Follow Up Presentation Quit Smoking Case Study.pptx

Follow Up Quit Smoking Case Study

1. Enrolled into QSS HPJ on 22/7/20 PATIENT’S DETAIL Name MS HH Age 51 years old Race Malay Gender Female Height 164 cm Weight 88kg (22/7/20) BMI (O) 32.7Kg/m 2

2. PATIENT MEDICAL HISTORY Complain To quit smoking for better health Past Medical/ Surgical History Arrythmia Presenting Illness Arrythmia Allergy History None Current Medication not mentioned

3. SOCIAL AND FAMILY HISTOR Y Occupation Factory manager Marital Status Single mother Family History of Illness none

4. Lifestyles staying with family (heavy smoker > 10 cigg/day) Inactive lifestyles and no routine exercise Sleep non-properly time due to work burden Diet : normal breakfast (10am), normal food for lunch (1 pm), dinner at 9 pm after work. Smoke more at work – 6-7 sticks in the morning after breakfast and 3-4 sticks at night after back from work.(average 10 sticks/day) SOCIAL AND FAMILY HISTORY

5. SMOKING AND QUIT SMOKING HISTORY Smoking Initiation Age 36 years old Duration of smoking history 15 years Average No. of Cigarettes / Day 10 sticks (Peter Styverson) Condition/Situation that trigger to smoke After meals In the toilet Stress No. of previous quit attempts 1 times (Cold Turkey) Longest Duration of Abstinence 6 mths Reason for relapse Stress

6. Physical examination/Parameters (Date of pre-counseling/pre-visit) Blood Pressure 116/79 mmHg Heart Rate 58 / min PEFR - L/min (Target PEFR : - L/min) Carbon Monoxide (CO) level - ppm DASS - FTND - * DASS : Depression, Anxiety and Stress Score

7. Management Plan Willingness : Strong will to quit Readiness : Action stage (Plan to quit within 30 days) Significant reason of quit : Health Concern Set a Quit plan Appointment : 2 weeks after pre-counseling and one year follow up

8. 1. Quit Plan(STAR)

9. 2. Follow- up Schedule 1 st Month Weekly (start 1 week after Initial Visit) Week 0 Initial Visit (SET QUIT DATE) Pharmacological Intervention Week 1 Follow-up Visit 1 Week 2 Follow-up Visit 2 Week 3 Follow-up Visit 3 2 nd – 3 rd Month Biweekly Week 5 Follow-up Visit 4 Week 7 Follow-up Visit 5/ Phone Week 9 Follow-up Visit 6 Week 11 Follow-up Visit 7/ Phone 4 th – 6 th Month Monthly Week 15 Follow-up Visit 8 Relapse prevention Week 19 Follow-up Visit 9/ Phone Week 24 Follow-up Visit 10 7 th – 12 th Month Every 3 months Week 36 Follow-up Visit 11/ Phone Week 48 Follow-up Visit 12 Appointment : 2 weeks after pre-counseling session ( 5 / 8 / 20 )

10. PROGRESSION

11. PHARMACOTHERAPY (25/10/17 – 25/1/18, 13 weeks) DATE Medication Justification for choice of treatment/change (quote reference) Duration Withdrawal symptom/ Side Effect/ Problem Explanation of the symptom causes and progress (quote reference) 22/7/20 Champix 0.5/1mg/ day Patient tried using gum before,not succeed 2 week Cough 5/8/20 Champix 0.5/1mg/ day 4 weeks Non-craving Complain of dry cough Identify the causes of the symptoms, was due to Champix and less drink water and how Champix cause the cough 19/8/20 Dry cough 2/9/20 7/10/20 Stop Champix 2 weeks Cough (lesser) 21/10/20 No medication 2 weeks Patient start to relapse due to stress (family problem) Started to take 1cigg/day. Then up to 1 pack/day Advise to focus on problem solving and to stop smoking 30/12/20 No medication 2 weeks 27/1/21 Champix for maintenance to maintain 4 weeks Increase appetite Able to reduce no of cigg reduce to 5-7cigg/day 24/2/21 Last appointment date patient missing

12. Physical examination/Parameters DATE BW (Kg) BP (mmHg) HR (bpm) CO (ppm) PEFR(I/min) 22/7/20 89 116/79 58 - - 5/8/20 88 141/91 55 - - 19/8/20 84.4 123/78 52 - - 2/9/20 89 140/81 51 - - 7/10/20 84 153/91 65 - - 21/10/20 91 124/70 62 - - 30/12/20 91 145/76 60 - - 27/1/21 - - - - -

13. PHARMACEUTICAL CARE ISSUES

14. PCI #1 : Non- compliance Patient was started on Champix 0.5mg/1mg on 22/7/20 Patient was not compliant to champix starter pack only took 1 week for total and smoked 5-7 cigarettes/day after meals Reason : - C/O dy cough on night and due to stress (family problem) 2 2 / 7/20 , Week 1, Follow – up Visit 1 Intervention (quote reference if applicable) Outcome Counselled on proper use of Champix (explained SE might due to wrong administration) Counselled on how to reduce stress and focusing on stop smoking treatment Quit smoking on 16/8/20 Comply to combination Champix and reduce stress

15. PCI #2 : Inappropriate lifestyle changes Patient reported heavy stress due to family problems Reducing weigh too drastic Inactive lifestyle and eating improperly Intervention (quote reference if applicable) Outcome Recommend starting exercise in the morning - 30 minutes 5 times a week or more Counsel on healthy balance diet and right portion (1/4,1/4,1/2) Emphasize the health benefits Emphasize on reducing stress by focusing on works, doing excercise and enough rest Patient’s BW maintain at 89-91kg after 2/9/20 (> wk 6) 5/8/20-19/8 (week 2-4)

16. Thank you for your attention