Etiology of the Diagnosis
Margaret was diagnosed with nicotine addiction and contraception needs. Identifying the causes is the primary consideration in examining the diagnoses. Nicotine can be classified as a recreational drug; when consumed regularly, it can affect metabolism, interfere with other drugs and substances, cause CNS effects, and alter the generation and functioning of platelets (Woo & Robinson, 2016).
A particularly noteworthy characteristic of nicotine is that it causes addiction because it interferes with chemical processes in the brain and stimulates the generation of adrenalin. With Margaret’s history of smoking one pack a day for ten years, quitting can be challenging for her. Along with physiological causes of the addiction, i.e. the exposure to nicotine for ten years, a psychological component should be recognized, too: many patients find it hard to quit because the ritual of having a cigarette becomes an important part of their everyday activities.
The second diagnosis, the contraception needs, is caused by the fact that the patient is of child-bearing age, her reproductive system is functioning normally, and she leads a healthy sexual life, but she does not want to become pregnant in the nearest future. She has been taking oral contraceptives for 20 years, and she intends to keep taking them because she finds this method of birth control the most effective.
Pathophysiology of the Diagnosis
Pathological processes associated with nicotine addiction primarily include biochemical and hormonal responses to the exposure to nicotine. When absorbed by the blood, nicotine is conveyed to the brain where it causes the release of adrenalin (this hormone is generated by the adrenals situated above the kidneys). This process itself is not pathological unless one should consider the intervention of a recreational drug as a pathological influence.
The process that can be seen as pathological with more certainty is the occurrence of withdrawal symptoms: the effect of adrenalin (normally, excitement and euphoria) is short-term, and the organism seems to require a new dose, which prompts a person to light up another cigarette. The discontinuation of nicotine use can cause negative effects, and apart from psychological effects (such as anxiety and irritability), physiological effects can be present, too, such as headache, increased feeling of hunger, and the feeling of muscle discomfort. The diagnosis of contraception needs does not involve pathological processes unless the process of suppressing ovulation through the chemical exposure to particular drugs should be seen as pathological, which is questionable because this process is not associated with the development of a disease.
Epidemiology
The incidence of addiction to cigarette smoking or other types of nicotine use is hard to measure due to the difficulties associated with identifying the limits of such exposures. Concerning the distribution, the addiction cannot be seen as infectious, although factors are recognized today that may increase the number of smokers in a given area or population due to the existing pattern of the addiction distribution; this refers to the psychological influences on people who decide to start smoking.
Addiction may not develop in the early stage of nicotine use, and occasional smoking may not qualify for the diagnosis of nicotine addiction (the challenges of diagnosing are among the factors that complicate the epidemiological analysis of nicotine addiction).
According to the estimate by the Centers for Disease Control (CDC), “in the United States, cigarette smoking and second-hand exposure to cigarette smoke results in at least 443,000 premature deaths annually” (Arcangelo & Peterson, 2013, p. 839). If one was to measure the epidemiology of contraception needs, the rate to turn to is the number of women in the world whose reproductive systems function normally and who may want to engage in birth control; it can be expected that this number will constitute the majority of women.
Diagnostic Criteria
According to Woo and Robinson (2016), criteria for diagnosing a patient with addiction can be divided into two major groups: dependence and withdrawal. Dependence criteria include tolerance (which causes the need to consume larger amounts of a substance to achieve the same effect that the substance caused on the early stage of use) and the presence of withdrawal symptoms. Arcangelo and Peterson (2013) add several important psychological and social criteria, such as the amount of time and effort a person spends on acquiring and consuming the substance, the number of social activities the person gives up to engage in substance use, the persistent desire to quit using the substance, and the unsuccessfulness of attempts to do so.
Further, the volume of intake is an important criterion, too; a person diagnosed with addiction has been using nicotine every day for at least several concurrent weeks. Withdrawal criteria may include the presence of depressed mood symptoms, insomnia, negative emotional manifestations (such as frustration or anger), and restlessness. The criteria for diagnosing the patient with contraception needs are the patient’s current contraception situation and her willingness to prevent the negative effects of nicotine use on her contraception efforts. There is no substantial need to confirm either diagnosis in the laboratory setting; however, blood tests can be administered to identify the level of nicotine and contraception-related hormones.
Goals of Drug Therapy
The goal of the proposed treatment in the presented case is smoking cessation. The general recommendation in this regard is that “all clinicians aggressively motivate and assist their smoking patients to quit” (Arcangelo & Peterson, 2013, p. 841). Various types of therapy can be listed; major ones include nicotine fading and aversion therapy. In any case, in addition to administering drugs, the patient will need to demonstrate self-management efforts and receive counseling and support from the members of the medical team.
Concerning drugs, nicotine (such as patches) and non-nicotine (such as bupropion) products can be used to help Margaret quit. The goal of nicotine replacement therapy is controlling the level of nicotine in the blood to prevent the occurrence of withdrawal symptoms and making it easier for the patient to adjust to living without smoking.
Prescription
PRIMARY CARE CLINIC
KEISER UNIVERSITY SCHOOL OF NURSING
Date: 9/21/17
Patient Name: Margaret Doe
Birthdate: 9/21/82
Name of Medication: Nicoderm CQ nicotine patch
SIG: A ten-week course: 21 mg per day for six weeks, then 14 mg per day for two weeks, and then 7 mg per day for 2 weeks
The patch should be worn for 16 to 24 hours per day
# dispensed: None
Signature:
Patient Education and Medication Effectiveness
The patient should be particularly instructed that the patch will reduce the physiological withdrawal symptoms but may not reduce the psychological ones, which is why substantial self-management efforts will be needed. The support provided to the patient will include the explanation of the medication effectiveness: the patch will assist in nicotine fading without shocking the organism with cold turkey after ten years of smoking (Biener & Hargraves, 2014).
The effectiveness will be monitored by Margaret’s demonstration of the cessation of cigarette smoking. There are no contraindications (“Nicotine patch,” 2017); however, the patient should be warned that adverse effects can be observed, including cutaneous irritation, dizziness, headache, and nausea. The success of drug therapy will allow Margaret to address her concern about nicotine interference with her contraceptives.
References
Arcangelo, V. P., & Peterson, A. M. (Eds.). (2013). Pharmacotherapeutics for advanced practice: A practical approach (3rd ed.). Ambler, PA: Lippincott Williams & Wilkins.
Biener, L., & Hargraves, J. L. (2014). A longitudinal study of electronic cigarette use among a population-based sample of adult smokers: Association with smoking cessation and motivation to quit. Nicotine & Tobacco Research, 17(2), 127-133.
Nicotine patch. (2017). Web.
Woo, T. M., & Robinson, M. V. (2016). Pharmacotherapeutics for advanced practice nurse prescribers (4th ed.). Philadelphia, PA: F. A. Davis.