Skilled-daily narrative bank — covered routine days
Ten skilled-daily exemplars, one per pattern, each proving a covered day — edit to the actual shift.
N1 / IV antibiotic day | Day 3 of IV ceftriaxone for a complicated UTI: 1 g IV via midline over 30 min per order, site clear and flushed, tolerated; afebrile, urine clearing, WBC downtrending. Licensed administration and monitoring required for the IV route and early reaction/line-complication recognition — a daily covered skilled procedure requiring SNF-level delivery. Supports Section N/O; ties to the infection goal. |
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N2 / Post-pneumonia observation | Post-pneumonia day 4: decreasing right-base crackles, RR 20, SpO₂ 94% on 2 L per parameter, afebrile. Skilled observation required to detect re-deterioration and evaluate the O₂ order; daily surveillance necessary given the potential for rapid change, SNF-level. Supports the Section O oxygen day; respiratory care-plan goal. |
N3 / Enteral feeding | PEG feeding at the ordered rate, residual within policy, tolerated without distension; site clean, no leakage; free-water flushes given. Skilled monitoring of tolerance and site required; enteral feeding meeting the coverage thresholds documented. Supports Section K/O; nutrition goal. |
N4 / Sterile wound care | Ordered sterile dressing change to a Stage 3 sacral pressure injury: wound bed 75% granulation (up from 60% last week), scant serous exudate, periwound intact; measured and redressed per order. Skilled procedure and healing-trajectory assessment required. Supports Section M; skin goal. (Full wound detail: Skin reference.) |
N5 / Management & evaluation | HF + diabetes + healing wound + fall risk on eight meds and two parameter orders: reconciled after a dose change, correlated a 2-lb rise with the diuretic/sodium plan, verified turning and fall interventions. Skilled RN oversight required to keep the unskilled care safe; daily need at SNF level. Care-plan problems for HF/skin/falls. |
N6 / Rehabilitation nursing | Restorative ambulation 75 ft with a rolling walker and contact-guard, 20 min, tolerated (SpO₂ 96%); RN adjusted the rest interval and cleared CNA carryover after a 5/5 return-demo. Management/evaluation of the program to maintain mobility (Jimmo). Supports O0500 and Section GG; mobility goal. |
N7 / Discharge teaching | Insulin-pen return-demo 9/9 (2nd attempt) and 15-15 teach-back 100% with the resident and daughter. Skilled instruction to competence required to prevent hypoglycemia/erratic absorption; a covered service, daily toward discharge. Written summary provided. Discharge-education goal. |
N8 / Trach care & suctioning | Tracheostomy care per order: suctioned scant white secretions, airway clear post-suction, stoma site without erythema, ties secure; SpO₂ 96%. Skilled aspiration and airway assessment required. Supports Section O; respiratory/airway goal. |
N9 / IV medication (non-antibiotic) + labs | Scheduled IV medication administered and monitored per order with the ordered lab drawn and coordinated; no reaction, site intact. Licensed administration and lab coordination required; daily covered skilled service. Supports Section N/O. |
N10 / Interval skilled day, stable | Multi-problem Part A resident, stable this shift: skilled observation and management of the plan with vitals within ordered parameters (BP 124/76 vs 128/74 yesterday), medications administered and monitored, and the unskilled care verified. Licensed judgment required to detect interval change and evaluate the regimen given the diagnoses; daily SNF-level need. Supports Section N; care-plan goals current. |