Substance Abuse During Pregnancy & NAS

Question 1

prenatal drug abuse

Answer 1

includes the use of alcohol and other drugs by pregnant women

Question 2

effect on alcohol on pregnancy

Answer 2

spontaneous abortion, inadequate weight gain, IUGR, FASD (leads to intellectual disability)

Question 3

effect of caffeine on pregnancy

Answer 3

vasoconstriction and mild diuresis in mother; fetal stimulation, but teratogenic effects not documented via research

Question 4

effects of nicotine on pregnancy

Answer 4

vasoconstriction, reduced uteroplacental blood flow, decreased birth weight, premature placental abruption, fetal demise & SIDS

Question 5

effects of cocaine during pregnancy

Answer 5

vasoconstriction, gestational hypertension, placental abruption, abortion, CNS defects & IUGR

Question 6

effects of marijuana during pregnancy

Answer 6

anemia, inadequate weight gain, “motivational syndrome”, hyperactive startle reflex, newborn tremors, prematurity, IUGR

Question 7

effects of opiates & narcotics during pregnancy

Answer 7

maternal and fetal withdrawal, placental abruption, preterm labor, premature rupture of membranes, perinatal asphyxia, newborn sepsis and death, intellectual impairment, malnutrition

Question 8

effects of sedatives during pregnancy

Answer 8

CNS depression , newborn withdrawal, maternal seizures in labor, neonatal abstinence syndrome (NAS), delayed lung maturity

Question 9

FASD (fetal alcohol spectrum disorder) birth defects

Answer 9

-Structural anomalies
-behavioral and neurocognitive disabilities

Question 10

What can alcohol consumption during pregnancy result in?

Answer 10

brain, craniofacial, and heart defects, neurotoxicity, and immune system dysfunction

Question 11

characteristics of FASD

Answer 11

craniofacial dysmorphia, IUGR, microcephaly, limb abnormalities, and cardiac defects

Question 12

craniofacial abnormalities in FASD

Answer 12

-thin upper lip
-small head circumference
-small eyes
-low nasal bridge
-short nose
-flat mid face
-minor ear abnormalities
-receding jaw

Question 13

cognitive & behavioral problems associated with FASD & ADHD

Answer 13

-inability to force consequences
-inability to learn from pervious experience
-lack of organization
-ID
-difficulty in school, specifically with math
-speech & language delays
-learning difficulties
-poor abstract thinking
-poor reasoning and judgement skills
-poor memory
-poor impulse control

Question 14

questions to ask your patient when assessing substance use

Answer 14

1. Have you ever used recreational drugs? If so, when & what?
2. Have you ever taken a prescription drug other than as intended?
3. What are your feelings about using drugs during pregnancy?
4. How often do you smoke cigarettes? How many per day?
5. How often do you drink alcohol?
6. Have you ever felt guilty about drinking or drug use?

Question 15

What questionnaire do you use if you suspect your pregnant client is using recreational drugs?

Answer 15

CRAFT

Question 16

how often do you see a pregnant person who is using substances?

Answer 16

2x per week or every 2 weeks

Question 17

Is methadone a daily appt?

Answer 17

yes

Question 18

Nursing management of substance use in pregnancy

Answer 18

-effects of substance spore on the fetus
-interventions to improve mother-child attachment & improve parenting
-psychosocial support if treatment is needed to reduce substance use
-referral to outreach programs to improve access to treatment facilities
-hazardous legal substances to avoid during pregnancy
-follow-up of children
-dietary counseling
-drug screen
-more frequent prenatal visits
-maternal and fetal benefits of remaining drug free
-cultural sensitivity
-coping skills, support systems, and vocational assistance

Question 19

when are UDS completed?

Answer 19

first prenatal visit & suspicion that they’re being used

Question 20

NAS

Answer 20

drug-withdrawal symptoms that result from chronic intrauterine exposure to a variety of substances, including opioids, barbiturates, SSRIs, alcohol, bentos, caffeine, & nicotine

Question 21

when do withdrawal symptoms start in newborns?

Answer 21

48-72 hours after birth

Question 22

how long do withdrawal symptoms last in newborns?

Answer 22

1 week to 6 months

Question 23

behavior of NAS

Answer 23

-high pitched cry
-tachypnea
-V/D

Question 24

nursing management to help with NAS

Answer 24

-keep lights dim to avoid seizures
-encourage things with movement to calm newborn down

Question 25

5 A’s

Answer 25

Ask - about quitting
Advise - treatment plan & benefits
Assess - 5 R’s
Assist - help protect newborn and fetus from complications
Arrange - schedule follow up visits to reinforce commitment

Question 26

5 R’s

Answer 26

-Relevance of cutting to woman
-Risk of continued maternal behaviors to fetus
-Rewards of quitting for both
-Roadblocks to quitting
-Repeat at every visit

Question 27

Caring for newborn exposed to substances

Answer 27

• promote comfort
  -meet nutritional needs (b/c poor feeding)
  -prevent complications (make sure they’re being seen right away)
  -promote parent-newborn interactions (1st couple of months are super important for bonding)