A nurse is performing a physical assessment of a newborn whose mother used cocaine throughout the pregnancy.
Which of the following findings should the nurse expect?
A.
Irritability.
B.
Hypotonicity.
C.
Decreased auditory startle response.
D.
Increased head circumference.
The Correct answer and Explanation is:
The correct answer is A. Irritability.
Explanation:
Cocaine use during pregnancy can have profound effects on the developing fetus, leading to a range of complications and symptoms in the newborn. Cocaine is a powerful stimulant that crosses the placental barrier, affecting fetal development and potentially causing long-term effects. When a pregnant woman uses cocaine, it can lead to vasoconstriction (narrowing of blood vessels) and reduced blood flow to the fetus, which can result in placental abruption, preterm birth, and growth restrictions. These effects contribute to a higher risk of physical, developmental, and behavioral issues in the newborn.
Expected Findings:
- Irritability: Newborns exposed to cocaine in utero are often irritable. This is due to withdrawal symptoms as the newborn’s nervous system has been exposed to a stimulant and is now deprived of it. These infants may be difficult to console, have a high-pitched cry, and exhibit tremors or jitteriness. They may also have difficulty sleeping and may be hyperresponsive to stimuli. This heightened irritability is a hallmark of neonatal abstinence syndrome (NAS), a condition that occurs when a newborn withdraws from certain substances, including cocaine, that were used by the mother during pregnancy.
- Incorrect Answers:
- B. Hypotonicity: Cocaine-exposed infants are more likely to exhibit hypertonicity (increased muscle tone) rather than hypotonicity (decreased muscle tone). Hypertonicity, along with jitteriness, is often observed as part of the withdrawal process.
- C. Decreased auditory startle response: In contrast, these infants are more likely to have an exaggerated startle response due to their heightened sensitivity and irritability.
- D. Increased head circumference: This is not a typical finding associated with prenatal cocaine exposure. Growth parameters, including head circumference, are generally within normal limits, although some infants may have low birth weight due to intrauterine growth restriction (IUGR).
In summary, the primary concern with a newborn exposed to cocaine is the presence of withdrawal symptoms, with irritability being one of the most consistent findings. This symptom is a direct result of the infant’s central nervous system being overstimulated and then suddenly deprived of the drug after birth. Therefore, the correct answer is A. Irritability.