Neonatal Abstinence Syndrome Nursing Diagnosis & Care Plans

Neonatal Abstinence Syndrome (NAS) is a complex condition that occurs when a newborn experiences withdrawal symptoms due to sudden discontinuation of exposure to substances they were exposed to in utero.

This nursing diagnosis is important to understand and address, as it can significantly impact the newborn’s health and development.

Causes (Related to)

Neonatal Abstinence Syndrome can result from various substances the mother used during pregnancy. The following are common causes of NAS:

  • Opioids (e.g., heroin, methadone, prescription painkillers)
  • Benzodiazepines
  • Barbiturates
  • Alcohol
  • Nicotine
  • Selective serotonin reuptake inhibitors (SSRIs)

Signs and Symptoms (As evidenced by)

NAS can manifest with a variety of signs and symptoms. In a physical assessment, a newborn with NAS may present with one or more of the following:

Subjective: (Caregiver reports)

  • Excessive crying or high-pitched crying
  • Difficulty feeding
  • Poor sleep

Objective: (Nurse assesses)

  • Tremors
  • Increased muscle tone
  • Hyperactive reflexes
  • Seizures
  • Sweating
  • Fever
  • Rapid breathing
  • Excessive sucking
  • Poor weight gain
  • Vomiting
  • Diarrhea
  • Dehydration
  • Excoriation of skin

Expected Outcomes

The following are the common nursing care planning goals and expected outcomes for Neonatal Abstinence Syndrome:

  • Newborn will demonstrate decreased signs of withdrawal
  • Newborn will maintain adequate nutrition and hydration
  • Newborn will exhibit improved sleep patterns
  • Newborn will show appropriate weight gain
  • Newborn will have stable vital signs within normal limits for age
  • Newborn will not experience seizures
  • Parents/caregivers will demonstrate an understanding of NAS and proper care techniques

Nursing Assessment

The first step of nursing care is the nursing assessment, during which the nurse will gather physical, psychosocial, emotional, and diagnostic data. The following section will cover subjective and objective data related to Neonatal Abstinence Syndrome.

  1. Obtain a detailed maternal history.
    A comprehensive maternal history, including substance use during pregnancy, is crucial for diagnosing and managing NAS. This information helps determine the potential severity and duration of withdrawal symptoms.
  2. Perform a thorough physical examination.
    Assess the newborn’s overall appearance, behavior, and vital signs. Look for signs of withdrawal, such as tremors, increased muscle tone, and excessive crying.
  3. Use the Finnegan Neonatal Abstinence Scoring System
    This standardized tool helps quantify the severity of NAS symptoms and guides treatment decisions. Scoring should be done every 3-4 hours.
  4. Monitor vital signs
    Check temperature, heart rate, respiratory rate, and blood pressure regularly. NAS can cause significant fluctuations in these parameters.
  5. Assess feeding patterns and weight.
    Monitor the newborn’s feeding ability, intake and output, and daily weight. NAS can significantly impact nutrition and hydration status.
  6. Evaluate sleep patterns
    Observe and document the newborn’s sleep-wake cycles. NAS often disrupts normal sleep patterns.
  7. Assess skin integrity
    Check for signs of excoriation, particularly in the diaper area, knees, and elbows due to excessive movement and irritability.
  8. Monitor for seizures
    Be vigilant for signs of seizure activity, which can occur in severe cases of NAS.
  9. Assess parent-infant bonding
    Evaluate the parents’ ability to care for and bond with their newborn. NAS can be stressful for both the infant and parents, potentially affecting attachment.
  10. Prepare for additional testing.
    Be ready to collect urine or meconium samples for toxicology screening if ordered by the healthcare provider.

Nursing Interventions

Nursing interventions and care are essential for the newborn’s recovery from Neonatal Abstinence Syndrome. In the following section, you’ll learn about possible nursing interventions for a newborn with NAS.

  1. Implement non-pharmacological interventions
  • Swaddling: Helps reduce stimulation and promotes comfort
  • Skin-to-skin contact: Encourages bonding and can help regulate the newborn’s temperature and heart rate
  • Minimizing environmental stimuli: Reduce noise and light in the newborn’s environment
  • Frequent small feedings. It can help manage gastrointestinal symptoms and ensure adequate nutrition
  1. Administer pharmacological treatment as prescribed
    Medications such as morphine, methadone, or phenobarbital may be ordered to manage severe withdrawal symptoms. Carefully monitor the newborn’s response to medication.
  2. Provide supportive care
  • Ensure proper positioning to prevent aspiration
  • Offer a pacifier to satisfy the newborn’s need for non-nutritive sucking
  • Provide gentle, slow rocking motions to comfort the newborn
  1. Manage nutrition and hydration
  • Assist with breastfeeding if appropriate and desired by the mother
  • Provide formula feeding if necessary, using special techniques for newborns with poor sucking reflexes
  • Monitor for signs of dehydration and report any concerns promptly
  1. Prevent and manage skin breakdown
  • Change diapers frequently
  • Apply barrier creams to prevent diaper rash
  • Use soft, breathable clothing and bedding
  1. Educate and support parents/caregivers
  • Teach parents about NAS and how to care for their newborn
  • Provide emotional support and resources for parents
  • Encourage parental involvement in care when appropriate
  1. Collaborate with the healthcare team
    Work closely with neonatologists, social workers, and other specialists to provide comprehensive care for the newborn and family.
  2. Monitor for complications
    Be vigilant for complications such as poor weight gain, dehydration, or seizures, and report any concerns immediately.
  3. Prepare for discharge planning.
    Begin discharge planning early, ensuring parents are prepared to care for their newborn at home and have appropriate follow-up care arranged.
  4. Document thoroughly
    Maintain accurate and detailed records of the newborn’s symptoms, interventions, and responses to treatment.

Nursing Care Plans

Nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. In the following section, you will find examples of nursing care plans for Neonatal Abstinence Syndrome.

Care Plan #1

Nursing Diagnosis Statement:
Ineffective Thermoregulation related to autonomic dysfunction secondary to Neonatal Abstinence Syndrome as evidenced by temperature instability and diaphoresis.

Related factors/causes:

  • Autonomic nervous system dysfunction
  • Metabolic instability
  • Increased energy expenditure due to withdrawal symptoms

Nursing Interventions and Rationales:

  1. Monitor and record the newborn’s temperature every 2-4 hours.
    Rationale: Frequent monitoring allows for early detection of temperature instability.
  2. Maintain a neutral thermal environment using an incubator or radiant warmer as needed.
    Rationale: Provides a stable environment to support thermoregulation.
  3. Dress the newborn in appropriate clothing and use blankets as needed.
    Rationale: Helps maintain body temperature and prevents heat loss.
  4. Implement kangaroo care (skin-to-skin contact) with parents when appropriate.
    Rationale: Promotes temperature regulation and bonding.
  5. Educate parents on proper techniques for swaddling and dressing the newborn.
    Rationale: Empower parents to assist in maintaining their newborn’s temperature.

Desired Outcomes:

  • Within 24 hours, a newborn will maintain a stable body temperature between 36.5°C and 37.5°C (97.7°F and 99.5°F).
  • Newborn will demonstrate decreased diaphoresis within 48 hours.
  • Parents will verbalize understanding of proper techniques for maintaining the newborn’s temperature by discharge.

Care Plan #2

Nursing Diagnosis Statement:
Imbalanced Nutrition: Less than Body Requirements related to feeding difficulties secondary to Neonatal Abstinence Syndrome as evidenced by poor sucking reflex and weight loss.

Related factors/causes:

  • Hypermetabolic state due to withdrawal
  • Uncoordinated sucking and swallowing
  • Gastrointestinal disturbances (vomiting, diarrhea)

Nursing Interventions and Rationales:

  1. Assess the newborn’s feeding patterns, including frequency, duration, and amount.
    Rationale: Provides baseline data to evaluate nutritional status and feeding improvements.
  2. Offer small, frequent feedings every 2-3 hours or on demand.
    Rationale: Smaller, more frequent feedings are often better tolerated in NAS.
  3. Implement non-nutritive sucking with a pacifier between feedings.
    Rationale: Helps satisfy the newborn’s increased sucking needs and provides comfort.
  4. Monitor daily weight and track growth patterns.
    Rationale: Helps assess the effectiveness of nutritional interventions.
  5. Collaborate with a lactation consultant if the mother is breastfeeding.
    Rationale: Provides specialized support to optimize breastfeeding success.

Desired Outcomes:

  • Newborn will demonstrate improved feeding skills within 72 hours.
  • Newborn will show a steady weight gain of 20-30 grams per day by the end of the first week.
  • Newborns will maintain adequate hydration, as evidenced by moist mucous membranes and an appropriate number of wet diapers.

Care Plan #3

Nursing Diagnosis Statement:
Disturbed Sleep Pattern related to central nervous system irritability secondary to Neonatal Abstinence Syndrome as evidenced by frequent waking and difficulty falling asleep.

Related factors/causes:

  • CNS hyperarousal due to withdrawal
  • Environmental stimuli
  • Gastrointestinal discomfort

Nursing Interventions and Rationales:

  1. Implement a quiet environment with minimal lighting and noise.
    Rationale: Reduces environmental stimuli that can disrupt sleep.
  2. Use gentle swaddling techniques to promote comfort and reduce startling.
    Rationale: Swaddling can help calm the newborn and promote longer sleep periods.
  3. Cluster care activities to allow for longer periods of uninterrupted sleep.
    Rationale: Minimizes disruptions to the newborn’s sleep cycle.
  4. Encourage skin-to-skin contact with parents during rest periods.
    Rationale: Promotes relaxation and can help regulate the newborn’s sleep-wake cycle.
  5. Educate parents on recognizing sleep cues and creating a sleep-conducive environment.
    Rationale: Empowers parents to support their newborn’s sleep patterns at home.

Desired Outcomes:

  • Newborn will demonstrate increased periods of uninterrupted sleep (2-3 hours) within 5 days.
  • Newborn will exhibit decreased irritability during awake periods within 1 week.
  • Parents will verbalize understanding of sleep promotion techniques by discharge.

Care Plan #4

Nursing Diagnosis Statement:
Risk for Impaired Skin Integrity related to excessive movement and diaphoresis secondary to Neonatal Abstinence Syndrome.

Related factors/causes:

  • Increased muscle tone and movement
  • Excessive sweating
  • Frequent loose stools

Nursing Interventions and Rationales:

  1. Assess the newborn’s skin condition every 4 hours, paying special attention to the diaper area, knees, and elbows.
    Rationale: Regular assessment allows for early detection of skin breakdown.
  2. Change diapers frequently and clean the perineal area gently with each change.
    Rationale: Prevents prolonged exposure to moisture and irritants.
  3. Apply barrier cream to the diaper area with each diaper change.
    Rationale: Protects the skin from moisture and irritation.
  4. Use soft, breathable clothing and bedding materials.
    Rationale: Reduces friction and allows for better air circulation.
  5. Teach parents proper skin care techniques, including gentle cleansing and moisturizing.
    Rationale: Prepares parents to continue appropriate skin care at home.

Desired Outcomes:

  • Newborn will maintain intact skin without signs of breakdown throughout hospitalization.
  • The newborn will show no signs of diaper rash or excoriation upon discharge.
  • Parents will demonstrate proper skin care techniques by discharge.

Care Plan #5

Nursing Diagnosis Statement:
Ineffective Coping (Family) related to newborn’s condition and hospitalization secondary to Neonatal Abstinence Syndrome as evidenced by expressed feelings of guilt and anxiety.

Related factors/causes:

  • Lack of knowledge about NAS
  • Feelings of guilt related to substance use during pregnancy
  • The stress of caring for a newborn with special needs

Nursing Interventions and Rationales:

  1. Provide education about NAS, its causes, symptoms, and treatment.
    Rationale: Increases parents’ understanding and reduces anxiety related to unknown factors.
  2. Encourage parental participation in the newborn’s care when appropriate.
    Rationale: Promotes bonding and increases parents’ confidence in caring for their newborn.
  3. Refer parents to support groups or counseling services as needed.
    Rationale: Provides additional emotional support and resources for coping.
  4. Teach parents stress-reduction techniques, such as deep breathing or mindfulness.
    Rationale: Equips parents with tools to manage their own stress and anxiety.
  5. Collaborate with social services to address any socioeconomic concerns or need for additional resources.
    Rationale: Ensures comprehensive support for the family beyond medical care.

Desired Outcomes:

  • Parents will verbalize decreased feelings of anxiety and guilt within 1 week.
  • Parents will demonstrate active participation in their newborn’s care by discharge.
  • Parents will identify at least two coping strategies they can use at home by discharge.

References

  1. Hudak, M. L., & Tan, R. C. (2012). Neonatal drug withdrawal. Pediatrics, 129(2), e540-e560. https://doi.org/10.1542/peds.2011-3212
  2. McQueen, K., & Murphy-Oikonen, J. (2016). Neonatal Abstinence Syndrome. New England Journal of Medicine, 375(25), 2468-2479. https://doi.org/10.1056/NEJMra1600879
  3. Wachman, E. M., Schiff, D. M., & Silverstein, M. (2018). Neonatal Abstinence Syndrome: Advances in Diagnosis and Treatment. JAMA, 319(13), 1362-1374. https://doi.org/10.1001/jama.2018.2640
  4. MacMullen, N. J., Dulski, L. A., & Blobaum, P. (2014). Evidence-based interventions for neonatal abstinence syndrome. Pediatric Nursing, 40(4), 165-172.
  5. Grossman, M. R., Berkwitt, A. K., Osborn, R. R., Xu, Y., Esserman, D. A., Shapiro, E. D., & Bizzarro, M. J. (2017). An Initiative to Improve the Quality of Care of Infants With Neonatal Abstinence Syndrome. Pediatrics, 139(6), e20163360. https://doi.org/10.1542/peds.2016-3360
  6. Herdman, T. H., & Kamitsuru, S. (Eds.). (2018). NANDA International Nursing Diagnoses: Definitions and Classification 2018-2020. Thieme.
  7. Bulechek, G. M., Butcher, H. K., Dochterman, J
Photo of author

Anna Curran. RN, BSN, PHN

Anna Curran. RN, BSN, PHN I am a Critical Care ER nurse. I have been in this field for over 30 years. I also began teaching BSN and LVN students and found that by writing additional study guides helped their knowledge base, especially when it was time to take the NCLEX examinations.