Which Tab Answers Which Step
A simulated record frame with six trapezoid tabs along the top edge and the active tab merged into the body panel; leaders run from each tab out to step chips stacked in step order rather than tab order, so the lines cross deliberately.
Client record — 64-year-old female · Postoperative day 2, open small bowel resection for obstruction
[ NURSES' NOTES ] VITAL SIGNS LABORATORY RESULTS ORDERS MEDICATION RECORD HISTORY AND PHYSICAL
Nurses' notes (active tab)
0800 · Client drowsy but rouses to voice and knows her name. States she is "at the church hall." Oriented to person only; oriented to person, place, and time at 0400 and at every check since admission. Skin warm to touch and flushed across the chest and face. Denies incisional pain when asked directly. Abdominal dressing dry and intact, abdomen firm on light palpation, more tender than charted at 0400. Urine in the collection bag dark and scant. Voided volume for the 0400 to 0800 period 90 mL; the previous two shifts averaged 60 to 70 mL each hour. Daughter at bedside states "she has never talked like this." —L. Danvers, RN
Vital signs
- 0400 — temperature 99.1 °F oral, heart rate 96, respirations 18, blood pressure 118/70 mm Hg, oxygen saturation 96 percent on room air.
- 0800 — temperature 100.9 °F oral, heart rate 112, respirations 22, blood pressure 104/62 mm Hg, oxygen saturation 94 percent on room air.
- 1200 — temperature 101.6 °F oral, heart rate 126, respirations 26, blood pressure 88/52 mm Hg, oxygen saturation 92 percent on 2 liters per minute by nasal cannula.
- Admission baseline — heart rate 76, blood pressure 138/78 mm Hg.
- Urine output 0800 to 1200: 45 mL total. Weight 68 kg → BOOK 07 · P5.
Laboratory results
- White blood cell count 18,900 per cubic millimeter at 0630, from 9,200 on admission.
- Serum lactate 3.4 mmol/L at 0630, from 1.1 on admission.
- Serum creatinine 1.8 mg/dL at 0630, from 0.9 on admission.
- Hemoglobin 10.2 g/dL at 0630, from 11.4 on admission → BOOK 07 · P5.
Orders
- Advance to clear liquids as tolerated, 0700 today.
- Ambulate three times daily with assistance.
- Notify the surgeon for temperature above 101 °F, heart rate above 110, or urine output under 30 mL each hour.
Medication record
- Acetaminophen 650 mg by mouth every 6 hours as needed for pain or fever. Last given 0200.
- Enoxaparin 40 mg subcutaneously daily. Given 0900.
- Hydromorphone 0.2 mg intravenously every 2 hours as needed for severe pain. Last given 2200 yesterday.
History and physical
Hypertension, controlled. No dementia, no prior confusion. Independent at home, drives, manages her own medicines. Admission mental status: alert and oriented to person, place, and time.
Tab-to-step map
| Tab | Step it usually serves | The one question to ask it |
|---|---|---|
| Nurses' notes | Recognize Cues | What is new since the last entry? |
| Vital signs | Analyze Cues, through trajectory | Which way is each number moving, and since when? |
| Laboratory results | Analyze Cues and Evaluate Outcomes | Which hypothesis does this support, and did it improve after we acted? |
| Orders | Generate Solutions | What am I already authorized to do without another call? |
| Medication record | Take Action | What has been given, when, and what does that rule in or out? |
| History and physical | Prioritize Hypotheses | What is this client's own baseline, so I know what counts as a change? |
The timestamp rule
Every entry carries a time. An exhibit read without comparing timestamps is being read as a snapshot, and reading a record as a snapshot is failure code F3 → BOOK 02 · P9.
Margin notethe tabs are the cue field.
TakeawayAn exhibit is not a document to read front to back; it is six labeled cue sources, and the step the item is asking about tells you which two to open first.