Group 3 Tan Teck Hee & Nicholas Sim

Case summary
My patient is a 43 years old married Malay gentleman, who works as staff nurse at HUSM. He
is an active smoker currently, who smokes about 20 cigarettes per day. He is under moderately
nicotine dependent based on Fagerstorm test. He started to smoke since 20 years ago due to
his friends influences. He realizes of his bad breath due to smoking. He attempted to quit
smoking twice before. The first attempt to quit smoking was due to personal health reason. The
second attempt to quit smoking was because of worrying about family health status when his
wife was diagnosed with cancer. The first and second attempt of quitting smoking last for 3
months and 6 months respectively. On the previous attempts, the withdrawal symptoms that he
faced was tension and restlessness. The reason for relapse is because of his social
environment and his own desire to smoke.

D(i). SCC FAGERSTROM TEST FOR NICOTINE DEPENDENCE FORM

Patient particulars
Patient Name: Haryadi Harith
Sex: M

1.

R/N:

Age (years): 43

Assessment date: 20.2.2016

UJIAN FAGERSTROM UNTUK KEBERGANTUNGAN NIKOTIN

Berapa lama anda menghisap rokok yang pertama selepas bangun tidur?

Selepas 60 minit (0)

31 - 60 minit (1)
6 - 30 minit (2)
Dalam masa 5 minit (3)
2.

Adakah anda berasa sukar untuk tidak merokok di tempat larangan merokok seperti sekolah,
hospital, klinik, kompleks membeli belah, dalam kenderaan awam, dan sebagainya?

Tidak (0)
Ya (1)
3.

Rokok manakah yang paling anda tidak suka untuk lepaskan?

Yang pertama pada waktu pagi (1)

Yang lain-lain (0)
4.

Berapa batang rokok anda hisap setiap hari?

10 atau kurang (0)

11 - 20 (1)
21 - 30 (2)
31 atau lebih (3)
5.

Adakah anda merokok lebih kerap dalam masa beberapa jam pertama selepas bangun tidur
berbanding dengan waktu lain pada hari tersebut?

Tidak (0)
Ya (1)
6.

Adakah anda merokok walau sekiranya anda sangat sakit dan berada di katil sepanjang hari?

Tidak (0)
Ya (1)
MARKAH UJIAN FAGERSTROM:

5
SCORE
0
1-2
3-5
6-8

NICOTINE DEPENDENCE
No dependence
Low dependence
Moderately dependent
Highly dependent

9-10

Very dependent

D(ii). SCC THE 5As GUIDELINE

Ask:
1. Status

: Active smoker since 20 years old

2. Brand

: Marlbolo

3. Sticks

: 20 sticks per day

4. Attempt to quit before

: Attempted twice, longest lasted for 6

months. But relapse.

5. If given a choice to stop smoking, will you stop? He is willing to quit
smoking.
Assess:
Stage of Behaviour
Change

Pre-contemplation

Contemplation

Decision/Preparation

Action

Maintenance

Justification

The patient is a current smoker who has made

attempts in the last year and is planning to quit
within the next 30 days.

Habits related to smoking: He must smokes after having meals.

Nicotine dependence: 5, Moderately dependent
Quit attempts: 2
Withdrawal symptoms: tension and restlessness
Advise:
- Advice the patient proactively against tobacco and impact on oral disease
and conditions.
- Clear: I think it is important for you to quit smoking now and I can help you.
- Strong: I need you to understand that quitting smoking is the most important
thing that you can do to protect your health and your family health start from

now and in the future.

- Personal: Relates tobacco use to current health, social and economic costs,
motivation to quit, and impact of tobacco use on family.
Assist:
- Assist the patient by helping him to develop a personalised quit plan with a
quit date
- Personalized quit plan: The patient is allowed to select the quit plan that he
preferred, which target on reducing the number of cigarettes gradually before
the set date.
- Quit date: 21 March 2016, which is 2 weeks after the intervention.
- Provide emotional support affirm benefits of not using tobacco
- Offer the patient an effective treatment options, include pharmacotherapy
discussion and over- the- counter nicotine replacement.
- Provide the patient resource materials and self- help pamphlets.
- Assists the patient in anticipating challenges, especially withdrawal
symptoms during the critical first few weeks.
- Suggest the patient to cope the withdrawal symptoms by taking deep
breaths, drinking lots of water, and involving in exercise or activity that can
distract himself, and delay the craving.
Arrange
- Arrange the smoking cessation counselling and intervention on 7 th March
2016 morning.
- The first follow- up is scheduled on the first week after the quit date.
- Subsequent follow- ups are scheduled weekly within the first month, every
two weeks for the second and third month, and monthly after that up to 6
months.

D(iii). SCC SCC PLAN

Patient characteristics:
- The patient is a 43 years old married Malay gentleman.
- An active smoker currently, who smokes about 20 cigarettes every day.
- Moderately nicotine dependent and bad breath.
- He started to smoke since 20 years ago due to his friends influences.
- He attempted to quit smoking twice before.
- The first attempt to quit smoking was due to personal health reason.
- The second attempt to quit smoking was because of worrying about family
health status when his wife was diagnosed with cancer.
- The first and second attempt of quitting smoking last for 3 months and 6
months respectively.
- On the previous attempts, the withdrawal symptoms that he faced was
tension and restlessness.
- The reason for relapse is because of his social environment.
Patient needs:
Normative need

: Plan a smoking cessation regime for the patient

Felt need

: Ready to quit the habit of smoking

Demand

: Replacement therapy

Aim: To quit smoking permanently and prevent relapse in future.

Objectives:
1. To improve Fagerstorm Test score to the lowest possible score until the
patient successfully quit smoking.
2. To improve awareness on importance and consequence of stop
smoking on general and oral health
3. To educate the patient on how to deal with withdrawal symptoms

4. To maintain the smoking cessation program

Resources:
- Power point slides presentation
- Pamphlets
- Video presentation
Content & methods:
1. Introduce the content in cigarette, and what are its effects towards
human body: Addiction, Staining, carcinogenic, mouth dryness
2. Motivate the patient to quit smoking using the 5Rs (Relevant, Risk,
Reward, Roadblocks, Repetition)
3. Explain the effects of smoking on long terms: Financially, COPD,
caries, aesthetics, bad breath, cancer
4. Provide multiple option and plans for the patient to quit smoking, allow
him to write it down on his own on a manila card.
5. Deal with withdrawal symptoms 4Ds (Deep breath, Drink water,
Distract, Delay)
6. Explain to the patient about the effect of smoking towards his family.
For example, giving bad impression towards his wife and children,
wasting money to buy cigarettes, the effects of secondary smoker
which are his family members
Evaluation methods:
- Arrange the smoking cessation counselling and intervention on 7 th March
2016 morning.
- The first follow- up is scheduled on the first week after the quit date.
- Subsequent follow- ups are scheduled weekly within the first month, every
two weeks for the second and third month, and monthly after that up to 6
months.