Thursday, March 22, 2007

I just gotta get this off, chest.

There's a post in this week's Change of Shift about the S.P.P.

"S.P.P" is a nice way of saying "Stinky Poontang Problem." You know, genital odor, most often encountered in women. The three-day-dead fish stink.

The post on the subject was funny, yes. The author gave fantastic ways of dealing with the situation. But I gotta, *gotta* get this off my chest:

Stinky Pink Bits Are Not Normal.

(hauling out feminist-health soapbox) We've been conditioned through years of fish jokes and horrible comments on shock-jock radio to think that women stink naturally. They don't. An offensive vaginal or vulval odor is caused by one of three things:

1. Poor hygiene. 'Nuff said. We can fix that, at least temporarily, in the hospital.

2. A major pelvic infection or sexually transmitted infection that's gone untreated.

3. Overgrowths of normal bacteria or yeast in the vaginal canal.

Of the three, numbers one and three are the ones we most often see, and number three is the one that is most likely to lead to a case of unrelenting stink. And we, as nurses, can do something about that.

The first thing I do when a patient comes in as an admit is start an IV. The second thing I do is catch a urine specimen (after changing the Foley, if it's there). The third thing I do is a thorough interrogation of my patient, which includes questions about their sexual and genitourinary health.

I'm programmed that way. Years of women's health clinics haven't worn off yet. And it's useful, though you might not think it, in a neuroscience setting. Often the first symptom of a brain problem is incontinence. No, really.

If I get a positive response on the "does it hurt when you pee" question, well, I've got a UA already and can start appropriate antibiotics according to protocol. If I get a mention of persistent vaginal odor, I can get a wet swab (it's not hard, honest) and send it off to the lab. A little metronidazole is all it takes (800 milligrams in a single dose will knock out most cases of bacterial vaginosis, or BV) and my patient is a tiny bit healthier than when she came in.

For those folks who can't speak (like one of my current patients with a bad case of S.P.P.), I corner the doctor and *tell* him or her (not ask, *tell*) that the I suspect a case of BV and would like X amount of metro for X number of days. Nine times out of ten the residents cave; they don't want to deal with anything but brains. (I should mention here that I have both an NP and a PA backing me up here; it's not like I'm dashing off on my own with a speculum and an attitude. Although that would be a great basis for a superhero.)

Here's another good reason for a neuro nurse to deal with the bits on the opposite end of the body. Sit back, it's a story:

We had a patient come in once with encephalopathy. Normally when that happens the neuro guys get all up in my grill with requests for various blood tests and lumbar punctures and so on.

I was the *one* nurse to do a thorough exam on my patient. During that exam, and during the question-and-answer period with her husband that followed, I learned that the patient had had six or seven really severe herpes outbreaks in the last year.

That one simple question, "Have you been concerned about any changes or noticed anything new in the sexual health department?" made it possible for us to start from a position of knowledge in the patient's care. Sure enough, she had herpes encephalopathy. It's most common in newborns who are infected by their mothers, but it can happen in adults, too.

So, people, empower your patients. I don't care if you're in the ED, the postpartum wing, on the neuro unit, or dealing with postsurgical patients in the plastics ward: let the patient know that here they have a safe space to talk about *anything*, and you might end up solving a problem they didn't even know they had.


Anonymous said...

So, uh, I have recurring yeast infections...

//makes appt with gyno
///...scratch, scratch

That reminds me of a very, very overweight and mentally handicapped girl that was on an adolescent psych ward with me. I heard *all* the residents -- and the attending! -- making fun of her stink. We couldn't use the bathroom after her because of the smell. The residents flipped a coin to see who would do the vag exam, laughing, and here I am -- twelve years old -- and having to listen to this, disgusting by their attitudes.

shrimplate said...

OK, I'll say it 1st before anyone else does: "the nose knows."

I have learned from my elderly female patients that UTI's are not to be ignored. These can knock people over to queer street for a few days.

Easy to treat once identified, usually.

Anonymous said...

Great post, and a reminder to always assess the WHOLE of my coworkers in home care just sent an elder back to the hospital- she came home with gangrenous toes - not noted on the referral or list of diagnoses - from a well-known medical center - apparently nobody took her socks off to look at her feet!

GingerJar said...

can we say soap and water....seems the nursing homes are short on these...most of the time that and a little fluid will cure the problem....unless there is a UTI bug.