Days like this make you wonder....

Tuesday was the second clinical day for me...we did the same thing as last week which was baths, feedings, changing adult diapers, etc.

There were a couple of things that did have me concerned...and I'm just praying that I can make it through the program.

One guy was 100% immobile from a stroke as well as completely incoherent. When we changed him, he urinated on the new pad, so my partner and I waited until he finished to change it out again.

This is ONLY URINE, and it was so concentrated I thought I was going to gag from the odor.

I have also been shocked at the deplorable condition these patients come in from the nursing home...feet where the toenails were actually raised 1/2" from the nail base due to fungus, buildup (I have no idea of what causes that).

It did reinforce the fact that I want to work with infants...but one of my friends who is doing her rotation in a nursing home spent an hour on wound care that was infected with MRSA, and she said it was all she could do to maintain composure and not be sick and at one point, had to step away from the patient (she was only assisting).

How do you get PAST this mental block?

I had the same concerns when I did geriatrics ( now almost done with semester 3). I started out with watering eyes or gagging with every bed bath or perineal care, I got to the point where gagging was very rare for me. Medications can make eliminated wastes powerfully odorous. The only thing that really gets my gag reflex now is advanced ulcers... maybe one day I will get past that also. You can get though this, just take it one day at a time.

Simple. Through multiple exposures, you get used to it. How would guys who work on trash trucks ever handle it otherwise?

Simple. Through multiple exposures, you get used to it. How would guys who work on trash trucks ever handle it otherwise?

HA! We don't think about that profession very often, but it has to be one of the most difficult ones. I also often think about the guys who drive around picking up road kill (I had the opportunity to see one of their trucks firsthand..very disgusting site) or that clean out the port-a-potties.

[Conrad283, BSN, RN]

You just get used to it. It stinks, but right now it's about all we have.

All of clinical and nursing isn't like that but it does prepare you for the "gross" stuff.

Soon you will be having all ages of pts with interesting cases!!

Hopefull, the deplorable conditions are a function of inadequate funding. Most places won't permit podiatry care by anyone other than a podiatrist, right down to cutting toenails. The urine is concentrated because demented old folks with dementia don't feel thirst and, with dyspagia, it's hard to get enough fluid into them. We have neither the money nor personnel for IV therapy.

There is one thing tht I can tell you about my old folks. Even the most demented respond to kindness, and being treated like adults. On a simple scale, but talk to them as if they are people, not infantilized objects.

One night, a resident who was very uncommunicative and with aphasia was unable to sleep and sitting with me and the aides. We were discussing menopause and she just joined in, "I never had trouble with that." Well, we masked our astonishment, but she participated jin this conversation simply because she had been included, seated at the same table with us, being addressed -

Always remember that there are human beings locked in there.

:)

Hopefull, the deplorable conditions are a function of inadequate funding. Most places won't permit podiatry care by anyone other than a podiatrist, right down to cutting toenails. The urine is concentrated because demented old folks with dementia don't feel thirst and, with dyspagia, it's hard to get enough fluid into them. We have neither the money nor personnel for IV therapy.

There is one thing tht I can tell you about my old folks. Even the most demented respond to kindness, and being treated like adults. On a simple scale, but talk to them as if they are people, not infantilized objects.

One night, a resident who was very uncommunicative and with aphasia was unable to sleep and sitting with me and the aides. We were discussing menopause and she just joined in, "I never had trouble with that." Well, we masked our astonishment, but she participated jin this conversation simply because she had been included, seated at the same table with us, being addressed -

Always remember that there are human beings locked in there.

:)

Thanks for the reply. The videos that they have been showing is have taught us that even if someone is in a comatose state, that you still address them when they come in and talk to them...out of respect, and I agree with you...you can never be sure that they can't hear you just b/c they can't respond.

We do have one patient that can barely move, but he cannot speak, but he does understand everything you say to him b/c if you ask him to lift his leg up, he does so immediately...so I am sure that alot of his cognitive functioning is still intact.

Poor guy can't even tell you yes or no...I finally had him squeeze my hand after we moved him/changed him so he could tell me if he was comfortable or not. It was just so sad b/c he doesn't appear to have family.

I like the grown people, not the babies. I haven't had an issue with urine, but rather suctioning and especially trachs. UGH! Something about large amounts of discolored sputum when suctioning freaks me out, especially when they cough it out of their trachea and onto you.

But at the same time, I am okay with it. Because I know they don't like it either. I try to take the best care of the patient, because I know that if I am ever in their place I would want a compassionate person not thinking I was gross. Thinking in those terms has helped me with many icky situations and code browns. I also find it helpful to talk/vent about my feelings about it with classmates.

I love geriatrics now, the smells don't even register now. Before though I was so close to losing my lunch practically everyday.

We have a nurse who comes and does footcare, it's not something we can do because of the risk of infection and the potential to cut to damage tissue.

I was the same way, I do not enjoy geriatrics and it just makes me very sad. I want to work in pediatrics. But that smell is something awful from BM, sores, and even urine. A trick we use is to put vicks vapor rub underneath your nose and it will help you from gagging so much. Thats a smell that I have never gotten use to and that I don't want to get use to! ha

It is quite a shock when you first start out clinicals..quite a big eye opener. But remember, this was only your second day of clinicals. I am now into my 6th week of clincials on a geriatric floor and I have noticed a dramatic change in myself. Although the smells still get to me, I have learned how to deal with it in an appropriate manner. As long as there is still someone with the patient, it is perfectly acceptable to excuse yourself from the pt for a minute to catch your breath. As much as the smell or sight of something may get to you, I think it so cool to see what we are seeing. This is life, and we are seeing all of it.

[Bumashes, MSN, APRN, NP]

My instructor suggested we carry some Vick's vapor rub with us to clinicals and use a Q-tip to swab a little in our nose before entering a situation like that.

I always liked working with the older folks. Kids whine and they have parents who annoy you. I know this because I have three kids and I myself am a very annoying parent when dealing with medical personnel and anything to do with my kids.

But older folks always have interesting stories to tell and usually appreciate the care you give. Smells barely bother me, I don't think they ever really did, just look at the person and everything else will fall away.

Not to be picky or mean, but check with the CNAs at the facility & see what term they use for adult diapers. Imagine your shame if you were old & had to wear a diaper. Ya, we know that's what they are but many of them feel bad when you call them diapers in front of them. We referred to them as disposible briefs or just briefs. Sounds so much more adult.

Dixie

[bookworm1]

I have nearly finished my first semester of clinicals and have loved every new thing I have come across. I have dealt with bowel incontinence with C-dif (what a smell!!), a huge tunneling wound that was being opened, for the first time, at the bedside. We lost one of our classmates with that one as the black and brown colored odiferous pus began running from the incision. I got a patient that had an abdominal dehis and I got to pack the wound. Did oral care on an elderly man that had 'chunks' of stuff coming out of his mouth. Saw a really cool MRSA wound freshly debrided so that about 2 inches of the humerus was visible. All of this I handled very well and enjoyed the new experiences...but...last night my youngest daughter developed a stomach virus and vomited all over her bed and floor and I was gagging continuously while trying to clean it up:lol2:. Go figure! I am told everyone has their weakness in nursing! Apparently emesis is my 'nemesis'. I hope none of my classmates find out about this:uhoh21:. They'll never let me live it down.

good luck to you!

"I have nearly finished my first semester of clinicals and have loved every new thing I have come across. I have dealt with bowel incontinence with C-dif (what a smell!!), a huge tunneling wound that was being opened, for the first time, at the bedside. We lost one of our classmates with that one as the black and brown colored odiferous pus began running from the incision. I got a patient that had an abdominal dehis and I got to pack the wound. Did oral care on an elderly man that had 'chunks' of stuff coming out of his mouth. Saw a really cool MRSA wound freshly debrided so that about 2 inches of the humerus was visible"

Thats amazing that you have seen that much in your first semester of clinicals. Good for you for handling everything that you did in the right manner. How exciting. I just saw my first real pressure ulcer to the bone (on the hip) two days ago and I thought it was so cool (but not really for the pt) and my friends think I am crazy. haha