Running head: CLINICAL EXEMPLAR

Clinical Exemplar
Patricia Korovich
University of South Florida

CLINICAL EXEMPLAR
Clinical Exemplar
It is of vital importance not only as a student nurse but also as a seasoned nurse to take
time and reflect on ones clinical experiences. Assessing a memorable professional scenario
allows us to examine what works well and what does not, just as an assessment of our patients
allows us to see what is well and what is unwell. This allows us to better our skills for the
betterment of our patient population. One way to conduct such an analysis is through the use of
clinical exemplars, which are first-person stories compiled by a nurse on a particular experience;
These can be easily disseminated to coworkers and allows many to benefit (Owens & Cleaves,
2012). The following is my clinical exemplar structured from an experience in my most senior
semester of nursing school.
A 45-year-old female patient arrived on the floor following a total abdominal
hysterectomy. Report from the PACU included a history of severe anxiety and the patient arrived
on the unit with a Dilauded PCA pump. The PACU nurse noted that the patient reported extreme
pain, and was screaming her head off, only resolved by an increase in the PCA dosing. On the
unit, patients returning to the floor from PACU must have their vital signs taken every 30
minutes for 2.5 hours. For this patient, the tech got the first set of vitals when she arrived on the
unit. During her assessment, it appeared that the patient was somewhat disoriented and
repeatedly expressed that she was so scared of being in pain. During the assessment, the
continuous pulse ox machine showed her saturation was dropping to the mid 80s when she fell
asleep. My preceptor and I administered first two, then three liters of oxygen. At this point I was
assessing her breathing patterns and rate, and I only counted 7 respirations per minute, and only
because I shook her awake when she fell asleep. The first set of vitals documented respiratory
rate as 18. I felt confident that this was inaccurate and expressed this to my nurse. I continued to

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personally take the remaining sets of vitals. Additionally, I remained posted outside of her door
and woke her up each time the continuous pulse ox alarmed until it stabilized.
Subjective and objective data included the patient expressing anxiety of being in pain
without ever actually reporting pain. The patients respiratory rate was under 10 per minute on
multiple occasions, and the pulse ox dropped under 90 multiple times. Both abnormal
presentation and my gut feeling caused me to be concerned about deterioration of respiratory
status. I know that anxiety is sometimes a symptom of low oxygenation and it caused me to
worry for my patients safety.
I brought my findings to my nurse preceptors attention and she attributed the patients
status to excessive narcotic administration. We subsequently reviewed medications she received
in the PACU as well as her PCA orders. If it were up to me, I would have notified the physician
since there was an order to do so if the respiratory rate was less then 12. If less than six, there
was an order for narcan to be administered. As it was not ultimately my decision, however, I
waited and watched the patient until her condition improved. I certainly would have liked to be
more proactive, but my preceptor maintained it was not necessary.
In hindsight, I should have been more insistent that the patients respiratory status be
addressed. However, the patients respiratory rate and saturation did reach desired levels over
time. I feel that my assessment was done well. However, I feel that I could have better escalated
my concerns for the safety of the patient. Additionally, I might have addressed the necessity for
accurate respiratory rate calculation with the tech. As a student it was difficult to voice these
concerns and be heard. However, in my future practice as an RN, I will be diligent in my
assessments and confident in my recommendations and interventions.
References

CLINICAL EXEMPLAR
Owens, A. L. & Cleaves, J. (2012, October). Then and now: Updating clinical nurse
advancement programs. Nursing, 42(10), 15-17. doi:
10.1097/01.NURSE.0000419437.60674.45