Report seizures, apnea, or inability to console/feed.
Before you read
Test yourself first: 4 questions
Question 1 of 4
A client is being discharged with a new antipsychotic. The nurse teaches the family to report which serious effect immediately?
Answer: B. Report high fever, severe muscle rigidity, and altered mental status (possible neuroleptic malignant syndrome) immediately — it is life-threatening. Mild dry mouth is a common, less urgent effect.
Question 2 of 4
A client takes an antipsychotic and develops high fever, muscle rigidity, and altered mental status. The nurse recognizes:
Answer: B. Fever, severe rigidity, autonomic instability, and altered consciousness suggest neuroleptic malignant syndrome (NMS) — a medical emergency. Stop the drug and get emergency care.
Question 3 of 4
A client taking an SSRI also starts a second serotonergic drug and develops agitation, tremor, sweating, and hyperthermia. The nurse suspects:
Answer: B. These features indicate serotonin syndrome — too much serotonergic activity. Stop the offending agents and provide supportive care; it can be life-threatening.
Question 4 of 4
A client with anorexia begins refeeding. The nurse monitors closely for:
Answer: B. Refeeding syndrome causes dangerous shifts — especially hypophosphatemia, hypokalemia, and hypomagnesemia — that can cause cardiac and neuro complications. Advance nutrition slowly and monitor electrolytes.
Keep the streak going with more questions like these, each with a full rationale.
What is neonatal abstinence syndrome?
After birth the maternal drug supply is cut off, producing central nervous system irritability, autonomic instability, and gastrointestinal and respiratory disturbances. Care centers on a quiet, low-stimulation environment, scoring of withdrawal severity, and sometimes pharmacologic weaning.
Key points to remember
- Classic signs are a high-pitched cry, hyperactive reflexes/tremors, irritability, poor feeding, and a difficult-to-console state.
- Other findings include excessive sucking, frequent yawning/sneezing, sweating, nasal stuffiness, diarrhea, and poor weight gain.
- A standardized tool (e.g., Finnegan scoring) guides assessment and pharmacologic treatment decisions.
- Pharmacologic management may use morphine or methadone with gradual weaning for opioid withdrawal.
- A swaddled, quiet, dimly lit environment with minimal stimulation reduces irritability.
- Skin breakdown from frequent loose stools and constant movement is a common complication.
Signs & symptoms
- High-pitched cry, irritable, jittery
- Tremors, hypertonia, poor feeding
- Diarrhea, sweating, sneezing, yawning
- Seizures = severe
Nursing priorities
- Provide a calm, low-stimulation environment: swaddle snugly, dim lights, reduce noise, and cluster care.
- Assess withdrawal severity with a scoring tool and administer/wean medications as ordered.
- Offer small, frequent feedings and monitor weight, intake, and output.
- Protect skin integrity, especially the diaper area and chin/knees from rubbing.
- Support maternal-infant bonding and connect the mother to substance-use resources without judgment.
Labs & values
Patient teaching
- Teach caregivers gentle soothing: swaddling, vertical rocking, a pacifier, and a quiet dim room.
- Explain the importance of small frequent feeds and tracking weight.
- Provide nonjudgmental support and referrals for maternal recovery and follow-up care.
Red flags: report now
- Report seizures, apnea, or inability to console/feed.
- Report poor weight gain, dehydration, or severe diarrhea/vomiting.
- Report rising withdrawal scores indicating need for or escalation of medication.
References
Clinical references for this topic
