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Foundations and Adult Health
Nursing
8 EDITION
Kim Cooper, RN, MSN

Associate Professor and Dean
School of Nursing
Ivy Tech Community College
Terre Haute, Indiana
President, Indiana State Board of Nursing
Kelly Gosnell, RN, MSN

Associate Professor and Department Chair
School of Nursing
Ivy Tech Community College
Terre Haute, Indiana
Table of Contents
Instructions for online access
Cover image
Title Page
Dedication
Copyright
Acknowledgments
Contributors and Reviewers
LPN/LVN Advisory Board
To the Instructor
Organization and Standard Features
Teaching and Learning Package
To the Student
Reading and Review Tools
Additional Learning Resources
Chapter Features
Unit I Fundamentals of Nursing
1 The Evolution of Nursing
History of Nursing and Nursing Education
Care of the Sick During Early Civilization
Changes in Nursing During the 20th Century
Significant Changes in Nursing for the 21st Century
Development of Practical and Vocational Nursing
Contemporary Practical and Vocational Nursing Education
Career Advancement
Factors That Influenced Practical and Vocational Nursing
Licensure for Practical and Vocational Nursing
Health Care Delivery Systems
Delivery of Patient Care
Nursing Care Models
Contemporary Practical and Vocational Nursing Care
Practical and Vocational Nursing Defined

Objectives and Characteristics of Practical and Vocational
Nursing Education
Roles and Responsibilities
Get Ready for the NCLEX® Examination!
2 Legal and Ethical Aspects of Nursing
Legal Aspects of Nursing
Ethical Aspects of Nursing
Conclusion
3 Documentation
Purposes of Patient Records
Electronic Health Record
SBAR
Basic Guidelines for Documentation
Methods of Recording
Documentation and Clinical (Critical) Pathways
Home Health Care Documentation
Long-Term Health Care Documentation
Special Issues in Documentation

4 Communication
Overview of Communication
Styles of Communication
Establishing a Therapeutic Relationship
Communication Techniques
Factors That Affect Communication
Blocks to Communication
Nursing Process
Communication in Special Situations
Conclusion
5 Nursing Process and Critical Thinking
Assessment Data
Diagnosis
Goal Identification
Planning
Implementation
Evaluation
Standardized Languages: NANDA-I, NIC, and NOC
Role of the Licensed Practical/Vocational Nurse
Managed Care and Clinical Pathways
Critical Thinking
6 Cultural and Ethnic Considerations
Culture Defined
Reference
Culturally Related Assessments
Nursing Process and Cultural Factors
Cultural Practices of Specific Groups
Unit II Fundamentals of Clinical Practice
7 Asepsis and Infection Control
Asepsis
Infection
Health Care–Associated Infections
Infection Prevention and Control Team

Standard Precautions
Isolation Technique
Surgical Asepsis
Cleaning, Disinfection, and Sterilization
Patient Teaching for Infection Prevention and Control
Infection Prevention and Control for Home and Hospice Settings
Nursing Process
8 Body Mechanics and Patient Mobility
Reference
Use of Appropriate Body Mechanics
Positioning of Patients
Mobility Versus Immobility
Neurovascular Function
Performance of Range-of-Motion Exercises
Moving the Patient
Nursing Process for Patient Mobility
9 Hygiene and Care of the Patient's Environment

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Patient's Room Environment
Bathing
Components of the Patient's Hygiene
Reference
Nursing Process for Hygiene
10 Safety
Safety in the Hospital or Health Care Environment
Workplace Safety
Fire Safety
Accidental Poisoning
Disaster Planning
Terrorism
Nursing Process for Patient Safety
11 Admission, Transfer, and Discharge
Common Patient Reactions to Admission to a Health Care

Facility
Cultural Considerations for the Hospitalized Patient or Long-
Term Care Resident
Admitting a Patient
Nursing Process for Patient Admission
Transferring a Patient
Nursing Process for Patient Transfer
Discharging a Patient
Nursing Process for Patient Discharge
Unit III Introduction to Nursing Interventions
12 Vital Signs
Guidelines for Obtaining Vital Signs
Temperature
Auscultating With the Stethoscope
Pulse
Respiration
Blood Pressure
Height and Weight
Nursing Process
13 Physical Assessment
Signs and Symptoms
Disease and Diagnosis
Assessment
14 Oxygenation
Standard Steps in Selected Skills
Skills for Respiratory Disorders
15 Elimination and Gastric Intubation
Standard Steps in Selected Skills
Skills for Urinary Tract Procedures
Skills for Gastrointestinal Procedures
16 Care of Patients Experiencing Urgent Alterations in Health
Obtaining Medical Emergency Aid
Moral and Legal Responsibilities of the Nurse

Assessment of the Emergency Situation
Cardiopulmonary Resuscitation (CPR)
Procedures to Manage Airway Obstruction by a Foreign Body
Shock
Bleeding and Hemorrhage
Wounds and Trauma
Poisons
Drug and Alcohol Emergencies
Thermal and Cold Emergencies
Bone, Joint, and Muscle Injuries
Burn Injuries
Nursing Process
17 Dosage Calculation and Medication Administration
Mathematics and Dosage Calculation Review
Mathematics Review and Principles
18 Fluids and Electrolytes
Fluids (Water)
Fluid Compartments
Intake and Output
Movement of Fluid and Electrolytes
Passive Transport
Active Transport
Acid-Base Balance
Types of Acid-Base Imbalance
Intravenous Therapy
Blood Transfusion Therapy
Nursing Process
19 Nutritional Concepts and Related Therapies
Role of the Nurse in Promoting Nutrition
Basic Nutrition
Life Cycle Nutrition
Medical Nutrition Therapy and Therapeutic Diets
Nutritional Support
20 Complementary and Alternative Therapies

Herbal Therapy
Chiropractic Therapy
Acupuncture and Acupressure
Healing Touch, Therapeutic Touch, and Reiki
Therapeutic Massage
Aromatherapy
Reflexology
Magnet Therapy
Imagery
Relaxation Therapy
Animal-Assisted Therapy
Yoga
Taiji
Biofeedback
Marijuana and Cannabinoids
Integrative Medicine and the Nursing Role
21 Pain Management, Comfort, Rest, and Sleep
Pain
Sleep and Rest
Nursing Process for Pain Management, Comfort, Rest, and

Sleep
22 Surgical Wound Care
Wound Classification
Wound Healing
Surgical Wound
Standard Steps in Wound Care
Care of the Incision
Complications of Wound Healing
Staple and Suture Removal
Exudate and Drainage
Bandages and Binders
Nursing Process
23 Specimen Collection and Diagnostic Testing
Diagnostic Examination
Specimen Collection
Electrocardiography
Nursing Process for Specimen Collection and Diagnostic Testing
Unit IV Nursing Care Across the Lifespan
24 Lifespan Development
Health Promotion Across the Lifespan
Growth and Development
Family
Stages of Growth and Development
25 Loss, Grief, Dying, and Death
Changes in Health Care Related to Dying and Death
Historical Overview
Grief
Nursing Process in Loss and Grief
Special Supportive Care
Issues Related to Dying and Death
Dying Patient
Grieving Family
26 Health Promotion and Pregnancy
Physiology of Pregnancy
Maternal Physiology
Antepartal Assessment
Determination of Pregnancy
Antepartal Care
Preparation for Childbirth
Nursing Process for Normal Pregnancy
27 Labor and Delivery
Birth Planning
Normal Labor
Labor and Delivery
Nursing Assessment and Interventions
Nursing Process for Normal Labor
Medical Interventions

28 Care of the Mother and Newborn
Anatomic and Physiologic Changes of the Mother
Transfer From the Recovery Area
Nursing Assessment of and Interventions for the Mother
Maintenance of Safety
Psychosocial Assessment
Nursing Process for the Postpartum Mother
Anatomy and Physiology of the Healthy Newborn
Nursing Assessment and Interventions for the Newborn
29 Care of the High-Risk Mother, Newborn, and Family With Special

Needs
Complications of Pregnancy
Bleeding Disorders
Complications Related to Infection
Complications Related to Existing Medical Conditions
Complications Related to Age
Adoption
Contraception
Postpartum Thrombophlebitis
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Complications Related to the Newborn
Complications Related to Postpartum Mental Health Disorders
Nursing Process for the Mother and Newborn at Risk
30 Health Promotion for the Infant, Child, and Adolescent
Healthy People 2020
Dental Health
Injury Prevention
31 Basic Pediatric Nursing Care
History of Child Care: Then and Now
Pediatric Nursing
Physical Assessment of the Pediatric Patient
Factors That Influence Growth and Development
Child Maltreatment
Hospitalization of a Child
Common Pediatric Procedures
Safety

32 Care of the Child With a Physical and Mental or Cognitive
Disorder
Physical Disorders
Mental and Cognitive Disorders
33 Health Promotion and Care of the Older Adult
Health and Wellness in the Aging Adult
Healthy Aging
Psychosocial Concerns of the Older Adult
Aging Body
Safety and Security Issues for Older Adults
Continuum of Older Adult Care
Unit V Fundamentals of Mental Health Nursing
34 Concepts of Mental Health
Historical Overview
Basic Concepts Related to Mental Health
How Illness Affects Mental Health
Crisis
Application of the Nursing Process
35 Care of the Patient With a Psychiatric Disorder
Types of Psychiatric Disorders
Treatment Methods
Application of the Nursing Process
36 Care of the Patient With an Addictive Personality
Addiction
Stages of Dependence
Alcohol Abuse and Alcoholism
Drug Abuse
Chemically Impaired Nurses
Unit VI Fundamentals of Community Health

Nursing
37 Home Health Nursing
Home Health Care Defined

Historical Overview
Types of Home Care Agencies
Changes in Home Health Care
Service Components
Typical Home Health Process
Quality Assurance, Assessment, and Improvement
Reimbursement Sources
Cultural Considerations
Nursing Process for Home Health Care
Conclusion
38 Long-Term Care
Settings for Long-Term Care
Safety Issues in the Long-Term Care Setting
Nursing Process
39 Rehabilitation Nursing
Need for Rehabilitation
Chronic Illness and Disability

Scope of Individuals Requiring Rehabilitation
Goals of Rehabilitation
Cornerstones of Rehabilitation
Comprehensive Rehabilitation Plan
Rehabilitation Team
Family and Family-Centered Care
Cross-Cultural Rehabilitation
Issues in Rehabilitation
Chronic Conditions Necessitating Rehabilitation Therapy
Polytrauma and Rehabilitation Nursing
Disability
Pediatric Rehabilitation Nursing
Gerontologic Rehabilitation Nursing
Conclusion
40 Hospice Care
Historical Overview
Palliative Versus Curative Care
Criteria for Admission to Hospice

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enterprise began, and the first proof was obtained of the woman's
veracity.
There upon the shore, within a few yards of them, was a great
encampment of the Indians, the warriors of their tribe, and fully
armed. The number of the Spaniards was eight, the number of the
Indians more than as many hundreds. For one moment the
Europeans rested on their oars in silence. It was no preconcerted
act, but one of involuntary homage paid by all things living, however
daring, when brought face to face with imminent death.
The half-whimsical, unbidden thought darted through Montoro's brain
that his mother had declared she should never see him again on
earth, and so she could not reasonably feel hurt if her words came
true. What unconnected thoughts flashed for that same supreme
instant through the mind of Diego Mendez none can say. It had
scarcely passed when he sprang into the shallow water, walked on
shore, and with an air of the most dignified composure advanced
alone into the very midst of the great fierce gathering.
Utterly overawed by the white man's astounding temerity, the Indians
fell back, with wonder and irresolution depicted on their
countenances. They answered questions with trepidation.
"Yes; they were on the war-path. Their Cacique had enemies in the
neighbourhood."
"Ah!" replied Diego Mendez with cool courtesy, "then our coming is
well-timed. In return for your Cacique's attentions to us we will now
aid his arms against his foes. We will accompany you on your
expedition."
"Not so," was the Indian chiefs angry reply. "We are strong enough
to fight our own battles; we seek no help. Only leave us: that is all we
desire."
By manifold signs his followers equally betrayed their impatience to
be rid of the new-comers, and strenuously declined to have anything
to do with the boat, or its crew. Seating himself in the small barque
with his face toward the Indian camp, and closely wrapped in his
cloak, Diego Mendez calmly sat, hour after hour, and watched the
dusky warriors.
The day waned; the short twilight drew on. One of the occupants of
the boat began to feel his courage cooling under this tedious
inaction, and he ventured to mutter somewhat anxiously—
"The night is coming, Señor Mendez. We shall be wholly at their
mercy in the darkness."
"Even so, Juan," was the calm answer; "and yet we must remain. We
set out with no thought of going in search of child's play. It is our lives
or the expedition."
And so they sat on in that boat, watching and watched, and the night
fell. Easily could the Indians have slain them all, but they were afraid.
The spirits of a thousand warriors were quelled by one man's
fearlessness. And as the blackness of night began to fade away into
pale dawn, the chief and his army faded from the scene—stole back
to Veragua stupefied and conquered. Moral power had won its
strange, bloodless victory. Then the watchers in the boat roused up,
took their oars again, and returned with their news to the ships.
"And thus the woman's truth is proved," said Montoro eagerly.
But his convictions were something lessened when the Admiral said
slowly—
"You are more sure than I, my son. That you saw an army of the
natives I fully believe. But that they had any purpose to attack us I
strongly doubt. Quibian has given many proofs of his friendly feelings
towards us. And even to-day he has sent us a plentiful supply of fish,
and game, and cocoa-nuts, maize, bananas, and pine-apples."
"And even to-day," interrupted Mendez with unusual heat, "even to-
day, Señor, the Cacique Quibian is meditating our massacre. Give
me but this cool-headed boy to go with me, and we will penetrate to
the very head-quarters of his people, to his very residence itself, and
learn the truth so fully that you shall no longer be able to doubt our
testimony."
There was a pause. The veteran navigator gazed with keen eyes at
his two excited companions, and at length said slowly—
"I send you not on so perilous a quest, but you may go."
The faces of his hearers lighted up as though he had endowed them
with some new-found gold mines, and with a hasty farewell from
Montoro to his half-jealous friend Fernando, the two companions
were rowed back again to land, and at once set out alone on their
desperate expedition.
For nearly an hour they walked on rapidly side by side in silence. At
last Montoro asked doubtfully,—
"Why keep we thus to the seaboard, Señor? Surely we have learnt
that the residence of the Cacique is far away up yonder, beyond the
forest. We should be turning inland if we wish to reach it."
Mendez turned his shrewd face towards his questioner with a slight
smile.
"Ah, my friend, thou art bold and brave beyond thy years, and ready,
to boot; but thou hast not yet quite an old head on thy shoulders, I
perceive. If our foes are watching for our destruction as we suppose,
how long thinkest thou, I and thou should live, bewildered, trapped,
and helpless, in yonder jungle? No, we will keep to the shore till we
reach the Veragua, and then we will follow the Veragua till it leads us
to this Cacique's village, and his own abode. Light, and a clear
space, are valuable to us just now."
Diego Mendez was willing to sacrifice his life freely for the general
good, but he had no idea of wasting it. Montoro did not wish to waste
his either, but to his impetuous nature this winding round, instead of
making a straight dash, was becoming very tedious, when they at
length reached the river's mouth, and at the same time came upon
two canoes and a party of native fishermen. Whether subjects of
Quibian or of his rival, the Spaniards could not ascertain, but
whoever they were, they showed themselves so kind and hospitable
that the tired and footsore pedestrians made signs to be taken into
the canoes, when they were about to set out on their return voyage
up the river.
Making sure of consent, the notary went so far as to put his foot on
to the end of the canoe ready for stepping in. But the owners sprang
forward to push him back, with most vigorous shakings of the head,
and still more significant pointings towards the village, and the
bundles of arrows in their own canoes.
Mendez and Montoro exchanged glances. There was no longer,
then, much doubt of the fate intended them, and ere many minutes
had passed they had learnt that the disconcerted warriors of last
night were only waiting for the next day, before making a fresh
descent upon the white intruders, shooting them, and burning the
new settlement.
"Even so," said Diego Mendez at last. "We have but learnt afresh
what we were well assured of before. But we will not wait for the
doom intended us. It better beseems Spaniards to be the first
aggressors."
As to the general humanity or morality of that sentiment young
Montoro might have taken exception at a quieter moment; but just
now he was infinitely too excited for tranquil thought, and eagerly
seconded his older companion in so urging to be taken up the river,
that at length the kind, simple-hearted fishermen consented,
although with great reluctance.
The poor people's astonishment was still greater when, on reaching
the village, picturesquely situated on the banks of the river, and now
in all the bustle of warlike preparations, their two passengers insisted
on landing, and putting themselves into the power of their enemies.
Still Diego Mendez preserved his cool presence of mind. Having
learnt that Quibian had been wounded by an arrow, he gave out that
he was a surgeon come to heal the injured leg; and demanding
immediate admission to the Cacique, he mounted the hill to the very
walls of the royal residence.
Arrived at the summit of the eminence, he and his companion
paused a moment to take breath, and Montoro, for all his courage,
could not wholly suppress a shudder at the hideous ornamentation of
the royal domain. Three hundred human heads, recently torn from
their trunks, were arranged in circles, in all their grim horribleness,
before the Cacique's abode, the trophies of his valour, and
significant warnings to his adversaries.
Mendez also glanced at these heads, and from them to the
handsome lad beside him, so rich with the blessings of vigorous
youth and health, and a shade of regret passed over his face.
But it was too late for such reflections now. The die was cast, and
they must advance, and resolutely. The slightest token of hesitation
or fear would most assuredly be fatal.
But however brave they might be, others were cowardly enough.
They had scarcely moved forward a dozen steps on the plateau of
the hill when a crowd of women and children caught sight of the
strange new beings, and throwing their arms wildly above their
heads in a very abandonment of terror, they fled in all directions,
startling the echoes with their shrieks.
It soon became evident that they had startled more than the echoes,
for a son of the Cacique, a tall, powerfully-built man, rushed out to
ascertain the cause of the commotion, and looked ready enough to
add the Spaniards' heads to his father's collection when he
perceived them thus braving him, as it were, on his own ground.
Not being versed in the laws of chivalry, he took the notary at
unawares with a blow which nearly sent him headlong down the hill,
and Montoro almost as suddenly dashed forward with doubled fists
to revenge his companion; but Mendez was far from desiring to be
so championed. Recovering his footing, he grasped the boy by the
shoulder and pulled him back, saying hastily,—
"My friend! patience is a virtue—when it is expedient."
Thus pocketing the affront for the present in a way that was very
astonishing to Montoro, the notary by signs complimented his
antagonist on his vigour, and ended by winning the powerful young
savage over to the side of peace and good-will by presenting him
with a comb, a pair of scissors, and a looking-glass, and giving him a
lesson in hair-dressing. So delighted was the great Quibian's heir
with that new accomplishment, that he fairly hugged his instructor,
and although he could not obtain the bold Spaniards an interview
with the angry, invalid monarch, he sufficiently showed his gratitude
by despatching them safe back again to the waiting Admiral, and
their anxious comrades.
He ended by winning the powerful young savage over to the side of

peace and good-will by presenting him with a comb, a pair of
scissors, and a looking-glass.
Thus began and ended Montoro de Diego's first great adventure in
the New World, and from henceforth he was marked out as one of
those for whom the new scenes were to be scenes of renown. With
the bitter termination, for others, of that exploit he had no concern.
He was lying in his berth in the unconsciousness of fever when, a
few days later, the Adelantado and eighty men, guided by Diego
Mendez, seized the unfortunate Cacique, and carried off his wives,
children, and chief friends to die miserable deaths of despair and
broken-heartedness. Well might the poor creatures long to prevent
even the least cruel of the white invaders from landing on their
shores.
Even in the present day it is hard to teach civilized people that the
uncivilized have rights equal with their own, and as sacred. In those
days it was impossible.
CHAPTER XIV.
MASTER PEDRO'S DOGS IN DANGER.
It was still high day when Mendez the notary, and Montoro de Diego,
returned from their expedition to the heart of the Cacique's territory,
and reported themselves once more on board the Admiral's ship; but
by the time the history of their doings and discoveries was ended, it
was too late for any further undertakings in the building line that
afternoon. Fernando got hold of his chosen friend and comrade as
the interview with the Admiral came to an end, and said resolutely—
"Come now, Diego, I take upon myself to say that thou hast earned a
holiday for the next twelve hours, and those not given to sleep I
intend shall be devoted to me; or, if it please you better, to me and
those dogs of thine."
"My dogs, indeed!" laughed Montoro. "I have told thee before, and I
tell thee again, that they are no more mine than thine. Had I but
known in time that I was to go ashore at Hispaniola, they should
have been landed there for their rightful owner, I can tell thee, and I
had been quit of their care once for all."
"Ay, and of their love too," retorted Fernando slyly.
Montoro shrugged his shoulders; but his affectation of indifference
went for nought. The mutual affection existing between the couple of
young bloodhounds, and their young keeper, was too well known by
every one on board for his occasional pretence of carelessness
about them to go for anything. His companion soon proved its
present shallowness.
"Oh, well," he said, in his turn shrugging his shoulders, "if you have
left off caring about them it's all right. But I do pity the poor brutes a
little myself, having nothing to eat for the past—well, there's no
saying how many hours. But you know you didn't feed them before
you went off yesterday."
"Of course I did not," returned Montoro angrily, all his coolness
utterly vanished. "It was much too early then to feed them; but I did
not suppose I left behind me a set of heartless wretches, who would
let poor dumb animals suffer."
Fernando Colon's lip twitched with something uncommonly like a
smile as he expostulated—
"Nay then, you know perfectly that you choose always to feed them
yourself. You have ever given small thanks to those who have dared
to do so in your place."
"Ah!" exclaimed Montoro with rising passion. "And so because,
forsooth, I choose to attend to the dogs myself, when I am on board,
if I were dead you would let them starve?"
"Nay, for I should not then have to fear your scowl," was the answer
ending with a laugh. But Nando added the next moment with a good-
natured smile—
"Even the Admiral himself was not afraid of your wrath anent those
doggies, when you were safe out of the way, for he fed them with his
own hands."
As those last words were uttered Montoro turned sharply away and
brushed his sleeve across his eyes. He turned back again almost as
quickly, and laid a tolerably hard grip of his strong fingers on his
companion's arm as he muttered huskily—
"You'll never let me get a hold over my temper, Nando, if you torment
me thus. But did—did thy noble father in very truth think upon the
wants of the poor doggies?"
Ferdinand's eyes were glistening too as he replied—
"Ay, that he did indeed. And know'st thou, Toro, half I feel jealous of
thee, for verily I believe that it was as much on thy account as for the
dogs' sake that my father did them so much honour. But hark to the
storm they are making. They have found out thou art on board.
Come away, and let them loose."
The next minute the two dogs of Master Pedro, the spice and
curiosity dealer of El Cuevo, were bounding up on deck, giving vent
to a succession of excited hurrahs in their own especial tongue.
Those half-unconscious caresses bestowed upon the hounds by
Doña Rachel Diego at the hour of parting, those tears with which, in
trying to conceal them, she had bedewed the dogs' heads, had so
endeared the animals to her son, that from the outset of his long
journeyings he ever considered their comfort before his own, and
reaped the just reward in their fidelity and strong attachment to
himself. But that evening he was destined to pay a somewhat heavy
penalty for the friendship.
"Toro, you never give the dogs a swim," said Ferdinand suddenly,
when, after a regular romping match, boys and animals had tumbled
themselves down together in a promiscuous heap, to get back
breath and energy for further proceedings. The dogs were so
enormously strong that playing with them was not easy work like
playing with kittens.
"I feel as if I had been engaged in a pretty stiff wrestling match," said
Montoro, laughing, and stretching his arms, "and oh! how warm it's
become, or I."
"You may as well add that 'or I,'" laughed back the other; "for I
suspect, as the sun is going down, that the air must be somewhat
cooler than when you came on board. But the hounds really do look
hot, poor creatures, and they could get such a splendid bathe here in
the river—and so could we."
"Umph!" growled that rather tired-out young Don Diego. "I think it
would have been a much more sensible suggestion that we could
have a splendid turn-in to our berths. But you are such a horrible
fellow. I don't believe you ever know what it is to feel done up."
"Nor you either, generally," said Ferdinand with another laugh.
But his companion was not going to be weak enough to echo it, not
he.
"'Generally' isn't 'never,'" he returned. "But here goes, you energetic
plague. In with you as hard as you like, I'll follow."
And so saying he rolled himself over with a very good imitation of
used-up laziness, and got himself slowly up from his hands and
knees on to his feet, with the wind-up of a solemn, self-satisfied
"Oh!"
"Oh, indeed!" came the mocking echo from half-a-dozen deep
throats, followed by shouts of laughter.
Montoro was just a trifle disconcerted. He had not known of these
extra witnesses of his performance.
"Pity but thy mother were here," said Diego Mendez, one of the
group. "Then wouldst thou have surely had such another lollipop as
must have rewarded thy first triumph in this exhibition."
"Nay then," came the reply, for the performer had not taken long to
recover his self-possession; "nay then, Señor, if you are pleased to
bestow that lollipop for the show it will be the first, seeing that on that
other past occasion of which you speak I returned myself to the floor
with a suddenness that bumped my forehead, and my reward,
therefore, was a plaster."
"Thy impudent mouth deserves a hot plaster now, methinks,"
muttered a surly hidalgo in the background.
But fortunately hot-tempered Montoro did not hear the mutter, and no
one else heeded it. The group of men moved off, and left the lads
once more to their own devices. Montoro stepped up to the side of
the vessel and looked over at the clear, bright waters of the river.
The dogs shook themselves and followed him, Don rearing himself
up on his hind legs on the right hand to look over, and Señor
resolutely pushing himself in between the two boys, and rearing
himself up on Montoro's left hand, with forepaws resting on the
vessel's edge.
"How different the river looks now to the dingy-coloured, troubled
stream we sailed up such a short time ago," said Montoro.
"Yes," answered Ferdinand; "the fair weather has given the mud and
sand time to settle. That is why I think it looks so tempting for a
bathe."
The dogs gave their answers also in an expressive fashion of their
own, like the hurrah business, hunching up their shoulders, and
settling their heads down between them with noses pushed forward,
and intent eyes that meant anything you like to imagine, except
disagreement with their friend. Still that same friend hesitated. His
human companion glanced at him with some wonder.
"Toro—"
"Ay, Nando, what now?"
"Only—the banks are very nigh on either hand, and thou canst swim
now, I take it, as well as any one on board these caravels?"
"Hey, what sayest thou?" said Montoro, with a bewildered stare in his
eyes, which was very nearly reproduced in the other pair when he
suddenly recollected himself, and exclaimed with a short laugh
—"Why now, Nando, you may fairly think that I have lost my wits; but
in truth they had but gone travelling on their own account hence to El
Cuevo, and—Come. I can swim, saidst thou? Truly can I then, and
I'll prove it by beating you and the dogs in a match from here to the
shore yonder, and back again."
"Done with you," exclaimed the sailor's son, beginning his disrobing
with eager haste as he spoke. "Antonio," he shouted to the pilot,
"Antonio! be good-natured; drop us over a rope, and bide here to
summon us back if we are wanted."
"A crocodile, maybe, will have you first," answered Alaminos as he
sauntered up.
"In saying so you belie your own boasted knowledge that these ugly
brutes will not, unprovoked, attack a human being," was the quick
retort.
"Even so," was the calm reply; "neither will they. But I said not they
would hesitate to make a snap at imps."
However, there were no crocodiles—to give the alligators the name
given to them at that time—to be seen, neither were other more
dangerous enemies to be seen, when the two boys and the two dogs
took their simultaneous plunge, with a splutter and dash and
commotion that drew two or three of the crew to keep watch beside
the pilot.
Once in the water, Montoro quite forgot that he was tired, and struck
out vigorously for the shore. Unfortunately, however, for the fulfilment
of his boast, his four-footed admirers would insist upon trying to help
him, first to get back to the caravel, which they appeared to consider
the wisest proceeding; and when he had at last thoroughly
convinced them that he intended to keep his face for the present
turned the other way, their attentions were little less retarding. One
would get a whole bunch of the curly black locks between his teeth
firmly, if not exactly comfortably to their owner, while the other made
perpetual lip-nibbles at his ears and shoulders. Montoro was not at
all sorry at last to join the laughing and exultant Ferdinand on the
river bank.
"Don and Señor shall go back first when we return," he said with a
reproachful shake of his head at the four-footed individuals in
question. "I should have beaten you easily but for them."
"Poor old doggies!" said Ferdinand, stroking the great head nearest
to him as he spoke. "Good old fellows; you'd better far make friends
with me, as he is so ungrateful to you."
As though the dogs understood the address made to them, when
Nando took his hand from Señor's head, and rolled himself down the
bank back into the water again, with a great souse, and forthwith set
to work floundering and swimming and diving and jumping, Señor
jumped up, gave a hasty lick to Diego's hand, and then followed the
other boy into the water, and the two together began to hurry back to
the ship, actuated at first by a spirit of mischief, and then, by the
sharply-uttered orders of the Admiral.
And while Columbus shouted his commands to his young son to
return to him, others were trying to obey the orders to man a boat
instantly, and put off from the ship for the shore Fernando and Señor
had just left.
"But there is no boat! they are all yonder!" groaned Antonio de
Alaminos as he wrung his hands. "And the bravest and brightest
spirit of us all will die unrevenged."
CHAPTER XV.
NOISE TO THE RESCUE.
That Montoro Diego should die 'unrevenged' was Antonio the pilot's
only moan. To wish for his life might well seem useless. How should
he live without aid, and how should aid be got to him in time, even
should there be a dozen boats available! Arrows were flying around
him, and arrows fly faster than any rowers yet heard of can ply their
oars.
The fact of the matter was this. Very few people care now-a-days,
nor ever have cared, for uninvited guests; and the Cacique of
Veragua and his people were no exceptions to the general rule.
When Columbus and his four caravels appeared off their coasts,
they were as pleased with the novel exhibition as we are with a sight
of the Persian Shah, an elephant called Jumbo, or a king of the
Cannibal Islands. And they treated the exhibitors very well, giving
them much more than enough for one feast; and then, when they
were satisfied with the sight, and had found that enough of that was
certainly, so far as they were concerned, as good as a feast, they
gave their visitors some very valuable little presents, and courteously
hinted—"Now you may go."
But, instead of taking the unacceptable hint, they didn't go. On the
contrary, they coolly took possession of other people's land, built a
considerable number of houses upon it, and showed plainly enough
that they meant to take up their abode there without an invitation.
These Spaniards would never have dreamt of trying to treat their
home neighbours, the Portuguese or the French, with such scant
ceremony. But these Veraguans were "only savages, heathen,
miserable dark-skinned creatures, with no rights at all." No claims to
halfpence, only to kicks.
Unfortunately, these poor heathen savages thought differently.
Quibian, with his bad leg laid up in his uncivilized palace, growled
forth his orders to his painted warriors to expel the impudent
intruders; and all his able-bodied subjects turned themselves into
volunteers for the furtherance of the same purpose. Here, there, and
everywhere around that bit of coast, and between the two rivers,
lurked the Spaniards' foes, and half-a-dozen particularly malicious
ones were concealed just within the borders of the forest, facing the
Admiral's ship, when Montoro and Ferdinand forsook its safety for
their ill-advised bathe. The spies grinned at each other with silent
delight when they saw the boys swim straight for the bank, mount it,
and actually place themselves in the full power of the enemy. The
arrows would have left the bows at once, and both the lads might
have suffered but for the dogs.
The Veraguans, like their neighbours on the great new continent,
had no domestic animals, and the gambols and tricks of Don and
Señor were most fascinatingly wonderful to those hidden spectators,
who almost forgot their desire to kill the dogs' companions in
delighted attention to the dogs themselves. But suddenly Fernando,
in that very unexpected way, rolled himself down the bank and
disappeared,—he and one of the four-footed friends,—only to
reappear to their eyes half-way back to the ship. The Indians were
furious at his escape and their own stupidity, and, darting out of their
hiding-place, shot off all six arrows simultaneously at the two hoped-
for victims still remaining in their power.
Rather, it should be said, the one hoped-for victim, for the Indians
would have rather preferred to spare Don had it been possible. But
the animal, obeying its instincts, sprang forward on seeing the
strangers, and received three out of the six arrows in its own body.
The others fell harmless, for Montoro, on seeing the unexpected
adversaries, had obeyed his natural human instincts, and sprung on
one side.
In so springing he involuntarily followed Fernando's example, and
rolled down the bank. Had he then and there set off swimming back
to his friends, he would in all probability have got off uninjured; but
the help Master Sancho, the merchant, had many a time in El Cuevo
seen him render to those more helpless than himself he was ready
with now, almost as much as a matter of instinct as the actions that
preceded the unselfish act.
As he disappeared down the bank the Veraguans uttered yells of
disappointed rage; but through those sounds there fell upon his ears,
with an accent of bitter disappointment, a most piteous moan. Poor
Don had given his body as a shield for his companion, and now that
he lay suffering, perhaps dying, his companion was forsaking him.
Don felt that to be very hard lines, and so he howled out his sorrow.
He certainly would not have treated his friend so, and though his
friend was only a human being, and not a faithful dog, he had
imagined this especial human being to be different to most. It
seemed he was mistaken, and so he howled for his disappointment.
And Montoro heard the mournful howl, and understood all it said as
well as if it had been the very longest and most comprehensive
German word that even Bret Harte ever got hold of.
Ten seconds later the spectators on board the ship saw the lad
remounting the bank with a wild bound, actually returning towards
his enemies—one unarmed, defenceless boy against half-a-dozen
fierce warriors.
"And all for the sake of a dog," said Alaminos to him some time later
with a touch of anger.
"All for the sake of a creature that cried to me for aid," was the reply.
"And ere I cease to care for such, I trust that I may no longer cumber
the earth."
But during those present moments, while Montoro was climbing the
bank, the pilot was standing with wide eyes gazing across at him,
and wondering greatly as to the motives for his strange proceeding.
He had forgotten about the dog, or thought it was dead and done for.
Poor old Don himself knew better. He was lying there helpless, with
three arrows in his faithful side; but he was not yet too dead or done
for to be able to give vent to an ecstatic weak squeak of a bark when
he caught sight again of his beloved master.
So astounded were the Indians that they beat a momentary retreat
into the forest, while Montoro knelt down and pulled the arrows out of
the dog's wounds, Don the while alternately licking his hands and
moaning. But it was no time just then for delicate handling. The three
arrows were out in little more than as many seconds, and then with
an inspiriting "Hi, good dog," Diego roused up the poor animal and
pulled it down the bank with him once more, just as a second flight of
arrows sped more truly to their intended mark. This time Diego
quivered, and uttered one sharp, irrepressible cry as four of the darts
struck and pierced his unprotected flesh. Pulling out the one most
accessible, he plunged into the water, the dog with him. The Indians
rushed forward. For those past few seconds they had imagined he
must have some means of defence at hand to make him so daring,
but now they were undeceived, and proportionably brave,
themselves. Another flight of arrows was launched, this time happily
with such eager, excited haste as to be harmless. But what
advantage was that? The foe had plenty more arrows, and would
apparently have plenty more time to shoot them at their wished-for
target, for both the lad and the dog were evidently much hurt, and
were swimming very slowly and feebly.
Then it was that Antonio de Alaminos wrung his hands and groaned
over his favourite's impending fate. But the Admiral did something
better than groan. There was no possibility of getting a boat across
from the building-ground in time to be of any use, and the position
was imminent. One more glance was cast by the father at his young
son rapidly nearing the vessel, and still unconscious of his friend's
danger, and then the order was shouted forth—"Fire off the guns—
wait not to take aim."
Answering shouts of comprehension greeted the order, and as the
guns were now always in a state of readiness for immediate use, it
was obeyed with almost incredible speed, so great was the
eagerness to save the young life now in jeopardy. Even while the
exhausted Montoro was plunging himself and Don under water to
escape another shower of arrows, there came the flash, the roar of
the four falconets, followed by peal upon peal of the most frantic
screechings from the Indians. Whether they were hurt was very
doubtful, but it was evident enough that they were madly terrified.
Flinging away their weapons, they decamped into the shelter of the
forest again, and it was only by the fading sound of the continued
shrieks that the direction of their retreat towards the village could be
learnt.
"That was a lucky thought—to fight by fear," said Diego Mendez with
a sigh of relief, as he prepared to spring into the river to the further
aid of the rescued Montoro; but the Admiral checked him one
moment, saying reverently—
"It was a blessed thought, my friend, for it was inspired by God."
Twenty minutes later Montoro was safe in his berth; the arrows had
been extracted, and the wounds dressed, and poor Don lay dozing
uneasily at his feet. It had just been suggested that the dog should
be put out of its sufferings forthwith by a blow on the head. But
Columbus would not have it done. The lad had nearly lost his life to
save the animal's, and it should not prove such a useless service.
"You will at any rate, my father, allow me a little time to try to get him
well?" said Ferdinand eagerly.
"Most assuredly, my son," answered the Admiral. "For thy friend's
sake, and for the dog's, it shall be so."
And thus it came to pass that while Montoro lay ill of fever from his
torn wounds and over-fatigue, many weighty things befell his
companions and the Indians of Veragua, and faithful Don lay at his
master's feet and licked himself back into wholeness. In fact, Don's
surgical appliances did him good far more speedily than those made
use of on behalf of Montoro. And when his comrade Señor's bones
lay bleaching in the American forest some few weeks later, he was
bounding about the deck in full strength and health, and utter
disregard of the calamities that had befallen nearly every other living
creature any way connected with him.
When Montoro again recovered consciousness the Admiral's caravel
was once more on the way to Hispaniola. The settlement at Veragua
had been half destroyed, wholly abandoned; the poor Cacique of
Veragua and his people were slain, dead or dispersed; and once
more Montoro de Diego, and many of his companions, had to turn
their hopes of fortune to the island colony that had already, in the
short space of eight years, been so frequently the hotbed of envy,
hatred, malice, and all uncharitableness.

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Contributors and Reviewers

LPN/LVN Advisory Board

Organization and Standard Features

Teaching and Learning Package

Additional Learning Resources

1 The Evolution of Nursing

History of Nursing and Nursing Education

Care of the Sick During Early Civilization

Changes in Nursing During the 20th Century

Significant Changes in Nursing for the 21st Century

Development of Practical and Vocational Nursing

Contemporary Practical and Vocational Nursing Education

Factors That Influenced Practical and Vocational Nursing

Licensure for Practical and Vocational Nursing

Health Care Delivery Systems

Delivery of Patient Care

Nursing Care Models

Contemporary Practical and Vocational Nursing Care

Practical and Vocational Nursing Defined

Roles and Responsibilities

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2 Legal and Ethical Aspects of Nursing

Legal Aspects of Nursing

Ethical Aspects of Nursing

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Purposes of Patient Records

Electronic Health Record

Basic Guidelines for Documentation

Documentation and Clinical (Critical) Pathways

Home Health Care Documentation

Long-Term Health Care Documentation

Special Issues in Documentation

Establishing a Therapeutic Relationship

Factors That Affect Communication

Communication in Special Situations

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5 Nursing Process and Critical Thinking

Role of the Licensed Practical/Vocational Nurse

Managed Care and Clinical Pathways

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6 Cultural and Ethnic Considerations

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Nursing Process and Cultural Factors

Cultural Practices of Specific Groups

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Unit II Fundamentals of Clinical Practice