HESI OB EXAM GUIDE AND NOTES- GREEN BOOK EXAM
NOTES
Normal Puerperium (Postpartum): Period after pregnancy and delivery (usually 6 weeks)
then the body
... [Show More] return to the nonpregnant state.
-Myometrial contractions occur for 12-24 hours postdelivery due to high oxytocin levels
-Involution occurs (1-2 cm/day)
First day: at or 1-2cm above umbilicus
7-10 days: decreases to 12 week size, slides back under symphysis pubis
-Cervix heals within 6 weeks
-Rugae in the vagina reappear within 3 weeks
-Vaginal walls are thin and dry until ovulation returns
-Engorgement of breasts may occur 2-3 days PP.
At Delivery:
-Maternal vascular bed is reduced by 15%
-Pulse may decrease to 50 (normal puerperal bradycardia)
-These changes are hypothesized to result in shivering
-BP and pulse should quickly return to prepregnant levels
First 72 Hours:
-24-48 hours pp, cardiac output remains elevated, will return to nonpregnant levels in
2-3 weeks.
-Diaphoresis (especially at night) helps restore normal plasma volume
-Hct rises, WBC count is elevated (12k-25k), diff to use WBC level for determining
infection
-Blood clotting factors are elevated; increased risk for thromboembolism
-Diuresis occurs; up to 3000 mL/day of urine
-Bladder distention and incomplete emptying are common
-Increase risk for UTI
-Urine glucose, creatinine, and BUN levels are normal after 7 days
-Excess analgesia and anesthesia may decrease peristalsis
-No bowel movements are expected for 2-3 days
-Hyperpigmentation regress, but some areas may remain permanently darker
-Pelvic muscles regain tone in 3-6 weeks
-Abdominal muscles regain tone in 6 weeks unless diastasis recti occurs
Normal Signs after Delivery for Mom:
-Temp of 100.4 F due to dehydrating effects of labor. If any higher could be infection
and needs reported.
-Pulse may decrease to 50. If greater than 100 may indicate excessive blood loss or
infection
-BP should be normal. If decreased, suspect hypovolemia, if increased suspect
preeclampsia
-RR rarely changes. If increase significantly suspect pulmonary embolism, uterine atony, [Show Less]