QLexNursing

Swaddle the newborn with flexed extremities

🔷 Swaddling with flexed extremities helps reduce the newborn’s tremors, hypertonicity, and exaggerated startle (Moro) reflex, which are common in NAS.

🔷 Flexed positioning mimics the contained intrauterine posture, which promotes self-regulation and decreases neurologic overstimulation.

🔷 This intervention helps lower energy expenditure caused by constant movement and irritability, supporting better physiologic stability.

🔷 Swaddling also supports improved sleep, which is crucial because this newborn has minimal sleep and a continuous high-pitched cry.

🔷 Comfort strategies like swaddling are first-line nonpharmacologic management that can reduce symptom severity and improve feeding tolerance.

Maintain a low stimulation environment

🔷 A low stimulation environment reduces sensory input that worsens NAS symptoms such as high-pitched crying, tremors, and irritability.

🔷 Decreasing noise, bright lights, frequent handling, and clustered care helps stabilize the newborn’s neurologic system.

🔷 Overstimulation increases autonomic stress responses, which can raise heart rate, respiratory rate, and temperature, all of which are already elevated.

🔷 A calm setting promotes longer sleep periods and reduces excessive crying, improving overall recovery and comfort.

🔷 This intervention is a key part of NAS supportive care and can reduce the need for pharmacologic treatment by minimizing symptom triggers.

Weigh the newborn daily

🔷 Newborns with NAS often have poor feeding coordination, uncoordinated suck/swallow, and high energy expenditure from tremors and crying.

🔷 These factors increase risk for inadequate caloric intake and weight loss, making daily weight monitoring essential.

🔷 Tracking weight helps evaluate effectiveness of interventions and detects early signs of dehydration or failure to thrive.

🔷 Frequent assessment supports timely nutrition adjustments, such as higher-calorie feedings or feeding support strategies.

🔷 Daily weights provide an objective measure of clinical progress and safety in a newborn experiencing withdrawal symptoms.

Plan to administer naloxone.

🔷Naloxone can trigger acute, severe withdrawal in newborns exposed to opioids, which can be dangerous.

🔷NAS is managed with supportive care and sometimes opioids like morphine, not naloxone.

Instruct the parent to avoid breastfeeding.

🔷Breastfeeding is often encouraged if the mother is in a supervised treatment program and has no contraindications (e.g., HIV, illicit drug use).

🔷Breastfeeding can actually reduce NAS severity by providing comfort and small consistent opioid exposure through milk in methadone-managed mothers.

Instruct the parent to avoid eye contact with the newborn during feeding.

🔷Eye contact supports bonding and soothing, and avoiding it is not therapeutic.

🔷NAS care promotes calm, consistent caregiver interaction, not detachment.

Perform Ballard newborn screening each shift.

🔷The Ballard score is used to estimate gestational age, not to monitor NAS severity.

🔷NAS monitoring uses structured withdrawal scoring tools (e.g., Finnegan), not Ballard assessments every shift.