Running head: CLINICAL EXEMPLAR 1

Clinical Exemplar:

Respiratory Distress in an Infant

Jessica Cadorette

University of South Florida

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Clinical Exemplar
Clinical exemplars are written to illustrate a clinical practice/experience. It describes in detail a
particular clinical situation that includes the nurse’s thoughts, feelings, intentions, critical thinking, and
decision- making process (Pacini 2016). In this clinical exemplar I explain a situation I experienced in the
NICU involving a patient in respiratory distress.
Patient History
The patient was a male born at 39 weeks and was twenty-two days old. He was born via
scheduled c-section due being breeched and ultrasound showing oligohydramnios. He was
admitted with respiratory distress syndrome (RDS) and was intubated in the delivery room. He
was later diagnosed with pulmonary arteriovenous malformation. He is currently on continuous
positive airway pressure (CPAP) +10, receiving a fentanyl drip, and feedings through an
orogastric tube.
Noticing
I noticed while receiving report that something was abnormal with this patient. I went to look at
the patient and noticed how he was using his accessory muscles to breath, mild subcostal
retractions, and I could hear him working hard to breathe. I asked the night shift nurse if he
looked like this all night and she told me that was his normal work of breathing. The patient
looked like he was in pain and was very irritable despite being on a fentanyl drip.

Interpreting
During my first assessment I auscultated and heard expiratory wheezing bilaterally. While
assessing him the patient was crying, which caused his oxygen saturations to decrease. I decided
to give him a break and sat him up to see if that helped. He immediately stopped crying, and
seemed a lot more comfortable. I decided that it might be more beneficial to get him a swing, so
his head would be elevated. I notified my preceptor of my idea and then I called the patient care
tech (PCT) and asked to bring a swing into his room. In this situation, the added stress was
causing a decrease in blood flow to his lungs and causing him to desat and increase his work of
breathing.
Responding
I decided to do something now because the patient was having a difficult time breathing and very
irritable. I will know my decision to put him in the swing will be best for him if his work of
breathing decreases and he seems calmer. I delegated to the PCT to get the swing, but I put the
patient in the swing to assess his reaction to it. According to Spooner et al. (2014), elevating the
head of bed has been shown to improve oxygenation and hemodynamic performance. Since a
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cribs head of bed can only be elevate to about 15 degrees and the patient was not doing well with
that, that is why I thought the swing might be better for him.
Reflecting
I believe that bringing the swing for patient was the right decision. The patient’s work of
breathing decreased, and he seemed very content in the swing. While he was in the swing we
were able to decrease his Fi02 demand by ten. I thought I came up with a good, quick
intervention based on the patient’s assessments. Next time when I see a patient with a similar
work of breathing I will instantly think to elevate the patients head, and if possible bring a swing
into their room.
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References
Pacini, C. (2016). Writing exemplars. Retrieved form
https://www.ucdmc.ucdavis.edu/cppn/documents/bridges_to_excellence/Writing_Exemplars.pdf

Spooner,A., Corley, A., Sharpe, N., Barnett, A., Caruana, L., Hammond, N., & Fraser, J.(2014). Head-
of-bed elevation improved end-expiratory lung volumes. Retrieved from
https://pdfs.semanticscholar.org/ca50/1cb63203ff048924c3b97d5131b08fd14996.pdf