Care of the Newborn of a Substance Abusing Mother

Lecture Fifteen: Care of the Newborn of a Substance Abusing Mother
NURS 2208
Fall 2002
T. Dennis RNC, MSN
Substances Commonly Abused During Pregnancy

1. Tobacco
2. Alcohol
3. Cocaine/Crack
4. Marijuana
5. Phencyclidine (PCP)
6. Heroin
7. Methadone

Fetal Alcohol Syndrome (pg. 832)

1. (FAS) A syndrome caused by maternal alcohol ingestion and characterized by microcephaly, intrauterine growth retardation, short palpebral fissures, and maxillary hypoplasia.
2. FAS rates are higher among Native Americans and Alaskans.
3. Fetal alcohol effects (FAE): alcohol related birth defects.
4. Ethanol freely crosses the placenta to the fetus.
5. Contributing factors may include drug abuse, caffeine, and poor diet.
6. Long term complications: 1) failure to thrive associated with weak suck development, persistent vomiting until 6 to 7 months of age. 2) hypotonicity, placidity, decreased ability to habituate repetitive stimuli. 3) normal or below normal IQ (environmental support does not typically increase IQ).

Nursing Assessment and Diagnosis (pg. 833)

1. Abnormal structural development and CNS dysfunction: 1)microcephaly,            2) hyperactivity and 3) mental retardation.
2. Growth deficiencies: 1) weight, length and head circumference are initially growth restricted, 2) growth  deficiences related primarily to head circumference and linear growth.
3. Distinctive facial abnormalities: 1) broad nasal ridge, 2) flattened midfacies, short upturned or beaklike nose, micrognathia (abnormally small lower jaw).
4. Associated anomalies: 1) septal and valvular defects of the heart, 2) eyes, 3) kidneys, 4) congenital dislocated hips (skeletal anomalies).

Nursing Diagnosis (pg. 833)

1. Altered Nutrition: Less than Body Requirements related to decreased food intake and hyperirritability.
2. Alteration in Neurodevelopmental Status related to central nervous system involvement secondary to maternal alcohol use.
3. Ineffective Family Coping related to dysfunctional family dynamics and substance-dependent mother.

Nursing Plan and Implementation (pg. 833)

1. Nursing plan includes recognizing signs characteristics of the FAS newborn and planning care aimed at avoiding heat loss, providing adequate nutrition, reducing environmental stimuli, and education for the family.
2. Interventions include: provide a quiet, dimly lighted environment, allow extra time for feedings, keep personnel and visitors to a minimum, monitor vital signs frequently and observe for seizure activity and respiratory distress.

Evaluation (pg. 833)

1. The FAS newborn is able to tolerate feedings and gain weight.
2. The FAS infant’s hyperirritability is controlled, and the newborn has suffered no physical injuries.
3. The parents are able to identify and meet the special needs of their newborn and accept outside assistance as needed.

Drug Dependence (pg. 833)

1. Almost all drugs cross the placenta and enter into the fetal circulation.
2. Intrauterine asphyxia
3. Intrauterine infection
4. Alterations in birth weight
5. Low apgar scores

1. Respiratory distress
2. Jaundice
3. Congenital anomalies and growth retardation
4. Behavioral abnormalities
5. Withdrawal

Long Term Effects (pg. 834)

1. Inability to express emotions
2. High risk for motor development problems, language skills, and feeding difficulties due to swallowing disorders
3. Increased risk of Sudden Infant Death Syndrome
4. Higher incidence of respiratory illness, gastrointestinal illness (May be related to the mother’s drug abuse problem which results in a lack of education regarding proper infant care, feeding and hygiene.
5. Subject to abuse, neglect or both.

Clinical Therapy (pg. 835)

1. The goal of clinical therapy is to prevent complications through prenatal management and pharmacologic management of newborn narcotic withdrawal.
2. The client should be placed on a methadone reduction program.
3. It is not recommended that the client be withdrawn completely from narcotics while pregnant.
4. Newborn treatment may include: 1) management of complications, 2) serologic tests for syphilis, HIV, and hepatitis B, 3) urine drug screen and meconium analysis, 4) and social service referral.
5. Pharmacologic treatment is based on drug exposure and symptoms. Drugs may include: phenobarbital, paregoric, oral morphine sulfate solution, Donnatal elixir, and simrthicone  (Mylicon) drops.
6. Nutritional support is important.

Nursing Assessment and Diagnosis (pg. 835)

1. Early identification of the newborn needing clinical or pharmacologic interventions decreases the incidence of mortality and morbidity.
2. Note mother’s last drug intake and dosage level.
3. Prepare for complications associated with substance abuse during pregnancy.
4. Identify symptoms of newborn withdrawal: Hyperirritability (incessant shrill cry), tremors, seizures, short unquiet sleep, tachypnea (>60 breadths per minute), poor feeding, disorganized suck, flushing, facial scratches.
5. Lab values are WNL with these infants.

Nursing Assessment and Diagnosis (pg. 835)

1. The fetus of a heroin addicted mother is likely to have meconium aspiration.
2. When caring for the client who abuses opiate narcotics, the nurse encourages regular attendance at prenatal classes, assesses for poor weight gain or for weight loss, and gives positive reinforcement for desired behaviors.
3. Do not encourage the client who abuses opiate narcotics to immediately stop using all narcotics.

Nursing Diagnosis (pg. 836)

1. Altered Nutrition: Less than Body Requirements related to vomiting and diarrhea, uncoordinated suck, swallow reflex, hypertonia secondary to withdrawal.
2. Impaired Skin Integrity related to constant activity.
3. Altered Parenting related to hyperirritable behavior
4. Ineffective Family Coping: Disabling related to drug abuse, poverty, and lack of education
5. Sleep Pattern Disturbance related to CNS excitability secondary to drug withdrawal

Nursing Plan and Implementation (pg. 836)
Care is based on reducing the withdrawal symptoms and promoting adequate respiration, temperature, and nutrition.

1. Temperature regulation
2. Monitor vital signs
3. Stimulation if apnea occurs
4. Small, frequent feedings
5. IV therapy as needed
6. Medications as ordered (paregoric, phenobarbital)
7. Proper positioning on the right side
8. Weigh the infant every 8 hours during withdrawal
9. Swaddling with hands near mouth
10. Place in a quiet, dimly lighted area of the nursery

Nursing Plan and Implementation (pg. 836)

1. The client’s educational plan should focus on the relationship of substance abuse to her health and the health of her baby.
2. Do not tell the patient you will report her to the authorities if she fails to comply with treatment.
3. The client she may be able to have medication for pain during labor depending on her current drug status.
4. Plan care for the infant who may be experiencing neonatal abstinence syndrome (withdrawal) to include a quiet area in the nursery, frequent, small feedings and close swaddling and/or mittens to prevent facial scratches.

Evaluation (pg. 836-840)

1. The newborn tolerates feedings, gains weight, and has a decreased number of stools.
2. The parents learn ways to comfort their newborn.
3. The parents are able to cope with their frustrations and begin to use outside resources as needed.