Vivid Dreams/ Problems Sleeping: Nausea/Upset Stomach: Itching/Rash
Addressing NRT Barriers • Assess the severity of symptoms (Is it tolerable?). • Assess Hx: onset, duration and any troubleshooting that has already taken place. If indicated, get history of these symptoms when not taking these medications. You may also ask how Pt. would normally treat these symptoms. • If symptoms are tolerable àdevelop troubleshooting plan with Pt. Inform Pt. that many symptoms will go away after a few days. Reassess at next visit, but ask Pt. to call if symptoms persist/worsen or become intolerable before next call/visit. • If symptoms are not tolerableàconsider changing products or dosages as applicable. Consult study physician, as needed. Refer Pt. to their personal physician, if needed (e.g., prescription strength creams). • All potential cardiac symptoms should be promptly reported to study physician. Advise Pt. to discontinue NRT when indicated or instructed by study physician. Vivid Dreams/ Problems Sleeping: - Assess if sleep is being disrupted. Is night waking normal for Pt. – what is Pts.’ normal routine? - May try taking patch off at night, keeping in mind cravings may be stronger in the AM. After a couple of nights, try again to wear patch overnight. If using more than 1 patch, may consider only wearing 1 at night. - May try removing patch at night and putting on 2 hours before waking, especially when early morning waking is part of routine. Otherwise, can set an alarm, put on patch, and go back to sleep. - Regulate eating and sleeping patterns and use sleep hygiene tips (relaxation training, avoid caffeine). - Do not smoke or use short-acting NRT within 1-2 hours of bedtime (especially if sleep initiation is the major complaint.) Nausea/upset stomach: - Ask if nausea is only after using gum/lozenge or also after smoking a cigarette.
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