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NURS 501 > Exam 4 - Neonatal Abstinence Syndrome > Flashcards

Exam 4 - Neonatal Abstinence Syndrome Flashcards

1
Q

What substance is the most dangerous to consume during pregnancy?

A

Alcohol - can lead to serious, permanent impairment

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2
Q

What effects does tobacco use during pregnancy have on the newborn?

A
  • Low birth weight
  • Behavior problems
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3
Q

True/false: research suggests that most of the illicit drugs used by mothers during pregnancy are more dangerous than they were previously thought to be

A

False - they are less dangerous

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4
Q

True/false: children of mothers who use drugs during pregnancy are at higher risk for physical, sexual, and emotional abuse

A

True - more common among mothers in lower SES, but abuse occurs across all socioeconomic classes

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5
Q

When should the provider consider drug abuse during pregnancy?

  • Physical evidence found on exam
A
  • Track marks
  • Nasal hyperemia
  • Septal defects
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6
Q

When should the provider consider drug abuse during pregnancy?

  • High risk historical or social factors
A
  • No prenatal care
  • Denial of pregnancy
  • Family history
  • Previous child abuse or neglect
  • Lack of support system
  • Psychiatric problems
  • History of legal problems
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7
Q

What obsteric complications could occur with drug use during pregnancy?

A
  • Abruption
  • Unexplained preterm labor
  • Uterine trauma/abuse
  • IUGR
  • Previous poor birth outcome
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8
Q

Neurologic maternal complications from substance abuse

  • Cocaine, amphetamines and LSD, heroin
A

Cocaine: seizures, postpartum intracerebral hemorrhage

Amphetamines and LSD: psychosis

Heroin: abstinence syndrome, menoneuritis, polyneuritis, transverse myelitis

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9
Q

Cardiovascular maternal complications from substance abuse

  • Cocaine and amphetamines, IV drug use
A

Cocaine, amphetamines: HTN, infarction, cardiomyopathy, arrhythmias, sudden death

IV drug use: bacterial endocarditis

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10
Q

Infectious maternal complications from substance abuse

  • IV drugs, and all drugs
A

IV drugs: hep B and C, HIV, cellulitis

All drugs: PNA, UTI, STIs

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11
Q

GI maternal complications from substance abuse

  • Cocaine, IV drug use
A

Cocaine: intestinal infarction

IV drug use: acute and chronic hepatitis

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12
Q

Nutrition maternal complications from substance abuse

A

Poor nutrition

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13
Q

What things should the provider do while collecting the patients substance abuse history?

A
  • Obtain verbally, no questionnaires
  • Private setting
  • Nonjudgemental
  • Be direct
  • Ask about drug abuse among household members
  • If admission of drug abuse, ask about dose, routes, duration of use
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14
Q

Can hospitals obtain drug screenings from pregnant women without their consent?

A

No - cannot test women for illegal drug use without conset and cannot report positive test results to law enforcement

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15
Q

Can hospitals obtain a drug test if a neonate presents with unexplained neurological symptoms?

A

Yes - drug test on the infant may be included without parental consent

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16
Q

Under what conditions can the provider contact child protective services?

A

If there are prior reports and to request a home evaluation

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17
Q

Urine toxicology time periods for positive test after last use

  • Alcohol, amphetamines and cocaine, opiates, LSD, marijuana
A
  • Alcohol: hours
  • Amphetamines and cocaine: 1-3 days
  • Opiates: 2-4 days
  • LSD: 2-3 days
  • Marijuana: 7-30 days
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18
Q

If the provider wants to identify whether an infant has been exposed to illegal substances, who should they collect a urine sample from?

A

Either maternal or neonatal urine sample

  • Urine tests for narcotics are negative at the time the neonate develops symptoms of withdrawal
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19
Q

Always review medical records for ___ ordered during labor to avoid false accusations

A

Narcotics or sedatives

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20
Q

___ and ___ screenings can be used to detect drug abuse during the ___ half of pregnancy

A

Meconium and hair screening can be used to detect drug abuse during the second half of pregnancy

  • Collect meconium sample from first 48 hours of life
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21
Q

What is cocaine?

A

Local anesthetic and CNS stimulant

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22
Q

Can cocaine cross the placenta? Does it have associated withdrawal symptoms?

A

Believed to be a teratogen and crosses the placenta

There is NO clinically documented neonatal withdrawal syndrome

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23
Q

Signs and symptoms of cocaine abuse

A
  • Premature labor
  • Placental abruption
  • Fetal asphyxia

Many infants show no s/s of affects of cocaine

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24
Q

When do neurobehavorial findings present in infants exposed to cocaine in utero?

A

Tend to present on days 2-3

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25
Q

Newborn findings that might indicate cocaine abuse during pregnancy

A
  • Low birth weight
  • IUGR
  • Prematurity
  • Fetal distress
  • Meconium staining
  • Microcephaly
  • Anomalies of urinary or GI tracts
  • Feeding difficulties
  • Irritability
  • Abnormal sleep patterns
  • Hypertonia
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26
Q

Can cocaine be found in breastmilk?

A

Yes - detectable in breastmilk so mothers who have used cocaine recently should not breastfeed

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27
Q

Management of cocaine-exposed neonates

A
  • Offer quiet environment
  • Involve child/family services
  • Higher rates of STIs in women who use cocaine - consider testing
28
Q

What are the long term effects of perinatal cocaine exposure?

A
  • Changes in IQ or behavior
  • Neurobehavorial dysfunction
  • Hyperactivity
  • Aggression
  • Short term attention span problems
29
Q

What is the definition of narcotic dependence?

A

Simultaneous tolerance to narcotics of any type, with symptoms of withdrawal upon discontinuation

30
Q

Examples of naturally occuring narcotics

A
  • Codeine
  • Morphine
  • Opium
31
Q

Examples of synthetic and semisynthetic narcotics

A
  • Fentanyl
  • Heroin
  • Hydromorphone (dilaudid)
  • Methadone
  • Meperidine (demerol)
  • Oxycodone (percodan and percocet)
  • Propoxyphene (darvon)
32
Q

True/false: withdrawal syndrome is less severe and less prolonged with methadone than with heroin

A

False - withdrawal syndrome is more severe and more prolonged with methadone than with heroin

33
Q

What medication can be given as an alternative to decrease the severity of withdrawal symptoms and reduce dependence?

A

Suboxone

34
Q

Are spontaneous abortions and stillbirths associated with narcotic use during pregnancy?

A

Yes - increased rates of spontaneous abortion and stillbirths, sometimes as a result of withdrawal syndrome

35
Q

What is thought to be the cause of IUGR in neonates to mothers who used narcotics during pregnancy?

A

May be due to direct effect on growth, poor nutrition, stressed lifestyle

36
Q

Sign and symptoms of neonatal abstinence syndrome (NAS)

A
  • High pitched cry
  • Tremulousness
  • Sleeplessness
  • Difficulty feeding
  • Sweating
  • Nasal stuffiness
  • Sneezing
  • Vomiting
  • Cramping
  • Diarrhea
  • Seizures
  • EEG abnormalities
37
Q

How do s/s of NAS differ in premature infants?

A

Symptoms tend to be less common in premature infants likely due to immature neurological system

38
Q

When is the usual onset of NAS?

A

Usually develops within 48 hours of life - 96% by 4 days

  • Symptoms usually present within 48-72 hours but can be delayed up until 4 weeks
  • Depends on half-life of drug of abuse and mothers last dose
    • If mothers last dose was >1 week prior to delivery, very low likelihood of withdrawal symptoms
39
Q

Does methadone withdrawal begin later or earlier than heroin withdrawal?

A

Methadone withdrawal begins later than heroin withdrawal but both typically begain before 48 hours of life

40
Q

When can neonates with NAS be discharged in relation to short acting and long acting opiates?

A

Babies asymptomatic at 72 hours (short acting opiate) or 5-7 days (long acting opiate) of life are usually discharged with plan for close follow up

41
Q

How long can symptoms of NAS persist after birth?

A

Symptoms can persist for 4-6 months after birth

42
Q

Maternal screening for comorbidities such as ___ need to be performed in association with NAS

A

HIV, hep B or C, and polydrug abuse

43
Q

What have many OB/GYN providers done to methadone dosages to reduce the severity of neonatal withdrawal?

A

Many obstetricians reduce the mother’s daily methadone dosage to <20 mg/kg because several studies have demonstrated a lower incidence and decreased severity of neonatal withdrawal with lower dosages

44
Q

Why have some obstetricins been reluctant to wean maternal methadone in late pregnancy?

A

Out of concern that the mother may turn to other illicit drugs

  • Some suggest increasing maternal methadone late in pregnancy based on lower maternal methadone plasma levels for the same dose
45
Q

What is the finnegan score used for?

A

Assesses neonatal drug withdrawal syndrome

46
Q

How should the provider utilize the finnegan score? How is it performed?

A

Assess the infant initially 2 hours after birth and then q4h –> total points for s/s seen during that interval

  • If score is >8, change to q2h and continue until 24 hours after the last total score of >8, then resume q4h
  • Use a new sheet for each day
  • Include mother in assessment of symptoms
47
Q

How is the lipsitz tool different from the finnegan score when assessing for neonatal drug withdrawal syndrome?

A

Lipsitz tool offers the advantages of a relatively simple numeric system and a reported 77% sensitivity using a value >4 as an indication of significant withdrawal signs

48
Q

How is the ostrea system different from the lipsitz tool and finnegan score?

A

The six criteria in the ostrea system are feasible, but the method is limited by the use of simple ranking rather than a numeric scale precluding summing the severity scores of multiple signs of withdrawal

49
Q

How would the provider treat NAS?

A
  • Frequent small feddings of hypercaloric formula (24 cal/oz)
    • 150 to 250 cal/kg/day needed for proper growth in neonates suffering withdrawal
  • Suck, swaddle, “sush”, swing
  • IV fluids/electrolyte replacement
50
Q

Do infants with confirmed drug exposure who do not have signs of withdrawal require therapy?

A

Infants who do not have signs of withdrawal do not require therapy

51
Q

What is the only defined benefit of using pharmacological intervention in NAS?

A

Short term amelioration of clinical signs

52
Q

What are the risks associated with pharmacological therapy to treat NAS?

A
  • Prolongs drug exposure and hospitalization time –> serves as detriment to maternal/infant bonding
  • Some believe pharmacological therapy of infant may reinforce maternal idea that discomfort or annoying behavior should be treated with drugs
  • Unknown risks (unproven)
    • Neonatal drug withdrawal decreased by pharmacological management of symptomatic infants
    • Risk of compounding intrauterine induced deficits with neonatal exposure to other drugs
53
Q

If pharmacologic management is chosen, what important detail regarding the type of medication should be considered?

A

Choose a drug from the same class as that causing withdrawal

54
Q

When do hospitals normally begin pharmacological therapy based on screening tools?

A

Most facilities begin treatment when three consecutive finnegan scores are >8 or when the sum of three consecutive finnegan scores is >24

55
Q

What are the only FDA approved drugs for the treatment of drug withdrawal?

A
  • Benzodiazepines for alcohol withdrawal
  • Methadone for opioid withdrawal
56
Q

What other agents that are not FDA approved has been shown to be favorable in the management of drug withdrawal?

A
  • Tincture of opium
  • Morphine
  • Clonidine
  • Phenobarbital
  • Diazepam
57
Q

What are the usual morphine doses to treat drug withdrawal?

A

0.24 to 1.3 mg/kg/day

58
Q

What other interventions would help improve the efficacy of pharmacological therapy in treating drug withdrawal?

A
  • Normal temperature curve
  • Ability of the infant to sleep between feeding and medications
  • Decrease in activity and crying
  • Decrease in motor instability
  • Weight gain
59
Q

What commonly medication category has been linked to neonatal withdrawal symptoms?

A

SSRIs (e.g. prozac, celexa, lexapro, zoloft, luvox)

60
Q

Research has linked third trimester use of SSRIs to neonatal signs of withdrawal. What are these symptoms?

A
  • Excessive crying
  • Irritability
  • Jitteriness
  • Shivering
  • Restlessness
  • Feeding difficulties
  • Sleep disturbance
  • Tremors
  • Hypertonia or rigidity
  • Tachypnea
  • Respiratory distress
  • Hypoglycemia
  • Seizures
61
Q

Onset and duration of SSRI withdrawal symptoms in neonates

A

Onset: several hours to several days

Duration: 1-2 weeks

62
Q

Are there associated neurodevelopmental outcomes in babies born to women on SSRIs?

A

No adverse neurodevelopmental outcomes

63
Q

Can SSRIs be continued during pregnancy?

A

SSRIs should be continued during pregnancy at the lowest possible dose

  • Withdrawal of medication could have harmful effects on the mother-baby dyad
64
Q

True/false: developmental scores on the mental index on the Bayley Scales of Infant Development are affected by severity of withdrawal or the treatment chosen

A

Developmental scores on the mental index on the Bayley Scales of Infant Development are NOT affected by severity of withdrawal or the treatment chosen

65
Q

What are the characteristics of withdrawal associated seizures in the neonate?

A
  • Primarily myoclonic
  • Respond to opiates
  • Carry no increased risk of poor outcome

NURS 501 (66 decks)

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