Pregnancy and addiction Case Study

PREGNANCY AND ADDICTION: Case Study of the drug addicted pregnant woman by Cindy Ziemkiewicz, MSN, RN and Reviewed by Lisa King, MSN, RN, WHCNP

Medical History

Medical Visit

Lena presents to the hospital complaining of contractions. She is admitted to the triage area. During the triage process she states that she is taking Percocet that was prescribed for her 2 years ago for her back surgery from a car accident. Since she is unable to get refills on the pills, her boyfriend has been providing them. She has been taking this throughout the pregnancy.
Her present weight is 150 pounds
She is 2 cm dilated, she is leaking light meconium stained fluid
Lena is requesting pain medication
(How would you approach and continue caring for this patient? The goal is to develop a non-judgmental rapport with this patient.)
(What data do you need to collect to care for both the patient and the fetus?)

Labor and Delivery

Lena is admitted to Labor and Delivery.
An IV of LR was started at 125ml/hour
Penicillin 5 million units followed by 2.5 IV over 30 minutes every 4 hours was ordered. (Why was this ordered?)
Lena’s urine drug screen returned positive for opiates.
A decision was made to give her an epidural early in labor verses the IV Nubain.
(Why was this the medical decision?)

Labor Assessment

Lena receives her epidural and the nurse documents the FHT assessment and labor assessment:
FHT baseline 155
Variability- moderate (6-25)
Occasional accelerations up to 170 lasting 40 seconds
Occasional variable deceleration
Contractions every 5 minutes lasting 60 seconds
Amniotic fluid color light green
Cervical exam 4 cm
What Category is this tracing?
What is the definition of a variable deceleration?
What concerns do you have?

3-Tier FHR Pattern Classification

Category I
Baseline rate: 110–160 beats per minute
Baseline variability: moderate
Late or variable decelerations: absent
Early decelerations: present or absent
Accelerations: present or absent
Category II
Includes all tracings not categorized as Category I or III
Category III
Absent baseline FHR variability and any of the following
• Recurrent late decelerations
• Recurrent variable decelerations
• Bradycardia, Sinusoidal pattern

Labor Assessment

Delivery

Mom/Baby

You are taking care of Lena and her baby girl . What concerns do you have regarding Lena’s infant?
Should this infant be breastfed?
What concerns do you have regarding Lena?

Baby Assessment

While performing your shift assessment on the infant you notice that the baby temperature is 36.5 degrees C, respirations are 62, you changed a diaper of a watery, loose stool. You notice tremors of the hands and legs when being handled or disturbed, with a high pitched cry. She has nasal stuffiness and sneezes frequently. The baby is rooting throughout your assessment but when you take her out to Lena to breastfeed, the baby has an uncoordinated suck, is a poor feed and is sweating.
What do you suspect?
How/what do you use to evaluate these symptoms?

Mother Assessment

You go into Lena’s room to do her 1^st PP day morning assessment.
T 37 degrees C
Pulse 100
respirations 20
Spo2 99%
Incision- clean, dry, and intact,
Lena is up about in her room, when you compliment her on getting around so well, she informs you that she is restless and a little anxious with caring for the baby. She is voiding well and tells you that she had a loose stool this morning. You notice a slight hand tremor and she yawned twice during your assessment. Lena is complaining of some mild muscle and joint aching. She complains of some nasal stuffiness and hopes she is not getting a cold.
What do you suspect?
How/What do you use to evaluate these symptoms?

Nursing Diagnosis

Discharge

PLACE THIS ORDER OR A SIMILAR ORDER ON CASE STUDY WITH SMASHING ESSAYS

The post Pregnancy and addiction Case Study appeared first on Smashing Essays.