The effects of smoking during pregnancy

and the effects of secondhand smoke on

infants.
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Assessment
Patient factors

An adolescent pregnant female with

minimal prior knowledge of the effects of
smoking while pregnant and second hand
smoke on infants. The patients
developmental level is identity vs role
confusion. She lives at home with her
parents and is ambivalent about becoming
a mother. Her motivation is the good
health of her unborn child. The patient
learns best if a combination of visual,
auditory and tactile styles are used.

Environmental factors

The room had adequate lighting and a

balanced temperature. However there
were distractions from other booths along
with no privacy. When teaching self breast
examinations to a teenage girl I believe a
more private area would be a better
learning environment. She would be kept
from becoming embarrassed while talking
about the care of her breasts. This can
interfere with her learning abilities.

Assessment
Patient factors

An adolescent pregnant female with minimal prior knowledge of the effects of smoking while pregnant
and second hand smoke on infants. The patients developmental level is identity vs role confusion. She
lives at home with her parents and is ambivalent about becoming a mother. Her motivation is the good
health of her unborn child. The patient learns best if a combination of visual, auditory and tactile
styles are used.

Environmental factors

The room had adequate lighting and a balanced temperature. However there were distractions from
other booths along with no privacy. When teaching self breast examinations to a teenage girl I believe
a more private area would be a better learning environment. She would be kept from becoming
embarrassed while talking about the care of her breasts. This can interfere with her learning abilities.

Diagnosis

Deficient knowledge RT the effects of smoking and secondhand smoke on self, fetus, and newborn
infant AEB the patient reports that she doesn't know how smoking can harm her baby.
Ineffective health management RT smoking while pregnant AEB the patient admitted to smoking during
pregnancy.
Ineffective coping RT teenage pregnancy AEB the patient admits to using cigarettes as a stress reliever.
Ineffective childbearing process RT tobacco abuse AEB the patient reports an inappropriate prenatal
lifestyle of smoking cigarettes.
Readiness for enhanced childbearing process RT the patient seeking necessary knowledge for an
appropriate prenatal lifestyle.

Goals
Short term goals: fulfilled during the teaching session.

The patient will

Describe rationales for cessation of smoking during pregnancy and thereafter.
Show confidence in her ability to quit smoking.
Identify resources that can be used for more support and information.
Discuss fears or problems that may arise while trying to refrain from smoking.
Recognize healthy and effective coping strategies.
Understand the risks of smoking cigarettes during pregnancy and second hand smoke on her
infant.
State the importance of smoking cessation.

Long term goals: fulfilled during pregnancy, postpartum, and further on.

The patient will

Report the use of healthy and appropriate coping strategies.
Report the cessation of smoking during her pregnancy and after the birth of her baby.
Use support systems for help in the cessation of smoking.
Remain free of smoking cigarettes.

Seek further help from her physician if needed.

Follow the agreed upon plan to stop smoking.
Incorporate knowledge given to her into a healthy prenatal lifestyle.
Use the tools given to her to quit smoking.

Interventions

Create a proper learning environment for the patient, including a comfortable temperature, seating for
the patient and the RN, make sure the patient has been to the restroom and that she doesnt need
anything before starting the teaching session.
R: A proper teaching environment will benefit the patient in providing the best learning experience for
her.
Use verbal and nonverbal therapeutic communication techniques; empathy, active listening, and open
ended questions to encourage the patient to express her emotions and concerns.
R: These techniques will promote the well-being of the patient, minimize psychosocial problems and
offer opportunities for her to open up.
Build a list of strengths the patient may have.
R: This will give the patient the reinforcement she needs to quit smoking.
Assist the patient in recognizing the source of her stressors aside from teenage pregnancy.
R: If the patient is able to identify her stressors then she will be one step closer to properly coping with
the stressors in a healthier way.
Encourage the patient to discuss what her current situation means to her.
R: Investigating what her pregnancy means to her can identify most of her teaching needs.
Help the patient set realistic goals for the cessation of smoking.
R: In order for any of these interventions to me useful the patient needs to set goals that she can work
towards.
Teach the patient about the negative effects of smoking on her fetus and how second hand smoke can
effect her newborn.
R: Educating the patient about the harmful effects of smoking will increase her chances of quiting.
Provide mental and physical activities for coping; reading, watching television, crafts, cooking,
exercise (discuss with OBGYN first), games, yoga, painting, clean, visit a friend, swimming, go for a
walk or talk to someone about current feelings.
R: Finding activities the patient can enjoy will help keep her from smoking a cigarette.
Stress smoking cessation at every prenatal and postpartum visit for the safety of the baby.
R: Reminding the patient frequently about smoking cessation will ensure a better outcome for the
patient.
Teach techniques that can be used to aid in smoking cessation; counseling, quitting buddy, and chew
gum or mints.
R: These alternatives to smoking can help the patient reach her goal of smoking cessation.
Encourage the patient to follow up with her regular prenatal visits.
R: Attending all of her prenatal visit will ensure the patient and the baby are safe, all needs are met
and help prevent any adverse birth outcomes.
Assess for psychosocial issues including fear, anxiety, loneliness, depression, socioeconomic problems
and lack of social support system.
R: Identifying a patients psychosocial concerns will make way for proper teaching, treatment and
improved prenatal health maintenance.
Assess the patients ability and readiness to learn before teaching her about the harm of smoking.
R: The nurse must know if the patient is able and ready to learn, otherwise the teaching will not help
the patient quit smoking.
Use individualized approaches that focus on the patients specific preferences.

R: Individualized interventions will have a positive effect on the patients outcomes.

Engage the patient as your partner in educational decisions.
R: This will increase self-efficacy, patient satisfaction and confidence.
Use motivational and problem solving teaching strategies to support self-management.
R: Encouraging the patient to be involved in her teaching plan will increase self control and create
empowerment.
Use visual aides to enhance learning for the patient.
R: This intervention is proven to be effective in learning the selected content.
Provide the patient with appropriate follow up resources for support during smoking cessation.
R: Multiple resources for the patient to use between prenatal visits will further stabilize her ability to
quit smoking.
Ask the patient if she has any questions for you or would like more explanation on a specific topic.
R: This is an important closing question to ask so the RN can be sure all the patients needs are met.

Teaching Outline
Negative effects of smoking during pregnancy.

Cigarettes contain chemicals like tar, nicotine, and carbon monoxide, that are toxic to your baby. The
nicotine will cause blood vessels to constrict, decreasing the amount of oxygen and nutrients that are
delivered to your baby. The carbon monoxide will also decrease the amount of oxygen delivered to the
baby.
Smoking during pregnancy puts the baby at risk for

Preterm birth
Intrauterine growth restriction
Placental abruption
Placenta previa
Small for gestational age
Ectopic pregnancy
Spontaneous abortion (miscarriage)
Birth defects such as cleft lip and cleft palate
Stillbirth
Congenital heart defects
Learning disorders and behavioral problems
After birth: respiratory problems, asthma, frequent ear infections and SIDS

Negative effects of exposing your fetus to second hand smoke.

During

If an infant is exposed to second hand smoke he/she is at risk for

SIDS
Bronchitis
Pneumonia
Ear infections
Asthma
Respiratory issues

pregnancy if exposed to second hand smoke your baby is at risk for

Spontaneous abortion
Small for gestational age
Preterm birth
Learning and behavioral deficiencies
SIDS

The negative effects of smoking while pregnant and second hand smoke would be best to be taught in a group
setting like a classroom to educate pregnant teens.
Aside from classroom learning, this needs to be taught to every mother at the first prenatal visit in the OBGYNs
office. The RN needs to screen every pregnant mother for smoking while pregnant.
Many new mothers don't know what birth defects are, therefore showing pictures of possible birth defects that
can be caused my smoking can help the patient visualize the harm cigarettes have on an unborn baby.
The RN in a clinic can give handouts for the patient to read over at home after the material has been taught.
The RN could ask the patient to simply research the effects of smoking on the fetus, this type of active self
learning could help instill the importance of the cessation of smoking.
Smoking cessation

There is no amount of smoking that is safe.

Nicotine replacement and medications to help to quit smoking are not recommended during pregnancy
as there has not been enough studies to show if they are safe and useful for pregnant women.
Cravings and withdrawal symptoms are normal and will decrease with time.

Some patients gain weight when they quit smoking but the benefits of not smoking out weigh a few
pounds of gained weight.
Health benefits of smoking cessation.
Within twenty minutes of quitting smoking your heart rate will drop
Within twelve hours the carbon monoxide levels in your blood will drop to normal
Within 2-12 weeks your risk of having a heart attack will start to drop and the function of your
lungs will start to increase

Within 1-9 months your shortness of breath and coughing will begin to decrease
Within one year your risk of coronary heart disease has dropped 50%
Within 5-15 years your risk of having a stroke decreases to the equivalent risk of a non smoker
In ten years your risk of developing lung cancer has dropped 50%
In fifteen years your risk of developing coronary heart disease is equivalent to that of a non
smokers risk

Tips and materials that can be used to quit smoking.

Pamphlets from the CDC, ACOG, and NIH with strategies that can be used to quit
Call a smoking quit line 1-800-QUIT-NOW
Resources not given at a prenatal visit can be found at
v www.cdc.gov
v www.nih.gov
v www.acog.org
Make a smoke free pledge by calling 1-866-SMOKE-FREE
Sign a quit contract with your healthcare provider that has an anticipated quit date and a
statement of I understand that the cessation of smoking is the best thing for mine and my
babies health
Have a social support system of family and friends that will encourage your to quit, and help in
any way for you to reach your goal
Cope with cravings by chewing gum, mints or a favorite snack
Teach the patient distraction techniques to handle the symptoms of withdrawal: i.e., go for a
walk, ride a bike, yoga, exercise, read, watch TV, crafts, cook, clean, visit a friend or family
member, go shopping, meditate, listen to music or take a relaxing bath.
Give the patient the option of picking a quitting buddy that can make a quit pact with her so
she has a friend working towards the same goal.

Talk with the patient about possible triggers for her that will make her want to pick up a
cigarette. Avoid the triggers as much as possible and use distraction techniques stated above as
needed.
Send the patient follow up letters and cards letting her know you are thinking of her on this hard
journey and she has a healthcare team supporting her.

Follow up with phone calls to the patient as needed.

Recommend counseling if the patient needs additional help outside of her physician and support
system.
Use the model of 5 As to help the cessation of smoking
Ask the patient about her smoking status at the initial prenatal visit and follow up at each visit
if she is a smoker. It can be documented as a vital sign so it is easily trackable.
Advise the patient to stop smoking by giving her advice of cessation and the harmful effects on
the patient, fetus and the newborn. Advice should be clear and strong.
Assess the patient of her readiness to quit smoking.
Assist the motivated patient in quitting smoking by providing her with smoking cessation
materials that are pregnancy specific.
Arrange follow up appointments with the patient to further assess and track her attempt to
quit smoking.

Focusing on the negative outcomes of smoking on the baby can also be ineffective if the patient is in denial
about the information given or if they believe they are not at risk. This can be from the patient knowing
someone personally who smoked while pregnant and their baby was born healthy and had no complications.
Acknowledge barriers that the patient will come into contact with while trying to quit and give her
encouragement. This will increase the chances of the patient taking the advice that is given.
Using a caring attitude towards the pregnant mother is essential for the patient to become successful in
quitting.

Evaluation
The patient has achieved an adequate learning experience.

The patient agreed to quit smoking.

The patient was able to name three negative outcomes for smoking while pregnant.
The patient stated that she would use any and all resources given to her to aid her in reaching the goal
of smoking cessation.

The patient feels confident in herself to have the strength to quit for her and the babies health.