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Weronika Dmochowska
Nursing students experience many different situations in the clinical setting during their
time in school. Writing an exemplar is a way for students to reflect on and discuss their
experiences as well as improve their understanding (Lipnevich, McCallen, Miles, & Smith,
2014). For nursing students, clinical exemplars are used in order to tell a story regarding a patient
they cared for and how the student’s actions benefited the patient. The following is a clinical
exemplar discussing a time in which I was able to identify the signs of sepsis in one of my
patients.
The patient was a 21 year old term primigravida/para (first pregnancy/birth) who came to
the Labor and Delivery triage where she had a vaginal exam and was 4cm dilated – in active
labor. She was then moved from triage to one of the delivery rooms where she came into my
care. We took a set of vitals and all of her vitals were within defined limits except for her
heartrate which was in the 120s. We looked at her CBC and noticed her WBC count was
elevated (20,000). At this point, my nurse and I realized she was possibly fighting an infection
and decided to keep a close eye on her vitals, especially her temperature. For the majority of the
shift, the patient was behaving as expecting regarding her labor and after she received epidural
analgesia, her HR went down to the 90s. I checked her temperature every 2 hours (instead of
every 4), and each time it was between 97° to 98°F. Around 1700, we noticed the patient looked
“off” and asked how she was feeling and she said she felt weird, was having difficulty breathing,
and had chest pain. She then started having full-body shivers so we took a set of vitals and she
had become tachycardic again (120-130s), hypotensive, her temp was 100.5°F, her respiration
rate was 24, and there was fetal tachycardia as well. My nurse did a vaginal exam and the patient
CLINICAL EXEMPLAR 3
was 7cm dilated with her amniotic sac still intact. I took her temperature again 30 minutes later
After noticing that our patient had a change in status, we needed to notify the patient’s
midwife in order for her to get the best care possible and get lab and medication orders. We also
notified the L&D safety nurse, who is the “go-to” nurse for any non-reassuring strips or any
concerns regarding the patient’s status. After noticing that all of my patient’s vital signs changed
so rapidly, seeing that she spiked a fever, and then having her say she feels weird and start
shivering, my gut feeling was that the patient had become septic. I asked my nurse and the
midwife what they thought and they said the patient probably developed chorioamnionitis which
is an infection of the placenta and amniotic fluid. This was a highly critical situation that needed
I told my preceptor that I think the patient might be septic and asked if we should get a
lactate level to determine the severity of the patient’s situation. My preceptor wasn’t sure so she
called the midwife and the midwife said yes to the start of the septic bundle. Sepsis is definitely a
situation in which you want to do something right away and not wait to see what happens, as the
mortality rate increases the longer you wait to begin interventions (Liu, Fielding-Singh,
Iwashyna, Bhattacharya, & Escobar, 2017). After getting the go-ahead from the midwife, we
started the sepsis bundle. For patients that are suspected to have sepsis, the Surviving Sepsis
Campaign introduced a sepsis bundle to immediately manage it. The bundle includes measuring
serum lactate level, obtaining blood cultures, administering broad-spectrum antibiotics, and rapid
administration of 30mL/kg of crystalloid IV fluids (Lester, Hartjes, & Bennett, 2018). Each step
of the bundle has been reliable at improving patient outcomes when completed together (Lester
et al., 2018). I asked my nurse if I can help with the blood draws but she said for the sake of
CLINICAL EXEMPLAR 4
time, it would be best for her to do them so I helped gather all the materials needed. We then
gave the patient a bolus of lactated ringers and hung the antibiotics with the oncoming nurse.
Because everything starting to happen right before shift change, by the time we had the
blood cultures drawn and hung the IV antibiotics, it was time to leave for the night so I do not
know what the end result was. Even though I wasn’t able to stay before the lab results came
back, starting the sepsis workup was the best decision. I believe this to be true because the
patient had met all of the criteria and even if the results came back negative, the interventions we
performed were the best care to prevent further injury to the patient and her baby. An
intervention that was successful was giving the patient the bolus of LR as her blood pressure
Something that I did well was recognizing what could possibly be happening with the
patient. After I told my preceptor what I thought, she did not want to agree with me but figured
she would ask the midwife if she wanted us to start a sepsis workup which she agreed to. This
made me feel confident in my assessment and knowledge of patient conditions. What I could
have done better is helped the patient and her family understand what is going on in more
laymen’s terms versus medical terms as they were not in the healthcare field and were most
References
Lester, D., Hartjes, T., & Bennett, A. (2018). A review of the revised sepsis care bundles: The
rationale behind the new definitions, screening tools, and treatment guidelines. AJN
Lipnevich, A.A., McCallen, L.N., Miles, K.P., Smith, J.K. (2014). Mind the gap! Students’ use
539-559. doi.org:10.1007/s11251-013-9299-9
Liu, V. X., Fielding-Singh, V., Iwashyna, T. J., Bhattacharya, J., & Escobar, G. J. (2017). The
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