Clinical placements

In at the deep end with a drug-related wound

Treating an agitated drug user with a thigh abscess was a tough call for Erin Carrabin in her second year, but the experience gave her confidence.

Treating an agitated drug user with a thigh abscess was a tough call for Erin Carrabin in her second year, but the experience gave her confidence


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My first placement in my second year was in the community, where I helped care for a patient with an open wound on his inner thigh caused by repeated trauma from intravenous drug use.

The patient was apathetic about his health. When I assessed the wound, it was clear it was infected, there was a high level of exudate and inflammation, and he was in significant pain.

I informed my mentor and swabbed the wound to identify which antibiotic would be most suitable to treat the infection. I then talked to the patient about wound progression and the importance of hygiene for aiding tissue granulation. I also explained why a healthy diet is important and how increasing his calorie and protein intake would help the wound to heal.

Breathlessness

While assessing the patient’s wound, I noticed that he was becoming breathless. He had asthma, which had been exacerbated by his poor living conditions and the inefficient technique he had for using his inhalers and peak flow meter.

I helped him take his salbutamol inhaler and encouraged him to sit up while using the pursed lipped breathing technique, which increased the efficiency of gaseous exchange and thoracic volume.

The patient refused to let us call an ambulance to take him to hospital, so my mentor and I talked with his GP to ensure antibiotics were prescribed for the infected wound and to arrange a review of his asthma management strategy.

We updated his care plan and arranged for food parcels to be delivered to him to help the wound to heal.

Increased awareness

This experience made me more sensitive to the needs of patients with addiction and more aware of the dangers of an apathetic approach to health and chronic conditions.

It also allowed me to expand my clinical knowledge of choosing the correct wound dressing and practise my skills in aseptic non-touch technique. I possessed little previous experience in carrying out wound packing and wound irrigation, so the placement also gave me a chance to use these techniques.

My knowledge of respiratory conditions, such as chronic obstructive pulmonary disease and asthma, was also enhanced, as were my communication and interpersonal skills. I had the opportunity to liaise with other health professionals to ensure my patient's needs were met.

Confidence boost

The person was easily agitated, so the experience gave me increased confidence in dealing with conflict and building an appropriate relationship with a difficult patient.

Before this experience, I had little knowledge of addiction. I learned more about some of the most common issues that surround addiction, such as social isolation, malnutrition and mental health issues including depression and psychosis.

I have become a more compassionate and understanding practitioner through this incident, which also gave me the opportunity to act as a patient advocate.


Erin Carrabin is a third-year nursing student at Birmingham City University

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