Help wanted for exemplar

[sairin8]

hi all

i have to write an exemplar for a job application and have no experience in writing one. we also did not do exemplars at my nursing school as the main employer here does not require them. i have written one (which i will include) and would like suggestions as to how to improve it for a new graduate position (either paediatrics, acute medical or acute surgical).

my patient was a 2 and a half year old girl who had come into paediatric outpatients with her family for a food challenge as she had a history of previous reaction to dairy.

the food challenge for dairy involved a number of steps. after recording baseline observations and checking the child for any sign of rash, the challenge started with a drop of milk touching the inside of the lip. if there were no sign of reaction 1ml would be given at the 20-minute mark, 5ml at the 40-minute mark, and so on until 2 hours had passed.

i admitted this girl to the ward on her arrival, including recording the baseline observations and her weight. i noticed that her mother, who was to stay for the duration of the challenge, appeared very anxious. after orienting the family to the ward and allowing the child and her brother to play, i sat down with the mother and explained what the plan for the day was. as part of this, i showed her the protocol for the dairy challenge and mentioned that this protocol had come from starship, information that she responded well to. i asked her to describe the reactions her daughter had previously had (rash from drinking a small amount of goats milk at 7 months and rash from contact with a yogurt stained cloth at 18 months). i explained what would happen if the child reacted to the dairy, paying attention to the plan for severe rash and for anaphylaxis as these were what concerned the mother most. as a result of this explanation, i noticed the mother visibly relax. this, i believe, helped the child to remain relaxed as well.

the child did react 10 minutes into the challenge. the mother and i both noticed a mild rash on her forehead and another on her neck. i pressed the call bell once as the child was not in any obvious distress, i was also aware that the nurses on duty would come in immediately regardless as there is extra awareness on a food challenge day. one nurse called the registrar who was covering the challenges and the decision was made, as per protocol, to end the challenge.

please note: spelling is uk not us (as is appropriate for where i am applying). starship is the childrens hospital in my country and is very well known and regarded, my potential employers will know this.

[dishes, BSN, RN]

What happened after the challenge ended? It sounds like your involvement ended at this point, if that is the case, explain what was done, by who and why, otherwise this exemplar will leave the reader hanging and they will not know if you understand the implications the allergy will have on this child and her family.

dishes

[sairin8]

Good point, hadn't thought about that. No, my involvement did not end there. I'll write that up after placement today and add it in

[sairin8]

addition to exemplar (at the end)

after the challenge was completed, the child had to remain on the unit for 2 hours. for much of this time, i handed over to other nursing staff in the same room with their patients undergoing various food challenges. this allowed me to deal with a number of other tasks that required input from a nurse or nursing student. i did come in for further observations, as per protocol, and saw the minor rash progress down the body. this progression followed the same pattern as previously, though not as severe. the child remained contently playing during this time, although she did express concern for another child who had suffered a more severe reaction.

discharge advice included the usual details of where to call if there were any concerns. it also included the advice of not coming into contact with dairy of any type at this point in time. there is likely to be a further dairy challenge when she is older as well as a wheat challenge.

[sairin8]

how does this sound so far?