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Guide Helps Clinicians Aid in Smoking Cessation

The United States Department of Health and Human Services publishes a quick reference guide for clinicians titled, "Treating Tobacco Use and Dependence."1 The comprehensive guide helps providers assist patients in smoking cessation.


Smokers tend to have one favorite cigarette that is the most difficult to give up. Perhaps it is the morning cigarette with coffee or the one after dinner. Ask the smoker to think about his favorite cigarette and what he will do in place of it. A well-conceived strategy is imperative to success.


Smokers realize cigarettes are addictive, and that often a whole day revolves around when to take cigarette breaks. Although most providers tell smokers that nicotine increases heart rate and blood pressure, smokers still use cigarettes for stress reduction. After all, cigarettes have accompanied smokers through all of life's stressors, including births, deaths, marriages, divorces, quarrels, celebrations and solitude.


Weight gain is a very important issue for the patient trying to quit smoking. Most will gain between 10 and 30 pounds, and women gain slightly more than men. 2 The fear of weight gain seems to have a more profound effect on some patients than maintaining overall health.


Seventy percent of smokers state a desire to quit. Studies indicate that a provider's advice to quit is an important motivator for patients to quit smoking. 4


REFERENCESFiore MC, Bailey WC, Cohen SJ, et al: Treating tobacco use and dependence. Quick reference guide for clinicians. Rockville, Md: Department of Health and Human Services. Public Health Service, October 2000. [Context Link]Williamson DF, Madans J, Anda RF, et al: Smoking cessation and severity of weight gain in a national cohort. N Engl J Med 1991; 324 ( 11 ): 739-45. [Context Link]Centers for Disease Control and Prevention: Health objectives for the nation: cigarette smoking among adults-United States, 1993. MMWR 1994; 43 ( 50 ): 925-30.Ockene JK: Smoking intervention: The expanding role of the physician. Am J Public Health 1987; 77 ( 7 ): 782-3. [Context Link]


Jean A. Harris, FNP-C


Raleigh, NC


Observe for Eating Disorders

Early identification of an eating disorder can lead to a quicker recovery. The first step is to take a thorough history and establish a rapport. Tools such as the Sick, Control, One Stone, Fat, and Food (SCOFF) questionnaire and the Guidelines for Adolescent Preventive Services (GAPS) questionnaire can assist in diagnosing eating disorders. 1


If an eating disorder is suspected, screen for alcohol and drug use, and any suicidal plans. The patient should be referred to a mental health professional and given a list of local support groups. Since the majority of patients with eating disorders are adolescents, the support of parents and families plays a major role. Regular follow up should be scheduled.


REFERENCEMoore A: A new screening tool for eating disorders. RN 2000; 63:14. [Context Link]


April Parrish DeGuzman, RN, BSN


Durham, NC


Drain the Green, Dry the Clear

Second and third generation antihistamines (Allegra, Claritin, Clarinex, and Zyrtec) claim they do not have anticholinergic effects. However, they still tend to dry mucous and mucous membranes. Most allergic conditions respond well to these antihistamines, particularly when mucous is clear. Once the mucous has become discolored, such as with a viral or bacterial infection, drainage promotion becomes necessary.


To promote drainage, mucolytics, such as guaifenesin, should be prescribed for the duration of the infection. Guaifenesin 600 mg 1 PO bid, with food, is usually sufficient for adults. Children generally tolerate Robitussin, as indicated according to age group. Oral antihistamines should be discontinued at this time to avoid excessive thickening and resultant stasis of infectious mucous.


If the benefits of an antihistamine are needed to provide relief of rhinitis symptoms, a nasal antihistamine spray, such as azelastine (Astelin), is an excellent option. It will usually provide immediate relief of nasal congestion, sneezing, rhinorrhea and postnasal drip, without compromising overall attempts to promote drainage. Steroid nasal sprays are also very helpful, but do not provide immediate relief. If opting to use a steroid nasal spray, preference should be given to agents free of fragrance, as fragrance agents have been associated with sinus headaches.


Donna Hogan, MS, RN, FNP-C


Decker School of Nursing, SUNY Binghamton



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