What should the nurse do for a postpartum mother with severe dysuria and perineal swelling after vaginal delivery?

Immediate Nursing Management of Postpartum Perineal Pain and Swelling

The nurse should monitor intake and output while encouraging increased fluid intake, as this addresses the most likely cause—perineal trauma from vaginal delivery—without prematurely initiating antibiotics before proper assessment and diagnosis. 1

Clinical Context and Differential Diagnosis

This presentation most likely represents perineal trauma from vaginal delivery causing localized inflammation and urethral irritation, rather than a urinary tract infection requiring immediate antibiotics. 2 The key distinguishing features are:

• Timing: Symptoms immediately postpartum suggest mechanical trauma rather than infection 1
• Localized findings: Perineal redness and swelling point to local tissue injury 2
• Dysuria mechanism: Pain during urination is likely from urine contact with traumatized perineal tissue, not true cystitis 2

Recommended Nursing Actions

Primary Intervention: Fluid Management

• Monitor intake and output closely to ensure adequate hydration and assess urinary function 1, 3
• Encourage increased oral fluid intake to dilute urine and reduce irritation of traumatized tissues 3
• This conservative approach is appropriate for uncomplicated perineal trauma without signs of systemic infection 1

Assessment Before Antibiotic Initiation

Do not start IV antibiotics empirically without proper evaluation, as this represents premature treatment. 1 Antibiotics are indicated only when:

• Systemic signs of infection develop (fever, tachycardia, hypotension) 1
• Third or fourth-degree perineal lacerations are present requiring repair 4
• Clinical evidence of wound infection emerges (purulent discharge, spreading erythema, warmth beyond expected inflammation) 4

When to Send Urine Sample

A urine culture is not immediately necessary for isolated perineal pain with visible trauma. 1 Consider urine testing if:

• Symptoms persist beyond 24-48 hours despite conservative management 2
• Patient develops fever or systemic symptoms 2
• Dysuria worsens rather than improves with hydration 2
• No visible perineal trauma adequately explains symptoms 2

Supportive Care Measures

Local Comfort Interventions

• Apply ice packs to perineum for first 24 hours to reduce swelling 1
• Encourage sitz baths after 24 hours for comfort and hygiene 1
• Provide adequate analgesia (NSAIDs preferred for anti-inflammatory effect) 1
• Instruct patient to pat dry rather than wipe after urination 1

Early Mobilization

• Encourage early ambulation as recommended for postpartum recovery, which also reduces thromboembolism risk 1
• Early mobilization does not worsen perineal healing and improves overall recovery 1

Red Flags Requiring Escalation

Notify the physician immediately if any of these develop:

• Fever >38°C (100.4°F) suggesting infection 1
• Increasing or spreading erythema beyond initial trauma site 4
• Purulent drainage from perineal area 4
• Urinary retention or inability to void 1
• Severe pain unresponsive to standard analgesia 1
• Signs of wound dehiscence in patients with repaired lacerations 4

Common Pitfalls to Avoid

• Starting antibiotics without indication: Overuse of antibiotics contributes to resistance and is not warranted for uncomplicated perineal trauma 1, 4
• Delaying fluid encouragement: Concentrated urine worsens dysuria from traumatized tissue 3
• Assuming infection without assessment: Most postpartum dysuria with visible perineal trauma is inflammatory, not infectious 2
• Inadequate pain control: Undertreated pain delays mobilization and recovery 1

Follow-Up Timeline

• Reassess within 24 hours to evaluate symptom trajectory 1
• Expected improvement should occur within 48-72 hours with conservative management 1
• Persistent or worsening symptoms at 48 hours warrant urine culture and physician evaluation 2