5. Disorders affecting psychosocio-cultural behaviors: substance abuse
1. Assessment: pregnant substance abuser
   1. Medical history
      1. Infections: HIV-positive status, AIDS, STDs, hepatitis, cirrhosis, cellulitis, endocarditis, pancreatitis, pneumonia.
      2. Psychiatric illness: depression, paranoia, irritability.
      3. Trauma related to violence.
   2. Obstetric history
      1. Spontaneous abortions.
      2. History of abruptio placenta
      3. Preterm labor.
      4. Preterm rupture of membranes.
      5. Fetal deat
      6. Low-birth-weight (LBW) infants.
      7. Tremors/seizures.
   3. Current pregnancy
      1. Preterm labor contractions.
      2. Hypoactivity or hyperactivity in fetus.
      3. Poor or decreased weight gain.
      4. STD
      5. Undiagnosed vaginal bleedin
      6. Drugs being used and methods of self-administration.
   4. Psychosocial history
      1. Attitudes re: pregnancy.
      2. Current support system: lacking
      3. Current living arrangements; lifestyle
      4. History of psychiatric illness.
      5. History of physical, sexual abuse
      6. Involvement with legal system.
   5. Physical examination
   6. Commonly abused substances
      1. Nicotine
      2. Alcohol (fetal alcohol syndrome ([FAS] or fetal alcohol effects [FAE])
      3. Marijuana
      4. Stimulants - cocaine,  crack, ice, methamphetamine
      5. Opiates - heroin, methadone, Darvon, codeine, Vicodin, Oxycontin.
      6. Sedatives, hypnotics.
      7. Caffeine
      8. Ecstasy.
   7. Neonatal outcomes
      1. LBW, small heads.
      2. Irritable, difficult to console
      3. Disorganized suck-swallow reflex.
      4. Impaired motor development.
      5. Congenital anomalies: genitourinary, gastrointestinal, limb anomalies.
      6. Cerebral infarctions.
      7. Breastfeeding contraindicated unless mother is drugfree for 3 months.
      8. Poor, slow weight gain; failure to thrive
2. Analysis/nursing diagnosis:
   1. Altered nutrition: less than body requirements - poor weight gain related to poor nutrition.
   2. Altered nutrition: less than body requirements - slow fetal growth related to slow gain in weight.
   3. Altered placental function related to high risk for abruptio placenta
   4. Noncompliance with health care protocols related to persistent drug use
   5. Altered parenting related to psychological illness (substance dependence).
3. Nursing care plan/implementation:
   1. Early identification of substance abuser.
   2. Stabilize physiological status.
   3. Fetal surveillance
   4. Urge consistent obstetric car
   5. Refer for social services.
4. Evaluation/outcome criteria:
   1. Seeks out and uses social services and drug treatment program.
   2. Abstains from illicit substances during pregnancy.
   3. Successfully completes an uneventful pregnancy, labor, and birth of normal healthy infant.