Nursing diagnosis for a mother that smoked during pregnancy and is continuing to smoke

RunBabyRN · Nov 3, 2014

What do you think?

We're not here to do your homework for you, but we can help guide you.

What are your assessment findings? How is the fetus doing?

kjnurse11 · Nov 3, 2014

Sorry new to this site! I should have mentioned the fetus was a well newborn at term and aga. Lungs were clear and no distress noted. Therefore the impact of smoking would be risks for after birth such as second hand smoke, the mother is choosing to breastfeed, increase risk for SIDS, mom is a single mom with spotty prenatal care and a hx of drug abuse (all to screen during pregnancy came back negative).

I was thinking that the diagnosis could be ineffective health maintainance r/t non compliance, lack of resources (social and financial) evidenced by hx of drug abuse, smoking while pregnant and pp, insufficient prenatal care

This is just rough draft I have. Any comments would be much appreciated!

cayenne06, MSN, CNM · Nov 3, 2014

So think about your hierarchies of need- ABCs, Maslov's, etc. What is the TOP priority(ies) in this situation? This answer might be different, depending on if your patient is the M/B dyad or just the mom.

Also- is it recommended for a smoking mother to continue breastfeeding? Why or why not? This is very important and should feature highly in your care plan, assuming you are doing the m/b dyad.

MegJackson · Nov 3, 2014

Ineffective peripheral tissue perfusion r/t vasoconstrictive effects of nicotine.

- you can even take it further than that and mention the sympathetic stimulation caused by nicotine, reducing peripheral tissue perfusion. Increased HR causes less time for the ventricles to fill enough to produce an adequate cardiac output to perfuse the periphery. Less perfusion to the periphery means less oxygen delivery to those tissues, as well as that baby.

Psychosocial diagnoses are always important as well, but they should never be your "top" priority diagnoses. The top diagnoses should be physiological. The easiest way to choose the priority issues is to think, "what is going to kill my patient(s), right now." Or what could potentially kill them. The "ABCs" should always be your top priority. Just remember what the immediate necessities are for hemodynamic stability- Airway, breathing, circulation. Circulation is so important with pregnancy and its outcome. I would place that at the top.

I hope this helps!!

BusyBee91 · Nov 4, 2014

I believe impaired parenting is a diagnosis that might fit this scenario.. possibly?

RunBabyRN · Nov 4, 2014

Ineffective peripheral tissue perfusion r/t vasoconstrictive effects of nicotine.
- you can even take it further than that and mention the sympathetic stimulation caused by nicotine, reducing peripheral tissue perfusion. Increased HR causes less time for the ventricles to fill enough to produce an adequate cardiac output to perfuse the periphery. Less perfusion to the periphery means less oxygen delivery to those tissues, as well as that baby.
Psychosocial diagnoses are always important as well, but they should never be your "top" priority diagnoses. The top diagnoses should be physiological. The easiest way to choose the priority issues is to think, "what is going to kill my patient(s), right now." Or what could potentially kill them. The "ABCs" should always be your top priority. Just remember what the immediate necessities are for hemodynamic stability- Airway, breathing, circulation. Circulation is so important with pregnancy and its outcome. I would place that at the top.
I hope this helps!!

I disagree. For example, I had a patient who had very poor nutrition, arrhythmias, all kinds of stuff r/t ineffective health maintenance, and was admitted because he needed a "foreign body" removed from his rectum, but this was secondary to depression. You can address the physical all you want, but you will see it all come back if you don't address the depression.

For the patient above, consider any potential bonding issues. If Mom has a h/o DOA, poor prenatal care, or other risk factors, she may (or may not- you saw this patient) neglect the newborn's needs because she is having trouble bonding or knowledge deficit r/t infant care. Psychosocial is SO overlooked, and we are finally starting to look at this as being just as important as the physical. Remember that the two are not independent of one another. How does one affect the other?

UmmIbrahim · Nov 5, 2014

Ineffective peripheral tissue perfusion r/t vasoconstrictive effects of nicotine.
- you can even take it further than that and mention the sympathetic stimulation caused by nicotine, reducing peripheral tissue perfusion. Increased HR causes less time for the ventricles to fill enough to produce an adequate cardiac output to perfuse the periphery. Less perfusion to the periphery means less oxygen delivery to those tissues, as well as that baby.
Psychosocial diagnoses are always important as well, but they should never be your "top" priority diagnoses. The top diagnoses should be physiological. The easiest way to choose the priority issues is to think, "what is going to kill my patient(s), right now." Or what could potentially kill them. The "ABCs" should always be your top priority. Just remember what the immediate necessities are for hemodynamic stability- Airway, breathing, circulation. Circulation is so important with pregnancy and its outcome. I would place that at the top.
I hope this helps!!

Yes, I was thinking vasoconstriction first as well. Thats a major problem with smokers...id say think basics first...simple...as others said...ABC's...vasoconstriction/ineffective perfusion=circulation (ABC's), maslows...etc. you'll get there, it takes time to get to the point where you can narrow it down on a more basic level.

nurseprnRN, BSN, RN · Nov 5, 2014

The new NANDA-I 2015-2017 is out, and it's a treat. Check "Risk for thermal injury," which includes several pertinent risk factors for this baby. Page 389. "Contamination," p. 418, includes defining characteristics and related factors which fit your assessment. Betcha NOBODY in your clinical group will use them, and your discharge teaching plan will shine when you write your plan of care to address them. Amazon.com, free 2-day delivery, overnight if you have Prime.

PS: we don't use the word "compliance" anymore, haven't for years. Patients always, always have the right to choose to adhere or not to adhere to healthcare providers' plans of care, be they nursing, medical, therapy, or anything else. "Compliance" means a person is bending to someone's orders, with the connotation of another holding authority over the person. We, physicians, and everyone else have no such authority. When you say "related to lack of adherence to medical / nursing plan of care" it gives you a whole 'nother way to look at the situation and see if you can figure out why they are making those choices.

MegJackson · Nov 6, 2014

Yes, "compliance" or anything insinuating that a patient is non-compliant is now a huge no-no.

As far as psychosocial goes, of course it is important. However, for NCLEX prep and learning purposes, ABCs will always be the answer to an NCLEX question if it's discussing any kind of nursing in the acute care/hospital setting.

Psychosocial diagnoses should always be included, but not as the #1 top diagnoses.. No matter what your personal opinion is. It's unfortunate, but that's the way it is! I've learned to accept it instead of fight it. If you always work up your care plans using personal feelings and not nursing judgement based on immediate threatening pathophys, you'll not only fail your boards, but you'll also just be making things harder for yourself. I hope you got all the feedback you needed! :)

nurseprnRN, BSN, RN · Nov 6, 2014

I think there's a case to be made here that safety for the babe, in terms of possibility of having ashes dropped on him (burn/thermal injury/also risk of fire in the home), eating butts (later when he crawls around), and inhaling the smoke as a contaminant. These are more likely, more assessable, and more addressable by nursing than the automatic-attractive choice of vasoconstriction from secondhand smoke.

Furthermore, the defining characteristics for ineffective tissue perfusion are very specific and extremely unlikely to be found in a baby even c secondhand smoke (e.g., absence of peripheral pulses (!), A/B index

Finally, secondhand smoke does not appear on the list of related factors for ineffective peripheral perfusion, anyway.

You see the difficulty in "choosing" a nursing diagnosis from a list without looking at its (required elements of) defining characteristics, of which you need at least one, and (required element of at least one) related factor(s).

You don't "choose" a ND, you MAKE a ND based on your nursing assessment. This discussion is a great reason illustrating why.

cayenne06, MSN, CNM · Nov 6, 2014

I'd argue that the effects of nicotine/smoke exposure to the newborn is top priority here.