Page 958 - Cardiac Nursing

009
1
2
0
6
A
A
A
2:0
4 A
qx
d
37.
p93
3-9
/
/
0
d
3
A
ara
43_
34
Apt
0-c
LWBK340-c43_p933-937.qxd 30/06/2009 12:04 AM Page 934 Aptara
L L LWB K34 0-c 43_ p93 3-9 37. qx d 3 0 / 0 6 / / / 2 009 1 2:0 4 A M Pa g g e 9 34 Apt ara
K34
LWB
e 9
A
A
A
A
A
M
Pa
A
934 PA R T V / Health Promotion and Disease Prevention
Communicable diseases,
Cancer + chronic maternal and perinatal
respiratory diseases + conditions and nutritional
diabetes deficiencies
22% 30%
■ Figure 43-1 Causes of death globally.
Injuries 9%
Cardiovascular diseases 30% Other chronic
diseases 9%
rates were significantly higher among smokers than among non- credibility and persuasiveness as smoking-cessation counselors.
smokers. 17 The water pipe, also known as argeela, arghileh, When many smokers are advised to quit, they often resist claim-
e
e
narghile, nargile, nargileh, hubbly-bubbly, sheesha, shisha, and goza, ing, “My doctor smokes” or “Doctors smoke.” For this reason,
y
y
e
e
is a popular form of smoking that is practiced socially in many re- health care professionals who smoke must be targeted for smoking-
gions in the world. This activity usually involves two or more peo- cessation interventions. This approach has a desirable secondary
ple who share the same water pipe. 18 Although a common mis- benefit: Anecdotal evidence suggests that health care professionals
conception persists that smoking a water pipe is not as harmful as who have successfully quit smoking are among the best smoking-
smoking cigarettes, one episode of smoking a water pipe produces cessation interventionists.
as much tar as smoking 20 cigarettes. One study found that water
pipe smoke contains an abundance of chemicals known to be risk Physical Activity
factors for cancer and CVD; the ratio of carbon monoxide to
nicotine was 50:1 as compared with 16:1 for cigarettes. 19 An Regular physical activity reduces the risk of CVD morbidity in
analysis of studies done in Arab countries reveals that 31% to general and of CVD mortality in particular. 24 The risk in physi-
57% of the population smokes a water pipe 20,21 and that more cally inactive people is about double. Developed and developing
women than men use tobacco in this way. 22 Among the reasons countries, however, vary in their perceptions of physical activity.
for this practice is the perception that smoking a water pipe causes In developed countries, routine and recreational activities are con-
25
fewer adverse health effects and is safer than cigarettes, it is a so- sidered physical activity (see Chapter 37) ; in developing coun-
cial activity, and it is considered attractive. 22 Nonetheless, this tries, occupational and nonrecreational activities are considered
practice may have serious consequences. Women who smoke a physical activity. 26 Regardless of how physical activity is defined,
water pipe in their homes expose their children to its fumes, the proportions of people who are physically inactive is increasing
which may adversely impact the health of these “passive smokers.” in many regions of the world. 27,28 According to the INTER-
Health care professionals must make smoking prevention and HEART study, the regions with the least physically active popula-
cessation high priorities in their practices. Details on smoking ces- tions are China (20.3%), Africa (10.1%), and the Middle East. 17
sation interventions are provided in Chapter 34. Such counseling Being physically active, however, presumes that a person is en-
must consider individual differences and use culturally appropri- gaged in regular moderate exercise, such as walking, cycling, or
ate and sensitive methods. Not all forms of pharmacologic aids for gardening, at least five times a week or more. 29
smoking cessation are available globally and may be costly. Nurses Physical activity is exceptionally important because it has a di-
also can work with nongovernmental organizations to ban smok- rect salutary effect on body systems and risk factors, such as high
ing. The WHO’s Code of Practice on Tobacco Control for Health blood pressure, low-density lipoproteins, and high-density
Professional Organizations adopted in Geneva in 2004 encour- lipoproteins, and contributes to the reduction of excess weight
ages and supports nurses to promote tobacco-free cultures. 23 and general fitness. Specific recommendations for increasing phys-
Health care professionals must be proactive in helping their ical activity and exercise can be found in Chapter 37. Culturally
patients to quit smoking. Nurse educators can have a major influ- appropriate environments (e.g., climate) and the cultural suitabil-
ence on tobacco control by teaching their students about smoking ity of exercising outdoors or in groups of mixed genders are also
prevention and smoking cessation for those who are already smok- discussed. According to the WHO, physical activity in the work-
ers. To successfully aid smokers who wish to quit, however, nurses place is recommended when other means for maintaining activity
often need more resources. An excellent and valuable resource that are not available. 30
offers references and education around the clock to nurses is the
www.tobaccofreenurses.org Web site. A discussion of effective Diet
smoking cessation interventions is provided in Chapter 34.
Although health care professionals can be effective role mod- Besides recommending food for energy and nutrition, the United
els, those who smoke—and continue to smoke—undermine their States Department of Agriculture Food Guide Pyramid also