Page 818 - Cardiac Nursing

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794 PA R T V / Health Promotion and Disease Prevention
patients avoid excessive weight gain. Patients must also be aware of importance in smoking cessation than do men. 107 If family
that the risks of continued smoking far outweigh the risks of gain- members or close friends smoke, it is important to initiate a plan
ing a few pounds. Weight gain cannot be treated lightly because to help the patient resist the temptation to smoke when around
67% of women in one study stated that they were very concerned others who are smoking. It is imperative to prepare the patient for
or somewhat concerned about weight gain after cessation. 117 In an- this situation if the family member or friend who smokes lives
other study, up to 75% of women and 35% of men reported an un- with the patient. Previous preparation is particularly important
willingness to gain 5 or more pounds as a result of stopping smok- for women living with a smoker because the odds of relapsing are
ing. In particular, more than half of women younger than 25 years 2.5 times higher in this population. 16 The ideal situation, of
and 39% of women older than 40 years stated that they were un- course, is when the family member or friend attempts to quit at
71
willing to gain any weight. It is important to note that weight gain the same time the patient does; therefore, interventions that tar-
is not just a concern of women. Weight gain in the first 3 months get other smokers in the household at the same time seem pru-
after cessation was predictive of relapse to smoking for men. In fact, dent. If this is not feasible, the nurse should counsel the family
the risk of relapse increased by 17% for every kilogram of weight member or friend to (1) not smoke in the presence of the patient
gained. 118 Providers must therefore openly discuss the possibility of if possible; (2) remove all cigarettes and other tobacco products
weight gain but stress to the patient that the amount of weight from the household; and (3) refrain from offering cigarettes to the
gained is usually limited and that a program of exercise and a patient who is trying to quit. Family members and friends should
61
healthy diet can control weight gain. In addition, current studies also be encouraged to provide daily positive reinforcement for pa-
indicate that NRT, particularly the gum, and bupropion SR have tients successful at quitting. It may also be appropriate for the
been shown to at least delay postcessation weight gain. 61,62 In the nurse to teach the patient some basic assertiveness skills, so that
case of bupropion SR, weight gain was actually significantly less the patient is prepared to ask assertively that the family member
compared with placebo, 3.8 kg versus 5.6 kg, respectively. 87 or friend not smoke in his or her presence, not offer him or her
cigarettes, and so forth. The Enhancing Recovery in Coronary
Social Support Heart Disease Patients (ENRICHD) Social Support Instrument
(ESSI) is a brief seven-item questionnaire that is useful in assess-
Support from a spouse or family members is directly related to ing social support in cardiac patients 120–122 and can help guide
quitting smoking and short-term maintenance of the nonsmoking where emphasis should be placed when designing an individual-
behavior. 119 Women in particular give social support higher ratings ized intervention when social support is low (Fig. 34-4).
Please read the following questions and circle the response that most closely describes your current situation.
1. Is there someone available to you whom you can count on to listen to you when you need to talk?
None of the time A little of the time Some of the time Most of the time All of the time
1 2 3 4 5
2. Is there someone available to give you good advice about a problem?
None of the time A little of the time Some of the time Most of the time All of the time
1 2 3 4 5
3. Is there someone available to you who shows you love and affection?
None of the time A little of the time Some of the time Most of the time All of the time
1 2 3 4 5
4. Is there someone available to help you with daily chores?
None of the time A little of the time Some of the time Most of the time All of the time
1 2 3 4 5
5. Can you count on anyone to provide you with emotional support (talking over problems or helping you make a
difficult decision)?
None of the time A little of the time Some of the time Most of the time All of the time
1 2 3 4 5
6. Do you have as much contact as you would like with someone you feel close to, someone in whom you can trust
and confide?
None of the time A little of the time Some of the time Most of the time All of the time
1 2 3 4 5
7. Are you currently married or living with a partner?
Yes No
■ Figure 34-4 ESSI. (Reprinted with permission from Mitchell, P. H., Powell, L., Blumenthal, J., et al.
[2003]. A short social support measure in patients recovering from myocardial infarction: The ENRICHD
Social Support Inventory. Journal of Cardiopulmonary Rehabilitation, 23, 398–403.)