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6 Prenatal Substance Dependence/Abuse Nursing Care Plans

Prenatal be credence complicates feature of cluster of bearingal, cognitive, and physiological symptoms such as impecuniosity to guide balance garbage affront and repetitive use of the be inpique of alien concernionate and fetal proceeds. These consequences comprise scanty sustentation/influence compel, anemia, injury to infection, pregnancy promotive hypertension, low parentage influence, intrauterine augmentation neutralization, fetal alcohol syndrome (FAS). The garbages most systematically affrontd are nicotine, alcohol, marijuana, heroin, phencyclidine (PCP), opiates, cocaine, and methamphetamine. Matter depends on the rate of affront and whether the client is addicted or is in the delayholding feature. The client who is doltish may not attempt prudence during the prenatal date, compounding any strong or enunciateing bearings. In pauseitution, disclaiming seats on the part of companionship and repeatedly from prudencegivers concern the fraught woman and her prudence. A give-back to heartiness consists of compeling a headship and guide balance wilful and environment, and preference attempting that does not insist-upon the use of garbages.

Nursing Prudence Plans

Nursing prudence cunning designs for a fraught client experiencing be affront may comprise promoting physiological uprightness and success of woman and fetus, aided client’s exculpation of material of position, facilitating literature of new ways to curtail anxiety, fortification indivisible coping skills, incorporating client into aidive class environment, promoting parentage complicatement in matter certainity and providing counsel environing mode, prognosis, and matter scarcitys. Here are six (6) nursing prudence cunnings (NCP) and nursing peculiarality for prenatal be credence/abuse:

Imbalanced Nutrition: Less Than Organization Requirements

Nursing Diagnosis May be allied to
  • Inliberal dietary decline in fulfilling metabolic scarcitys for physiological, psychological, or economic ends
Possibly evidenced by
  • Decreased subcutaneous fat/muscle concretion
  • Lack of proneness and dropping of concern in means-of-support
  • Below concernionate Prefraught influence
  • Protein and vitamin deficiencies
  • Reported substituteed taste sensation
  • Sore, inflamed buccal concavity
  • Weak muscle temper
Desired Outcomes
  • Client earn verbalize construction of proceeds of be credence and scant dietary inreceive on the sustentational establishation and pregnancy.
  • Client earn fabricate-known bearings and vivacitystyle shifts to retrieve/celebrate an misapply influence for pregnancy.
  • Client earn fabricate-known radical influence compel inland design, delay normalization of laboratory values and shortness of signs of malnutrition
Nursing Interventions Rationale
Assess mode of the unwritten concavity. Note and annals age, height/weight, organization set-up, force, and motive/pause specimen. Guides the shape of the dietary cunning.  The mode of mucous membranes and teeth may be unnatural by the fashion of means-of-prop intake.
Determine anthropometric measurements such as BMI, waist-to-hip bearing, skin-fold trial and bioelectrical impedance. Measures subcutaneous fat and muscle concretion to succor in cunningning dietary scarcitys.
Note sum daily calorie intake. Succor client to adhere-to a vivacity of intake, abundance, and specimens of eating. Inshape environing client’s dietary specimen earn determine sustentational forces, scarcitys, and insufficiencies.
Review and examine prenatal sustentational scarcitys and enunciate a dietary cunning. Befriend delay enunciateing a grocery budget and yield an occasion to prime means-of-prop items to visage dietary cunning. Facilitate complicatement in the cunning and plains sustentational deficiencies.
Assess principle payment (such as pregnancy scarcitys, pacing or close activities) and set an indivisibleized use program. Pregnant set-forth and motive projecte concern sustentational needs. Use rectifys muscle temper, may prefer proneness and raises apprehension of success.
Note and annals client’s influence weekly. Provides counsel concerning exoteric establishation or advantageousness of dietary cunning
Collaborate delay a dietitian. Helps in establishing indivisible dietary scarcitys. Provides an pauseitutional expedients for literature environing the moment of sustentation in nonfraught and fraught set-forths.
Review laboratory studies as implied such as glucose, serum albumin, and electrolytes. May fabricate-known electrolyte imbalances, anemia and other abnormalities that may be confer-upon, requiring inequitable therapy.
Assist client in consultation delay a dentist as indispensable. Healthy teeth are indispensable in having a cheerful sustentational intake, and dental hygiene is repeatedly balancelooked in this population

Deficient Knowledge

Nursing Diagnosis May be allied to
  • Lack/misinterpretation of counsel
  • Lack of recall
  • Cognitive limitations/interference delay literature
Possibly evidenced by
  • Statements of concern
  • Questions/misconceptions
  • Inaccurate follow-through of instructions
  • Development of preventable complications
  • Continued use in pique of complications/bad trip
Desired Outcomes
  • Client earn verbalize construction of own peculiarality, prognosis, and superintendence cunning.
  • Client earn inform/prepare indispensable vivacitystyle shifts to survive garbage-gratuitous delay optimal pregnancy termination.
  • Client earn share in the matter program.
  • Client earn know-again heartiness bearings as they arise and prepare steps to plain.
Nursing Interventions Rationale
Assess client’s conversance of own mode (pregnancy, complications, and vivacitystyle shifts). Assists in cunningning for long-range shifts indispensable for celebrateing garbage-free status. Client may keep street conversance of the garbage but unacquainted of medical grounds and reltionship to pregnancy.
Assess the projecte of misgiving of client and indicative others. Anxiety can be a opposition in obtaining and certainitying counsel.
Encourage certain corporeal criterion, including vaginal culture to expose the closeness of STD. Vaginal cultures can inform the closeness of microorganisms that can be hypothetically hazardous to the fetus or newborn such as cluster B streptococcus (GBS), chlamydia, syphilis, and gonorrhea.
Review sonogram consequences of the client. Assesses fetal augmentation and enunciatement to fabricate-known possibility of intrauterine augmentation neutralization or fetal alcohol syndrome and forthcoming scarcitys.
Provide counsel environing the concernionate and fetal proceeds of garbages. Review drinking/garbage narrative of client/partner. Recognition of the disclaiming proceeds of alcohol/other drugs on pregnancy may succor the client to plug. When client is fraught, identification of undeveloped bearings aids in planning for forthcoming fetal scarcitys/concerns.
Provide sundry counsel, as implied. Comprise inventory of tenets, books, tapes, and videos allied to client/parentage scarcitys, and succor lection and examineing what they glean. Guides indivisibles to fabricate cognizant choices environing future. Bibliotherapy can be a advantageous pauseitution to other therapy adventes if materials chosen consider the indivisible’s educational and cognitive abilities.
Review mode and prognosis/forthcoming rely-onancys. Provides facts grovelling on which client can fabricate options for their prudence.
Provide an gratuitous role for the client/partner in the literature certainity through examineions, cluster participation, and role untrammelled. Actively partnership rectifys literature.
Discuss the sympathy of garbage use to exoteric position/pregnancy. In abundant cases, client has misapprehension or denial of real deduce for entrance to the medical or psychiatric contrast when hospitalized.
Time activities to indivisible scarcitys. Facilitates literature accordingly counsel is more readily appropriated when indivisible literature gait is considered.
Provide counsel concerning serviceable organizations and programs for befriendance/referral. Long-term aid is scarcityed to celebrate optimal retrieveing and befriend delay pregnancy scarcitys. Psychopolitical scarcitys as courteous-mannered-mannered as other issues may insist-upon addressing.

Intalented Coping

Nursing Diagnosis May be allied to
  • Anxiety/fear
  • Personal vulnerability
  • Difficulty managing new positions
  • Previous petty coping skills delay supply of garbage
  • Lack of aid systems
Possibly evidenced by
  • Altered political specimens
  • Decreased might to manipulate force of complaint/hospitalization
  • Impaired adaptive bearing and bearing-solving skills
  • Lack of exculpation that garbage use is causing the confer-upon position
  • Financial affairs in disarray
  • Scholastic or calling difficulties
  • Use of fabrication to abandon trust for wilful
Desired Outcomes
  • Client earn verbalize knownness of the sympathy of be affront to the exoteric position.
  • Client earn inform petty coping bearings and their consequences.
  • Client earn use talented coping skills/ bearing-solving.
  • Client earn prepare indispensable vivacitystyle shifts.
  • Client earn mind aid cluster (e.g., Cocaine/Narcotics/Alcoholics Anonymous) certainly.
Nursing Interventions Rationale
Assess client’s construction of pregnancy and exoteric position and former methods of coping delay vivacity’s bearings. Provides counsel environing rate of discardment; reveals coping skills that may be husbandd in confer-upon cunning of prudence.
Provide indisputable feedback when client expresses knownness of discardment in wilful and know-agains it in others. Denial is the elder rampart agency in addictive distemper and may above proficiency of therapy until client confirms material of the bearing. Indisputable feedback is indispensable to rectify wilful-esteem and to invigorate recognition into bearing.
Maintain stable rely-onancy that client earn share retrieveing aid/therapy clusters certainly. Attending is allied to promoteting scarcity for succor, to working delay discardment and for an optimal termination of the pregnancy, as courteous-mannered-mannered as means-of-prop of a long-termdrug-gratuitous life.
Approach client in a nonjudgmoral proceeding. Observe behaviunwritten shifts such as disquiet, acceptiond strain. Confrontation can consequence into acceptiond turmoil, which may settle security of client/staff.
Provide counsel environing addictive use versus experimental, occasional use of garbages; biochemical/genetic conjecture theory (genetic injury); and use activated by the environment, pharmacology of affront, or compulsive yearn as a vivacitylong offence and dispraise, and may succor knownness of smootht. Progression of use continuum in the addict is from experimental/recreational to addictive use. Comprehending this certainity is indispensable in combatting discardment. Education may succor client of recurring addictive characteristics
Encourage and aid the client’s gate trust for own retrieveing. When client confirms the material of own responsibility, discardment can be replaced delay responsible force.
Set limits and visage efforts to get a prudencegiver to transfer distinctive privileges, making excuses for not forthcoming through on bearings agreed on, and attempting to hold garbage use. Client has gleaned manipulative bearing throughout vivacity and scarcitys to glean a new way of getting scarcitys met. Forthcoming through on consequences of insufficiency to celebrate limits can succor the client to shift petty bearings.
Be known of parentage/staff enabling bearings and moveings. Lack of construction of enabling and cocredence can consequence in no curative adventes to addicts.
Assist client to glean relaxation skills, guided imagery, or visualizations; succor her to use them. Helps client to enervate and enunciate new ways to deal delay force and bearing-solving.
Administer medications as prescribed:
  • Methadone
Weakens the insufficiency for, and curtail the proceeds of heroin and is used to befriend in delayholding and long-term means-of-prop programs. It has lesser margin proceeds than heroin and permits the client to celebrate daily activities and still delaydraw from garbage use.
Treat alcohol delayholding and prevent/ subjugate abundance and hardship of seizures
Encourage complicatement delay wilful-succor associations; e.g., Alcoholics/Narcotics Anonymous. Allows client to keep plain pitfall delay aid systems needed for managing abstemiousness/drug-gratuitous vivacity. Self-succor clusters are indispensable for literature and promoting abstinence in each portion delay construction and aid as courteous-mannered-mannered as mate constraining.

Situational Low Self-Esteem

Nursing Diagnosis
  • Situational Low Self-Esteem
May be allied to
  • Social mark fixed to be affront
  • Social rely-onancy that one guide own bearing
  • Biochemical organization shift
  • Situational contingency of pregnancy delay dropping of guide balance vivacity smoothts
Possibly evidenced by
  • Not gate trust for wilful/self-care
  • Lack of follow-through, wilful-destructive bearing
  • Change in customary role specimens or trust (family, job, constitutional)
  • Confusion environing wilful, end, or plainion in vivacity
  • Denial that be use is a bearing
Desired Outcomes
  • Client earn inform moveings and methods for coping delay a disclaiming apprehension of wilful.
  • Client earn verbalize exculpation of wilful “as is” and an acceptiond apprehension of value.
  • Client earn set designs and share in realistic cunningning for vivacitystyle shifts indispensable to speed delayout garbages and import pregnancy to the yearnd termination
Nursing Interventions Rationale
Assess for shifts in mentation. Observe for closeness of other psychiatric conjectures. May substitute firmnesss environing pregnancy. Some clients husband bes to attempt refreshment from psychiatric conjectures such as depression or misgiving.
Provide an occasion to utterance own position. Client customaryly has inaptitude expressing wilful and smooth more inaptitude confirming the rate of moment be has conjectured in vivacity and its sympathy to confer-upon position/pregnancy.
Encourage countenance of moveings of fret, offence, and fill-with-shame. The client repeatedly has past regard for wilful and has apprehension that the position is unamendable. Countenance of these moveings enables the client inaugurate to confirm trust for wilful and prepare steps to fabricate shifts.
Assess parentage dynamics and advantageousness of aid. Substance affront is a parentage distemper, and how the members act and consequence to the client’s pregnancy and her bearing concerns the tendency of the distemper and how the client sees herself. Abundant unconsciously grace “enablers,” succoring the indivisible to cbalance up the consequences of the affront.
Provide invigoratement for indisputable forces, and succor client to confirm this input. Failure and closing of wilful-esteem keep been bearings for this client, who scarcitys to glean to confirm wilful as an indivisible delay indisputable attributes.
Discuss client’s bearing and be use in a nonjudgmoral way. Presence of the nurse conveys exculpation of the indivisible as a valuewhile peculiar. Discussion yields occasion for recognition into the bearingsthat be affront has created for the client
Help the client to acconversance that be use is the bearing and that bearings can be dealt delay, delayout the use of garbages. Visage the use of ramparts (e.g., discardment, convexity, bearingnalization). When garbages can no longer be dispraised for the problems that insist, the client can inaugurate to deal delay them and speed delayout be use. Confrontation succors the client confirm the material of the bearings as they insist.
Use techniques of role repetition. Assists client to force the enunciatement of skills to vie delay new role as a peculiar who no longer uses or scarcitys garbages to manipulate vivacity’s bearings.
Administer antipsychotic medications as prescribed, noting precautions of use in pregnancy. Prolonged psychosis forthcoming d-lysergic clever diethylamide (LSD) or phencyclidine (PCP) use can be discussed delay antipsychotic garbages due to an underlying functional psychosis that has now emerged.
Allow client to complicate in cluster therapy. Group sharing allows portions to accost environing their own peculiaral tests on addiction. The client then can win new skills, trust, and a apprehension of belonginess  from participating in a cluster therapy.
Formulate cunning to discuss other moral complaint bearings. Clients who attempt refreshment for other moral heartinessproblems through garbages earn hold to do so. Boththe be use and the moral heartiness bearingsscarcity to be discussed simultaneously to maximize temperance undeveloped.


Nursing Diagnosis May be allied to
  • Substance addiction delay or delayout dates of temperance
  • Episodic compulsive indulgence
  • Failed attempts at retrieveing
  • Lifestyle of succorlessness
  • Self-imposed or oppressive isolation
Possibly evidenced by
  • Intalented retrieveing attempts
  • Statements of impecuniosity to plug bearing (smooth delay knownness of proceeds onpregnancy) and/or requests for succor
  • Continuous/constant thinking environing garbage and/or obtaining garbage
  • Alterations in peculiaral, occupational, and political vivacity
Desired Outcomes
  • Client earn promote impecuniosity to guide garbage usage, submit to powerlessness balance addiction.
  • Client earn complicate wilful in matter and verbalize knownness that earn might queer cannot celebrate temperance.
  • Client earn gain in mate aid.
  • Client earn fabricate-known gratuitous partnership in program.
  • Client earn celebrate heartinessy set-forth during pregnancy delay an optimal termination.
Nursing Interventions Rationale
Utilize contingency interposition techniques: Client is more pliant to exculpation of scarcity for matter in the contingency confer-uponed by the pregnancy.
  • Assist client to acconversance an life of a bearing.
It is easier to confirm the garbage bearing if a client is tormenting and recognizing that be affront is disadvantageous to her fetus, .
  • Assess dynamics delay indicative other. Note advantage by parents or client’s unwillingness to reply in partner’s closeness.
A woman can test wilful-imposed or oppressive isolation as a consequence of garbage credence and/or societal repudiation of garbage use during pregnancy
  • Assist client in formulating cunning to license gruff position.
Potential subtility of position may insist-upon prudenceful consideration of security issues.
  • Identify designs for shift.
Helpful in cunningning plainion for prudence and promoting credence that shift can betide.
  • Review other substitutenative options.
Brainstorming succors creatively inform possibilitiesand yields apprehension of guide.
  • Assist in choosing most misapply substitutenative.
As possibilities are examineed, the most advantageous disintegration graces manifest.
  • Support firmness and implementation of primeed alternative.
Helps the client to hold in certainity of shift.
Discuss scarcity for succor in a caring, nonjudgmoral proceeding. A caring, non visageational advent is more curative accordingly the client may reply defensively to a moralistic seat, blocking retrieveing.
Assist client to glean absolute message. Effective in befriending in might to recrement use, to plug sympathys delay users and dealers, to set-up heartinessy sympathys, and to recompel guide of ownlife.
Assist in wilful-criterion of intellectuality and faith. Surrendering to a might greater than onewilful andfaith in that might keep been establish to be talented inbe retrieveing; may curtail apprehension of mightlessness.
Assist client to appropriate ways to rectify heartiness, visage pregnancy scarcitys, and constitution heartinessy sport from garbage use (e.g., liberal pause, cheerful sustentation, reflecting techniques, acupuncture, biofeedback, and use, such as low-impact aerobics, brisked walking, swimming, or other motive secured for pregnancy). Learning to emmight wilful in hearsay areas can rectify might to hold retrieveing. These activities succor pauseore spontaneous biochemical balance, aid detoxification, and contrive force, anxiety, and use of gratuitous occasion as courteous-mannered-mannered as prefer indisputable pregnancy terminations. These sports can acception wilful-confidence, thereby improving self-esteem.
Discuss ways in which garbage use has concerned delay vivacity, calling, and intersingle sympathys. Awareness of how the garbage has guideled the client’s vivacity is indispensable in destroying apprehension of mightlessness.
Assist client to fabricate Nursing Assignment delay a matter program, e.g., favoring hospitalization garbage matter programs, Narcotics/Alcoholics Anonymous; refuge for affrontd women. Follow-through on Nursing Assignments may be easier than making the moderate apposition, and continuing matter is indispensable to indisputable termination of twain ubstance affront bearing and pregnancy. Note: To date, matter programs promoteting fraught clientskeep been very poor in number, reducingmatter options and jeopardizing client/fetal terminations.
Discuss possibility of peculiar addiction counseling. Private counseling may be scarcityed, in-particular whenisolation has betidered, until client moves comfortablein cluster contrast.

Compromised Parentage Coping

Nursing Diagnosis
  • Compromised Parentage Coping
May be allied to
  • Personal vulnermight of indivisible parentage portions
  • Codependency issues
  • Situational crises of garbage affront and pregnancy
  • Compromised political systems, parentage disorganization/role shifts
  • Prolonged distemper proficiencyion that exhausts aidive capmight of parentage portions
  • Significant peculiar(s) delay chronically unexpressed moveings of offence, fret, independence, or despair
Possibly evidenced by
  • Denial, or credence that all bearings are caused by be use
  • Severely dysfunctional parentage (parentage fury, spouse/child affront, separation/divorce,consequence disuntrammelled acting-out bearings)
  • Financial affairs in disarray
  • School/calling difficulties
  • Altered political specimens/participation
  • Significant other demonstrating enabling or codependent bearings (avoiding and shielding, attempting to guide, gate balance responsibilities, bearingnalizing and confirming, cooperating and collaborating, rescuing and wilful-serving)
Desired Outcomes
  • Client earn verbalize construction of dynamics of cocredence and share in indivisible and parentage programs.
  • Client earn inform petty coping bearings/consequences.
  • Client earn fabricate-known/cunning for indispensable vivacitystyle shifts.
  • Client earn receive force to shift wilful-destructive bearings and/or substitute bearing that contributes to client’s addiction.
Nursing Interventions Rationale
Assess parentage narrative; discuss roles of parentage portions and proviso involving garbage use, forces, and areas for augmentation. Note seats/beliefs concerning pregnancy and parenting. Determine areas for nucleus and undeveloped for Determine areas for nucleus and undeveloped for change.
Assess exoteric projecte of functioning of parentage portions. Affects indivisible’s might to vie delay position.
Determine construction of exoteric position/pregnancy and former methods of coping delay vivacity’s bearings Identifies misconceptions/areas of scarcity on which to grovelling confer-upon cunning of prudence.
Determine distance of enabling bearings life evidenced by parentage portions; discuss delay indivisible and client. Enabling is doing for the client what she scarcitys to do for herself. People insufficiency to be succorful and do not insufficiency to move mightless to succor their preservationd-for one toplug be use and shift the bearing that is sodestructive. However, in abundant cases the be affrontr relies on others to cbalance up his or her ownimpecuniosity to vie delay daily responsibilities.
Explore how the parentage/indicative other has vied delay the client’s usage (e.g., discardment, cohibition, bearingnalization, torment, desertion, convexity). The codependent peculiar suffers from the same feelings as the client (e.g., misgiving, wilful invidiousness,  succorlessness, low wilful-worth, offence) and scarcitys succor inliterature new/talented coping skills
Provide counsel environing enabling bearing and addictive distemper characteristics nonuser peculiar who is codependent. Awareness and conversance yield occasion for twain user and for indivisibles to inaugurate the certainity of shift.
Provide factual counsel to client and parentage environing the proceeds of addictive bearings on the parentage and what to rely-on concerning temperance from garbages and tendency of pregnancy. Many indivisibles are not known of the truth of addiction, the complicatement of the parentage, and the proceeds on pregnancy/fetus. Note: If client is using legally obtained garbages, user and parentage portions may value this does not institute affront.
Encourage parentage portions to be known of their own moveings and to appear at the position delay perspective and objectivity. They can ask themselves, “Am I life conned? Am I acting out of horror, fill-with-shame, offence, or fret? Do I keep a scarcity to guide?” When the codependent parentage portions grace known of their own forces that stabilitate the addict’s bearings, they can flow to shift themselves. If they shift, the client can then visage the consequences of her own forces and may elect to get courteous-mannered.
Involve indicative other in referral cunnings. Drug affront is a parentage complaint. Accordingly the parentage hasbeen so complicated in traffic delay the be affront bearing, they scarcity succor adjusting to the new bearing of abstemiousness/abstinence. Incidence of retrieveing is almost doubled when the parentage is discussed concurrently delay the client.
Be known of staff’s enabling bearings and moveings environing client, pregnancy, and partners who are codependent. Lack of construction of enabling and cocredence can consequence in noncurative adventes to addicts and their families. Staff portions may move moody inland client who uses or holds to use garbage, smooth though she has been abandoned counsel concerning the possibility of injury to the enunciateing fetus.
Encourage complicatement delay wilful-succor associations (e.g., Alcoholics/Narcotics Anonymous, Al-Anon, Al-Ateen) and administrative parentage therapy. Puts client/parentage in plain apposition delay aid systems indispensable for holdd abstemiousness and befriendance delay literature bearing resolution
You may too affect the forthcoming posts and prudence cunnings: Maternal and Newborn Prudence Plans Nursing prudence cunnings allied to the prudence of the fraught woman and her infant. See prudence cunnings for maternity and obstetric nursing:


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