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Nursing Care Infants

Nursing Care for Infants of Drug/Alcohol Abusing Mothers

QuestionAnswer
What does the term teratogenicity mean? It is something that causes a birth defect or birth deformity.
What are the concerns we would have for a fetus when the mom is using alcohol? The fetus is going to get the alcohol transmitted to the placental circulation and the fetus cannot remove the breakdown products of alcohol from their bodies.
What will using alcohol during pregnancy cause? Neurologic damage. They will have a vitamin B deficiency.
Characteristics of children with Fetal Alcohol Syndrome. These children are cognitively impaired. Cranial facial abnormalities. Short palpable fissures in their skull. Thin upper lip and no creases between the nose and upper lip. A little upturned nose, and a flat nasal bridge.
What is the incidence or Fetal Alcohol Syndrome in newborns? 2 per 1000 newborns
Most of those who appear to be affected by Fetal Alcohol Syndrome are: Native Americans and African Americans - but it can affect any ethnic group.
In children with Fetal Alcohol Syndrome, the more severe the craniofacial abnormalities... The more severe the retardation.
What kinds of problems to kids with Fetal Alcohol Syndrome experience. Difficulty in schoolLanguage delays and recall problems. Developmental delays. Acting out when they get older.
What ar signs a person is using cocaine? Dilated pupils, nose bleeds, nasal congestion or sniffing, tachycardia,elevated BP, impaired movement, insomnia, anorexia, seizures.
Some women use cocaine during their pregnancy because they know it will do what? Bring about their labor early and get it over with.
When a pregnant woman uses cocaine/crack, it will cvause an increase in: Catecholamines
What are catecholamines? Epinephrine or Nor Epinephrine. Your fight or flight.
What will an increase of catecholamines in the body cause? Vasoconstriction
Why is vasoconstriction bad for a developing fetus? Because it reduces blood flow to the brain.
Why is vasocontriction bad for the pregnant mother? It causes reduced blood blow to the placenta and an increase for preterm labor. It can cause abruptia placenta which is the premature separation of the placenta. This can lead to serious bleeding complications.
Long term babies whose moms use cocaine can have what conditions? Motor development porblems, delays in language skills, congenital anomalies growth retardation and all that goes with your imparied neuronal development.
When vasoconstriction causes reduced placental blood flow, both the mom and the fetusare going to have increased: BP
An increase in BP in the feuse can lead to: Intracranial pressure and stroke
Intra Uterine Growth Restrictions (IUGR)are caused by: Reduced placental blood flow.
What does reduced placental blood flow cause? Intra Uterine Growth Restrictions (IUGR)Decreased oxygenCan lead to ischemic hypoxic brain injury.
What are the teratogenic effect of mothers using cocaine/crack? Smaller head. Feeding and Swallowing difficulties. Higher incidence of SIDS.
When will withdrawal symptoms appear in the newborn baby whose mother abused drugs during pregnancy? As early as 12-24 hours after birth, or as late as 2-3 weeks after birth.
How long can withdrawal symptoms in the newborn baby whose mother abused drugs during pregnancy last? They can last for 6-9 weeks. Hyperirritability can last for3-4 months.
When do the most pronounced symptoms of withdrawl occur in the newborn baby whose mother abused drugs during pregnancy? Between 48-72 hours.
What kind of a maternal history would you get from the mother who is using cocaine/crack while pregnant? History of drug addiction? Prenatal care type and length? Prenatal conditions or disorders? Drug treatment or rehab in the past? History of previous addiction? History of alcohol abuse?
What do we do to assess the infants status of an infant of a mother who is using cocaine/crack is born? APGAR Weigh the baby and check for SGA or LGA.
The number one reason for SGA is: Poor nutrition
If a mother is in a methadone treatment program, then those babies tend to be: LGA
What gastrointestinal findings will be present in the newborn baby whose mother abused drugs during pregnancy? Poor feedings. Vomiting and diarrhea.
Unless a baby is preterm, you wouldn't expect to see uncoordinated sucking an swallwoing. if there is uncoordinated sucking and swallowing there is something wrong: Neurologically
What integumentary findings will be present in the newborn baby whose mother abused drugs during pregnancy? Redness. Marks on the elbows and knees from the infant rubbing their elbows and kicking their heels when they are due for a drug.
What neurological findings will be present in the newborn baby whose mother abused drugs during pregnancy? Irritability, hypertonicity, opisthotonus (arching), kicking when due for a drug, shrill high pitch cry. Babies will have an inability to sleep and they my convulse.
If you have a baby in an isolette and they are jumping with no stimulation at, it is called: Hyperactive reflexes
What pulmonay findings will be present in the newborn baby whose mother abused drugs during pregnancy? Stuffy nose, sneezing, tachypnea, increased respiratory rate, chest retractions, apnea.
If there is no other reason for apnea in a newborn, and it is not a result of prematurity, we would suspect: Substance abuse by the mother.
What is the NAS? Neonatal Absinence Scoring Sheet. Used when substance abuse by the mother has been identified. The more severe the behavior, the higher the numbers.
What is it important to do before completing the NAS? Feed the infant because hunger can mimic some of the things on the scoring sheet.
A total of 8 on the NAS indicates what? Severe withdrawal.
What labs will be ran if an infants is indicated as being in withdrawal? Toxicology on mom and baby, serum electrolyte levels, serum glucose levels, CBC and blood culture.
Why do we run labs when an infant has been indicated as being in withdrawal? We want to eliminate things that can possibly give false positives such as electrolyte imbalances, glucose imbalances, or sepsis. These can cause some of the behaviors on the NAS.
What kind of interventions would we do for the infant who is positive for withdrawal? Assess for withdrawal symptoms, determine whether there is maternal drug use in pregnancy,provide calming techniques,administer medication for withdrawal.
What are mylicon drops used for in infants going through drug withdrawal? Use for the cramping and abdominal pain the baby may have.
What is donnatol used for in infants going through drug withdrawal? It is a GI relaxant.
What is paregoic used for in infants going through drug withdrawal? Relaxe the GI tract and relieve muscle cramps. Very controversial.
What is drug is used for babies with heroin withdrawal? Chlorpromazine or Thorazine
What will a baby that is convulsing in an unstable environment be given? Phenobarbital by IV
What are calming techniques? Swaddling the baby with hands near the midline of the body. Rocking the baby. Very little tactile stimulation, less stroking. Keep in a dark room and decrease noise. Use water beds. Small frequent feedings r/t of difficulty in swallowing and sucking.
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