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Clinical Exemplar
Nina Wilczynski
The University of South Florida College of Nursing
CLINCIAL EXEMPLAR
CLINCIAL EXEMPLAR
On his second day post operatively, the client was placed on a formula feeding diet. He
had had only one episode of emesis the previous day, and none during the night. As soon as his
diet orders were changed, I went in to inform the mother she could feed her child. Right as she
picked him up to give him the bottle, the child had a large amount of projectile bloody emesis.
He was again placed on an NPO diet. The doctor was informed and an upper gastrointestinal
series was ordered to look for blockage in his GI tract.
At one point during the day, I checked on the patient and he showed no signs of distress
but was sleeping peacefully in his grandmother's arms. I reset his fluids to run for two more
hours (per hospital policy). About an hour later, he was crying. This time he was screaming in a
manner that was louder and more urgent than normal. I knew something was wrong. I was about
to walk in before the mother of the patient came out and told me his foot was swollen. The
patients IV had infiltrated and his entire leg was swollen and firm. He was in real danger of
compartment syndrome. I stopped the IV fluids and discontinued the IV right away, as well as
wrapped the affected leg in warmers to help his tissues absorb the fluid. About five minutes later,
the transport team came on the unit to take the patient to have his scan.
It was at this moment that I experienced the most stressful time in my clinical experience,
as well as the most heart breaking. The child was screamingly uncontrollably and my preceptor
and I needed to start another IV on him right away for his scan. He was a difficult stick, meaning
it was very hard to start an IV on him, and all of his extremities showed signs of bruising from
where nurses had attempted to start them. A member of the IV team happened to be on the unit.
We asked her to come and start an IV on the child since we could delay the transport no longer.
As she was taking the child to the procedure room, the noise and the fast paced environment was
a lot to take in. My preceptor and I were both rushing, and I happened to be the last person out of
CLINCIAL EXEMPLAR
the room. In the corner of my eye, I saw the patients mother draw back and start crying. She had
cried before, and understandably so, when her child would vomit blood or cry out of hunger.
Now, she was curled up in a ball on the couch and was sobbing harder than ever before. I
stopped for half a second, walked back in the room, and asked her if she needed anything.
Tearfully, she gave me a broken smile and said no. I walked out of the patients room in tears.
The IV was started on the child and he was sent to get his scan. His mother went
alongside him. In about twenty minutes, everything from stopping the infiltrated IV, to speaking
to the patients crying mother, to restarting an IV and sending the patient with transport occurred.
It was a high stress time, and a heartbreaking time watching the patients mom. I learned so
much on that day. I learned how quickly IVs can infiltrate, especially on babies. I learned about
managing care in a high stress environment. Most importantly, I was reminded about the
importance of caring for a clients emotional needs. While the physical needs of a patient in an
emergency need to be taken care of immediately, the emotional needs of the patient and family
are just as important and need to be remembered.
CLINCIAL EXEMPLAR
5
References
Owens, A. L., Cleaves, J. (2012). Then and now: Updating clinical nurse advancement programs.
Nursing 2012, 42, 15-17. doi: 10.1097/01.NURSE.0000419437.60674.45