A client without prenatal care gives birth to a newborn at term gestation. The client denies opioid or other illicit drug use during pregnancy. When monitoring the newborn, which of the following signs would indicate neonatal abstinence syndrome to the nurse? Select all that apply.

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11ecbb05_cc1c_c297_b433_65e74920f8f2_MD0009_00 Neonatal abstinence syndrome (NAS) or opioid withdrawal results from maternal, habitual use of illicit drugs during pregnancy and begins within days or weeks after birth. Opioid abuse (eg, hydrocodone, methadone, heroin) is the most common cause, although other medications (eg, benzodiazepines) can contribute to the condition. Some affected newborns require pharmacologic management of symptoms. Clinical manifestations of NAS may be: Central nervous system findings (eg, irritability, restlessness, high-pitched crying, abnormal sleep pattern, increased muscle tone, hyperactive primitive reflexes), which may require interventions such as swaddling and minimizing stimulation (Option A)Related to the autonomic nervous system (eg, nasal congestion, sweating, frequent yawning, sneezing, tachypnea) (Option D)Gastrointestinal (eg, poor feeding, vomiting, diarrhea), which may require smaller, more frequent feedings and skin protection (Option E) Central nervous system findings (eg, irritability, restlessness, high-pitched crying, abnormal sleep pattern, increased muscle tone, hyperactive primitive reflexes), which may require interventions such as swaddling and minimizing stimulation (Option A) Related to the autonomic nervous system (eg, nasal congestion, sweating, frequent yawning, sneezing, tachypnea) (Option D) Gastrointestinal (eg, poor feeding, vomiting, diarrhea), which may require smaller, more frequent feedings and skin protection (Option E) (Option B) Meconium ileus (ie, intestinal obstruction) is a classic finding in clients with cystic fibrosis. Floppy muscle tone is typical of clients with Trisomy 21 (Down syndrome). (Option C) Microcephaly and cleft palate are manifestations of early prenatal exposure to teratogenic agents (eg, alcohol, cytomegalovirus, valproic acid) and are not associated with NAS. Limited evidence has shown that opioids are generally not teratogenic. Educational objective: Prenatal exposure to illicit drugs may result in neonatal abstinence syndrome. A history of opioid abuse is the most common cause. Manifestations may include irritability, restlessness, a high-pitched cry, nasal congestion, frequent yawning/sneezing, poor feeding, and diarrhea.

A Client Without Prenatal Care Gives Birth to a Newborn