The Worst Wound I Had Ever Seen.

Helping another nurse with wound care can be a learning experience. From observation to participation, there is a lot to absorb. Nurses Announcements Archive Article

The Worst Wound I Had Ever Seen.

Time to care

I have always believed that night shift nursing is a time for learning. Doctors are out of sight, administrators are home in bed and the pace is steady but manageable. Here is a time when a nurse can really learn about their patients and the real aspects of nursing care. Tim, one of our newer nurses, asked me if I would help him with a wound dressing change. I jumped at the chance only because the single reason I decided to work at an LTAC was to gain experience; and what better place to do it than at a hospital where the wounds were massive and the educational opportunities plentiful. With a smile, Tim said he would meet me in the patient's room after thirty minutes as he was administering her pain medication.

I made sure my patients were settled and comfortable as I had heard this particular patient's wound care takes about an hour. I told my tech where I was going and headed down Tim's hall.

Once I had the plastic gown, mask and gloves in place I stepped into the somber room. The patient, a young looking 52 year old black woman with her eyes shut, was lying in bed covered only with a sheet. Both fluorescent tubes at the head of the bed were lit but this was never enough light, especially at night. Tim, suited in plastic blue as me, was preparing supplies on the overbed table. My nose took immediate attention to the smell of fresh ground beef. My eyes saw a hospital room but my nose was in a meat locker.

Time to do

Tim and I have done wound care before and I knew since this was his patient my role was to hand him supplies and do as he asked. That's how we team with our patients. I stepped to the opposite side of the bed and waited. Tim pulled the sheet up and revealed a wound like I have never seen before. The patient had a cyst removed from her groin which left her stripped of skin from the navel to the pilonidal dimple in an hourglass shape. There was a small raised bump where the catheter entered the urethra. The orifice was missing, unless the meat was pulled apart. The entire area appeared as a bright red slab of muscle. Immediately, the smell of raw ground beef became overwhelming.

Tim gingerly removed the dripping dressing that had been placed only eight hours prior. It was both red and yellow in color and resembled nothing of its prior state eight hours ago. Using wound cleaner and gauze, Tim carefully and completely cleaned the red muscle. With each step he calmly reassured her as to what he was doing and that she might feel some pain. During the wound care the woman moaned but did not cry, groaned but did not flinch, bit her lip but did not speak. We used countless tubes of wound gel, rolls of Kerlix, ABD pads, foam pads and held it all in place with mesh shorts. Looking at Tim I could only see his eyes, but they were a window to his heart; wet with empathy. Silently we cleared away our trash and left the woman as comfortable as possible in the darkened room alone with her grief.

Time to reflect

Although this was the worst wound I had ever seen, since that time I have been exposed to so much more. However, I always learned a lot working with Tim; the biggest thing being empathy. He had a way with patients so that they trusted him, they often asked for him. But with this patient I learned something different, and the lesson wasn't that night. My discovery was two days later and I learned how some hospitals run their business. The patient's insurance ran out and she was sent to a nursing home for recovery. With that severe of a wound I often wonder how her recovery went...

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choyles

About choyles

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Specializes in ICU.

I have had three patients myself with wounds exactly like you describe. They even fit the exact same profile. Three black women with what started as just a bump on the mons pubis or labia majora that turned into necrotizing fasciitis that ended up taking most of their abdomen, genitals, and even into their buttocks after they came back from surgery.

It is a weird coincidence.

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Specializes in Neurosciences, stepdown, acute rehab, LTC.

Oh thats horrible :(

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Specializes in LTC,Hospice/palliative care,acute care.

If she came to ours nursing home she would do well,we have a wound care team and the nursing staff in general have received a great deal of education.Wounds are closely tracked in LTC.

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Specializes in Pediatric Hematology/Oncology.

It becomes unfathomable at the way peoples' bodies can be absolutely ripped apart like that. I helped a nurse do wound care on a patient who had been left far too long in a wheelchair and the resulting pressure ulcers were far worse than anything they had showed us in school. Once we got through it, I just couldn't imagine how this still happens to people. It's just so far out there. Two days later in clinical I was faced with nearly the exact same wounds, only this time infected and purulent and smelling as such. Again, I still just don't get how people end up this terribly injured but there they are. So much to be learned from and so much to grateful for. Still, can't shake just how badly things can get.

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:no: I hope she recovered well. I saw that alot in the nursing home as a CNA. Its sad
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Specializes in Med-Surg, Emergency, CEN.

I've seen wounds like that. The ones I've seen in younger populations were necrotizing fasciitis.

A very elderly nursing home pt I admitted had a tunneling sacral pressure ulcer almost up his entire spine. Surgery had to come clean/dress it instead of nursing.

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With the huge push for patients to heal at home I believe we are going to see more of these types of wounds. Especially when there are limited resources (family, friends, HHS) available.

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Wow, that sounds like a wound for the record books and quite a learning experience!

My worst wound so far was two stage 3 wounds on the backside on a super sweet little ol black lady who had rt sided paralysis and her caretakers were her family at home. So sad. Not lack of heart, but a lack of knowledge in that case.

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Specializes in Emergency Department.

I've seen some Stage 4 ulcers that were large enough to tuck a football into, with room to spare. I was lucky enough to be able to follow a patient over the course of a few months that had such a wound and I got to see it progress from a large Stage 4 to about have the diameter and 1/4 volume Stage 2, all with excellent wound care. I wasn't a nurse back then.

Good lessons to remember...

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A young double amputee cam to the hospital... When I was getting report from the ER, they told me they tried to insert s foley and it came out of his back.... I really don't know how to describe it, it was horrific. He had very little back and butt left.

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With the huge push for patients to heal at home I believe we are going to see more of these types of wounds. Especially when there are limited resources (family, friends, HHS) available.

I know of someone (male in this case) who had a similar wound, scrotum and everything was gone. Insurance was denying further hospital days and they were trying to send him home. I wouldn't have accepted him and I think there are some cases where the home health agencies all have to say no, for the patients' sake. There are some things that are too much to ask the family to do, and I can and have dealt with some severe situations but there is a line.

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