Daniel Morales · CNA Timeline
Morales, Daniel
CNA Delegation
Arrange the Timeline
Work through Daniel's morning one time slot at a time. Type the correct card number into each slot before the next one unlocks.
Decision Point
Daniel's card image goes here
(re-send the crop and I'll drop it in)
(re-send the crop and I'll drop it in)
Daniel is walking back from the bathroom. Where should he sit for breakfast?
To the chair for breakfast. Having Daniel sit in a chair supports:
- Safe eating by reducing the risk of aspiration
- Better lung expansion and oxygenation
- Early mobility after knee replacement
- A complete nursing assessment, which can still be performed effectively while he's seated
- Patient comfort
Staying in bed for breakfast skips a low-effort chance to get Daniel upright and moving. Early, frequent mobilization after a total knee replacement helps prevent stiffness, DVT, and deconditioning, and sitting up in a chair also lowers his aspiration risk while eating. There's no clinical reason to keep him in bed if he's tolerated getting up already. Choose again.
Clinical Reasoning
You've pulled up Daniel's MAR on Card #72. Which medication is the right choice right now?
Percocet is the right call. He's been responding well to it, he's due for his next dose, and there's no reason to escalate to an IV opioid.
Daniel has been responding to Percocet, and there's no sign it isn't working. Jumping to an IV opioid means more sedation risk than he needs right now, without a clinical reason to escalate. Choose again.
Therapy starts at 10:30, and it's 9:45 right now. About how many minutes of lead time does giving the medication now give it to take effect before therapy?
minutes
10:30 minus 9:45 is 45 minutes, a solid window for an oral medication to reach peak effect before a painful activity like therapy.
Daniel already received one Percocet dose earlier this shift (325mg of acetaminophen). If he receives this next dose too, how many total mg of acetaminophen will he have had today?
mg
325mg + 325mg = 650mg so far. Each Percocet tablet carries 325mg of acetaminophen, so tracking the running total matters. Most facilities cap total daily acetaminophen around 3,000–4,000mg, so this dose is well within range, but it's still something to track with every dose.
Focused vs. Comprehensive Assessment
Sort each item into the assessment it belongs to.
Pain level
CMS check of the surgical leg
Vital signs
Surgical dressing / incision check
Lung sounds, all fields
Bowel sounds
Head-to-toe skin check
Peripheral pulses, all extremities
🎯 Focused (q4h)
+ tap to add
🧞 Comprehensive (q8h)
+ tap to add
Focused, every 4 hours: zeroes in on the surgical site and anything that can change fast.
- 💣 Pain level
- 🦟 CMS of the surgical leg
- ❤️ Vital signs
- 🩹 Dressing / incision check
- 💭 Lung sounds
- 🍒 Bowel sounds
- 🧭 Skin, head to toe
- 👍 Pulses, all extremities
Plan for Discharge Teaching
We will plan to complete this at 12:00. Let's gather our thoughts so we're ready when he returns from therapy.
Mark each topic as Needed or Not Needed for Daniel's total knee replacement discharge teaching.
Signs of infection to report (redness, warmth, drainage, fever)
Infection is a real risk after any joint replacement, and Daniel needs to know what to watch for.
Signs of a blood clot to report (calf pain, swelling, redness)
DVT risk is elevated after lower-extremity joint surgery, so this is a standard teaching point.
How to safely use a walker or cane
Daniel will be relying on an assistive device at home, so safe use is essential.
Home exercise program from physical therapy
Ongoing exercises are central to regaining knee function after a total knee replacement.
Pain management plan for home
Daniel needs to know what to take, when, and how to taper off opioids as pain improves.
Follow-up appointment details
He'll need follow-up with the surgeon to monitor healing and progress.
How to care for a wound vacuum device
Daniel's incision is a simple closure, not a wound vac, so this doesn't apply to his recovery.
How to check and log blood glucose at home
Nothing in Daniel's history points to a need for home glucose monitoring.
Excellent planning!
Take Card #2, your packet of paperwork for Mr. Morales.
Card 2 back
(image coming soon)
(image coming soon)
At-Home Lovenox Teaching
Daniel has a history of DVT, so he'll go home on enoxaparin (Lovenox) self-injections. Mark each statement as something you'd teach him to do, or not.
Rotate injection sites each time (alternate sides of the abdomen)
Rotating sites helps prevent bruising and tissue damage from repeated injections in the same spot.
Watch for and report excessive bruising or bleeding
Lovenox increases bleeding risk, so Daniel needs to know what's expected versus what to report.
Dispose of used needles in a sharps container
Safe sharps disposal protects Daniel and anyone else in the home.
Do not expel the air bubble in the prefilled syringe before injecting
The air bubble in a prefilled Lovenox syringe is intentional and helps ensure the full dose is delivered.
Inject into the muscle instead of the fatty tissue under the skin
Lovenox is given subcutaneously, into the fatty tissue, not into muscle. This is incorrect technique.
Massage the injection site after injecting to help it absorb
Massaging the site actually increases bruising. Daniel should be taught not to rub it.
Verify His Technique
Daniel will give himself the injection while you watch. Put the steps in the order he should follow.
Handwashing and site prep come first to reduce infection risk, then the pinch-and-inject technique itself, and disposal always comes last, right after the needle is withdrawn.
Timeline Complete!
Congratulations on completing the timeline and organizing Daniel's morning. Every step landed in the right order and at the right time, exactly what a busy ortho morning calls for.
Take Card #90