Nursing Care Plan for (NCP) Fetal Alcohol Syndrome (FAS)

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Pathophysiology

Infants who were exposed to alcohol, consumed by the mother during pregnancy, results in a disorder known as Fetal Alcohol Syndrome (FAS) that can cause problems with growth and development and can lead to brain damage. The severity of the disorder in the infant can vary and normally includes a mix of physical, behavioral, and mental disorders. These children often have varying degrees of learning disabilities. The effects of FAS may not be fully recognized at birth, but may continue to develop over time, even after entering school and into adulthood.

Etiology

Fetal Alcohol Syndrome (FAS) is caused by a woman consuming alcohol while pregnant. Alcohol enters the bloodstream and crosses the placenta to the growing fetus, resulting in a much higher concentration in the baby’s blood. The alcohol in the baby’s system disrupts the delivery of oxygen to the growing tissues and organs. Since the organs are not fully developed, they cannot metabolize the alcohol and results in dysfunction of the brain, heart and physical feature deformities. Complications of exposure may arise later in the child’s life and include mental disorders, depression, ADHD, physical and sexual aggression and inappropriate behaviors that can lead to alcohol or drug use and dependency, risky lifestyles and death.

Desired Outcome

Patient will exhibit optimal cognitive functioning, appropriate behaviors and impulse control; Patient will have minimal

Fetal Alcohol Syndrome (FAS) Nursing Care Plan

Subjective Data:

Patient’s mother/caregiver may report:

  • Poor coordination
  • Jitteriness or hyperactivity
  • Frequent mood changes
  • Difficulty in social settings (daycare, school)
  • Difficulty switching tasks
  • Learning disorders

Patient may report:

  • Trouble paying attention or focusing
  • Poor memory
  • Vision problems

Objective Data:

  • Distinct facial features that include small eyes, thin upper lip, short nose
  • Slow physical growth (before and after birth)
  • Small head circumference
  • Heart defects
  • Joint / bone deformities

Nursing Interventions and Rationales

  • Perform complete assessment of systems including heart and lung auscultation

 

FAS often results in deformities of the heart and lungs and may result in murmurs, heart valve disorders or respiratory diseases such as asthma

 

  • Assess infant for signs of withdrawal that include:
    • High-pitched cry
    • Postural arching (of the back)
    • Slow or delayed breathing (apnea / bradypnea)
    • Slow or irregular heartbeat

 

It is still controversial as to whether or not infants experience withdrawal symptoms.

There are certain symptoms that appear to be consistent in infants with FAS as listed and should be monitored if FAS is suspected.

 

  • Obtain history of pregnancy from patient’s mother

 

  • Determine how much alcohol was consumed throughout pregnancy and frequency.
  • Severity of symptoms may be determined by amount of exposure.
  • NO amount of alcohol consumed is considered safe during pregnancy.

 

  • Measure head and abdominal circumference of infant

 

Infants with FAS generally have smaller head size that indicates microcephaly.

Abdomen may be distended following birth. This may require nasogastric intubation.

 

  • Minimize external stimuli

 

Infants and children with FAS are often easily excitable and become agitated and fussy with excessive noise and physical stimuli.

Maintain calm atmosphere and cluster care as much as possible.

 

  • Provide education and counseling for parents/caregivers

 

  • Provide resources for parents that include alcohol cessation programs and support groups
  • Provide resources for child to include counseling, specialists (cardiology, neurology, orthopedics, etc) and special education programs
  • There is NO KNOWN safe amount of alcohol to be consumed during pregnancy

Writing a Nursing Care Plan for (NCP) Fetal Alcohol Syndrome (FAS)

A Nursing Care Plan for (NCP) Fetal Alcohol Syndrome (FAS) starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.


References

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Transcript

This is the nursing care plan for fetal alcohol syndrome. So the pathophysiology behind fetal alcohol syndrome is that there are some infants who were exposed to alcohol, consumed by the mother during pregnancy, and it results in this disorder, fetal alcohol syndrome. This causes problems with growth and development and can lead to brain damage. There’s a variety of the disorder in that the infant can vary and normally includes a mix of behavioral, physical and mental disorders. These children often have varying degrees of learning disabilities. The effects of FAS may not even be recognized until the child develops over time, even after entering school and into adulthood, the nursing consideration. So we want to do a head and abdominal assessment. There could be some abnormalities there, with the FAS children. We want to monitor coughs. We want to monitor vital signs. We want to do a respiratory and cardiac assessment. We want to educate pregnant mothers and monitor the growth and development of these children. The desired outcome in managing these patients is that the patient is going to exhibit optimal, cognitive functioning, appropriate behaviors, and impulse control. The patient is going to have minimal effects. So the patient, mother, or caregiver may report that this patient with fetal alcohol syndrome is showing signs of a poor coordination, 

Jitteriness, maybe some hyper activity. There may also be frequent mood changes, difficulty in social settings, such as daycare in school. There may also be difficulty switching tasks. There may be some learning disorders. Once the patient is old enough to report their own subjective data, they may complain of having difficulty or trouble paying attention, and poor memory. Some of these children or adults may also report vision problems. Some objective things. So we’re going to see some distinct facial features. These distinct facial features may include small eyes, thin upper lip, and a short nose. They may also have short stature; so slow physical growth. And this is before and after birth. These babies are typically born with a small head or microcephaly. They may present with some heart defects or some joints and bone deformities. So what are some things that we can do from this patient? Well, the first thing we need to do is to do a full head-to-toe assessment, paying close attention to the respiratory and the cardiac. So we want to do an assessment and we want to keep those eyes looking at the heart and the lungs. Okay. It’s very important to do this. The patients with fetal alcohol syndrome may result in deformities of the heart and the lung. And you may hear things such as murmur valve disorders, or you may hear some respiratory diseases such as asthma or respiratory distress. Okay? The next thing we want to do is we want to assess the effect for signs of withdrawal. So these infants can still withdraw from alcohol dependence from when the mother had her last drink. So these signs and symptoms of withdrawal include a high pitched cry. This is characteristic for patients with fetal alcohol syndrome. They may do some postural arching. They may have slow or delayed breathing, or they may have a slow or irregular heartbeat. We want to measure the head. We want to measure the hair in the abdomen for circumference for the infant. Remember, but if it’s with a fetal alcohol syndrome, generally have a smaller head size that indicates microcephaly. So measurements would show microcephaly, and the abdomen may be distended following birth. So let’s do that. We want to do an abdomen distension. This may require an NG tube. We want to obtain a history of pregnancy from the patient’s mother. We want to determine how much alcohol was actually consumed throughout the pregnancy. And how often was it consumed? I remember no alcohol is ever okay during pregnancy. So we want to do that. We want to get history from the mother on consumption. And finally, we want to minimize external stimuli. Remember the patients with FAS are easily excitable and become agitated and fussy with excessive noise and physical stimulus. So we want to keep them calm, let them rest, let them work on healing. Some of the pathophysiology behind this is that infants who were exposed to alcohol consumed by the mother during pregnancy results in this disorder known as fetal alcohol syndrome. Some of the things that may be reported, some of the subjective data, is they report poor coordination, poor memory. They may be jittery. They may have learning disabilities. Some things that we’re going to notice is we may observe some objective data such as heart defects, maybe microcephaly, small head, small eyes, and a thin upper lip. So what can we do? Well, we want to do a good cardiac assessment. Remember that cardiac assessment is going to let us know if this patient has any congenital defects. Remember patients who have fetal alcohol syndrome tend to have a deformity. So things wrong with the heart, things wrong with the lungs; an ECG monitoring, and a thorough cardiac assessment will help us diagnose that next. We want to make sure we educate the caregiver. We want to educate the parents or the caregiver. We want to provide education on this disease process. We want to, we may need to refer the patient to a cardiologist and neurologist or a special education program. We love you guys; go out and be your best self today. And, as always, happy nursing.

 

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