Surgical Clinic

In this context, the subject is still considered a great challenge for the nurses, therefore it understands that a quality assistance must be pautada in technician-scientific abilities and to be exempt of risks to the patients, and institutions familiar, professional. PASSAGE METODOLGICO Sugerimos that each patient who to receive high hospital from the Surgical Clinic receives a printed matter composed from orientaes from the most diverse types that favor its reestablishment faster prevent the reicindivas. RESOURCES material Availability (computer, printer, ink and A4 paper), physics (local appropriate for these orientaes) and human being (nurses leased in the Surgical Clinic) will be the resources that will become feasible the project. CRONOGRAMA OF ACTIVITIES Of permanent character in the unit of the Surgical Clinic of the Hospital of the West. ' ' The significant evaluation if makes in the proper process, as part of it, while it develops itself, without, for this, if he must always carry through a stop formal.' ' (Gandin, 2000). ORIENTAES FOR PATIENTS PS-ALTA WITH DIABTES 1. Not to smoke; 2.

Not to use hot water stock markets on the feet; 3. Not to leave the feet dived in the water; 4. Not to walk on hot surfaces as the sand of beach or cement; 5. Not to walk bare-footed; 6. Not to use chemical agents for the removal of calluses/calosidades; 7. Not to use adhesive ribbon in the feet; 8. Not to use brace-binds to arrest stocking-pants; 9. Not to use finger sandals; 10.

Not to remove calluses/calosidades; 11. To make a periodic auto-examination of the feet; 12. To carry through the cut of the nails appropriately; 13. To use adequate footwear; 13. To keep a good metabolic control of diabetes and the clinical comorbidades; 14. To practise physical exercises; 15. To have a balanced diet and to rigorously follow the recommendations given for its doctor.

The National Institute

The possibility of primary and secondary prevention of the uterine crvico cancer has grown in the last few decades to the measure that increases the knowledge concerning the factors of risks that involve the illness. The cancer can be decurrent of internal and external factors to the organism, being both interrelated. The external factors are said ambient, corresponding the 80 90% of the cases, and the interns are, in its majority, the tumors genetically predetermined (DAVIM et al., 2005). It is important to add, on the basis of hospital registers of cancer, that 50% of the carrying women of the illness had been diagnosised in stadiums III and IV. This probably reflects the difficulty of precocious diagnosis, the lack of information and the difficulty of access of the woman to the net of health (ALMEIDA; FEITOSA, 2007).

The cancer of the col of the uterus is initiated slowly from an daily pay-invasive injury, that generally advances per years, before reaching invading stadiums of the illness, being: Stadium I A1 (invasion of estroma, 3 mm and up to 5 mm of depth and 7mm of extension). The average period in way to the detention of a lightweight displasia (HPV, NIC I) and the development of carcinoma in situ is of 58 months, while for the moderate displasias (NIC II) this time is of 38 months, in the serious displasias (NIC III) of 12 months. In particular, they is esteem that the great majority of the injuries of low state will regredir spontaneously, while about 40% of the treated injuries of high degree they will not evolve for invading cancer in an average period of 10 years. The National Institute of Cancer of the United States calculates that only 10% of the carcinoma cases in situ will evolve for invading cancer in the first year, whereas 30% 70% will have evolved passed the 10 12 years, in case that treatment is not offered (INCA/MS, 2000).

Adjustable Gastric Band

The first operations they made a linking of the beginning of the thin intestine with the final portion of the same, hindering that the ingested food passed and was absorbed by the 5 meters of thin intestine. These surgeries, although to provide great emagrecimento, led to serious malnutrition e, by this, had been abandoned until the research showed a safer way for these patients. Today, the surgery for cure of the mrbida obesidade is presented in the press and argued between them efficient congresses because in recent years, surgeries mdicosem had appeared, propitiating a emagrecimento with health. Three types of baritrica surgery are known, namely: Baritricas surgeries that basically provoke the emagrecimento hindering that the foods pass all for the thin intestine. They are the result of the evolution of those first described surgeries already and are called desabsortivas. The most known it is the operation of Scopinaro.

A part of the stomach also is removed, however, it has great reduction of food ingestion. Add to your understanding with endocrinologist. Baritricas surgeries that provoke the emagrecimento for diminishing the size of the stomach, making with that the patient eats little. They are, therefore called gastrorestritivas. The most known she is the Adjustable Gastric Band. This operation is carried through by video-laparoscopia and consists of if placing a band involving the stomach and making with that the ingested food is initially motionless in a small part of the stomach propitiating the saciedade sensation, what makes the person to feel itself satisfied and without hunger after to have eaten well little.

Baritricas surgeries that provoke the emagrecimento diminishing the stomach and also hindering that it has absorption for small part of the thin intestine. Therefore they are called mixing. The most known it is the operation of Capella-Fobi, a homage to the two surgeons had idealized who it. This has been the operation most used in Brazil because it presents, in general, a emagrecimento more effective than the Adjustable Gastric Band and a lesser malnutrition that the operation of Scopinaro.


If, after 72-96h, will have a great reaction of skin, means that it can have an active infection or one hipersensibilidade for the previous vaccination with BCG made in infancy. Then, this examination does not confirm the diagnosis, but it can assist the doctor. Reading of the test, classified in millimeters: 0 a4 mm not reactor: individual not infectado for the M. tuberculosis or with reduced hipersensibilidade; 5 a9 mm weak reactor: individual vacinado with BCG or infectado by the M. turculosis or other mycobacteria; 10 strong reactor mmou more: individual infectado for the M. tuberculosis, that it can be sick or not, and individuals vacinados with BCG in last the two years. Dr. John Mcdougall: the source for more info. Other resources for the confirmation of the illness exist. Amongst them he is inhaled gastric is inhaled content of the stomach to the search of the bacillus contained in escarro deglutido.

It is more usadoem children. Ja fibrobroncoscopia is very used in the cases where it does not have expectorao. In this examination, a flexible device enters in the lung and collects material that must be directed for the research of the bacillus of the tuberculosis. In few cases, the pulmonary bipsia, through surgery, can be necessary. Other disgnostic methods still exist to assist the doctor. Notification of the case of Tuberculosis the case will have to be notified through the fulfilling of the fiche of notification of the SINAN, for the professional of health (nurse or doctor) of the UBS that the patient took care of.

This fiche will have to be directed to 1 informatizado level for digitao of Agravos de Notificao (SINAN). Treatment Generally, the hard treatment six months, but, in cases special, can be longer. In first the two months, the three together medications are used. Already in last the four months, they are used the rifampicina associated with the isoniazida one.

Increase Diabetes

For the author, the cardiovascular illness is responsible mostly of the increase, superior the three times of the general population, in the index of mortality found in the patients with DM1. The therapeutical project with insulina in the person with diabetes mellitus type 1 must be individualizado, leading in consideration: age, phase of growth and development, frequency and intensity of physical activity, socioeconmico and intellectual level, familiar and objective infrastructure of the treatment. Before initiating the treatment with insulina, the person with diabetes mellitus must receive orientaes basic, as: places for application, conservation of the insulina, dosage, signals and symptoms of hipo and hiperglicemia and initial behavior in these situations and other acute intercorrncias (RIBEIRO et al., 2006). Gonalves (1996) and Motta (1997) consider that, when has disgnostic confirmation of diabetes mellitus type 1 in a child, &#039 occurs concomitantly; ' surgimento' ' of the diabetic family, by means of the redistribution of responsibilities, reorganization of the daily routine and the renegotiation of the familiar papers. The families guided on the illness have conditions to deal with the feelings created by change and obtains to remain itself balanced front to this reality. Exactly in children with average of equal age the 11 years and duration of diabetes of only 4 years, the thickness of the average close layer of the cartidas ones and aorta was significantly bigger of what of controls of the same age.

The espessamento was sharper in aorta of what in the cartidas ones, and the magnitude of the increase was similar to the observed one in children with hipercolesterolemia. A more intense nip, comprometimento of a bigger number and distais pursuings of the coronary arteries, has been found in patients with DM1 when compared the not diabetic individuals (RIBEIRO et al., 2006). A bigger prevalence of cardiovascular illnesses (DCV) or the risk biggest in developing them in the individuals with SM is told by studies of common knowledge.

Clinical Examination

According to KUDO (1980), for the accomplishment of clinical examinations on the development of the baby the fonoaudilogo must have in mind different stages of the development and arrive at interdisciplinar, with aid of psychologists, neuropediatras occupational therapists. Orientation must be given to the parents not to superprotect its children for being fissurados, relating the importance of ambient stimulatons. Before the surgeries the parents of the fissuradas children they must be guided on the types of procedure that its children will go to submit itself, as for example: the types of cares that will have the surgery after, to guide them on the habit change, feeding and cares in general. According to ALTMANN (1997), the initial information had helped to tranquilize the familiar ones with regard to the type of carried through surgeries, consequentemente, will contribute for a good development of just been born fissurado. all the team to multidiscipline will have to be to the disposal for the familiar contact. We perceive then that the fonoaudiolgico treatment does not have to be interrupted in the period of the surgeries.

When the surgery is if approaching, the parents are guided to have a bigger care with the children, therefore to any infection the surgery can be cancelled, because with any problem of health it can hinder the cicatrizao of the surgery. (ALTMANN, 1997). We still saw in ALTMANN (1997), that after the surgery of the queiloplastia (surgery carried through in the lips) the doctors do not recommend the use of chupetas or baby’s bottle for a certain period of time, the feeding must balanced and be managed under the medical orientaes.). From the medical orientaes we wait that the postoperative one is tranquilo, propitiating a result of the satisfactory surgery. (ALTMANN, 1997). FINAL CONSIDERAES In this final stage, we perceive that the period of training in the Association Kisses Flower, in it provided a greater to them better knowledge of palatinas the carrying children of fiction lip, teaching it to us distresses to respect it for which parents and mothers pass when being in a public hospital.

National Organization

The sectors, units, and the processes interact are interdependent with comprometimento of the direction with focus in the customer, sistmica boarding of the management. With differences between the two instruments of evaluation, ISO9001: (2008) all its requirements of norms are generic, term product has the meaning of services, and these requirements are applied to all productive organizations including the lenders of services, leading in consideraes, types, size, supplied product. However and total demanding when if it speaks in exclusion reasons, limiting themselves, justifying to the contained requirements, it is the applicable processes prescribed with structure in the form of process boarding and development implementing with improvement of the effectiveness. Now the ONA its instruments of evaluation is specific in the work with concept of the sistmica logic, applying all obligatorily joint, structuralized in sections and hospital subs-section to the sectors and services. (4) In such a way it was objectified to evaluate the knowledge of the pupils of graduation of nursing as professional of nursing of the average level, in relation to the process of the certification, according to National Organization of Acreditao (ONA), the institution of health where it acts or acted during the process. Materials and methods Are about a field study of the descriptive type exploratrio, carried through in the period of 24 and 26 of May of 2011, carried through in the college of Nursing of the University Braz Cubas, located in the city of Mogi of Crosses, So Paulo. It was preceded of the approval of the Committee of Ethics in Research of the University Braz Cubas under the number: 010/11 and of the attainment of the signature of the Term of Assent Free and Clarified by the participants of the study. 41 pupils of the course of graduation in nursing of the seventh and eighth semesters of the matutino and nocturnal period had been enclosed in the study, that acts or acted as assistant or technician of nursing in institution passing for the process of the acreditao or believed by the ONA its diverse levels.

The Patient

However, in the case of some tumors, the majority of the patients already presents metstatica illness at the moment of the diagnosis. In the evaluation of a surgery of great transport for patient determined one, it is important to evaluate the relation risk, benefits of the procedure I contest in it of the general health of the patient, the extension of the tumor and the probability of that the tumor can completely be removed, the type of necessary anesthesia and the experience of the team that also must take consideration. As advance in such a way in the x-ray how much in the chemotherapy, the necessity dede a radical surgery diminishes. However, the surgery continues to be a primary boarding of the biggest importance in the curativa therapy of the cancer (AUSIELLO, 2005). The breast cancer occurs in any point of the breast, however the majority is found in the external superior quadrant, where if it locates most of the fabric mammary. In general the injuries are painless, instead of painful; it fixes instead of you move; induradas with irregular edges, instead of encapsulated and smooth (SMELTZER; BARE, 2005). With regard to the surgical treatment for Smeltzer; Bare, (2005), discloses that the main goal of the surgical treatment is to eradicate the presence of the evasivo cancer of breast is the mastectomia, with or without reconstruction and the surgery of conservation of the agreed breast to the x-ray.

On the basis of the studies of Smeltzer; Bare, (2005), cares after – operatrios of the patient who if submits the surgery of the cancer of breast as well as any another surgery, the immediate focus is the recovery of the general anesthesia and treatment pain. Moreover, the patient who suffered the surgery from the breast can try the effect physical and psychological. The possible ones, complications accumulate include it of blood, hematoma besiege in it of incision, infection and accumulate delayed of serossanguinolento liquid, and seroma after the drain.

Nursing Professionals

The professional of the nursing participates as integrant of the society and the actions that they aim at to satisfy to the necessities of the population. The lack of comprometimento of the professionals with the ethics is today the main desencadeante factor of illness in such a way in the health professionals, how much in the population in general. For Cohen and Segre (2002), the professional of the health area has responsibilities for obtains exactly, stops with the patient and stops with third (stops with the society, even stops with the profession and it stops with proper environment) 4. According to Reich (1995) apud Sbaraini (2006), biotica is the systematic study of the moral dimensions? including vision, decisions, behavior and politics moral? of sciences of the life and attention to the health, using a variety of ethical methodologies in a scene to interdisciplinar 5. Professional ethics and the nursing the practical one of the health professionals, in the hospital scope, come desumanizando front to the attention to the illness, and not to the sick being. To recognize and to promote the humanizao, to the light of ethical consideraes, demand an effort to review, mainly, attitudes and behaviors of the involved professionals direct or indirectly in the care of the patient, what also it is taken root in the Code of Ethics of the Professionals of Enfermagem (CEPE), evidencing that the professional codes of ethics, while expression of systems of values, explicitam the morality of a group, estimating the imposition of these values, and not it its questioning 6.

Intensive Therapy

Some, for being transparent, allow the monitorizao of the wound. Hidrocolide: it possesss as white exsudativas ulcers fast-moderately (Degree II/III), with fabric necrtico (autoltico desbridamento), having as characteristic the made up of carboximetilcelulose, gelatin or pectina, impermeable to the bacterium, water vapor and to the oxygen (surrounding hipxico that favors the proliferation and angiognese fibroblstica, and inhibits the bacterial proliferation). The formation of a gelificado composition has analgesic effect and reduces the tack to the ulcer, diminishing the epithelial trauma associate to its removal. Activated Coal: one is about an bactericidal antibiotic, in which it presents the function of absorption, indicated for infectadas wounds, exudativas and with odors ackward, superficial or deep, beyond to possess the advantage of being able for more than to remain in the stream bed of the wound 24 hours. It can be used in association with ACTS and alginatos.

Alginato of calcium does not require daily exchange: one is about dressing used in highly exsudativas ulcers (Degree II/-IV), cavitadas ulcers or with fistulosos passages. It can be used in infectadas ulcers since that already she has been initiated sistmica antibioterapia and if it uses a half-oclusivo secondary covering. Excellent hemosttica action in the hemorrhages after-desbridamento. Having as characteristic composites derived from kelps (alginato of sodium), with great capacity of absorption of exsudado, hemosttica and bacteriosttica action. Gauze with saline solution: it is used in exsudativas ulcers (Degree II-IVI), ulcers moderately infectadas, fulfilling of socket.

Having as Characteristic bacteriostticas properties, capacity of moderate absorption, allows application of topical agents and the socket fulfilling. Because must be used I think it as covering for ulcers? which the importance of the use of saline solution for the cleanness of the injury? What ROCK, 2006, bring it is that the current coverings are half-oclusivos (half-permeveis membranes) reducing the water vapor transmission and creating a humid micron-environment, that demonstrated to promote the reverse speed-epitelizao and the autoltico debridamento, reducing the bacterial contamination and pain. As well as it is very simple how much to the saline solution (physiological serum) which is the ideal agent of cleanness in all the type of pressure ulcers, having the trauma of the ulceroso stream bed to be the possible minor.