Figure 3-1. Circular process of nursing care.
a. You are a M6 practical nurse assigned to a surgical ward. It is 1630 hours,
and the Emergency Department calls to inform the registered nurse (RN) in charge that
the ward will be receiving an admission. Sergeant Jones, age 30, is admitted to the
ward a short time later. His diagnosis is traumatic amputation and avulsion of a portion
of the right foot. The injury occurred when Sergeant Jones accidentally entangled his
foot in the blades of his power mower. You assist the RN in assessing Sergeant Jones.
You find that he appears generally healthy and well nourished. He is alert and oriented,
and his vital signs, although slightly abnormal, are stable. His skin is cool and clammy,
his face pale. He has an intravenous infusion (IV) that is infusing well. The surgeon on
duty removes the bulky dressing in order to evaluate the injury. You observe that the
4th and 5th toes are missing and that a portion of the lateral foot has been avulsed.
The wound is slowly oozing blood. The surgeon decides to take Sergeant Jones to the
operating room (OR) as soon as possible. He discusses the preparations with the RN
in charge. As you are obtaining the preoperative laboratory specimens from Sergeant
Jones, he tells you that he is extremely concerned about the welfare of his two small
children, now waiting in the cafeteria with a neighbor. Sergeant Jones explains that his
wife is on temporary duty (TDY) elsewhere and there is no one at home to care for the
children while he is hospitalized. You relay this information to the RN, who is
completing the assessment of Sergeant Jones. Based upon the assessment, the
following needs have been identified. Sergeant Jones is stable, but must be closely