Question

Nikki is a 17-year-old G1P0 at 33 weeks' gestation. Nikki comes to the clinic today for her prenatal visit and you notice that her hair and clothing have the distinct odor of marijuana and tobacco smoke. You directly ask Nikki if she has been taking any other drugs besides marijuana. Nikki is surprised by the question and denies it. When you explain that you can smell it in her hair and on her clothing, she starts to cry and says, “Please don’t take my baby away from me.” After reassurance, Nikki further admits to sporadic binge alcohol consumption and smoking “pot” and cigarettes. She relates that she also consumes 4 to 5 caffeinated beverages per day. (Learning Objective 10 and 12)

1. How do cigarette smoking, marijuana use, binge alcohol consumption, and excessive caffeine intake affect Nikki’s pregnancy?
2. What possible affects are there to Nikki’s baby from the maternal ingestion of these substances?
3. What is the nursing care you would provide for Nikki?

Answer 1

A.The habit of cigarette smoking, marijuana use, binge alcohol consumption, and excessive caffeine intake affect pregnancy in many ways. The chance of moderately increased risk of preterm delivery,  perinatal mortality, spontaneous abortion, increase in the incidence of placenta previa and abruptio placentae are major effects found in pregnant women who use drug and alcohol during pregnancy. It also cause maternal malnutrition by increased metabolic rate which can lead to low availability of calories and decreased availability of some nutrients such as vitamin B12, amino acids, vitamin C, folate, and zinc.

B. There is high incidence of low birth weight among infants of women who had substance abuse and smoking during pregnancy. Fetal growth retardation is seen due to maternal malnutrition,reduction in uteroplacental blood flow. The infants of these women will have long trem effects like deficits in long-term physical growth, intellectual performance, and behavioral development. Fetal alcohol syndrome (FAS) and intellectual impairment, prenatal or postnatal growth retardation, distinct facial anomalies, and mental deficiency, cardiac and genitourinary abnormalities are specifically seen in infant of an alcohol dependent mother.

C. The patients nursing care should mainly focused on the health education and monitoring of maternal and fetal health.

• health education should include the information regarding the  maternal and fetal effects of drugs and measures to overcome the habit.
• Encourage the patient to participate in her own recovery.
• Provide access to supportive group and quitline for self help.
• Assess the physical and psychological condition and provide adequate support as needed.
• Arrange psychological, group therapies.
• Monitoe maternal nutrition level.
• Provide multivitamins and other nutritional suppliments as needed.
• Develop and maintain an proper diet plan and encourage the patient to follow it.
• Assess the fetal growth.