3. Altered nutrition, less than body requirements, related to feeding problems secondary to respiratory distress and Gl hypermotility.
4. High risk for impaired skin integrity related to scratching, secondary to withdrawal symptoms.

6. Nursing care plan/implementation:
   1. Goal: prevent/minimize respiratory distress.
      1. Position: side-lying, head dependent—to facilitate mucus drainage.
      2. Suction pm with bulb syringe for excess mucus—to maintain patent airway.
      3. Monitor respirations and apical pulse.
   2. Goal: minimize possibility of convulsions.
      1. Decrease environmental stimuli—quiet, touch only when necessary, offer pacifier.
      2. Keep warm, swaddle for comfort.
   3. Goal: maintain nutrition/hydration.
      1. Food/fluids—oral or IV, as ordered.
      2. I&O.
      3. Daily weight.
   4. Goal: assist in diagnosis of drug and drug level. Collect all urine and meconium during first 24 hr for toxicologic studies.
   5. Goal: maintain/promote skin integrity.
      1. Mitts over hands—to minimize scratching.
      2. Keep clean and dry.
      3. Medicated ointment/powder, as ordered, q2-4h, to excoriated areas.
      4. Expose excoriated areas to air.
   6. Goal: minimize withdrawal symptoms. Administer medications, as ordered.
      1. Paregoric elixir—to wean from drug.
      2. Phenobarbital—to reduce CNS hyperirritability, hyperbilirubinemia.
      3. Chlorpromazine , diazepam —to tranquilize, reduce hyperirritability. Note: Valium is contraindicated for jaundiced neonate because it predisposes to hyperbilirubinemia.
      4. Methadone.
   7. Goal: emotional support to mother.
      1. Encourage verbalization of feelings of guilt, anxiety, fear, concerns.
      2. Refer to social service.
7. Evaluation/outcome criteria:
   1. Infant responds to medical/nursing regimen.
      1. Maintains adequate respirations.
      2. Feeds well, gains weight.
      3. No evidence of CNS hyperirritability, convulsions; demonstrates normal newborn reflexes.
   2. Infant evidences bonding with parent(s). Responsive to mother’s voice.

7. Disorders affecting psychosocial-cultural function: fetal alcohol syndrome (FAS). General aspects:
   1. Maternal alcohol abuse has been associated with:
      1. Malnutrition, vitamin deficiencies.
      2. Bone marrow suppression.
      3. Liver disease.
      4. Child abuse.
   2. Infant at risk for:
      1. Congenital anomalies.
      2. Mental deficiency; learning disabilities.
      3. IUGR.
   3. Pathophysiology—permanent damage to developing embryonic/fetal structures; cardiovascular anomalies (ventricular septal defects).
   4. Etiology—high circulating alcohol levels are lethal to the embryo; lower levels cause permanent cell damage.
   5. Assessment:
      1. Characteristic craniofacial abnormalities:
         1. Short, palpebral fissure.
         2. Epicanthal folds.
         3. Maxillary hypoplasia.
         4. Micrognathia.
         5. Long, thin upper lip.
      2. Short stature.
      3. Irritable, hyperactive, poor feeding.
      4. High-pitched cry, difficult to comfort.
   6. Nursing care plan/implementation:
      1. Goal: reduce irritability.
         1. Reduce environmental stimuli.
         2. Wrap, cuddle.
         3. Administer sedatives, as ordered.
      2. Goal: maintain nutrition/hydration.
      3. Goal: emotional support to mother.
   7. Evaluation/outcome criteria: see VI. Drugdependent (heroin) neonate, p. 178.
      1. No respiratory distress.
      2. Infant feeding properly.
      3. Maternal bonding apparent.
      4. Social service—home involvement.
8. Classification of infants by weight and gestational age
   1. Terminology
      1. Preterm, or premature—37 wk gestation or less (usually 2500 g [5 lb] or less).
      2. Term—38-42 wk gestation.
      3. Postterm—over 42 wk.
      4. Postmature—gestation greater than 42 wk.
      5. Appropriate for gestational age (AGA)—for each week of gestation, there is a normal range of expected weight (between 10th and 90th percentile).
         1. Term infants weighing 2500 g or more are usually mature in physiological functions.
         2. If respiratory distress occurs, it is usually related to meconium aspiration syndrome.
      6. SGA or dysmature—weight falls below normal range for age (< 10th percentile).
         1. Preeclampsia.
         2. Malnutrition.
         3. Smoking.
         4. Placental insufficiency.
         5. Alcohol syndrome.
         6. Rubella.