Subinvolution

Description
  • Subinvolution is delayed return of the enlarged uterus to normal size and function.
Etiology
  • Subinvolution results from retained placental fragments and membranes, endometritis, or uterine fibroid tumor; treatment depends on the cause .
Pathophysiology
  • Uterine atony or placental fragments prevent the uterus from contracting effectively.
Assessment Findings

Clinical manifestations include:

  1. Prolonged lochial discharge
  2. Irregular or excessive bleeding
  3. Larger than normal uterus
  4. Boggy uterus (occasionally)
Nursing Management

1. Prevent excessive blood loss, infection, and other complications.

  1. Massage uterus, facilitate voiding, and report blood loss.
  2. Monitor blood pressure and pulse rate.
  3. Administer prescribed medications. (see Drug Chart )
  4. Be prepared for possible D&C.

2. Assist the client and family to deal with physical and emotional stresses of postpartum complications.

Drug Chart Medications Used for Postpartum Complications
 Classifications  Used for  Selected Interventions
Anticoagulants

Heparin sodium injection
(Hepalean)
Lovenox
  • Blocks the conversion of prothrombin to thrombin and fibrinogen to fibrin thus decreasing clotting ability
  • Inhibits thrombus and clot formation
  • Heparin IV should be administered as a “piggy back” infusion.
  • Heparin SQ is given deep into the site (abdomen), sites are rotated, do not aspirate, apply pressure (do not massage).
  • Used to prevent and treat pulmonary embolism and thrombosis.
Warfarin sodium

(Coumadin, Warfilone)
  • Interferes with hepatic synthesis of vitamin K –dependent clotting factors (II,VII, IX, X)
  • Women on anticoagulopathy therapy should no be given estrogen or aspirin.
  • Obtain baseline coagulation studies.
  • Obtain serial coagulation studies while the client is on therapy.
  • Keep protamine sulfate readily available in case of heparin overdose.
  • Assess client for bleeding from nose, gums, hematuria, and blood in stool.
  • Observe color and amount of lochia. Institute pad count.
  • Avoid IM injections to avoid formation of hematomas.
  • Inform the client that this drug does not pass into breast milk.
  • Monitor for the following side effects; hemorrhage, bruising urticaria, and thrombocytopenia.
  • Women on anticoagulant therapy should not be given estrogen or aspirin.
  • Obtain baseline coagulation studies while on therapy.
  • Keep AquaMEPHYTON (vitamin K) on hand in case of Coumadin overdose.
  • Assess client for bleeding from nose, gums, hematuria, and blood in stool.
  • Observe color and amount of lochia. Institute a pad count.
  • Avoid IM injections to avoid formation of hematomas.
  • Inform the client that this drug passes into breast milk and its use is contraindicated during pregnancy. Monitor the following side effects: hemorrhage, fever, nausea, and cramps.
Oxytoxic

methylergonovine
maleate
(methergine)
(PO, IM, IV)
  • Directly stimulates uterine and vascular smooth muscle
  • Promotes uterine contraction
  • Used for prevention and treatment of postpartum or postabortion hemorrhage caused by uterine atony or subinvolution.
  • Obtain a baseline calcium level.
  • Advise the client that this medication will cause menstrual-like cramps.
  • Assess for numb fingers and toes, cold, chest pain, nausea, vomiting, muscle pain, and weakness.
  • May cause decreased serum prolactin.
  • IV administration is used for emergency dosage only. Administer at a rate of 0.2 mg over at least 1 minute.
  • DO NOT MIX THIS DRUG WITH ANY OTHER DRUG.
  • Use solution only if it is clear and colorless, with no precipitate. May store at room temperature for 60 days. The drug deteriorates with age.
  • Monitor for the following side effects: dyspnea, palpitations, diaphoresis, chest pain, hypotension, and headache.
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