Lesson L3-10 · authored fragments (docs/43)
Primary review content — the AI-avatar narration, in order.
Two quick questions before you go. One is about what you watch for after a first dose. The other is about what you do if something looks wrong. Take your time — this is the exact judgment you'll use at the cart. Then that's Module 3 done.
Let's lock in the writing part, because an observation nobody wrote down is an observation that never happened as far as the record is concerned. When the window is over, you go to the BACK of the MAR — the comments section, the same place a PRN response goes — and you write what you saw. Do it right then, not from memory at the end of your shift. Keep it simple and true: the date, the time, the medication, and how Don did — in his own words when you can, like 'Says he feels fine, breathing easy.' If a sign showed up, you write exactly that instead. Then your legend initials, the same initials you sign your doses with. Date, time, med, what you saw, initials. That entry is the receipt that says this resident's first dose was watched — and it's what the doctor reads before deciding on the next one.
So what are you actually watching for? To make it easy to remember, we group it into four buckets. One — BREATHING. Is Don breathing the way he was before the dose? Any new wheeze, cough, fast breathing, or tightness in the chest? Two — SKIN. Any redness, rash, or hives? Any swelling — especially around the face, lips, or throat? Three — LEVEL OF CONSCIOUSNESS. Is Don alert and himself, or is he suddenly sleepy, confused, or hard to wake? Four — GI, meaning the stomach. Any new nausea, vomiting, or cramping? Breathing, skin, level of consciousness, GI. You don't need any special tools to check these — you use your eyes, your ears, and what Don tells you. Four buckets. Run through them the whole window.
Here is a moment that lands on your shift more often than you'd think. Your resident, Don, just took the very first dose of a brand-new medication — his new Albuterol. It's the first time his body has ever met this drug. So here's the real question: now that the dose is in, are you done? You are not. A first dose is not a give-and-walk-away. It's a watch-and-write. If Don's body is going to react badly to this new med, the first dose is the most likely time it happens — and you are the person standing right there. In this lesson I'll show you exactly what to watch for, what to do if something looks wrong, and how to put it on the MAR so it counts. Let's protect Don.
Most of the time, good news — everything looks normal. Don's breathing is steady, his skin is clear, he's alert and himself, and his stomach is fine. When that's the case, you don't stop early. You keep watching all the way to the end of the window, because a reaction can show up a little later than you'd expect. When the window is up and Don still looks good, you go to the back of the MAR and write down what you actually saw. Not just 'gave dose.' Something real, like: breathing normal, no rash, alert, no upset stomach, no change. Then your initials. Writing 'no change' is not busywork — it's the proof that somebody actually watched this resident through his first dose and he tolerated it. That record is what the doctor needs before dose number two.
Start with the rule that never changes: when a resident takes the FIRST dose of a new medication, you watch them afterward for a set window of time. Not because you did anything wrong — because a first dose is a first meeting, and a body can react to something brand new. So you don't hand out the dose and move on to the next resident. You stay close, and you keep your eyes on Don for the whole window. How many minutes that window is depends on the medication and what your agency trains — so follow your training and the med's instructions for the exact time. What I want stuck in your head is the shape of it: new med, first dose, you watch. Every new med. That's the habit that catches a reaction before it becomes an emergency.
Now the part that protects Don's life. If ANY of those signs show up, you STOP. And here is the rule that never bends: you do NOT give a second dose. Never chase a reaction with more medication — that can make it worse. After you stop, you get help, and how fast depends on how bad it looks. A mild sign — a small rash, a little nausea, and Don is breathing fine and alert — you call your supervisor and they tell you the next step. A severe sign — trouble breathing, swelling of the face, lips, or throat, sudden confusion, chest pain, or Don going limp — is an emergency: you call 911 first, then your supervisor, then you document. One more thing while you watch: you use your eyes, your ears, and Don's own words. Taking clinical vital signs is a nursing job, not part of your first-dose watch. Stop, don't re-dose, and get the right help fast.
25 of 25 critical claims are verified_by: null (Gate-2 SME sign-off pending → preview only, production-blocked under the Rule-3.6 waiver). · runtime budget: 4:30
# Concept mirror — MA.L3-10.A (First-Dose Observation) > **MIRROR / NOTES ONLY.** The authoritative concept entry is **docs/42 §E, `MA.L3-10.A`** > (Instructional Domain Model). This file is the local traceability ledger + decision queue for the > derived-asset bundle; if it ever disagrees with docs/42, **docs/42 wins** (docs/43 §22 authority flow). | Field | Value | |---|---| | `concept_id` | `MA.L3-10.A` | | `competency_id` | `C-3.10` (⇄ `C-3.7` Adding a New Order / `MA.L3-7.A`, `C-3.9` PRN Documentation / `MA.L3-9.A`, `C-4.4` Emergencies / `MA.L4-4.A`; builds on `C-3.4`, `C-3.5`, `MA.L3-1.F`, `C-2.8`) | | `lesson_ids` | `[L3-10, all route lessons]` (cross-cutting — a first dose of any new medication on any route requires observation, not oral-specific; feeds forward to L4-4 Emergencies) | | `clinical_risk` | **High** → ≥90% KC mastery, spaced repetition. **KC keys are NOT SME-locked** (`keyProtected: false`). **BUT the MAR Simulator force-fails on a missing first-dose observation entry (docs/42 §H)** even though the KC tier is High — the sim gate is stricter than the KC mastery tier. | | `medication_error_prevented` | A new medication's first dose given with no observation and no back-of-MAR observation entry — an early adverse reaction goes unseen and unrecorded, a second dose may be given into a developing reaction, and the prescriber has no record that the resident did or did not tolerate the new drug | | `sme_status` | `in_review` | | `apd_traceability_status` | **partial** — three sourced anchors (document-the-observation core, Form 65G-7.008 A back-of-MAR section, severe-reaction escalate path) + **seven `[Needs Owner Review]` TODOs** (`L310-1..7`) + two `[Waiver360-added]` framings | ## Rule-3.6 author-ahead waiver (recorded 2026-07-06) The concept is `in_review`, not `approved`. Per docs/42 §I.1 / docs/43 §4, this bundle is authored **ahead of concept approval under a Rule-3.6 waiver** as part of the Oral Route reference implementation. Consequence: **every fragment in this bundle is `sme_status: "draft"`, preview-flag only, and production-publish-blocked** until (a) the concept reaches `approved` and (b) a Gate-2 SME sign-off is recorded in `content_revisions.sme_signoff_*`. This concept is **High** (not Critical), so the KC keys are not SME-locked — but **both KC keys rest on unresolved `[Needs Owner Review]` conventions**: Q1's four-category taxonomy (`TODO(source-L310-3)`) and no-vital-signs scope (`TODO(source-L310-5)`), and Q2's mild-vs-severe escalation split (`TODO(source-L310-4)`). The **observation window minutes** (`TODO(source-L310-1)`, 20-vs-30-vs-30–60 disagreement) may not be locked into any narration or KC key. The **observe-every-first-dose → document-it-on-the-back-of-the-MAR → STOP-and-escalate-and-never-re-dose** STRUCTURE is the safe, sourced spine everything else hangs on (Module 1 s71 + ck v4/v5 Q1 via ⇄MA.L3-1.F / C-2.8; the Module 3 new-med observation checkpoint; the Module 3 severe-reaction escalate path). ## Source ledger (projects into `payload_json.sources`) - `curriculum_source`: "APD BMA Module 1 s71 (document immediately) + checkpoint Mod1 v4/v5 Q1 (⇄ MA.L3-1.F / C-2.8) + APD BMA Module 3 (first-dose/new-med observation checkpoint; s21–22, s51 + ck Q11 severe-reaction escalate, ⇄ C-4.4 / MA.L4-4.A) + APD MAR practical exam (Don Montana Albuterol first dose)" - `form_reference`: "APD Form 65G-7.008 A (MAR — back-of-MAR comments section)" | # | Claim | Tag | Source | verified_by | |---|---|---|---|---| | C1 | The first dose of a new medication requires the resident to be observed for adverse effects and the observation documented on the back of the MAR | `[APD]` | Module 3 first-dose/new-med observation checkpoint + Module 1 s71 (⇄ C-2.8) | null | | C2 | Documentation happens immediately after the window (record only what happened), on the back-of-MAR comments section, with legend initials | `[APD]` | Module 1 s71; ck v4/v5 Q1 (⇄ MA.L3-1.F / C-2.8); Form 65G-7.008 A | null | | C3 | A severe first-dose reaction triggers a STOP + escalate-to-emergency path | `[APD]` | Module 3 s21–22, s51 + ck Q11 (⇄ C-4.4 / MA.L4-4.A) | null | | C4 | The observation window is a specific number of minutes | `[Needs Owner Review]` | **`TODO(source-L310-1)`** — sources disagree: Mod3 ck = 20 min, MAR-DM 2d = 30 min, legacy L3-10 = 30–60 min. No number locked into narration/KC keys. | null | | C5 | Observation applies to **every** new medication, no exceptions | `[Needs Owner Review]` | **`TODO(source-L310-2)`** — universality not confirmed against Module 3 (some meds may carry a different/longer window per insert) | null | | C6 | The four observation categories are BREATHING · SKIN · LEVEL OF CONSCIOUSNESS · GI | `[Needs Owner Review]` | **`TODO(source-L310-3)`** — DSP-training-script-derived taxonomy, not confirmed against Module 3. Gates the Q1 key. | null | | C7 | The escalation split is supervisor-first (mild) vs 911-first (severe) | `[Needs Owner Review]` | **`TODO(source-L310-4)`** — scope-of-practice-sensitive for unlicensed personnel. Gates the Q2 key + the sim escalation copy. | null | | C8 | A MAP observes with eyes/ears/words and is not authorized to take clinical vital signs | `[Needs Owner Review]` | **`TODO(source-L310-5)`** — scope framing unconfirmed. Used in the Q1 distractor (a) rationale. | null | | C9 | The MAR practical-exam answer-key IDs that carry a documented first-dose observation | `[Needs Owner Review]` | **`TODO(source-L310-6)`** — §F cites MAR-RS/SW; frozen legacy lesson cites MAR-DM 2d (Albuterol first dose, 30-min observation) with no MAR-RS/SW. Reconcile before citations lock. | null | | C10 | The observation is recorded in the resident's own words, when possible | `[Needs Owner Review]` | **`TODO(source-L310-7)`** — APD-preferred format unconfirmed (same quoted-format family as MA.L3-9.A `L39-3` / MA.L3-6.A quoted-reason, which is [Waiver360-added]) | null | | C11 | The **fixed four-bucket "watch list" structuring** and the **"never give a second dose into a developing reaction"** explicit rule | `[Waiver360-added]` | Instructional structuring of APD's observe-for-adverse-effects + document-immediately + STOP/escalate requirements — not APD-verbatim | null | ## Patient-safety chain (owner directive — this is a patient-safety concept) 1. **Medication error prevented.** A new medication's first dose is given to **your resident** and then nobody watches — or nobody writes it down. An early adverse reaction (a rash, a breathing change, swelling of the face or throat, sudden confusion, GI upset) goes **unseen and unrecorded**. Because there's no observation entry, a **second dose can be given straight into a developing reaction**, and the prescriber has no record of whether the resident tolerated the new drug. For a first-dose PRN, the same missing back-of-MAR entry is also the lost C-3.9 response (⇄ MA.L3-9.A). 2. **Why staff make this mistake (the real reason).** It isn't "they forgot." Once the dose is in, the task *feels* finished — the med is given, the front cell is initialed, and there are three more residents waiting. First-dose observation is the one step with **no immediate prompt**: nothing on the cart tells you to stay, and the window asks you to *do nothing but watch* while other work piles up. So the pressure of a busy shift quietly deletes the watch, and because most first doses are uneventful, skipping it seems to "work" — right up until the one time it doesn't. 3. **How the lesson/transcript prevents it.** The narration reframes a first dose as **watch → write → (if a sign) STOP-and-escalate, never re-dose**. It drills a fixed four-bucket watch list (breathing, skin, level of consciousness, GI) so watching has a shape you can run instead of a vague "keep an eye on him," and it makes the back-of-MAR observation entry — even a "no change" — the proof that a human actually watched this first dose. "New med, first dose: you watch, then you write." 4. **How the simulator reinforces it.** The MAR Simulator first-dose-observation entry (Don Montana 1/9 Albuterol first dose) **force-fails** any pass that completes with **no back-of-MAR observation entry** (docs/42 §H — stricter than the High KC tier), and **hard-blocks a second dose** during any adverse-sign branch — the exact two failures this concept exists to prevent. A mild-sign branch routes to supervisor; a severe-sign branch (lip swelling + trouble breathing) requires STOP + 911-first + no second dose. 5. **How the KC verifies mastery.** Q1 makes the learner name **what** to watch for (the four categories), rejecting vital-signs overreach, long-term-wellness signs, and "no observation needed." Q2 makes them choose **what to do on a severe sign** — STOP, no second dose, 911 first, then supervisor, then document — rejecting "give a second dose to push through," "wait and see," and "always call the supervisor first." ≥90%-gating (High). Both keys are HELD pending the `[Needs Owner Review]` TODOs below. ## Decision queue → owner / SME (Michele + Nicole) 1. **`TODO(source-L310-1)` — observation-window minutes.** Sources disagree: Module 3 checkpoint = **20 min**, MAR-DM 2d = **30 min**, frozen legacy L3-10 = **30–60 min**. No number is locked into narration or a KC key; the bundle teaches "a set window." Confirm the accepted window before it locks (config-driven placeholder in the `mar_first_dose_observation` spec + storyboard V-L3-10-01). 2. **`TODO(source-L310-2)` — "every new medication / no exceptions" universality.** Confirm against Module 3 (some meds may carry a different/longer window per the insert). Held as a flagged narration claim. 3. **`TODO(source-L310-3)` — four-category taxonomy.** BREATHING · SKIN · LEVEL OF CONSCIOUSNESS · GI is DSP-training-script-derived, not confirmed against Module 3. **Gates the Q1 key.** Confirm the taxonomy or badge the four-bucket structuring `[Waiver360-added]`. 4. **`TODO(source-L310-4)` — mild-vs-severe escalation split.** Supervisor-first (mild) vs 911-first (severe) is scope-of-practice-sensitive for unlicensed personnel. **Gates the Q2 key and the sim escalation copy.** Confirm the split for APD scope of practice before it locks. 5. **`TODO(source-L310-5)` — "no clinical vital signs" scope framing.** Confirm a MAP is not authorized to take clinical vital signs as part of first-dose observation. Used in the Q1 distractor (a) rationale. 6. **`TODO(source-L310-6)` — MAR answer-key step IDs.** §F cites **MAR-RS / MAR-SW**; the frozen legacy lesson cites **MAR-DM 2d** (Don Montana Albuterol first dose, 30-min documented observation) with no MAR-RS/SW. Reconcile which MAR scenario actually carries a documented first-dose observation step before citations lock (parallels MA.L3-9.A `source-L39-7`). 7. **`TODO(source-L310-7)` — "client's own words, when possible" documentation format.** Confirm the quoted / own-words observation format is APD-preferred (same terminology family as MA.L3-9.A `L39-3` and MA.L3-6.A). If APD is silent, badge `[Waiver360-added]`. 8. **Confirm C11 framing** — is the fixed four-bucket watch list, plus the explicit "never give a second dose into a developing reaction" rule, acceptable as `[Waiver360-added]` scaffolding of APD's observe-for-adverse- effects + document-immediately + STOP/escalate requirements? > **Route note (docs/42 §I.3.5):** the Don Montana **Albuterol** first dose is an **inhaled**-route med used > here **only** as MAR-documentation/observation practice — never as oral-route administration teaching. The > first-dose-observation skill is **route-agnostic** (`lesson_ids` = all route lessons). ## Bundle manifest → `../MA.L3-10.A.manifest.json` · human index → `../MA.L3-10.A.README.md` (aggregator-owned)
Don just took the first dose of his newly ordered Albuterol inhaler. You are staying with him to observe for the window after the dose. Which four categories are you watching for?
Why: Breathing, skin, level of consciousness, and GI are the four adverse-effect categories you watch for after a new medication. You don't need any instruments — you use your eyes, your ears, and Don's own words.
Error prevented: A new med's first dose given with no observation — an early adverse reaction (rash, breathing change, facial/throat swelling, altered level of consciousness, GI upset) goes unseen, and a second dose may be given into a developing reaction.
Misconception: "As long as the dose was correct, no observation is needed," "observation is only for injections / high-risk drugs," and "vital signs are part of first-dose observation."
A short time after Don's first dose of the new Albuterol, you see his lips swelling and he says he is having trouble catching his breath. What do you do?
Why: Swelling of the lips plus trouble breathing is a severe reaction — an emergency. You STOP, you do NOT give a second dose into the reaction, and you call 911 first because seconds matter. Then your supervisor, then you document.
Error prevented: A second dose given into a developing severe reaction, or a delayed emergency call while a resident's airway is swelling — the highest-consequence first-dose failure.
Misconception: "If a rash or reaction appears, give the next dose to push through it," "wait and see if a severe sign settles," and "always call the supervisor first, even in an emergency."
Entry: In the Don Montana MAR Simulator, Don takes the first dose of his newly ordered Albuterol (delivered and given at 3:15 PM on 1/9, handed off from the C-3.7 new-order branch). The observation window opens.
Mastery: >=90% KC mastery (High). NOTE: the MAR Simulator itself force-fails on a missing first-dose observation entry (docs/42 §H) regardless of the High KC tier — the sim gate is stricter than the KC mastery tier.
Force-fail: FORCE-FAIL. Per docs/42 §H the MAR Simulator force-fails on a missing first-dose observation even though the concept's KC mastery tier is High, not Critical. The scenario cannot complete until the observation is recorded; a re-dose action during a sign branch is hard-blocked. The sim does not silently fail: it surfaces the same compassionate-framing modal as the KC, with a direct link to the L3-10 re-anchor clips and a 'Try again' CTA.
Shot: MS Michele at the med cart, group-home living room behind; brand bug top-right. Cut to B-roll: Don takes the first puff of a newly-delivered Albuterol inhaler, a corner clock ticking; the empty first-dose-observation header card ghosts in.
Camera: Open on eye-level medium shot; slow push-in on 'now that the dose is in, are you done?'; cut to insert B-roll of the first puff + the corner clock; return to Michele for 'Let's protect Don.'
Avatar: Michele on-camera for the framing lines; voiceover over the B-roll for the 'first meeting' beat.
Visual: Establish the real give-and-walk-away temptation before any rule — the dose is in and the task feels finished; the ticking clock and the still-empty observation card are the unanswered questions the lesson resolves. Reframes a first dose as watch-and-write, not give-and-walk-away.
Animation: Corner clock starts ticking after the puff; the first-dose-observation header card fades in with the window field shown as a blurred placeholder (no number). Footnote chip: 'window minutes = HELD (owner review)'.
Infographic: Lower-third chip 'First dose = watch + write'; a small 'observation?' tag ghosts over the header card.
Shot: Full-screen first-dose-observation header card; a watch-loop clock sits beside it advancing from start toward a window-end marker; the Albuterol row highlighted on the sample MAR beneath.
Camera: Static hold on the header card; a soft arc-sweep on the watch-loop clock as the narration lands 'you stay close, you keep your eyes on Don for the whole window'.
Avatar: Voiceover; Michele off-screen.
Visual: Anchor the rule that never changes — new med, first dose, you watch — as a shape, NOT a number. The window field is deliberately shown as a flagged placeholder so 'a set window' is taught while the exact minutes stay owner-review.
Animation: The watch-loop clock advances from start toward a window-end marker; a 'new med → first dose → WATCH' chip builds. No specific minute value is ever shown on the card face. Reuses the L3-9 clock-advance affordance (V-L3-9-03) recognition-only.
Infographic: Header card 'FIRST-DOSE OBSERVATION'; window callout rendered as a placeholder token '[window per your training + the med]'. Footnote chip: 'window minutes = HELD (owner review)'; small tag ''every new med' = HELD (owner review)'.
Shot: Four-category icon set builds one bucket at a time: BREATHING (lungs), SKIN (skin/rash), LEVEL OF CONSCIOUSNESS (head), GI (stomach); each with a short plain-language sign list.
Camera: Static grid; a light nudge-in as each bucket lights up; on 'you don't need any special tools' the icons for eyes/ears/words pulse.
Avatar: Voiceover counting the four buckets.
Visual: Give first-dose watching a shape you can run — four buckets instead of a vague 'keep an eye on him'. Explicitly show the observation is done with eyes, ears, and the resident's own words, not instruments.
Animation: Each of the four icon cards drops in as it is named with its sign list; the 'eyes · ears · words' strip lights on the no-tools beat. The four-bucket structure is captioned as an instructional aid, never as APD-required.
Infographic: Numbered icon cards 1-4: Breathing, Skin, Level of consciousness, GI; an 'eyes · ears · his own words' strip beneath. Footnote chip: 'four-bucket taxonomy = HELD (owner review); structuring = Waiver360-added'.
Shot: Left ('Normal — keep watching') panel of the escalation split-screen; the watch-loop clock runs to the window end, the four icons stay calm/green; flip to the back-of-MAR and a 'no change' observation line types in.
Camera: Settle on the 'Normal — keep watching' panel; clock-advance insert to the window end; card-flip to the back-of-MAR; slow pull-out on the completed 'no change' line.
Avatar: Voiceover; 'you don't stop early … you keep watching all the way to the end of the window'.
Visual: Make 'don't stop early' concrete — the reaction can show up late, so the clock must run out before you write. Show that even a 'no change' entry is real proof somebody watched, not busywork.
Animation: The four icons hold calm as the watch-loop clock runs to the window-end marker; on the window end the view flips to the back-of-MAR and the 'no change' line types in with legend initials. No specific window number is shown.
Infographic: Left panel 'NORMAL — keep watching'; a completed back-of-MAR line 'breathing normal · no rash · alert · no upset stomach · no change · M.D.'. Footnote chip: 'window minutes = HELD (owner review)'.
Shot: Right ('STOP') panel of the escalation split-screen; an adverse sign appears on Don (lip swelling + hand to chest); a tentative 'second dose' action is stamped WRONG; the panel splits again into a MILD row (supervisor first) and a SEVERE row (911 first).
Camera: Snap from the calm 'Normal' state to the 'STOP' state as the sign appears; hold on the WRONG stamp over the 'second dose' action; then reveal the mild/severe two-row split; end on 'stop, don't re-dose, get the right help fast'.
Avatar: Voiceover; firm, protective; slight lean-in on 'you do NOT give a second dose'.
Visual: This is the life-safety beat. Make the never-re-dose rule unmissable by stamping the 'second dose' action WRONG, then split escalation by severity. Show observation stays eyes/ears/words — vital signs are a nursing job, out of scope.
Animation: The adverse sign appears → the screen flips to the STOP/escalate state → a 'second dose' action button is pressed and immediately stamped WRONG (never demonstrate a completed second dose). The mild and severe rows slide in. Escalation copy is delivered but not captioned as APD-required.
Infographic: Right panel 'STOP — no second dose'; a 'second dose' action struck through with a WRONG stamp; two rows 'MILD → supervisor first' and 'SEVERE (trouble breathing · face/lip/throat swelling · sudden confusion · chest pain · collapse) → 911 first, then supervisor, then document'; a 'no clinical vital signs' scope tag. Footnote chips: 'mild-vs-severe split = HELD (owner review)'; 'no-vital-signs scope = HELD (owner review)'; 'never-a-second-dose rule = Waiver360-added'.
Shot: Flip to the BACK of the MAR comments section (the same section as the C-3.9 PRN response); one blank observation row highlighted, then filled field-by-field: date, time, medication, what-you-saw (in Don's own words), legend initials.
Camera: Card-flip front->back; macro hold on the highlighted row; small nudge-in on the quoted 'own words' field; pull out to reveal the finished entry as the 'receipt'.
Avatar: Voiceover; 'do it right then, not from memory at the end of your shift'; 'that entry is the receipt'.
Visual: Land the writing step as the proof the watch happened — an observation nobody wrote down never happened for the record. Reuse the same back-of-MAR comments section the PRN response uses (⇄ C-3.9) so learners see one place, one habit.
Animation: Each field types into the observation row as named — date, time, 'Albuterol inhaler', the quoted 'own words' line, then 'M.D.' legend initials; the finished entry gets a soft 'receipt' check. Quotation marks briefly emphasized (own-words format HELD).
Infographic: Numbered callouts alongside the row: Date · Time · Medication · What you saw (in his own words, e.g. 'Says he feels fine, breathing easy') · Initials. A 'receipt for the next dose' chip. Footnote chips: 'own-words format = HELD (owner review)'; 'MAR answer-key IDs = HELD (owner review)'.
Shot: MS Michele centered with the completed back-of-MAR observation still beside her; on-screen 'Knowledge Check — 2 questions'; close on the disclaimer footer.
Camera: Centered medium shot for the sign-off; hold the completed observation entry on-screen; end card with the disclaimer footer.
Avatar: Michele on-camera; calm, warm close; 'one about what you watch for, one about what you do if something looks wrong … then that's Module 3 done'.
Visual: Tie watch → write → escalate together as one finished record and hand off to the two KCs; reinforce the mnemonic before the check and close out Module 3.
Animation: The completed observation still holds; the closing chip fades in; the disclaimer footer holds ~5s.
Infographic: Closing chip 'Every first dose — watch, document, never a second dose into a reaction'; KC signpost '2 questions'; disclaimer footer 'APD-aligned educational content. Not an APD-approved training program.'
First-dose-observation header card with an observation-window callout; the window minutes are shown as a flagged, config-driven PLACEHOLDER (no number), plus a watch-loop clock advancing from start toward a window-end marker.
🖼 image prompt: Clean flat-vector 'FIRST-DOSE OBSERVATION' header card, clinical neutral palette, high legibility, no logos; a window callout rendered as a placeholder token reading '[window per your training + the med]' (NO specific minute value); a small watch-loop clock icon beside it. Layout suitable as a MAR Simulator observation-entry background. [APD] observe-then-document structure; window minutes are a config-driven placeholder [Needs Owner Review] pending TODO(source-L310-1) — never render a number.
🎬 video prompt: The header card fades in; a watch-loop clock advances from a start mark toward a window-end mark over ~1.2s; a 'new med → first dose → WATCH' chip builds; the window field stays a blurred placeholder token with no number. No camera move; transparent background. Window is HELD — do not caption as APD-required. [APD] + [Needs Owner Review] TODO(source-L310-1).
Four-category observation watch list: BREATHING (lungs), SKIN (skin/rash + face/lip/throat swelling), LEVEL OF CONSCIOUSNESS (head), GI (stomach), each with a plain-language sign list; an 'eyes · ears · his own words' strip showing no instruments are used.
🖼 image prompt: Four flat-vector icon cards in a row — a lungs icon 'Breathing', a skin/rash icon 'Skin', a head icon 'Level of consciousness', a stomach icon 'GI' — each with a short plain-language sign list; beneath, an 'eyes · ears · his own words' strip (no stethoscope, no BP cuff, no thermometer); clinical neutral palette, synthetic content only, no logos. [Waiver360-added] four-bucket watch-list structuring of APD's observe-for-adverse-effects requirement; the specific four-category taxonomy is [Needs Owner Review] pending TODO(source-L310-3) — not confirmed against APD BMA Module 3.
🎬 video prompt: The four icon cards drop in one at a time as each bucket is named, each revealing its sign list; then the 'eyes · ears · words' strip lights up on the no-tools beat; ~1s; no camera move; transparent background. Taxonomy is HELD — caption the four buckets as a memory aid, not as APD-required. [Waiver360-added] + [Needs Owner Review] TODO(source-L310-3).
Escalation split-screen: LEFT 'Normal — keep watching' (calm icons, run the clock out, then write); RIGHT 'STOP — no second dose' with a 'second dose' action stamped WRONG, then split into MILD (supervisor first) and SEVERE (911 first, then supervisor, then document).
🖼 image prompt: Two-panel flat-vector infographic. LEFT panel 'NORMAL — keep watching': calm/green four-icon strip, a clock running to a window-end mark, an arrow to a back-of-MAR 'write what you saw' tag. RIGHT panel 'STOP — no second dose': a 'second dose' action button struck through with a red 'WRONG' stamp; below it two rows — 'MILD → call supervisor first' and 'SEVERE (trouble breathing · face/lip/throat swelling · sudden confusion · chest pain · collapse) → call 911 first, then supervisor, then document'; a small 'no clinical vital signs' scope tag. Clinical neutral palette, no faces, no logos. [APD] STOP-and-escalate path (Module 3 s21–22, s51 + ck Q11, ⇄ C-4.4 / MA.L4-4.A); the 'never a second dose into a developing reaction' rule is [Waiver360-added]; the mild-vs-severe split is [Needs Owner Review] TODO(source-L310-4); the no-vital-signs scope is [Needs Owner Review] TODO(source-L310-5).
🎬 video prompt: Start on the calm 'Normal' panel; an adverse sign cue appears and the view snaps to the 'STOP' panel; a 'second dose' action is pressed and immediately stamped WRONG (never show a completed second dose); the MILD and SEVERE rows slide in; ~1.5s; no camera move; transparent background. Escalation split and scope are HELD — deliver but do not caption as APD-required. [APD] core + [Waiver360-added] never-re-dose + [Needs Owner Review] TODO(source-L310-4)/TODO(source-L310-5).
Populated back-of-MAR observation row in the comments section (the same section as the C-3.9 PRN response): date · time · medication · what-you-saw (in the resident's own words) · legend initials; both a 'no change' normal example and a filled 'own words' example.
🖼 image prompt: Flat-vector back-of-MAR 'Comments' table, top-down, one highlighted observation row filled: date, time, 'Albuterol inhaler', a what-you-saw field in the resident's own words (e.g. 'Says he feels fine, breathing easy'), then MAP legend initials 'M.D.'; a second calm example row reading 'breathing normal · no rash · alert · no upset stomach · no change · M.D.'; numbered 1-5 callouts; clinical neutral palette, synthetic content only, no logos. Same comments section the C-3.9 PRN response uses (Form 65G-7.008 A). [APD] document-immediately core (Module 1 s71, ⇄ C-2.8); the 'own words, when possible' format is [Needs Owner Review] pending TODO(source-L310-7); MAR answer-key IDs are [Needs Owner Review] pending TODO(source-L310-6).
🎬 video prompt: Sequential type-on into one back-of-MAR observation row: date, time, 'Albuterol inhaler', the quoted own-words line 'Says he feels fine, breathing easy', then 'M.D.' legend initials; quotation marks briefly emphasized; a soft 'receipt' check lands on completion; no camera move; transparent background. Own-words format is HELD. [APD] + [Needs Owner Review] TODO(source-L310-7).
Target runtime: 4:30 · 7 chapters · not rendered (url: null)
After a first dose is shown as given, the learner (1) watches across a simulated clock advance of observationWindow while running a configurable category checklist (each category can be flagged normal or abnormal), (2) is routed by the branch they observe — normalBranch (keep watching to end of window, then document a 'no adverse signs' observation), mildSignBranch (STOP, do not re-dose, escalate per mildEscalation, then document), or severeSignBranch (STOP, do not re-dose, escalate per severeEscalation, then document) — and (3) records the back-of-MAR observation via observationFields (what was seen, in the resident's own words when possible, + MAP legend initials), graded by case-insensitive pattern match. A missing observation entry fails. Pattern-only grading (no model/LLM in the runtime).