Olfaction – a nurse’s secret tool

I was at work one time when I experienced a nurse with a superpower, or so I thought. The nurse walked in to the room of the patient I was specialling and she said “Have you checked this man’s urine? I’m pretty sure he has a UTI.” I was a little baffled, I had no idea how she new or suspected it. I know enough about UTI’s (Urinary Tract Infections) to know that my patient was at risk by simply being immobile in a hospital. He also had a urinary catheter in-situ which is another risk factor. Still, risk factors don’t lead an experienced RN to be quite certain that a UTI exists.

While the nurse was preparing meds for the patient I went through all of this in my head and my student curiosity took over. “Why do you think he has a UTI?” I asked. She explained to me that as soon as she walked in the room she could smell the typical musky, sweet odour of urine from a patient suffering a UTI. A urine dipstick and a urine test to pathology confirmed the nurse’s diagnosis and a course of antibiotics soon followed. 

Despite being bitterly disappointed that the nurse did not have an actual superpower, I was very impressed with her use of her olfactory sense in order to do her job. While her sense of smell was not a diagnostic tool, she used it to flag a potential issue with her patient that would otherwise have gone unnoticed until the patient’s urine was tested later in the day.

My discovery made me feel like I’d just found a new potion in a nerdy video game, another tool to add to my nursing toolbox. Now, while my sense of smell isn’t the best, I spent the rest of the shift and several shifts after that, smelling everything I could. Was it weird? Yes, but I was subtle.

One of my recent placements allowed me to experience a large number of wounds of all shapes and sizes, from fresh trauma to weeks old ulcers. I got to write ‘purulent’ and ‘fetid’ more times than I can count on patient notes about their wounds. You can imagine the gore I experienced under some of these dressings.

One thing I started doing was ensuring I opened up my sense of smell, not stick my nose in the wound have a breather, but just make sure I acknowledge the scents that my nose naturally picked up while I was tending the wound. Some smelled sweet which points to certain types of bacteria. Others smelled like my green wheelie bin outside which can point to necrotic tissue. Without even looking at the wound, before I took off a dressing, I had an idea of what I would find underneath, just based on the smell. This allowed me to look rather efficient in front of my facilitator as I prepared a very specific tray of equipment and dressings to deal with a specific set of problems.

You may have read my first ostomy experience where I detail the shock of copping the smell of an ileostomy bag for the first time. This has led to the use of my sense of smell in identifying patients who had inadvertently opened their bowels who may be bed bound of cognitively unaware. It also led me to being able to identify the amount of mess I would be dealing with when I got to cleaning up the patient. I have found that diarrhoea has a pungent odour that is quite recognisable and malaena is downright foul-smelling, unmistakable after the first time.

Not all hospital smells are diagnostic, in fact most of them aren’t. So while you have your nose open to all these wonderful clinical smells, be careful you don’t experience one of the more common unpleasant ones.

Body odour is one of the worst. Some people are naturally prone to body odour and will smell no matter what you do for them, some people just don’t wash and others have more legitimate excuses like being feverish and stuck in a bed covered in blankets unable to care about anything more than feeling better.

There is also the dreaded halitosis which can be an indication in itself of gum disease, but more often than not, it’s because the patient hasn’t brushed their teeth after their third coffee on top of breakfast in the morning. Again, this may occur no matter what you do for the patient. Not even the subtly placed toothbrush in the bathroom next to their shaving or showering supplies is enough.

So what do we do with this wonderful nursing tool? On one side it’s a remarkably helpful and accurate diagnostic aid that allows for early action. On the other side it’s a trap, forcing you to take a great lungful of something awful that really doesn’t need diagnosis. I think I’m lucky that my nose is selective in its sense of smell, picking up some things and not others and dulling everything else. This is rather helpful for me due to the convenient surgery I had many years ago in my nasal passages, but it’s not a useful solution to you if you don’t require the same operation. I’ve heard a hundred different ways to avoid foul smells in a hospital, and I’m sure you have your own.

In general, I try and keep my sense of smell open but ensuring I know where the nearest can of stench masker is, where the ventilation shafts are and to never, EVER breathe in through your mouth.

Written by Brad Winter.

Properties of Common Essential Oils

-There are various applications for essential oils. Aromalamp diffuses the scent.  Blended in a massage oil, the essential oil penetrates and soothes the skin. In a compress, the essential oil is absorbed.  Essential oils can also be used in aerosol application and in bath and foot soaks. They are also great when simply smelled for certain issues such as congestion, nausea, and anxiety. 

Juniper-  skin detoxifier, astringent, soothing agent, analgesic, antidiabetic, antiseptic, digestive tonic, diuretic, litholytic, sleep inducing. *no known contraindications, may be neurotoxic, flammable.

Bergamot- conditions skin, soothes, antiseptic, phototoxic, antibacterial, antiinfectious, calming and sedative, cicatrizant, tonic, good for digestive problems and good for calming emotional states such as agitation and mood swings *photosensitizer

Lemon- soothing agent, antiseptic, antibacterial, anticoagulant, antifungal, anti infectious, anti inflammatory, antiseptic, antispasmodic, antiviral, calming, carminative, digestive, diuretic, expectorant, immunostimulant, litholytic, stomachic. Good for greasy skin, can lift the spirits and relieve depression. *photosensitizer

Cedarwood- antiseptic, skin conditioner, deodorant, soothing agent. Good for oily skin and scalp disorders. *not for pregnant women and small childen. Not to be taken internally

Ylang Ylang- reduces stress and tension. Helps fear and irritability, effective against introversion and shyness. Helps regulate cardiac and respiratory rhythms. *use in moderation, can lead to headaches

Orange- astringent, soothing agent, skin conditioner. Bitter orange can be helpful for poor circulation, digestive problems and constipation and promotes positive thinking and feelings. *photosensitizer

Eucalyptus- antiseptic, soothing, skin conditioning, sinus cleansing, analgesic, anticatarrhal, anti infections, antiviral, balancing, decongestant, digestive stimulant, expectorant, prophylactic. Good for muscle pain, effective against colds and coughs as preventative and remedy. *no contraindications 

Fennel- analgesic, antibacterial, antifungal, anti inflammatory, antiseptic, antispasmodic, cardiotonic, carminative, decongestive, diuretic, emmenagogic, lactogenic, laxative, litholytic, respiratory tonic *no contraindications

Tea tree- analgesic, antibacterial, antifungal, anti infectious, anti inflammatory, antiparasitic, antiviral, immunostimulant, neurotonic. Can be applied directly to the skin. *no known contraindications

Lavender- analgesic, antibacterial, antifungal, anti inflammatory, antiseptic, antispasmodic, calming and sedative, cardiotonic, carminative, cicatrizant, emmenagogic, hypotensive, tonic. Aids in sleep, relieves tension headaches, calms nerves *no known contraindications

Rosemary- antiseptic, muscle relaxant, soothing agent, skin conditioner, analgesic, antibacterial, antifungal, anti inflammatory, antispasmodic, antiviral, carminative, cicatrizant, venous decongestant.*no use if high blood pressure or pregnant

Geranium- analgesic, antibacterial, antidiabetic, antifungal, anti infectious, anti inflammatory, antiseptic, antispasmodic, astringent, cicatrizant, decongestant, relaxant. Helps with grief and anger, useful for moodiness and to balance pms mood swings. *no known contraindications

Ginger- analgesic, anticatarrhal, carminative, digestive stimulant, expectorant, general tonic, sexual tonic, stomachic. Alleviates digestive problems, flatulence, constipation, nausea, lack of appetite. Good for muscle pain and sciatica, useful for fear and apathy, draws out withdrawn personality *no known contraindications

Peppermint- analgesic, antibacterial, antifungal, anti inflammatory, antimigraine, antispasmodic, carminative, decongestant, digestive, expectorant, insect repellent, neurotonic, reproductive stimulant, soothing. Clears congestion, asthma, colds, aids in concentration, useful against anger, guilt and apathy *no known contraindications

Niaoli- analgesic, antibacterial, anticatarrhal, anti infectious, anti inflammatory, antiparasitic, antiseptic, antiviral, expectorant, immunostimulant, skin tonic *no known contraindications

Patchouli- antifungal, anti infectious, anti inflammatory, aphrodisiac, cicatrizant, decongestant, immunostimulant, insect repellent. Sedative effect on emotions, helps soothe overactive mind. *no known contraindications

Clary sage- antifungal, antiinfectious, antispasmodic, decongestant, neurotonic, regenerative. Excellent for menstrual complications. Useful for hotflashes, encourages menstruation, helpful for depression and fear. *no known contraindications

» carminative- soothes intestines, induces expulsion of gas

»cicatrizant- promotes healing of scars

» emmenagogic- stimulates blood flow to pelvis and uterus, promotes menstruation 

»depurative- decontaminates/ purifies

»litholytic- dissolves calculi/mineral deposits in urinary system