Question

Nikki 17 year old G1PO at 33 weeks gestation. Nikki comes to the clinic today for her prenatal visit and you notice that her hair and clothing has the distinct odor of marijuana and tobacco smoke. You directly ask Nikki whether she has be taking any other drugs besides marijuana. Nikki is surprise by the question and denies it.When you explain that you can smell init on her chair and on her clothing she started to cry and say, Please don't take my baby away from me. After being reassured.Nikki further admits to sporadic binge alcohol consumption and smoking "pot" and cigarettes. She relates that she also consumes four to five caffeinated beverages per day.

1. How will cigarette smoking, marijuana, binge alcohol consumption, and excessive caffeine intake affect Nikki's pregnancy.?

2.What possible effect of Nikki's ingestion of these substances have on her baby?

3. What nursing care would you provide for Nikki.?

Answer 1

Antenatal substance abuse is a critical public health concern that is linked with several harmful maternal and fetal consequences. Frequently used substances are tobacco, alcohol, cannabis and other illicit substances.

1 & 2 .Cigarette smoking during pregnancy also have adverse effect on the fetus. These include damage to the umbilical cord structure, miscarriage, increased risk for ectopic pregnancy, low birth weight, placcental abruption, preterm birth and increased infant mortality. The deleterious effects of second hand smoke on new born are respiratory and ear infections, sudden infant death syndrome, behavioral dysfunction and cognitive impairement. More over research has proven that the smoking woman stops breastfeeding early so that they can take up smoking again and this badly results on newborns health.

Marijuana use during pregnancy can cause health problems in newborns especially increases the chances for low birth weight. Breathing marijuana smoke has the same effect as tobacco smoke which increases the chances of developmental problems in baby. After birth, it may result in attention and learning problem

Heavy alcohol consumption during pregnancy to negative effects on the birth such as increased chances for miscarriage, still birth and infant mortality, congenital anomalies, low birth weight, reduced gestational age, preterm delivery and small for gestational age. It may also affect adversly on the fetal health, causes fetal alcohol spectrum disorders and neurodevelopmental problems. Cognitive and behavioral changes, adverse speech and language outcomes, functional deficits in children and psychosocial consequences in adulthood are the long term effects of alcohol consumption.

Excessive caffiene intake may not appear to cause birth defects but increases the chances miscarriage and low birth weight babies which later results in developmental defects.

3. Nursing care

• Conduct screening to know the intake which must include history of the substance use disorders, psychiatric disorders, complete medical, surgical, gynecologic and obstetric history.
• Conduct intake health assessment such as appropriateness for treatment, medical comorbidities, psychiatric comorbidities.
• Performing appropriate screenings including infectious diseases, drug abuse, the readiness ruler, domestic abuse etc
• Perform ongoing treatment monitoring at each office visit.
• Conduct educational sessions on various therapies for both patient and family
• Provide care and health eduction depending on the patient condition
• Provide a care that is interdisciplinary by collaborating care providers such as obstetrician, psychiatrist, psychologist, community based resources, social service providers, legal authorities, employment section etc..