The difference between physiological and nonphysiological jaundice is that nonphysiological jaundice

Choice A) Calm, easy to comfort is incorrect because this is not a sign of intrauterine drug exposure, but rather a sign of normal or healthy newborn behavior. Newborns who are calm and easy to comfort are usually well-adjusted and have a good temperament. They respond positively to soothing techniques such as holding, rocking, or singing.

They do not show signs of distress or withdrawal, which are common in newborns who are exposed to drugs in utero. Therefore, this response is irrelevant and inaccurate.

Choice B) Tremors is correct because this is a sign of intrauterine drug exposure that can indicate neurological damage or withdrawal syndrome. Tremors are involuntary shaking or quivering movements of the body or limbs that occur due to abnormal electrical activity in the brain or nervous system. Newborns who are exposed to drugs such as opioids, cocaine, or alcohol in utero may develop tremors as a result of brain injury, hypoxia, hypoglycemia, or seizures. They may also experience tremors as a symptom of neonatal abstinence syndrome (NAS), which is a condition that occurs when the newborn stops receiving the drug from the mother and goes through withdrawal. NAS can cause various physical and behavioral problems in the newborn, such as irritability, poor feeding, vomiting, diarrhea, sweating, fever, or seizures. Therefore, this response is clear and accurate.

Choice C) Persistent shrill cry is correct because this is a sign of intrauterine drug exposure that can indicate pain or discomfort in the newborn. Crying is a normal and natural way for newborns to communicate their needs and feelings. However, some newborns who are exposed to drugs such as opioids, cocaine, or alcohol in utero may cry more often, louder, or longer than usual. They may have a high-pitched or piercing cry that is difficult to soothe or stop. This may be due to various factors such as hunger, colic, infection, injury, or withdrawal. A persistent shrill cry can also affect the bonding and attachment between the newborn and the parents or caregivers. Therefore, this response is clear and accurate.

Choice D) Difficult to console is correct because this is a sign of intrauterine drug exposure that can indicate emotional or behavioral problems in the newborn. Newborns who are difficult to console are usually unhappy and restless. They do not respond well to soothing techniques such as holding, rocking, or singing. They may have trouble sleeping, feeding, or interacting with others. They may also show signs of agitation, anxiety, or depression. These problems may be caused by exposure to drugs such as opioids, cocaine, or alcohol in utero, which can affect the development and function of the brain and nervous system. They may also be influenced by the environment and relationship of the newborn with the parents or caregivers. Therefore, this response is clear and accurate.

Choice a) Breasts firm and tender is incorrect because this is not a sign of normal involution, but rather a sign of breast engorgement, which is a common problem in the first few weeks of breastfeeding. Breast engorgement occurs when thE breasts become overfilled with milk, causing them to feel hard, swollen, painful, and warm. It can be prevented or relieved by frequent and effective breastfeeding, applying warm or cold compresses, massaging the breasts, expressing some milk, and wearing a supportive bra.

Choice b) Episiotomy slightly red and puffy is incorrect because this is not a sign of normal involution, but rather a sign of inflammation or infection of the perineal wound. An episiotomy is a surgical cut made in the perineum (the area between the vagina and the anus) to enlarge the vaginal opening during delivery. It can take several weeks to heal and may cause pain, swelling, bruising, bleeding, or discharge. It can be cared for by keeping the area clean and dry, applying ice packs or witch hazel pads, taking painkillers or sitz baths, and avoiding constipation or straining.

Choice c) Fundus below the symphysis and not palpable is correct because this is a sign of normal involution, which is the process of the uterus returning to its pre-pregnancy size and shape after delivery. The fundus is the upper part of the uterus that can be felt through the abdomen. Immediately after delivery, the fundus is about the size of a grapefruit and can be felt at or above the umbilicus (the navel). It gradually descends about one fingerbreadth per day until it reaches the level of the symphysis pubis (the joint where the two pubic bones meet) by about 10 days postpartum. By 14 days postpartum, the fundus should be below the symphysis and not palpable.

Choice d) Moderate bright red lochial flow is incorrect because this is not a sign of normal involution, but rather a sign of excessive or prolonged bleeding after delivery. Lochia is the vaginal discharge that consists of blood, mucus, and tissue from the lining of the uterus. It changes in color and amount over time, from red to pink to brown to yellow to white. The normal lochia flow should be scant to moderate in amount, dark red to brown in color, and last for about 4 to 6 weeks postpartum. A moderate bright red lochial flow on day 14 postpartum may indicate that the uterus is not contracting well or that there is an infection or retained placental tissue in the uterus.