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.
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.