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Neonatal Abstinence Syndrome - Coggle Diagram
Neonatal Abstinence Syndrome
Treatment
morphine PO 0.4 mg/mL give 0.03 mg/kg X 2.71 kg every 3 hr. Once withdrawal symptoms are controlled maintain dose for 48-72 hours then taper by 10-20% every 2-7 days.
minimize stimuli
cluster care
educate parents about symptoms and teach coping strategies
encourage rooming in
prevent skin breakdown, dehydration, and electrolyte imbalance
Symptoms
high pitched cry
mottled skin
tremors
uncoordinated sucking
inconsolable
disrupted sleep
excoriations
tachypnea
exaggerated Moro reflex
hypertonicity
Diagnosis
neonatal abstinence scoring system
lab toxicology results
positive for marijuana and subutex
Nursing diagnoses
Impaired comfort R/T drug withdrawal AEB irritability, diaphoresis, and disturbed sleep.
Short Term-Infant will be able to sleep for at least 3 hours at a time. Met-For the last three days infant has been consistently sleeping at least three hours between most feedings.
Long Term-Infant will exhibit no signs of drug withdrawal or discomfort. Pending-Signs of drug withdrawal are reduced.
Assess for sources of discomfort other than withdrawal. To prevent unnecessary sources of discomfort.
Reduce stimuli and cluster care to minimize disturbances. To allow infant to develop normal sleep/wake cycles.
Administer morphine as prescribed. To reduce infant's discomfort and pain.
Use comfort measures such as non-nutritive sucking, swaddling, and swinging/rocking. To provide as much comfort as possible.
Disorganized infant behavior R/T drug exposure AEB tremors, mottling, grunting, and frantic, uncoordinated movements.
Short Term-Infant will demonstrate increased signs of stability. Pending-Infant demonstrates stable respirations consistently, but calm focused alertness only intermittently.
Long Term-Infant will demonstrate self-regulatory skills. Not met-Infant still shows no signs of self-regulatory behavior.
Provide consistent schedules for feeding and routine care. To encourage self-regulatory skills and allow for normal sleep/wake cycles.
Try to initiate infant calming on the caregiver's body and then transferring to a crib. To support the infant's self-regulatory behaviors.
Watch for and respond promptly to hunger cues. To help infant learn more organized feeding behaviors.
Position infant in postures that permit flexion and minimize flailing. To decrease stress, conserve energy, and enhance normal development.
Risk for delayed development R/T drug exposure and limited parental involvement.
Short Term-Infant will show improved neurological responses. Met-Infant's neonatal abstinence scores are consistently decreasing.
Long Term-Child will start school on time with no intellectual delays. Pending.
Provide appropriate sensory stimuli as tolerated. To prevent further delays in developmental milestones.
Encourage parental involvement as appropriate. To provide teaching opportunities to help parents learn how to interact with the infant.
Respond to crying promptly and consistently. To encourage development of trust.
Refer to a neonatal occupational therapist. To provide specialized treatment for the at risk infant.
Dysfunctional family processes R/T drug use AEB a complete lack of parental/infant bonding.
Short Term-Parents will express interest in the infant by visiting him in the hospital at least once a week and calling daily. Not met-Parents have not visited in 12 days and not called in 5 days.
Long Term-Infant will be released to parents care, when he is ready to leave the hospital, with reasonable certainty that the parents will lovingly meet all needs. Pending-No signs that the parents will care for the infant, but there is still time before he will leave the hospital.
Encourage mother to join a substance abuse recovery program. To allow mother's personal healing so she is able to care for others.
Allow mother opportunities to admit to drug abuse. To allow treatment of her problem to begin.
Establish a trusting relationship with the parents. To allow for open discussions between nurse and parents and establish rapport with the parents.
Refer family to a family counselor. To allow family members to discuss feeling and learn appropriate ways of dealing with them.