A Clinical Exemplar

Running head: CLINICAL EXEMPLAR 1
Clinical Exemplar
Alejandra Rodriguez
University of South Florida College Of Nursing
CLINICAL EXEMPLAR 2
Clinical Exemplar
Introduction
Clinical exemplars can be defined as a way nurses share their experiences in the clinical
setting to identify the significance of caring that is essence in the nursing profession. These are
the situations that nurses recall again and again. They are the circumstances that eventually
become milestones to nurses (Harvey & Tveit, 1994). A clinical example that I found significant
in my experience was during preceptorship in the mother baby unit. Although this experience
was a situation that can happen during postpartum, it was a challenging and demanding event
because it taught me the importance of being proactive in emergent situations.
Clinical Experience
A 29 year old patient presented to the hospital with contractions continuing every 5
minutes. Patient was admitted for labor and had a C-section for fetal distress. Patient delivered a
baby girl on 2/9/17 at 11:53am with a gestational age of 39 and 3 weeks. When patient was
admitted into the mother baby unit after 2 hours of recovery she stated she was feeling very
nauseas and light headed. She continuously kept vomiting green clear bile. The patient was very
diaphoretic and pale upon assessment. When trying to get her vitals her temperature was difficult
to obtain due to her symptoms. When we were finally able to get an accurate reading the
temperature read 95.7 F. When palpating the patients fundus she kept bleeding more than
expected every time we pressed down on her belly. During one of the fundus checks I also noted
the patient had a small clot pass through. Before coming down to the mother baby unit the labor
and delivery nurse administered Zofran IV to the patient but it did not help relieve the symptoms.
CLINICAL EXEMPLAR 3
I knew there was problem when we were admitting the patient. During the admission
process, I thought that perhaps this patient may be at a point of hemorrhaging or an infection
caused by the C-section because of the symptoms that my patient was experiencing. This can be
a critical situation because since she was experiencing lightheadedness and vomiting she was at a
risk for falling or any septic reaction.
After communicating my concern to my preceptor we know we had to immediately
initiate the hemorrhage protocol. We also notified the charge nurse so she can assist us with this
situation. At the moment I knew we had to involve the doctor. When we tried contacting her we
were told that she was in another delivery and she would contact us as soon as possible. While
we waited for the doctor we continued massaging her fundus to see if some of the bleeding
would decrease. I felt like we were making the right decision as we stayed with the patient to
continue to monitor her status and her vital signs. I felt comfortable with calling the doctor and
telling her what was going on with the patient and that she needed immediate attention to relieve
her reaction.
When we were finally able to get the doctor to come see the patient she concluded that
my patient was having a vasovagal reaction perhaps because of the C-section and the anesthesia
given. After assessing the patient the provider ordered a bair hugger, lactated ringers and a
Phenergan suppository for our patient.
Conclusion
According to a study, the abrupt dilatation of the cervix is a well-known potent stimulus
of parasympathetic activity that can result in a vasovagal reaction (Firth, 2013). A recent study
showed an 18 year old who a similar complication during postpartum but her reaction had caused
CLINICAL EXEMPLAR 4
her to lose consciousness and lose about 700ml of blood not including the blood lost during birth
because it was not caught right away. She ended up needing two blood transfusions to get her
stable (Firth, 2013). As I read this article I feel like we made the right decision by staying with
our patient at bedside intervening to reduce any risk of any worse complication that could have
occurred. I felt like being there and continuously monitoring her vital signs while we waited the
doctor also helped because we knew that the blood pressures were maintaining stable and that
are patient was conscious although she was losing some blood it was not as much to initiate a
blood transfusion. I am glad that in my patients situation the decision of administering fluids,
the bair hugger and the Phenergan suppository had a positive outcome for my patient. This had
an impact for me in my nursing career because it was an experience that I was able to assess and
manage with positive outcomes. With the help of my preceptor and the other team members on
the mother baby unit we achieved our goal for my patient to then be able to enjoy her newborn
baby girl without further complications.

CLINICAL EXEMPLAR 5
References
Firth, P. (2013). Vasovagal syncope: an unusual cause of postpartum collapse. Journal Of
Obstetrics & Gynecology, 17(5), 491. doi:10.1080/01443619750112574
Harvey, C., & Tveit, L. (1994). Clinical exemplars to recognize excellence in nursing
practice. Orthopedic Nursing, 13(4), 45-53.

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What symptoms did the patient present with and what interventions were initially taken?

What was the provider's conclusion and treatment plan for the patient?

Running head: CLINICAL EXEMPLAR 1

because it taught me the importance of being proactive in emergent situations.

risk for falling or any septic reaction.

After communicating my concern to my preceptor we know we had to immediately

Phenergan suppository for our patient.

baby girl without further complications.

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