Running head: CLINICAL EXEMPLAR 1

Clinical Exemplar
Alejandra Rodriguez
University of South Florida College Of Nursing
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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.
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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
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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.

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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.