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LEARNING OBJECTIVES

After completing this case study, the reader should be able to:

  • Identify a patient’s location in the stages of change process to develop a tailored intervention plan to promote smoking cessation and nicotine abstinence.

  • Design a patient-specific plan for initiating lifestyle modifications and pharmacologic treatment to assist a patient in quitting smoking.

  • Compare the side-effect profiles of individual nicotine replacement products.

  • Develop appropriate educational information on the use of pharmacotherapy for treatment of nicotine dependence.

  • Formulate monitoring and follow-up plans for a patient attempting to quit smoking based on patient-specific information and the prescribed regimen.

PATIENT PRESENTATION

Chief Complaint

“My sugars are still running high, and I feel tired all the time. I think these cigarettes have something to do with how I’m feeling and I’m over it! I tried to quit once using nicotine gum for two days, but it made me sick to my stomach and made my jaw hurt; plus I was still craving cigarettes. I have two kids and a wife, and I want to get better so I can take care of my family. I’ve seen commercials on what smoking can do to you and I’m scared that could happen to me!”

HPI

Phil Morris is a 41-year-old African-American man who presents to the primary care clinic to review his most recent laboratory results. He reports a 2-week history of extreme thirst and hunger, excessive urination and is generally feeling unwell. His symptoms are interfering with his job. He has missed 2–3 days of work each week in the last month. He is concerned that he will not have enough money to cover his family’s expenses. He states that his insurance premiums and deductibles are high, and he struggles to pay for medical expenses. He reports difficulty remembering to take his medication for blood glucose as prescribed. He wants to feel better because he wants to be able to work and provide for his family.

PMH

Type 2 diabetes mellitus without complications

Nicotine dependence × 18 years

Obesity

Stage 1 hypertension

FH

Father: 67 years old, prior myocardial infarction at age greater than 60; hypertension

Mother: 64 years old; type 2 diabetes mellitus, ovarian cancer

Son: 12 years old; asthma

Daughter: 7 years old; ADHD

SH

Caffeine Use: Daily cola consumption of 8+ cans a day

Tobacco use: Current everyday smoker for 18 years. Smokes a pack of cigarettes daily when he can afford to buy them. He wishes to stop smoking ...

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