Scribd
Upload
82 views

Clinical Exemplar Deborah Ogunrinde University of South Florida

The patient was transferred due to a large pleural effusion causing shortness of breath. A thoracentesis removed 400cc of fluid, temporarily improving symptoms. Further imaging found persistent effusion, so a chest tube was placed removing over 3.5 liters of fluid. The patient was also found to have pneumonia and was started on antibiotics. The nurse monitored chest tube output and pain levels, finding the chest tube was effectively draining fluid but caused pain. Repeated imaging was planned to check for resolution and possible chest tube removal.

Uploaded by

api-402469727
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
82 views

Clinical Exemplar Deborah Ogunrinde University of South Florida

The patient was transferred due to a large pleural effusion causing shortness of breath. A thoracentesis removed 400cc of fluid, temporarily improving symptoms. Further imaging found persistent effusion, so a chest tube was placed removing over 3.5 liters of fluid. The patient was also found to have pneumonia and was started on antibiotics. The nurse monitored chest tube output and pain levels, finding the chest tube was effectively draining fluid but caused pain. Repeated imaging was planned to check for resolution and possible chest tube removal.

Uploaded by

api-402469727
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
You are on page 1/ 4

1

Clinical Exemplar
Deborah Ogunrinde
University of South Florida

Draft 8-18-16_LL
2

A clinical exemplar is a story about your clinical practice that conveys something memorable or
something you remember as important, significant or that comes to mind periodically
(Pacini,2006). The patient that I will be talking about, was one that I took care of during my
preceptorship on a medical surgical unit.

Noticing
The patient was a transfer from Wachulla hospital after being admitted for shortness of breath.
The patient was found to have a large left pleural effusion and was transferred to Lakeland
regional hospital. The patient was seen and evaluated at bedside and stated that he had worsening
shortness of breath. The patient had an INR of 6.6. On 2/24/18 the patient had a thoracentesis in
which 400cc of serosanguinous fluid was removed. After that procedure, the patient stated that
his shortness of breath had improved. On. 2/25/18, at CT of the abdomen and pelvis was
performed which showed no acute intracranial progress. The CT showed that the patient still had
a persistent left pleural effusion of his abdomen and pelvis. On 2/27/18, the patient had a chest
tube placement with over 3.5 liters of output. Currently the patient is still having a chest tube that
is off suctioning and just using gravity. We suspected that there was a problem because upon
admission the patient complained of shortness of breath, so when a CT was done, it showed that
he has a pleural effusion. Another indication that there was a problem was that his INR was a 6.6
which can indicate an increased risk of bleeding because their blood is too thin.
Interpreting
The patient had 2 pulmonologists closely following him. One of them placed the chest tube and
400cc came out. On 3/1, they did a chest x-ray to make sure the fluid was not continuing to build
up more, and the results showed that there was no more building up of fluid in his pleural space
but the results also showed that he had persistent left lower lobe pneumonia, so the doctor
ordered the patient to be started on levofloxacin. The situation is critical because if not treated in
a timely fashion, his pneumonia could get worse and expand to other parts of his lungs.
Untreated pneumonia can lead to respiratory failure or death if not treated in a timely fashion.
The nurse and I then hung his antibiotic and we made sure to monitor his chest tube output
throughout the day.
Responding

Draft 8-18-16_LL
3

It is important as the nurse to continuously monitor any new orders that the patient may receive.
We are continuously monitoring the output of the chest tube to make sure it is not filling up too
much. We felt that placing the chest tube was the right decision because that is the only way that
the fluid could get out of his pleural space. A pleural effusion is one indication that a chest tube
is needed (Mohammed,2015). The chest x-ray was also done to make sure that fluid was not
building up in the pleural space. Over the 2 days that I spent with the patient, the patient, he
would sometime complain of stomach pain after every meal and pain near the insertion site of
the chest tube. We gave him gas-x and fentanyl for pain. Another chest x-ray was scheduled to
be done on 3/2/18, to see if there was more build up in his pleural space. If there was not the
patient would be able to get the chest tube removed.
Conclusion
As an interdisciplinary team, we felt that we were making the right decision because our main
goal was to get rid of all the fluid in his pleural cavity and the chest tube helped accomplish that.
We felt that the desired outcome was reached because when the chest x ray was done, it showed
that there was no more fluid in his pleural space and we just had to wait and see if the second
chest x-ray would show the same thing again so that his chest tube could be removed. Something
that I felt that I did well was keeping up with the patient’s pain management. The patient
complained of pain at the site of his chest tube so we did our best to manage his pain in a timely
fashion.

Draft 8-18-16_LL
4

References

Mohammed. (2015, July 03). Chest tube care in critically ill patient: A comprehensive review. from

https://www.sciencedirect.com/science/article/pii/S0422763815300467

Pacini, C. (2006). Writing Exemplars.

https://www.ucdmc.ucdavis.edu/cppn/documents/bridges_to_excellence/Writing_Exemplars.pdf

Draft 8-18-16_LL

You might also like