Term 54 |
A gravida 5 para 2 client delivers a 3,000-gram neonate at 38 weeks' gestation. During the assessment, the nurse notes that the neonate is hyperactive, jittery, and has a hyperactive rooting reflex combined with inconsolable crying. She also notes intrauterine growth retardation and suspect facial characteristics, such as short palebral fissures, flattened midfacies, short upturned nose, thin upper lip, and smooth philtrum. Based on these findings, what information should the nurse include in the mother's discharge plan? 1. Referral to an alcohol treatment counselor 2. Client education on isotretinoin (Retin-A) 3. Instructions on dietary sources of folic acid 4. Referral to cocaine treatment counselor
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Definition 54 |
RATIONALES: The neonate is displaying signs of fetal alcohol syndrome, which occurs as a result of fetal alcohol exposure. The nurse should include referral to an alcohol treatment counselor as part of the mother's discharge plan. Teratogenic effects of isotretinoin include microtia, central nervous system defects, cleft lip and cleft palate, mental retardation, microphthalmia, and dysmorphic craniofacial features. Folic acid is recommended during pregnancy to prevent neural defects. Teratogenic effects of cocaine use during pregnancy include intrauterine growth retardation, microcephaly, cerebral infarction, and congenital malformations of the limbs, heart, genitourinary tract, and face.
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