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.
Rina’s NCLEX Study Plan
Concepts Covered:
- Cardiovascular
- Emergency Care of the Cardiac Patient
- Circulatory System
- Cardiac Disorders
- Disorders of the Posterior Pituitary Gland
- Endocrine
- Disorders of Pancreas
- Disorders of the Thyroid & Parathyroid Glands
- Hematology
- Gastrointestinal
- Liver & Gallbladder Disorders
- Lower GI Disorders
- Multisystem
- Neurological
- Nervous System
- Central Nervous System Disorders – Brain
- Renal
- Respiratory
- Urinary System
- Respiratory System
- Noninfectious Respiratory Disorder
- Basics of NCLEX
- Test Taking Strategies
- Respiratory Disorders
- Hematologic Disorders
- EENT Disorders
- Basics of Chemistry
- Adult
- Medication Administration
- Acute & Chronic Renal Disorders
- Emergency Care of the Respiratory Patient
- Respiratory Emergencies
- Studying
- Substance Abuse Disorders
- Disorders of the Adrenal Gland
- Behavior
- Infectious Disease Disorders
- Oncology Disorders
- Female Reproductive Disorders
- Anxiety Disorders
- Renal Disorders
- Prenatal Concepts
- Vascular Disorders
- Gastrointestinal Disorders
- Peripheral Nervous System Disorders
- Integumentary Disorders
- Immunological Disorders
- Sexually Transmitted Infections
- Upper GI Disorders
- Microbiology
- Labor and Delivery
- Communication
- Proteins
- Newborn Care
- Hematologic System
- Urinary Disorders
- Eating Disorders
- Musculoskeletal Disorders
- Bipolar Disorders
- Terminology
- Pregnancy Risks
- Concepts of Population Health
- Factors Influencing Community Health
- Postpartum Complications
- Prioritization
- Psychotic Disorders
- Basics of Human Biology
- Neurologic and Cognitive Disorders
- Labor Complications
- Writing
- Statistics
- Community Health Overview
- Dosage Calculations
- Musculoskeletal Trauma
- Neurological Trauma
- Note Taking
- Cardiovascular Disorders
- Concepts of Mental Health
- Health & Stress
- Endocrine and Metabolic Disorders
- Cognitive Disorders
- Depressive Disorders
- Developmental Considerations
- Shock
- Documentation and Communication
- Legal and Ethical Issues
- EENT Disorders
- Fundamentals of Emergency Nursing
- Emotions and Motivation
- Renal and Urinary Disorders
- Digestive System
- Integumentary Disorders
- Intraoperative Nursing
- Fetal Development
- Basics of Mathematics
- Prenatal and Neonatal Growth and Development
- Childhood Growth and Development
- Preoperative Nursing
- Postoperative Nursing
- Neurological Emergencies
- Understanding Society
- Somatoform Disorders
- Reading
- Emergency Care of the Neurological Patient
- Infectious Respiratory Disorder
- Metabolism
- Oncologic Disorders
- Developmental Theories
- Basics of Sociology
- Emergency Care of the Trauma Patient
- Med Term Basic
- Med Term Whole
- Suffixes
- Central Nervous System Disorders – Spinal Cord
- Muscular System
- Neonatal
- Newborn Complications
- Male Reproductive Disorders
- Adulthood Growth and Development
- Perioperative Nursing Roles
- Concepts of Pharmacology
- Endocrine System
- Postpartum Care
- Trauma-Stress Disorders
- Psychological Disorders
- State of Consciousness
- Shock
- Skeletal System
- Learning Pharmacology
- Hematologic Disorders
- Prefixes
- Delegation
- Tissues and Glands
- Personality Disorders
- Basic
- Musculoskeletal Disorders
- Disorders of Thermoregulation
- Integumentary Important Points
- Reproductive System
- Psychological Emergencies
- Growth & Development
- Intelligence and Language
- Pediatric
- Sensory System