Running head: CLINICAL EXEMPLAR

Clinical Exemplar
Tanisha Cathren
University of South Florida, College of Nursing

Clinical Exemplar

CLINICAL EXEMPLAR

A clinical exemplar can be defined as a clinical example that displays

implementation of critical thinking and decision making during the delivery of
patient centered care (Black, 2002). This clinical exemplar illustrates an experience
that occurred during my preceptorship rotation in the Cardiac/Stroke ICU. This
particular incidence required a rapid response and need for nursing intervention.
Situation
A 75-year-old male presented to the ER via EMS with shortness of breath and
severe dehydration. After various lab tests and assessment, he was diagnosed with
left lower pneumonia. While being treated in the ER, the patient had a grand mal
seizure. He was given one dose of diazepam (1 mg) and admitted to the
cardiac/stroke ICU for further observations. No additional tests were completed in
the ER. Pertinent medical history for the patient includes a history of COPD, CVA,
osteoarthritis, diabetes, and hypertension.
After receiving report from the night shift nurse, my preceptor recognized
that there was a stat order for a CT scan from the provider. My nurse decided to
post-pone the morning assessment in order to get the CT scan completed as soon
as possible. While I was preparing the patient for transport down to CT, I noticed he
began to have mild jerky movements in his lower extremities. During that time, my
nurse left the room to grab a portable cardiac monitor and oxygen so I decided to
approach the patient to access the quality of the movements. After examining the
patient, I noticed the movements began to occur in his upper and lower extremities.
From that point, I recognized that the patient was potentially having another seizure
and required immediate interventions to aid in decreasing the time of activity.

CLINICAL EXEMPLAR

Interpreting & Response

I have never witnessed an actual seizure, but based on the jerky movements I
concluded that the patient was possibly having a seizure. It was an extremely
critical situation that required immediate intervention. The patient was already
admitted for respiratory distress so it was important to ensure that the patient had
maximum oxygen as well as padded rails for safety. While witnessing the seizure, I
immediately yelled out to my nurse for assistance. Once my nurse arrived and
concluded that the patient was, indeed, having a seizure, she called out to the
intensivist for authorization for a dose of diazepam in an effort to stop the seizure
activity.
Once I witnessed the patients seizure-like movements, I began to observe
the patients level of consciousness to ensure that his saturations remained above
95%. I also called out to the floor PCA for two additional blankets to place around
the lower rails. The patient only had padded rails by his head and I knew he needed
padded security all around him for safety. Most importantly, once I noticed possible
seizure activity I documented the time it started because I knew that was pertinent
information for documentation.
Reflection
I absolutely believe that I made the right decision to contact my nurse when I
saw the movement. Even though I was unsure if it was an actual seizure, I still felt
his movement needed to be addressed based on his recent seizure in the ER. The
patient was given two doses of diazepam and stopped seizing within 5 minutes of

CLINICAL EXEMPLAR

onset. He was stabilized and transported down to CT 1 hour later for immediate
observation of his brain. He was also placed on Keppra in hopes to deter future
seizure activity. Overall, the desired outcome was achieved and the patient was able
to sustain from further seizure activity throughout the duration of his stay. I felt as I
identified there was a problem occurring with my patient quickly and notified my
nurse immediately to ensure that the patient received prompt, essential care.

CLINICAL EXEMPLAR

References
Black, J.P. (2002). US National Library of Medical Institutes of Health: Use of the
Clinical Exemplar in Performance Appraisals. Retrieved from
http://www.ncbi.nlm.nih.gov/pubmed/9325873