Maternal substance use may consist of any combination of drug, chemical, alcohol, and tobacco use during the pregnancy. Show
While in the womb, a fetus grows and develops due to nourishment from the mother via the placenta. However, along with nutrients, any toxins in the mother's system may be delivered to the fetus. These toxins may cause damage to the developing fetal organs. A baby also may become dependent on substances used by the mother. WHAT ARE THE SIGNS AND SYMPTOMS SEEN IN AN INFANT OF A SUBSTANCE-USING MOTHER? Babies born to substance-using mothers may have short- or long-term effects.
More significant long-term developmental problems may be seen in babies who are born with growth failure or various organ problems.
WHAT IS THE TREATMENT FOR AN INFANT OF A SUBSTANCE-USING MOTHER? The baby's treatment will depend on the drugs the mother used. Treatment may involve:
In the case of babies whose mothers used narcotics, the baby is most often given small doses of a narcotic at first. The amount is slowly adjusted as the baby is weaned off of the substance over days to weeks. Sedatives are sometimes used as well. Infants with organ damage, birth defects or developmental issues may need medical or surgical therapy and long-term therapies. These infants are more likely to grow up in homes that do not promote healthy emotional, social, and mental development. They and their families will benefit from long-term support. IUDE; Intrauterine drug exposure; Maternal drug abuse; Maternal substance use; Maternal drug use; Narcotic exposure - infant; Substance use disorder - infant Hudak M. Infants of substance-using mothers. In: Martin RM, Fanaroff AA, Walsh MC, eds. Fanaroff and Martin's Neonatal-Perinatal Medicine. 11th ed. Philadelphia, PA: Elsevier; 2020:chap 46. Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM. Abstinence syndromes. In Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 126. Martin GI. Marijuana: the effects on pregnancy, the fetus, and the newborn. J Perinatol. 2020;40(10):1470-1476. PMID: 32507859 pubmed.ncbi.nlm.nih.gov/32507859/. Wallen LD, Gleason CA. Prenatal drug exposure. In: Gleason CA, Juul SE, eds. Avery's Diseases of the Newborn. 10th ed. Philadelphia, PA: Elsevier; 2018:chap 13. Warner TD, Roussos-Ross D, Behnke M. It's not your mother's marijuana: effects on maternal-fetal health and the developing child. Clin Perinatol. 2014;41(4):877-94. PMID: 25459779 pubmed.ncbi.nlm.nih.gov/25459779/. Updated by: Kimberly G. Lee, MD, MSc, IBCLC, Clinical Professor of Pediatrics, Division of Neonatology, Medical University of South Carolina, Charleston, SC. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team. 1) A nurse in a delivery room is assisting with the delivery of a newborn infant. After the delivery, the nurse prepares to prevent heat loss in the newborn resulting from evaporation by: 2)
A nurse is assessing a newborn infant following circumcision and notes that the circumcised area is red with a small amount of bloody drainage. Which of the following nursing actions would be most appropriate? 3) A nurse in the newborn nursery is monitoring a preterm
newborn infant for respiratory distress syndrome. Which assessment signs if noted in the newborn infant would alert the nurse to the possibility of this syndrome? 4) A nurse in a newborn nursery is performing an assessment of a newborn infant. The nurse is preparing to measure the head
circumference of the infant. The nurse would most appropriately:
5) A postpartum nurse is providing instructions to the mother of a newborn infant with hyperbilirubinemia who is being breastfed. The nurse provides which most appropriate instructions to the mother?
6) A nurse on the newborn nursery floor is caring for a neonate. On assessment the infant is exhibiting signs of cyanosis, tachypnea, nasal flaring, and grunting. Respiratory distress syndrome is diagnosed, and the physician prescribes surfactant replacement therapy. The nurse would prepare to administer this therapy by:
7) A nurse is assessing a newborn infant who was born to a mother who is addicted to drugs. Which of the following assessment findings would the nurse expect to note during the assessment of this newborn?
8) A nurse prepares to administer a vitamin K injection to a newborn infant. The mother asks the nurse why her newborn infant needs the injection. The best response by the nurse would be:
9) A nurse in a newborn nursery receives a phone call to prepare for the admission of a 43-week-gestation newborn with Apgar scores of 1 and 4. In planning for the admission of this infant, the nurse’s highest priority should be to:
10) Vitamin K is prescribed for a neonate. A nurse prepares to administer the medication in which muscle site?
11) A nursing instructor asks a nursing student to describe the procedure for administering erythromycin ointment into the eyes if a neonate. The instructor determines that the student needs to research this procedure further if the student states:
12) A baby is born precipitously in the ER. The nurses initial action should be to:
13) The primary critical observation for Apgar scoring is the:
14) When performing a newborn assessment, the nurse should measure the vital signs in the following sequence:
15) Within 3 minutes after birth the normal heart rate of the infant may range between:
16) The expected respiratory rate of a neonate within 3 minutes of birth may be as high as:
17) The nurse is aware that a healthy newborn’s respirations are:
18) To help limit the development of hyperbilirubinemia in the neonate, the plan of care should include:
19) A newborn has small, whitish, pinpoint spots over the nose, which the nurse knows are caused by retained sebaceous secretions. When charting this observation, the nurse identifies it as:
20) When newborns have been on formula for 36-48 hours, they should have a:
21) The nurse decides on a teaching plan for a new mother and her infant. The plan should include:
22) Which action best explains the main role of surfactant in the neonate?
23) While assessing a 2-hour old neonate, the nurse observes the neonate to have acrocyanosis. Which of the following nursing actions should be performed initially?
24) The nurse is aware that a neonate of a mother with diabetes is at risk for what complication?
25) A client with group AB blood whose husband has group O has just given birth. The major sign of ABO blood incompatibility in the neonate is which complication or test result?
26) A client has just given birth at 42 weeks’ gestation. When assessing the neonate, which physical finding is expected?
27) After reviewing the client’s maternal history of magnesium sulfate during labor, which condition would the nurse anticipate as a potential problem in the neonate?
28) Neonates of mothers with diabetes are at risk for which complication following birth?
29) By keeping the nursery temperature warm and wrapping the neonate in blankets, the nurse is preventing which type of heat loss?
30) A neonate has been diagnosed with caput succedaneum. Which statement is correct about this condition?
31) The most common neonatal sepsis and meningitis infections seen within 24 hours after birth are caused by which organism?
32) When attempting to interact with a neonate experiencing drug withdrawal, which behavior would indicate that the neonate is willing to interact?
33) When teaching umbilical cord care to a new mother, the nurse would include which information?
34) A mother of a term neonate asks what the thick, white, cheesy coating is on his skin. Which correctly describes this finding?
35) Which condition or treatment best ensures lung maturity in an infant?
36) When performing nursing care for a neonate after a birth, which intervention has the highest nursing priority?
37) When performing an assessment on a neonate, which assessment finding is most suggestive of hypothermia?
38) A woman delivers a 3.250 g neonate at 42 weeks’ gestation. Which physical finding is expected during an examination if this neonate?
39) A healthy term neonate born by C-section was admitted to the transitional nursery 30 minutes ago and placed under a radiant warmer. The neonate has an axillary temperature of 99.5*F, a respiratory rate of 80 breaths/minute, and a heel stick glucose value of 60 mg/dl. Which action should the nurse take?
40) Which neonatal behavior is most commonly associated with fetal alcohol syndrome (FAS)?
ANSWERS
Which assessments would the nurse include during the initial assessment of a newborn after birth?One of the first assessments is a baby's Apgar score. At one minute and five minutes after birth, infants are checked for heart and respiratory rates, muscle tone, reflexes, and color. This helps identify babies that have difficulty breathing or have other problems that need further care.
When caring for a newborn after birth which intervention has the highest nursing priority?With every newborn contact, respiratory evaluation is necessary because this is the highest priority in newborn care. The Silverman and Andersen index can assess respiratory distress and its varying degrees.
Which action would the nurse implement to follow standard precautions when providing care to a newborn before the first bath?1. Implement safety principles when bathing newborns: • Use standard precautions, including wearing gloves until after the newborn's first bath (which ideally should be between 6-24 hours after birth). Ensure bath equipment is not a source of cross contamination among newborns.
Which intervention would the nurse perform as soon as a newborn is delivered?Immediate care for the newborn
One of the first checks is the Apgar test. The Apgar test is a scoring system to evaluate the condition of the newborn at 1 minute and 5 minutes after birth. The healthcare provider or midwife and nurses will evaluate these signs and give a point value: Activity; muscle tone.
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