Substance Abuse During Pregnancy & NAS Flashcards
prenatal drug abuse
includes the use of alcohol and other drugs by pregnant women
effect on alcohol on pregnancy
spontaneous abortion, inadequate weight gain, IUGR, FASD (leads to intellectual disability)
effect of caffeine on pregnancy
vasoconstriction and mild diuresis in mother; fetal stimulation, but teratogenic effects not documented via research
effects of nicotine on pregnancy
vasoconstriction, reduced uteroplacental blood flow, decreased birth weight, premature placental abruption, fetal demise & SIDS
effects of cocaine during pregnancy
vasoconstriction, gestational hypertension, placental abruption, abortion, CNS defects & IUGR
effects of marijuana during pregnancy
anemia, inadequate weight gain, “motivational syndrome”, hyperactive startle reflex, newborn tremors, prematurity, IUGR
effects of opiates & narcotics during pregnancy
maternal and fetal withdrawal, placental abruption, preterm labor, premature rupture of membranes, perinatal asphyxia, newborn sepsis and death, intellectual impairment, malnutrition
effects of sedatives during pregnancy
CNS depression , newborn withdrawal, maternal seizures in labor, neonatal abstinence syndrome (NAS), delayed lung maturity
FASD (fetal alcohol spectrum disorder) birth defects
-Structural anomalies
-behavioral and neurocognitive disabilities
What can alcohol consumption during pregnancy result in?
brain, craniofacial, and heart defects, neurotoxicity, and immune system dysfunction
characteristics of FASD
craniofacial dysmorphia, IUGR, microcephaly, limb abnormalities, and cardiac defects
craniofacial abnormalities in FASD
-thin upper lip
-small head circumference
-small eyes
-low nasal bridge
-short nose
-flat mid face
-minor ear abnormalities
-receding jaw
cognitive & behavioral problems associated with FASD & ADHD
-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
questions to ask your patient when assessing substance use
- Have you ever used recreational drugs? If so, when & what?
- Have you ever taken a prescription drug other than as intended?
- What are your feelings about using drugs during pregnancy?
- How often do you smoke cigarettes? How many per day?
- How often do you drink alcohol?
- Have you ever felt guilty about drinking or drug use?
What questionnaire do you use if you suspect your pregnant client is using recreational drugs?
CRAFT
how often do you see a pregnant person who is using substances?
2x per week or every 2 weeks
Is methadone a daily appt?
yes
Nursing management of substance use in pregnancy
-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
when are UDS completed?
first prenatal visit & suspicion that they’re being used
NAS
drug-withdrawal symptoms that result from chronic intrauterine exposure to a variety of substances, including opioids, barbiturates, SSRIs, alcohol, bentos, caffeine, & nicotine
when do withdrawal symptoms start in newborns?
48-72 hours after birth
how long do withdrawal symptoms last in newborns?
1 week to 6 months
behavior of NAS
-high pitched cry
-tachypnea
-V/D
nursing management to help with NAS
-keep lights dim to avoid seizures
-encourage things with movement to calm newborn down
5 A’s
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
5 R’s
-Relevance of cutting to woman
-Risk of continued maternal behaviors to fetus
-Rewards of quitting for both
-Roadblocks to quitting
-Repeat at every visit
Caring for newborn exposed to substances
- 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)
