MODULE 8-10 NM621 study guide Flashcards
Fetal Alcohol Spectrum Disorder
• a group of conditions that can occur in a person whose mother drank alcohol during pregnancy. These effects can range from mild to severe. They can affect each person in different ways and can include physical problems and problems with behavior and learning. (CDC)
FAS fetal alcohol syndrome
• the severe end of FASD spectrum • IS a diagnosis • has three distinct features a. facial abnormalities b. growth deficits c. CNS abnormalties
FAE (fetal alcohol effects)
negatively affect a child’s growth, cognition, physical appearance, and behavior over the lifespan. (Mengel)
incidence of FAS
- 1-3% of live births in the US. “one in 30 women who know they are pregnant reports “risk drinking” (7 or more drinks per week or 5 or more drinks on any one occasion). At least 1 in 10 women will continue to consume alcohol during pregnancy. (LT and Mengel)
• FAS Incidence 0.5-1.5/1000 births; the incidence of FASD is thought to be at least 3X the incidence of FAS (CDC link in LT)
FAS Screening methods
• Quantity/Frequency questions
• days per week of drinking
• average number of drinks per day
• max number of drinks consumed in 1 day during past month
• TWEAK
• Tolerance:
a. How many drinks does it take before you feel high (the first effects of alcohol)? or
b. How many drinks can you hold? (How many drinks does it take before the alcohol makes you fall asleep or pass out? If you never pass out, what is the largest number of drinks you have?)
• Worried: Have your friends or relatives worried about your drinking in the past year?
• Eye opener: Do you sometimes take a drink in the morning when you first get up?
• Amnesia: Are there times when you drink and afterwards can’t remember what you said or did?
• K/Cut Down: Do you sometimes feel the need to cut down on your drinking?
• Receive 2 points if they can hold 5 drinks before passing out, 2 points if yes to “worry”, 1 pt for every other category. Any total score 2 or over=referral for further evaluation/treatment
• T-Ace
- Tolerance: How many drinks does it take to make you feel high?
- Annoyed: Have people ever annoyed you by criticizing your drinking?
- Cut Down: Have you ever felt that you needed to cut down on your drinking?
- Eye opener: Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover?
- Because of social desirability, some pregnant women, particularly heavy drinkers, may be more likely to reliably report their actual alcohol use in a computerized or “pencil and paper” task rather than through a face-to-face interview.
- Receive 2 points if answer to Tolerance questions is 2 or more drinks, 1 pt for every other category. Any total score 2 or over=referral for further evaluation/treatment
• Know factors associated with drinking alcohol,
- age >30, caucasian, Hx binge drinking or long hx of drinking, college educated, low or high SES, special education population, poor Native Americans, Hx of physical/sexual abuse ever, Hx physical abuse in last year, heavy drinking by male partner or any family member, loss of children to foster/adoptive care, poly-drug use/cigarette smoking, previous child with FAS, major depressive d/o, unmarried, early age of drinking onset.
how to counsel women on drinking alcohol in pregnancy
: assessment first #1
Brief intervention
• Assessment alone seems to reduce alcohol consumption. Among pregnant women, formal screening with tools such as the T-ACE alone, reduces prenatal consumption. Physician advice or written educational information improves patients’ knowledge of the risks of drinking during pregnancy. Providing information alone may reduce the risk of an alcohol-exposed pregnancy through reduced consumption or increased use of effective contraception. Information’s beneficial effects on reducing risk may persist for up to 9 months. It is likely that when coupled with education and advice, assessment may be adequate to prevent further drinking during pregnancy among most patients.
Counsel women: Motivational interviewing (MI) #4
Motivational interviewing (MI), a counseling model developed for health risk behavior, has also demonstrated success in reducing prenatal alcohol use—particularly among heavier drinkers.
counseling women : brainstorming #3
After establishing drinking goals; the patient is encouraged to “brainstorm” environmental triggers (eg, socializing with friends who are drinking) and develop behavioral alternatives for these at-risk periods. Counseling is augmented by written patient educational material such as self-paced workbooks. Keeping a drinking diary, recording the number of alcoholic drinks, and drinking circumstances each day, is often recommended.
counseling women : providing information #2
• After completing an initial screening and providing general information about the risks for drinking during pregnancy, at-risk patients should receive individualized feedback. The physician explains how the patient’s drinking compares with other pregnant women or those of childbearing age. If possible, the physician then describes risks specific to the patient. Next, the physician and patient establish drinking goals, complete cessation of drinking during pregnancy is recommended.
• Know the trends and prevalence of smoking in pregnant women
o Currently, 11% of women in the United States smoke during pregnancy. It is estimated that worldwide up to 30% of pregnant women smoke during pregnancy. The highest rates of smoking during pregnancy occur in underdeveloped and poor countries, where access to prenatal care and education about smoking risks are less likely to be available.
• Know the physiological effects on the placenta, fetus and newborn, and prenatal complications of smoking
o Placenta- previa, abruption, decrease placental weight, adverse morphological changes
o Fetus- Increased FGR and low birth weight, PROM (#1 way to prevent LBW is to increase smoking cessation rates)
o Newborn- Increased risk for SIDS, lower offspring IQ, increased childhood respiratory d/o such as chronic asthma, earaches, learning and behavior problems
o Prenatal complications- Increased first trimester loss, ectopic pregnancy, preterm birth
o CO2 & CO1 decrease available of O2 to fetus, nicotine is neurotoxic to fetal brain, nicotine cause adverse maternal CV changes that results in decreased placental blood flow and ultimately decreased O2/nutrient to fetus.
know the strategies to promote smoking cessation in pregnant women and their families : 5 A’s
o The 5A’s and R’s The 5 A’s: the primary approach to quitting (nurse managed intervention)
• Ask about tobacco use
• Advise to quit- Clear, strong, personalized advice to quit
• Assess willingness to make a quit attempt
. If willing move on to assist
a. If not willing move on to the 5 R’s
• Assist in quit attempt
• Arrange f/u
the 5 R’s
• The 5 R’s: to be used when patients don’t want to quit
• Relevance- have pt identify why quitting might be personally relevant
. ie: children in home, need for money, hx of smoking related illness
• Risks- ask if she knows about risks of smoking during pregnancy, reiterate benefits for her and baby
• Rewards- baby gets more O2 after just 1 day, clothes and hair smell better, she will have more money, food will taste better, she will have more energy
• Roadblocks- negative moods, being around other smokers, triggers and cravings, time pressures
. to overcome: smoke on hard candy, engage in physical activity, express yourself with writing or talking, relax, think about positive pleasant things, ask for support, ask friend to quit with you, ask others not to smoke around you, assign nonsmoking areas, leave room when others smoke, keep hands and mouth busy
a. Cravings will lessen within a few weeks, anticipate triggers, change routine (brush teeth immediately after eating), distract yourself with pleasant activities, change lifestyle to reduce stress, increase physical activity
• Repetition
o Hypnosis-Has not been proven for cessation, may help decrease amount of smoking
o Nicotine replacement- not well studied but considered better than cigarettes b/c of all of the chemicals inhaled with smoking. recommend that nicotine gum, sprays, or inhalers should be used rather than patches; a patch provides a higher total dose because it is on the woman continuously. ACOG states these should only be considered once other interventions have failed and/or those that are heavy smokers (>1ppd)
• Know the trends and prevalence of street drug use in pregnant women
o The common perceptions of substance abuse as a problem of the poor, ethnic minority, and adolescent are inaccurate. These perceptions may often be acted upon by health care professionals in a prejudicial manner. Studies show similar rates of substance abuse during pregnancy by women of all racial, socioeconomic status and age categories. Demographic features are only related to the type of substance used with Black and poorer women most likely to use illicit substances, especially cocaine, while White women and better educated women tend to use alcohol.
o About 1 in 20 women (5%) take street drugs during pregnancy
Marijuana sign and symptoms
tachycardic lung infection trouble paying attention memory problems trouble thinking clearly clumsiness/poor balance
marijuana maternal effects
reduced fertility (street drugs in pregnancy)
marijuana : fetal effects
crosses the placenta, PTB, LBW, unclear evidence, CNS effect in children-changes in brain activity, sleep patterns, and behavior (street drugs in pregnancy)
cocaine signs/ symptoms
affects CNS
• loss of smell r/t (snorting)
• change in eye sight, sound and touch
stomach pain, nausea, anorexia, weight loss, tremors, HA, restless, scared, angry, heart attack, stroke, resp failure
cocaine maternal effects
local anesthetic, CNS stimulant (street drugs in pregnancy
cocaine fetal effects
Placental abruption, preterm birth, lower birth weight, respiratory distress, bowel infarctions, cerebral infarctions, fetal growth restriction and increased risk of seizures, early pregnancy loss, birth defects, CNS problems when the child is older, readily crosses the placenta and metabolizes slowly in the fetus, newborn withdrawl (street drugs in pregnancy)
Amphetamines s/sx
insomnia, tachycardia, sweating, hallucinations, dizziness, brain death/coma, death
amphetamines maternal effects
Stimulant (tachycardia, insomnia, anorexia..). Dextramphetamine (Desoxyn) is rx, appears to carry no risk but no studies in pregnant women (street drugs in pregnancy)
Dextramphetamine is used to treat ADHA, sleep disorders, or as an appetite suppressant→ NOT recommended for use in pregnancy