Subinvolution
Included In This Lesson
Outline
Overview
- Subinvolution is a medical condition in which after childbirth, the uterus does not return to its normal size.
Nursing Points
General
- Fundal height normally drops by 1 cm below the umbilicus per day postpartum
- Contraction of uterus clamps down and prevents bleeding
- Subinvolution = Large risk of postpartum hemorrhage
Assessment
- More uterine bleeding than expected
- Fundal height not decreasing as expected
- Uterus larger than expected
Therapeutic Management
- Treat the cause
- Remove retained fragments
- Treat infection
- Get the uterus to contract
- Medications to contract the uterus
- Oxytocin
- Methylergonovine
- Carboprost Tromethamine
Nursing Concepts
- Clotting
- Perfusion
- Safety
Patient Education
- Report any pain greater than usual when palpating
- Report frequent saturation of pads
ADPIE Related Lessons
Related Nursing Process (ADPIE) Lessons for Subinvolution
Transcript
In this lesson I will explain subinvolution and your role in caring for this patient.
So what is subinvolution and what is the big deal?. Subinvolution occurs after childbirth when the uterus does not return to its normal size. So normally we have a uterus and it carries a baby and grows larger and larger right? Then the baby is born and that uterus goes way down to around the umbilicus and then slowly moves down 1 cm each day. Well that is the normal situation and here our patient has subinvolution. So the uterus does not make its way back down into the pelvis the way that it should. This could be because of retained placenta, overdistended uterus from carrying multiples or many pregnancies, and the biggest cause is uterine infection. So all of these items are causes.. So remember the fundus is not contracting and moving down the way that is should so it puts the patient at risk for postpartum hemorrhage.
Assessment of this patient will be more uterine bleeding than expected. The fundal height is not going to be decreasing as expected so because of this the uterus is larger than expected.
So management of this patient is going to be to fix the cause. So if the subinvolution is happening because there is retained placental parts then the retained pieces need to be removed. A huge cause of subinvolution is infection so if there is a uterine infection then we of course want to treat that with antibiotics. We can also give medications to contract the uterus. If we can get it to contract it will clamp down and move towards the pelvis where it should be. So medications are methylergonovine, carboprost tromethamine, and oxytocin.
Ok so onto our patient education. You will educate this patient on a couple things. If the pain is worse than usual on palpation of the uterus she should report it. This pain can indicate there is a uterine infection which would cause subinvolution to occur. We also really need them to report if they are frequently saturating their pads. So any heavy bleeding, we want to know about that!
Our concepts are clotting, perfusion, and safety because of the increased bleeding risk and danger that subinvolution can cause.
Alright let’s review this. So subinvolution is when the uterus doesn’t contract properly post delivery and move down into the pelvis. This can be caused by a uterus that has been over distended. So perhaps from carrying multiples or been through multiple pregnancies. It is just overstretched. It could also be from retained placenta, which is going to cause bleeding or from a uterine infection. With the infection there is inflammation so the uterus is larger. Our treatment will be to fix whatever the cause is. So it might be we need it to contract more so we give medications for that, our methylergonovine, carboprost, or oxytocin. If there is retained placenta then we need to get that removed. If there is an infection then we need to treat that with antibiotics.
Make sure you check out the resources attached to this lesson adn review treatment for subinvolution. Now, go out and be your best selves today. And, as always, happy nursing.
Tiona RN
Concepts Covered:
- Studying
- Medication Administration
- Adult
- Emergency Care of the Cardiac Patient
- Intraoperative Nursing
- Microbiology
- Cardiac Disorders
- Vascular Disorders
- Nervous System
- Upper GI Disorders
- Central Nervous System Disorders – Brain
- Immunological Disorders
- Fundamentals of Emergency Nursing
- Dosage Calculations
- Understanding Society
- Circulatory System
- Concepts of Pharmacology
- Hematologic Disorders
- Newborn Care
- Adulthood Growth and Development
- Disorders of Pancreas
- Postoperative Nursing
- Pregnancy Risks
- Neurological
- Postpartum Complications
- Noninfectious Respiratory Disorder
- Peripheral Nervous System Disorders
- Learning Pharmacology
- Prenatal Concepts
- Tissues and Glands
- Developmental Considerations
- Factors Influencing Community Health
- Childhood Growth and Development
- Prenatal and Neonatal Growth and Development
- Developmental Theories
- Basic
- Neonatal
- Pediatric
- Gastrointestinal
- Newborn Complications
- Labor Complications
- Fetal Development
- Terminology
- Labor and Delivery
- Postpartum Care
- Communication
- Basics of Mathematics
- Statistics
- Basics of Sociology
- Cardiovascular
- Shock
- Shock
- Disorders of the Posterior Pituitary Gland
- Endocrine
- Disorders of the Thyroid & Parathyroid Glands
- Liver & Gallbladder Disorders
- Lower GI Disorders
- Respiratory
- Delegation
- Perioperative Nursing Roles
- Acute & Chronic Renal Disorders
- Respiratory Emergencies
- Disorders of the Adrenal Gland
- Documentation and Communication
- Preoperative Nursing
- Legal and Ethical Issues
- Oncology Disorders
- Female Reproductive Disorders
- Musculoskeletal Trauma
- Renal Disorders
- Male Reproductive Disorders
- Sexually Transmitted Infections
- Infectious Respiratory Disorder
- Integumentary Disorders
- Emergency Care of the Trauma Patient
- Urinary Disorders
- Musculoskeletal Disorders
- EENT Disorders
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- Basics of NCLEX
- Integumentary Important Points
- Multisystem
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- Urinary System
- Emergency Care of the Neurological Patient
- Central Nervous System Disorders – Spinal Cord
- Respiratory System
- Emergency Care of the Respiratory Patient
- Cognitive Disorders
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- Prioritization
- Community Health Overview
- Gastrointestinal Disorders
- Integumentary Disorders
- Respiratory Disorders
- Neurologic and Cognitive Disorders
- Renal and Urinary Disorders
- Infectious Disease Disorders
- EENT Disorders
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- Note Taking
- Concepts of Population Health
- Basics of Human Biology