3-6. ILLUSTRATION

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 observed for shock. Surgical repair of the foot is necessary and Sergeant Jones must be prepared for surgery. There is also the need to alleviate his anxiety over the welfare of his children.

b. The nursing plan is to prepare Sergeant Jones for surgery, scheduled for one hour later. You will monitor him closely since a change in vital signs could indicate a change in his stable condition. While the RN begins the pre-operative arrangements for Sergeant Jones, you will call social services to arrange for someone to help Sergeant Jones with childcare. These are Sergeant Jones' immediate needs. Several projected needs have also been identified. As the wound is considered "dirty," there is an additional danger of infection for Sergeant Jones. The RN decides that it would be best to isolate Sergeant Jones in a private room post-operatively, and you begin to make the necessary preparations for the room. Additionally, Sergeant Jones will need the services of other activities. Physical therapy will be consulted for post-surgical rehabilitation. Since Sergeant Jones will most likely suffer a sense of loss and depression caused by the disfigurement of his foot, mental health services will be consulted.

c. The ward staff now begins to implement the plan. The surgical paperwork is prepared and placed in Sergeant Jones' chart. The RN accompanies the surgeon to Sergeant Jones' room to witness the surgical

counseling and signing of the operative permit. Sergeant Jones' vital signs are taken every 15 minutes in order to monitor his status. Since the RN had assigned you the duty of passing medications for that shift, you prepare and administer the pre-op medication ordered by the physician. Social work services has sent a representative to the ward to assist Sergeant Jones and child care arrangements are made. A patient administration clerk is notifying Sergeant Jones' unit of his admission and will request that a representative of the unit come in the hospital to visit Sergeant Jones and assist him with his personal matters.

d. The staff evaluates the plan 45 minutes later and finds that Sergeant Jones' condition is stable and he is ready for surgery. The appropriate paperwork is completed and placed in the patient's chart. Social work services have arranged for Sergeant Jones' neighbor to care for the children until his wife can be notified and return from TDY. A private room has been prepared for Sergeant Jones to occupy following surgery. Pre-op blood and urine specimens have been sent to the lab. X-rays have been obtained from the radiology section and are ready to be sent to the OR with Sergeant Jones. The RN has completed pre-op counseling and teaching and you have taken Sergeant Jones through his first coughing and deep breathing exercises. Based upon this evaluation, it is determined that all of the initial short-term nursing care goals have been accomplished. As he is transported to the operating room, you are already preparing for Sergeant Jones' return, when a re-assessment must be done and a new plan implemented.