De forma geral, as atividades de diálise devem ser realizadas por pessoas capacitadas, sendo a rotina de funcionamento estabelecida por escrito e assinada pelo responsável técnico e por enfermeiro responsável pelo serviço. Quanto aos recursos humanos, de acordo com a RDC nº 154, de 15 de junho de 2004, estão vinculados a esse serviço o número mínimo dos seguintes profissionais:
M.E.F., 23 anos de idade, três meses de gestação, compareceu à consulta de pré-natal na Unidade Básica de Saúde queixando-se de tosse seca, sudorese e perda acentuada de peso (45kg). Após avaliação médica e exames de diagnósticos, foi confirmado caso novo de tuberculose pulmonar bacilífera. Considerando que a doente nunca tinha feito tratamento para a tuberculose anteriormente, a conduta adequada do profissional de saúde com relação ao tratamento da tuberculose recomendado pelo Ministério da Saúde seria
No caderno de atenção básica nº 28, os profissionais de saúde da atenção primária recebem subsídios para intervir precocemente no manejo das complicações do Diabetes Mellitus, a fim de evitar consequências mais graves. Nesse sentido, os sinais e sintomas de hipoglicemia e hiperglicemia devem ser ensinados aos portadores da doença, para que seja possível reduzir a sua vulnerabilidade aos quadros graves. Na prevenção de hiperglicemias, dentre as regras básicas que devem ser orientadas à família e ao usuário, destaca-se:
A fixação do número de membros dos Conselhos Regionais de Enfermagem será feita pelo respectivo Conselho Federal, proporcionalmente ao número de profissionais inscritos. Já o mandato dos membros dos Conselhos Regionais de Enfermagem será honorífico e terá a duração de
A Lei Nº 8666/93 estabelece as seguintes modalidades de licitação:
No estado do Pará, em um assentamento de sem terras que conta com 300 famílias cadastradas e que não apresenta estrutura de serviços de saúde e saneamento básico, foi encontrada uma senhora, de 68 anos, que se intitulava auxiliar de enfermagem e prestava cuidados simples de enfermagem naquela comunidade. Tendo sido abordada por um profissional de saúde quanto ao exercício da profissão, informou ter o certificado de enfermeiro prático. Segundo o Decreto nº 94.406/87, é correto afirmar que o certificado de enfermeiro prático ou prático de Enfermagem foi
THERE ARE 5 QUESTIONS OF MULTIPLE CHOICE IN YOUR TEST. EACH QUESTION HAS 4
ALTERNATIVES (A, B, C, AND D) FROM WHICH ONLY ONE IS CORRECT. CHECK THE CORRECT
ONE.
Don't Get Sick in July
By Theresa Brown
Published: July 15, 2012
It's one of those secrets you normally don't learn in nursing school: ''Don't go to the hospital in
July.'' That's the month when medical residents, newly graduated from medical school, start learning how
to be doctors, and they learn by taking care of patients. And learning means making mistakes.
There's disagreement in the medical literature about whether a so-called July Effect, where
medical error rates increase in the summer, actually exists. But a 2010 article in the Journal of General
Internal Medicine and a 2011 article in the Annals of Internal Medicine both found evidence of it. In an
interview, Dr. John Q. Young, lead author of the latter review, likened the deployment of new residents to
having rookies replace seasoned football players during ''a high-stakes game, and in the middle of that
final drive.''
From what I've experienced as a clinical nurse, whether or not the July Effect is statistically
validated as a cause of fatal hospital errors, it is undeniably real in terms of adequacy and quality of care
delivery. Any nurse who has worked in a teaching hospital is likely to have found July an especially
difficult month because, returning to Dr. Young's football metaphor, the first-year residents are calling the
plays, but they have little real knowledge of the game.
This experience deficit plays out in ways large and small, but I remember an especially fraught
situation one July when a new resident simply did not know enough to do his job and a patient quite
literally suffered as a result.
The patient was actively dying. He was old and his death was expected. He had kept his cancer
at bay for several years, but there were no more curative treatment options left and he had opted to die
peacefully in his bed, surrounded by his family. He had also wanted to die in the hospital, and his death
was coming on quickly enough that the hospital decided to allow it. He was grumpy, charming, funny and
impressively clear-eyed about the end of his life. During our brief, two-day acquaintance I developed a
strong attachment to him.
Death came closer quickly on that second day and as it neared, his pain increased significantly.
Dying from cancer often hurts. He needed oxygen to breathe comfortably, and because he was alert he
fully felt the intense pain.
I'm a nurse, so legally I cannot decide to increase a patient's dose of pain medication, but I can
call a physician and describe the patient's distress. That's part of a nurse's job, but there is also a chain
of command for getting medication orders, and another part of my job is adhering to that hierarchy.
I paged the first-year resident covering the patient. Since it was July he was an M.D. on the
books, but he was brand new to actual doctoring. I explained things, but he would not increase the
ordered dose. I paged him again. We talked over the phone, and I insisted. Then I pleaded. He would
not up the dose.
Looking at the situation from his point of view, I understand his reluctance. I was asking him to
prescribe a very large dose of narcotic, a killingly big dose if the patient was unused to opioids. The
resident might have learned in medical school about pain during dying, but he had not actually been with
a patient going through it. Seeing such pain -- the body twisting, the patient crying out helplessly -- is
categorically different from reading about it.
I also imagine the resident had been taught to prescribe narcotics judiciously, perhaps even
sparingly, and the amount of drug I was asking for was neither.
The patient's wife was kind; his daughter, a nurse, forthright. They and he deserved better than
they were getting, so I decided to take a risk. Ignoring the chain of command, I paged the palliative care
physician on call. She and I had talked about the patient the day before.
I described the patient's sudden lurch toward death, the sharp increase in pain and the resident's
reluctance to medicate the patient enough to give him relief. ''Ah,'' she said, ''I was worried about that,''
meaning that the patient might begin actively dying sooner than the medical team had expected. She
ordered a morphine pump. I got the drug, loaded and programmed the machine. The patient died fairly
soon after. He was conscious to the very end, and I can say he did not meet his death in agonizing pain.
A few hours later I ended up in the elevator with the new resident. He and I both started talking at
once. Looking stricken, he apologized to me for having been busy, overwhelmed with several new
patients. Knowing it is never easy to have someone's footprint on your head, I apologized for having
called in an attending physician. ''I don't usually jump the line,'' I started to explain, when he interrupted
me. ''You did the right thing for the patient,'' he said.
Such an exchange is rare. A nurse who goes over a doctor's head because she finds his care
decisions inappropriate risks a charge of insubordination. A resident who doesn't deliver good care risks
the derision of the nurse caring for that patient. Nurses aren't typically consulted about care decisions,
and this expectation of silence may lead them to lash out at doctors they see as inadequate.
The July Effect brings into sharp relief a reality of hospital care: care is becoming more
specialized, and nurses, who sometimes have years of experience, often know more than the greenest
physicians. We know about medicating dying patients for pain, but we know a lot of other things, too:
appropriate dosages for all kinds of drugs, when transfusions and electrolyte replacements are needed,
which lab tests to order and how to order them, whether consulting another specialist is a good idea,
whether a patient needs to go to intensive care because his vital signs are worryingly unstable.
The problem can be limited by better supervision from senior residents, fellows and attending
physicians, as well as by nurses. We need to acknowledge this fact, because admitting that new
residents need help, and that nurses can and do help them, is the beginning of owning up to our shared
responsibilities in providing care. For the good of our patients, nurses and doctors need to collaborate.
(http://query.nytimes.com/gst/fullpage.html?res=9C02E3DB143FF936A25754C0A9649D8B63&ref=nursingandnurses)
The word underlined in this passage of the text “I'm a nurse, so legally I cannot decide to increase a patient's dose of pain medication” means
Formulários são instrumentos do processo administrativo que se caracterizam como
A aplicação de conhecimentos, habilidades e técnicas na realização de determinadas atividades para atingir a um conjunto de objetivos pré-definidos através da mobilização de recursos técnicos e humanos denomina-se gestão
O Orçamento Público é um mecanismo de
Nos Sistemas de Informação, dados são
Um jovem, 26 anos de idade, procurou a unidade municipal de saúde do seu bairro com queixas de lesões avermelhadas no braço direito, região cervical e tórax posterior. O profissional de saúde que o atendeu, suspeitando de hanseníase, avaliou-o e descartou a possibilidade da doença. Precisando, contudo, referenciá-lo ao médico dermatologista para diagnóstico e tratamento das lesões, informado pelo técnico de enfermagem que as consultas de especialidades estavam suspensas por tempo indeterminado. Na situação relatada e de acordo com a Lei 8.080 de 19/09/90, considera-se que, nesse caso, foi ferido o princípio do SUS relativo à
A portaria do Ministério da Saúde que aprova a política Nacional de Atenção Básica para Estratégia Saúde da Família (ESF), em seu anexo I, dispõe sobre os princípios e as diretrizes gerais da atenção básica. Nessa portaria, considera-se como fundamento e diretriz de atenção básica
De acordo com o regulamento técnico para o funcionamento dos serviços de diálise de que trata a resolução RDC nº 154, de junho de 2004, o serviço de diálise deve estar licenciado por autoridade sanitária competente, seja do estado ou do município, e deve atender aos requisitos mínimos para funcionamento, além de estar capacitado para oferecer as modalidades de hemodiálise, diálise peritoneal ambulatorial contínua e diálise ambulatorial automatizada. Com base neste regulamento, a alternativa correta quanto ao número de pacientes a ser atendido na hemodiálise é de
Sr. João, 34 anos, foi atendido na unidade municipal de saúde de Iracema referindo manchas esbranquiçadas no rosto, costas e nádegas e dores nos trajetos dos nervos ulnar e radial. Após os exames dermatoneurológicos, foi confirmado caso de hanseníase multibacilar. Seu João convivia há mais de dez anos com a esposa (contato A), 32 anos, e com dois filhos (contatos B e C), 16 e 18 anos, respectivamente. A enfermeira do programa, seguindo as recomendações do Ministério da Saúde, examinou os contatos intradomiciliares e observou a presença ou não de cicatriz da vacina de BCG-ID, obtendo o seguinte resultado: Contato A – apresentava sinais e sintomas da doença e não tinha cicatriz de BCG-ID; Contato B – não apresentava sinais e sintomas da doença e apresentava uma cicatriz de BCG-ID; Contato C – não apresentava sinais e sintomas da doença e não tinha cicatriz de BCG-ID. Diante da situação descrita e com relação à vacinação de BCG dos contatos, a conduta adequada seria
