Addicted Newborn
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Outline
Overview
- Many drugs cross the placenta and when the infant is born, they are no longer receiving the drug that they have been getting during development, putting them at risk for withdrawal
Nursing Points
General
- It is important, if possible, to identify the specific drug and the amount to anticipate symptoms and complications, and also to plan the care
- With increased usage of opioids, more newborns are being born addicted to prescription pain meds in addition to illegal drugs (cocaine, heroin, etc.)
- Remember even if they have a prescription doesn’t mean they can’t be born addicted (ie: Oxycodone)
- Known as neonatal withdrawal, neonatal abstinence syndrome (NAS)
Assessment
- This is generalized list of the main symptoms and will depend on how the patient is affected
- Fever/diaphoresis
- High-pitched cry/irritable
- Respiratory: Tachypneic/ distress
- Gastric issues: diarrhea, vomiting
- Sneezing, stuffy nose
- Excessive suck, poor feeding
- Tremors
- Hypertonic
Therapeutic Management
- This can vary, depending on drug that’s involved
- Close monitoring and assessment of cardiac, respiratory, neuro systems
- Scoring tool (ie: Finnegan)
- Typically more fussy, they should be held tightly during feedings and other routine care
- Decrease stimulation as much as possible (quieter isolette area)
- Swaddle effectively
- Skin precautions: prevent breakdown from, tremors, loose stools, excessive rubbing or sucking
- May require smaller, slower feedings or even tube feedings
Nursing Concepts
- Health promotion
- Comfort
- Skin integrity
Patient Education
- Involve case management to assist mother with resources
- Scoring tool
- Here to ensure the safety of her child
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Related Nursing Process (ADPIE) Lessons for Addicted Newborn
Transcript
In this lesson I will explain the addicted newborn and help you understand who is at risk, the assessment,and the care you will provide.
First I just want to real quick let you know some other terms that you might hear these newborns described as. It can be known as neonatal withdrawal or neonatal abstinence syndrome, “NAS” for short. When a mom comes in we are going to gather her history. If she has a history of drug use or admits to current use then we might to get orders to get a urine toxicology screen on her. If we can identify the specific drug it will help us with the plan of care for the newborn. There has been a huge increase of opioid use and this is the most frequently seen drug that newborns are born addicted to. Remember that even if a patient has a prescription for oxycodone doesn’t mean the baby won’t be born addicted or need treatment. So I tell you this because it is not always illegal substances.
So your patient is addicted. What will you find on assessment? Some of this will depend on the drug but I’ll go over the common symptoms. These babies are hurting and have neurological symptoms occur. A high-pitched cry is one of the big symptoms. It is like a shrill, the worst sound coming from a newborn and they are inconsolable. They have tremors. Fever because their body is working hard crying and tremorring. They have diaphoresis because they have a fever and they are in pain. The stomach is upset so gastric wise you will see runny, loose stools, and vomiting.They will have respiratory issues or distress which is mainly observed with tachypnea. A patient breathes fast when uncomfortable, right? With respiratory there is also frequent sneezing and stuffy nose.
A few more symptoms are mottling of the skin, difficulty feeding although you will see them have excessive suck but then they cannot coordinate themselves well enough to feed. Seizures can also occur or clonus. They have really tight tone. So the baby that used to be able to be put in a pull to sit position and have that head lag or drop will now be so so tight and tense. Reflexes will also be hyperreactive. So the moro reflex is typically the one seen that is hyperactive. We get these babies all time and we are mostly seeing babies born addicted to methadone or Subaxone. These are women who are in treatment programs but are given high doses of legal opioids to stop the use of things like heroin. It is so hard. They cry nonstop and need to be help tight. They sweat and tremor while you snuggly hold them. It is very challenging and we frequently will not have the same nurse care for them more then one day in a row if they are doing poorly because it is so grueling.
Our treatment will vary some depending on drug that’s involved. We can only really treat opioid addicted babies. So let me explain why. If a mom uses methamphetamines and cocaine we can’t really give those to the baby to help withdrawal. If the baby shows addiction signs to opioids then we can treat with opioids if it is severe enough. We will be closely monitoring and assessing. A scoring tool will be implemented if it is an opioid addiction. The main one used is finnegan. The baby is assessed every three hours and each symptom is given a score and when you get a high enough score then treatment will be started. For some facilities this will vary. At some it will be 2 scores above 12 at others your might see 3 scores above 8. Some therapeutic measure can be to tightly swaddle and hold. This can help the fussiness and offer them the feeling of safety. We also want to decrease stimulation as much as possible. So keep it quiet, lights dim, cluster care and no rocking while feeding. Rocking can offer a lot of stimulation and some babies can not handle it, especially with NAS. So when feeding if rocking is eliminated it allows them to solely focus on the feeding. The skin need to be protected and watched. The baby can get breakdown from a few things. Th tremors cause rubbing and breakdown at the elbows, knees and most commonly the chin. They also have loose stools so their butts need to be watched and barrier cream applied. And last the baby might require smaller, slower feedings or even tube feedings because they have poor feedings. Nipple changes to slow flow can sometimes help. We need to make sure they are getting the calories they need.
Our education should Involve case management coming to give any education and assistance with resources for the mother once her and baby are discharged. We want to education on the scoring tool. She needs to know what we are looking for an why. And the really important piece is to educate that we are doing this for the safety of her child. Most of these mother’s feel so judged so we want to let her know that we care about her baby and want to do the best thing for her baby.
Concepts will include comfort because this patient is in pain and we are offering comfort, skin integrity because we are concerned with watching for breakdown and abrasions from withdrawal and health promotion because we are trying to promote good health for this mother and baby.
So let’s review the important points. Newborns can be born addicted to substances that the mother took during pregnancy. Opioids are the most commonly seen addiction. The newborn will be watched for withdrawal symptoms. Some of these symptoms are tremors, excessive weight loss, fever, hypertonic, sneezing, mottled skin and loose stools. Treatment will be prolonged monitoring and possibly giving opioids and doing a slow, monitored weaning process.
Make sure you check out the resources attached to this lesson and review the symptoms of withdrawal. Now, go out and be your best selves today. And, as always, happy nursing.
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Communicating with Other Nurses
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Abortion in Nursing: Spontaneous, Induced, and Missed
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Addicted Newborn
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Ectopic Pregnancy for Certified Emergency Nursing (CEN)
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Hyperemesis Gravidarum for Certified Emergency Nursing (CEN)
Hyperglycemia Management Nursing Mnemonic (Dry and Hot – Insulin Shot)
Hypovolemic Shock Case Study (OB sim) (60 min)
Incompetent Cervix
Infections in Pregnancy
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Inserting a Foley (Urinary Catheter) – Female
Intra Uterine Device – Potential Problems Nursing Mnemonic (PAINS)
Isotonic Solutions (IV solutions)
Labor Progression Case Study (45 min)
Leopold Maneuvers
Lung Surfactant
Lung Surfactant for Newborns
Magnesium Sulfate
Magnesium Sulfate
Magnesium Sulfate (MgSO4) Nursing Considerations
Magnesium Sulfate in Pregnancy
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Menstrual Cycle
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Fluticasone (Flonase) Nursing Considerations
Gas Exchange
Gentamicin (Garamycin) Nursing Considerations
Glucose Lab Values
Gluten Free Diet Nursing Mnemonic (BROW)
Guaifenesin (Mucinex) Nursing Considerations
Heart Sounds Nursing Mnemonic (APE To Man – All People Enjoy Time Magazine)
Hematocrit (Hct) Lab Values
Hemoglobin (Hbg) Lab Values
Hemophilia
Hierarchy of O2 Delivery
Hydrocephalus
Hypoxia – Signs and Symptoms (in Pediatrics) Nursing Mnemonic (FINES)
Ibuprofen (Motrin) Nursing Considerations
Immunizations (Vaccinations)
Imperforate Anus
Impetigo
Indomethacin (Indocin) Nursing Considerations
Influenza – Flu
Integumentary (Skin) Assessment
Intussusception
Intussusception for Certified Emergency Nursing (CEN)
Iron Deficiency Anemia
Isolation Precaution Types (PPE)
Isolation Precautions (MRSA, C. Difficile, Meningitis, Pertussis, Tuberculosis, Neutropenia)
Lactulose (Generlac) Nursing Considerations
Leukemia
Levels of Consciousness (LOC)
Levetiracetam (Keppra) Nursing Considerations
Lung Sounds
Marfan Syndrome
Meningitis
Meningitis Assessment Findings Nursing Mnemonic (FAN LIPS)
Meningitis for Certified Emergency Nursing (CEN)
Methylphenidate (Concerta) Nursing Considerations
Mixed (Cardiac) Heart Defects
Mumps
Nephroblastoma
Nephrotic Syndrome
Nephrotic Syndrome Case Study (Peds) (45 min)
Neuro Assessment
NSAIDs
Nursing Care Plan (NCP) for Acute Bronchitis
Nursing Care Plan (NCP) for Appendicitis
Nursing Care Plan (NCP) for Asthma
Nursing Care Plan (NCP) for Asthma / Childhood Asthma
Nursing Care Plan (NCP) for Attention Deficit Hyperactivity Disorder (ADHD)
Nursing Care Plan (NCP) for Bronchiolitis / Respiratory Syncytial Virus (RSV)
Nursing Care Plan (NCP) for Burn Injury (First, Second, Third degree)
Nursing Care Plan (NCP) for Celiac Disease
Nursing Care Plan (NCP) for Cerebral Palsy (CP)
Nursing Care Plan (NCP) for Cleft Lip / Cleft Palate
Nursing Care Plan (NCP) for Clubfoot
Nursing Care Plan (NCP) for Congenital Heart Defects
Nursing Care Plan (NCP) for Constipation / Encopresis
Nursing Care Plan (NCP) for Cystic Fibrosis
Nursing Care Plan (NCP) for Decreased Cardiac Output
Nursing Care Plan (NCP) for Dehydration & Fever
Nursing Care Plan (NCP) for Eczema (Infantile or Childhood) / Atopic Dermatitis
Nursing Care Plan (NCP) for Enuresis / Bedwetting
Nursing Care Plan (NCP) for Epiglottitis
Nursing Care Plan (NCP) for Fluid Volume Deficit
Nursing Care Plan (NCP) for Hemophilia
Nursing Care Plan (NCP) for Hydrocephalus
Nursing Care Plan (NCP) for Impaired Gas Exchange
Nursing Care Plan (NCP) for Imperforate Anus
Nursing Care Plan (NCP) for Impetigo
Nursing Care Plan (NCP) for Infective Conjunctivitis / Pink Eye
Nursing Care Plan (NCP) for Influenza
Nursing Care Plan (NCP) for Intussusception
Nursing Care Plan (NCP) for Marfan Syndrome
Nursing Care Plan (NCP) for Meningitis
Nursing Care Plan (NCP) for Mumps
Nursing Care Plan (NCP) for Neural Tube Defect, Spina Bifida
Nursing Care Plan (NCP) for Omphalocele
Nursing Care Plan (NCP) for Otitis Media / Acute Otitis Media (AOM)
Nursing Care Plan (NCP) for Pediculosis Capitis / Head Lice
Nursing Care Plan (NCP) for Pertussis / Whooping Cough
Nursing Care Plan (NCP) for Phenylketonuria (PKU)
Nursing Care Plan (NCP) for Reye’s Syndrome
Nursing Care Plan (NCP) for Rheumatic Fever
Nursing Care Plan (NCP) for Rubeola – Measles
Nursing Care Plan (NCP) for Scoliosis
Nursing Care Plan (NCP) for Sickle Cell Anemia
Nursing Care Plan (NCP) for Tonsillitis
Nursing Care Plan (NCP) for Varicella / Chickenpox
Nursing Care Plan (NCP) for Vomiting / Diarrhea
Nursing Care Plan for (NCP) Autism Spectrum Disorder
Nursing Case Study for Pediatric Asthma
Obstructive Heart (Cardiac) Defects
Ocular Infections (Conjunctivitis, Iritis) for Certified Emergency Nursing (CEN)
Omphalocele
Opioid Analgesics
Pancrelipase (Pancreaze) Nursing Considerations
Pediatric Bronchiolitis Labs
Pediatric Gastrointestinal Dysfunction – Diarrhea
Pediatric Oncology Basics
Pediatrics Course Introduction
Pediculosis Capitis
Pertussis – Whooping Cough
Phenylketonuria
Phenytoin (Dilantin) Nursing Considerations
Platelets (PLT) Lab Values
Pneumonia
Promotion and Evaluation of Normal Elimination Nursing Mnemonic (POOPER SCOOP)
Pulmonary Function Test
Red Blood Cell (RBC) Lab Values
Respiratory Acidosis (interpretation and nursing interventions)
Reye’s Syndrome
Reyes Syndrome Case Study (Peds) (45 min)
Rheumatic Fever
ROME – ABG (Arterial Blood Gas) Interpretation
Rubeola – Measles
Salmeterol (Serevent) Nursing Considerations
Scoliosis
Selegiline (Eldepyrl) Nursing Considerations
Sickle Cell Anemia
Spina Bifida – Neural Tube Defect (NTD)
Steroids – Side Effects Nursing Mnemonic (6 S’s)
Stoma Care (Colostomy bag)
Strabismus
Sudden Infant Death Syndrome (SIDS)
Sympathomimetics (Alpha (Clonodine) & Beta (Albuterol) Agonists)
Thorax and Lungs Assessment
Tonsillitis
Topical Medications
Tracheal Esophageal Fistula – Sign and Symptoms Nursing Mnemonic (The 3 C’s)
Transient Incontinence – Common Causes Nursing Mnemonic (P-DIAPERS)
Treatment of Sickle Cell Nursing Mnemonic (HOP to the hospital)
Umbilical Hernia
Vaccine-Preventable Diseases (Measles, Mumps, Pertussis, Chicken Pox, Diphtheria) for Certified Emergency Nursing (CEN)
Varicella – Chickenpox
Varicella Case Study (Peds) (30 min)
Vitals (VS) and Assessment
Vomiting
White Blood Cell (WBC) Lab Values
X-Ray (Xray)
ADLs (Activity of Daily Living) Nursing Mnemonic (BATTED)
Emotions and Motivation
Growth & Development Theories
Maslow’s Hierarchy of Needs in Nursing
Psychological Disorders
State of Consciousness
Stress and Crisis