Lasting Learning Opportunities
In this profession it is an honor
and privilege to be a part of someone's care. Being a nurse for so many years,
I never dreamed that I would have the opportunities I have been afforded by
being a practitioner. While this is not earth shattering, I just really
appreciate performing the basic office procedures that I have been studying and
first introduced in a lab setting. I can remember the many labs where we made
casts, or removed a tick, sutured, trigger point injections and remove foreign
bodies from mannequin noses and ears. Those were fun times, and then I
graduated!
Now I am faced with those very same
procedures in my correctional facility environment and truthfully I do not have
a clue. I resorted to my hard copy resources and my digital ones but the one
that is the most invaluable is in my collaborating physician. I had a client
whom has been suffering with an ingrown toenail. In the environment such as a
correctional facility we attempt to limit any excisions at all cost due to the
risk of infection. The area is clean, but often times the clients will not
leave any abnormal bump, rash or pustule alone -- they will pick until it
bursts.
This young man was no exception; he
was treated with warm foot soaks, antibiotic therapy and a mild analgesia. He
continued to pick at the extra cuticle skin that overlapped his toe. I had
attempted previously to instill lidocaine and excise the area but he did not
tolerate the procedure very well so I continued his foot soaks and mild
analgesia.
My next option was to use nitrate
sticks to cauterize the tissue. It discolored the tissue and one week later he
returned with blanched/charred tissue that remained over his nail. After
speaking to my collaborative physician regarding my care, I asked for her help.
She asked, "Have you ever performed a wedge resection of a toenail?" and I had
not! I could only refer to my physical and digital references and my lab
environment.
It was very interesting how after
providing a nerve block to the great hallux, the ease in which the nail was
lifted and removed. It was possibly minor to most, but it was a great learning
opportunity for me. Lastly, he was able to state finally, "It feels so much
better!"