Assessment of Respiratory Status.
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.
The Video Transcript: Anne: Let's see... my next patient is Mary. She's 53, Caucasian, and had a heart attack a year ago. She is being seen today for an exacerbation of COPD. She also has controlled Type II diabetes. She's had depression that started when she lost her job a year ago. She's still is unemployed but receiving government checks. But that isn't enough income for her to live independently. She had to move in with her daughter and son-in-law.
Today her chief complaint is a harsh productive cough and increased shortness of breath. And she's still smoking, which is upsetting her daughter who has a young child who is bothered by the second-hand smoke.
Anne: Hi, Mary. How are you feeling today?
Mary: Overall, I feel pretty healthy. I walk for about half an hour every single day. And I've been following the diet that the dietician suggested, watching what I eat. I'm proud of the fact that my diabetes has never been better controlled!
Anne: So far, so good. Is there anything that concerns you?
Mary: Yes. Lately I've been coughing so hard and having difficulty catching my breath which is causing me to feel like I might be having some twinges in my chest, and I'm scared to death I'm going to have another heart attack. I want to know what more I can do to prevent that from happening again.
Anne: I'd be happy to explore healthy options. To start, I'd like to ask you a few follow-up questions related to the history form you filled out in the waiting room. You're still smoking?
Mary: (Sigh...) Yes, cigarettes are my one remaining vice. I've been smoking over 40 years. My parents smoked and they taught me how to light their cigarettes when I was 12!
Anne: How much are you smoking?
Mary: About a pack a day. That's 20 cigarettes. I light up first thing in the morning. If I don't, it's all I think about. My body craves it. It is just so frustrating, especially since it is upsetting my daughter and son in law so much. I don't know where I will go if they kick me out of their home.
Anne: I'm sure that is very upsetting to think about, Mary. Let me take a quick listen to you and then we can discuss some options that may be available to you.
Mary: Sure, that would be fine.
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?
What will you do to follow-up on Mary's smoking cessation process?