Running head: CLINICAL EXEMPLAR

Clinical Exemplar
Brian Poirier

CLINICAL EXEMPLAR

According To Minerath (2013), An exemplar is a story of a real patient told to illustrate

an RNs practice. The exemplar is written in the first person and describes in detail a particular
clinical situation that includes the nurses thoughts, feelings, intentions, actions, critical thinking
and decision-making process. In my opinion, an exemplars most important function may not be
to simply illustrate a nurses practice for a third party, but for the nurse to reflect on their own
practice and actions, acting as a journal and a place of self-reflection and review. In order to truly
gain experience from practice I think it is critical a nurse review their actions daily. The clinical
experience does not stop at the hospital. The following is a journal entry I composed during my
preceptorship that will serve as a clinical exemplar in which my actions as a nurse will be
detailed. I thoughtfully recorded my activities in order to reflect upon my actions and learn from
my successes or failures.
Two day post op patient complained of increasing nausea and abdominal pain/discomfort,
exhaustion, and anorexia. Objective signs I observed were decreased O2 saturations, increasing
lethargy, ABD distention, vomiting, diet intolerance, constipation and dyspnea. Patient continued
to vomit after eating, could not pass flatus or stool, and was having difficulties breathing and
increasing abdominal distention. Patient was also desatting into the mid 80s with 4 liters of
oxygen via a nasal cannula. I needed to know what was happening internally to cause the ABD
distention and decreasing O2 saturation. My preceptor and I suspected an ileus or pulmonary
embolism, but the O2 desat could have been caused by pneumonia acquired during his stay, or
complications from the patients COPD. My preceptor and I notified respiratory therapy to help
control his dyspnea and decreasing O2 saturation. A duoneb breathing treatment was
administered and a high flow nasal cannula was placed delivering 40L O2 with a fluctuating

CLINICAL EXEMPLAR

FiO2 rate. A CXR and KUB XRAY were ordered to differentiate between a suspected
pulmonary embolism or ileus. We also notified the attending physician of his status. The
situation was becoming critical quickly; in one afternoon the patient went from satting 94-96
with 2L O2 to the mid 80s with 4L. Additionally, the patients ABD was noticeably increasing
in size from distention. The situation was very critical while waiting for radiology results as we
suspected a pulmonary embolism before the KUB x-ray returned and showed an ileus of the
transverse colon and distention that was preventing his diaphragm from descending. The patient
was placed NPO for 24 hours following the KUB x-ray to allow the Ileus to resolve. Following
24 hours NPO, ABD distention subsided, the patient passed a BM, and as the ileus resolved, his
O2 level rebounded and we were able to begin to wean his O2.
Today was a great example of interdisciplinary cooperation and I am confident all of my
actions were sound. On reflection, I feel I made one mistake: I should have been preforming
more routine physical assessments even though the unit only calls for affected extremity
assessments q4 hours. If I would have performed at least one in depth physical assessment
besides my morning assessment, we would have caught the ABD distention earlier and provided
treatment sooner. The patient was obese and suffered from COPD making it difficult to discern
ABD distention from his barrel chest and large figure, but another assessment may have caught
this development.
This is a very memorable case to me as it is the first time a patient began to crash while
under my care. I was very proud of my actions and can confidently utilize this case as a positive
clinical exemplar.

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References

Minerath, S. (2013). Professional Development Framework: Exemplar. Retrieved from

http://www.med.umich.edu/nursing/framework/application/exemplar.htm.