Only a nurse would understand!

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    Oh my gosh! What is that? A nurse and colleague find a way to help each other and laugh at themselves, in spite of a new situation for both of them.

    Only a nurse would understand!

    I have NEVER experienced anything like this, and I have seen & dressed some pretty horrible, deep, and long wounds. Some of the wounds I have seen and/or dressed required patients to get on their hands/knees, just so the area could be assessed and properly cleaned and dressed. Imagine the discomfort, pain, and the feeling of "distorted body image," these patients must have experienced.

    So, when I have a patient who has developed some kind of scrotum abscess, what's a nurse to do? The abscess was discovered when one of the nursing assistants was helping the patient shower and saw blood oozing and dripping from the perineal area. The nurse went to assess, but couldn't find from where the blood was oozing, so the patient was cleaned and an ABD pad was put in place.

    Enter me, on my shift, and I have to assess and redress the area. I get another nurse to help me because I can't find the spot, either. So, we begin by asking the patient if he has any pain in that area and we ask him if he has ever experienced this before. The patient responds, "No," to our questions, so we being the physical assessment. As we assess and move things around down there, purulent drainage shoots out from the area.

    "Oh my gosh. What is that? Where did that come from?" we are both thinking, with the astonished looks on our faces, as we look at each other. So, we keep "searching," asking our patient if he has any pain, to which he calmly says, "No. I'm ok."

    As we continue our search for the open area, we find it, and it looks like a small os, that is just oozing out purulent, sero-sanguinous fluid. So, now, we have to continue draining this abscess, and boy does it drain.

    When we finished, including cleaning, dressing the area, and reassessing the patient for pain and any other S/S of infection, and after we leave the room, I whisper to my colleague, "If I gotta do that again, I'm not coming back to work!"

    We both laughed heartily at ourselves. We laughed at how we looked at each other as if we were both saying, "Ok, what now? What are we supposed to do?" Neither of us had ever experienced this and we still had questions to research as to how this could have happened. We were amazed that our patient had zero pain or discomfort, as if he couldn't feel a thing down there.

    I finished up by making sure this was documented and reported and an ultrasound was scheduled and completed.

    I did return to work and of course, I had to assess my patient. Thankfully, his wound and dressing were intact, clean, dry, no purulent fluid drainage, no drainage at all. The patient was started on antibiotics, and is responding well.

    After all that, my patient thanked us for taking care of him. WOW! That made this whole situation worth the experience, time, and outcome.

    So, what is the lesson I learned? To always expect a possible worse situation than what is described in report and documentation. To keep your composure in front of patients, even if you don't really know what to do, and neither does your colleague. To follow up with some research, if only for yourself, so you will better understand how these things develop and the progression of healing. To use these rare opportunities not only as a teaching moment, but as a learning opportunity. To never be afraid to ask for help from a colleague, and to be able to laugh at yourself and with your colleagues.
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    About Eschell2971, RN

    This RN loves to laugh, even at herself. She also loves to dance, cook, and travel.

    Eschell2971 has '2' year(s) of experience and specializes in 'Acute Care'. From 'Maryland'; Joined Mar '14; Posts: 57; Likes: 227.

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    9 Comments

  3. by   flying_ace2
    I had a similar situation on my very first day of my very first nursing school clinical. My patient, among a host of other issues, had severe scrotal swelling, such that my instructor helped me to make a sling for him so that he could hold them up with it. It was quite a lesson in professionalism, compassion, and teamwork, and the patient thanked both of us from the bottom of his heart afterward because no one else ever thought to try to help him with that issue - personally, I can't imagine how much it hurt the guy! After we finished my instructor and I had a little laugh about it - welcome to nursing, it's never quite what you expect!
  4. by   mamagui
    OP, I am still a student, so not sure, but is it OK to drain an abscess without a Dr. order? It seems like an order would be necessary here where I live.
    I love a nasty wound..not sure what it is, but the grosser the better. I once took care of a Pt with a ruptured sebaceous cyst on his back...he had a hole the size of a dinner plate and 5cm deep (literally, he was an obese guy). Love it!
  5. by   Eschell2971
    FYI: There are physicians and NPs in-house, right on the floor, making rounds. We had orders to do it. It was implied in the story.
  6. by   OldGrayNurse
    I used to work in rural health, and part of our services was women's health and prenatal care. We normally had a nurse practitioner that was wonderful with the ladies, made them comfortable (as we got many women who had STD's, were being abused, etc.) and was just a joy to work with. She called in sick one day when we had a full clinic, and our internal med doc was sent over from our main office to cover her patients. He normally did not do pelvic exams, and was extremely inexperienced. We got through the morning shift with only having to do one actual pelvic as most of our morning clients were simple prenatal follow ups. That afternoon, we a client who earned her living on the streets and had been treated numerous times for STDs. I warned him ahead of time that she was most likely going to need a pelvic, as she usually only came in when her symptoms became unbearable. Sure enough, she had an absolutely horrible case of Herpes breakout. I mean, super, super, bad. Poor thing could hardly walk. I set her up for an exam, and informed the doc. Now, any nurse who's worked clinic knows that during a pelvic exam, the doc is somewhere that the client cannot really see his face, as he's on a stool. However, the nurse is usually standing, and in full view of the client. My poor internist "assumed his position" and proceeded to contort his face in shapes and ways I've not seen before or since. And if that wasn't bad enough, he was silently mouthing, shall we say, less than helpful comments as he was performing his exam. I've never tried so hard to keep a stoic expression on my face and my mouth shut in all my life.
  7. by   anon456
    Ah yes, the composed calmness and facial expression in the midst of something very alarming or unexpected. Trying to keep a straight face when emptying JP drains or ostomy bags of a patient who is depending on your calm demeanor. Or suctioning copious mucous from a trach, or performing oral care on someone with a mouth that is in a very bad state. We deserve medals. We really do.
  8. by   Ndy-RN
    Quote from JulesAtkinson
    I used to work in rural health, and part of our services was women's health and prenatal care. We normally had a nurse practitioner that was wonderful with the ladies, made them comfortable (as we got many women who had STD's, were being abused, etc.) and was just a joy to work with. She called in sick one day when we had a full clinic, and our internal med doc was sent over from our main office to cover her patients. He normally did not do pelvic exams, and was extremely inexperienced. We got through the morning shift with only having to do one actual pelvic as most of our morning clients were simple prenatal follow ups. That afternoon, we a client who earned her living on the streets and had been treated numerous times for STDs. I warned him ahead of time that she was most likely going to need a pelvic, as she usually only came in when her symptoms became unbearable. Sure enough, she had an absolutely horrible case of Herpes breakout. I mean, super, super, bad. Poor thing could hardly walk. I set her up for an exam, and informed the doc. Now, any nurse who's worked clinic knows that during a pelvic exam, the doc is somewhere that the client cannot really see his face, as he's on a stool. However, the nurse is usually standing, and in full view of the client. My poor internist "assumed his position" and proceeded to contort his face in shapes and ways I've not seen before or since. And if that wasn't bad enough, he was silently mouthing, shall we say, less than helpful comments as he was performing his exam. I've never tried so hard to keep a stoic expression on my face and my mouth shut in all my life.
    But seriously I need to learn to not contort my face because there are some smells I still cannot handle and I can't help it....my face has a mind of its own sometimes. I will be better [emoji30][emoji37][emoji43][emoji40]
  9. by   hawaiicarl
    I had to do packing on a 600 pound patient with a scrotal abscess. The off going nurse told me 4 rolls of 4" Kling .... I thought she was joking. So I gathered my posse, I had one person hold up the pannus, and another hold out the leg, then I went in. The abscess tunneled up into the pannus and around a corner, So I pulled out 4 rolls of Kling, but the wound still smelled, so I had a 4th staff grab a flashlight, and I saw a 5th roll of Kling packed into the far corner. I reached in (to my elbow ..... shudder), and grabbed the last roll of packing, that had to be in there for days, probably the most foul smelling thing I have found in 25 years of nursing. The patient did well and went home!

    Cheers
  10. by   Ndy-RN
    Quote from hawaiicarl
    I had to do packing on a 600 pound patient with a scrotal abscess. The off going nurse told me 4 rolls of 4" Kling .... I thought she was joking. So I gathered my posse, I had one person hold up the pannus, and another hold out the leg, then I went in. The abscess tunneled up into the pannus and around a corner, So I pulled out 4 rolls of Kling, but the wound still smelled, so I had a 4th staff grab a flashlight, and I saw a 5th roll of Kling packed into the far corner. I reached in (to my elbow ..... shudder), and grabbed the last roll of packing, that had to be in there for days, probably the most foul smelling thing I have found in 25 years of nursing. The patient did well and went home!

    Cheers
    WOW
  11. by   Bat Lady
    We had a patient come in, an elderly African-American woman who'd had repeated UTIs over the preceding year and was now having not only a UTI but some nasty vaginal drainage. She was a hospitalist patient, and the hospitalist had called in a GYN consult. She also wasn't my patient to begin with, but her nurse had gone home at 5, so I inherited her. Anyway, the GYN came in, a very nice African-American doctor who was extremely respectful to this lady and her daughter who was with her. He asked a great many questions, and it developed through the interview that somewhere along the line a urologist had inserted a pessary and never told the patient or daughter anything about how to care for it. On repeated trips to the same urologist or the family doctor for UTIs, the UTI was treated but the pessary was never addressed (!). It was unclear whether the family doctor even knew about it! So the GYN asked for an exam tray and a light, and he reached up into the lady's vagina and pulled out the most godawful smelling pessary that had been in there for at least a year! Somehow he and I both maintained perfectly straight and composed faces, but the lady's poor daughter just about gagged herself to death. The lady herself just sighed in relief. She said afterwards that the thing had hurt her for months but she thought it was supposed to help so she never said anything. (And I thought afterwards that if I lived there--I was a traveler--that doc would be my GYN! He was so kind and respectful and just generally nice, both to the patient and family and to me.)

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