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The patient states that they have a glass of wine with their meals in the evening, how should
you counsel her? - correct answer -- We do not know how much alcohol is acceptable for the
fetus, therefore no alcohol during pregnancy is safe
- Risk for fetal alcohol syndrome, altered growth, IUGR
- Many different congenital anomalies
What substance can lead to miscarriages, pre-term labor, placental abruption, and stillbirth? -
correct answer -Cocaine (any CNS stimulant)
What effect can smoking have on a fetus? - correct answer -- IUGR and low birth weight
- Preterm birth
- Respiratory issues/asthma later in life
- Cognitive impairments such as ADHD
- Increased risk for abruptio placentae
What 3 categories are associated with fetal alcohol syndrome? - correct answer -- Craniofacial
dysmorphologies
- Skinny facial features
- Impaired growth
- CNS abnormalities
Fetal Alcohol Spectrum Disorder - correct answer -Fetal alcohol syndrome (FAS), alcohol-related
neurodevelopment (ARND), and alcohol-related birth defects (ARBD)
,A woman presents to labor and delivery in pre-term labor, she has not had any prenatal care.
The infant has the following characteristics: small for gestational age, microcephalic, small eyes,
and a thin upper lip. What drug do you suspect she has been abusing? - correct answer -
Alcohol
What should you include in a plan of care for an infant suffering from drug withdrawal? - correct
answer -5 S's: sucking, swaddling, side/stomach lying, shushing, swaying
What drug is most common cause of preventable cognitive impairment when abused during
pregnancy? - correct answer -Alcohol
At the first week of life an infant has a copper-colored rash on their palms and around their anus
and mouth. What is their diagnosis? - correct answer -- Syphilis
May also see:
- Enlarged liver/spleen Irritability
- FTT Cracking of skin where rash is
- Fever Skeletal abnormalities
When are FAS symptoms usually identified? - correct answer -When the child starts school
developmental delays present themselves
Infants whose moms have abused drugs during pregnancy require a multi-system approach.
What is the first step in providing care? - correct answer -Neonatal abstinence scores; guides
care
You are doing an educational session with a group of pregnant women. They ask about taking
prescription and over-the-counter medication during pregnancy. How should you respond? -
correct answer -Even OTC meds, herbs, and natural remedies can be teratogenic; read labels
and consult with pharmacist
,An infant whose mom abused heroin is admitted to the NICU, what kind of nursing care will you
provide? - correct answer -- Tightly swaddle the infant
- Morphine tapering or buprenorphine, sucrose, 5 s's
- DO NOT GIVE NARCAN, can cause extreme withdrawal symptoms and pain
The infant is showing signs of neonatal abstinence syndrome. What drug is contraindicated in
neonatal abstinence syndrome? - correct answer -Narcan; increases effects of withdrawal, puts
stress on body
A mother states that she smoked during the pregnancy and plans to continue after discharge,
she also plans to breastfeed. How would you counsel her? - correct answer -Encourage her to
breastfeed since breastfeeding is protective for the infant, then counsel her on quitting smoking
An infant is admitted to the NICU. The mother has not had prenatal care. The infant is seizing,
constantly mouths for food, and has a high-pitched cry. What test do you ask the doctor for? -
correct answer -Urine toxicity screen (drug screen)
What signs are associated with neonatal abstinence syndrome? - correct answer -- Excessive
hunger (constant rooting and mouthing)
- Persistent high-pitched cry
- Inconsolable
- Irritable
- Seizing, tremors/shaking
**Think FLACC**
An infant born addicted to cocaine is given oral morphine. What is the rationale behind giving
oral morphine? - correct answer -- Oral morphine does not contain any alcohol and helps
correct diarrhea
- Slower uptake
, An infant in the NICU is very fussy, you plan to use the 5 S's. What does that include? - correct
answer -- Swaddling
- Sucking
- Shushing
- Side/stomach lying
- Swaying
Substance abuse can occur in many forms. What are some of the substances that can be
abused? - correct answer -Alcohol and prescription, illicit, and OTC drugs
What physical findings would lead you to a diagnosis of fetal alcohol syndrome? - correct
answer -- Renal issues
- Cardiac issues
- Hearing issues
- Facial dysmorphologies: thin lip, flat space between lip and nose, small eyes, small head
What infant is at risk for thermoregulation issues? - correct answer -Low birth weight and
premature babies (no or low fat stores)
What is the best way to check a core body temperature? - correct answer -Rectally
Most critical action immediately after birth? - correct answer -Suctioning, mouth first to
prevent aspiration
Why do we encourage breastfeeding immediately after birth? - correct answer -Stimulates
release of oxytocin which causes uterine contraction and reduces risk of hemorrhage