9 Substance Abuse in Pregnancy Nursing Care Plans

Imbalanced Nutrition: Less Than Body Requirements

Many women with substance dependency come late in their pregnancy for prenatal care because they are worried their substance use will be discovered and they will be reported to the authorities. She may have difficulty following prenatal instructions for proper nutrition because, although she may desire to eat well, if she only has enough money to buy either drugs or food, she may choose drugs over food. She may not have money for supplemental vitamins or iron preparations for the same reason.

Nursing Diagnosis

• Imbalanced Nutrition: Less Than Body Requirements

May be related to

• Inadequate dietary consumption in fulfilling metabolic needs for physiological, psychological, or economic purposes

Possibly evidenced by

• Decreased subcutaneous fat/muscle mass
• Lack of appetite and loss of interest in food
• Below maternal pre-pregnant weight
• Protein and vitamin deficiencies
• Reported altered taste sensation
• Sore, inflamed buccal cavity
• Weak muscle tone

Desired Outcomes

• The client will verbalize understanding of the effects of substance dependence and insufficient dietary intake on the nutritional status and pregnancy.
• The client will demonstrate behaviors and lifestyle changes to regain/maintain an appropriate weight for pregnancy.
• The client will demonstrate progressive weight gain toward a goal, with normalization of laboratory values and absence of signs of malnutrition.

Nursing Assessments and Rationales

1. Assess the condition of the oral cavity. Note and record age, height/weight, body build, strength, and activity/rest pattern.
This guides the formation of the dietary plan.  The condition of mucous membranes and teeth may be affected by the type of food intake. Methamphetamine users describe their teeth as ‘blackened, stained, rotting, crumbling, or falling apart. Poor oral hygiene, high intake of refined carbohydrates, and increased acidity in the oral cavity from oral intake of amphetamine, GI regurgitation, or vomiting also lead to an increased number and severity of carious lesions in clients who abuse methamphetamine (Hamamoto & Rhodus, 2008).

2. Determine anthropometric measurements such as BMI, waist-to-hip ratio, skin-fold test, and bioelectrical impedance.
This measures subcutaneous fat and muscle mass to help in planning dietary needs. The majority of clients who abuse drugs present below-normal BMI, biochemical values, and clinical signs of nutrient deficiency because of the consumption of poor quality nutrient-deficient foods. It was found that pregnant women addicted to methamphetamine had smaller biceps skinfold thickness, a measure of body fat, and they had significantly lower BMI compared to non-addicted pregnant women (Sebastiani et al., 2018).

3. Note total daily calorie intake. Encourage the client to keep a journal of intake, frequency, and patterns of eating.
Information about the client’s dietary pattern will determine nutritional strengths, needs, and insufficiencies. Metabolic problems are often associated with heroin, cocaine, and ecstasy drug although they produce a variety of medical problems. Heroin addicts consume less than the minimum daily quantity of vegetables, fruits, and grains recommended by the food pyramid and eat more portions of sweets (Sebastiani et al., 2018).

4. Assess energy expenditure (such as pregnancy needs, pacing, or sedentary activities).
Pregnant state and activity level affect nutritional needs. Prenatal exposure to methamphetamine was associated with neurobehavioral patterns of decreased arousal, increased stress, and poor quality of movement in a dose-dependent manner. Chronic abuse of methamphetamine alters the activity of the dopamine system in the brain leading to reduced motor function that can lead to significant social, occupational, and medical impairments (Hamamoto & Rhodus, 2008).

5. Note and record the client’s weight weekly.
This provides information regarding the current status or effectiveness of the dietary plan. Cocaine acts as an appetite suppressant that tends to reduce body weight due to its anorexigenic effect (Sebastiani et al., 2018).

Nursing Interventions and Rationales

1. Review and discuss prenatal nutritional needs and develop a dietary plan.
The use of illicit drugs suppresses appetite and affects food habits leading drug-dependent clients to crave ‘empty-energy’, potentially nutrient-deficient foods that cause micronutrient deficiency. The carbohydrate-metabolism health problems could be reversed by increasing the dietary intake of protein and reducing simple carbohydrates in the form of vegetables and whole grains (Sebastiani et al., 2018).

2. Assist with developing a grocery budget and provide an opportunity to select food items to meet dietary plans.
This facilitates involvement in the plan and resolves nutritional deficiencies. Nutrition is a protective factor against alcohol and drug abuse teratogenicity. Recent research is focusing on nutritional intervention in order to reverse the detrimental effects of alcohol and drug abuse on the nutritional status of the mother. Some experimental studies suggest treating women with minerals and antioxidants (like vitamin E or C) in order to substitute the nutritional deficits described in substance-dependent mothers and to protect the fetus (Sebastiani et al., 2018).

3. Set an individualized exercise program.
Exercise improves muscle tone, may promote appetite, and raises a sense of well-being. Available evidence indicates moderate-to-vigorous intensity exercise may improve substance use disorder (SUD) abstinence rates and anxiety/depressive symptoms across multiple SUDs. Exercise may be an effective adjunct treatment for those with substance use disorders in terms of abstinence and withdrawal and also improves mood (Ashdown-Franks et al., 2019).

4. Promote intake of essential micronutrients and multivitamins.
Micronutrient supplementation would in part reverse the toxic effect of alcohol and drugs on fetal neurological development, although it is difficult to establish the optimal range of micronutrients during pregnancy. Nutrients such as choline, vitamin E, betaine, folic acid, methionine, and zinc can attenuate alcohol-induced changes to the epigenome and oxidative damage (Sebastiani et al., 2018).

5. Collaborate with a dietitian.
This helps in establishing individual dietary needs and provides an additional resource for learning about the importance of nutrition in nonpregnant and pregnant states. A partnership should be created with the client, and a plan for compromises and treatment should be developed. Dietary support, monitoring of the client’s weight gain, and fetal assessment promote better pregnancy outcomes.

6. Review laboratory studies as indicated such as glucose, serum albumin, and electrolytes.
This may reveal electrolyte imbalances, anemia, and other abnormalities that may be present, requiring specific therapy. Studies about opiate addiction disorders showed extreme nutritional deficiencies of key proteins, fats, vitamins, and minerals like zinc, iron, calcium, chromium, magnesium, potassium, and other essential nutrients. The use of heroin has been implicated in blood sugar disorders with different mechanisms. Fasting insulin levels were found to be four times higher in heroin addicts than in control subjects and insulin resistance caused by opioid use may be coupled with beta-cell dysfunction (Sebastiani et al., 2018).

7. Educate the client about outreach and food assistance programs.
Management of pregnant substance abusers must address the needs of poorly nourished, homeless, and/or incarcerated pregnant substance dependents. In addition to education about nutrition and weight gain, some of these women may need a referral to food assistance programs and shelters, and the provision of transportation vouchers and prenatal multivitamins (Sebastiani et al., 2018).

8. Assist client in consultation with a dentist as necessary.
Healthy teeth are important in having a good nutritional intake, and dental hygiene is often overlooked in this population. Dental management for a client who abuses drugs is always a challenge. Dentists need to be aware of the clinical presentation and medical risks presented by these clients and attempt to get the client to seek professional help (Hamamoto & Rhodus, 2008).