Planning Care Through Non-Pharmacologic Interventions - Paper Example

Introduction

The neonatal abstinence syndrome (NAS) has posted a significant challenge to many clinicians and nurses. The condition arises due to exposure of infants to substances like opioids, cocaine and other drugs while in the womb. It happens shortly after birth where the fetus was exposed to opiate, cocaine, heroin and other drugs while in the womb of the expectant mother. To address the situation, it requires a lot of knowledge and training which the neonatal intensive care unit has not considered. Both pharmacological and non-pharmacological interventions are necessary for addressing neonatal abstinence syndrome. Non-pharmacological interventions help in the reduction of the hospitalization time as well as reduce the risks associated with the medication time.

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Theory Information

Non-pharmacological interventions aim to reduce the risk of neonatal abstinence syndrome in infants. Pharmacological interventions aim at speeding up the withdrawal process and involve the administration of drugs which are used to tackle the syndrome in the infant. Both of this intervention are used handy to ensure quick withdrawal of the infant from the neonate conditions. The condition is responsible for seizures, sweating, tremors, and tachypnea. Therefore, the infant is always at risk until nurses take up action against the condition. In this case, pharmacological and non-pharmacological interventions are involved in the planning of care for the infant. The interventions address comfort issues of the infant to enable him or to respond well to stimuli and new environment.

Non-pharmacological interventions involve breastfeeding, parental presence, as well as soothing care. Pharmacological interventions, on the other hand, involve the administration of morphine, methadone or buprenorphine into the infant or breastfed milk of the infant. These methods are used to speed up intervention to ensure the infant is taken care of.

Breastfeeding is critical for mothers who are receiving medication-assisted treatment (Jones et al., 2016). Morphine, methadone, and buprenorphine are added to the breastfed milk to attack the neonates in the infant who was exposed to illicit substances.

Parental presence is an essential non-pharmacological intervention in the planning of care for the neonatal syndrome in infants. A study by Welle-Strand et al., (2013) proved that the presence of the mother reduced the hospital stay to shorter than nine days compared to when the mother has a shorter presence. The study further showed that the infants had a lower pharmacological thereby of less than eight days due to parental presence.

Moreover, soothing care is very critical in addressing pharmacological and non-pharmacological intervention in the infant. Soothing care involves limiting exposure to light and sound as well as maintaining proper nutrition for the infant. These measures will ensure the infant response well to the treatment, and fast results will be exhibited resulting in quick response and recovery of the neonates from the syndrome.

Therefore, pharmacological and non-pharmacological interventions are essential for addressing neonatal abstinence syndrome in infants. They have to be integrated into planning care to ensure that nurses provide critical care for infants. Infants need primary care; thus, nurses have to provide these interventions at primary care before the infant is released from the hospital.

Planning the Care

Assessment

Absorption of opioids by pregnant mothers has exposed their infants to neonate conditions. Immediately after birth, the infant's body starts to respond to these conditions by showing withdrawal symptoms of the neonatal abstinence syndrome (Maguire, 2014). The child experience lack of sleep, excessive crying, poor feeding, diarrhea as well as hypertonia. Therefore, neonatal abstinence syndrome is likely to affect the child exposed to the substances. The pathophysiology of this condition is that drugs are transferred from the mother through the placenta to the fetus. Therefore, during delivery, then when the placenta is cut the transfer of narcotics is interrupted which results in the withdrawal syndrome in the infant.

The most common medication used is morphine. Morphine is used to increase activity in infants and improve the withdrawal process which controls some of the symptoms of the condition. Morphine improves feeding in the affected infant and prevents seizures. However, to ensure effective morphine functioning, the Finnegan scoring system is used to examine the score of morphine in the infant body. Other treatment options include clonidine and methadone (O'Donnell & Jackson, 2017). The drugs perform the same treatment as morphine in increasing activity in the infant withdrawal process from the neonatal abstinence syndrome.

Nursing Diagnoses

Screening is an effective way of identifying the condition in infants. The nurses have to study the maternal urine of the infant in the lab to identify any pathogens or substances that the infant body cannot withstand (Pryor K. & Pryor G., 2015). The test procedure is essential in studying the effectiveness of the scoring system and will establish whether the treatment options like morphine have a critical intervention. Screening is done to ensure the objective of the scoring system is met for addressing the performance of the Neonatal Abstinence Syndrome (NAS) condition in infants. Also, it is designed to ensure proper and sufficient care has been administered to the young baby to ensure appropriate physiological functioning in the body. The level of nutrition is established in the infant and helps determine any deficiencies where the mother has to improve on breastfeeding to address weight loss and other nutritional effects in the body of the infant.

Also, while undergoing these procedures, an infant should be given high care consideration by being placed in clean rooms where there are minimal disruptions. Mothers of the infant have to ensure proper feeding as the infant has to be adequately fed to make sure the withdrawal process is going on effectively. Moreover, an infant should be kept in a manner that it is comfortable for it and their mothers have to ensure their skins are well covered and protected. The skin is likely to be infected, and this may prevent the recovery process. The infant should be given proper nutrition, and in case of any difficulties, medics are to be briefed to prescribe a suitable remedy for the condition.

Planning

Nevertheless, to ensure efficiency and effectiveness of the systems, specific environmental and nutritional concerns have to be met. Also, comfort matters in the withdrawal process. The environment has to be of primary care like the incubator where primary care nurses can study and investigate the condition effectively in the child. The Neonatal Intensive Care Unit (NICU) recommends for the growth and development units where nurses can quickly develop their assessment skills and ensure the reliability of the withdrawal process by monitoring the infant response to treatment (Harris et al., 2016). Also, it is critical to inform the parent of the kid why that is necessary to ensure they are aware of the physiological process going on with the child with the aim of complete recovery and wellbeing of the infant. Parental awareness will also ensure their willingness to support the process as well as provide a suitable environment which will ensure the infant is well-taken care off (Kondili & Duryea, 2019). Parents are essential at offering comfort to the infant and are to be educated on how to ensure the infant is not exposed to external stimuli (Holmes et al., 2016). The external stimuli may affect the withdrawal process due to exposures, and the aim of the primary care may not be achieved. Therefore, comfort measures are critical for the response process and may also help the clinicians establish specific symptoms in the infant even though they do not indicate. Comfort measures aim to develop a controlled environment where medical practitioners subject a patient to identify and investigate a particular condition and in this case. It involves the Neonatal Abstinence Syndrome (NAS). The environment will ensure positive response and salient examination to facilitate proper recommendations on the health of the infant.

Implementation

There is a need for proper knowledge and skills to be established to ensure the nursing model works effectively. Nurses and other medical practitioners have to equip themselves with salient skills which are essential for addressing and handling Neonatal conditions in infants. The government has to establish training facilities in hospitals and other primary care units that will ensure the knowledge is spread effectively. Also, mothers have to be educated on how to take care of young infants and the way they should monitor them to comply with necessary medical procedures and notify of any extreme conditions. There is a need for continuous pediatrician analysis and notification in case the infant is feeling unwell. Maternal health care has to be equipped with the Finnegan scoring system (FSS) which need to be used to address these conditions among infants. Proper training should be done sufficiently and not selectively among all primary care nurses since the scoring tests are reviewed daily every two to four hours to ensure the effectiveness of the treatment in patients. The knowledge and skills will necessitate the administration of adequate levels of morphine or other drugs that are used to control the neonatal withdrawal response among the infants.

Evaluation

Whenever the system score is greater than 8, the medical team has to assess the adjustment procedure for morphine intake in the infant. The aim is to ensure that the withdrawal process is simple and effective to avoid any complications in the body of the infant. The scores have to be reviewed daily to establish whether any impending concerns have to be addressed. For example, the daily review is done to assess whether the amount of morphine should be increased or decreased in the infant to speed or reduce the withdrawal process. There is a range of scores which are established and are used in the administration of a particular level of morphine in the infant's body. Any Finnegan score higher than 12 has to be reviewed by a second nurse and pediatrician is contacted to examine the situation. Also, the Finnegan score greater than eight has to be considered by a second nurse to ensure certainty of the treatment and make sure the infant is responding reasonably to the medication. The pediatrician always makes proper prescriptions for the neonatal therapy for the infant to ensure that her response to the withdrawal is real and maximum care is obtained. Moreover, this is done at the primary care unit, that is, neonatal intensive care unit since the infant is in a dire critical condition of early growth and development.

Theory Critique

Pharmacological and non-pharmacological intervention is critical in reducing the length of stay in the hospital for infants struggling with neonatal abstinence syndrome. Non-pharmacological interventions such as parental presence (Howard et al., 2017). Parental presence has reduced the stay to only nine days for non-pharmacological intervention and less than eight days for pharmacological intervention (Welle-Strand et al., 2013). The length of stay is reduced since the need for treatment decreases as the mother may be used to administer treatment through breastfed milk. In this case, medically assisted treatment (MAT) is applied where neonatal syndrome treatment drugs are added to the breastfed milk to increase response rate and reduce the time required to take care of the infant.

Non-pharmacological measures are esse...