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Plan of Care

Ashley Buccio

Delaware Technical Community College

NUR 320

Helen Cameron

November 26, 2022

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Plan of Care

Mr. K is a 36-year-old male. The patient's health problems include a history of tobacco

use and hypothyroidism. The patient (pt), is at risk for relapse. He reports that he has recently

had urges to smoke. Mr. K started smoking in 1998 in middle school and quit smoking in 2009.

He then relapsed in 2010 for a few months and again quit later that year. When he initially quit

he quit cold turkey and started eating a lot to cope. He claims he relapsed due to stress and

social influence as well as a tough breakup and lowered inhibitions due to alcohol. The patient

stated, “a cigarette goes best with alcohol”. Upon examination, pt does not appear to have

symptoms of tobacco withdrawal. The patient claims they have not had a cigarette in 12 years.

Prior to the patient relapsing from smoking tobacco, the patient started noticing

symptoms of hypothyroidism but did not know they were symptoms of hypothyroidism. Mr. K

was diagnosed in 2010 with hypothyroidism around the age of 23. Upon interview, pt stated that

they had experienced anxiety/panic attacks and initial severe weight loss then weight gain.

Fatigue malaise and mental fog. The patient stated that the mood changes affected his

relationships. He is currently taking levothyroxine and is still having occasional fatigue and

mood changes. Upon examination, the patient appears to have dry skin on their face as well as

hair loss on their head. All of which are signs of hypothyroidism.

The patient has a family history of tobacco addiction. His dad and paternal grandfather

are former smokers. He had poor social influences and his close friends around him were

smoking. Mr. K continues to have occasional “cravings” for nicotine. Smoking or even having a

history of smoking can cause patients to have major health risks. According to the centers for

disease Control and Prevention (CDC) “Smoking causes cancer, heart disease, stroke, lung

diseases, diabetes, and chronic obstructive pulmonary disease (COPD), which includes

emphysema and chronic bronchitis” (2020, para. 1). Smoking also increases the risk for

tuberculosis (TB), certain eye diseases, and problems of the immune system, which can include

rheumatoid arthritis (RA) (Centers for Disease Control and Prevention [CDC], 2020, para. 1).
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The patient also has a family history of hypothyroidism. His maternal grandmother and

paternal grandmother have hypothyroidism. Hypothyroidism is a continuing condition that he will

have to take medication for the rest of his life. The medications are not curative and even while

taking the medicine the patient still has symptoms that affect him.

In patients who are current smokers “nicotine replacement therapy is considered the

lowest risk option. It introduces few new risks and can be stopped abruptly without losing its

effectiveness” (Mendes, 2022, p. 525). Currently, in hospitals, we offer nicotine replacement

therapy in the form of patches. However in this case the patient decided to quit cold turkey on

their own without using nicotine replacement therapy. For hypothyroidism “Thyroxine is

administrated in all cases of hypothyroidism and is considered the mainstay of therapy”

(Halawani et al., 2018, p. 3). Like most medications, it comes with side effects and does not

always control all the symptoms of hypothyroidism. As the patient stated they still have

“occasional fatigue and mood changes”.

The patient was informed that the Centers for disease control and prevention (CDC)

website has multiple resources and information to help with the smoking cessation journey

https://www.cdc.gov/tobacco/campaign/tips/quit-smoking/guide/staying-smokefree.html The

CDC also has a number that people can call to help with quitting smoking 1-800-QUIT-NOW.

The patient was also informed that another great resource specifically for in-person treatment is

ChristianaCare located near the patient at 4755 Ogletown Stanton Rd, Newark, DE 19718. They

also have online resources at https://christianacare.org/health/smoking-cessation-program/ and

they have a number specifically for helping quit smoking at 302-623-4661.

The Monarch Wellness Center of Delaware is a place that specializes in thyroid-related

diseases and issues. The place is located near the patient at 2601 Annand Dr, Suite 17,

Wilmington, DE 19808. The website https://monarchwellnesscenterdelaware.com/ was also

given to the patient as a resource along with their phone number, 302-482-2289, and email

monarchwellnessde@gmail.com. At the facility, they can get blood work done and give
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injections and help with the symptoms of hypothyroidism such as weight changes. Another great

resource is https://www.thyroid.org/patient-thyroid-information/ They have a lot of information on

hypothyroidism as well as clinical trials and newsletters and support links for patients' frequently

asked questions a health blog information on thyroid specialists as well as other resources.

Upon further examination the patient’s health literacy is excellent. The goal is for the

patient to verbalize an understanding of both tobacco use and hypothyroidism and their risk

factors. Another goal is for the patient to verbalize their triggers for smoking by the end of the

visit and continue to avoid them as best as possible. The patient did mention that they relapsed

due to stress, social influence, and alcohol lowering their inhibition. The other goal is for the

patient to continue to take medication as prescribed and report any new symptoms next visit.

The patient's goal is to verbalize the thyroid medication that they are currently taking and what

they are taking it for by the end of the first interaction. He should be able to verbalize places

they can find resources on the web and in person by the end of the hospital stay. The patient

should be able to verbalize the importance of getting bloodwork done as well as what they are

testing for.

Upon follow-up appointments with the patient, they utilized their resources and the

suggested resources to learn more about and get treatment for their condition. Pt should remain

smoke-free. Pt should also remain free of cravings. As well as Mr.K continues to have minimal

to no symptoms and continues to get bloodwork checked. The implemented interventions would

be evaluated by interventions by having Mr. K explain back to me what steps he needs to

continue to take to remain symptom-free. I will evaluate how well the patient is doing with the

advised treatment plan and resources through follow-up visits. Pt remains smoke-free. Pt also

remains free of cravings. As well as Mr.K continues to have minimal to no symptoms and

continues to get bloodwork checked.

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Next time a patient is taught their health literacy should be evaluated first. The patient

had a good understanding of their condition and their history of smoking as well as the negative

implications of it. The patient was able to find good resources on their own.

I learned that a health condition can affect decision-making and cause poor health

choices. In my patient's case, the symptoms of hypothyroidism caused the patient to lose

relationships with loved ones which caused poor decision-making habits of drinking and

smoking. Even though I try not to judge people based on a habit. I have always been quick to

judge people for smoking especially when they understand the consequences. In Mr. K's case,

he started at a very young age when he didn't fully understand the consequences. He also

relapsed at a very difficult time in his life when he was dealing with a disease that he didn't know

he had. Knowing this, I have more empathy for the patients who smoke because I never know

what they have been through that caused them to smoke.

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References

Centers for Disease Control and Prevention. (2020, April 28). Health effects. Centers for

Disease Control and Prevention. Retrieved November 24, 2022, from

https://www.cdc.gov/tobacco/basic_information/health_effects/index.htm#:~:text=Smokin

g%20causes%20cancer%2C%20heart%20disease,immune%20system%2C

%20including%20rheumatoid%20arthritis.

Centers for Disease Control and Prevention. (2022, February 4). Prepare to stay smokefree.

Centers for Disease Control and Prevention. Retrieved from

https://www.cdc.gov/tobacco/campaign/tips/quit-smoking/guide/staying-smokefree.html

Halawani, M. S., Nughays, R. O., Altemani, A. F., Hussien, N. M. M., Alghamdi, N. M., Alasadi,

F. H. A., Wasfi, L. A., Alrehaili, M. A., Alharbi, A. A., & Siraj, M. M. (2018). Causes,

Diagnosis, and Management of Hypothyroidism. Egyptian Journal of Hospital Medicine,

71(1), 2250–2252. https://doi-org.libproxy.dtcc.edu/10.12816/0045298

Mendes, A. (2022). Nurses’ role in smoking cessation interventions. British Journal of

Community Nursing, 27(11), 525–526.

https://doi-org.libproxy.dtcc.edu/10.12968/bjcn.2022.27.11.525