Exam 2
Review
Chapters 19 & 20
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Chapter 19
High-Risk Pregnancy
Bleeding Conditions
●
Spontaneous abortion
●
Ectopic pregnancy
●
Gestational trophoblast disease
●
Cervical insufficiency
●
Placenta previa
●
Abruptio placenta
●
Placenta accreta
Before wk 20
After wk 20
Conditions Associated with Early
Bleeding
● First half of pregnancy (before 20 wk)
○ Spontaneous abortion
■ 80% occur in the first trimester
○ Ectopic pregnancy
○ Gestational trophoblastic disease
○ Cervical insufficiency
Spontaneous Abortion
●
< 20 weeks gestation—miscarriage
●
>20 weeks gestation—stillbirth
●
Cause unknown
●
○
1st trimester can be fetal genetic abnormalities
○
2nd trimester r/t maternal conditions
Nursing assessment
○
Pad counts 🡪 want no more than one per hour
○
blood color, clots present; save clots to determine if it is fetal matter
○
Note severe/painful contractions/cramping and their frequency
○
Make sure mother is aware of what happens
○
monitor hCg levels—high levels indicate leftover fetal tissue
○
Emotional support—ensure the mother this is NOT her fault
Medications Related to Abortions
**These meds stimulate uterus to contract to induce labor
●
Misoprostol (Cytotec)
○
●
Mifeprisone
○
●
Allows prostaglandins to cause contractions
PGE2 (Cervidil)
○
●
Stimulate contractions and help with expulsion of fetal matter
Cause uterine contractions and effacement/dilation
RhoGAM
○
Suppress the immune response by the mom
○
Given if the mom is Rh negative and the fetus is Rh positive
Ectopic Pregnancy
●
●
●
Ovum implantation outside the uterus (fallopian tube most common)
○
May also implant in abdominal cavity, cervix, or ovaries
○
Can rupture = massive hemorrhage 🡪 medical emergency
○
Dx: low levels hcG
Risk factors
○
PID after chlamydia or gonorrhea infection (tube scarring)
○
Previous ectopic pregnancy
○
Smoking (alters mobility in tube), fibroids, tubal surgery, IUD
Nursing Assessment
○
Hallmark sign: abdominal pain with spotting within 6-8 week of
missed menses
Ectopic Pregnancy (cont..)
●
Can give meds: methotrexate, prostaglandins, miso, actinomycin
●
Methotrexate: inhibits cell division
○ Criteria to give: early dx, hemodynamically stable, no bleeding, no rupture
○ IM single dose (can’t be bleeding)
○ Side effects: n/v/d, abd pain
●
Surgery if ruptured
○ HYPOVOLEMIC SHOCK: inc pain, inc HR, low BP, dizzy
●
Nursing Management:
○ Analgesics for pain
○ Meds
○ Teach about signs of rupture
○ Surgery
Gestational Trophoblastic Disease
●
Neoplastic disorder in placenta (grows from gestational tissue)
●
Cause unknown
●
2 types:
●
○
Hydatidiform mole – benign neoplasm
○
Choriocarcinoma – cancer of chorion membrane
Vessels filled with fluid: no fetal content (no heartbeat)
○
No actual fetus, but s/s preg (including growing uterus)
●
Uterus grows rapidly: hCG abnormally high
●
Immediate evacuation of contents (D&C)
●
Up to 1yr monitor hCG (may be on methotrexate)
○
●
Can’t get preg for up to 1yr
Signs similar to miscarriage
Cervical Insufficiency
●
Premature dilatation of cervix
○
Spontaneously dilating with no contractions
○
Cornerstone dx. resulting in loss of pregnancy during 2nd and 3rd trimester
●
Cause unknown; possibly due to cervical damage/trauma
●
Therapeutic Management
○
EDUCATE ON SIGNS OF PRETERM LABOR
○
Bed rest—removes pressure
○
Pelvic rest
■
No intercourse
○
Avoidance of heavy lifting
○
Cervical cerclage
■
Keeps cervix closed (don’t dilate), we want full-term preg!
Cervical Insufficiency (cont…)
●
●
Assessment
▪
Pink-tinged vaginal discharge or pelvic pressure
▪
Cervical shortening via transvaginal ultrasound
▪
Picked up between 16-20 weeks; risk for preterm labor
Nursing Management
○
Continuing surveillance and close monitoring for preterm labor
○
Provide emotional support
○
■
Important because mom becomes attached to the baby
■
Stressed, scared, and worried about the unknown
Education – baby might have to go to the NICU or mom might be
wondering why this is happening to them
Conditions Associated with Late
Bleeding
●
Second half of pregnancy (after 20wk)
○
Placenta previa (implants lower)
○
Abruptio placenta (pulls away)
○
Placenta Accreta (implants too deep)
Placenta Previa
● Unknown Cause
● Placenta implants over cervical os
(no internal exams)
● Apparent around 27-32 weeks
gestation
● Dx by transvaginal ultrasound/MRI
● Risk Factors
■ Over age 35; or really young
■ Previous c-section
■ Cocaine use
■ Hx of placenta previa
■ Infertility tx
■ Multiple gestations,
smoking, HTN, gestational
diabetes
■ Possible scarring (uterine
endometrial lining)
Placenta Previa (cont..)
● Vaginal Bleeding
○ PAINLESS
● Nursing Management
○ Pad counts
○ Bright red in 2nd/3rd trimester
○ Avoid vaginal exams
○ Spontaneous cessation than
recurrence
○ Fetal kick counts
○ FHR
○ Monitor VS (q15-30 mins if active
bleeding)
○ Lay on side if fetal distress
○ S/S: backache & preterm labor
○ Possible c-section
Abruptio Placentae
●
Placenta pulls from uterus: leading to
compromised fetal blood supply
○
●
Leads to hemorrhage
○
●
Occurs in upper 2/3 of uterus
Medical emergency: fetal demise & maternal
Nursing Assessments
○
Bleeding (dark red)
○
Painful (knife-like), uterine
tenderness, contractions
○
FIRST SIGN: TACHYCARDIA
○
Firm uterus
○
Fetal distress (decels or absent HR) =
SMOOTH & WAVY SAVE THE
BABY
Abruptio Placentae (cont..)
● Nursing management
○ Tissue perfusion:
■ Left lateral position
■ Bed rest
Risk Factors:
- Hydramnios (a lot of fl)
- Increased BP (not good flow)
■ O2
■ VS (q15min)
■ Fundal ht
● Inc. in size indicates bleeding – measures higher when pulling away
■ Continuous fetal monitoring
○ Assess, control, restore blood loss
■ Can lose up to 40% blood volume
Manifestation
Placenta Previa
Abruptio Placentae
Onset
Insidious
Sudden
Type of Bleeding
Always visible; slight, then
more profuse
Can be concealed or visible
Blood Description
Bright red
Dark
Discomfort/pain
None (painless)
Constant; uterine tenderness
on palpation
Uterine tone
Soft and relaxed
Firm or rigid
Fetal heart rate
Usually in normal range
Fetal distress or absent
Fetal presentation
May be breeched or
No relationship
transverse lie; engagement is
absent
Placenta Accreta
● DEEPLY attached
● Implanted too deep
● HIGH risk postpartum
hemorrhage
Hyperemesis Gravidarum
● SEVERE N/V
● Resolve by week 20 (low hCG)
○ Weight loss >5% of pre-pregnancy body weight
○ DHD, metabolic acidosis, alkalosis, and hypokalemia
● Nursing Assessment
○ Onset, duration, course of N/V; diet hx
○ Baseline wt
○ NPO (IV inserted), bowel rest
○ S/s dehydration
■ Skin turgor, mucous membranes, I&Os, hypotensive, weakness, fatigue, elevate
HR & liver enzymes
Hyperemesis Gravidarum (cont..)
● NPO, IV fluids, hygiene, oral care, I&O
○ Zofran, Compazine, Phenergan (Rectal/IV)
● Check electrolyte levels—decrease in K, Na, Cl
● Separate fluid from food
● Avoid tight waistband
● Look at ketones present/spec gravity
Hypertensive Disorders
Gestational HTN
Preeclampsia
Eclampsia
Gestational HTN
● BP elevation: >140/90 ONLY!
● Identified after 20 weeks gestation
○ Occurs two occasions 6 hours apart after 20 weeks gestation
● No proteinuria
● BP returns to normal by 12 weeks postpartum
● Hypertension occurs during pregnancy only
● Common complication
● No change in lab values
Mild Preeclampsia: Home
● Bed rest
● Antepartum visits/diagnostic testing
● Can monitor BP at home (take meds)
● Fetal movement counts
● Test urine (for protein)
● Monitor wt gain
● 6-8 glasses H20, Na restricted
Mild:
- Sys +140
- Dis +90
- 24hr urine: 300mg,
+1 dip
- No seizures/no coma
- No hyperreflexia
- Wt gain, mild edema
Mild Preeclampsia – Hospital
● Monitor for s/s of severe pre-e/eclampsia
● Fetal surveillance
○ Fetal kick count
○ NSTs
○ Serial ultrasounds
● IV mag-sulfate during labor
○ Prevention of seizures
○ Toxicity >8
■ Dec RR, dec reflexes, <30ml/hr urine, hypocalcemia
■ Antidote: Ca gluconate
Severe Pre-e: Management
●
Birth of baby is only cure
●
Management:
●
○
Quiet environment
○
Dec light & stimuli
○
Seizure precautions (padded bed rails)
○
Give HTN meds
○
Monitor reflexes
Severe:
- Sys +160
- Dys +110
- 24hr urine: 500mg, +3 dip
- No seizures/no coma
- YES hyperreflexia, +2, clonus
- Ha, dec urine output, blurred
vision, RUQ pain, pulm edema
(SOB, cough)
■
2 or 3+ is normal on 1-4 scale
■
Check for clonus—push foot to dorsiflex, if it shakes when you let go, positive
clonus
Run mag-sulfate & Pitocin
Eclampsia
●
●
Seizure management
○
Suction after seizures
○
L side
○
Fluid to replace urine loses
○
Breathing stops while seizing due to muscle
spasms
○
Mag-sulfate continues 24 hours after birth
○
Assess vitals q4
Fetal monitoring, uterine contraction
monitoring, preparation for birth, follow-up
care
Eclampsia:
- Sys +160
- Dys +110
- Proteinuria
- Yes seizures/yes
coma
- Yes hyperrflexia
- Severe ha, RUQ pain,
cerebral hemorrhage,
SEIZURES
Hypertensive Disorders
Medications for Pre-E and Eclampsia
● Magnesium Sulfate—seizures
● Hydralazine hydrochloride (Apresoline)
○ Smooth muscle relaxation for vasodilation/increased perfusion
○ Decreases BP
● Labetalol
○ Beta blocker to decrease BP
● Nifedipine (Procardia)
○ Calcium channel blocker (dilate arteries)
● Sodium nitroprusside (Nipride)
○ Rapid vasodilation which rapidly decreases BP
● Furosemide (Lasix)
○ Pulm edema
For the client who is receiving intravenous
magnesium sulfate for severe preeclampsia,
which assessment findings would alert the nurse
to suspect hypermagnesemia?
a.
Decreased deep tendon reflexes
b.
Cool skin temperature
c.
Rapid pulse rate
d.
Tingling in the toes
For the client who is receiving intravenous
magnesium sulfate for severe preeclampsia,
which assessment findings would alert the nurse
to suspect hypermagnesemia?
a.
Decreased DTRs
Remediation :
Typical signs of hypermagnesemia include decreased deep tendon
reflexes, sweating or a flushing of the skin, oliguria, decreased
respirations, and lethargy progressing to coma as the toxicity increases.
The nurse should check the client’s patellar, biceps, and radial reflexes
regularly during magnesium sulfate therapy
A primigravid client at 38 weeks’ gestation diagnosed
with mild preeclampsia calls the clinic nurse to say she
has had a continuous headache for the past 2 days
accompanied by nausea. The client does not want to take
aspirin. The nurse should tell the client:
a.
Take two acetaminophen tablets, as they won’t upset your stomach
as much
b.
I think the healthcare provider should see you today. Can you come in
this morning?
c.
You need to like down and rest. Have you tried a cold compress?
d.
I’ll ask the HCP to call in for antiemetics. What is your pharmacy
number?
A primigravid client at 38 weeks’ gestation diagnosed
with mild preeclampsia calls the clinic nurse to say she
has had a continuous headache for the past 2 days
accompanied by nausea. The client does not want to take
aspirin. The nurse should tell the client:
b. I think the HCP should see you today. Can you come to the clinic this morning?
Remediation:
A client with preeclampsia and a continuous headache for 2 days should be seen by
a health care provider (HCP) immediately. Continuous headache, drowsiness, and
mental confusion indicate poor cerebral perfusion and are symptoms of severe
preeclampsia. Immediate care is recommended because these symptoms may lead to
eclampsia or seizures if left untreated.
HELLP
●
Hemolysis,
Elevated Liver
Enzymes, Low
Platelets
○
Hemolysis—death of
RBC
●
Nursing Assessment:
similar to that for severe
preeclampsia; laboratory
test results
●
Nursing Management:
same as for severe
preeclampsia
Blood Incompatibility
●
Rh incompatibility:
○
Exposure of Rh-negative mother
to Rh-positive fetal blood
■
●
○
Sensitization
○
Antibody production
○
Risk increases with each
subsequent pregnancy and fetus
with Rh-positive blood (2nd preg)
Nursing Assessment
○
●
IDEAL: mom & baby blood don’t mix
maternal blood type and Rh status
Nursing Management
○
300mg IM @ 28wk & 72hr after
birth
Hydramnios
● Amniotic fluid >2,000 mL
● Therapeutic management
○ close monitoring
○ removal of fluid
○ Indomethacin (decreases fluid by decreasing fetal urinary output)
● Nursing assessment
○ risk factors, fundal height, abdominal discomfort, difficulty palpating fetal parts, or
obtaining FHR
● Nursing management
○ ongoing assessment and monitoring
○ assisting with therapeutic amniocentesis
Oligohydramnios
● Amniotic fluid <500 mL
● Therapeutic management
○ Serial monitoring
○ Amnioinfusion
○ birth for fetal compromise
● Nursing assessment: risk factors, fluid leaking from vagina
○ Urine is more acidic that amniotic fluid; if suspected fluid leak, test pH
● Nursing management: continuous fetal surveillance; assistance with amnioinfusion, comfort
measures, position changes
● Perfusion worries
○ Cord compression, baby can get stuck on one side of uterus
Premature Rupture of Membranes PROM
●
PROM—women beyond 37 weeks’ gestation
●
PPROM—women less than 37 weeks’ gestation (Preterm PROM)
●
As soon as fluid comes out = CHECK BABY HR!!!!!!
●
Always assess for S/S of infection
○ Fever, increase fetal HR, elevated WBC, abd tenderness, cloudy or foul-smelling
amniotic fluid
●
Tx
○ No unsterile digital cervical exams
○ Expectant management if fetal lungs immature
■ Administer betamethasone
●
Cord Prolapse: EMERGENCY - stat c-section, get baby out
Premature Rupture of MembranesPROM (cont..)
● Nursing Assessment
○ risk factors
○ signs and symptoms of labor
● Nursing Management
○ Infection prevention
○ electronic FHR monitoring
○ Identification of uterine
contractions
○ amniotic fluid characteristics
○ Education and support
○ Nitrazine test & fern test
○ ultrasound
Multiple Gestations
● Therapeutic management: serial ultrasounds, close monitoring during labor,
operative delivery (common)
● Nursing assessment: uterus larger than expected for EDB; ultrasound
confirmation
● Nursing management: education and support antepartally; labor
management with perinatal team on standby; postpartum assessment for
possible hemorrhage
● Monozygotmatic—identical twins (share same placenta)
● Dyzygomatic—two eggs, two sperms—fraternal twins
Chapter 20
Management of High-Risk Pregnancies
Diabetes Classifications
● Diabetes is a chronic disease characterized by a relative lack of insulin or absence of the
hormone that is necessary for glucose metabolism.
● Classified into type 1 and 2.
● Gestational diabetes
○ Detected around 24-28 weeks
● Classification during pregnancy
○ Pregestational (diabetes prior to pregnancy)—type 1 and type 2
○ Gestational Diabetes—diabetes developing WHILE pregnant
Diabetes Mellitus: Patho
and Pregnancy
● Role of placental hormones
○ Normal pregnancy: placental hormones cause insulin resistance = gluc goes to baby (parallel growth as
placenta grows)
○ HPl: increases in direct correlation with growth of placental tissue, rising through the last 20 weeks of pregnancy =
causing insulin resistance
● Changes in insulin resistance
○ Insulin secretion increases to overcome resistance of hormones (in a healthy pregnancy, the pancreas can
properly respond)
○ In gestational diabetes, moms can't do this & baby gets more glucose
■ *mom insulin does not cross placental barrier
Diabetes: Effects
● Effects on mother
○ Hydramnios because of
fetus diuresis (more amnio fl)
○ Gluc spills over into urine UTI/vaginitis
○ Ketoacidosis
○ Gestational HTN
○ Preterm labor/PROM
○ Increased risk of stillbirth
○ Hypoglycemia risk
● Effect of fetus
○ Born early, large, lungs not dev well - resp
distress
○ Usually not head down
○ More at risk for prolapsed cord
○ Macrosomia (large baby – risk of dropping
their blood sugar - early feeds)
○ Anomalies—GI/CNS/cardiac/neural tube
defects
Diabetes Mellitus:
Therapeutic Management
● Preconception counseling
○ How does she manage current diabetes? Meds? Diet/exercise? How often does she check BG?
○ Goal is to manage diabetes
○ If diabetes is all over the place (unregulated), it is best to wait to get pregnant to avoid any risks
● Blood glucose level control (HbA1C <7%)
○ If higher than 8%--intervention is needed
● Hypoglycemic agents
○ Insulin can be given as well as metformin—does NOT affect fetus
○ If they are already on insulin, dosage may be lowered to avoid hypoglycemia in 1st trimester (lots of
nausea and vomiting)
Diabetes - Nutritional
● Control glucose levels—exercise and GOOD NUTRITION (eating for 2 does not just mean more
volume)
○ 40% carbs
○ 35% protein
○ 25% unsat fats
○ Small, freq meals (bedtime snack)
○ 8-10 glasses H2O/day – hydrate, flush out kidneys/bladder (risk for infec)
● Diet & exercise – help diabetes alone
Diabetes – during labor
● Insulin & metformin does not cross placenta – safe to give!!
● Sometimes need to inc sliding scale insulin
● Watch for hydramnios, size of baby, wt gain, mom’s gluc (check 4x/day, meals & HOS)
● During birth:
○ Test q1-2h
○ 110 or lower
○ Can run insulin during labor
○ Have dextrose 50g on hand in case mom goes too low
Diabetes: Hyper/hypo
● Sugar high – HOT & DRY
● S/S hyperglycemic:
○ High sugar level
○ Blurred vision
○ Warm
○ Thirsty
● Cold & clammy – GIVE ME CANDY
● S/S hypoglycemic:
○ Tachy
○ Irritable
○ Restless
○ Sweaty
○ Clammy
Diabetes: surveillance
● Mom surveillance:
○ Renal func (creat clearance)
○ Eye exam
(1st
trimester)
○ HbA1C q4-6wks
○ Urine: protein, ketones, gluc
● Fetal survellience:
○ Ultrasound
○ Amnio fl level
○ Wk gestation baby
○ Amniocentesis: in 3rd trimester determines lung
dev/surfactant
○ BPP: 8-10
○ NST
Screening 24-28wk:
• 1st screen (no fast): give gluc, 130-140+ =
more testing
• 2nd screen (fasting): give gluc, 3h long fasting
test, test BG level
■ Reactive: inc 15bpm for 15sec
○ Alpa-feta 16wk
■ High: neural tube
■ Low: down syndrome
Diabetes: long-term/client education
● Long-term consequences:
○ Creatine clearance (renal func)
○ Retinal tests (eyes) – get eyes checked in 1st trimester
○ Kidney issues
○ Nerve issues (neuropathy)
● Edu mom:
○ Fetal kick counts
○ Gluc monitor
○ Diet/exercise/hydrate
○ S/s to come in: preterm labor
Diabetes Mellitus: Nursing Management
● Prevention of Complications
○ Prenatal visits more frequent—come every 2 weeks up until 28
weeks and twice a week until birth
○ Measure fundal ht
○ Check BP and output
○ Fetal heart tones
● After birth:
○ CBG q2h for 48 hrs
○ Insulin needs should start to decrease
○ Gestational moms can return to baseline, some stay diabetic
Congenital and Acquired Heart Disease
●
Patho
○
Hemodynamic changes overstressing woman’s
cardiovascular system
●
Therapeutic management
● Assessment
○ VS, heart sounds, fetal wellbeing:
■ Kick counts
○
Get PMH
○
Cardiothoracic history—12-week ECG and pulse ox
■ Preterm labor—teach s/s
○
Increased prenatal visits
■ Lower back pain
○
Stabilize mom
■ Contractions and pelvic pressure
■ Lasix, dig, beta blocker, anticoagulants (not
coumadin)
Signs and Symptoms of Cardiac
Decompensation
● Change in BP
● SOB
● Cyanosis around mouth/nail beds
● Dependent edema
● JVD
● Rapid breathing
● Abnormal bilateral rails
● Freq cough
● Increased fatigue
Iron Deficiency Anemia
● Most common preg issue (1/4 women)
● From inadequate dietary intake
● Can develop PICA – soil, clay, dirt, ice
● Nursing Assessment (s/s)
○ Fatigue/weakness/malaise, susceptibility to infection (frequent colds), pale mucous membranes, tachycardia,
n/v/anorexia/constipation, dark stools, metallic taste
● Management:
○ Eliminate symptoms and correct deficiency
○ *TAKE 30mg Fe PRENATAL VITAMIN
Iron Deficiency Anemia: Nursing
Management
● Teach:
○ Take iron with vitamin c—helps with absorption (OJ), take on empty stomach
○ Milk inhibits absorption
○ Take with food if it helps with nausea—better to take it than to not take it all
○ Foods high in iron
■ Red meat, green leafy, dried fruits, PB, whole grains, legumes
○ Side effects: GI related
■ Mainly constipation; metallic taste in mouth
■ Constipation: increase fiber, fluids, and exercise
● Take frequent rest periods!
Group B Streptococcus
●
Found in vagina and rectum (25% carriers)
●
36wk tested
●
Not serious in adults—life threatening in newborn
○
●
Can result in pneumonia, sepsis, meningitis
Give penicillin – 2 doses before delivery, then IV drip during labor
■ Needs treated 4 hours minimum prior to delivery
●
Thought to cause chorioamnionitis
■ infection of chorion and amnion
■ Elevated VS
■ Cloudy, foul smelling fluid
■ Elevated WBC
■ More tender uterus
●
Related to PP wound infection
●
Low socioeconomic status, African Americans, less than 20 yrs, GBS in urine, previous GBS infection
Vulnerable Populations
● Adolescents
● Pregnant women over age 35
○ More chronic conditions
● Obese pregnant women
● Women who are positive for the human
immunodeficiency virus (HIV)
● Women who abuse substances
Pregnant Adolescent:
Nursing Management
● Support
● Drop out, financial issues, anger/conflict (don’t shake baby!!)
● Future planning (return to school; career or job counseling)
● Options for pregnancy
● Evaluate: physical and emotional well-being
● Stress management; self-care
● Education
● Note: pregnant adolescents become emancipated minors!!
Women over 35
● Nursing Assessment
○ Preconception counseling; lifestyle changes; beginning pregnancy in optimal
state of health
○ Laboratory and diagnostic testing for baseline; amniocentesis; quadruple
blood test screen
● Nursing Management
○ Promotion of healthy pregnancy; education; early and regular prenatal care;
dietary teaching; continued surveillance
Substance Abuse
● Placenta acts as an active transport system—it does NOT protect
○ Crosses placenta within 1h of mom taking it
○ Same dose mom takes baby gets
●
●
●
●
●
Fetus experiences substance abuse and addiction
Counseling is essential!!
Many SA pregnant women do not seek prenatal care—afraid they’ll be reported to CPS
SA starts before pregnancy
Methadone conversion program
○ Methadone because quick withdrawal is dangerous for babies
○ Decrease withdrawal in newborn—decrease drug craving
● Maintenance therapy has same withdrawal effects on baby
● Effects EVERYONE that uses
NAS Babies
(Neonatal Abstinence Syndrome)
● Babies: more prone to mortality, small for gest. age, low
birth weight, & preterm
● NAS babies
○ no head lag (very tense)
○ Tremors
○ Oral secretions
○ Poor suck/swallow reflex – high risk aspiration
○ Get morphine to withdrawl
Effects of Common Substances
●
Alcohol
○ FAS
■ Intrauterine growth restriction
■ Microcephaly
■ More prone to cardiac defects and limb
abnormalities
● Heroin can cross placenta within 1 hour
○ Affects developing brain
○ Behavioral abnormalities
○ Associated with NAS
■ ADD, delayed reaction time, poor scholastic
performance
●
Marijuana
○ Anemia, inadequate weight gain, hyperactive startle
reflex, tremors, prematurity, IUGR
●
Opiates/Narcotics: Neonatal Abstinence Syndrome (NAS)
○ Baby will be sneezing wiping nose, hyper flexed,
irritable, screeching cry/scream
Communication:
○ Nonjudgmental approach
○ State protection agency investigation for positive
newborn drug screen
Good luck & deep breaths!
You will do amazing!
If anyone needs anything at all, please do not hesitate to email me or Dr. Hoeberg!
Also, if you want a one-to-one tutoring appointment and there is not a time on the CAA that
works for you just email/text me and we can figure something out :)
My contact info:
abupp@live.carlow.edu
724-407-8018