Tutorial 4: Case 2

Question 1

David and his wife are expecting a baby which is a great motivation for quitting smoking. He asks if you have anything to help

Not standard WWHAMMA questions due to the nature of this case

A) Who is it for?

B) Have you tried to give up smoking before?

C) Tried anything before to help quit smoking and if so what did or didnt work?

D) Any medical conditions

E) Medications being taken?

F) Allergies

Answer 1

A) Myself

B) Quite a few times, though whenever I had a stressful time at work or at home in the following few weeks I started back again.

C) Only cold turkey

D) None

E) None

F) None

Question 2

Appropriate extended questions

1. How many cigarettes do you smoke each day?
2. How long to first cigarette upon waking?
3. Assess motivation - are you ready to this now? 6 months? Reasons?
4. Any preference for the treatment type?

Answer 2

1) 20-25 each day
2) Around 15-20 minutes after getting up
3) I am ready to quit today, I have come in here determined to start today and I need to do this so my new baby is never exposed to me smoking so I am around all their life
4) No time to go Dr in the next week to consider prescription tablets. Think I would like a patch as I can hide it under my clothes and not think about chewing gum

Question 3

What is your response to the patient regarding his choice to quit now and motivation?

Answer 3

• Encourage him and set a plan
• Health benefits outweighs the risks
• You may get withdrawals
• Come back and talk to me if you think of relapsing

Question 4

What product would you recommend for this patient? Provide IDARL.

Answer 4

Nicotine Transdermal patch

• Indication: Transdermal patch (step 21) is appropriate as he smokes more than 10 cigarettes a day. Will help with cessation and reduce symptoms of withdrawal.
• Dosage and directions: 1 patch a day 21mg/24 hours. Apply patch to clean dry non-hairy skin on the upper part of body or arm, use different site each day.
• Adverse effects: Sleep disturbances, irritation, redness
• Duration of treatment, time to recovery, when to refer: Stop use within 12 weeks or redice slowly to 14mg and mg doses. Refer if you have cardiovascular problems, diabetes, intolerable to NRT side effect/.
• Lifestlye/self care: Avoid situations where you want to smoke and have a healthy diet.

I will give you a self care-card smokimg and a consumer medication information leaflet. Do you have any questions for me?