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Week 5 PP and PP
Complications Recap Q &
A
Chapter 21
- Discuss the process of Involution (ch. 20 pg. 473)
- The return of the uterus to a nonpregnant state after birth
- Process begins immediately after the expulsion of the placenta with contractions of the uterine smooth muscle
- How does this work each day?
- End of third stage of labor → uterus is midline, 2cm below U, within 12 hrs fundus can rise 1cm above U
- Each day, fundus descends 1-2 cm every 24 hrs
- Day 6 PP, fundus between U and symphysis pubis
- Uterus should not be palpable abdominally after 2 weeks, return to prepreg location 6w
- What is after pains?
- periodic relaxation and vigorous contractions, causing uncomfortableness after birth
- resolve 3-7 days PP
- more noticeable after births in which uterus was distended
- breastfeeding and exogenous oxytocin med intensify afterpains
- What should be the normal consistency and location of the fundus immediately after birth? 24 hours after birth? By 2 days PP? By the end of day 9 PP? - Immediately after delivery: Midline, approx. 2cm below the level of the umbilicus - Within 12 hrs: Fundus can rise to the level of the umbilicus or 1 cm above - Every postpartum day after delivery: uterus descends 1-2 cm (fingerbreadths) below the umbilicus. - Uterus can be expected to return to normal pre-pregnant state within 6 weeks postpartum - Which of the following findings would be expected when assessing the PP client? - A. Fundus 1cm above the U on PP day 3 - B. Fundus palpable in the abdomen at 2 weeks PP - C. Fundus slightly to the right and 2cms above the U on PP day 2 - D. Fundus 1cm above the U 1 hour PP
- What if the uterus is displaced to the left of the woman’s abdomen? What might be occurring and how to remedy the situation? - Uterine atony and displacement to the left may indicate a full bladder and possible urinary retention caused by intrapartum factors including epidural anesthesia, episiotomy, extensive vaginal/perineal lacerations, instrument-assisted birth, or prolonged labor. Women who have had indwelling catheters can experience some difficulty voiding following removal. - Encourage the woman to void spontaneously as soon as possible. - Assist to the bathroom or provide her with a bedpan. - Have her listen to running water, place hands in warm water, or pour warm water over her perineum from a squeeze bottle. - If anticipated pain is preventing voiding, provide analgesics. - Catheters may be inserted if other measures are unsuccessful. - She can void up to 3000ML/day for first 2-3 days (prior output minimum 30ml/hr)
- Describe the different phases of lochia-consistency, color, last how many days? Can a woman move back and forth through the various phases of lochial changes? - Rubra: dark red and consists mainly of blood and decidual and trophoblast debris (up to 3 days PP) - Serosa: pink or brown; days 4- - old blood, serum, leukocytes, tissue debris - Alba: yellow or white, days 10- - leukocytes, decidua, epithelial cells, mucus, serum, bacteria - lochia can persist up to 4-8 weeks after birth, flow of lochia increases with ambulation and breastfeeding - On which of the PP days can the client expect to see lochia serosa? - A. Day 3 and 4 PP - B. Days 4-10 PP - C. Days 10-14 PP - D. Days 14-21 PP
- What is considered excessive lochia? What can be possible causes of excessive lochia discharge?
- Vaginal laceration: occur in conjunction with perineal laceration; extend up lateral wall
- Cervical injuries: occur when cervix retracts over advancing fetal head; occur at the angles of external os
- When and why would a nurse assess for REEDA?
- Nurses should assess episiotomies, laceration repairs, and cesarean incisions for redness (erythema, edema, ecchymosis (bruising), drainage, and approximation (REEDA).
- Signs of wound infection include fever, edema, warmth, tenderness, pain, seropurulent drainage, and wound separation.
- Does estrogen and progesterone decline or increase in the PP period?
- decreases occur after the expulsion of the placenta
- estrogen and progesterone levels drop and reach their lowest 1 week PP
- decreases in estrogen levels associated with diuresis of excess ECF
- What is the function of prolactin?
- Prolactin levels in blood rise progressively throughout pregnancy.
- Prolactin levels increase after birth as progesterone decreases.
- Prolactin levels are highest during the first month after birth in breastfeeding women and remain elevated above nonpregnant levels as long as she is breastfeeding.
- Serum prolactin levels are influenced by the frequency of breastfeeding, the duration of each feeding, and the degree to which supplementary feedings are used.
- Individual differences in the strength of an infant’s sucking stimulus also affect prolactin levels.
- In nonlactating women, prolactin levels decline after birth and reach the prepregnant range by the third postpartum week
- What are the functions of Oxytocin in the PP period?
- Oxytocin is essential to lactation. As the nipple is stimulated by suckling, the posterior pituitary is prompted by the hypothalamus to produce oxytocin.
- Oxytocin is responsible for the milk ejection reflex (MER) or let-down reflex.
- Myoepithelial cells surrounding the alveoli respond to oxytocin by contracting and sending milk forward through the ducts to the nipple.
- MER is triggered by thoughts, sights, sounds, and odors that the mother associates with her baby - such as hearing the baby cry.
- MER can also be triggered during sexual activity as oxytocin is released during orgasm.
- Oxytocin stimulates uterine contractions, and can trigger MER during labor which readies the breasts for feeding after birth.
- Uterine contractions stimulated by oxytocin also help to control postpartum bleeding and promote uterine involution. Mothers who breastfeed are at decreased risk for PPH.
- When do menses return for breastfeeding (BF) mothers and bottle-feeding mothers?
- Depends on breastfeeding status
- Non-breastfeeding: 7-9 weeks for menses to return
- Breastfeeding: 6-18 months
- Contraception must be used with intercourse as breastfeeding is not a guaranteed method of birth control
- Discuss weight loss in the PP period:
- Average of 12 lbs lost immediately after childbirth
- 5-8 lbs lost from uterine involution and diuresis/diaphoresis:
- Postpartal diuresis, caused by decreased estrogen levels, removal of increased venous pressure in lower ext., and loss of the remaining pregnancy induced increase in BV, aids body in ridding excess fluid
- UO of 3000mL each day between days 2-3 is normal
- fluid loss thru perspiration and increased UO accounts for weight loss of about 2.25 kg (5lbs) during early puerperium
- 12 months to pre-pregnant weight
- Discuss the phenomenon of excessive diuresis? Why is it important to assess the bladder?
- Within 12 hrs pp: begin to lose excess fluid from tissues
- Postpartum diuresis is caused by:
- Decreasing estrogen levels
- Decreased venous pressure in lower extremities
- Loss of blood volume
- Decreased aldosterone (leading to less sodium retention)
- Urine output of 3000ml/day common for first 2-3 days pp
- Factors leading to urinary retention?
- Immediately PP, bladder may be congested, edematous, and hypotonic
- Causes:
- Episiotomy/laceration (3rd/4th degree)
- Perineal edema/tenderness
- Prolonged labor
- Assisted vaginal delivery (forceps/vacuum)
- Previous catheterization
- Anesthesia
- When should you expect the woman to void? After assessing the woman, it is determined she had a bulge on the right side and therefore has a full bladder with boggy uterus and displacement to the side at +2. What would be your interventions in this scenario? (488/491)
- mother should void within 4 hrs post-delivery
- volume of at least 150mL for each voiding
- interventions for inability to void → listen to running water, place hands in warm water, pouring water over perineum, shower or sitz bath, relaxation techniques, analgesics
- Perform straight cath if unable to void, especially if interfering with uterine contractility and increased lochia
- A mother is 1 day PP and complains of frequent trips to the bathroom to void. She
- What should you teach your patient who is planning not to breastfeed?
- May have profuse nodules and engorgement as milk comes in
- Breast distention is primarily due to congestion of veins and lymphatics (rather than continuous accumulation of milk) - Do not express milk!! - Well fitted/supportive bra - Ice packs - Cool cabbage leaves may relieve pain & swelling - No stimulation of breasts - No warm water falling on breasts in shower - Mild analgesics
- Engorgement discomfort usually ceases within 24-36 hours
- Lactation ceases within a week
- Why is Cardiac Output (CO) elevated 2-3 days PP?
- The immediate blood loss reduces plasma volume without reducing cardiac output. This is due to the compensatory influx of nearly 500 ml of blood into the maternal system from the uteroplacental bed, a rapid decrease in uterine blood flow, and mobilization of extracellular fluid.
- Typically cardiac output is increased immediately after birth by 60% to 80% over prelabor values; it returns to pre-labor values within 1 hour. By 2 weeks after birth, cardiac output decreases by 30% and gradually decreases to prepregnant levels by 6 to 8 weeks postpartum in the majority of women.
- How does the body get rid of excessive blood volume?
- During the first few days after birth the plasma volume decreases further as a result of diuresis
- Urine output of 3000 ml or more each day during the first 2 to 3 days is common. Profuse diaphoresis often occurs, especially at night, for the first 2 to 3 days after birth.
- Fluid loss through perspiration and increased urinary output accounts for a weight loss of approximately 2.25 kg (5 lb) during the early puerperium.
- Is Leukocytes of 30,000/mm3 during the PP period abnormal? List your rationale.
- 30,000/mm3 during the PP period is abnormal
- normal values during pregnancy: 12,000/mm
- 4-7 days after birth: 20,000-25,000/mm3 normal < acute infection
- When is the best time to check H&H after delivery? What is expected initially then later?
- H & H may fluctuate during the first PP days
- Hct may rise immediately after delivery as a result of hemodilution and dehydration
- Average blood loss: H & H may drop moderately for 3-4 days
- Considerable blood loss: H & H may drop further and require interventions
- By 8 weeks PP, values return to normal
- Why are women prone to clots in the PP period?
- Clotting factors and fibrinogen are normally increased during pregnancy and remain elevated in the immediate puerperium.
- When combined with vessel damage and immobility, this hypercoagulable state causes an increased risk for venous thromboembolism, especially after a cesarean birth
- Fibrinolytic activity also increases during the first few days after birth.
- Factors I, II, VIII, IX, and X decrease to nonpregnant levels within a few days.
- Integumentary changes- what will take place in the PP period?
- melasma disappears
- hyperpigmentation of areola and linea negra may not regress after birth
- striae gravidarum may fade but do not disappear completely
- spider angiomas (nevi) and palmar erythema regress as a response to decreased estrogen
- 3 months after birth, woman report hair loss
- What are things to keep in mind when giving instructions on ambulating and why is this important? Bedrest?
- early ambulation reduces risks of venous thromboembolism (VTE)
- free movement is encouraged after analgesia wears off, ambulate frequently
- inform the woman that she may feel dizzy or lightheaded assess BP
- How would you teach a patient about Kegel Exercises and its importance?
- kegel exercises strengthen muscle tone, helps woman regain muscle tone that is lost as pelvic tissues are stretched and torn during preg
- performing exercises incorrectly increase risk of incontinence
- Assessing for clots? Homan’s Sign- performed yes or no?
- Assessment:
- Palpation/Inspection: warmth, tenderness erythema, hardness or nodules along a vein
- Assess DTRs and clonus
- Assessment of Homan’s sign (per hospital policy):
- Straighten the pts leg flat on the bed or hold her heel in your hand
- Let her total weight rest in your hand or on the bed
- Gently flex the foot toward the body
- Feeling of pain in the calf upon flexion of either foot is positive for Homan’s sign
- Although a positive Homan’s sign may be a sign of a thrombotic disorder, it is not a definitive sign
- A PP patient is experiencing headaches? What could be the possible cause and how would you assess further? What about blurred vision and photophobia?
follows: T: 100.5, P: 90, RR: 20, BP 90/50. Her PP assessment is unremarkable. What is the nurses’ best initial intervention now?
- A. Increase your assessment of vital signs - B. Give the mother more to drink and return to check her VS in an hour - C. Notify the doctor or midwife - D. Get her up to urinate as that is why she is feeling warm
- What determines and influences length of stay in the hospital after delivery?
- Vaginal delivery: 24-48 hrs
- C-section: 72-96 hrs
- After delivery of the placenta what is the expected procedure for vital signs assessment for vaginal delivery, cesarean section, what else is involved in the assessment of these two women with the two modes of delivery? (Incentive spirometer (IS), wound care, REEDA, Ambulation, I&O, Foley, IV, sexual activity, baby care, F/U, etc.)
- The doctor orders simethicone and Colace for the woman after delivery? What is the expected mechanism of action? Is it okay to give her both? Simethicone helps break down gas bubbles inside the intestines to decrease gas and flatulence. Colace on the other hand increases water absorption in the gut, therefore softening the stool in the process. These two are given together in order to relieve and help the mother in having a more comfortable bowel movement. Sometimes mothers who had a vaginal delivery can have lacerations or had an episiotomy so these meds help prevent irritation of these wounds and promote healing.
- What is involved in teaching for the woman who had a baby for the first time, second time, vaginal VS c-section? Evaluation of teaching? Discuss my experience here and as a legal consultant? Include Health Promotion measures
- Determine knowledge base of patient and examine patient’s desired goals
- Areas of teaching:
- Uterine involution: fundal palpation
- Lochia changes including amount and color
- Hand-washing, change peri-pad upon saturation or with each void, clean linens/chucks, peri-bottle clean, wipe/pat using spray bottle in front to back method
- Breast care and breastfeeding
- Measures to suppress lactation if not breastfeeding
- Perineal care/lacerations/episiotomies/c-section
- Kegel exercises
- Promoting rest/sleep
- Nutrition and fluid maintenance
- Exercise
- Resuming sexual activity: usually after first appointment in office at 6 weeks PP
- Follow-up MD appointments:
- C-section: 2 weeks & 6 weeks PP
- Vaginal: 6 weeks PP
- Follow-up MD appointments:
- Signs of infection: maternal and newborn
- Evaluation: return demonstration or verbalizing understanding
- What vaccines might be given to the woman in the PP period and time frame for some?
- Rubella, MMR, TDAP
- RhoGAM: may be given within 72 hrs after birth to prevent sensitization in the Rh negative woman who may have had a feto-maternal transfusion of Rh positive fetal RBCs
- Given routinely at 28 weeks then again at 72 hrs post delivery if baby is Rh positive and mom is Rh negative.
- May also be given anytime prenatally if mom was in MVA or fell on abdomen. Chapter 22
- Describe the following phases: 1) Taking in, 2) Taking Hold and 3) Letting Go?
- Taking in
- first 24 -48 hours after delivery
- focus: self and meeting of basic needs
- reliance on others to meet needs for comfort, rest, closeness, and nourishment
- excited and talkative
- desire to review birth process experience _- Maternal passivity and dependence
- Preoccupation with self
- Reviews the reality of giving birth
- Compares infant to her “fantasy child”
- Concerned with rest, food, and comfort_
- Taking hold
- Focus: care of baby and competent mothering
- Desire to take charge
- Still has need for nurturing and acceptance by others
- Eagerness to learn and practice, possible experience with “blues” _- Resumes control over her life
- Concerned about self-care
- Interested in caring for her newborn
- Begins to gain self-confidence_
- Letting go
- Focus: forward movement of family as unit with interacting members
- Reassertion of relationship with partner
- Resumption of sexual intimacy
- Resolution of individual roles _- May take several weeks to reach
- Influenced by cultural beliefs_
or pain in genital tract, boggy or displaced uterus, and decreasing hematocrit levels. Late signs of PPH include decline in blood pressure, tachycardia, tachypnea, cold and clammy extremities, lightheadedness, or paleness (Lowdermilk et al., 2016).
- What are involved in PP thrombophlebitis? Inflammation of a vein with secondary clot formation. Caused by venous stasis and hypercoagulation. Immobilization especially after C-section. Bed rest increases risk. Superficial venous thrombosis is the most common form of postpartum thrombophlebitis. It is characterized by pain and tenderness in the lower extremity. Physical examination may reveal warmth; redness; and an enlarged, hardened vein over the site of the thrombosis.
- Discuss the various PP infections? Possible causes? Findings? Cllinical infection of the genital tract that occurs within 28 days after miscarriage, induced abortion, or birth also includes mastitis. Caused by streptococcal and anaerobic organisms. Endometritis -most common that usually begins at the placental site. Higher rate after cesarean birth; fever, increased pulse, chills, anorexia, nausea, fatigue and lethargy, pelvic pain, uterine tenderness, and foul-smelling, profuse lochia Cesarean incision and repaired lac or episiotomy site - fever, erythema, warmth, tender, pain, drainage, and wound separation. UTI -low-grade fever, dysuria, frequency and urgency, urinary retention, hematuria, and pyuria. Chapter 31 Substance Abuse/Mental Illness
- Mr. S.J. called the PP unit stating his wife cries then happy and then cries again and he is not sure what to do. How would you respond and what do you need to know? What might you suspect?
- Mr. S.J. calls back a few days and states his wife is crying a lot and does not want to take a shower or feed the baby? What might be occurring here and how would you assess and respond?
- Mr. R.R. calls asking for help because his wife had a baby recently and states she is hearing voices and no interest in any activities. What are you wanting to find out more about?
- What goes hand in hand with substance abuse for most part? Barriers to treatment? What are the 4 P’s in the assessment? 4Ps stand for Parents, Partner, Past, and Present To conduct the 4Ps Screening: ASK:
- Parents: Did any of your parents have problems with alcohol or other drug use?
- Partner: Does your partner have a problem with alcohol or drug use?
- Past: In the past, have you had difficulties in your life because of alcohol or other drugs, including prescription medications?
- Present: In the past month, have you drunk any alcohol or used other drugs?
- Tobacco use during pregnancy and put the pregnancy at risk for what?
- Fetal tobacco exposure is well known to be a risk factor for low birth weight and intrauterine growth restriction (IUGR). Decreasing birth weight is related to the number of cigarettes smoked.
- Multiple studies have demonstrated a clear association between maternal smoking and perinatal morbidity and mortality.
- Maternal complications related to smoking include placenta previa, placental abruption, preterm premature rupture of membranes, and ectopic pregnancy.
- Fetal and neonatal risks related to maternal tobacco use include IUGR, low birth weight, perinatal mortality, and sudden infant death syndrome.
- Children born to mothers who smoke during pregnancy are at increased risk of asthma, infantile colic, and childhood obesity
- What about alcohol use during pregnancy?
- Alcohol is a known teratogen. It easily crosses the placenta to the fetus. A significant concentration of the drug can be identified in the amniotic fluid as well as in maternal and fetal blood. Ethanol has direct teratogenic effects during the embryonic and fetal stages of development. It also causes altered neurotransmitter levels in the brain, altered brain morphology and neuronal development, and hypoxia.
- Prenatal exposure to alcohol is probably the most common preventable cause of cognitive disability in the United States.
- Children exposed to binge drinking are 1.7 times more likely to be intellectually impaired and 2.5 times more likely to demonstrate delinquent behavior than children who were not exposed to alcohol.
- Disorders associated with prenatal alcohol exposure include fetal alcohol syndrome (FAS), alcohol-related birth defects (ARBDs), and alcohol-related neurodevelopmental disorder.
- Discuss the use of Cocaine and Methamphetamine?
- Methamphetamine readily crosses the placenta and the blood-brain barrier and stimulates the CNS. Maternal risks associated with its use include preterm birth and placental abruption. Fetal effects include small size, lethargy, and heart and brain abnormalities
- Pregnant cocaine users have an increased incidence of miscarriage, preterm labor, and placental abruption. They may give birth to infants who are small for gestational age. Intrauterine fetal demise (IUFD, stillborn) is also a risk. Because cocaine easily crosses both the placenta and the blood-brain barrier, it can cause significant teratogenic effects in the developing fetus
- Neonate withdrawal symptoms:
- Irritability
- Seizures
- Hyperactivity
- High pitched cry
- Tremors
- Hyper-reflexia
► ROM x 30 hours, meconium ► Labor x 36 hours ► Delivered at 37 weeks 6 days ► Baby in NICU, FOB in NICU with baby ► Maternal VS: T 100.7, P 90, R 20, BP 90/ ► Scenario ► Connie, 30 years old ► G2 P ► B+, GBS neg ► Was on modified bedrest x 3 weeks for PTL ► 5’2, 260lbs ► Delivered at 35 weeks ► Postpartum day 3 ► Had CPD during labor ► Father of baby at side ► Hasn’t gotten out of bed since birth ► Scenario ► Lisa, 37 years old ► G5 P5 A0 L ► O+, GBS neg ► Baby weighed 4100 grams ► She is hoping to go home tomorrow ► FOB home with the other kids ► Bleeding just increased, saturated a pad in one hour ► Vitals BP 120/78, P 82, R 18, T 99. ► Scenario
► Lisa, 17 years old ► G2 P1 A1 L ► O+, GBS unknown, Rubella non-immune ► Delivered at 39 weeks ► Within 2.5 hours of onset of delivery ► On day of delivery, hoping to go home tomorrow ► FOB not involved ► Bleeding just increased, saturated a pad in 15 minutes ► Vitals BP 118/78, P 82, R 22, T 100. Scenario ► Joan, 16 years old ► G2 P1 A1 L ► O+, GBS Neg ► Hx of Bipolar Disorder ► Delivered at 41+1 weeks ► On day of delivery, hoping to go home tomorrow ► FOB not involved ► Bleeding just increased, saturated a pad ► Fundus firm @U, midline, voided 500 mL 15 minutes ago ► Vitals BP 90/55, P 110, R 22, T 100. Scenario ► Jill, 39 years old ► G1 P1 A0 L ► O+, GBS unknown, Tdap was 12 years ago ► Was given Pitocin Augmentation due to quality of contractions less intense and spacing out with slow dilation and effacement ► Labor lasted 47 hours and ended in a cesarean section for failure to progress
5. Vacuum assist: Vacuum extraction involves attachment of a vacuum cup to the fetal head. Generally not performed prior to 34 weeks gestation. Indications for use are the same as forceps assist. There must be informed consent, a completely dilated cervix, ruptured membranes, engaged head, vertex position, and no suspicion of cephalopelvic disproportion(CPD). Vacuum assists require an experienced operator and adequate anesthesia. The woman will be encouraged to push during contractions. Risk to the newborn includes cephalohematoma, scalp lacerations, and subdural hematoma. This puts the baby at risk for hyperbilirubinemia and neonatal jaundice. The caput succedaneum usually disappears in 3- days. Maternal risks include laceration and soft tissue damage. FHR should be assessed frequently. 6. Hemolytic disease of the newborn (Rh and ABO) - Rh Incompatibility: when mom is negative and baby is positive (w/Rh --> positive, w/o Rh -- > negative) - affects subsequent pregnancies - RhoGAM given at 24-48 wks gestation or 72 hrs after birth - ABO Incompatibility: blood group of mother and baby conflict - Mom: Type O (has Anti-A and Anti-B) - Baby: Type A, B, or AB (Anti-B, Anti-A, or no antibodies, respectively) --> maternal blood type causes baby’s blood to lyse - Pathophys: antigens attack babies blood --> baby compensates by making more RBCs (immature RBCs) --> unconjugated bilirubin rises --> jaundice w/in 24 hrs of birth - Diag: CBC, bilirubin, Coomb’s (Rh worse than ABO) - Prevention: Early ID via Coombs test (maternal antibody titer) --> (+) --> amniocentesis done to type fetus - Treatment: phototherapy, transfusion (5-10 mL at a time), RhoGAM - Complications: Erythroblastosis Fetalis (destruction of fetal blood cells by mom’s antibodies), Hydrops Fetalis (severe hemolysis, anemia. 7. Apgar : 1 and 5 min --> if baby adjusting to outside world A ctivity (muscle tone active) P ulse(>100) G rimace(prompt response to stimulus) A ppearance(pink) R espiration(Vigorous cry). These values will give 10 on APGAR score. -8 to 10: good -10 min means interventions, 7 score means stimulation Neonate/newborn Adaptation to outside (extrauterine) world normal and abnormal findings PP hemorrhage – assessment, causes, early and late, treatments, various type caused by uterine atony
VS not caused by uterine atony
8. AROM : Artificial Rupture of the Membranes In situations where the cervix is ready for delivery labor can be induced through an amniotomy. An Amnihook or other sharp instrument is inserted through the vagina and cervix. Labor usually begins within 12 hours of AROM. It is often used in conjunction with oxytocin induction. There are some risks involved such as: 1) If labor does not begin chorioamnionitis can be caused (inflammation and infection of the placenta and chorion). 2) Variable FHR deceleration patterns can occur as a result of cord compression associated with umbilical cord prolapse or a decrease in amniotic fluid. Nursing considerations: 1) Explain what will be done 2) Assess FHR before procedure for baseline 3) Place underpads under patient to collect fluid 4) Elevate hips with rolled towel, padded bedpan, or fracture pan 5) Assist with procedure (sterile gloves/lubricant) 6) Reassess FHR 7) Assess color consistency and odor of the fluid 8) Assess temperature every 2 hours or by protocol 9) Assess for signs and symptoms of an infection. 9. SROM Meconium fluid - Meconium Aspiration Syndrome: in utero --> hypoxic episode -Causes: placental insufficiency, maternal HTN, preeclampsia, oligo, drug use -S/S: cyanosis, grunting, nasal flaring, intercostal retractions, tachypnea, barrel chest, green urine (meconium pigments absorbed in lungs and excreted as urine) -Treatment: amnioinfusion, suction, mech vent, Abx, strict I/O, dark/minimal touching environment, IV sedation, x-rays Jaundice (types, causes, treatment, etc.) -Jaundice: excessive accumulation of bilirubin in blood à yellow skin -unconjugated/indirect: not soluble in water; must be broken down in liver -conjugated/direct: water soluble; excreted in feces and urine -Causes: inability to keep up w/rapid breakdown of RBCs, immature liver, bile duct
