Substance Dependence/Abuse is a continuum of phases incorporating a cluster of cognitive, behavioral, and physiological symptoms that include loss of control over use of the substance and continued use of the substance, despite adverse maternal/fetal consequences (e.g., poor nutrition/weight gain, anemia, predisposition to infection, PIH, fetal defects/IUGR, fetal alcohol syndrome [FAS]). The drugs most often abused are alcohol, cocaine (crack), heroin, methamphetamine, barbiturates, marijuana, and phencyclidine (PCP). Care depends on the degree of abuse and whether the client is intoxicated or is in the withdrawal phase. The client who is addicted may not seek care during the prenatal period, compounding any existing or developing problems. In addition, negative attitudes on the part of society and often from caregivers affect the pregnant woman and her care.
A return to health consists of gaining a mastery and control over self and environment, and pleasure seeking that does not require the use of drugs.
NURSING PRIORITIES
1. Promote physiological stability and well-being of client and fetus.
2. Support client’s acceptance of reality of situation.
3. Facilitate learning of new ways to reduce anxiety; strengthen individual coping skills.
4. Incorporate client into supportive community environment.
5. Promote family involvement in treatment process.
6. Provide information about condition, prognosis, and treatment needs.
DISCHARGE GOALS
1. Free of injury/complications to self and fetus/newborn.
2. Engaged in treatment modalities by identifying and using support systems.
3. Responsibility for own life and behavior assumed.
4. Abstinence from drug(s) maintained on a day-to-day basis.
5. Dependence condition and its impact on pregnancy, prognosis, and therapeutic regimen verbalized.
6. Participation in follow-up care by making and keeping all appointments, managing therapeutic regimen.
Nursing diagnosis of Prenatal Substance Dependence/Abuse: Nutrition: altered, less than body requirements may be related to insufficient dietary intake to meet metabolic needs for psychological, physiological, or economic reasons possibly evidenced by low-weight gain, prepregnant weight below norm for height/body build, decreased subcutaneous fat/muscle mass, poor muscle tone, reported altered taste sensation, lack of interest in food; sore, inflamed buccal cavity; laboratory evidence of protein/vitamin deficiencies.
Desired Outcomes:
1. Verbalize understanding of effects of substance abuse and reduced dietary intake on nutritional status and pregnancy.
2. Demonstrate behaviors and lifestyle changes to regain/maintain appropriate weight for pregnancy.
Nursing intervention with rationale:
1. Determine age, height/weight, body build, strength, and activity/rest pattern. Note condition of oral cavity.
Rationale: Provides information on which to base caloric needs/dietary plan. Type of diet/foods may be affected by condition of mucous membranes and teeth.
2. Obtain anthropometric measurements, e.g., triceps skinfold.
Rationale: Calculates subcutaneous fat and muscle mass to aid in determining dietary needs.
3. Note total daily calorie intake. Encourage client to maintain a diary of intake, times, and patterns of eating.
Rationale: Information about patient’s dietary pattern will identify nutritional strengths, needs, and deficiencies.
4. Discuss prenatal nutritional needs and develop dietary plan. Assist with developing a grocery budget and provide opportunity to choose foods or snacks to meet dietary plan.
Rationale: Enhances participation/sense of control and may promote resolution of nutritional deficiencies.
5. Evaluate energy expenditure (e.g., pregnancy needs, pacing or sedentary activities), and establish an individualized exercise program.
Rationale: Pregnant state and activity level affect nutritional needs. Exercise enhances muscle tone, may stimulate appetite, and promotes sense of well-being.
6. Weigh client weekly and record.
Rationale: Provides information regarding current status/effectiveness of dietary plan.
7. Consult with dietitian.
Rationale: Useful in establishing individual dietary needs/plan. Provides additional resource for learning about the importance of nutrition in nonpregnant and pregnant states.
8. Review laboratory work as indicated; e.g., glucose, serum albumin, and electrolytes.
Rationale: Identifies anemias, electrolyte imbalances, and other abnormalities that may be present, requiring specific therapy. Note: Toxic vapor abuse of toluenebased solvents (such as spray paint or glue) may cause a distal renal tubular acidosis with resultant hypokalemia, hypophosphatemia, hypomagnesemia, and hypocalcemia as well as rhabdomyolysis.
9. Refer for dental consultation as necessary.
Rationale: Teeth are essential to good nutritional intake, and dental hygiene/care is often neglected in this population.
