11.08 Fetal Alcohol Syndrome (FAS)

Overview

  1. A group of conditions that can occur when a mother consumes alcohol while pregnant
    1. No safe amount
  2. Can be mild or very severe

Nursing Points

General

  1. You may only note the physical assessment issues, kids with FAS can grow to have issues with judgement, behavior, problems hearing/seeing, or low intelligence
  2. Also known as Fetal Alcohol Spectrum Disorder

Assessment

  1. Various craniofacial abnormalities can be noted
    1. Small eye openings
    2. Wide set eyes
    3. Smooth between nose and mouth (no philtrum)
    4. Thin upper lip
    5. Up turned nose
  2. CNS issues
    1. Encephalopathy
    2. Increased sensitivity to stimuli
    3. Seizures
    4. Learning disabilities
    5. Memory trouble
    6. ADHD
    7. Impulsive
  3. Growth deficiencies
    1. Small height
    2. Small weight
    3. Small head size

Therapeutic Management

  1. Low stimulation
  2. Pace feedings
  3. Consult developmental specialist
  4. Consult for other concerns/comorbidities that require a specialist

Nursing Concepts

  1. Human Development
  2. Health Promotion

Patient Education

  1. The child will have cognitive deficits for life
  2. The child may experience judgment and impulse control issues
  3. There is NO KNOWN safe amount of alcohol during pregnancy

Reference Links

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Video Transcript

In this lesson I will help you understand fetal alcohol syndrome and your role in this patient’s care.

So during pregnancy the mother should not drink. There is no safe amount that protects her fetus. Drinking will put her baby at risk for Fetal Alcohol Syndrome. Drinking alcohol in pregnancy can cause problems with fetal development. So the big things are craniofacial and central nervous system. There are noticeable changes in facial characteristics. Growth is altered so they are typically small and either are short, low weight or both. There can be other concerns with cardiac and different systems but these are really comorbidities of having fetal alcohol syndrome and the big diagnosis pieces are craniofacial and central nervous system. Facial will be our biggest assessment piece because we can easily see this and they are specific facial characteristics. So let’s look at our assessment.

For the assessment we will really see craniofacial abnormalities. The biggest things are the eyes have small openings and can be wideset. The upper lip will be thin and the skin above the lip will be smooth between nose and mouth. The little divot between the nose and mouth is called a philtrum but a newborn with FAS might have a smooth philtrum. You can see in this image there are smaller eyes openings, smooth philtrum and thin upper lip. There will also be central nervous system findings but these are typically going to be seen later. These are things like ADHD, impulsiveness, memory, processing and behavioral problems. Growth deficiencies might occur. They might be born with a smaller head, short height, low weight or a combination.

This patient will have very little management. The newborn might require a low stimulation environment so we can help support that. We will need to pace feedings and make sure they are getting adequate calories for growth since they are already starting out smart. If there is a big concern like cardiac then we would be monitoring and referring to a specialist. If there are any comorbidities we can consult a specialist and we also want to involve case management to help with any referrals to developmental specialist because it is likely that the child will have learning delay.Education should really be given prior to pregnancy that there is no safe amount ever in pregnancy and they need to know the risks. There are cognitive deficits that can not be fixed and the child might have judgment, impulse control issues, and learning disabilities.

Human Development is a concept because the alcohol is affecting the development and health promotion because we want to ensure the health of this newborn going forward.

The key points are that fetal alcohol syndrome can occur when a mother drinks excessive alcohol during her pregnancy and here is no safe amount! There is a cluster of characteristics and these mostly all facial. So things like thin upper lip, small eye openings, smooth philtrum. Later some neurological concerns will show. So learning difficulty, maybe they are impulsive or have anger problems. Things that we won’t know at delivery. There is no treatment or lab test for this diagnosis. It is clearly just assessment findings at delivery with mom’s history being considered.

Make sure you check out the resources attached to this lesson and the key points. Now, go out and be your best selves today. And, as always, happy nursing.

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  • Question 1 of 10

A woman who tested positive for alcohol on several lab tests at her prenatal appointments delivers her 37 week baby. Which assessment finding would be expected for this newborn?

  • Question 2 of 10

A nurse is caring for an infant with fetal alcohol syndrome. The nurse knows that this infant needs which of the following?

  • Question 3 of 10

A nursing student asks a nurse what things to look for on a newborn for fetal alcohol syndrome. Which items should the nurse include in this teaching? Select all that apply.

  • Question 4 of 10

A pregnant client asks the nurse if it’s okay to have the occasional glass of red wine. What is the most appropriate response by the nurse?

  • Question 5 of 10

The nurse is developing a plan of care with the treatment team for a newborn that is suspected to have fetal alcohol syndrome. What should be included in this plan of care?

  • Question 6 of 10

The nurse is assessing a child with fetal alcohol syndrome. Which of the following findings does the nurse note? Select all that apply.

  • Question 7 of 10

A nurse is performing a newborn assessment on the infant of a mother who consumed alcohol throughout her pregnancy. Which assessment finding would alert to possible Fetal Alcohol Syndrome?

  • Question 8 of 10

Which of the following characteristics would the nurse expect to see in a pediatric client with fetal alcohol syndrome?

  • Question 9 of 10

A nurse is caring for a mother with a neonate who has fetal alcohol syndrome. Which of the following nursing interventions would be most helpful in this situation?

  • Question 10 of 10

A nurse is instructing a pregnant client about the dangers of drinking alcohol during pregnancy. Which information most likely characterizes fetal alcohol syndrome (FAS)?

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