Running head: CLINICAL EXEMPLAR 1

Clinical Exemplar: Interdisciplinary Care

Olivia Taylor

University of South Florida

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Clinical Exemplar: Interdisciplinary Care

As nursing students and novice nurses gain experience and understanding, it is often a

challenge to apply learned principles to real-life clinical situations (Gillespie & Peterson, 2009).

Reflecting on experiences, decision making, and outcomes serves to increase knowledge, skill,

and confidence. One way to aid in the development of this critical thinking is through a clinical

exemplar. A clinical exemplar is the retelling of a clinical story, written in first person, that

describes a nurse’s thoughts, feelings, and decision-making process (Pacini, 2006).

Patient History

The patient, a 65-year-old female, was brought to the emergency department via EMS.

Her husband recently passed away and, after being unable to contact her, the patient’s family

called the police to request a wellness check. She was found unresponsive in her home with a

bottle of Valium next to her. The patient was found to have aspiration pneumonia and severe

respiratory acidosis. She was admitted to the CCU and subsequently intubated.

When reviewing the patient’s labs, her liver function tests and ammonia were markedly

elevated; at this point, we were addressing this with lactulose and rifaximin. As this was

potentially an intentional overdose, psychiatry was consulted. The psychiatrist noted these

markedly elevated labs could be indicative of alcohol abuse that the healthcare team was

unaware of.

Interpretation

As the patient was not awake or oriented, we could not ask her directly about a history of

alcohol abuse. A common, but very serious problem related to alcohol abuse is Wernicke-

Korsakoff Syndrome (WKS), in which a severe thiamine deficiency causes encephalopathy and

progresses to chronic cognitive impairment. After speaking with the psychiatrist, my preceptor
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and I decided that we would speak with the intensivist and request an order for thiamine

replacement.

Responding

We decided we would bring the issue to the attention of the interdisciplinary team during

rounds, as they would be taking place within the next thirty minutes. Per Nilsson and Sonne

(2013), signs of WKS are often ambiguous, leading to delayed diagnosis and inadequate

treatment. They recommend that all patients with a history of alcohol abuse be treated with

parenteral thiamine (Nilsson & Sonne, 2013). During rounds, the intensivist agreed to order

replacement thiamine, stating that if the patient needed thiamine, it would help to prevent WKS;

however, if she did not need thiamine replacement, it would simply be excreted in her urine. We

requested thiamine from pharmacy and administered it parenterally.

Reflecting

I believe we made the right decision because the benefits of thiamine replacement greatly

outweigh the nearly negligible risks. In this situation, helping to facilitate communication

between physicians improved my personal communication skills and gave me a more complete

understanding of my patient’s needs. I was reminded to view my patient in a holistic manner and

to keep the entire clinical picture in mind.

This experience deepened my appreciation for interdisciplinary collaboration and the

unique role that each healthcare team member plays. Psychiatry is not a discipline I worked with

often while in the CCU; and to be honest, the consultation seemed premature, as the patient was

still intubated and sedated. However, this physician’s training and experience provided a fresh

perspective and highlighted factors we were overlooking. His valuable input resulted in our

patient receiving better care and allowed us to avoid a potentially serious complication.
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References

Gillespie, M. & Peterson, B. (2009). Helping novice nurses make effective clinical decision: The

situated clinical decision-making framework. Nursing Education Perspectives, 30(3),

164-170.

Nilsson, M., & Sonne, C. (2013). Diagnostics and treatment of Wernicke-Korsakoff syndrome

patients with an alcohol abuse. Ugeskrift for Laeger, 175(14), 942-944.

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

https://www.ucdmc.ucdavis.edu/cppn/documents/bridges_to_excellence/Writing_Exempl

ars.pdf