Question

A 25-year-old female who is 3-months pregnant is being seen for her first prenatal visit. The nurse is completing the assessment of the woman and believes that the patient may have an alcohol issue. A. The nurse completes the T-ACE alcohol screening questionnaire for use in pregnant women. The patient says she has 1 or 2 glasses of wine every day to feel good and her husband has told her to stop drinking. She usually has a glass of wine with breakfast to get rid of the shakes. She does not feel that she need to cut down on her drinking. What is the patient's score on the T-ACE Alcohol Screening Questionnaire? B. When the baby is born, what assessment quidelines need to be considered for identifying fetal alcohol syndrome disorder? C. The nurse makes a referral to the Nurse-Family Partnership program for the patient. What is the aim of the Nurse-Family Partnership program? D. The nurse includes motivational interviewing techniques during the assessment and counseling session to help the woman explore and resolve ambivalence toward her drinking and its impact on the unborn child. What elements are generally included in motivational interviewing?

Answer 1

A.  

• A pregnant woman places her unborn child at risk for alcohol-related birth defects with any alcohol use.
• T-ACE is a measurement tool of four questions that are significant identifiers of risk drinking (i.e., alcohol intake sufficient to potentially damage the embryo/fetus).
• The T-ACE is completed at intake. The T-ACE score has a range of 0-5. The value of each answer to the four questions is totaled to determine the final T-ACE score.

A total score of 2 or greater indicates potential risk for the purposes of Pregnancy Outreach Program identification of prenatal risk.

1. How many drinks does it take to make you feel high? 0. less than or equal to 2 drinks 1. more than 2 drinks	Tolerance
2. Have people annoyed you by criticizing your drinking? 0. No 1. Yes	Annoyance
3. Have you felt you ought to cut down on your drinking? 0. No 1. Yes	Cut Down
4. Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover? 0. No 1. Yes	Eye Opener

The patient's score on the T-ACE Alcohol Screening Questionnaire is 2 (Tolerence - 0, Annoyance - 1, Cut Down - 0, Eye Opener- 1)

B. The standard for diagnosis of FAS includes the following clinical indicators:

Diagnostic Criteria for Fetal alcohol syndrome(FAS)

1. FAS with confirmed maternal alcohol exposure

A) Confirmed maternal alcohol exposure.

B)  Evidence of characteristic pattern of facial anomalies including: short palpebral fissures and abnormalities in the premaxillary zone (e.g., flat upper lip, flattened philtrum, and flat midface)

C) Evidence of growth retardation, in at least one of the following :

• low birth weight for gestational age
• decelerating weight over time not due to other identified causes
• disproportional low weight to height

D) Evidence of CNS abnormalities in at least one of the following :

• decreased cranial size at birth
• structural brain abnormalities (e.g., microcephaly, cerebellar hypoplasia)
• neurological hard or soft signs (as age appropriate), such as impaired fine motor skuls, neurosensory hearing loss, poor tandem gait, poor hand-eye coordination

2. FAS without confirmed maternal alcohol exposure

• B, C, and D above

3.Partial FAS with confirmed maternal alcohol exposure

A) Confirmed maternal alcohol exposure

B) Evidence of some components of the pattern of characteristic facial anomalies AND either C or D or E below

C) Evidence of growth retardation, in at least one of the following

• low birth weight for gestational age
• decelerating weight over time not due to nutrition
• disproportional low weight to height

D) Evidence of CNS abnormalities in at least one of the following :

• decreased cranial size at birth
• structural brain abnormalities (e.g., microcephaly, cerebellar hypoplasia)
• neurological hard or soft signs (as age appropriate), such as impaired fine motor skills, neurosensory hearing loss, poor tandem gait, poor hand-eye coordination

E) Evidence of a complex pattern of behavior or cognitive abnormalities that are inconsistent with developmental level and cannot be explained by familial background or environment alone, such as learning difficulties; deficits in school performance; poor impulse control; problems in social perception; deficits in higher level receptive and expressive language; poor capacity for abstraction or etacognition; specific deficits in mathematical skills; or problems in memory, attention, or judgement.

C. The primary goals of Nurse-Family Partnership (NFP) are:

• To improve pregnancy outcomes by promoting health-related behaviors.
• To improve child health, development and safety by promoting competent care-giving.

• To enhance parent life-course development by promoting pregnancy planning, educational achievement, and employment.

The program also has two secondary goals:

• To enhance families’ material support by providing links with needed health and social services.
• To promote supportive relationships among family and friends.

D.

Motivational interviewing is a technique in which you become a helper in the change process and express acceptance of your client. It is a way to interact with substance-using clients, not merely as an adjunct to other therapeutic approaches, and a style of counseling that can help resolve the ambivalence that prevents clients from realizing personal goals.

The Nurse practices motivational interviewing with five general principles in mind:

• Express empathy through reflective listening.
• Develop discrepancy between clients' goals or values and their current behavior.
• Avoid argument and direct confrontation.
• Adjust to client resistance rather than opposing it directly.
• Support self-efficacy and optimism.