It is difficult of being differentiated of and many times if it associates with other common causes of miocardiopatia in the diabetic ones as: aterosclerose and arterial hipertenso. The Metabolic Syndrome When diabetes mellitus type 2 is associated with others two factors of cardiovascular risk hipertenso, obesidade, hipertrigliceridemia, low levels of HDL-C and/or microalbuminuria constitutes the metabolic syndrome, also known as ' ' X' syndrome; ' ' ' syndrome of resistance to the insulina. In the whole world, it has had, in the last few decades, an increase in the incidence of the metabolic syndrome which had to a bigger prevalence of overweight/obesidade in the general population. Currently, the modification in the life style has been emphasized (loss of weight and regular physical activity) as therapy of first line. The treatment medicamentoso can be necessary associate to the mannering modification in the handling of the risk factors, mainly the aterognica dislipidemia, the protrombtico state and the insulnica resistance.
The typical lipdico profile of the metabolic syndrome consists of a low HDL, increase of the triglicerdeos and rich particles in triglicerdeos and a dense LDL small e. (LYRA et al, 2006). Prevention Half of the new cases could be prevented, preventing the excess of weight and others 30% as combat to the sedentarismo. (BORIAN et al, 2006). Main Symptoms: Much headquarters; Will of urinar diverse times; Loss of weight (exactly feeling more hunger and eating more than what the habitual one); Exaggerated hunger; Embaada vision; Infections repeated in the skin or mucosae; Hurt that they delay to heal; Fatigue (inexplicable fatigue); Pains in the legs because of me the circulation. (OLIVEIRA, 2008). I diagnosis the diagnosis of diabetes mellitus in adults is based on one of the following criteria, that they must be confirmed by the repetition of the test in one day different case the hiperglicemia observed initially leaves edges for doubts.
The carrier of the Syndrome of Down is a person who loads in itself a genetic problem, problem this responsible one for some characteristics natural of the syndrome, and for character of the pathology it is necessary stimulatons so that its activities are executed, and a specific accompaniment of professionals so that more can become effective and satisfactory the results gotten in its treatment. The description of the syndrome of Down and the methods used for the fisioterapia in the clinical cares with these carriers add the objectives of this work, seen the great relation of dependence of the carriers of the syndrome of Down to the professional Physiotherapist. This work is fit in a research of bibliographical compilation, that brings in its context the presentation of the syndrome of Down and performances of the fisioterapia and the benefits of these actions for the carrier of the Syndrome of Down. The bibliographical survey was to the main metodolgica base for the fact of this work, research in articles, books and periodic appraised in this seek area they had served as mirror for the conclusion of the same. The seen results are well satisfactory, where a well light improvement of the functional anatomical systems occurs, mainly the engines that seriously are affected by the genetic deficiency of the syndrome of Down. The main contributions of this work are to the importance of the biggest inclusion of the professional Physiotherapist in the accompaniment to the carrier of the syndrome of Down, which had to its great proportionate benefits, and the desmistificao of some myths that the society had regarding the carrier of the syndrome of Down. Word-key: fisioterapia, treatment, Down. INTRODUCTION the Syndrome of Down is faced by many as an illness, that demands a special treatment in the direction of a specific accompaniment so that the carrier develops its potentialities, thus having one better quality of life being this one of the main item that the professional physiotherapist searchs to apply in these children..
Word-keys: Syndrome of Down, Obesidade, Metabolism. 1 INTRODUCTION Only in 1959, with the discovery and perfectioning of microscopy, was demonstrated that the individuals with Syndrome of Down (SD) were trissmicos for one of its chromosomes, originally identified as 21. The determinative ones of fentipo Down had been located in the trissomia of a segment of the long arm of chromosome 21. The incidence of the S.D sufficiently is correlated to the age materna. Women with more than 35 years of age give light more than 80% of the children with S.D. Studies tell the incidence of the S.D are three times bigger in children of women who had had infectious hepatitis before the gestation the increased occurrence of S.D in the advanced age materna are exponential, in any event, even so the causes are not total clear, the effect of the age sufficiently are established. The hypothesis of the fetal origin or programming has as basic principle to the nutricionais lacks suffered during stages from the fetal development and infancy, followed of better feeding in posterior stages of the life, being able to take to the sprouting of chronic-degenerative illnesses and obesidade.
One of the bases of this theory would be the occurrence of the low weight to the rising as resultant of the development of not transmissible illnesses chronic in the adult life. It is known that children with Syndrome of Down frequently are born with low weight, what could be one of the causes of the overweight/obesidade in the adult life. The interest in centering the study in the subject the occurrence of the obesidade in the carriers of Syndrome of Down appeared with the objective to study if a relation between the obesidade and the S.D exists. In this way we will search to focus the reason carrying people of S.D present a bigger probability to the development of the obesidade. .
The pulmonary tuberculosis is an illness infectious and contagious with progressions that reach in general, first the pulmes, consequentemente other agencies or symptoms, as treated to correct and efficient way. The nurse as educator has a paper important and main in the cares and orientaes with the tuberculosis carrier, helping to prevent it or to attenuate greaters damages that can come to happen and the familiar ones the same, stimulating the importance and adhesion to the treatment. The tuberculosis continues being a world-wide problem of public health, increasing each time more the mortality taxes and morbidade infectando approximately one tero of the population of the world, remaining as main cause of death, enters the HIV carriers? positives (SMELTZER and BARE 2006). The general objective of this work is to analyze and to understand the pulmonary tuberculosis as a transmissible, infectious illness, that it needs cares having as main person who orientates the nurse. Having as objective specific, to identify to the essential cares to the tuberculosis carrier, showing the importance of the treatment and its complications, thus it can provide one better quality of life. The importance of if choosing this subject involve the tuberculosis as an eminently social and important illness for public health so that if it can obtain its control, diminishing the risk factors, therefore the knowledge of the same one facilitates one better Prophylaxis. According to Health department 2003, ‘ ‘ Brazil declared the control of the tuberculosis as a national priority surrounds 65 infectados million approximately 80 a thousand people adoecem to each year, incidence of 39 cases for 100 a thousand inhabitants and about five a thousand deaths per year. The research methodology is of quantitative nature, being made through identification and collection of books and authors, searching positioning for better recital of the carried through bibliographical research, that argues the thematic pulmonary tuberculosis and the importance of the nurse while educator..
According to studies of the secretariat of health of So Paulo, in last the three years it increased in 78% the number of women who look treatment in the health centers. It has other surveys that strengthen the alert one: the young is early initiating the routine of excessive alcoholic consumption, what it can favor hepticas the illnesses alcoholic. The alcoholic heptica cirrhosis generally is of the type to micronodular, however into the abstinentes patients who take much time, it can be become into macronodular, when predominating the regenerative phenomena and having ceased the consumption alcohol, that is an inhibitor of cellular regeneration (BERTELLI, CONCI, 2001). In many cirrhotic patients the granule deposit is observed of hemossiderina in the hepatcitos, that can easily be placed in evidence by means of the coloration of Perls. In some the deposit is only so massive that it can induce to the diagnosis of hemocromatose (RUBIN, FARBER, 2008). In some fgados of patients with alcoholic cirrhosis intra-hepatocitrios globular inclusions of alpha-1-antitripsina are identified and if they must to fentipo Z, but to the excretor defect of the normal alpha-1-antitripsina as consequence of the proper cirrhosis.
In about 15% of the alcoholics, the necrosis to hepatocelular, fibrose and regeneration finish taking the formation of fibrosos septos that surround nodules hepatocelulares, constituting the two characteristics that define the cirrhosis (ROBBINS et al., 2005). Other injuries of the alcoholic hepatopatia, esteatose heptica and acute or persistent alcoholic hepatitis frequently are observed in conjunction with the cirrhosis. Not yet it was established if the typical alcoholic hepatitis that is, inflammatory heptica injury and acute necrosis represent a necessary precursor of the cirrhosis. However, some form of persistent necrosis causes clearly to the development of cirrhosis (RUBIN; FARBER, 2008). In accordance with Diepenbrock (2005), in the cases of established alcoholic cirrhosis, the prognostic it is, in its bigger part, considerably better for that they do not abuse the alcohol. However, many patients evolve for the hepatopatia in terminal period of training, and the alcoholic hepatopatia constitutes the only more common cause for liver transplant. 2,3 CLASSIFICATIONS OF CIRRHOSIS HEPTICA Due the inherent difficulties to any type of classification, we will present three distinct boardings, in the attempt to classify the cirrhosis, which are: morphologic, etiolgica and clinical (RUBIN; FARBER, 2008). In accordance with Brazilian Son (2006), this classification is
It is clearly that these tools not only exist to facilitate the work of the professional, but yes to bring quality to the service? translated in improvement of the attendance to the customer with more humanizao. However, many times these benefits very cost to be recognized as beneficial for all. unhappyly, in some institutions these benefits really are used to advantage so only by the external customers (the patients) and not for the internal clientele (employee of the institution), and this also influences in the attendance. In any place that occurs changes exist conflicts, however to leave the comfort zone and to work with conflicts bring the growth, therefore of this form we can work on of the committed errors, searching the improvement of the quality of the attendance. Thus these tools, theoretically, bring deep changes, in the form to think and to act in structure of the health services, therefore the work with quality in this area cousin for the individualizado attendance and with humanizao not only stops with the customer as well as for the team of workers, being that the learning and improvement are constant. For this reason the impact at a first moment seems to be sufficiently negative, and also in elapsing of many processes, for innumerable factors? implantation of new assistenciais protocols for example, increases the number of documents (pops, routines, books, registers, pointers, fiches, scales, etc.), however at some moments facilitates the process all, with clear indication of the activities, norms and routines, although to seem that the teams have more work to make, this work is most organized and structuralized, bringing future and perhaps not immediate improvements. for this reason perhaps that a delayed process becomes so, therefore to modify the way to act of the people through the education and of the imposition does not take time. At last, if these tools will be well used, of correct form, with continued education, estruturao and discernment in accordance with the Brazilian reality (legislaes, culture, economy, etc.) becoming a change in the structure of thinking it to act in the work this if translates beneficial results for the company and its customers, however if used in errnea way cause many upheavals and loss of time.
The life of the people next to the sick person becomes entirely dedicated the same, mainly if the cuidador will be a son or conjugates, where they leave its lives of side and opt to taking care of of the other instead of proper itself (CORREIRA, 2009). Caetano apud Correira (2009) affirms that the esquizofrnico episode if unchains in a crisis. Being thus, its consequences are not previsible, however the way where the family deals with this crisis and the carrier of the upheaval negative intervenes positive or with its prognostic. Therefore the family does not only have to be seen as an informer, or coadjuvante of the treatment of the sick person, but also she must be treated, displaying its difficulties, yearnings, fears, you distress and ansiedades, carrying through a shelter of the family. (CORREIRA, 2009). Performance of the nursing professional the psychiatric nursing is based on the interpersonal relationship nurse-patient, through which if it observes the biopsicossociais aspects of the human being. In the biological aspect, the nursing observes collateral effect of the medication and folloies the general health of the young patient and its family. In the psicossocial field, it can be become involved in diverse activities, such as the domiciliria visit, the coordination of groups of patients in workshops and other subjects (GIACON ET AL 2006).
The actions of nursing occur in specific services for the attendance of the first one occasion and in services of primary health. As soon as patient and families present one better acceptance of the new condition, are encouraged to face it through activities with resources of the community, what she makes possible the recovery of social life e, a faster and efficient whitewashing (GIACON ET AL 2006). The nurse and its team need to direct its action to take care of the necessities presented for the esquizofrnico. The nurses, together with the too much members of the team, play basic role in the care and the fight against the stigma of the schizophrenia, in all the phases of the treatment and the recovery of the people (I CASTRATE ET AL 2008).
The states of reacionais are reactions of the imunolgico system of the patients to the M. Leprae are about an acute and subagudo inflammatory process, that can occurs before, during, in the end and after the treatment with the PQT. They are classified in 2 types the Reaction type one or Reao Reversa (RR) and Reaction two type or Eritema Hansnico (ENH) (SANGI al et., 2009). The Reaction type one or Reaction Reversa RR, occurs in patients PB, and is characterized by infiltration, alteration in the color and edema in the old injuries, surgIimento of new dermatological injuries (neurite), with or without acute cutaneous injuries (2002, HEALTH DEPARTMENT, 2008; SANGI al et., 2009). The Reaction type two or ENH, occurs in patients MB who are characterized by painful subcutaneous nodules, folloied or not of fever, pains to articulate and malaise generalized, reacionais erite or iridociclite, orrquiepididimite, hands and feet, glomerulonifrite, comprometimento of peripheral nerves (neurite). The patients who to present these reactions will have to be directed the Unit of Reference to be dealt with other medicines to control reactions (HEALTH DEPARTMENT, 2002, SANGI el at., 2009) .3.7.
Monitoring Epidemiologist and Control of HansenaseEm 1991, the Assembly of the World-wide Organization of the Health promoted for the World-wide Organization of Sade (OMS), established a goal of ' ' Elimination of the Hansenase' ' as a problem of public health until the year of 2000. less defined a prevalence of of one case in each 10,000 inhabitants (WEDGE et al, 2007; LACKWOOD, SUNEETHA; 2005). According to Lana et al., (2000), Brazil appeared in the statisticians of the World-wide Organization of Sade (OMS), in the year of 1998, as as the country in absolute prevalence of cases with 75.000 known cases, only losing for India that represents 85% of the cases in Latin America with prevalence of 4.54 of cases for 10.000 inhabitants.
In turn, Martin (14, P. 33) of the emphasis the ethical question in the formularization of its concept, basing not only on the values how much right and duties the author continues that: ‘ ‘ The ethics visualize not them things as they are, but as they can be and as they must look for to unmask to the logic of the mechanisms that had been the dream possvel’ ‘. In this context, he is explicit that the humanizao in itself the act for which the individual becomes human being, and hospital scope, involves patients and professionals of the health, this last second Zoboli (22, P. 35) argues that: … Cuidar is more than what an act or moment of attention, zeal and desvelo. It is an attitude and for attitude, in this situation, it is understood generating source of many acts that they express to the concern, the radical responsabilizao and the approach to tie with the other.
To take care of, therefore, configures an attitude that makes possible sensitivity stops with the experience human being recognizing the other as person and citizen …. In this direction, it does not remain to the lesser doubt that the ethical space as humanizao instrument in such a way guides that the care to the patient inserts the relations human beings, considering the beliefs how much the values of the patients who are being attended. Thus, Bergamini (3, P. 33) argues that: In this process, the health professional, possibly, will have conditions to understand its condition human being and its condition to take care of of other human beings, respecting its condition of citizen, its individuality, privacy history, feelings, right to decide how much what she desires for itself, for its health and its body.
Intubados patients have high risk of respiratory infection. The settling of orofaringe is an important firing pin of the pneumonia; the gastric settling, refluxo and the aspiration increase the risk for patient in ventilation mechanics. The prevention of the respiratory infection must be constant concern of the team to multidiscipline. The rise of the headboard of the stream bed of the patient submitted to the ventilation mechanics is one simple prophylactic measure of aspiration of the gastric content. The job of correct techniques in the manuscript of the ventilation equipment mechanics is prevention factor, therefore the bacterial contamination of these can premake use to the pneumonia development.
To guide and to educate the members of the team to also multidiscipline are function of the nursing professional. (Craven, 1993; Towers, 1994 apud CINTRA; NISHIDE; NUNES, 2003, P.362) Unhappyly, the use of the mechanical fan at the same time where it favors the air bombardment for the pulmes, also can bring great complications as the pneumonia, that has in bigger index in patients who follow in use of this support. The pneumonia associated with the use of the mechanical fan can be characterized as bacterial pneumonia that occurs in patients with acute respiratory insufficience where these are making use of the ventilatrio support for a minimum period of 48 hours. The pneumonia acquired in the hospital, especially when associated to the ventilation mechanics represents a great disgnostic challenge and therapeutical, thus optimum treatment for patients must be assured who for some reason had acquired the pneumonia. Knowing that the diagnosis and treatment of the pneumonia associated with the ventilation mechanics provide a bigger cost of what would be invested in its prevention, it is necessary then that the team is enabled to identify the signals and apparent symptoms in the interned patient and thus precociously to get the correct diagnosis since not infectious causes of these symptoms exist being able to confuse the diagnosis and in sequence not to reach I hesitate in its treatment.