Normal narrative bank — stable / at-baseline
Seven upgraded normal narratives. Each shows what was assessed, the objective finding, the baseline comparison, and the skilled reason the visit required a nurse — edit to the actual visit.
N1 Post-op TKA, precautions intact, ROM improving | Skilled musculoskeletal assessment for a left total knee replacement at three weeks. Active knee flexion 0–95°, improved from 0–85° last week; quadriceps strength 4/5, improved from 3/5; incision well approximated without warmth or drainage; mild stable swelling. Gait steady with a front-wheeled walker over 50 ft, no loss of balance. The graded strength and measured range-of-motion gains, compared to the prior visit, confirm the recovery is progressing on plan and the activity order remains appropriate; the home-exercise program was reinforced exercise by exercise with correct return demonstration, and progress coordinated with PT. |
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N2 Stable osteoarthritis at baseline function | Skilled assessment of a patient with bilateral knee osteoarthritis. Strength 4/5 and symmetric at baseline; chronic crepitus without new effusion or warmth; range of motion at the patient’s baseline arc. Gait steady with a cane over 40 ft. Pain 3/10 with activity, controlled with the scheduled regimen, without new functional limitation. The findings, compared to baseline, confirm stable osteoarthritis without acute change; joint-protection strategies, pacing, and correct cane use were reinforced, with the patient return-demonstrating correct technique. |
N3 Post-op THA, hip precautions, safe transfers | Skilled assessment for a right total hip replacement (posterior approach) at two weeks. Hip precautions observed — no flexion past 90°, no adduction past midline, no internal rotation; incision intact without drainage; strength 4/5 in the operative leg. Stand-pivot transfers performed with contact-guard assist and a gait belt, precautions maintained throughout. The intact precautions and safe transfers, assessed directly, confirm the early recovery is on track; precautions and transfer technique were re-taught with correct return demonstration by the patient and caregiver. |
N4 Interval strength monitoring, HEP reinforced | Skilled assessment of generalized weakness following hospitalization for pneumonia. Manual muscle testing 4/5 in the upper extremities and 4/5 in the lower extremities, symmetric and improved from 3/5 two visits ago; no new joint findings. Gait steady with a rolling walker over 60 ft, improved from 40 ft. The graded improvement against baseline confirms reconditioning is progressing and continued home exercise is indicated; the program was reinforced and advanced per the therapy plan, with the patient return-demonstrating the new exercises correctly. |
N5 Healing fracture, neurovascular intact | Skilled assessment of a left distal-radius fracture in a removable wrist orthosis. Orthosis fitted correctly; distal neurovascular status intact — fingers warm, capillary refill under 3 seconds, sensation and movement intact; mild stable swelling, no new deformity. Pain 2/10, controlled. The intact distal neurovascular status and correct immobilization, assessed directly, confirm uncomplicated fracture healing; orthosis care, elevation, and finger range-of-motion were taught, with the patient return-demonstrating correctly and verbalizing the signs that require a call. |
N6 Compression fracture, mobility maintained | Skilled assessment of a patient with a stable thoracolumbar compression fracture. No new focal weakness; strength 4/5 and symmetric in the lower extremities; sensation intact; no bowel or bladder change. Gait cautious but steady with a rolling walker over 30 ft, using correct body mechanics. Pain 4/10, controlled with the regimen and activity modification. The absence of new neurologic deficit and maintained safe mobility, assessed directly, confirm stability; body mechanics, brace use, and pain-paced activity were reinforced with correct return demonstration. |
N7 Improving gait and balance with PT coordination | Skilled assessment of gait and balance in a deconditioned patient. Timed Up and Go 18 seconds, improved from 24 seconds two visits ago; single-task standing balance steady with the device; no near-falls reported. Strength 4/5 symmetric. The measured improvement in the timed test against baseline confirms balance and mobility are progressing and the current plan is effective; fall-prevention strategies and correct device use were reinforced with return demonstration, and the gains were coordinated with physical therapy. |