Running head: Clinical Exemplar

Clinical Exemplar: Patient Experiencing an MI

Audrey Bradley
University of South Florida

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Clinical Exemplar: Patient Experiencing an MI

The use of clinical exemplars allow nurses to process and analyze patient cases that have
left an impression on them. Even in nursing school, theres multiple opportunities to enhance
clinical thinking and the ability to make quick decisions. As Tingen and others describe the
primary role of the nurse, regardless of the location or setting that the nurse works, as the patient
advocate while providing optimal care with evidenced based research (2009). With more
experience the nursing student or new graduate nurse begins to develop better critical thinking
and decision making skills. The case I will be discussing in this exemplar regards an Asian
woman (referred to as Ms. M) who had experienced a myocardial infraction during the shift I
was working alongside my preceptor.
Ms. M was a 60 year old Asian woman who was day two post-op of a restriction of the ileum
due to a small bowel obstruction. During the beginning of the shift she was receiving a unit of

RBCs and would receive another unit afterwards. She showed no reaction from the blood
transfusion and her vitals were all within normal limits. I had been rounding on her every hour
and seeing how she felt, due to receiving the blood and she reported no complaints. After
returning from lunch, the nurse and I went to check in on Ms. M and she was reporting trouble
breathing, chest pain, and an increasing sense of doom. I immediately hooked her up to the pulse
oxygen machine and her stats were in the low 80s. She was placed on oxygen with 2 liters, and
my preceptor called for a respiratory therapist. Ms. Ms other vitals were normal but we still kept
an eye on her oxygen stat. The charge nurse was notified of the situation happening and a call
was placed for labs (Troponins), and an EKG to be taken. By involving the charge nurse it took
some of the burden off of the nurse and also kept the charge nurse informed to a critical situation.

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It could have been many different processes that could have caused this, but it seem most likely
to be a myocardial infraction but all bases have to cover to ensure that nothing is missed.
My preceptor left to make calls out and I stayed with the patient. I let Ms. M know I was
there and what was happening. While the respiratory therapist came and evaluated Ms. M we
increased her oxygen to 10 liters and her stats were still ranging from low 80s to mid-90s. Once
the EKG came it showed that there was some evidenced of a possible myocardial infraction. The
labs showed that her troponins were elevated and it was ordered that she be transferred to a
cardiac unit so she could be monitored.
This patient had no previous cardiac history and was relatively stable for a post-op
patient, making her MI even more unpredictable. She had no MONA (morphine, oxygen,
nitroglycerin, and aspirin) therapy ordered, so that left my preceptor with limited options to help
before providers could arrive to evaluate the situation. I would have never thought to call the
respiratory therapist, to rule out a pulmonary embolism or fluid overload. To see the difference
from a nursing student to an experienced nurse was clear and it with experience that allows
nurses to grow.

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References

Tingen, M. S., Burnett, A. H., Murchison, R. B., & Zhu, H. (2009). The Importance of Nursing
Research. The Journal of Nursing Education, 48(3), 167170.