Health Promotion and Maintenance
98. A client, who is 24 years old, gravida 4, para 3, has had no prenatal care and does not know when her last menstrual period was. She presents to labor and delivery completely dilated and crowning. She precipitously delivers a 5-pound, 6-ounce infant. The client's urine toxicology screen shows methamphetamines. The client admits that she uses methamphetamine daily. Which observations should a nurse expect in the neonate that would be consistent with methamphetamine exposure in utero? Select all that apply.
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Test-Taking Tip
Methamphetamines are manufactured with a variety of toxic chemicals that can cause DNA damage in the developing fetus. Many defects can be attributed to methamphetamine exposure in utero.
Content Area: Child Health, Newborn; Integrated Process: Nursing Process, Assessment; Cognitive Level: Application; Client Need/Subneed: Physiological Integrity/Pharmacological and Parenteral Therapies/Adverse Effects/Contraindications/Interactions
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Health Promotion and Maintenance
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Answer 1 is correct because the developing fetus appears to be vulnerable to DNA damage from methamphetamine exposure because it hasn't yet developed the enzymes that protect it against free radicals. Methamphetamines can cause neural tube defects such as cleft lip and palate. Answer 2 is correct because, when a neonate is withdrawing from methamphetamine, there is an increased incidence of irritability, inability to be consoled, and difficulty sleeping. Answer 3 is correct because methamphetamine exposure can cause skeletal malformations such as clubfoot. Answer 4 is incorrect because hyperbilirubinemia is not associated with exposure to methamphetamines. Answer 5 is correct because gastroschisis—when all of the intestines are outside of the body—is a common birth defect in methamphetamine-exposed infants.
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