Antenatal_Complications_Written_Report.pdf.pdf

Cebu Doctors’ University
College of Nursing
1 Dr. P. V. Larrazabal Jr. Avenue, North Reclamation, 6014 Mandaue City, Cebu, Philippines
Tel. No. +63 (32) 238-8746 Web: www.cebudoctorsuniversity.edu E-mail: cdu- cn@cebudoctorsuniversity.edu
NCM 109: Care of Mother and Child At-Risk or
With Problems (Acute and Chronic)
Reporting: Antenatal Complications
Submitted by:
TAGHOY, Monicca
TAN, Zacht
TORRED, Jewel
TUMULAK, Nicole
ULEP, Benedict
UY, Elaiza
VILLANEUVA, Cassandra Maureen
YBANEZ, Brian Anrou
YU, Marie Yvonne
ZALDUMBIDE, AINHOA
UBAS, MA. JHORIZA
VILLACERAN, Roby Claire
VILLAMOR, Henrelyn
BSN 2F - F4
Submitted to:
Mrs. Dolores M. Saldivia, MAN, RN

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DRUG ABUSE
1. Definition/Description
Drug abuse is the maladaptive or excessive use of drugs for non-medical purposes
despite the possible problems that may arise.
2. Etiology/Cause
Drug addiction can start with experimental and/or voluntary use of a recreational drug
in situations, and, for some people, it is being used more frequently. For others,
particularly with opioids, drug addiction begins with people who are exposed to
prescribed medications, or receiving medications from someone who has been
prescribed the medication.
3. Types if Applicable
● Alcohol. Chronic alcohol use during pregnancy may cause miscarriage,
stillbirth, and a range of lifelong physical, behavioral, and intellectual
disabilities also known as fetal alcohol spectrum disorders (FASDs). There is
no safe limit of alcohol consumption during pregnancy as some studies have
shown that small amounts of alcohol can have the same adverse effects to
the fetus as binge drinking.
● Opioids or narcotics. Prescription opioids used for pain relief are generally
safe when taken for a short time and as prescribed by your healthcare
provider. However, opioid dependence, addiction, and overdose especially
during pregnancy can cause problems for both the mother and the baby
which may include neonatal abstinence syndrome, neural tube defects,
congenital heart defects, miscarriage, preterm labor, and low birthweight. .
● Cocaine and methamphetamine. Using these may cause serious problems
for the baby before and after birth such as placental abruption, premature
birth, low birthweight, miscarriage, neonatal abstinence syndrome, and other
long-term health problems.
● Marijuana. Pregnant women who smoke marijuana have a higher risk of
premature birth and a low birth weight. This can also make a pregnant mother
dizzy and have altered judgment, putting them at risk of falls or other injury, as
well as damage the lungs and cause breathing problems.THC and other
chemicals in marijuana can also be passed to a baby through breast milk,
increasing the baby’s risk for problems with brain development.
● Nicotine. Pregnant women who smoke pass the nicotine and other
carcinogenic chemicals to the growing fetus. According to the CDC, mothers
who smoke early in their pregnancy are more likely to have placenta
problems and deliver babies that have several different heart defects, low
birthweight, and are premature.
● Phencyclidine. It is a frequently abused drug due to its euphoric effect and
has also been shown to cross the placenta and may cause harmful effects in
the fetus.

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4. Signs and Symptoms
Regular use of drugs can cause severe health consequences for the mother and
neonatal abstinence syndrome for the baby. On mother:
Physical Symptoms
● Bloodshot eyes
● Change in complexion (Might look older)
● Poor personal hygiene
● Interrupted sleep patterns
● Losing weight quickly
Psychological Symptoms
● Low self-esteem
○ May demonstrate lack of self conscience in connection to their
abilities, looks, and intelligence
● Mood swings and irritability
○ There is a feeling agitation and unpredictable temper and moods that
manifests on a drug user
● Depression and anxiety
○ One common symptom for a drug user is losing a lot of interests in
things including their loved ones.
○ They may be oversleep or not sleep at all that leads to a dramatic
weight loss
On baby:
Symptoms of drug withdrawal in a newborn can develop immediately or up to 14
days after birth and can include:
1. Blotchy skin coloring
2. Seizures
3. Sleep problems
4. Excessive or high-pitch crying
5. Abnormal sucking reflex
6. Rapid breathing
Effects of using some drugs could be long-term and possibly fatal to
the baby
● Premature birth
● Small head circumference
● Birth defects
● Low birth weight
● Sudden Infant Death Syndrome (SIDS)
5. Management
a. Nursing
Assess client’s :
● History

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Ask the client his/her history. Clients who have a parent or other family
members who are addicted to drugs or alcohol may describe a chaotic
home life, however this is not always the case.
● Thought process
Clients are inclined to minimize their substance usage, blame others
for their difficulties, and rationalize their conduct throughout the
evaluation of the thinking process and content.
● Sensorium and intellectual process
During the assessment unless the client is suffering from withdrawal
symptoms, they should be normally focused and aware.
● General appearance and motor behavior
A comprehensive assessment of appearance and behavior typically
reveals that appearance and speech of the client is normal.
● Self concept
Clients tend to have poor self-esteem, which they may express openly
or cover up through dramatic behavior.
Also:
● Closely monitor maternal and fetal well-being
● Explain the benefits of abstinence of substance abuse during pregnancy
● Discuss possible effects of drugs on the newborn.
● Provide support to the client and family
● Provide support for the decision to stop substance use.
● Provide education opportunity pamphlets, consultation with appropriate
persons.
b. Medical
In order to manage withdrawal symptoms, prevent relapse and treat
co-occurring conditions, medications and devices are utilized through:
● Withdrawal.Through withdrawal, detoxification can occur throughout
the body. Although this is usually accompanied by further treatments
after withdrawal since there is a higher chance that users will go back
to their usual habit in drug use.
● Relapse Prevention. Medication can help patients re-establish normal
brain function and reduce cravings. Opioid (heroin, prescription pain
medicines), tobacco (nicotine), and alcohol addictions can all be
treated with medications. Other drugs to treat stimulants (cocaine,
methamphetamine) and cannabis (marijuana) addiction are being
developed by scientists. People who use numerous drugs, which are
fairly frequent, require medical attention for all of their drugs.
c. Pharmacologic
Pharmacologic treatment in substance abuse has two main purposes: to
permit safe withdrawal from alcohol, sedative-hypnotics, and

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benzodiazepines and to prevent relapse.
● Benzodiazepines. Alcohol withdrawal is usually managed with a
benzodiazepine-anxiolytic agent, which is used to suppress the
symptoms of abstinence.
● Disulfiram. Disulfiram (Antabuse) may be prescribed to help deter
clients from drinking.
● Acamprosate. Acamprosate (Campral), may be prescribed for clients
recovering from alcohol abuse or dependence to help reduce
cravings for alcohol and decrease the physical and emotional
discomfort that occurs especially in the first few months of recovery.
● Methadone. Methadone, a potent synthetic opiate, is used as a
substitute for heroin in some maintenance programs.
● Levomethadyl. Levomethadyl is a narcotic analgesic whose only
purpose is the treatment of opiate dependence.
● Naltrexone. Naltrexone (ReVia) is an opioid antagonist often used to
treat an overdose. It can also be used to treat alcohol abuse.
d. Surgical
Patients with severe opioid addiction are being given brain implants to
help reduce their cravings, in the first trial of its kind in the US. Deep brain
stimulation (DBS) is a powerful tool for modulating dysregulated networks
that has demonstrated successful application and been granted approval for
the treatment of several neurological disorders, and has also been considered
for the treatment of substance addiction.
6. Relevant Pictures/Videos

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Drug Deep Stimulation https://allthatsinteresting.com/deep-brain-stimulation
VIDEOS:
https://youtu.be/OtBPqN78f-0

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5. One (1) priority Nursing Care Plan for each complication
NURSING CARE PLAN (DRUG ABUSE)
Needs/Problems/
Cues
Nursing Diagnosis Scientific Basis Objectives of Care Nursing
Interventions
Rationale
Physiological
Problem: Inadequate
dietary consumption
Objective cues:
● Small body
frame
● Weak looking
● Has dry skin
● Below
maternal
recommende
d weight
Subjective:
● The client
reported that
she has
altered taste
sensation
● The client
verbalizes
that she has
no appetite
Imbalanced
nutrition:less than
body requirements r/t
substance abuse
Pregnancy alcohol
usage is typically
coupled with poor
nutrition, which
might significantly
worsen brain
damage. Pregnant
women frequently do
not consume
adequate levels of
micronutrients,
including several that
may be particularly
crucial in FASD, such
as choline, folate,
vitamin B 12, iron,
and vitamin A.
Alcohol and drug use
can impede nutrient
absorption, reducing
the quality and
amount of proper
After 2 days of
holistic nursing care,
the client will be able
to recognize the
relationship of
substance abuse to
the current situation.
Specific Objectives:
After 1 day of
nursing intervention,
the client will:
- Verbalize
understanding
of effects of
substance
dependence
and
insufficient
dietary intake.
- Demonstrate
behaviors and
Measures to help
improve client's
nutritional intake:
1. Assess the
clients
anthropometri
c
measurements
2. Educate the
client about
the
advantages
and
disadvantages
of
well-balanced,
nutritious
intake
3. Encourage
the client to
1. This helps
measure
subcutaneous
fat and
muscle mass
to help in
planning
dietary
needs.
2. To help the
client
understand
the pros and
cons of
having a well
balanced
diet. As well
as guiding
them to

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nutrient and energy
intake, resulting in
malnutrition,
particularly of
micronutrients
(vitamins, omega–3,
folic acid, zinc,
choline, iron, copper,
and selenium). When
the nutritional status
of the mother is
damaged by alcohol
and other drugs of
abuse, the availability
of vital nutrients for
the baby is reduced,
which can result in
fetal abnormalities
such as Intrauterine
Growth Restriction
(IUGR) or Fetal
Alcohol Spectrum
Disorder (FASD).
Sources: Crane, M.
(2021, December
13). Nutrition for
lifestyle
changes to
regain/mainta
in an
appropriate
weight for
pregnancy.
- Demonstrate
progressive
weight gain
toward goal,
with
normalization
of laboratory
values and
absence of
signs of
malnutrition
have a food
diary
4. Monitor the
client's
laboratory
results as
indicated
5. Monitor the
client's
nutritional
intake as
recommended
by the
dietitian
6. Collaborate
with a
nutritionist to
obtain an
individualized
nutritional
plan.
Sources:
Doenges, M. E.,
make
informed
choices about
the future.
3. This will help
determine
the client’s
nutritional
strengths,
needs, and
insufficiencies
.
4. The data that
will be
gathered will
be used to
determine
the patient’s
overall health
and well
being.
5. This will help
determine
and measure
the amount
of progress
made for the
nutrition

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Addiction Recovery.
Retrieved from
https://recovery.org/t
reatment-therapy/nut
rition/
Sebastiani, G. (2018,
July 2). The Effects
of Alcohol and Drugs
of Abuse on Maternal
Nutritional Profile
during Pregnancy (M.
Roig, C.
Borrás-Novell, M.
Casanova, & M.
Pascual Tutusaus,
Eds.). Retrieved from
https://www.ncbi.nlm
.nih.gov/pmc/articles
/PMC6116049/
Moorhouse, M. F., &
Murr, A. C. (2019).
Nurse's pocket guide:
Diagnoses, prioritized
interventions, and
rationales (Vol. 15).
F.A. Davis Company.
Martin, P. (2019, June
1). 6 prenatal
substance
dependence/abuse
nursing care plans.
Nurseslabs. Retrieved
from
https://nurseslabs.co
m/6-prenatal-substan
ce-dependence-abuse
-nursing-care-plans/#
imbalanced_nutrition_
less_than_body_requi
rements
intervention
and to check
whether the
expected
goals are
being met.
6. Collaborating
with a
nutritionist
can help the
patient
improve and
recover by
creating
individualized
meal plans
that are
aimed to help
them get the
proper
nutrition they
need.

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URINARY TRACT INFECTION
Urinary tract infection, or UTI, is an infection in any part of the urinary system,
namely the kidneys, bladder, ureters, and urethra. This infection commonly happens
when bacteria enter through the rectum or urethra and infect the urinary tract.
Females are at higher risk of this infection since their urethra is shorter and closer to
the rectum.
2. Etiology/Cause
Urinary tract infections are caused by microorganisms — usually bacteria — that
enter the urethra and bladder, causing inflammation and infection. Though a UTI
most commonly happens in the urethra and bladder, bacteria can also travel up the
ureters and infect your kidneys.
A urinary tract infection may involve different sections of the urinary tract including
the following:
● Urethritis - An infection of the urethra, the hollow tube that drains urine from
the bladder to the outside of the body.
● Cystitis - A bacterial infection in the bladder that often has moved up from
the urethra.
● Pyelonephritis - An infection of the kidneys that is usually a result of an
infection that has spread up the tract, or from an obstruction in the urinary
tract. An obstruction in the urinary tract causes urine to back flow into the
ureters and kidneys.
● Vaginitis - Is an inflammation of the vagina that can result in discharge,
itching and pain.
● Bacteriuria - The presence of bacteria in the urine
● Asymptomatic Bacteriuria - absence of symptoms but there is the
presence of bacteria in the urine (silent infection)

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● Pain or burning when urinating (Dysuria)
● Suprapubic pain
● Frequent Urination
● Blood in the urine (Hematuria)
● Need to urinate even when bladder is empty
● Fever
● Chills
● Nausea
● Vomiting
● Uterine contractions/ activity (This is due to the infection causing smooth
muscle irritability)
5. Management
a. Nursing
Nursing care of the patient with UTI focuses on treating the underlying
infection and preventing its recurrence.
Nursing Assessment
A history of signs and symptoms related to UTI is obtained from the patient
with a suspected UTI.
● Assess changes in urinary pattern such as frequency, urgency, or
hesitancy.
● Assess the patient’s knowledge about antimicrobials and preventive
health care measures.
● Assess the characteristics of the patient’s urine such as the color,
concentration, odor, volume, and cloudiness.
b. Medical
● Obtain urine sample
○ The doctor may ask for a urine sample for lab analysis to look for
white blood cells, red blood cells or bacteria. To avoid potential
contamination of the sample, you may be instructed to first wipe your
genital area with an antiseptic pad and to collect the urine midstream.
● Lab analysis of the urine
○ This will help tell the doctor what bacteria are causing your infection
and which medications will be most effective.
● Creating images of the patient’s urinary tract.
○ If the patient has frequent infections it may be caused by an
abnormality in the patient’s urinary tract. You may have an ultrasound,
a computerized tomography(CT) scan or magnetic resonance imaging
(MRI).
● Use scope to see inside the bladder from the urethra

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○ If you have recurrent UTIs, your doctor may perform a cystoscopy,
using a long, thin tube with a lens (cytoscope) to see inside your
urethra and bladder. The cystoscope is inserted in your urethra and
passed through to your bladder.
c. Pharmacologic
The therapeutic management of uncomplicated bacterial urinary tract
infections (UTIs) is based on short-term courses of oral antibiotics. The
preferred drugs are:
● nitrofurantoin trimethoprim-sulfamethoxazole,
● fosfomycin trometamol,
● fluoroquinolones and
● β-lactam agents.
The choice of agent for treating uncomplicated UTIs should be based on the
pharmacokinetic characteristics of the molecule so that clinical benefit is
optimized and the risk of antibacterial resistance is minimized.
d. Surgical
● Surgery remains a very important and viable solution. Removal of
identified sources, treating the obstruction, and improving urinary
drainage, are all goals of surgical management. Surgical options for UTI
management can range from minimally invasive procedures such as
endoscopic or percutaneous, through to more invasive requiring
laparoscopic or an open approach.

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Source:
https://www.urinaryhealthtalk.com/wp-content/uploads/difference-between-uti-and-bladder-infection-co
mpare-the.png
Video (UTI in Pregnancy):
https://www.youtube.com/watch?v=YEQNnO64wLc&ab_channel=khanacademymedicine

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NURSING CARE PLAN (UTI)
Needs/Problems/
Cues
Interventions
Rationale
Physiological
Problem:
Acute pain
Subjective:
“Sakit inig pangihi
nako” as verbalized
by the client.
Objective:
● Facial
grimace
● Restlessness
● Pain scale:
4/10
Impaired Urinary
Elimination related to
dysuria and frequent
urination evidenced
by irritated and
inflamed urethra
Urethritis, a condition
in which the urethra
becomes inflamed
and irritated, typically
causes pain while
urinating and an
increased urge to
urinate which are
some of the factors
that impact urinary
elimination and place
patients at risk for
impaired elimination.
This often signifies
an infection by
bacteria.
O’Connell, K. (2019,
March 8). Urethritis.
Healthline. Retrieved
from
https://www.healthlin
e.com/health/urethriti
s#_noHeaderPrefixe
After 2 days of
the client will
experience normal
and painless
urination.
After 1 day of nursing
intervention, the
client will:
- Identify
causing
factors of the
STD
- Demonstrate
behaviors and
actions to
reduce
infection
Independent
1. Assess the client's
elimination pattern.
2. Limit use of
indwelling catheters
to manage
incontinence
3. Encourage client
to drink cranberry
juice.
4. Encourage the
client to void
1. To provide an
overview of the
severity of the
condition.
2. Frequent usage of
indwelling catheters
poses a higher risk of
catheter-related UTI
as bacteria/viruses
accumulate on the
material.
3. Cranberry juice
could reach the
urinary tract and
prevent bacterial
adhesion within eight
hours.
4. Frequent voiding
every 2 to 3 hours to

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dContent
RegisteredNursing.or
g Staff Writers.
(2021, August 25).
Elimination:
NCLEX-RN.
RegisteredNursing.O
rg. Retrieved from
https://www.registere
dnursing.org/nclex/eli
mination/
frequently.
5. Use
non-pharmacological
techniques to
manage pain.
Dependent
1. Monitor laboratory
and diagnostic
studies,as indicated.
2. Administer
analgesics or
antispasmodics, as
indicated.
completely empty the
bladder is
encouraged to
prevent bladder
distention, lower
bacterial urine
counts, reduce stasis
of the urine, and
prevent reinfection.
6. Alternative
therapies such as
relaxation, massage,
guided imagery, or
distraction may
decrease pain and
provide comfort.
1. Lab results will
indicate if there is a
change to the state of
the problem.
2. Antispasmodic and
analgesic agents are
useful in relieving
bladder irritability,
spasm, and pain.

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3. Administer
antibacterial
agents,as indicated.
3.Trimethoprim
(TMP) or cephalexin
are usually the first
choices of antibiotics.
Short-course therapy
using a single
antibiotic or a 3-day
course reduces
treatment cost,
increases compliance
to therapy, and a
lower rate of side
effects.

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STD
Sexually transmitted diseases (STDs), or sexually transmitted infections (STIs), are
infections that are passed from one person to another through sexual contact. The
contact is usually transmitted through vaginal, oral, or anal sex. There are scenarios
wherein they can spread through other intimate physical contact due to some STDs,
like herpes and HPV, which are spread by skin-to-skin contact.
2. Etiology/Cause
STDs can be caused by bacteria such as gonorrhea, syphilis and chlamydia; viruses
such as HPV, genital herpes and HIV; and parasites such as trichomonas baginalis.
Pelvic Inflammatory Disease
- A serious condition in women. 1 in 8 women with a history of PID experience
difficulties getting pregnant. It is a complication often caused by some STDs,
like chlamydia and gonorrhea. This scarring can make an ectopic pregnancy
more likely and has also been linked to infertility, with around 1 in 10 people
with PID becoming infertile as a result.
Tertiary Syphilis
- The early stages of syphilis —a relatively uncommon infection — are
considered an STI. However, around a quarter of people will go on to develop
tertiary syphilis from here —a process that can take between 10 and 30 years
after the initial infection.
Cancer
- Certain sexually transmitted diseases (STDs) or sexually transmitted
infections (STIs) can increase a person’s risk of developing several cancer
types. Human Papillomavirus (HPV) according to CDC can lead to cancer in
women. These are cervical cancer, vaginal and vulvar cancer.
Genital Warts
- These skin-colored or white bumps show up on the genitals or anus, with over
350,000 people developing them every year. They are treatable, but not
curable, as the virus that causes them may remain. (In some cases, HPV
disappears on its own. Genital warts can also go away by themselves, but
they can also come back.
AIDS
- AIDS stands for acquired immunodeficiency syndrome. It is the final stage of
infection with HIV. It happens when the body's immune system is badly
damaged because of the virus. Not everyone with HIV develops AIDS.

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Human Papillomavirus (HPV)
- HPV is one of the most common STDs in the U.S. There are more than 40
types of HPV, some of which can cause genital warts. Genital warts are small
pink or flesh-colored bumps in the genital area, and may cause itching,
discomfort and bleeding. Some types can lead to cervical cancer, which may
be detected during a routine screening PAP smear.
Herpes
- Herpes is commonly associated with cold sores or fever blisters (oral herpes),
but also genital or anal sores. Both types of herpes can be sexually
transmitted and cause genital herpes. Herpes can also affect the developing
fetus in a pregnant woman, especially if the woman becomes infected during
the first trimester.
Syphilis
- Syphilis is caused by a bacterium called Treponema pallidum. It is spread
through direct contact with sores, called chancres. Early syphilis infections
may begin with a painless, round, and firm single sore located where the
bacteria entered the body (e.g., penis, vagina, anus, mouth).
Chlamydia
- Chlamydia is a sexually transmitted disease caused by a bacterium named
Chlamydia trachomatis. While many people infected with chlamydia have no
signs or symptoms of infection, others may experience burning sensation
during urination, abnormal vaginal discharge and penile discharge. If not
treated, chlamydia can lead to PID in women, which may eventually damage
a woman’s reproductive systems and cause infertility.

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● Sores or bumps on the genitals or in the oral or rectal area
● Painful or burning urination
● Discharge from the penis
● Unusual or odorous vaginal discharge
● Unusual vaginal bleeding
● Pain during sex
● Sore, swollen lymph nodes, particularly in the groin but sometimes more
widespread
● Lower abdominal pain
● Fever
● Rash over the trunk, hands or feet
5. Management
a. Nursing
● Assessment. Gather data and information provided by the patient as well
as from the collected data during physical examinations.
● Health Promotion. Preventive education regarding sexual exposure,
encouraging “SAFE SEX”, providing sufficient information regarding
STDs.as well as promoting routine check-ups and screenings for cervical
cancer, etc.
● Treatment of Choice. Administration of parenteral penicillin for pregnants
with syphilis.Those who are allergic to penicillin should be desensitized
and treated with penicillin G. Skin testing or oral graded penicillin dose
challenge might be helpful in identifying women at risk for acute allergic
reactions.
● Adequate case finding and treatment contacts as well as reporting of all
cases to local public authorities.
b. Medical
Laboratory tests can identify the cause and detect coinfections you might also
have.
● Blood Tests
○ Blood tests can confirm the diagnosis of HIV or later stages of
syphilis.
● Urine samples
○ Some STIs can be confirmed with a urine sample
● Fluid samples
○ If you have open genitalmouth sores, the doctor may get a
swab of any discharge or sores
c. Pharmacologic

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STDs/STIs caused by bacteria or parasites can be treated with antibiotics.
These antibiotics are most often given by mouth (orally). However, sometimes
they are injected or applied directly to the affected area. The treatments,
complications, and outcomes for viral STIs depend on the particular virus
(HIV, genital herpes, human papillomavirus, hepatitis, or cytomegalovirus).
Treatments can reduce the symptoms and the progression of most of these
infections. Individuals with HIV need to take special antiretroviral drugs that
control the amount of virus they carry. These drugs, called highly active
antiretroviral therapy, or HAART, can help people live longer, healthier lives
and can prevent onward transmission of HIV to others.
The antibiotics prescribed depends on what infection you have. The various
antibiotics prescribed for different bacterial STDs are:
- Azithromycin
- Doxycycline
- Erythromycin for Chlamydia
- Ceftriaxone
- Cefixime
- Ciprofloxacin, and
- Ofloxacin for Gonorrhea
d. Surgical
For patients with HPV
● Freezing with liquid nitrogen (cryotherapy).
○ Freezing works by causing a blister to form around the wart.
● Electrocautery.
○ This procedure uses an electrical current to burn off warts. The
patient may experience some pain and swelling after the
procedure.
● Surgical Excision.
○ The doctor might use special tools to cut off warts.
● Laser treatments
○ This approach, which uses an intense beam of light, can be
expensive and is usually reserved for extensive and tough to
treat warts. Side effects can include scarring and pain.
For patients with Hepatitis:
In some cases, significant liver damage can occur from hepatitis
infections, and a liver transplant may be needed.

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Video :
What are STDs? #FactCheck

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NURSING CARE PLAN (STD)
Needs/Problems/Cu
es
Interventions
Rationale
Objective Cues:
- Client has
facial grimace
- Restlessness
Subjective Cues:
- Client rates
pain an 8 on
the numerical
pain scale
- Client
verbalizes
that she is in
pain
Acute pain r/t body
response to an
infective agent
Sexually transmitted
diseases (STDs) are
infections transmitted
from an infected
person to an
uninfected person
through sexual
contact. STDs can be
caused by bacteria,
viruses, or parasites.
Examples include
gonorrhea, genital
herpes, human
papillomavirus
infection, HIV/AIDS,
chlamydia, and
syphilis.
Pregnant women with
an STD may infect
their baby before,
during, or after the
baby's birth. For this
reason, your
After 1 week of
to manage and
identify ways to
alleviate pain.
After 3 days of
the client will:
- Report pain is
relieved or
controlled
- Demonstrate
use of
relaxation
skills and
diversional
activities.
- Verbalize
sense of
Independent
1. Perform
comprehensive
assessment of pain.
Note the location,
intensity, duration,
frequency, and
onset.
2. Instruct client to
report pain as it
develops rather
than waiting for it to
be severe.
3. Encourage client
to verbalize their
feelings.
4. Provide non
pharmacological
1. It helps ensure that
the patient receives
effective pain relief.
2. To assess what
condition is present
and could help in
treating it before
getting worse.
3. To help the client
feel less anxious
about the problem.
4. To help the patient
to gain relaxation
which aids in
reducing perception
of pain.

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healthcare provider
will screen you for
most STDs at your
first prenatal visit. If
you have sex with
someone who is
affected, after your
initial screening, you
will need to be tested
again. Treatment of
STDs is the best way
to protect you and
your baby.
Sources: Sexually
Transmitted
Diseases. (2015,
August 6). NIH:
National Institute of
Allergy and
Infectious Diseases.
Retrieved February 3,
2022, from
https://www.niaid.nih
.gov/diseases-conditi
ons/sexually-transmit
ted-diseases
control of
response to
situation and
positive
outlook for the
future.
methods of pain
management like
deep-breathing
exercises and
meditation
Dependent
1. Administer
analgesics and/or
antipyretics as
ordered.
2. Evaluate the
effectiveness of
medication as
ordered and
observe for any
signs and
symptoms.
1. These medications
may enhance pain
relief.
2. Medications
should be adjusted to
achieve optimum
pain relief without
causing severe
adverse effects.

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Sexually Transmitted
Diseases (STDs) &
Pregnancy: Risks &
Prevention. (n.d.).
Cleveland Clinic.
Retrieved February 3,
2022, from
https://my.clevelandcl
inic.org/health/article
s/10246-pregnancy--s
exually-transmitted-d
iseases

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TORCH
1) Definition/Description
TORCH infection is an infection of a developing fetus or newborn that can occur before birth,
during delivery, or after birth. It can be caused by any of the group of infectious agents
indicated in the acronym TORCH which stands for Toxoplasma gondii, Other agents such as
Treponema pallidum, varicella zoster virus (VZV), parvovirus B19, and human
immunodeficiency virus (HIV), Rubella, Cytomegalovirus (CMV), and Herpes simplex virus
(HSV).
2) Etiology/Cause
Caused by in-utero infection with one of the TORCH (agents, disrupting fetal
development. A baby contracts a TORCH infection in the uterus when the mother
catches the infectious disease and carries it through her bloodstream to the baby.
Infections in this category may be caused by various viruses. Other organisms such
as bacteria, spirochetes, protozoa, or yeast also may cause maternal infections,
which are harmful to the developing fetus.
Infection organism may also be acquired through:
● Sexual intercourse
● Human body fluids (semen, saliva, blood, urine, cervical mucus, breast milk,
and stool
● Eating undercooked meat
● By contact with infected cat feces in the litter box
3) Types if Applicable
T= toxoplasmosis
a parasitic illness caused by the microscopic parasite Toxoplasma gondii This
one-celled parasite is most prevalent in cats, but it may also infect people and other
animals.
O=other Agents (Treponema Pallidum, VZV, Parvovirus B19, HIV)
a bacterial infection usually spread by sexual contact.
R=rubella
a contagious viral infection best known by its distinctive red rash. It can cause
serious problems for unborn babies whose mothers become infected during
pregnancy.
C=cytomegalovirus (CMV)
a common virus. Once infected, your body retains the virus for life. It has a a wide
range of symptoms: from no symptoms to fever and fatigue
H=herpes simplex (HSV)
a viral infection that causes genital and oral herpes.

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4) Signs and Symptoms
Signs and Symptoms vary depending on specific underlying conditions/infections but
share non-specific signs and symptoms:
● Fever
● Lethargy
● Cataracts
● Jaudice
● Redish brown spots on skin
● Hepatosplenomegaly
● Congenital heart disease
● Microcephaly
● Low birth weight
● Hearing loss
● “Blueberry muffin” rash
5) Management
○ Nursing
● Assess for any previous history of sexually transmitted disease
● Demonstrate proper handwashing techniques
● Discuss hygienic and dietary measures that will help reduce the risk of
infection
○ Medical
Treatment is highly dependent on the specific agent responsible for the
infection. A TORCH screen is a panel of tests for detecting infections in
pregnant women. Infections may be passed on to a fetus during pregnancy.
Early detection and treatment of an infection can prevent complications in
newborns. The tests screen for antibodies to infectious diseases. Antibodies
are proteins that recognize and destroy harmful substances, such as viruses
and bacteria.
○ Pharmacologic
Most healthy people don't require toxoplasmosis treatment. But if you're
otherwise healthy and have signs and symptoms of acute toxoplasmosis,
your doctor may prescribe the following drugs:
● Pyrimethamine (Daraprim)
○ This medication, typically used for malaria, is a folic acid
antagonist. It may prevent your body from absorbing the B
vitamin folate (folic acid, vitamin B-9), especially when you
take high doses over a long period. For that reason, your
doctor may recommend taking additional folic acid.
○ Other potential side effects of pyrimethamine include bone
marrow suppression and liver toxicity.

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● Sulfadiazine
○ This antibiotic is used with pyrimethamine to treat
toxoplasmosis.
○ Surgical
1. Routine universal screening should not be performed for pregnant women
at low risk.
2. Serologic screening should be offered only to pregnant women considered
to be at risk for primary Toxoplasma gondii infection.
3. Suspected recent infection in a pregnant woman should be confirmed
before intervention by having samples tested at a toxoplasmosis reference
laboratory
4. Amniocentesis should be offered to identify Toxoplasma gondii in the
amniotic fluid by polymerase chain reaction.
5. Amniocentesis should not be offered for the identification of Toxoplasma
gondii infection at less than 18 weeks' gestation and should be offered no less
than 4 weeks after suspected acute maternal infection to lower the
occurrence of false-negative results.
6. Toxoplasma gondii infection should be suspected and screening should be
offered to pregnant women with ultrasound findings consistent with possible
TORCH (toxoplasmosis, rubella, cytomegalovirus, herpes, and other)
infection, including but not limited to intracranial calcification, microcephaly,
hydrocephalus, ascites, hepatosplenomegaly, or severe intrauterine growth
restriction.
6) Relevant Pictures/Video
Relevant Picture:

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Relevant video:
https://youtu.be/QYUvnv4MFEc

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7) One (1) priority Nursing Care Plan for each complication
NURSING CARE PLAN (TORCH)
Needs/Problems/Cu
es
Nursing Diagnosis Scientific Bases Objectives of Care Nursing
Interventions
Rationale
I. Physiologic
Problem:
Increase body
temperature
Objective Cues:
- Temperature
of 38.5
degrees
celsius
- Rapid and
shallow
breathing
- Flushed skin
- Profuse
sweating
- Weak pulse
Hyperthermia r/t
infection as
evidenced by
increase in body
temperature higher
than normal range
Hyperthermia is an
abnormally elevated
body temperature
that is not produced
by a resetting of the
temperature set
point. It is a condition
in which the body's
thermostat (located in
the hypothalamus)
resets to a higher
temperature, usually
in response to an
infection. Moreover,
The body raises a
fever in an attempt to
kill the virus or
bacteria that caused
the sickness. When
the body's
temperature is
normal, most of those
bacteria and viruses
General objective:
After 3 days of
the client will be
able to regain
normal body
temperature.
After 8 hours of
nursing
interventions the
client will:
1. Regain a body
temperature below
39° C (102.2°F)
2. Maintain normal
blood pressure and
heart rate.
Measures to help the
client normalize her
temperature :
1. Monitor the
patient’s heart rate
and blood pressure.
1. This is done
to have data
to compare
when
assessing
whether the
interventions
are effective
on the client.
These vital
signs are
specifically
important to
take note of
as in
hyperthermia
both the heart
rate and
blood

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Subjective cues:
- “Galain akong
lawas unya
init kaayo
akong lawas”
as verbalized
by the client
thrive. With fever,
they will have a
tougher time
surviving.
Sources:
Bush, L. M. (2022,
January 24). Fever -
infectious diseases.
MSD Manual
Professional Edition.
Retrieved from
https://www.msdman
uals.com/professional
/infectious-diseases/b
iology-of-infectious-di
sease/fever#:~:text=F
ever%20occurs%20w
hen%20the%
U.S. National Library
of Medicine. (2022,
February 2). Fever.
MedlinePlus.
Retrieved from
https://medlineplus.g
ov/fever.html
2. Monitor fluid intake
and urine output.
3. Evaluate the
effects/degree of
hyperthermia.
pressure
increase.
2. Fluids,
especially
cool fluids,
are a way to
lower the
body
temperature.
Furthermore,
monitoring
both intake
and output of
fluids is
important as
dehydration is
a factor in
hyperthermia
and should be
treated
appropriately.
3. This is done
to give the
appropriate
interventions
depending on
the symptoms
and the
degree of the

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4. Promote surface
cooling by means of
undressing and
application of tepid
sponge bath.
5. Administer
antipyretics as
prescribed by the
physician
Sources:
Doenges, M. E.,
Moorhouse, M. F., &
Murr, A. C. (2019).
client’s
hyperthermia.
4. Undressing
reduces heat
and promotes
evaporative
cooling. Tepid
sponge bath
is also
another way
of promoting
evaporative
cooling which
aids in
lowering the
client’s
temperature.
5. The use of
antipyretics is
a
pharmacologi
c way of
lowering the
client’s body
temperature.

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Nurse's pocket guide:
Diagnoses, prioritized
interventions, and
rationales (Vol. 15).
F.A. Davis Company.
Vera, Matt. (2021,
October 31).
Hyperthermia nursing
care plan. Nurselabs.
Retrieved from
https://nurseslabs.co
m/hyperthermia/

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MULTIPLE PREGNANCY
A multiple pregnancy is a pregnancy with 2 or more fetuses. Naturally, twins occur in
about one in 250 pregnancies, triplets in about one in 10,000 pregnancies, and
quadruplets in about one in 700,000 pregnancies. As the number of fetuses
increases, the expected duration of the pregnancy decreases. The average duration is
35 weeks for twins, 33 weeks for triplets, and 30 weeks for quadruplets.
2. Etiology/Cause
Multiple pregnancy occurs when more than one egg is fertilized. It can also happen
when one egg is fertilized and subsequently divides into two or more embryos, each
of which develops into two or more newborns. When one fertilized egg divides into
two, the newborns are known as identical twins.
a. Fraternal Twins - Also referred to as “dizygotic” twins. Formed when two
separate eggs are fertilized and implanted in the uterus. The twins may look
similar or different and may differ or have the same sex.
b. Identical Twins - Also referred to as “monozygotic” twins. Formed when a single
fertilized egg is split in half wherein both halved embryos are genetically identical
and the babies will share many characteristics.
c. Triplets and “Higher Order Multiples” (HOMs) - also referred to as
“trizygotic”.Triples, quadruplets and more can be a different combination of the
two previous types of multiple pregnancy: fraternal and identical.
Each woman may have slightly different symptoms. But the most common symptoms
of multiple pregnancy are:
● Uterus is larger than expected for the dates in pregnancy
● More morning sickness
● Greater appetite
● Too much weight gain, especially in early pregnancy
● Babies’ movement felt in different parts of the stomach at the same time

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5. Management
a. Nursing
● Assess the mothers nutrition
- Mothers carrying two or more fetuses need more calories, protein, and other
nutrients, including iron. Higher weight gain is also recommended for multiple
pregnancies. The mother's nutritional status and weight should also be monitored
more closely.
● Encourage mother to increase rest
- Higher-order multiple pregnancies often require bedrest starting in the middle of the
second trimester.
b. Medical
● Maternal and fetal testing
○ Testing may be needed to monitor the health of the fetuses, especially
if there are pregnancy complications.
● Referrals
○ Referral to a maternal fetal medicine specialist, called a perinatologist,
for special testing or ultrasound evaluations, and to coordinate care of
complications, may be necessary.
c. Pharmacologic
● Tocolytic medications - Tocolytic medications may be given, if preterm
labor occurs, to help slow or stop contractions of the uterus. These
may be given orally, in an injection, or intravenously. Tocolytic
medications often used include magnesium sulfate.
● Corticosteroid medications - Corticosteroid medications may be given
to help mature the lungs of the fetuses. Lung immaturity is a major
problem of premature babies.
d. Surgical
● Cesarean Delivery
- Cesarean delivery is default in twins when the first fetus to be
delivered is not in vertex position. However, if only the second fetus is
not vertex then the first one is delivered through normal vaginal
delivery (NVD) and the second one has to be rotated or an emergency
cesarean may be done. Without any of the mentioned conditions and
any other complications twins can be delivered NVD. For 3+
pregnancy, a planned cesarean delivery is used/ highly recommended
due to the number of risk factors when delivering 3 or more babies
vaginally. Moreover, some of these risk factors are due to the position
of the fetuses and their placentas. During a NVD the umbilical cord
can be compressed and there is a much higher risk of entanglement.

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Video: https://youtu.be/x7QHAasiDgE

College of Nursing
NURSING CARE PLAN (MULTIPLE PREGNANCY)
Needs/Problems/Cu
es
Interventions
Rationale
I. Physiological
Problem:
Fatigue
Objective Cues:
- Pale or
yellowish skin
- Rapid
heartbeat
- Shortness of
breath
Subjective Cues:
- The client
verbalized
“kapoy kaayo
akong lawas
permi unya
Fatigue r/t increased
physiological demand
of a multifetal
pregnancy
Extreme fatigue is
the most commonly
reported complaint
by mothers with
multiple pregnancy.
During the first
trimester, sleepiness,
lethargy, and
exhaustion is
increased becuase
the body is working
overtime to nurture
more than one baby.
Fierro, P. P. (2021).
Signs and symptoms
of a twin or multiple
pregnancy. Retrieved
from
https://www.verywell
family.com/is-it-twins
-10-signs-youre-preg
After 4 hours of
to feel relieved and
well rested
After 2 hours of
the client will:
1. Have a normal
heart rate and
respiration.
2. Have a better
activity and rest
schedule.
3. Understand the
underlying causes of
fatigue
Measures to gain
adequate rest and
sleep:
1. Evaluate the
client’s
description of
fatigue:
severity and
its changes
over time,
aggravating
factors or
alleviating
factors.
1. Using an
appropriate
quantitative scoring
scale, such as 1 to
10, might help the
patient formulate the
amount of exhaustion
experienced. Using
graphics or
descriptive text,
additional scoring
scales can be
created. This system
allows the nurse to
compare changes in
the patient's fatigue
level over time. It is
critical to determine
whether the patient's

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sige sad ko
ug ka lipong,
usahay mag
labad sad
akong ulo”.
nant-with-more-than-
one-2447305
2. Observe the
client’s
physiological
reaction to
activities such
as any
alterations in
BP,
respiratory
rate, or heart
rate.
3. Educate the
client and
family about
the underlying
causes and
effects of
fatigue, as
well as
non-pharmac
ological
techniques to
promote rest.
4. Aid the client
level of weariness is
consistent or varies
over time.
2. This is done to
determine physical
responses related to
both physiological
and emotional
conditions.
3. To give awareness
to the client as well
as to the family about
the condition. On the
other hand,
nonpharmacologic
techniques is very
helpful to the client to
easily alleviate
fatigue.
4. A schedule that

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in developing
a schedule for
daily activity
and rest.
5. Administer
medication as
prescribed by
a physician.
6. Teach energy
conservation
methods.
Collaborate
with a
occupational
therapist if
alternates between
periods of activity
and periods of rest
can help the patient
perform desired
activities while
reducing fatigue
levels.
5. Taking your
prescription as
directed, often known
as medication
adherence, is critical
for controlling chronic
disorders, treating
acute conditions, and
overall long-term
health and
well-being.
6. To use available
energy to perform
desired activities,
patients and
caregivers may need
to develop skills such
as task delegation,

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needed. prioritization, and
clustering care.
Organization and
time management
can assist the patient
in conserving energy
and decreasing
weariness. The
occupational
therapist can provide
assistive gadgets to
the patient as well as
educate the patient
on energy
conservation
techniques.

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HYDRAMNIOS
Hydramnios (Polyhydramnios) is a condition in which the amount of the Amniotic
Fluid(AF) is more than 2000ml relatively to the Age of Gestation (AOG). It happens
in about 1% of pregnancies. However, to make the diagnosis more accurate and
practical in clinical settings, in ultrasonography, Hydramnios has a Single Deepest
Pocket (SDP) equal or greater than 8cm and an Amniotic Fluid Index (AFI) equal or
greater than 25cm.
2. Etiology/Cause
The amount of fluid increases until the 36th week of pregnancy. After that, it
slowly decreases. If the fetus makes too much urine or does not swallow enough,
amniotic fluid builds up. This causes hydramnios. Other causes are related to an
underlying diseases such as:
● fetal malformations and genetic anomalies
● maternal diabetes mellitus
● multiple pregnancies
● fetal anemia
● other causes, e.g. viral infections, Bartter syndrome, neuromuscular
disorders, maternal hypercalcemia.
○ Viral infections which can lead to polyhydramnios include parvovirus
B19, rubella, and cytomegalovirus.
○ Other infections, e.g. toxoplasmosis and syphilis, can also cause
polyhydramnios 80,81,82.
Mild Hydramnios
- Mild hydramnios may not cause any problems. Often, extra fluid that appears
during the second trimester returns to normal on its own. Mild hydramnios is
more common than severe hydramnios.
Moderate Hydramnios
- With moderate hydramnios, the extra fluid may make it more difficult for you
to feel your baby moving. You may also be uncomfortable and breathless
because of the extra fluid pressing against your lungs and other parts.
Severe Hydramnios
- Severe hydramnios may mean there is a problem with the fetus
- Birth defects of the brain and spinal column
- Blockages in the digestive system
- A genetic problem (a problem with the chromosomes that is inherited)

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● Fast growth of your uterus
○ Some may exhibit an overly enlarged uterus accompanied with some difficulty
in feeling the baby during prenatal checkups
● Stomach discomfort
● Uterus that is larger than normal for how far along you are in pregnancy
● Labor pains (contractions)
● Dyspnea
● Heartburn
● Fetal malposition
● Uterine discomfort
● Abdominal pain
5. Management
a. Nursing
● Advise the patient to take bed rest to increase uteroplacental
circulation and reduce the pressure on the cervix.
● Help the woman avoid constipation, as straining could increase uterine
pressure and cause rupture of the membranes
● Assess the woman’s vital signs and lower extremity edema frequently
b. Medical
a. Blood tests. Blood tests for infectious diseases associated with
polyhydramnios may be offered..
b. Nonstress test. This test checks how your baby's heart rate reacts
when your baby moves. During the test, you'll wear a special device
on your abdomen to measure the baby's heart rate. You may be asked
to eat or drink something to make the baby active. A buzzer-like
device also may be used to wake the baby and encourage movement.
c. Biophysical profile. This test uses an ultrasound to provide more
information about your baby's breathing, tone and movement, as well
as the volume of amniotic fluid in your uterus. It may be combined
with a nonstress test.
c. Pharmacologic
● Prostaglandin Synthetase Inhibitor
- This stimulates fetal secretion of arginine vasopressin which results to
vasopressin induced antidiuresis, which reduces renal blood flow that
results to reduced urine output. Moreover, this also inhibits fetal lung

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liquid production or can increase the reabsorption. This medication is
used in the 1st and 2nd trimester of pregnancy and patients are
advised not to take these medications after the 28th day of gestation.
● Sulindac and Indomethacin
- These are non steroidal anti-inflammatory drugs (NSAIDs) and are
used to reduce amniotic fluid volume.
d. Surgical
Amniocentesis may be used by the doctor to remove extra amniotic fluid from
your uterus. This technique has a low risk of complications, such as preterm
labor, placental abruption, and premature membrane rupture.

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Source: Polyhydramnios - Symptoms and causes. (2020, December 8). Mayo Clinic.
Retrieved February 4, 2022, from

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https://www.mayoclinic.org/diseases-conditions/polyhydramnios/symptoms-causes/syc-2036
8493
Video: https://www.youtube.com/watch?v=95pCZM_Hfxk

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NURSING CARE PLAN (HYDRAMNIOS)
Needs/Problems/Cu
es
Interventions
Rationale
I. Physiological
Problem:
Acute Pain
Objective Cues:
- Sweating
- Shows facial
grimace
- Restlessness
Subjective cues:
- The client
verbalized
that she is
experiencing
cramping in
her abdomen
and back.
- The client
rates the pain
intensity 7 out
of 10
Acute pain related to
increased uterine
pressure as
evidenced by pain
rate of 7 out of 10
As pregnancy
progresses, the
uterus stretches and
the pelvic floor
weakens to
accommodate the
growing baby. This
pressure can cause a
feeling of fullness in
the vagina or
generalized pain and
pressure in the hips,
abdomen, and pelvis.
Villines, Z. (2020,
January 18). Is
having vaginal
pressure during
pregnancy normal?
Medical News Today.
https://www.medicaln
ewstoday.com/article
s/322304#:%7E:text=
The%20extra%20wei
After 8 hours of
to report that she
feels comfortable and
better.
After 3 hours of
the client will:
1. Provide a pain
intensity of 4 or
lower.
2. Understand the
risks and underlying
causes of the acute
pain
3. Display a better
behavior and/or
Independent
1. Obtain
consent from
the patient to
perform
amniocentesi
s (as ordered)
after
explaining the
procedure’s
purpose,
benefits, and
risks
2. Conduct a
comprehensiv
e of pain
using
COLDSPA
1. Severe cases may
require the drainage
of excess amniotic
fluid through
amniocentesis. This
procedure will help
reduce the pressure
in the uterine and
abdominal walls, thus
alleviating the pain.
2. Using COLDSPA
will help improve the
nurses’
understanding of the
patient’s concerns.
This allows the nurse
to create a
customized nursing
care plan that
effectively addresses

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ght%20of%20pregna
ncy,in%20the%20hip
s%20and%20pelvis.
McDermott, A. (2015,
June 18). Abdominal
Pain During
Pregnancy: Is It Gas
Pain or Something
Else? Healthline.
https://www.healthlin
e.com/health/pregna
ncy/gas-pain-during-
pregnancy#round-lig
ament-pain
mood
3. Place the
mother on
close
monitoring
4. Assess the
patient’s vital
signs
Dependent
1. Administer
medications
prescribed for
the
management
of Amniotic
Fluid Volume
(AVF)
2. Administer
the patient’s need for
comfort.
3. Pregnant women
with mild hydramnios
will be closely
monitored for any
worsening signs and
symptoms.
4. To monitor
effectiveness of
medical treatment for
the pain of relief.
1. The physician may
prescribe medication
to facilitate the
reduction of the AVF.
2. To alleviate
abdominal pain.

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medications
as ordered for
pain
References:
Centers for Disease Control and Prevention. (2021, December 8). Sexually transmitted diseases. Retrieved from
https://www.cdc.gov/std/general/default.htm#:~:text=Sexually%20transmitted%20diseases%20(STDs)%2C,%2C%20oral%2C%20and%
20anal%20sex.
Centers for Disease Control and Prevention. (2022, January 14). Suffering from a urinary tract infection? Retrieved February 4, 2022, from
https://www.cdc.gov/antibiotic-use/uti.html
Habak, P. J., & Griggs, R. P. (2021, July 10). Urinary Tract Infection In Pregnancy. National Center for Biotechnology Information. Retrieved
February 4, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK537047/
Healthdirect Australia. (2019, December). Multiple birth - triplets or more. Pregnancy Birth and Baby. Retrieved February 4, 2022, from
https://www.pregnancybirthbaby.org.au/multiple-birth-triplets-or-more#:%7E:text=In%20about%203%20out%20of,sudden%20breaking%20of%
20the%20waters
Hamza, A., Herr, D., Solomayer, E. F., & Meyberg-Solomayer, G. (2013). Polyhydramnios: Causes, Diagnosis and Therapy. Geburtshilfe und
Frauenheilkunde, 73(12), 1241–1246. https://doi.org/10.1055/s-0033-1360163

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Mavrogiannis, M. (2020, November 22). TORCH Infection What Is It, Symptoms, Treatment and More. Osmosis. Retrieved February 04, 2022,
from https://www.osmosis.org/answers/torch-infectionfrom
Mayo Clinic. (2018, October 26). Drug addiction(Substance abuse disorder). Retrieved from
https://www.mayoclinic.org/diseases-conditions/drug-addiction/symptoms-causes/syc-20365112
National Institute on Drug Abuse. (2019, January). Treatment approaches for drug addiction drugfacts. Retrieved from
https://nida.nih.gov/publications/drugfacts/treatment-approaches-drug-addiction
Gateway. (2020, September 4). Warning Signs and Symptoms of Substance Drug Abuse in Adults. Retrieved February 3, 2022, from
https://www.gatewayfoundation.org/faqs/signs-and-symptoms-of-drug-abuse-in-adults/
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