ch 37 substance abuse, grief and loss

Question 1

risk factors substance abuse during pregnancy

Answer 1

-low self esteem
-hx of psychiatric disorder
-hx of abuse, victim of violence

Question 2

maternal consequences of tobacco use

Answer 2

-thromboembolic effects
-resp complications

Question 3

possible fetal consequences of tobacco use

Answer 3

-miscarriage
-PPROM, preterm birth
-**IUGR/SGA/LBW
-placenta previa
-placenta abruption

Question 4

criteria for fetal alcohol syndrome (3)

Answer 4

-dysmorphic facial features
-growth deficiency
-CNS abnormalities (structural, neurological, developmental, functional)

Question 5

5 disorders in fetal alcohol spectrum disorders

Answer 5

-fetal alcohol syndrome
-partial FAS
-alcohol related neurodevelopmental disorders (ARND)
-alcohol related birth defects (ARBD)
-neurobehavioral disorder associated with prenatal alcohol exposure

Question 6

other characteristics related to fetal alcohol syndrome (other than criteria)

Answer 6

-microcephaly
-strabismus
-abnormal palmar creases, irregular hair growth
-poor suck, cleft lip, cleft palate
-cardiac and joint abnormalities
-mental deficiences
-ADHD

Question 7

possible consequences of using narcotics during pregnancy

Answer 7

-miscarriage
-preterm labor and birth
-placental abruption
-chorio
-IUGR
-fetal distress

Question 8

S+S neonatal abstinence syndrome (withdrawal from opioids)

Answer 8

-restlessness, hyperactive
-tremors
-high pitched cry
-increased muscle tone
-irritable, inconsolable
-increased DTRs
-exaggerated moro reflex
-poor feeding, frantic suck
-V/D
-nasal stuffiness

Question 9

meds for neonatal abstinence syndrome

Answer 9

-methadone
-buprenorphine

Question 10

nursing care for baby experiencing opioid withdrawal

Answer 10

-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

Question 11

swansons caring theory (5)

Answer 11

-knowing (assess)
-being with (caring presence)
-doing for
-enabling (offers options)
-maintaining belief (encourage)

Question 12

types perinatal loss

Answer 12

-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)

Question 13

3 stages miles’ parental grief response

Answer 13

1. acute distress (shock - accept reality)
2. intense grief (disorganization - work through pain, learn how to live without baby)
3. reorganization (searching for meaning - function without baby)

Question 14

nursing interventions for parents with perinatal loss

Answer 14

-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

Question 15

how to prepare deceased baby for parents to see

Answer 15

-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

Question 16

how to help parents acknowledge and express their feelings with loss of baby

Answer 16

-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

Question 17

what to say to bereaved parents

Answer 17

-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

Question 18

what not to say to bereaved parents

Answer 18

-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

Question 19

state of being without a valued other, especially by death

Answer 19

bereavement

Question 20

emotional state with profound feelings of sadness and despair accompanying loss

Answer 20

grief

Question 21

involves culturally mandated traditions and rituals in the period after a death occurs

Answer 21

mourning

Question 22

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

Answer 22

ambiguous loss

Question 23

occurs when a person’s responses to loss are not openly acknowledged and mourned publicly, thereby limiting social support

Answer 23

disenfranchised grief

Question 24

complex situation in which grief may not resolve over time and the bereaved person grieves chronically

Answer 24

complicated grief

Question 25

any in utero death prior to 20 weeks of gestation

Answer 25

miscarriage

Question 26

any death prior to birth after 20 weeks of gestation

Answer 26

fetal death
(early 20-27 weeks EGA, late >28 weeks EGA)

Question 27

fetal death occurring at 20 weeks or later

Answer 27

stillbirth

Question 28

Death of a live-born infant fewer than 7 days old

Answer 28

early neonatal death

Question 29

death of a live-born infant occurring between 7 and 28 days

Answer 29

late neonatal death

Question 30

live birth of a child who dies within the first year

Answer 30

infant death