A Pack in 30 Minutes

Jo Ann Serota, MSN, RN, CPNP; Carol Rudy, MPH, ARNP, CPNP; Sally Walsh, MSN, RN, CPNP; Jo Ann Serota, MSN, RN, CPNP


J Pediatr Health Care. 2007;21(3):180-181, 209-21. 

In This Article

Case Study

A 19-year-old woman who was home from college for spring break came to the office with a chief complaint of persistent sore throat, morning cough, intermittent hoarse voice, decreased appetite with a 5-lb weight loss this semester, and an occasional feeling that her was heart racing. She denied having any syncope, dizziness, or positional hypotension. She had not experienced any fevers, upper respiratory symptoms, vomiting, or change in her bowel or bladder habits. Her periods had been regular, and she denied having any sexual activity. She had the usual college schedule of staying up very late and skipping meals, then eating junk food; she was stressed about assignments and felt overwhelmed at times. She denied excessive alcohol consumption and use of recreational drugs, and she did not smoke cigarettes. Her family is supportive, and there were no underlying issues she believed were contributing to her symptoms.

The patient's physical examination was within normal limits except for a few shotty cervical nodes. Her lungs were clear, and her pharynx was slightly injected. She had experienced a 6-lb weight loss since her last examination about 7 months ago. Her blood pressure was 118/80, and her pulse was 80 and regular; results of a urinalysis obtained in the office were normal. She was up to date with immunizations including the Menactra, Human Papillomavirus Vaccine (HPV), and Tetanus and reduced Diptheria and Pertussis Vaccine (Tdap). A throat culture was obtained to rule out the presence of Group A ß-hemolytic streptococcus. Laboratory tests for Epstein-Barr virus, mono spot, a complete blood cell count, complete metabolic panel (CMP), sedimentation rate, T3, T4, thyroid-stimulating hormone, thyroid antibodies, and Tuberculin Purified Protein Derivative (Mantoux), along with a pregnancy test, were ordered.

The patient's complaints did not match her examination. I asked about her extracurricular activities. She was a member of the basketball and softball teams and was currently between sports. She socializes with her dorm friends and team members. Presently, she is not involved with a "significant other."

Her usual hangouts included a newly opened restaurant where people partake in hookah. She explained that hookah is smoking tobacco through a water pipe. She and her friends smoke two to three times a week. The smoking sessions lasted about 45 minutes, with six participants sitting around the same hookah or water pipe. The tobacco was flavored and mixed with a sweetener, making it "taste good." She said that she thought the hookah was much safer than cigarettes. Also, she describes feeling a little "high" after smoking at the hookah bar.

Case Study Questions

  1. What is hookah smoking?

  2. What are the health concerns with hookah smoking?

  3. Is hookah smoking safer than other tobacco products?

  4. Why is hookah smoking so attractive?

  5. What can the pediatric nurse practitioner and other health care providers do to educate adolescents, young adults and their parentsabout the risks of hookah smoking?


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