HESI OB EXAM GUIDE AND NOTES- GREEN BOOK EXAM NOTES

HESI OB EXAM GUIDE AND NOTES- GREEN BOOK EXAM NOTES Normal Puerperium (Postpartum): Period after pregnancy and delivery (usually 6 weeks) then the body 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,