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Clinical Exemplar
Willamina Folks
University of South Florida
CLINICAL EXEMPLAR
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Clinical Exemplar
CLINICAL EXEMPLAR
when the arterial blood pressure (ABP) was consistently reading 80s for the systolic pressure
with a mean arterial pressure (MAP) below 60. Also, when reviewing the patients ABP in EPIC I
determined that this was very abnormal for the patient since previous trends was within normal
range. I immediately told my preceptor that my patients ABP is consistently decreasing and from
recent trends noted in the Medical Record this was an abnormal finding for this patient. My
preceptor had me page the provider. When the provider called back a bolus order was placed.
There are things that could have potentially affected the patient if the ABP and MAP was
not corrected in a timely manner. An arterial blood pressure (ABP) is a major determinant of
regional flow and is frequently used as an alternate indicator of tissue perfusion (Magder, 2014).
For example, an abnormal ABP was a red flag for me and the first thought that comes to my
mind is lack of perfusion. This issue could result in critical organs not receiving essential
nutritions and oxygen needed when a MAP is consistently below 60 and ABP below its normal
range. If an intervention is not in place I am thinking the worst case scenario is the patient could
go into cardiac arrest which isnt good for either parties. Therefore, intervening was necessary to
prevent things from getting worse.
Conclusion
This was a great experience to assess my decision-making and critical thinking skills. I
feel that once the problem was identified I reassessed the patients blood pressure, made sure the
line was zeroed accordingly and in the phlebostatic axis position, and closely monitored the
arterial blood pressure. Within minutes I felt that an intervention was needed to correct the
patients arterial blood pressure. I feel that I was about to make the best decision based off of my
understanding of normal arterial blood pressure range. Then by assessing the patients trend
CLINICAL EXEMPLAR
while in the MICU was a significant factor that calling the provider for an order was necessary
since a standing order to correct this situation was not in place.
CLINICAL EXEMPLAR
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Reference
Magder, S. A. (2014). The highs and lows of blood pressure: toward meaningful clinical targets
in patients with shock. Critical Care Medicine, 42(5), 1241-1251 11p.
doi:10.1097/CCM.0000000000000324