A2 / Unwitnessed fall on anticoagulation

Found on the floor 03:20, on apixaban: injury survey (no deformity), neuro checks q15min then per protocol, vitals stable, unwitnessed LOC. SBAR 03:35, head CT + neuro checks ordered; representative notified 03:40; mat and hourly rounding added; fall coded Section J; root-cause initiated. Daily post-fall surveillance required (delayed-bleed risk).

A3 / Suspected sepsis

Temp 101.6°F, HR 112, BP 96/58, new confusion in a resident with an indwelling catheter — concerning for urosepsis. Vitals and a rapid assessment obtained, sepsis pathway initiated, SBAR to provider, transfer order received; representative notified; event and serial vitals documented. Skilled recognition and escalation required.

A4 / HF decompensation onset

4-lb gain over 48 h, new 3+ pretibial edema and an S3, mild orthopnea — early decompensation. Parameter-based diuretic applied; SBAR 14:10, higher dose + BMP ordered; dose witnessed 14:25; representative notified 14:30; relief after voiding. Reassess next shift. Supports Section N. (HF-specific: CHF overlay.)

A5 / Hypoglycemia

BG 52 with diaphoresis and tremor — treated with 15 g fast carbohydrate per protocol, recheck in 15 min BG 88, symptoms resolved; held the next dose pending review; SBAR to provider; representative notified; cause (missed meal) identified. Skilled recognition and treatment required. Supports Section N. (DKA/hyperglycemia: DM overlay.)

A6 / New focal deficit

New right-arm drift with slurred speech (negative last exam) — positive BE-FAST. Stroke/transfer pathway activated immediately, provider and representative notified 11:05; time last-known-well documented. Reassess after evaluation; update MDS/CAA on return. Time-critical, especially on anticoagulation.

A7 / New/worsening pressure injury

New Stage 2 sacral pressure injury on the weekly sweep, not present on admission (facility-acquired) — POA status recorded, stage/measurements documented; provider notified and treatment ordered; repositioning/surface plan intensified; dietitian consulted; injury coded Section M; care plan revised. Weekly trending planned. (Detail: Skin reference.)

A8 / Acute change in mental status

New disorientation and lethargy from an oriented baseline, no focal deficit — delirium workup initiated (vitals, glucose, O₂, infection/medication screen); SBAR to provider, orders received; representative notified; safety measures in place. Reassess; evaluate for SCSA. Skilled assessment required.

A9 / Significant weight loss identified

8-lb loss over 30 days (≈5.1%), unplanned, with intake at 40% and new coughing at meals — dietitian and provider notified, swallow eval + altered diet ordered, aspiration precautions reinforced; weight loss and nutritional approach coded Section K; care plan revised. (Detail: Nutrition reference.)

A10 / IV line complication

Midline site with new erythema, tenderness, and a streak — concerning for phlebitis/infection; infusion held, line assessed and discontinued per protocol, site cared for; SBAR to provider, new access and possible culture ordered; representative notified. Skilled recognition of the line complication required. Supports Section O.

Disease-specific days are authored in their overlays and not duplicated here. HF decompensation and GDMT titration route to the CHF overlay; DKA/hyperglycemia and glycemic management to the DM overlay; COPD exacerbation action plans to the COPD overlay; stroke-rehab progression to the CVA overlay; post-op orthopedic precautions to the Post-Surgical overlay; supratherapeutic INR and bleeding to the Anticoagulation overlay; sepsis/urosepsis to the Sepsis overlay.