Thursday 12 November 2015

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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