(g) Other complications include pulmonary hemorrhage, pneumonia,
Nursing care considerations.
Observe for respiratory distress.
(b) Monitor I&O.
Provide stable thermoregulation. Keep the infant warm and away
(d) Support the parents by listening and answering questions.
Jaundice is a marked accumulation of serum bilirubin levels.
(1) Physiologic. Jaundice occurs after 24 hours past delivery and
generally disappears seven to ten days after delivery. It is caused by the inability of the
infant's immature liver to modify bilirubin so it can be excreted from the body.
(2) Pathologic. Jaundice occurs before the baby is 24 hours of age and
persists beyond seven days. It may be caused by Rh or ABO incompatibility sepsis,
excessive bruising, or metabolic disorders.
b. Signs and Symptoms.
(1) Appearance. Jaundice is a yellowish appearance in the skin, sclera of
the eye, or oral mucosa. The onset of jaundice is usually on the face with advancement
to the trunk and extremities. Blanching the skin on a bony prominence allows for easy
NOTE: The blanch test refers to applying pressure with the thumb over a bony area for
several seconds to empty all capillaries in that spot. The blanched area will
look yellow before the capillaries of jaundice is present.