Abnormal narrative bank — focused / at-risk
Six focused abnormal narratives carrying the full necessity chain — finding, severity, comparison, risk, action, notification, and reassessment.
A1 Lymphangitis / cellulitis | Skilled assessment of a post-node-dissection right arm with new warmth, red streaking extending proximally, and tenderness, with a temperature of 101.2°F — new from baseline and concerning for lymphangitis with cellulitis. The provider was notified at 10:55; orders for antibiotics and evaluation were received and the first dose coordinated. The limb was elevated, the erythema margin marked and timed, and the patient educated on the warning signs of systemic spread with instruction to seek emergency care for rigors, confusion, or rapid progression; the streaking, girth, and temperature will be reassessed (cross-reference Integumentary). |
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A2 New hard, fixed nodes | Skilled assessment identifying a new hard, fixed, matted left supraclavicular node that was not present at baseline — a finding concerning for malignancy. The provider was notified at 09:45 and an evaluation requested; the node was measured for tracking. The patient was educated on the reason for evaluation and the symptoms to report; the node will be reassessed (cross-reference Hematologic, Psychosocial). |
A3 Rapidly worsening lymphedema | Skilled assessment of an at-risk arm with a rapid increase in girth over days, new tightness and heaviness, and low-grade systemic symptoms — a rapid progression requiring urgent evaluation. The provider was notified at 13:20; orders for evaluation and intensified management were received. Compression and elevation were reinforced and a therapy referral requested; the patient was educated on the warning signs of infection, and girth will be reassessed (cross-reference Peripheral Vascular). |
A4 Post-operative limb infection | Skilled assessment of an at-risk limb with new erythema, warmth, and a small area of purulent drainage from a skin break, with a low-grade fever — findings concerning for a limb infection in a lymphedema-prone limb. The provider was notified at 14:40; orders for antibiotics and a wound assessment were received. The area was protected and the patient educated on infection precautions and the warning signs of spread; the site and temperature will be reassessed (cross-reference Integumentary, Wounds). |
A5 New unilateral swelling, possible DVT | Skilled assessment of new unilateral lower-leg swelling with calf tenderness and warmth that is more consistent with a deep vein thrombosis than with the patient’s known lymphedema pattern — a change requiring the venous assessment. The provider was notified at 11:15; orders for urgent evaluation were received. The patient was instructed on the signs of pulmonary embolism and to seek emergency care for chest pain or shortness of breath; the limb will be reassessed and the venous workup coordinated (cross-reference Peripheral Vascular). |
A6 Compression complication | Skilled assessment finding new skin breakdown and a constriction ring beneath an ill-fitting compression garment, with increased distal swelling — a compression complication. The garment was removed and the limb reassessed; the provider was notified at 15:30 and orders for a refitting and skin care received. The patient was re-taught proper application and the signs of an ill-fitting garment; the skin and swelling will be reassessed (cross-reference Wounds). |