NAS Care Plan Flashcards
Actual and potential problems
problem:
Withdrawal symptoms of opioid use during pregnancy
Potential problems:
- poor feeding
- irritability
- dehydration - loose bowels
- sepsis - high temp
- seizures
- poor skin integrity
- lack of sleep - impairs development
goals of care
- Rule out other diagnosis like sepsis
- Confirm maternal history and use of substances
- support adequate nutritional intake
- support normothermia
- Provide family support
- Maintain developmental care
- Monitor weight gain is consistent
- Monitor fluid balance to prevent dehydration
- Support skin integrity
- Support lactogenesis II establishment
- Promote bonding and attachment
- maintain BGL
- commence therapeutic morphine if required to minimise symptoms
Interventions and rationale
Monitor NAS symptoms using Finnegan scoring system 4hrly
Monitor vital signs
Assess weight
- to monitor dehydration or poor growth
Developmental care principles
- to support development and protect sleep
Support mother to establish breastfeeding
Assess level of feeding intolerance and ascertain appropriate feeding method for the infant
Administration of therapeutic morphine
Evaluation
Continue assessing NAS score
Vital signs remain WNL
Weight gain and FBC are normal
Decrease in morphine requirements
Discharge planning
NAS scoring is done for the 3 days post morphine discontinuation, or until discharge home
Infant can be discharged home when
- no signs of withdrawal
- off morphine for 72 hours
- home environment is assessed
- any child protection issues have been addressed
- medical and MCHN visits are organised
Education
- SIDS - NAS babies have an increased risk of sids
- breastfeeding and transmission of substances through breastmilk - preparation of formula prior to substance use
- secondary exposure to smoking
- soothing methods - NNS, breastfeeding, swaddling, S2S
- symptoms/reasons to seek medical attention
- paediatric resus
Referrals
- social support
- drug and alcohol support groups
- child protection if needed
