Mortality

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..

CONCI Alcoholic

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

The Comfort

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.

Nursing

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).

Unit Type

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.

Bergamini

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.

Pneumonia

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.

Obstetricians Knowledge

We live deeply in the practical a imposition of norms and routines said humanizadas and spread in the maternities. The humanizao attitude, however, little is assimilated and understood for the professionals who give the care to the woman in labor. However, the concern with the normatizaes techniques still prevails in the institutions. The bond that if establishes between the professionals and the woman in labor can rescue the process of humanizao in the childbirth, who was forgotten in the world the technology, and search action come back to the attendance of the human being with its necessities. It was looked through this work to describe an attendance focado in the necessities of the gestante.

Demonstrating the advantages of a physical and emotional preparation where the woman interacts with its body and starts to trust fully its potential to give birth. was developed with bibliographical bases, and in the knowledge acquired through the course of after-graduation in Nursing Obsttrica and Social Obstercia of the FADAP/FAP of the city of tup, where childbirth was possible to develop a theoretical knowledge of all the stages of the daily pay-childbirth/. It is important that the nursing has an including knowledge of the process so that can have domain of the situation and pass the maximum of security for the gestante, therefore beyond taking care of of all the referring procedures to the daily pay-childbirth and childbirth, it? the nursing? it needs to know to interpret and to act wisely to each verbal or corporal manifestation of the patient. Objectives General? To present a revision of current scientific literature approaching the thematic one e, to analyze the contribution of the research produced on the Obsttrica Nursing and attention humanizada during the childbirth. Specific? To raise the scientific productions of the historicidade of Obstetricians to the Obsttrica Nursing; To raise the scientific productions on Obsttrica Nursing and the humanizada attention of these during the childbirth; To evaluate the effectiveness of applied not invasive strategies for the relief of the intensity of the pain of women in labor in the active phase of the period of dilatao during the childbirth work; To descriptive analyze the results of the research produced for the construction of the knowledge in the area.

Brazil

With passing of the years the activities of the professor surpassed the mediation of the discovery process of the pupil, what it is of its basic ability. It was extended mission of the professional stops beyond the classroom, in order to guarantee a joint between the school and the community. Of the professor it is demanded beyond the view of the knowledge, the participation of the pertaining to school management and the planning, what it means a devotion ampler, which if extends to the families and to the community (GASPARINI, S.M. et al., 2005). The depreciation of the work of the professor, on the part of the pupils and of the society in general, associates to the wage, ambient conditions, extreme collection for results and comprometimento, beyond the indifference with education in the national scene reflects in the loss of the quality of the health of the professors (TENFEN, W. 1992). With the loss of the quality of work and health of the educators, indirectly who suffers is pupils, reflecting in low the quality of information, and difficulty of assimilation of the content. In this manner for accumulation of work and psicossocial and physical pressure, the similar educator and professionals tend to alliviate its tensions through medicines, amongst other drugs, to keep the waited educational level, for they themselves, its superiors and pupils.

The easiness of acquisition of medicines without medical lapsing, that is, the practical one of the self-medication, is the imediatista solution to minimize its problems of health, however, this practical must be rethink and be corrected. The self-medication is a potentially harmful phenomenon to the individual and collective health, therefore no medicine is incuo to the organism (VILARINO, J.F. 1998). In Brazil, middle 1994, of agreement with the Brazilian Association of Indstrias Farmacuticas (ABIFARMA), about 80 million people carried through the self-medication (IVANNISSEVICH. the 1994). Today the trend is that these data have grown in important way, mainly motivated for the increase of offers of medicines in the pharmaceutical establishments and the difficult access to the public health.

Health Department

The neurite can be acute, characterized for pain (neuralgia), hipersensibilidade to the palpao, edema and espessamento of the nerves or chronicle of insidiosa evolution that attends a course with sensitive alteration and loss of the muscular force, the chronic form can have pain or not, quiet neurite (HEALTH DEPARTMENT, 2002). The main acometidos neural trunks are: in the face (trigmio and face), in the superior members (ulnar and the medium one) and in the inferior members (to fibular and the posterior tibial). The neurological evaluation consists of inspection of the eyes, superior and inferior nose, members, palpao of peripheral nerves, evaluations of muscular force of ocular and cutaneous sensitivity (ARAJO, 2003; HEALTH DEPARTMENT, 2002). Ahead one suspicion of hansenase, they need complementary examinations beyond the physician as the baciloscopia must be carried through in all the patients, the result is important disgnostic it and auxiliary in the classification of the clinical form. The bipsia of injury and the nerves with histopatolgico examination for the clarification of the diagnosis.

The Mitsuda test that evaluates the cellular delayed hipersensibilidade and has high especificidade for the M. Leprae for classification of the illness and definition of prognostic (ARAJO, 2003; HEALTH DEPARTMENT, 2002). According to Health department (2002), the importance of the distinguishing examination is that similar illnesses of skin and neurological illnesses to the injuries of hansenase exist that they present signals and symptoms, as esbranquiadas or colored spots, injuries in plates, infiltrations and nodules. Examples of skin injuries that can confuse with hansenase, the Pitrase, Eczimtide, Vitiligo, Had of the Body. the neurological ones, Syndrome of the tunnel of carpo, parestsica Neurology, alcclica and diabetic Neuropatias and injuries for repetitive effort (TO READ). It is important to stand out that the main difference between hanseniase and other illnesses of skin are that will not have alteration of sensitivity. Some images for illustration of the diagnosis of Hansenase.