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Running head: CLINCIAL EXEMPLAR

Clinical Exemplar
Nina Wilczynski
The University of South Florida College of Nursing

CLINCIAL EXEMPLAR

The purpose of this paper is to provide a clinical exemplar of an experience I found


deeply meaningful during nursing school. Owen and Jane (2012) define a clinical exemplar as a
story written by a nurse in first person depicting a clinical experience. This is a story about a
pediatric patient I took care of during my last semester in nursing school. He was only two
months old. Although the child was my client, I was also taking care of the needs of his parents.
Familial involvement is both common and oftentimes expected in pediatric nursing, especially
when the client is so young.
The parents of the child brought him to the hospital with complaints of persistent
vomiting and failure to thrive. The child was diagnosed with hypertrophic pyloric stenosis. He
underwent surgery to correct the procedure. In school, I was taught that this procedure is
relatively common and usually corrects the childs feeding issues right away. The night following
the procedure, the child had five episodes of bloody emesis. The following morning, the childs
bloodwork revealed a hemoglobin level of 5.5. The physician was not called and informed of
neither the emesis nor the low hemoglobin level. The usual standard of care at this hospital, as
well as many other healthcare institutions, is to provide a blood transfusion to a patient with a
hemoglobin level of 8 or lower. To make matters worse, the doctor became very angry when she
wasnt informed of the patients critical status.
I took care of the patient the first two days after his procedure. His first day post
operatively, he was placed on an NPO diet because of the high risk of bloody emesis further
lowering his hemoglobin levels. I knew he was constantly crying. There would be spurts of time
that would last anywhere between half an hour to two hours where he would be asleep and calm.
Then he would wake up hungry and cry.

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

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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

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