Running head: CLINICAL EXEMPLAR

Clinical Exemplar
Kacy McMurry
University of South Florida

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Clinical Exemplar

In an article by Pacini, she defines a clinical exemplar as a story of a real patient

that a nurse tells in order to illustrate practice/experience. (Pacini, 2006). She goes on to
further explain how it should be memorable and it should be an experience that you think
of occasionally. A clinical exemplar is not a case study, they should however, explain a
clinical situation that taught you something and may have changed how you look at how
you practice (Pacini, 2006).
During my preceptorship on the oncology unit, I was lucky enough to take care of
Mr. H., as 28 year old patient that was diagnosed with AML, several times. He was
admitted for a right pleural effusion, as well as a round of chemotherapy treatment. On
the first day of his hospitalization, the patient underwent a thoracentesis, where 1.4 liters
of amber fluid were removed. The patient was brought back to the floor and had stable
vital signs. Upon bedside handoff on the second day of Mr. H.s admission, I noticed that
he presented as tachypneic and he also complained of shortness of breath and left sided
pain. Having had this patient previously, as well as after his initial thoracentesis, I knew
this was not his baseline. My nurse and I decided to take a few sets of vital signs, which
showed that his SpO2 level read 97. Taking his vital signs were important because the
patient was also receiving 24-hour chemotherapy and we needed to be sure it was not a
reaction to the chemotherapy. I then completed a focused assessment where I noticed the
patient was using accessory muscles to assists his breathing efforts, which was not
normal for the patient.
Seeing that the patients condition had declined since our prior shift, I voiced my
concern to my nurse about the possibility of calling his physician as well as the STAT

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team. After another reassessment of the patient, we decided to go ahead and call the
STAT team and physician. Upon the STAT teams assessment, they decided that Mr. H.
needed to be moved to the ICU for closer monitoring as well as the possibility for another
thoracentesis. The physician agreed that this was the best course of action, so Mr. H. was
brought to the ICU.
I knew I made the right decision by calling the other care providers because Mr.
H.s breathing became a concern. I knew that he had a pleural effusion and even though
he already underwent a thoracentesis, this made him a candidate to have another one.
With his lungs being filled with fluid, this made it harder for him to breathe. Upon
examination of his X-Ray, his trachea was also deviated, making it even harder for Mr. H.
to breathe. This situation was critical and the patient needed to be taken care of right
away.
While in the ICU, the patient underwent two more thoracentesis, where a
significant amount of fluid was removed. The patient was brought back to the oncology
unit after three days in the ICU. The patients condition had improved greatly, and he had
returned to his positive attitude. The patient had a PluerX placed, a device where the
patient can remove fluid from his lungs himself. Since Mr. H. is young and wanting to
take care of his health, he was a great candidate for the PleurX. My nurse and I educated
Mr. H. and his girlfriend on how to use the device, which included instructional videos,
as well as a demonstration. They both stated they understood the process, as well as
resources for help upon discharge. Mr. H. was discharged later that day, and I felt
confident that with the PluerX, that he would be fine to go home and continue treatment.

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Not only did I get to use critical thinking with Mr. Hs case, but I also was able to
experience how much a patients positive attitude can affect their outcome.

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References

Pacini, M. C. (2006). Nurse Action Days. Retrieved from

https:www.ucdmc.ucdavis.edu/cppn/documents/bridges_to_excellence/writing_ex
emplars