Clinical exemplar

Full Answer Section

    Recognizing Deterioration and Advocating for Change: Prior to the Ommaya placement, routine lower extremity Doppler studies revealed a new thrombus in the left common femoral vein. The plan changed to IVC filter placement followed by the Ommaya procedure later that day. While preparing the patient, I noticed rapid clinical deterioration. He became increasingly tachycardic and tachypneic. My clinical judgment raised concerns about his tolerance for the planned procedures. I immediately informed the physician and expressed my concerns about his hemodynamic stability. Rapid Response and Critical Intervention: Based on my advocacy, the physician re-evaluated the patient. Unfortunately, my concerns were confirmed as he rapidly decompensated, becoming hypotensive and hypoxic. Recognizing the urgency, I activated the rapid response team. The patient required emergent intubation and immediate transfer to the ICU. A portable chest X-ray revealed free air under the diaphragm, suggesting a bowel perforation that likely contributed to his respiratory failure. Throughout this critical event, I kept the family informed and provided emotional support as they grappled with the sudden deterioration of their loved one. Impact of Clinical Proficiency:

• Clinical Knowledge: My understanding of hemodynamic parameters and the potential complications associated with procedures like IVC filter placement allowed me to identify early signs of decompensation.
• Leadership and Education: I proactively advocated for the patient by voicing my concerns to the physician, demonstrating leadership through strong communication and assertive communication.
• Evidence-Based Practice: Activating the rapid response team ensured timely intervention and adherence to established protocols for critically ill patients.

Reflection and Learning: This event has profoundly impacted my clinical practice. It reinforced the importance of constant patient observation and trusting my clinical judgment. I learned that early intervention and advocating for my patients can make a significant difference in their outcomes. Continuous Improvement: Looking back, perhaps a more in-depth discussion regarding the patient's overall stability and tolerability for the planned procedures could have occurred before proceeding with additional interventions. Additionally, ensuring earlier communication with the family regarding potential complications and the criticality of his condition may have helped prepare them for the sudden turn of events. Conclusion: This complex event highlighted the importance of a Clinical Nurse III's critical thinking, collaborative spirit, and patient advocacy. By effectively utilizing my clinical knowledge, communication skills, and evidence-based practice, I played a key role in identifying and responding to this critical situation, ultimately facilitating timely intervention for the patient. This experience continues to shape my practice as I strive to be a more proactive and vigilant nurse, ensuring the best possible outcomes for all my patients.    

Sample Answer

   

This past year, as a Clinical Nurse III, I played a pivotal role in identifying and responding to a critical situation with an 80-year-old male patient. This experience exemplifies the importance of clinical judgment, patient advocacy, and collaboration within a multidisciplinary team.

Clinical Event:

The patient, an 80-year-old man with relapsed/refractory IgG kappa multiple myeloma and a history of hypertension, GERD, and lung nodules, was admitted due to progressive neurological symptoms. An MRI spine revealed diffuse leptomeningeal enhancing lesions and cord involvement. A lumbar puncture confirmed the presence of plasma cells, further supporting the diagnosis of leptomeningeal involvement by his myeloma. He was scheduled for Ommaya reservoir placement to facilitate intrathecal chemotherapy.