Care of Mother and Child at Risk or with

Problems (Acute and Chronic)

Module #3 Teacher’s Guide

Lesson Title: CARE OF THE HIGH-RISK PREGNANT CLIENT Materials:

(PRE-GESTATIONAL CONDITIONS-SUBSTANCE ABUSE)
Pen, paper, index card, book, and class List
Learning Targets:
At the end of the module, students will be able to:
1. Define types and effects of substance abuse to pregnancy, References:
including preexisting factors that contribute to its development
such as cardiovascular disease. Pilliteri, Adele and Silbert-Flagg, JoAnne
2. Integrate knowledge of substance abuse to nursing process to (2018) Maternal and Child Health Nursing, 8th
achieve quality maternal and child health nursing care. Edition. USA: Lippincott Williams and Wilkins

A. LESSON PREVIEW/REVIEW

Instruction: True or False. Write T if the statement is true and F if false.

T 1. Vomiting decreases CHO intake link to metabolic acidosis

F 2. The mother has gestational Diabetes Mellitus if FBS>95 or 1 result of OGTT is high.
T 3. Vaginal delivery is preferred
T 4. Plan to deliver birth weight 36-40 weeks when fetus is mature enough but not too large to cause CPD.
T 5. Norplant or progestin only pills(minipills) may be used safely by diabetic women

B. MAIN LESSON
Substance Abuse is the inability to meet major role obligations, increase in legal problems or risk-taking behavior, or
exposure to hazardous situations due to an addicting substance.

Substance dependent if she has withdrawal symptoms after discontinuation of the substance

These substances are usually of low molecular weight & can readily cross the placenta; the fetus has 50% drug
concentration as that of the mother

Common substances abused:

1. cocaine
2. amphetamines
3. marijuana
4. alcohol
5. inhalants
6. opiates
7. phencyclidine

1. Cocaine is most frequently abused drug during pregnancy

 Causes extreme vasoconstriction severely compromising fetal circulation leading to premature separation of
the placenta resulting to preterm labor or fetal death.

Fetal withdrawal symptoms of COCAINE:

 tremulousness
 irritability
 muscle rigidity
 learning defects (later in life)
 intracranial hemorrhage
 Detected by urinalysis

Cocaine Use
 Amphetamines-methamphetamines (speed)
 has effects like cocaine

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 Care of Mother and Child at Risk or with
Problems (Acute and Chronic)

Module #3 Teacher’s Guide

Newborn symptoms:
 jitteriness,
 poor feeding,
 growth restriction

2. Marijuana or hashish-
 When smoked causes tachycardia & a sense of well-being.
 Used to counteract nausea in early pregnancy
Effects:
1. loss of short-term memory
2. reduced milk production
3. incidence or respiratory infection
4. excretion of drug in breast milk

3. Phencyclidine (PCP)
 animal tranquilizer frequently used as a street drug
 increases cardiac output & gives a sense of euphoria
 causes hallucinations (flashback episodes)
 tends to leave the maternal circulation & concentrate in fetal cells
4. Narcotic Agonists
 Used for pain (morphine or meperidine), cough suppression (codeine); is a potent analgesic and provides
euphoric effect.

HEROIN
 Main opiate used recreationally & is used ID (skin-popping), by snorting or IV (shooting).
 Produces immediate but short-lived euphoria followed by sedation.

Withdrawal symptoms
1. Nausea and Vomiting
2. Diarrhea
3. abdominal pain
4. Hypertension
5. Restlessness
6. Shivering
7. Insomnia
8. body aches
9. muscle jerks

Fetal effects:
 Small for Gestational Age
 increased incidence of fetal distress
 meconium aspiration

Management:
 Methadone maintenance program during pregnancy

5. Inhalants
 Airplane glue, cooking sprays, computer keyboard cleaner
 Refer to sniffing or huffing of aerosol drugs
 May lead to severe cardiac and respiratory irregularities
 May limit fetal O2 supply
6. Alcohol
 Causes cognitive challenges and memory deficits

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 Care of Mother and Child at Risk or with
Problems (Acute and Chronic)

Module #3 Teacher’s Guide

Fetal alcohol Syndrome is a condition in a child that results from alcohol exposure during the mother's pregnancy.
Fetal alcohol syndrome causes brain damage and growth problems.

CHECK FOR UNDERSTANDING

The instructor will prepare 10 questions that can enhance critical thinking skills. Students will work by themselves to
answer these questions and write the rationale for each question.

1. A newborn has a condition that results from alcohol exposure during the mother's pregnancy that causes brain damage
and growth problems. Which of the following condition does the newborn has?
A. Substance Abuse
B. Fetal Alcohol Syndrome
C. Drug Abuse
D. HIV/AIDS

2. An 18-week pregnant client was caught sniffing cooking spray at the Female comfort room You know using this type of
drug may lead to severe cardiac and respiratory irregularities and may limit fetal oxygen supply. Which of the following
does the pregnant client is using?
A. Heroin
B. Marijuana
C. Phencyclidine
D. Inhalants

3. A 24-week pregnant client is using a drug recreationally she use it by “snorting”. What drug does the client is using?
A. Heroin
B. Marijuana
C. Phencyclidine
D. Inhalants

4. A 12-week pregnant client is smoking a “weed”. You know that this type of substance that when smoked causes
tachycardia & a sense of well-being and is used to counteract nausea in early pregnancy.
A. Heroin
B. Marijuana
C. Phencyclidine
D. Inhalants

5. A 27-week pregnant client is using an “animal tranquilizer”. You know as a nurse that frequent use or a street drug that
increases cardiac output, gives a sense of euphoria and causes hallucinations. Which of the following drug is the pregnant
woman is using?
A. Heroin
B. Marijuana
C. Phencyclidine
D. Inhalants

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 Care of Mother and Child at Risk or with
Problems (Acute and Chronic)

Module #3 Teacher’s Guide

6. A 37-week pregnant woman gave birth to a newborn and is experiencing Heroin withdrawal symptoms. The following
are Heroin Withdrawal Symptoms, EXCEPT:
A. Intracranial hemorrhage
B. Restlessness
C. Shivering
D. Insomnia

7. A pregnant woman is using cocaine. You know as a nurse that once she will give birth, her child will experience
Cocaine Withdrawal Symptoms. The following are Withdrawal symptoms for Cocaine, EXCEPT:
A. tremulousness
B. irritability
C. muscle rigidity
D. restlessness
E. intracranial hemorrhage

8. You interviewed a pregnant client using a Marijuana to manage her nausea. You know the effect of Marijuana use in
pregnant women and with the fetus. EXCEPT:
A. loss of short-term memory
B. reduced milk production
C. intracranial hemorrhage
D. incidence or respiratory infection

9. A pregnant woman asked you what the effects of Narcotic use with the fetus are. You answered the following,
EXCEPT:
A. Small for Gestational Age
B. Increased incidence of fetal distress
C. Meconium aspiration
D. Restlessness

10. A pregnant client asked you what the effects of Phencyclidine (PCP) are. You answered the following, EXCEPT:
A. increases cardiac output
B. gives a sense of euphoria
C. loss of short-term memory
D. causes hallucinations

C. LESSON WRAP-UP

AL Activity: Muddiest Point: Students respond to this one question: “In today’s session, what was least clear to you?”
This technique will help you determine which key points were missed by the students.

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 Care of Mother and Child at Risk or with
Problems (Acute and Chronic)

Module #3 Teacher’s Guide

Instructions:
1. Reserve a few minutes at the end of class session. Leave enough time to ask the question, to allow students to respond,
and to collect their responses.
2. Pass out slips of paper on index cards for students to write on. You may also ask students to bring out and write on a
half sheet of paper instead.
3. Collect the responses as or before students leave. One way is to station yourself at the door and collecting “muddiest
point papers” as students file out.
4. Respond to students’ feedback during the next class meeting or as soon as possible.
5. DO NOT use this method after every class or it will become monotonous, and the information will not be as useful.
In today’s session, what was least clear to you?

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