Long story short, had 2nd clinical ever today and was assigned to a very edematous bed-bound pt with right-sided CHF. She had really bad skin breakdown and, as we were turning her to change the sheets, I felt like a lot of "debris" from the sheets went up into to the air. I could actually see it in the air. I wanted to slap the nurse b/c she wasn't being careful with them. Anyway, I feel like I definitely inhaled whatever "particles" these were and now I can't get the taste of "poop", for lack of a better word, out of my mouth.
Does skin break-down have a certain smell that mirrors feces? She had been using the bed-pan for her bowel movements, but I'm not sure if she had feces in between her skin folds or in the old sheets, b/c I wasn't on that side of her when turning her.
It is really rather unpleasant. I've tried brushing my teeth and mouth-washing and it has still come back on and off over the past few hours. UGH.
Am I crazy? What did I inhale? Should I be worried?
I assume you were referring to the post about a patient being treated for head and neck cancer. I am pretty sure the smell was from an exposed excoriated open wound, not the cancer.
I am pretty sure cancer doesn't smell until, unless, it causes an open excoriated wound. Even then it is most likely the wound that smells not the cancer.
However I believe there have been a few articles about dogs smelling cancer.
Cancer does indeed smell and it depends on where it is located that informs the smell (there are differences between an oral cancer and OB cancer, for instance, and I've heard that OB cancers are the worst). This is just one example but I've recently encountered a very large rhabdomyosarcoma in the oral cavity of a patient that was fairly refractory to treatment. The tumor developed a grayish pseudomembrane and was friable and bled easily. Along w/ the difficulty the bleeding caused in performing proper oral care, the tumor over time started becoming dark as it became necrotic. Tumors that get to the outside world do this and they have a peculiar smell when all the above factors are considered. It's not necessarily something that will knock you on your butt but you can definitely tell something isn't right and it's coming from the tumor. Generally, it's a combination of necrosis, blood, sometimes the chemo, and that weird, dried saliva smell that kind of fills the room.
Specializes in Cardiology, School Nursing, General.
In noting your surprise that a student with only two days of clinical time under his belt is criticizing the nurse's technique it might surprise you to find out that there are instructors out there who direct their students to look for faults in how the nurses do this or that. They tell the students that nurses who have been in the trenches too long take shortcuts and that this can harm the patient, and direct their students to report back on what they noticed that was not in line with what they have been taught in class. Notice I said In The Trenches Too Long, not Nurses with Experience, I think there's the thinking that getting things done fast and without demonstrating every possible step of the interim process means that they are taking dangerous shortcuts. Not informing the student isn't the same thing as taking dangerous shortcuts, it usually means just not explaining everything to the student!
in this case it might be that the instructor has told this student to watch for behaviors he would not want to emulate or see what happened that he can come back and tell everyone his recognition of something being done wrong. Maybe, maybe not, I'm not even saying this is what happened only that before you get a little put off that he is behaving this way on Day Two of clinical it might be worth knowing that there are too many instructors out there who encourage this.
I saw it firsthand myself when I had an instructor who told me and my classmates to "see what you can find wrong and tell us about it when we meet later", and I've seen it in students that have trailed around with me and have said their instructor told them to see what we did that didn't fall in line with what they were taught so they can be ready to explain to the instructor and the class what the nurses were doing wrong. Not nice, but it happens.
Not a nurse, but I can verify this on any medical program, they do tell us this. But my teacher told us straight up that we may need to learn a different way after school, but for now she wants us to learn the basics on things so we can be ready on how to do it another way.
Amethya and brownbook, I worked oncology for 23 years, cancer definitely has a smell, just like Pseudomonas and C.diff. They are all different smells, very distinctive. I could often tell if someone had cancer before the actual path report came back. Not a skill I wanted, and not 100% but pretty close. Sometimes if it was a very small tumor I couldn't smell it, but with lung cancer and colon cancer and breast cancer I was usually about 100%.
And as a part-time nursing instructor, when I have students clinical, I will always explain that there are ideal ways to do things and there are what you do if you want to go home at a reasonable hour. I explain that the book way is NOT always the practical way.
There is a distinctive smell associated with the dying patient. I don't know if the patient you were taking care of was in the dying process, but I find that it happens particularly often with edematous patients who have skin breakdown, such as the one your described. Maybe other nurses can confirm this. But I do know what you are talking about and have experienced the sense of not being able to "forget" an odor even hours after the incident. I liked the one suggestion about a peppermint--it's just one of those things that happens sometimes in nursing. Hang in there! Joy
Don't be such a baby, for crying out loud. My first five minutes of my first ever clinicals involved me kneeling on the floor facing a LTC male resident's behind while attempting to clean feces off of the longest set of testicles imaginable, (seriously they nearly went down to his knees) while he hurled insults at his roommate who wouldn't stop singing! Nursing is a whole different animal. Seriously, suck it up butter cup!
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
I think that as experienced nurses we need to offer support to those entering the profession. "Suck it up buttercup" isn't necessarily the most supportive action we can take as mentors.
OP....nursing is unlike any other profession. It takes getting used to....I always used a mask and vicks under my nose or peppermint oil on a mask to help with those less than pleasant smells. I also carries a pocket spray of Ozium.......it cleared many smells.
You do "get used" to a certain amount but pregnancy was my Achilles heel....nothing helped and I spent time in the bathroom. I had to go out on early leave for hyperemesis due to smells...LOL
Don't be such a baby, for crying out loud. My first five minutes of my first ever clinicals involved me kneeling on the floor facing a LTC male resident's behind while attempting to clean feces off of the longest set of testicles imaginable, (seriously they nearly went down to his knees) while he hurled insults at his roommate who wouldn't stop singing! Nursing is a whole different animal. Seriously, suck it up butter cup!
"However, just because I don't have any experience doesn't preclude me from being allowed to be annoyed. If I were a nurse with 20 yrs experience, everyone on here would probably say 'omg, I know I hate when people do that', instead of smacking me down b/c of lack of experience."
... weeeeell the key difference here.. nurses of 20+ years experience, I imagine, "vent" about serious issues (they prioritize.. ya know pick and choose their battles) opposed to getting so mad/ frustrated they'd imagine slapping someone who took the time to teach them valuable real world nursing skills.
As a cna I've experienced "poo dust" and skin debris. I've been peed on, stepped in poop, stabbed by a psych patient, had people with mrsa cough in my face, had people with the flu sneeze on me, touch me, and cough in my face. I had a woman with shingles rub her rash on me, accidentally of course. I'm sure I've been vomited on and have had to clean up every kind of bodily fluid imaginable.. how did you react in front of the patient? Did you throw a fit like you did on this post? That would be unacceptable..
Sheets get thrown, they get tossed around and crap sometimes flies around. You are thinking that theory = practice.. poor reasoning on your part and frankly the part of your nursing school. They need to prepare you for the real world BETTER. Theory does not = practice. Practice is practice and theory is theory. This reasoning is for practical purposes (like time management and patient care- avoiding mass neglect and med errors, etc.), test time theory is the way to go. Has no one told you this before? You are not lowering a standard of care.. I mean REALLY when bathing yourself would you fold the wash cloth over every time you wiped your own skin?? No. Well.. probably not 100% necessary to do then (and a time suck) when giving a bed bath before you have meds to run and a million other things to do. Sheesh.. that's exactly why nursing schools encourage prospective students to become CNAs FIRST before they decide to pursue nursing careers.
My cna clothes and shoes would come off as I hit the door going into my house. Shoes stayed outside. The first thing I did was throw my clothes in the washing machine, take a shower, then run the washing machine with my scrubs twice.. why? Because it's a nasty job.. and I don't like walking around my house with poo dust falling onto everything. But seriously.. of all the things to complain about.. just make sure your eyes don't start to itch because poo dust in the eyes causes pink eye ;o
la_chica_suerte85, BSN, RN
1,260 Posts
Cancer does indeed smell and it depends on where it is located that informs the smell (there are differences between an oral cancer and OB cancer, for instance, and I've heard that OB cancers are the worst). This is just one example but I've recently encountered a very large rhabdomyosarcoma in the oral cavity of a patient that was fairly refractory to treatment. The tumor developed a grayish pseudomembrane and was friable and bled easily. Along w/ the difficulty the bleeding caused in performing proper oral care, the tumor over time started becoming dark as it became necrotic. Tumors that get to the outside world do this and they have a peculiar smell when all the above factors are considered. It's not necessarily something that will knock you on your butt but you can definitely tell something isn't right and it's coming from the tumor. Generally, it's a combination of necrosis, blood, sometimes the chemo, and that weird, dried saliva smell that kind of fills the room.