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:
- Prolonged lochial discharge
- Irregular or excessive bleeding
- Larger than normal uterus
- Boggy uterus (occasionally)
Nursing Management
1. Prevent excessive blood loss, infection, and other complications.
- Massage uterus, facilitate voiding, and report blood loss.
- Monitor blood pressure and pulse rate.
- Administer prescribed medications. (see Drug Chart )
- 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.
|
