| Medical Diagnosis:Intrauterine drug exposure, methadone withdrawal (3-week-old newborn male suffering from Neonatal Abstinence Syndrome) |
| Pathophysiology:Opioid withdrawal is a complex bio-medical issue that affects the fetus on a cellular and molecular level. Opiate drugs, such as methadone, have an easy access into the fetus through the placenta, as they have low molecular weights, are easily dissolved in water, and possess a lipophilic structure, which contributes to the possibility of being transmitted from mother to child (Kocherlakota, 2014). Withdrawal symptoms are motivated by the accumulation of the drug within the fetus, as it has a fairly long half-life period, which increases as the child passes through the gestation period. Opioids affect the body through G-protein coupled receptors, which are extensively distributed through the nervous system of the child (Kocherlakota, 2014). They are located in the peripheral nervous systems, gastric and intestinal systems, as well as others, so the withdrawal affects the entire body. The drug affects the opioid receptors, causing cellular ionic imbalance, increased adenyl cyclase activity, and provoking a cascade of enzymatic activities (Kocherlakota, 2014). Etiology: Neonatal abstinence syndrome occurs when the mother takes opioid-based drugs, which, in this case, is methadone, during pregnancy, resulting in the accumulation of the drug inside the fetus, followed by methadone withdrawal. As the placenta connects the mother’s bloodstream to that of the baby, the child becomes affected by the drug as much as the mother, causing a dependency on the drug and adverse effects upon withdrawal (“Neonatal abstinence syndrome,” 2017). Signs/Symptoms (Clinical Manifestations): Standard symptoms of methadone withdrawal include excessive crying, muscle contractions, hyperactivity, poor sleep, poor feeding, sneezing, vomiting, fever, diarrhea, and blotchy skin coloring. As these symptoms are common to many diseases encountered during the early stages of life, additional testing is required (Hudak & Tan, 2012). Medical/Nursing Intervention: standard interventions used in this scenario are high-calorie diets administered in smaller portions, TLC (tender love and care procedures), methadone and morphine intake for more serious cases of withdrawal. Prognosis: Standard procedures will relieve most of the symptoms within different periods of time, depending on the severity of NAS. The child may experience disturbed sleeping patterns for months after being released from hospital care. The expected time required for the major symptoms of NAS to fade are from 2 weeks to a month. In severe cases, the child must remain under hospital observation for a longer period of time (“Neonatal abstinence syndrome,” 2017). |
| Nursing Diagnosis: Disturbed sleeping patterns, mood swings, crying and poor appetite caused by Methadone Withdrawal. | |
| Nursing interventions: | Expected outcomes: |
| 1. The nurse will apply TLC (Tender Loving Care) in order to calm down the child. The procedures include holding and gently rocking the baby, having him enclosed in a blanket, and reducing the lights and noise. | 1. The child’s crying will be reduced and the sleeping patterns would begin to normalize within 2-3 days of constant application of TLC during peaks of physical and emotional discomfort. |
| 2. The nurse will be administering food in smaller portions at more frequent intervals. The food mix would have a high calorie count to ensure the child is getting its energy even if the appetite does not allow for greater food intake. | 2. The child’s feeding pattern would start improving after approximately 1 week after the start of the treatment. Depending on the severity of the case, the timelines may change for better or worse. The procedure must be repeated until the feeding pattern normalizes and the child would be able to receive food at regular intervals. |
References
Hudak, M.L., & Tan, R.C. (2012). Neonatal drug withdrawal. Pediatrics, 129(2), 540-560.
Kocherlakota, P. (2014). Neonatal abstinence syndrome. Pediatrics, 134(2), 547-561.
Neonatal abstinence syndrome. (2017). Web.