Running head: WITHDRAWAL

Withdrawal in an Infant
Emily Morgan
University of South Florida

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Withdrawal in an Infant

Clinical exemplars are a vital part to the practice of nursing. In order for our patients to
receive the best evidence based care they can, we need to be constantly researching and changing
our practice. Exemplars are a way to enlighten others on a practice change and illustrate how this
change impacted the outcomes of their patients (McConnell, Lekan-Rutledge, Nevidjon, &
Anderson, 2004). During my time interning on the neonatal intensive care unit, I have taken care
of several infants suffering from neonatal abstinence syndrome (NAS). This occurs when the
mother takes high levels of legal or otherwise illegal, addictive drugs during her pregnancy. The
infant is then born addicted to a substance and it is important for them to be treated during their
withdrawal process to prevent adverse outcomes.
In one situation that I took care of a NAS infant, it was clear to me that she was not being
treated well enough for her withdrawal. During my first assessment of this patient, her
respiratory rate was 120, she had a temperature of 38 degrees Celsius, loose stools, undisturbed
tremors, mottling of the skin, and she was sneezing quite a bit. This patient's NAS scores had
been in the fives and sixes the prior night, but when I assessed her in the morning, I could tell she
was going to score much higher. I gathered all of my assessment data that I needed to score her.
Taking everything into account, she scored a 10 that morning. I notified my nurse of her high
score, and during grand rounds I notified the healthcare team during my report of her score of 10.
They had recently weaned her morphine down from 0.44 to 0.4, so perhaps she wasn't
ready for the wean. The Neonatologist ordered her morphine back up to 0.44 because we do not
want NAS infants to suffer more than they need to and her symptoms were not under control. It
is important that we treat them properly.

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Later in the day after we increased her morphine her scores never hit 10 again. I felt so
bad for her when I took care of her in the morning and I was happy to see her be a little more
comfortable later in the day. I think I used my clinical judgment very well. After assessing the
patient, it was clear to me that she was not coping well with her withdrawal and needed to be
treated more aggressively.
In my situation I learned how important it is to assign NAS infants an accurate score
when you are assessing them. My nurse informed me that sometimes other nurses downplay their
symptoms so they do not "rock the boat" during rounds and the infant appears to show
improvement. However, this can ultimately negatively impact the infant. If a NAS infant is not
being treated properly they can have seizures which can lead to death. Through this experience I
learned that treating the patient should be nurses first concern over everything else.

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References

McConnell E.S., Lekan-Rutledge D, Nevidjon B, Anderson R. Education and Clinical Center,

Durham Veterans Affairs Medical Center, NC, USA. The Journal of Nursing
Education [2004, 43(2):84-87].