The Nose of A Nurse: Dealing with Bad Smells in the Hospital

In the clinical setting, nurses come across all manner of sights, sounds, and yes…smells. But beyond the obvious ones that people complain about (which I never understand…you DID know what you were getting into, right?), certain smells can tell you a thing or two about your patient’s health. In this post we’ve compiled a list of a few disease states that come with a special odor all their own. So, while bad smells in the hospital probably aren’t your favorite part of your job, there are times when they can come in handy. Don’t worry…we’ll get to how to handle them in a minute!

Pseudomonas: Many people describe this bacteria as smelling like grapes, cheesy grapes, fruity cheesy grapes, or bad sweet wine. Pseudomonas is pretty common in pneumonia, bacteremia , wounds and UTIs.

Arsenic – A patient with arsenic poisoning could have a garlic odor to their body tissues or breath. Other signs include hematuria, stomach cramps, hair loss, excessive saliva and diarrhea that can be severe.

Cyanide – Not everyone can detect it, but the odor of cyanide poisoning has universally been called a “bitter almond” smell. More often noticed in autopsies rather than the clinical setting…but interesting nonetheless! In a live patient, you may notice it on the breath…if you have the gene that enables you to smell it, of course.

Really Really Really Bad Breath –  In liver failure, namely with portal hypertension, thiols go straight to the lungs where they are then exhaled. The smell, known as fetor hepaticus, is described as musty, raw fish, fecal, and rotting eggs. It’s one you’ll never forget. Liver failure patients are exceptionally difficult to treat as they can have myriad problems. Read more about taking care of patients in liver failure here.

Fruity acetone or nail polish remover – In DKA, the patient’s breath typically has a fruity/acetone smell, which is the odor of the ketones the body is trying to get rid of. Want to learn more about DKA? We got you.

Ammonia – Oftentimes, a UTI or problem with the kidneys will cause the urine to smell of ammonia.

Stale Beer – Having an odor of stale beer could mean your patient has scrofula, an infection described as “tuberculosis of the neck” but if you want to be more scientific, it’s essentially lymphadenitis of the cervical lymph nodes, very often associated with tuberculosis mycobacteria.

Vinegar – If your patient’s sweat smells of vinegar, consider schizophrenia as the cause.

Freshly baked bread – Typhoid can cause the skin to have the distinctive odor of bread.

Rotting eggs – Gangrene, aside from being disfiguring and a massive source of infection, tends to smell pretty bad…namely like rotting eggs.

Fish odor – Patients who are unable to break down trimethylamine (found in liver, eggs, some fish)  will produce a strong fishy odor.

Two odors that are described as indescribable

There are two more odors that you will encounter A LOT in the clinical setting…and I have to be honest, they are pretty bad. Describing them specifically is difficult, but once you smell them you will never forget. All it will take is one whiff and you’ll be able to say with pretty good accuracy that your patient has one of these common afflictions.

GI bleed  – the smell of melana (the dark, bloody stools of a GI bleed) is one of those distinctive yet indescribable smells. I have no words…but once you experience it,  you’ll know it when you smell it.

And then, of course there’s C-Diff...which has such a characteristic, yet hard-to-explain odor. Most people describe it as rancid, slightly-sweet-but-not-in-a-good-way, STRONG odor.

How to handle bad smells in the hospital

Which brings us to the next obvious question…how do you handle intense odors with grace and compassion? The first step is to recognize that one of your jobs as a nurse is to care for people who are vulnerable. [bctt tweet=”By maintaining grace in an ungraceful situation, you help that patient retain his/her dignity at a very difficult time.” username=”StraightANurse”] NEVER let your patient know that you are affected by any unpleasant odors…if you have to leave the room for a minute, make up excuse and leave the room…but don’t let it show. Please.

Below are a few tips that might help your encounter with rough odors a not-so-traumatizing experience:

• Place a tea bag inside a face mask and smell the scent of lemon or mint instead
• Sprinkle a few drops of essential oil inside a face mask (peppermint is good one!)
• Smear a little Vicks Vapor Rub under your nose
• Pop in a menthol cough drop before you head into the room
• Keep a small container of coffee beans in your work bag; as soon as you leave the room take a big whiff of the coffee beans to clear any residual unpleasant odors out of your nose
• When emptying ostomy bags, immediately place a washcloth or hand towel over the container and set it aside as you finish cleaning and caring for the patient.
• When cleaning stool, coverage is the key. Immediately cover the stool on the absorbent pad with either another pad (or fold the one you are using over) or a towel. Use cleansing spray liberally…not only does it help with odors, it makes cleanup easier.
• Many times we’ll get patients who haven’t bathed in a really, really, really long time. Oftentimes, these are our homeless patients and one of the most rewarding things you can do is get them clean and comfortable (I promise they will most likely appreciate this!). In addition to giving them a thorough bath, grab a few of those bedside shower cap things we use to wash patient’s hair…put one on the head and one on each foot. Double bag all clothing and, if you’re sweet and coming back to work the next day, take the clothing home and wash it for them…this makes a HUGE difference! (but only if you’re sure they’re not going to be discharged while you sleep!).
• Did you know you can nebulize COFFEE???? Ask one of the RTs to set it up for you, and you will be AMAZED at how well it clears the air In particularly odorous rooms.
• Some hospital units use aromatherapy. I worked in a unit that had diffusers and it helped SO MUCH. Your unit may have to get certified in order to use it with patients, but you might be able to use it at the nurse’s station without extra certification.
• Place some coffee grounds or cups of shaving cream strategically around the room to help keep the air fresh.
• And last, but definitely not least…KEEP YOUR PATIENTS CLEAN! Bathe them daily, remove the SCDs and wash their lower legs. If the SCDs are rank, toss ’em out and get a new pair (you’ll be shocked at how much odor those sweaty legs can produce!). Same goes for BP cuffs that are on 24/7 (like in ICU). Change their linens, change their gowns, wash their hair…it sounds so basic, but you’d be shocked how often these small things are overlooked.

What smells have you come across in the clinical setting that help you identify what’s going on with your patients? And how do you handle them gracefully? Share them in the comments below!

Get this on audio in episode 105 on the Straight A Nursing Podcast!

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