Question about CAD

[Nurseinprocess]

If you have a patient that has CAD, how would you determine which of his bad habits/lifestyle choices you should encourage them to change first? I am torn between the smoking and the high fat diet. I have read through my med-surge book and did online searches on CAD and I can't determine which one is the best for the pt to try and work on first. I would guess smoking, but I'm not sure if there is a cut and dry answer or if all the bad behaviors have the same level of detriment to the pt's health. I don't think smoking would be as easy to stop as eating bad foods would be, but I think not smoking may give a quicker return on lowering the risk. Can anyone point me in the right direction? TIA :).

[Daytonite, BSN, RN]

I think you are right about the smoking. It has to be dealt with first. Smoking is not only a habit but has elements of addiction as well. Habits are difficult to break. If you look at the pathophysiology of smoking, its effects are more dangerous and absolute that the high fat diet. Not all people get the same effect from a high fat diet. The dietary changes can be talked about while the smoking cessation is going on.

[S.T.A.C.E.Y, LPN]

Your assessment of the patient, may effect which health issue to tackle first. The patient may be very interested in losing weight and eating healthy, but have no interest in hearing about quitting smoking. In that case, it may be better to tackle the diet issue first. On the other hand, if the patient is from a culture that consistently eats high fat foods, and the patient has expressed willingness to quit smoking, then smoking may be the better idea. Sometimes its all about picking your battles. Sure the patient should do both, but in reality, that may not be case.