New Drainage, a Tube of Ointment, and a Lab Question
You are working 3 p.m. to 11 p.m. At 4:10 p.m. the charge nurse is in a room with a dying resident's family. Mrs. Patel, 68, is eight days past abdominal surgery. She calls you in. The dressing over her incision now has a palm-sized circle of fresh red drainage that was not there when you checked at 3:15. She says her pain is "8 out of 10, worse than yesterday," and her skin feels warm and damp. As you step into the hall, her son hands you a tube of prescription antibiotic ointment from home and says, "The last aide put this on her incision. Can you do it again? And while you're here, what did her white blood count show this morning?"
1. The nurse is tied up with a family. What do you do about Mrs. Patel - and do you interrupt?
Read the worked answer
Yes, interrupt. Fresh drainage that was not there 55 minutes ago, new and worse pain, and warm damp skin together suggest bleeding, a wound opening, or infection. These are "the nurse comes now" findings, not "I'll mention it in report at 11 p.m." findings. Waiting is the wrong kind of politeness.
How to interrupt well:
- Knock, step in, low voice, and lead with the facts and the concern in one sentence: "Mrs. Patel in 12 - her dressing has a palm-sized area of fresh red drainage that wasn't there at 3:15, her pain is worse, and she feels warm and clammy. Can you come?"
- Then let the nurse decide whether to come now or send someone. Your job is to make sure the information arrives, not to make the triage decision.
What you may and may not do at the bedside:
- If there is active heavy bleeding, put on gloves and hold firm pressure with a clean pad while you call for help - that is first aid, not a dressing change.
- Do not remove, reinforce, or change the dressing on your own initiative. A surgical incision dressing is the nurse's responsibility, and what you do to it can destroy the information the nurse needs.
- Keep her calm, lying comfortably, call light in reach. Don't leave her alone if she seems unwell.
Chart the time, the drainage (color, amount compared with 3:15), her pain score in her words, her skin, and when you notified the nurse.
2. The son wants you to apply the ointment from home. What do you do?
Read the worked answer
Decline - and take the tube to the nurse.
Why "the last aide did it" changes nothing: that is not an order, and if it happened, it is information the nurse needs, not permission. Say it neutrally to the nurse - "Her son says an aide applied this before" - as a fact to be looked into, not as an accusation in the hallway.
Three separate reasons to refuse:
- Scope. Applying a prescription product to a surgical wound is not a nursing assistant task. Nothing goes on broken skin without an order and the training to carry it out.
- Assessment. You do not know whether that incision is intact, opened, or infected, and a topical antibiotic can mask or change exactly what the nurse needs to see.
- No medications from home. A tube brought from home has no verified identity, no current order, and no place in a facility medication system.
What to say: warm, short, and final. "I'm not able to put anything on her incision - that's not something I can do. I'll get her nurse to look at it right now, and I'll give her the tube to check."
Then: hand the tube to the nurse, say the son requested it and mentioned a previous aide, and chart that you declined and referred. Don't leave the tube on the bedside table, where the next person may use it.
3. The son asks what his mother's white blood count was this morning. How do you handle that - and what makes this harder than a simple "no"?
Read the worked answer
You don't answer it - no number, no "it looked fine," no "I think it was normal." A laboratory value is clinical information. Even a correct number without context can frighten him or falsely reassure him, and interpreting it is not your role. A half-answer is still a disclosure.
What to say: "I can't share her results - let's find her nurse, who can talk with you about them." Brief, calm, and without apologizing as though you personally refused him. The rule protects his mother.
What makes it hard:
- He is standing in front of you, worried, and you are the only staff member in sight. "No" feels like abandonment.
- He is likely next of kin and may well be entitled to the information - but from the nurse, who can also confirm what he is authorized to receive and explain what the number means.
- His mother's dressing is actively draining, so the question isn't idle curiosity; he has probably already noticed something.
So don't just refuse - connect. Walk him toward the nurse, or tell him when the nurse will be free and make sure the nurse knows he is asking. Then chart the request and your referral.
Also: don't leave charts, lab printouts, or a medication cart screen open where family can read them, and don't discuss any of this in the hallway or elevator.