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Clinical Exemplar:

Preterm Labor

Morgan McMahon

University of South Florida

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Clinical Exemplar:

Preterm Labor

Nursing is a profession that often involves emotionally intense situations that require empathetic

and intellectually demanding responses. It can often be challenging for students and novice

nurses to have the ability to balance these two aspects of patient care. Owen (2006), describes a

written framework that allows nurses to review and reflect on their experiences as well as

analyze their decision making process in a clinical exemplar. This format leads to the nurse to

evaluate the decisions made and to shape future decisions in order to produce better patient

outcomes.

Patient History

The patient was admitted to the antepartum unit after being transferred from a different

hospital for preterm labor. She was a Gravida 3 Para 0, and the gestational age was 32 weeks and

0 days. The patient was 1 cm dilated, and her membranes were still intact. The patient was

having mild contractions every two to six minutes, and she had been having this contraction

pattern for over six hours. She was put on magnesium sulfate as a tocolytic to stop preterm labor.

During the admission, the patient expressed anxiety about the situation, and she stated

feeling overwhelmed with the possibility of losing another baby. Along with her anxiety, the

patient was put on magnesium sulfate. Magnesium is a high risk infusion, and the patient needed

hourly lung and reflex assessments. During one of the assessments, I noticed a change in her left

lower lobe which went from clear to diminished lung sounds with rhonchi.

Interpretation

After listening to the patient share her anxiety and feelings of dread about the situation, I

tried my best to assure her that she is in the right place. I told the patient that we do not know for
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sure what will happen, but I and the nurse will do everything in our ability to take care of her and

her baby. Along with therapeutic communication, my nurse and I also got an order from the

provider for an anxiolytic medication.

According to Xiao, Gangal, and Abenhaim (2014), magnesium sulfate treatment is

strongly associated with the development of pulmonary edema when used either as a tocolytic

agent or for seizure prophylaxis. Knowing this, the change in lung sounds was extremely

concerning, and a response was needed to prevent future complications.

Responding

In this situation, I needed to act right away and tell the necessary people about the

assessment findings. The doctor told my nurse and I to keep the magnesium going, and to call if

any changes occurred. I asked my nurse if we could ask the provider for a slower infusion rate or

discontinuation of the magnesium sulfate. However, my nurse did not want to yet. In this case, I

regret not advocating for the patient myself, and asking the doctor if there was anyway to change

the order for the magnesium.

Reflecting

After this experience, I realized how important it is to advocate for my patient’s even

when my voice may not be heard. Although no other issues occurred for the patient on that shift,

there could have been serious or even fatal complications. I also experienced how important it is

to take the time to listen to the patient. Even if I cannot calm them down, it makes an immense

difference to them to know that they have someone who hears them and cares about them. I am

thankful for how this experience has shaped me and the effect it will have on my future as a

nurse.
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References

Owen, S. A. (2006). Clinical exemplar demonstrates critical thinking and assertive perioperative

nursing intervention. AORN journal, 65(2), 444-447. Retrieved from

https://aornjournal.onlinelibrary.wiley.com/doi/pdf/10.1016/S0001-2092(06)63353-X

Xiao, C., Gangal, M., & Abenhaim, H. A. (2014). Effect of magnesium sulfate and nifedipine on

the risk of developing pulmonary edema in preterm births. Journal of perinatal medicine,

42(5), 585-589. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/24566358