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Cystic Fibrosis and Narcotic Withdrawal in the Newborn

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Cystic Fibrosis and Narcotic Withdrawal in the Newborn. Jessica Brandt. and. Susie Clabots ... DOB: 12/20/07 (4 wks premature per cesarean delivery, with a ... – PowerPoint PPT presentation

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Title: Cystic Fibrosis and Narcotic Withdrawal in the Newborn


1
Cystic Fibrosis and Narcotic Withdrawal in the
Newborn
  • Jessica Brandt
  • and
  • Susie Clabots

2
Patient Information
  • Male (approx. 1 mo)
  • DOB 12/20/07 (4 wks premature per cesarean
    delivery, with a birth weight of 2.14kg)
  • Current weight 2.5 kg (below 5th percentile)
  • VS HR 151, RR 46, SpO2 98 on RA, Temperature
    98.1 F
  • Diagnosed with Cystic Fibrosis (homozygous F?508)
    and Narcotic Withdrawal (methadone)
  • Neonatal bilirubin 8.9 (1-7mg/dL)
  • Direct bilirubin 0.5 (0-0.5mg/dL)
  • Fecal Negative for ova and parasites, rotavirus
    negative.
  • Sputum culture negative for WBCs, rare squamous
    epithelial cells, P. aeruginosa, S. maltophilia,
    B. capacia, S. aureus, H. influenzae.

3
Family History
  • Mother, father also have a 4 year old at home and
    other siblings from previous marriages are living
    with other spouses (not much contact).
  • Dad works full time, has insurance through work.
  • Mom not employed. Mom has history of depression,
    illegal drug use, diabetes, and hypothyroidism.
    She was attempting methadone tx for addiction to
    opioids.
  • Most recently she was obtaining methadone
    illegally, about 60mg BID for 1.5 years.
  • Mom uses bus for transportation to the hospital
    and states difficulty in finding a sitter for the
    other sibling.

4
More Family Issues
  • Family reports a lack of knowledge regarding CF
    (possible nursing Dx Knowledge deficit r/t
    family unfamiliarity with chronic disease
    management)
  • Although they initially expressed a willingness
    to learn and are scheduled for classes, they are
    repeatedly not showing up for them.
  • Mothers lack of presence.
  • No heat in the familys home because their power
    was shut off? (The baby is underweight and does
    not have much fatty insulation to keep warm, also
    has a large diaper rash that covers most of his
    buttocks and must be open to air (which is cold
    and uses even more of his scarce energy).
  • Hospital will not discharge the baby to the
    family until standards are met.
  • Possibility of patient ending up in the foster
    care system realistic?

5
Narcotic Withdrawal in the Infant
  • Transferred from Swedish Medical Center on 1/3/08
    for CF clinic, monitoring, and family teaching.
  • Weaned using morphine starting 12/17/08
  • Stable on 0.3mg PO q3h weaned by 10 dose
    (0.03mg) qd.
  • By 1/2/08 at 0.15mg PO q3h.
  • Breastfeeding and a maintenance dose?

6
Current Health Issues
  • Feeding difficulty
  • Possible Nursing Dx Imbalanced nutrition less
    than body requirements r/t inability to digest
    nutrients.
  • Failure to Thrive
  • Intermittent use of nasogastric tube for feedings
  • Diaper rash increasing in severity and has spread
    to scrotum and frequent stooling irritates the
    affected areas.
  • Possible Nursing Dx Acute pain r/t excoriation
    from the diaper rash.
  • Diarrhea (dehydration, electrolyte imbalance,
    susceptible to illness, excoriated buttocks are
    not healing).
  • Obtaining adequate nutrients using supplements
    (fat soluble vitamins ADEK).
  • Administering digestive enzymes with meals to
    promote breakdown and use of nutrients.
  • Chest physiotherapy

7
References
  • http//www.uwcfcenter.org/acc/
  • http//www.newbornmedicine.com/methadone/methadone
    Paper.htm
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