Smoking Nursing Diagnosis and Nursing Care Plan

Last updated on May 15th, 2022 at 10:56 am

Smoking Nursing Care Plans Diagnosis and Interventions

Smoking NCLEX Review and Nursing Care Plans

Smoking or nicotine dependence arises when there is a strong need for nicotine and the inability to stop using it. Nicotine is a substance found in cigarettes, and it has a pleasant momentary effect on the brain that makes quitting difficult.

This makes smoking addictive. The more the patient smokes, the more addictive it gets. When the patient tries to stop, unpleasant mental and physical changes may be experienced, which are considered smoking withdrawal symptoms.

Stopping can improve the patient’s health regardless of how long the patient has been smoking. However, it is not easy to suddenly break the smoking dependence, but there are many effective treatments available to help the patient.

Several countries have already raised cigarette taxes significantly and regularly undertake anti-smoking initiatives. In some nations, smoking is prohibited in shops and other public areas.

Signs and Symptoms of Smoking and Nicotine Dependence

For some patients, even a tiny amount of tobacco can develop into smoking dependence.

The following are signs and symptoms of smoking dependence:

  • Inability to quit smoking. It happens when there are several unsuccessful attempts to stop smoking.
  • Presence of withdrawal symptoms. Symptoms like solid cravings, anxiety, irritation, restlessness, difficulty concentrating, depressed mood, frustration, anger, increased appetite, insomnia, constipation, or diarrhea have all resulted from the attempts to quit smoking.
  • Smoking despite having health problems. There is an inability to stop smoking even if there is a developing problem to the heart and lungs.
  • Failure to participate in social activities. It happens when there are some restrictions on smoking, like smoke-free restaurants and socializing with family and friends.

Causes of Smoking and Nicotine Dependence

Nicotine is a substance in cigarettes that is addictive. Within seconds of taking a cigarette, nicotine reaches the brain and will stimulate the release of brain chemicals known as neurotransmitters, which are responsible for controlling mood and behavior.

Dopamine is one of these neurotransmitters, it is released in the brain’s reward center and promotes sensations of pleasure and an enhanced mood. When a person stops smoking for a few hours, the levels of these hormones fall, causing anxiety and possibly anger. This may necessitate the intake of additional nicotine.

The following are some examples of scenarios that trigger smoking and nicotine dependence:

  • Having a cup of coffee
  • Taking a break at work
  • Making a phone call
  • Consuming alcoholic beverages
  • Driving
  • Having fun with friends

Risk Factors for Smoking and Nicotine Dependence

Anyone who smokes or uses other forms of cigarettes is at risk of becoming addicted. The following are some of the factors that influence smoking dependence:

  • Age. The majority of people start smoking throughout their childhood or adolescence. The younger the person starts smoking, the more likely they become addicted.
  • Genetics. The chances that the person starts smoking and keeps smoking may be partly inherited. The way nicotine receptors on the surface of the brain’s nerve cells respond to high doses of nicotine provided by cigarettes may be influenced by genetic variables.
  • Peers and parents. Children who grow up with smoking parents are more likely to become smokers themselves. Children who have smoking friends are more prone to try and become addicted to it.
  • Other mental illnesses or depression. There is a link between depression and smoking, according to numerous research. Smokers are more prone to suffer depression, schizophrenia, post-traumatic stress disorder, or other mental illnesses.
  • Substance use. Smokers are more likely than nonsmokers to abuse alcohol and illegal drugs.

Diagnosis of Smoking and Nicotine Dependence

Psychological Assessment. To determine the patient’s level of dependency on nicotine, the healthcare provider may ask for questions or may ask to fill out a questionnaire.

Then the healthcare provider will be able to identify the best treatment plan based on the level of dependency. The more cigarettes smoked every day, and the earlier started smoking after waking up, the more dependent the patient gets.

Complications of Smoking and Nicotine Dependence

Cigarette smoking contains over 60 recognized carcinogens, as well as thousands of additional hazardous compounds. Even “all-natural” or herbal cigarettes contain carcinogens.

It is already known that smokers are far more likely than non-smokers to acquire and die from certain diseases. However, the patient may be unaware of the wide range of health issues that smoking dependence causes:

  • Lung cancer and lung disease. Lung cancer is the most common cause of mortality. Smoking also leads to lung disorders, including emphysema and chronic bronchitis. Asthma is also worsened by smoking.
  • Other types of cancer. Many forms of cancer, including cancers of the mouth, throat (pharynx), esophagus, larynx, bladder, pancreas, kidney, cervix, and some types of leukemia, are increased by smoking. Smoking is responsible for 30 percent of all cancer deaths.
  • Heart and circulatory system problems. Smoking raises the chances of dying from heart and blood vessels or cardiovascular diseases, such as heart attack and stroke. Smoking worsens the condition if there is heart failure.
  • Diabetes. Cigarette use causes insulin resistance, which can lead to type 2 diabetes. If there is a presence of diabetes, smoking can speed up the progress of complications like kidney damage and vision problems.
  • Eye problems. Smoking raises the chance of significant eye issues such as cataracts and macular degeneration, which can lead to vision loss.
  • Infertility and impotence. In women, smoking raises the risk of infertility, while in men, it increases the risk of impotence.
  • Complications during pregnancy. Mothers who smoke while pregnant are more likely to have preterm births and babies with lower birth weights.
  • Colds, flu, and other illnesses. Smokers are more susceptible to respiratory diseases such as colds, flu, and bronchitis.
  • Gum disease and tooth decay. Smoking is linked to an increased risk of gum inflammation and significant gum infection, which can destroy the teeth’s support system or is known as periodontitis.

Prevention of Smoking and Nicotine Dependence

Avoid starting to smoke. The most excellent approach to avoid smoking dependence is to avoid smoking in the first place.

Become a role model. The most excellent method to prevent children from smoking is to become role models and refrain from smoking. According to research, children whose parents do not smoke or who have successfully quit smoking are far less likely to start smoking.

Treatment for Smoking and Nicotine Dependence

Most smokers have tried to quit at least once. However, quitting smoking on the first attempt is unusual, especially if there is no help. It is far more probable that the patient will be able to quit smoking if medications and counseling are utilized, both of which have been proven to be helpful, especially when used together.

  1. Medications. Certain quit-smoking products are referred to as nicotine replacement therapy because they contain various levels of nicotine, some of these nicotine replacement medications are available without a prescription, while others do. There are two FDA-approved nicotine-free quit-smoking drugs, both of which are only available by prescription.
  2. Counseling. Medications can help manage smoking dependence by reducing the withdrawal symptoms and cravings, while behavioral therapy can help the patient learn the skills needed to quit smoking for good. The more time spent with a counselor, the better the outcome of the treatment. The patient will learn ways that can help quit smoking through individual or group treatment. Treatment programs are available from a variety of hospitals, healthcare plans, healthcare providers, and businesses. Residential treatment programs, the most intensive form of treatment, are available at several medical institutes.
  3. Methods to avoid. Electronic cigarettes (e-cigarettes) have not been proven to be safer or more successful than nicotine replacement drugs in helping patients quit smoking. In fact, many people who try to quit smoking with e-cigarettes end up using both products instead of quitting. Substituting another sort of cigarette for smoking is not very ideal. Cigarette in any form is dangerous. The following should be avoided:
  • Dissolvable cigarette products
  • Smokeless cigarettes
  • Lollipops and balms containing nicotine
  • Pipes and cigars
  • Hookahs
  1. Lifestyle Changes.Nicotine addiction treatment mostly relies on medications as well as having the time to go through withdrawal symptoms and learn coping skills. To make the transition away from nicotine easier, the following methods are suggested:
  • Get some exercise on a regular basis.
  • Pick snacks that will keep the mouth and hands occupied.
  • Cigarette products should be removed from the home and vehicle.
  • Avoid situations that could lead to a relapse, such as being in the company of other smokers.
  • Make healthy food choices.
  • Set reasonable treatment goals.
  • Set little goals and a reward system.

Prevention of Smoking and Nicotine Dependence

  1. Smoking cessation. The nurse should encourage the patient to start deciding to quit smoking, and the nurse should help the patient in crafting an effective quit-smoking action plan and when to get started.
  2. Support group. The nurse should determine if the patient will have a strong support group that can include family, friends, and the healthcare provider.
  3. Manage withdrawal symptoms. The nurse should educate the patient on possible challenges that may arise during the quit-smoking phase and how to overcome those challenges.

Nursing Diagnosis for Smoking and Nicotine Dependence

Smoking Nursing Care Plan 1

Impaired Gas Exchange

Nursing Diagnosis: Impaired Gas Exchange related to ventilation-perfusion imbalance secondary to smoking and nicotine dependence, as evidenced by difficulty in breathing, changes in mentation, hypoxemia, and cyanosis

Desired Outcomes:

  • The patient will be able to show signs of improved ventilation and adequate oxygenation of tissues resulting in arterial blood gas within the patient’s normal range.
  • The patient will be free from symptoms of respiratory distress.
Smoking Nursing InterventionsRationale
Assess the patient’s breathing rate, depth, and ease of breathing. Determine if the patient is using the accessory muscles, pursed-lip breathing, changes in skin or mucous membrane color, pallor, and cyanosis.Increased work of breathing and cyanosis may indicate increased oxygen consumption and energy expenditures, as well as a reduction in respiratory reserve as a result of pain or as an initial compensatory mechanism to accommodate for the loss of lung tissue.
Monitor and document the patient’s arterial blood gas and pulse oximetry. measurements, take note of the patient’s hemoglobin levels as well.Partial pressure of oxygen decreases or increases, indicating the need for ventilatory support. Significant blood loss can reduce Pao2 by lowering oxygen-carrying capacity.
Assess the patient for signs of restlessness and changes in the level of consciousness or mentation.This may indicate increased hypoxia.
Evaluate the patient’s reaction to the activity. Rest periods should be encouraged, and activities should be limited to the patient’s tolerance.    Increased oxygen consumption demand might cause increased dyspnea and changes in vital signs with activity; however, early mobilization is preferred to avoid pulmonary problems and to achieve and maintain respiratory and circulatory efficiency. Respiratory impairment can be avoided with adequate rest and activity.
Encourage the patient to perform deep breathing and pursed-lip breathing techniques as needed.Breathing exercises will help the patient to relax, and pursed-lip breathing reduces shortness of breath and is a simple and effective strategy to slow down the breathing rate, making each breath more effective.
Administer supplemental oxygen to the patient using a nasal cannula, a partial rebreathing mask, or a high-humidity face mask, if needed.Increases the amount of oxygen available, especially when ventilation is decreased due to anesthetics, depression, or pain.

Smoking Nursing Care Plan 2

Ineffective Airway Clearance

Nursing Diagnosis: Ineffective Airway Clearance related to increased mucus production secondary to smoking and nicotine dependence, as evidenced by remarkable changes in the respiratory rate or depth, abnormal breath sounds upon auscultation, difficulty in breathing, and ineffective cough.

Desired Outcome: The patient will be able to demonstrate a patent airway with clear breath sounds during chest auscultation, silent respirations, and fluid secretions easily expectorated.

Smoking Nursing InterventionsRationale
Assess the patient’s chest by auscultation and determine the character of breath sounds and the presence of secretions.Retained secretions and/or airway blockage are indicated by noisy respirations, rhonchi, and wheezes.  
Demonstrate to the patient the proper deep breathing and coughing techniques while in an upright or sitting position.Maximum lung expansion is favored in an upright position.  
Encourage the patient to maintain an oral fluid intake of at least 2500 mL/day, within cardiac tolerance.Hydration helps to keep secretions loose and improves expectoration.  Apply a humidified oxygen nebulizer and/or an ultrasonic nebulizer to help the patient breathe easier and Administer additional IV fluids as needed.Maximum hydration aids expectoration by loosening or liquefying secretions. To maintain hydration, patients with impaired oral intake require additional IV supplementation.
Assess the patient for pain or discomfort and administer medication before doing breathing exercises on a regular basis.To avoid respiratory insufficiency, this method encourages the patient to walk, cough more effectively, and breathe deeply without pain.
Determine the patient’s volume and characteristics of sputum or secretions aspirated. Investigate for any changes indicated  Sputum that is thick or tenacious, bloody, or purulent indicates the onset of secondary problems such as dehydration, pulmonary edema, local bleeding, or infection that must be addressed.
Administer bronchodilators, expectorants, and/or analgesics to the patient as needed.    This Improves airflow by relieving bronchospasm. Expectorants help to remove mucus by increasing mucus production and liquefying, and reducing the viscosity of secretions. Chest pain relief encourages cooperation with breathing exercises and improves the efficiency of respiratory treatments.

Smoking Nursing Care Plan 3

Ineffective Breathing Pattern

Nursing Diagnosis: Ineffective Breathing Pattern related to mucus and airway irritants secondary to smoking and nicotine dependence, as evidenced by abnormal rate, rhythm, depth in breathing, nasal flaring, orthopnea, pursed-lip breathing, and the use of accessory muscles when breathing.

Desired Outcomes:

  • The patient will be able to maintain an effective breathing pattern, as evidenced by relaxed breathing at a normal rate and depth and absence of dyspnea.
  • The patient will be able to verbalize or demonstrate feeling more comfortable when breathing.
  • The patient will be able to report feeling rested every day.
  • The patient will be able to perform effective diaphragmatic pursed-lip breathing.
Smoking Nursing InterventionsRationale
Assess the patient’s respiration at least every four hours, check and record the respiratory rate and depth.    Adults breathe at a pace of 10 to 20 breaths per minute on average. When there is a change in breathing patterns, it is critical to act quickly to recognize early indicators of respiratory system problems.
Determine the patient’s arterial blood gas levels in accordance with facility policy.This device keeps track of the patient’s oxygenation and ventilation levels.
Ask the patient if there is a feeling of “out of breath” and document any sign of dyspnea.Anxiety can sometimes cause dyspnea. Keep an eye on the patient for signs of “air hunger,” an indication that the cause of shortness of breath is physical.
Position the patient with optimal body alignment for maximum breathing pattern.Sitting or upright position allows for the most lung excursion and chest expansion.  
Encourage the patient to breathe diaphragmatically.This approach relaxes muscles while also increasing the oxygen levels of the patient.
Encourage the patient to take regular rest periods and educate the patient to pace activities.Shortness of breath might be exacerbated by increased activity. Ensure that the patient gets plenty of rest in between heavy activity.
Advice the patient to always keep the airway open.Encouraging the patient to mobilize their own secretions through effective coughing facilitates proper clearance of secretions.
Encourage the patient to take small frequent feedings.Small frequent feedings keep the diaphragm from getting too crowded.
Assist the patient with activities of daily living, as needed.This method will help the patient to save energy and prevent overwork and exhaustion.

Smoking Nursing Care Plan 4

Activity Intolerance

Nursing Diagnosis: Activity Intolerance related to hypoxemia and ineffective breathing patterns secondary to smoking and nicotine dependence, as evidenced by an increased amount of supplemental oxygen required, dyspnea, Signs of pain such as frequent grimace, reluctancy to initiate activities, and inability to perform activities of daily living.

Desired Outcomes:

  • The patient will be able to determine the significance of continuous physical activity.
  • The patient will be able to immediately report the onset of pain during exercises.
  • The patient will be able to express a greater willingness to participate in activities.
  • The patient will be able to demonstrate how to manage energy effectively.
  • The patient’s vital signs will have returned to normal.
Smoking Nursing InterventionsRationale
Determine the source of the patient’s activity intolerance.      Planning and treatments will be guided by the reason why the patient is unable to participate in activities. Whether the cause is physical, psychological, or motivational, the treatment plan will be different.
Assess the patient’s capacity to participate in activities and the tolerance for the activity.This data serves as a starting point for care planning.  
Assess the patient’s suitability for daily scheduled activities.    The patient’s state may fluctuate from day to day. Frequent assessments are essential for getting the patient up and moving as soon as possible
Teach the patient how to perform some range of motion (ROM) exercises.  Range of motion exercises improve circulation and help prevent contractures.  
Encourage the patient to engage in active range of motion exercises.  Muscle strength, flexibility, and joint and tendon alignment are all improved with regular exercise. Repeated workouts help build tolerance, which is necessary for performing activities of daily living.
Explain the importance of continuing activities for both the patient and the family/caregiver.Regular exercise helps to maintain muscle strength and a conditioned state.  
Educate the patient and the family about the following ways how to conserve energy:   To avoid rushing, plan ahead.To carry out activities, take a seat.For sponges and brushes, use extension handles.Instead of pull, push.Before engaging in more significant activities such as eating and showering, take a break.When these approaches are used correctly, they limit oxygen use and prevent the patient from becoming fatigued rapidly.    

Smoking Nursing Care Plan 5

Deficient Knowledge

Nursing Diagnosis: Deficient Knowledge related to unawareness of information or resources due to a lack of exposure secondary to smoking and nicotine dependence, as evidenced by statements of concern, request for additional information, inability to follow instructions, agitated and apathetic behavior.

Desired Outcomes:

  • The patient will be able to verbalize understanding of the treatment plan,
  • The patient will be able to participate in the smoking cessation program actively.
  • The patient will be able to verbalize a full understanding of the therapeutic regimen.
  • The patient will be able to perform the necessary treatment methods and explain the actions correctly.
Smoking Nursing InterventionsRationale
Assess the patient’s capacity to learn the required healthcare services.Cognitive deficits must be identified before a proper teaching strategy can be devised.
Examine the patient’s drive and readiness to cooperate in the smoking cessation program.Learning takes a lot of effort. Patients must see a reason or need to learn.
Determine the importance of the patient’s learning needs in the context of the overall care plan.  This is to determine what has to be stated, particularly if the patient has prior knowledge of the situation. Knowing what to prioritize will assist the nurse to avoid valuable time.
Provide the patient with a calm and relaxing environment that is free from smoking triggers.The patient can concentrate and focus more fully in a tranquil setting away from any distractions.
Include the patient in the development of the quit-smoking plan, beginning with the establishment of learning objectives and goals at the start of the session.Setting goals allows the patient to anticipate what will be discussed and what they can expect throughout the session.

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon


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Anna Curran. RN, BSN, PHN

Anna Curran. RN-BC, BSN, PHN, CMSRN I am a Critical Care ER nurse. I have been in this field for over 30 years. I also began teaching BSN and LVN students and found that by writing additional study guides helped their knowledge base, especially when it was time to take the NCLEX examinations.

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