Running head: CLINICAL EXEMPLAR

Clinical Exemplar: My Purpose

Jean Ching
University of South Florida
College of Nursing
j.ching23@gmail.com

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Clinical Exemplar: My purpose

My journey through nursing school has taught me an abundant of lessons. These lessons
learned not only help me improve and develop my skills as a nurse, but taught me tremendous
growth as a person. Every opportunity spent at the hospital, I am reminded on the diversity of
becoming a nurse and the honor of obtaining and upholding the title of nursing. Although there
are the good and bad days, the time spent learning has serve the same purpose, that is, my
purpose. I want to reminisce on one past experience that has made a positive impact on me by
indulging on this clinical exemplar. A clinical exemplar enables the nurse to demonstrate critical
thinking and decision making skills that exemplifies the delivery of excellent patient care by
reflecting on a meaningful situation (Black, 1997).
The patient was a 52 year old, female who was brought into the Emergency Department
(ED) with a compliant of a rash and itching from an allergic reaction. The patient was sent home
on doxycycline, but she returned a week later with the same complaint of a rash and itching. The
patient was presumed to have an allergic reaction to doxycycline and was given IV Solu-Medrol
in the ER. While the patient was going to the bathroom, the patient went into a respiratory arrest.
Four rounds of epinephrine was given with CPR. The patient was intubated and bronchoscopy
was performed but the patient showed no inflammation in the lung. The patient was transferred
to the Cardiovascular intensive care unit, where I was doing my clinical preceptorship.
The patient was one day post-extubation when I had the privilege to take over her care. I
did my morning assessment and noted that the patient was alert and oriented to all but she was
forgetful at times. She was normal sinus rhythm and BP systolic in the 120-140. She was on
room air and saturation of 100%. She had adequate output and her foley was discontinued prior
to that morning. I assisted her ambulation to the bedside commode and noted a steady gait but

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she forgets limitations. Her skin was warm, dry, and intact but had a couple small scratches from
itching. When I walked in for the morning assessment, she was continuously itching at her leg
and stated how uncomfortable she was. I applied lotion to her back and legs but the patient still
complained of itching. I checked her medical record to see if she had anything for her itching.
The patient had Bendryl, twice a day, but she was not scheduled for another dose until 1400 that
day with no other medication available as needed.
The itching symptom was the main problem for that day and the goal was to reduce her
itching. While talking to the patient, I discovered that the patients symptoms started after her
primary doctor has prescribed her Lisinopril. I looked up the patients present and past medical
history to look for documentation of this reaction. Luckily, it was documented and the patient has
been prescribed another blood pressure medication in place of Lisinopril. I then investigated how
effective the Bendryl was to the patient because it did not seem to relieve her symptoms. The
patient looked restless in bed and stated that the Bendryl didnt help at all. I called the health care
provider and updated him on the patients status using SBAR and recommended for the patient to
receive a medication to help with her itching. Within 10 minutes, her medical record showed an
order for Claritin as needed, once daily by mouth. I reassessed the patient for itching and
processed to administer her medication. In an hour, I reassessed her symptoms and she reported
that her itching has decreased. Later that day, I reassessed her again and she noted that the itching
has completely subsided.
Although this situation is not critical, I felt that I made a positive difference in the
patients care. I addressed her main issue of why she came to the ED in the first place. The
patient met her goal that day to report no itching by the end of the shift. I believe I made the best

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interventions for my patients basic care of comfort. Even a minuscule accomplishment can make
a great impact and remind me of my purpose to provide safe and quality care.

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References

Black, P. (1997, August). Use of the clinical exemplar in performance appraisals. Newborn
Network, 5(73), 8th ser. Retrieved June, 2016.