22.C: Prenatal substance abuse

A newborn in the nursery is exhibiting signs of neonatal abstinence syndrome. Which of the following signs/symptoms is the nurse observing? (Select all that apply) 1. Hyperphagia (excessive Hunger) 2. Lethargy. 3. Prolonged periods of sleep. 4. Hyporeflexia. 5. Persistent shrill cry

1, 5

There is a baby in the neonatal intensive care unit (NICU) who is exhibiting signs of neonatal abstinence syndrome. Which of the following medications is contraindicated for this neonate? 1. Morphine. 2. Opium. 3. Narcan. 4. Phenobarbital.

3. Narcan.

Many common drugs of abuse cause significant physiologic and behavioral problems in infants who are breastfed by mothers currently using (Select all that apply): a. Amphetamine. b. Heroin. c. Nicotine. d. PCP. e. Morphine.

A, B, C, D Amphetamine, heroin, nicotine, and PCP are contraindicated during breastfeeding because of the reported effects on the infant. Morphine is a medication that often is used to treat neonatal abstinence syndrome

Which if the following signs and symptoms would you expect to see in an infant withdrawing from heroin? Select all that apply. a. Temperature 36.5ºC b. RR 88 c. Diaphoretic d. Constipation

B, C

Use of opiates during pregnancy can result in a drug withdrawal syndrome called....

Neonatal abstinence syndrome

Of the following actions, which would the nurse identify as inappropriate for the plan of care of a newborn experiencing neonatal abstinence syndrome? a. Place in well-lit area with TV on b. Bundle in tight clothing/blankets c. Provide low amount of stimulation d. Initiate skin to skin contact during periods of irritability

a. Place in well-lit area with TV on

True or False: In-utero exposure to opioids can be confirmed by laboratory testing. a. True b. False

a. True Confirmation of in-utero opioid exposure can be done by testing an infant's cord blood, hair, meconium, or urine.

Pregnant women who have opioid use disorder should be treated with a. supervised opioid maintenance therapy. b. abrupt withdrawal. c. supervised opioid withdrawal. d. medical monitoring.

a. supervised opioid withdrawal The treatment then of a pregnant woman who has opioid use disorder presents clinicians with a choice, a choice that reduced to its simplest terms is this: prescribe supervised opioid maintenance or supervised opioid withdrawal.... Supervised opioid withdrawal with methadone is the treatment recommended by the American College of Obstetricians and Gynecologists, and this approach has been successfully used since the 1970s.

The onset of neonatal abstinence syndrome can be __________ after birth. a. two to four hours b. <24 hours to seven days c. two to three weeks d. one to two months

b. <24 hours to seven days "Withdrawal may occur 24 hours of birth or it may be delayed up to seven days after birth, and there is no way to reliably predict when it will begin."

True or False: Breastfeeding is absolutely contraindicated for infants who have neonatal abstinence syndrome. a. True b. False

b. False Literature reviews and single studies have shown that the severity of neonatal abstinence syndrome and the need for pharmacologic treatment are reduced if infants are breastfed, and a shorter hospital stay may be possible, as well.... Treatment of NAS should begin with symptomatic and supportive care. Unless there are specific contraindications, breastfeeding is encouraged and it has been shown to be an effective treatment.

Which of the following are common signs of the neonatal abstinence syndrome? a. Hypothermia and bradycardia b. Seizures and drowsiness c. Agitation and sleep disturbances d. Respiratory depression and seizures

c. Agitation and sleep disturbances Commonly seen signs of neonatal abstinence syndrome include, but are not limited to agitation, excessive crying, fever, poor feeding, sleep disturbances, and tachycardia. Serious complications such as seizures are uncommon and if the syndrome quickly detected and promptly treated, death is very unusual

Providing care for the neonate born to a mother who abuses substances can present a challenge for the health care team. Nursing care for this infant requires a multisystem approach. The first step in the provision of this care is: a. Pharmacologic treatment. b. Reduction of environmental stimuli. c. Neonatal abstinence syndrome scoring. d. Adequate nutrition and maintenance of fluid and electrolyte balance.

c. Neonatal abstinence syndrome scoring.

The first-choice therapy for neonatal abstinence syndrome is: a. Clonidine. b. Supplemental oxygen. c. Morphine. d. Supportive care.

d. Supportive care. Non-pharmacologic supportive care is the first choice for treating infants who have neonatal abstinence syndrome but in most cases, it is insufficient and pharmacologic intervention is required.... Treatment of NAS should begin with symptomatic and supportive care.

Long-term effects of neonatal abstinence syndrome may include a. susceptibility to infection. b. cardiac arrhythmias c. liver disease. d. cognitive deficits

d. cognitive deficits Unfortunately, there is comparatively little research that has been done examining what, if any, organ system damage may be caused by in-utero exposure to opioids, but what is available is not reassuring. [...] there is evidence that in-utero exposure to these drugs negatively affects the development of the nervous system and cognitive and psycho-social functioning.... There is evidence that both in-utero exposure to opioids and the neonatal abstinence syndrome can cause cognitive and behavioral abnormalities and social issues, problems that begin in childhood and persist into adolescence and beyond.