Maternal- Alcohol, Ethical, Alteration in oxygen quiz

• Women more prone to substance abuse

  • Below poverty level
  • Exposed to violence as a child
  • With history of domestic abuse
  • Suffer depression or other mental health problems
  • Have less than a high school education
  • Unmarried
  • Unemployed
  • Involved with the criminal justice system
• Substance use is highest in the first trimester
• The most common form of substance use in pregnancy is smoking among white women
• Because tobacco, alcohol and drug use in pregnancy occurs across all demographic groups, nurses should screen all women
• Addiction


  Does not occur unless psychological and social conditions promote continued drug use
• Nurses


  Are better able to provide support and nonjudgmental care if they respect substance users
• Addiction


  Is produced when biological, psychological and social predisposition combine with exposure to substances and an environment that supports regular substance use
• Nursing assessment


  • Should focus on a broad scope of personal, familial and social stressors and coping skills
• Nurses' role in prenatal and acute care settings

  1. Thoroughly assess psychosocial risks

  2. Conduct mutual goal-setting to minimize harm associated with psychosocial risks

  3. Offer support and respect
• The sense of being valued can help drug users begin to make changes
• Teratogens


  Any substance that can cause development of abnormal structure in an embryo
• Substance abuse during pregnancy

  Utilization of chemical agents such as alcohol and drugs to change behavior and mood
• Common substances


  • Amphetamine
  • Cocaine
  • Marijuana
  • Heroin
  • Alcohol
• Cocaine


  Derived from erythroxylum coca, a plant which is exclusively grown in South Africa. CNS Stimulant - addictive due to marvelous sense of pleasure it creates. Commonly administered by snorting, smoking and injecting.
• Maternal effects of cocaine

  • Vasoconstriction - compromising the placental circulation that leads to elevation of blood pressure, abruptio placenta, tearing loose of the placenta, pre-terms birth and worse fetal death
  • Cardiovascular stress to heart attack, stroke and liver disease
  • CNS Stimulation causes seizure and perforation of nasal septum
• Fetal effects of cocaine

  • SGA (Small for Gestational Age)
  • Increase in Intracranial pressure
  • Muscle rigidity
  • Withdrawal syndrome or tremulousness
  • IUGR (Intrauterine Growth Retardation)
  • Spontaneous abortion
  • Irritability
  • Cognitive and developmental delays
• Diagnosis of cocaine use

  Can be detected through urinalysis because the metabolites of cocaine can be detected into the urine up to 1 week after use
• Maternal effects of amphetamines

  • Cardiac dysrhythmias
  • Loss of appetite (anorexia)
  • Insomnia (inability to sleep)
  • Placental abruption
  • Preterm labor
• Fetal effects of amphetamines

  • Jitteriness (nervousness)
  • IUGR
  • Poor feeding at birth
• Marijuana


  Derived from Cannabis plant. Usually rolled into cigarettes and smoked, also could be mixed into food and eaten. Causes an intoxicating and sensory distorting high pleasure. It crosses the placenta causing the increase in carbon monoxide level in the mother's blood circulation hence reducing the fetal oxygen supply.
• Maternal and fetal effects of marijuana

  • Not able to produce milk
  • Loss of short term memory
  • Respiratory infections such as chronic bronchitis, cough with phlegm and shortness of breath
  • Tachycardia
• Heroin


  Classification: opiate. Usually injected but also can be smoked or snorted. Produces euphoria (extreme feeling of excitement), relief from pain and apathy, detachment from reality, impaired judgement and drowsiness
• Signs and symptoms of heroin use

  • Constricted pupils
  • Respiratory depression
  • Increase risk for HIV
  • Constipation
  • Slurred speech
• Withdrawal symptoms of heroin

  • Nausea and vomiting
  • Diarrhea
  • Abdominal pain
  • Shivering
  • Hypertension
  • Insomnia
  • Respiratory depression
  • Body ache
• Maternal and fetal effects of heroin

  • Rupture of membrane
  • Preterm labor / prematurity
  • Fetal growth interference and fetal distress
  • Heroin addiction or opiate dependent
  • Meconium aspiration
• Assessment findings for substance abuse


  • Determine the substances used, the amount and last time taken, and take note if it was combined with other drugs
  • Observe for papillary changes, vital signs, level of consciousness, presence of dehydration, presence of nutritional and vitamin deficiencies, suicidal potential: ideation, gestures, level of anxiety
• Possible nursing diagnoses


  • Anxiety
  • Ineffective individual / family coping
  • Fear
  • High risk for fluid volume deficit
  • High risk for injury
  • Self-care deficit
  • Self-esteem disturbance
  • Sensory perceptual alterations
  • Sleep pattern disturbance
  • Altered thought process
  • High risk for violence
• Nursing interventions


  1. Stay with the client

  2. Monitor for vital signs, level of consciousness

  3. Institute suicide precautions

  4. If the patient is experiencing panic, seek the assistance of the family and friends

  5. If the patient is hallucinating, reinforce reality and speak in a calm voice

  6. Provide non-threatening environment

  7. Provide adequate diet and fluid
• Alcohol abuse


  CNS Depressant and a potent teratogen
• Assessment findings for alcohol withdrawal

  • Hallucination (auditory, tactile, and visual)
  • Illusions
  • Nervousness
  • Disorientation
  • Insomnia
  • Hyperactivity
  • Increase in blood pressure
  • Confusion
  • Tremors
  • Tachycardia
  • Loss of appetite
• Delirium Tremens (Alcohol Withdrawal Syndrome)


  Acute disorder occurring as symptom following withdrawal from alcoholic intoxication. Seizure may last from 3-6 days with hallucination
• Korsakoff's psychosis (Korsakoff Syndrome)


  Disorder that produces a symptom of permanent amnesia resulting from alcoholism and thiamine deficiency (Vit. B1) which causes brain damage, particularly the thalamus which helps in processing sensory information
• Wernicke's Encephalopathy


  Brain disease caused by thiamine deficiency
• Maternal and fetal effects of alcohol abuse

  • Fetal Alcohol Syndrome (FAS) - growth retardation, failure to thrive, facial anomalies, CNS dysfunction, increased in placidity (quietness)
  • Low birth weight
  • Infant may be alcohol dependent
  • Perinatal mortality
  • Newborn may suffer withdrawal
• Nursing management for alcohol abuse

  1. Assess intoxication: Normal alcohol level in the blood: 0.08 to 0.10

  2. Stay with the client and prevent injury

  3. Monitor for both maternal and fetal vital signs

  4. Encourage pregnant woman to keep on coming for her prenatal check-up

  5. Properly observe for the medication that will be given which could affect the fetus inside the mother's womb such as anti-anxiety: Librium, valium (may cause cleft - lip/palate, and cardiac defects)
• Autonomy


  Right to self-determination, right to decide for oneself, informed consent
• Privacy and confidentiality


  Personal profile or any information regarding the case of the patient will never be publicly divulged, respect and safe-guard patient's private information
• Beneficence


  Do good, right to protection from harm and discomfort, right to protection from exploitation
• Nonmaleficence


  Do no harm, the benefits should be far greater than the risks
• Respect for human dignity


  Absence of coercion in decision making, right to full disclosure (absence of deception or concealment)