ch 37 substance abuse, grief and loss Flashcards
risk factors substance abuse during pregnancy
-low self esteem
-hx of psychiatric disorder
-hx of abuse, victim of violence
maternal consequences of tobacco use
-thromboembolic effects
-resp complications
possible fetal consequences of tobacco use
-miscarriage
-PPROM, preterm birth
-**IUGR/SGA/LBW
-placenta previa
-placenta abruption
criteria for fetal alcohol syndrome (3)
-dysmorphic facial features
-growth deficiency
-CNS abnormalities (structural, neurological, developmental, functional)
5 disorders in fetal alcohol spectrum disorders
-fetal alcohol syndrome
-partial FAS
-alcohol related neurodevelopmental disorders (ARND)
-alcohol related birth defects (ARBD)
-neurobehavioral disorder associated with prenatal alcohol exposure
other characteristics related to fetal alcohol syndrome (other than criteria)
-microcephaly
-strabismus
-abnormal palmar creases, irregular hair growth
-poor suck, cleft lip, cleft palate
-cardiac and joint abnormalities
-mental deficiences
-ADHD
possible consequences of using narcotics during pregnancy
-miscarriage
-preterm labor and birth
-placental abruption
-chorio
-IUGR
-fetal distress
S+S neonatal abstinence syndrome (withdrawal from opioids)
-restlessness, hyperactive
-tremors
-high pitched cry
-increased muscle tone
-irritable, inconsolable
-increased DTRs
-exaggerated moro reflex
-poor feeding, frantic suck
-V/D
-nasal stuffiness
meds for neonatal abstinence syndrome
-methadone
-buprenorphine
nursing care for baby experiencing opioid withdrawal
-swaddle tightly with hands midline, arms at side
-carry firmly and close to body
-decrease stimuli
-pacifier
-minimize handling (cluster care)
-rock in slow rhythmic fashion when distressed
swansons caring theory (5)
-knowing (assess)
-being with (caring presence)
-doing for
-enabling (offers options)
-maintaining belief (encourage)
types perinatal loss
-miscarriage
-fetal death/still birth
-early neonatal death
-late neonatal death
-infant death (within 1st year)
-serious fetal diagnosis
-other (complicated pregnancy, preterm birth, birth experience, NICU, gender/appearance of baby)
3 stages miles’ parental grief response
- acute distress (shock - accept reality)
- intense grief (disorganization - work through pain, learn how to live without baby)
- reorganization (searching for meaning - function without baby)
nursing interventions for parents with perinatal loss
-help pt hold baby
-help parents with decisions
-help them understand different responses to loss
-help them acknowledge and express their feelings
-create memorabilia for parents to take home
-medical care for mom as PP
-acknowledge spiritual/religious beliefs
-sensitive discharge and followup care
how to prepare deceased baby for parents to see
-prepare parents for what to expect with appearance
-treat baby as you would live baby
-put him under radiant warmer
-dress baby in clothes
-smell: lotion or baby powder
-warm blanket
how to help parents acknowledge and express their feelings with loss of baby
-validate experience and feelings of parents
-encourage them to tell their stories
-listen with care
-offer helpful responses
-allow enough time to engage with them without distraction
what to say to bereaved parents
-im sad for you
-how are you doing with all of this
-this must be hard for you
-what can i do for you
-im sorry
-im here and i want to listen
what not to say to bereaved parents
-god had a purpose for them
-be thankful you have another child
-life must go on
-i know how you feel
-its god’s will
-you have to keep on going for her sake
-you’re young, you can have other babies
-we’ll see you back here next year and you’ll be happier
-now you have an angel in heaven
-this was for the best
-better for this to happen now before you knew the baby
-there was something wrong with the baby anyway
state of being without a valued other, especially by death
bereavement
emotional state with profound feelings of sadness and despair accompanying loss
grief
involves culturally mandated traditions and rituals in the period after a death occurs
mourning
characterizes some types of perinatal loss such as a fetus that has never been physically seen or held by his or her parents and is unknown to others
ambiguous loss
occurs when a person’s responses to loss are not openly acknowledged and mourned publicly, thereby limiting social support
disenfranchised grief
complex situation in which grief may not resolve over time and the bereaved person grieves chronically
complicated grief
any in utero death prior to 20 weeks of gestation
miscarriage
any death prior to birth after 20 weeks of gestation
fetal death
(early 20-27 weeks EGA, late >28 weeks EGA)
fetal death occurring at 20 weeks or later
stillbirth
Death of a live-born infant fewer than 7 days old
early neonatal death
death of a live-born infant occurring between 7 and 28 days
late neonatal death
live birth of a child who dies within the first year
infant death
