12.1c Perinatal Substance Abuse Flashcards
Warning Signs of Substance Abuse
- Receiving no Prenatal Care
- Late entry into care
- Sporadic care with multiple missed appointments
- Evidence of poor nutrition
- Frequent encounters with law enforcement
- Engaging in Marital/Family Disputes
Affects of Drugs
- Teratogen in early pregnancy
AFTER MAJOR STRUCUTRES DEVLEOPED
- Abnormal growth/maturation
- Alterations in neurotransmitters and their receptors
- Brain organization
INDIRECT EFFECTS
- Altered delivery of nutrients to baby (placental insufficiency)
- Altered maternal health behaviors
MOTHER MAYBE
- Uncompliant to healthcare
- Increased exposure to violence
- Increased risk of infection/illness
Tobacco
- Thromboembolic Diseases and Respiratory Complications for Mother
Pregnancy Related Complications
- Miscarriage
- Preterm Birth
- IUGR
- Placental Previa/Abruption
- LBW
- PROM
Alcohol
- Increases chances of birth defects (FETAL ALCOHOL SYNDROME - FAS)
Other Risks
- Miscarriage
- Stillbirth
- Preterm Birth
Marijuana
- Associated with IUGR
Opioids
- Can cause withdrawal symptoms
- IUGR
- Placental Abruption
- Intrauterine passage of meconium
- Preterm Labor
- Fetal Death
Cocaine
- Miscarriage
- Preterm Labor
- Small for Gestational Age
- Placental Abruption
- Stillbirth
- Fetal Anomalies
Methamphetamines
- IUGR
- Preterm Birth
- Placental Abruption
Barriers To Treatment
- Social stigma of substance abuse or psychiatric disorders may produce unique barriers to treatment.
- They also may have insufficient knowledge
Legal Considerations
- Some states it is criminal for substance abuse during pregnancy
- Can be defined as child abuse in some states
- Some states require that this be reported
- A few states also require prenatal drug exposure tests
Screening
- All should be screened for tobacco/alcohol/drugs
- This includes OTC, Prescription and Herbals
- When screening always begin with OTC and Prescriptions
Toxicologic Testing used to test for illicit drugs
EDUCATION
- The type of test, purpose of test, management based on test results, benefits/consequences of testing.
4 P’s Screening
Parents - Did either parent have alcohol/drug problems
Partner - Does partner have alcohol/drug problems
Past - Have you ever had beer, wine or liquor
Pregnancy - How many cigarettes did you smoke in the past month before you knew you were pregnant, and how much alcohol did you consume after knowing you were pregnant
Medical Management of Substance Abuse
- Begins with education on risks of each drug used
- Abstinence should be recommended
- Periodic Screening
Nursing Interventions
- Typically have low control behavior and low pain threshold
- Increased dependency can cause lack of involvement in care
- Substance abuse is an illness and nurses must treat patients with patience, kindness and consistency.
BREASTFEEDING CONTRAINDICATIONS
- Amphetamines, Alcohol, Cocaine, Heroin, Marijuana.
- Smoking can affect MER (Milk Ejection Reflex)
FOLLOW UP
- Before discharge, home situation must be assessed for safety
Effects of Medication
- Teratogens (Embryonic Period 3-8 weeks)
- Fetal Period (8 weeks+ may cause fetal growth issues and organ function)
- May cause withdrawal effects in newborn
- Oral Contraceptives (Makes Last Menstrual Period not a good predictor of gestational age)
