Running head: CLINICAL EXEMPLAR

"I Feel Okay"- The Story of Mr. V

Liza McGill
University of South Florida

CLINICAL EXEMPLAR

"I feel Okay"- The Story of Mr. V

According to Harvey and Tveit, "clinical exemplars are a way to capture and demonstrate
the true nature of nursing. They define clinical exemplars as a situation that stands out as the
quintessence of nursing" (1994). It was March, 2016, my final of the clinical rotations. I knew I
was in for a real challenge since this was the start of my preceptorship. I was placed on the
medical telemetry/surgical unit. This meant that I will be acting as a nurse and providing all the
care for the patients, which I have never done before. I use this story because it is this experience
that made me realize that as a nurse, I would have to change my thinking. It was this experience
that made me know I truly made a difference in a patients life; the day I learned my capabilities
as a nurse. This paper will share my story by giving a detailed description of what happened and
my feelings during and after the incident.
It was a Tuesday morning, the sixth shift of my preceptorship. As usual, I always start my
shift by examining my patients electronic chart to get an understanding of why they were here. I
would then look for my nurse preceptor, because we had to go take report. I would then go
around and quickly glance in on my patients and introduce myself, before I start my assessment.
Things were going great all day, my patients were all looking good and showing signs of being
stable. I was feeling confident, as my nurse was complementing me on the good job I was doing.
Little did I know, things were going to "amp up" and take me to another level, of what it truly
means to provide care as a nurse. This story begins about 2:30 in the evening, as I made one of
my hourly rounds. I went into Mr. Vs, room to take a quick look on him and to see if there was
anything I could do for him. Mr. V was a 72 year old white male, who was in the hospital for
chemotherapy. I asked him how he was doing and he smiled and told me he was okay, no pain or

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anything, only that he was just ready to go home. I had to agree he looked comfortable and
showed no sign of discomfort; in fact, he was practically asleep.
When I left his room, I decided to check on his heart rate on the monitor; I saw that his
heart rate was in the low hundreds. I stood there watching it and realized that it kept elevating,
and the machine started to alarm. I told my nurse and we both ran in; Mr. V was sound asleep. I
woke him up and asked him if he felt unusual, but he said was okay. We explained to him what
was happening with his heart; that his heart rate was tachycardic. He looked ok, so we left and
went to check the monitor and his heart rate was back to sinus rhythm. About 5 minutes into
sitting down, the heart alarm started going off again, it was Mr. Vs heart rate racing again. My
nurse and I rushed in again, there he was on his back watching television, not exhibiting any
signs of distress. This time we took a set of vitals and assessment and he was asymptomatic with
only his heart rate elevated. We called the physician and told him what was happening and he
told us to give him a one-time dose of 50mg of metorpolol. However, this did nothing for this
issue, as Mr. Vs heart rate kept flipping back and forth from sinus rhythm 75 to sinus
tachycardia, to the 150's for short spans, lasting anywhere from 3 to 5 minutes at a time. Each
time I checked on him, he was either sleeping or watching the television. When I checked on
him, he would always says he is feeling okay.
Mr. V, had no prior history of heart problems, so this was scary and weird at the same
time. We proceeded to called the physician again, and this time he told us to consult the
cardiologist. My nurse and I along with other nurses on the unit, talked among each other to see
if we could figure out what was going on with Mr. V. We had no other signs and symptoms to
come up with an answer. We all knew that there had to be a problem for this to be happening. I
continued to check on him and he still said he was okay. My gut just never felt relaxed, as I was

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worried that something could be happening to my patient and I couldn't help him. The
cardiologist came, and he watch and saw Mr. Vs heart rate constantly flipping back and forth
and sustaining for about 5 minutes. He went to his room and asked him a few question and he
told him the same thing "I feel okay". He told him because he wasn't showing any signs, he was
going to give him a medication called adenosine that would stop his heart rate for less than a
minute to help show if there was any abnormal electrical issue going on. Mr. V agreed, as he too
wanted to know what was going on before he was discharged.
However, as we were setting up by getting the crash cart and the medications, we
connected Mr. V to the heart monitor and his heart rate flip into sinus 80's and stayed like that, as
we all stood there for at least 15 minutes, talking about this problem. We were all just in shock as
we had no explanation. The cardiologist and his team decided that since it was maintaining the
sinus rhythm, Mr. V was to be put on amiodarone drip, to help maintain and keep the rate. Mr.
Vs heart rate stayed sinus for the remainder of the shift. However, because we could not figure
out what was wrong, as there were no extra signs and symptoms, we asked the cardiologist to
order blood work up, to settle our minds and gut from any worsening problem. My nurse drew
his blood and sent it down; the results showed that Mr. Vs hemoglobin was low.
The above situation had a positive outcome as it was discovered that Mr. V was having
internal hemorrhoids bleeding and he had to received blood transfusion. I know this experience
will provide me with the ability to recognize that a problem may be happening and be persistence
in intervening for the betterment of my patient. I used this story because it opened my eyes to
the fact that even when the all the signs don't show up, I should keep intervening, because if left
unchecked, it could lead to a worse outcome.

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References
Harvey, C. V., & Tveit, L. C. (1994). Clinical Exemplars to Recognize Excellence in Nursing
Practice. Orthopaedic Nursing, 13(4), 45-53. doi:10.1097/00006416-199407000-00008.