I know my problems are meaningless to you all but that doesn't make them go away. Please help with some words of encouragement.
I was called out today to a new admits house to change a dressing (no one told me what it was) because the nurse who covered that area was a man and the patient didn't want a male nurse. So the nurse meets me with the papers and I go over. It is a patient with an abdominal abscess and a wound vac. The wound was directly next to the pt's ileostomy bag.
I wish I had checked the orders in detail before I started, but I got ahead of myself and got really nervous.
I have had an inservice on wound vacs but have not done one on a live person before, and of course, the first thing the patient asked was, have you ever done this before?
But I get to work on taking off the old dressing. The patient's skin is very sensitive and she winces and yells out even though I am as gentle as I can be. But the bad part doesn't come until I try to remove the foam from the wound bed. It is stuck very tightly and it takes an hour to get the foam out because the patient is nearly jumping out of her skin from the pain (she took two Lortab before I started, but it didn't help much). So I call the wound center where she at the hospital and asked them for help. The nurse said it was odd this happened because she didn't act like it hurt when *they* changed it. The patient is a very alert woman who quickly reminded the nurse over the phone that when *they* changed the dressing she was still receiving IV pain meds and was still feeling the effects of being sedated from having the wound opened.
The wound had virtually no drainage after two days and I asked the nurse if it would be permissible to leave the wound vac off and use a sterile dressing instead?
Anyway, the doctor is not in today so they tell me to call back tomorrow and advise I put the wound vac dressing on. The DON told me anytime I needed help to call her, but everytime I have needed help and called her so far she has acted like I'm on my own and I should know what to do.
So I cut out my foam all neat and tidy and fit it on the wound bed, just like the old dressing was. Only when I start putting the membrane on I get really nervous and start sweating and I'm finding it increasingly difficult to function because the pt's granddaughter (who is a 1st year nursing student at a 4 yr college) has her face pressed practically in mine questioning everything I am doing and making me really doubt myself. So after I finished and she informed me the wound care center had it covered differently and that the way I had it the suctioning would not be right I told the patient that like it or not I was going to have to call in the nurse who was supposed to cover her area in the first place. So she said do what I need to. The male veteran RN, sweetheart he is, comes out. Well, he puts a different dressing on, in my opinion not as good as the one I had fixed (that round thing with the tube that connects to the wound vac was partly on her skin and I had been told the foam should be under that so it doesn't leave marks on the skin, but I really trust him so I don't say anything. When patient is comfortable we leave.
I'm home tonight going through the many papers and I see where it says home health nurses are to apply Miradex powder before applying the wound vac.
I DIDN'T APPLY MIRADEX POWDER!!! > insert smiley crying out in agony here
I'm worried sick here. Am I done? Will I be fired? She is scheduled to have the wound vac dressing changed again Saturday. Do you think it will be okay?
