenda-tion when smokers giveexcuses for not quitting. Forexample, say “I can see youhave concerns, but I stillmust recommend that youquit. Smoking is a majorhealth threat for you.” Neverargue about the excuses oraccept the excuses. Alwaysend with your patientsknowing you think theyshould quit.

3. Prepare Your Smokers To

Ask the patient to set atarget quit date within 1 to3 weeks from now. If thattime frame doesn’t work,explore what time framemight be better. Ask patientswho are not ready to quit tothink seriously next weekabout the reasons forquitting.

Have the patient writehis/her quit date on theattached patient handout.This contract can be madebetween the patient andyou or a friend or relative.Ask them to complete therewards part later. Stressthe need to reward them-selves.

Mention the three main tipsin “Breaking the Habit” inthe enclosed patienthandout. Show this to them.These three tips are 1) dosomething else instead ofsmoking, 2) avoid temptingsituations, and 3) stick withyour effort to stop smoking.Express confidence thatthey can and will quit.

Followup

Advise

Prepare

Ask


Tell patients they willexperience withdrawalsymptoms for about 2 to 4weeks after quitting. Showthem the handout on this.Offer them information onhow to obtain a prescriptionfor nicotine gum or thenicotine patch, ifappropriate and notcontraindicated.

Offer information on localsmoking cessationprograms. Write the phonenumbers on the patient’shandout. You could alsogive patients one of the self-help booklets listed on the“Breaking the Habit” patienthandout.

how they do. If you plan to

Tell all patients you are

followup, tell them you will.

very interested in hearing

If you cannot followup withthem, tell them you will bethinking of them on theirquit day. If you can handlecalls, ask them to call youwith their progress.

Talk with all patients

4. Followup: Let Your

briefly about their smokingthe next time you see

Patients Know You Care

them—the nextappointment, home visit,wherever. Ask them if theysmoke and for theirthoughts on what you saidabout smoking. As timepermits, talk to them abouttheir progress, problems,and plans.

Give new ex-smokers a “paton the back” each time yousee them.

Send cards or call patientsat home a day or so beforetheir quit day and/or soonafter their visit, when youcan. This is a very helpfulway to show you care. Italso reminds them of theircommitment to quit.

Work with healthprofessionals in othersettings to stay in contactwith patients and reinforceno-smoking messages.

Selected ReferencesU.S. Department of Health andHuman Services. Reducing theHealth Consequences ofSmoking: 25 Years of Progress. AReport of the Surgeon General.Office on Smoking and Health,Rockville, MD: 1989, DHHS 89-8411.

U.S. Department of Health andHuman Services. How You CanHelp Patients Stop Smoking:Opportunities for RespiratoryCare Practitioners. NationalHeart, Lung, and Blood Institute,Bethesda, MD: 1989, NIHPublication No. 89-2961.

Schneider, Nina. How to UseNicotine Gum and OtherStrategies to Quit Smoking. NewYork: Pocket Books, 1988.

U.S. Department of Health andHuman Services. ClinicalOpportunities for SmokingIntervention: A Guide for theBusy Physician. National Heart,Lung, and Blood Institute,Bethesda, MD: 1992, NIHPublication No. 92-2178.

U.S. Department of Health andHuman Services. How to HelpYour Patients Stop Smoking: ANational Cancer InstituteManual for Physicians. NationalCancer Institute, Bethesda, MD:1989, NIH Publication No. 89-3064.

American Lung Association.Freedom From Smoking in 20Days. New York: American LungAssociation, 1981, Item No. 0034.

American Lung Association. ALifetime of Freedom FromSmoking. American LungAssociation, New York: 1981, ItemNo. 0026.

For technical questions, contact:

Office on Smoking and HealthCenter for Chronic Disease

Prevention and HealthPromotion

Mail Stop K-50Centers for Disease Control1600 Clifton Road, N.E.Altanta, Georgia 30333(404) 488-5708

Acknowledgments

Developed by:

National Heart, Lung, and BloodInstitute

Smoking Education ProgramP.O. Box 30105Bethesda, Maryland 20824-0105

Contributing Authors:

Joan E. Blair, R.N., M.P.H.National Heart, Lung, and Blood

InstituteBethesda, Maryland

Ted Buxton, M.P.H.University Research CorporationBethesda, Maryland

Illustrations and PublicationDesign By:

Jeanne KellyAardvark Design AssociatesLeesburg, Virginia

Quit and Be FreeWhat Will It Take For YouTo Quit Smoking?Many smokers have quitsmoking because of the manybenefits of being smoke-free.Some waited until they hadsymptoms like a cough orbreathing problems. And otherswaited until they were told theyhad cancer or a heart problem.What will it take for you to stopsmoking?

Think About Your Reasonsfor Quitting Each DayWhat do you want to gain fromquitting? Check your reasons inthe list below, then write themdown. Pick a few times duringthe day to read and review yourlist. Tape the list on yourrefrigerator or bathroom mirrorwhere you will see it.

Think of your reasons to quiteach time you reach for yourpack of cigarettes. By repeatingyour reasons often, your drive toquit smoking will grow stronger.Try it.

By Quitting Smoking, I Will Get These Benefits...

I will greatly lessen my chances of getting cancer or having aheart attack.I will have fewer colds or flu each year.I will have better smelling clothes, hair, breath, home, andcar.I will climb stairs and walk without losing my breath.I will have more money to spend on other things.I will reduce the number of coughs, colds, and earaches myyoung child will have.I will have fewer wrinkles.I will be free of my morning coughI will increase my sense of control over my life.I will

I Lose These Benefits Each Day That I Do Not Quit Smoking

Think of When You WillQuit

Tell them your reasons forwanting to quit. Ask for their

Choose a quit date and promisesupport.

yourself not to smoke. Write thedate on the contract below andhave someone sign it with you.

Prepare, Take Charge andQuit

List how you’ll reward yourself, The methods listed on thetoo. handout, “Breaking the Habit,”

have helped thousands of formerTell your friends, family, and smokers to break the habit. Askcoworkers about your quit date. your nurse for this handout, and

begin to practice these methodsnow. You will quit smoking.

I will quit smoking on(date)

. I will reward myself

for not smoking as follows:

First day of not smoking(reward)

Each week of not smoking(reward)

(signed)

(cosigned)

Breaking the HabitDo Something ElseInstead of SmokingThink of some common timeswhen you smoke. For instance,you might smoke after meals,while driving, or when you arebored. For each of these times,find something else to do inplace of smoking. This willdistract you from your urge tosmoke. And before you know it,the urge to smoke will fade.Here’s what you should do.

Each time you feel an urge tosmoke, do the following quickly:

Stop

Think

Act

Say, “Stop!” toyourself, even outloud.

Repeat the reasonswhy you are quitting.Tell yourself that youcan wait out the urge.

Put something in yourmouth.Sip water, chew ice orsugarless gum, eat fruitor a low-calorie snack,or use a toothpick.

Keep your hands busy.Try beads, paper clips,doodling, crosswordpuzzles, or handling acoin.

Move. Get up andwalk.

Call or see a helpfulfriend.

Yawn, sigh, or breathedeeply.

Starting today, practice StopThink-Act when you want tosmoke. Right now, do Stop-Think-Act. Use it to postponesmoking a few cigarettes eachday for 10 minutes. When yourquit day comes, you’ll be incontrol. Practice makesnonsmokers.

Avoid TemptingSituations

Destroy all cigarettes thenight before quit day. Also,throw away all ashtrays,matches, and lighters.

Avoid people who smoke infront of you.

Avoid those places whereyou smoked, when you can.

Do not drink alcohol for atleast the first 2 weeks of notsmoking.

Ask family members andfriends not to offer youcigarettes or leave themlaying around.

Stick With Your Effort toStop SmokingIf you do smoke a cigarette,regain control:

1. Stop smoking and get rid ofany cigarettes you might have.

2.Forget about feeling guilty.You were in a tough situation.Learn from it and then justforget it.

3. Plan and practice what youwill do next time in thatsituation. Talk to a friendabout it. Take charge and youwill quit smoking.

Nicotine gum or the nicotinepatch may also help you quitsmoking. It will reduce yourwithdrawal symptoms. Yourdoctor or dentist must write aprescription for you to get thegum or the patch. Ask themabout it.

Call For More Information. Callthe National Cancer Institute(1-800-4-CANCER) to order thebooklet, Quit for Good. TheOffice on Smoking and Health(404-488-5708) offers Clearing theAir. Call the local chapters of theAmerican Heart Association,American Cancer Society, andAmerican Lung Association toobtain other materials andschedules of group programs.Ask your nurse for these phonenumbers or look in your phonebook.

Being in Control of Withdrawal Symptoms

T here will be withdrawal 2 to 4 weeks. Your knowing this It is helpful to remind yourselfsymptoms after you quit. will help you stay in control and that these symptoms will be overThese symptoms are not smoke. soon. You will not smoke in

good signs that your body is spite of these symptoms likerecovering from smoking. The When symptoms occur, you can millions of other formersymptoms may come and go, get distract yourself from them or smokers.stronger or weaker, or stay the reduce them. The table belowsame. Most symptoms end within tells you some things you can do.

Withdrawal Symptom

Craving for cigarettes

Things You Might Do

Do something else; take slow deep breaths; tell yourself, “Don’t doit.”

Anxiety Take slow deep breaths; don’t drink caffeine drinks; do other things.

Irritability Walk; take slow deep breaths; do other things.

Trouble sleeping

Lack of concentration

Tiredness

Don't drink caffeine drinks in evening; don’t take naps during theday; imagine something relaxing like a favorite spot.

Do something else; take a walk.

Exercise; get plenty of rest.

Sit or lie down when needed; know it will pass.Dizziness

Headaches

Coughing

Tightness in chest

Constipation

Hunger

Relax; take mild pain medication as needed.

Sip water.

Know it will pass.

Drink lots of water; eat high-fiber foods like vegetables and fruits.

Eat well-balanced meals; eat low-calorie snacks; drink cold water.

Nicotine Gummay helpN icotine gum

you stay off smoking byreducing your

withdrawal symptoms. Someexamples of withdrawalsymptoms are dizziness,headaches, and lack ofconcentration. The gum givesyou nicotine at a lower, moreeven dose than your cigarettesdo. Nicotine gum is used onlywhen all smoking hasstopped—on quit day andbeyond. Do NOT smoke and usethe gum!!

When used with a stop smokingprogram, nicotine gum mayhelp you quit for life. These stopsmoking programs includegroup sessions and self-helpbooklets. These will help youcope with your cravings tosmoke. The gum does little toreduce your cravings to smoke.

The gum is most helpful tosmokers who are addicted tonicotine. Each piece of gumcontains 2 mg of nicotine. Thegeneral plan is to switch tonicotine gum, stabilize on it untilyou are accustomed to being anonsmoker, and then taper offand be off in 3 to 6 months.Nicotine gum is not for everyone.Check with your doctor to see if itis best for you. You can only getthe gum with a prescription.

Nicotine gum does not containany sugar.

How It WorksWhen you chew nicotine gum,the nicotine from the gum isabsorbed through the lining ofyour mouth. Next, the nicotinetravels through your blood toyour brain to help replace thenicotine your body got used towhen you smoked. This will helpyou feel fewer withdrawalsymptoms. Talk to your doctor ornurse and read the instructionsthat come with the gum to learnhow to use it.

Some Important Things toRemember

Talk to Your Doctor AboutHow Much To Use—Start using the gum upon

waking on quit day

—Your doctor will tell you:• how many pieces per

day you can use,• when you should use

the gum during the day,and

• when you can begin towean off the gum.

Chew the Gum, Then Put Itinto Your Cheek, ThenRepeat This.—Put the gum in your

mouth and chew it slowlyuntil you taste it.

—Then place the nicotinegum between your cheekand your gum. Hold itthere.

—After the flavor goesaway, bite or chew slowlyuntil you taste the gumagain. Then put the gumback in your cheek. Thisshould happen onceevery minute or so.

—Use each piece of gum for20 to 30 minutes and thenthrow it away.

Not Drink LiquidsAround the Time You Usethe Gum—Wait at least 15 minutes

after drinking acidicbeverages such as coffee,tea, milk, fruit juice, or softdrinks before using thegum. If you do not wait 15minutes, you will losemuch of the effect of thegum.

—Do not drink any liquidswhile the gum is in yourmouth.

Prevent the Side Effectsfrom the Gum: Chew Slowly—Most side effects can be

prevented by chewing thegum more slowly. Tellyour doctor if you haveany side effects such as asore jaw, a sore mouth,extra saliva, heartburn,feeling sick to yourstomach, or hiccups.

Stop Using the Gum WhenYou Are Ready

—As the urge to smokecomes less often, slowlyreduce the number ofpieces of gum used eachday.

—Most people are off thegum in 3 to 6 months, butsome may need it longer.

(continued on next page)

Nicotine Gum (continued)

Make Special Note ofThese Things When Usingthe Gum—Nicotine from any source

(smoking, nicotine gum,or the nicotine patch) canmake some health prob-lems worse. For example,heart or circulation prob-lems (such as anirregular heartbeat,chest pain, or a heartattack), high bloodpressure, stomach ulcers,overactive thyroid, anddiabetes that needsinsulin.

—Nicotine gum should notbe used by patients whohave life-threateningcardiac arrhythmias,severe angina, or whohave had a recentmyocardial infarction.

—Nicotine gum can alsocause problems withpregnancy and a babybeing nursed.

—Chewing nicotine gummay make jaw joint(temporomandibularjoint) disease worse.The gum may alsocause problems with

dentures, bridges, orother dental conditions.

—Nicotine gum is not foreveryone.

—Be sure to tell your doctor:• If any of the above

situations exist,• If you have any side

effects from nicotinegum,

• What medications youare on, and

• If you are not ready toquit smoking.

The Nicotine Patch

T he nicotine patch mayhelp you stay off smokingby reducing your

withdrawal symptoms. Someexamples of withdrawalsymptoms are dizziness,irritability, headaches, and lackof concentration. The patch givesyou nicotine at a lower, moreeven dose than your cigarettesdo. The nicotine patch shouldonly be used when all smokinghas stopped—on quit day andbeyond. Do NOT smoke and usethe patch!!

When used with a stop smokingprogram, the nicotine patchmay help you quit for life. Thesestop smoking programs includegroup sessions and self-helpbooklets. The patch is mosthelpful to smokers who areaddicted to nicotine. The generalplan is to switch to the nicotinepatch, stabilize on it until youare accustomed to being a non-smoker, and then taper off withsmaller patches and be off inseveral months. The nicotinepatch is not for everyone. Checkwith your doctor to see if it is bestfor you. You can only get thepatch with a prescription.

How It WorksWhen you wear the nicotinepatch, it delivers a steady dose ofnicotine through your skin intoyour bloodstream. The nicotinetravels to your brain to helpreplace the nicotine your bodygot used to when you smoked.This will help you feel fewerwithdrawal symptoms.

How to Use the Nicotine PatchTalk to your doctor or nurse andread the instructions that comewith the patch to learn how touse it. Your doctor will tell you:

—When to put the patch on(usually first thing in themorning),

—What dose or size of patch touse,

—How long to keep it on eachday,

—How many weeks you shoulduse the patch,

—How you should wean yourselfoff the patch. (Tell your doctorif you think you need to use thepatch for a shorter or longerperiod of time.)

Make Special Note of TheseThings When Using the NicotinePatch

Nicotine from any source(smoking, nicotine gum, orthe nicotine patch) canmake some health problemsworse. For example, heartor circulation problems(such as an irregular heartbeat, chest pain, or a heartattack), high blood pressure,stomach ulcers, overactivethyroid, or diabetes thatneeds insulin.

The nicotine patch shouldnot be used by patients withlife-threatening cardiacarrhythmias, severe orworsening angina, or arecent myocardialinfarction.

The nicotine patch can alsocause problems withpregnancy and a babybeing nursed.

The nicotine patch may notwork as well if you haveskin problems or if your skinis irritated. In some users,the patch may causenormal skin to become redor swollen.

The nicotine patch is not foreveryone.

Be sure to tell your doctor:

—If any of the abovesituations exist,

—If you have side effectsfrom the nicotine patch,such as: red or swollenskin, abnormal dreams,sweating, insomnia, ordiarrhea

—What medications youare on, and

—If you are not ready toquit smoking.

Some Important Things to RememberDon't use the patch if you are still smoking. You will get toomuch nicotine in your body.Don't put the patch on skin that is irritated, burned, or hurt inany way.Don't put the patch on the same place on your skin for al leasta week.Don't use more than one patch at a time.Don't let children or pets touch the patch.You can swim, exercise, take a bath or shower, and go insidea sauna while you are wearing a nicotine patch.If the patch falls off, throw it away and put on a new one in adifferent place that is clean and dry.Keep the patch inside its envelope until you are ready to use it.Put a new patch on and take the old patch off at the sametime each day, or as directed by your doctor.Use other smoking cessation programs or material while youare using the patch.

Pocket Guide to Nurses'Smoking Intervention

1. AskAsk patients if they smoke andhow much.

Congratulate ex-smokers.

Record their smoking status.

2. Adviseask patients about thebenefits of quitting smoking.

Express concern andrecommend that patients quit.

3. PrepareSet a quit date.

Review tips for quitting onhandout.

Tell patients you will followupor you will think of them onquit day.

4. FollowupAsk patients if they smoke.

give ex-smokers a "pat on theback."

Send cards or call patientssoon after their visit and/orjust before quit day.

Discrimination Prohibited: Under provisions of applicable public laws enacted by Congress Since 1964, no person in the United States shall, on the grounds of race, color, national origin, Handicap, or age, be excluded from participation in, be denied the benefits of, or be subjected To discrimination under any program or activity (or, on the basis of sex, with respect to any Education program or activity) receiving Federal financial assistance. In addition, Executive Order 11141 prohibits discrimination on the basis of age by contractors and subcontractors in The performance of Federal contracts, and Executive Order 11246 states the no federally Funded contractor may discriminate against any employee or applicant for employment Because of race, color, religion, sex, or national origin. Therefore, the National Heart, Lung, and Blood Institute must be operated in compliance with these laws and Executive Orders.

U.S. DEPARTMENT OFHEALTH AND HUMAN SERVICES

Public Health ServiceNational Institutes of Health

National Heart, Lung, and Blood Institute

NIH Publication No. 92-2962January 1993

nurses: help your patients stop smoking...smoking is a part of the smoker’s life. to stop smoking,...

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