RESUMEN
Medical activities consist of a series of operational procedures,involving the manipulation of pa-tient's body and the use of information materials,which exists the risk of privacy exposure.Based on expounding the working process of interventional operating room,this paper analyzed the potential risks and factors of privacy exposure of interventional patients existing in the process of each interventional surgery procedure: before the inter-ventional surgery,during the interventional surgery,after the completion of the interventional surgery,and put for-ward protective measures to avoid exposure of patient privacy,thus to avoid patient's privacy exposure,respect pa-tients,respect patients' personality and reflect the concept of humanistic literacy service.
RESUMEN
El linfangioma es una lesión benigna que se origina del tejido linfático. Se considera también una proliferación hematomatosa de los vasos linfáticos y tejidos asociados, por lo que representa una anomalía del desarrollo o malformación congénita que aparece en niños durante los primeros años de vida. La mayoría aparece desde el nacimiento y aproximadamente en el 90% de los casos surgen hasta los 2 años de edad. Esta lesión se presentó en el reborde alveolar inferior de una niña recién nacida, con su base en la zona de los incisivos inferiores, de 3 cm de diámetro, valorada por el cirujano maxilofacial del Hospital Pediátrico Octavio de la Concepción de la Pedraja, de Holguín, en enero del 2006. Se le realizó una intervención quirúrgica a las 16 horas de nacida, pues el linfangioma impedía su alimentación. La biopsia corroboró este diagnóstico. Se evolucionó por varios años hasta la actualidad sin presentar recidivas ni secuelas. No necesitó otros tratamientos.
Lymphangioma is a benign lesion that originates from lymphatic tissue. It is also considered a hematomatous proliferation of lymphatic vessels and associated tissues, so it is a developmental anomaly or congenital malformation that appears in children during the first years of life. Most of these lesions appear from birth and approximately 90% of cases arise up to 2 years of age. This lesion was located in the lower alveolar ridge of a newborn girl, with its base in the area of the lower incisors, 3 cm in diameter, assessed by the maxillofacial surgeon of the Pediatric Universitary Octavio de la Concepción de la Pedraja Hospital, on January 2006. Surgical intervention was carried out at 16 hours from birth, since the lymphangioma prevented its feeding. The biopsy corroborated this diagnosis. The patient was consulted for several years to date without recurrence or sequelae. The patient did not need other additional treatments.
RESUMEN
Este estudo, realizado em um hospital geral e privado, teve como objetivos identificar problemas apresentados pelos pacientes cirúrgicos após a alta hospitalar, correlacioná-los com a assistência perioperatória e discutir ações possíveis pela enfermagem para a melhoria da evolução dos pacientes após a alta hospitalar. A população foi constituída de 112 pacientes submetidos a cirurgias eletivas no período de março a maio de 2004. Os dados foram obtidos dos prontuários e de entrevista com os pacientes, buscando informações sobre problemas apresentados e aspectos da assistência prestada referentes a: cirurgia, anestesia, preparo pré-operatório, períodos de permanência hospitalar pré e pós-operatória, visitas pré e pós-operatórias dos profissionais relacionados ao processo cirúrgico, momento das visitas, orientações recebidas para alta, entre outros. Os resultados mostraram que 69,6% dos pacientes relataram problemas, relacionados a alterações emocionais e fisiológicas e dúvidas. O mais frequente referiu-se à ferida cirúrgica, que correspondeu às principais queixas relatadas. Dentre os problemas, 5,3% demandou reinternação. Os resultados referentes à assistência perioperatória apontam relação de alguns fatores com os problemas relatados. As orientações para a alta mostraram-se incompletas. Considerou-se que, na maioria dos casos, os períodos de permanência hospitalar pré e pós-operatórias são curtos e não favorecem momentos e locais formais para o preparo, avaliação e orientações ao paciente. O período pós-operatório é ainda mais curto, pelo tempo demandado para a recuperação anestésica que, neste estudo, predominaram aquelas mais complexas. Houve associação significativa entre período pós e tipo de anestesia. Não foram todos os pacientes que receberam visitas, nestas fases, por profissionais diretamente envolvidos com processo cirúrgico e, dentre os que receberam, foram significativas aquelas realizadas apenas no centro cirúrgico, principalmente entre os anestesiologistas. Os problemas após a alta que demandaram internação ocorreram em pacientes que não receberam visita pré-operatória pelo cirurgião e anestesiologista. Os pacientes só retornam ao hospital quando complicações já ocorreram. A alta do processo cirúrgico, portanto, ocorre no consultório do cirurgião e o hospital não tem condições de participar na prevenção dos problemas após a alta. Com o avanço da tecnologia, o processo cirúrgico se modificou. As intervenções cirúrgicas são cada vez mais rápidas, permitindo o restabelecimento em menor tempo. Por outro lado, o processo cirúrgico tem sido realizado em vários locais, além do hospital, podendo determinar "vácuos" nas etapas da assistência perioperatória e favorecer problemas, tanto durante a fase transoperatória quanto pós-operatória. Configura-se a necessidade de novas estratégias assistenciais que garantam a integralidade deste processo. E a enfermagem pode ser uma destas estratégias, como elo de integração entre paciente/família/hospital/médico. A determinação de momentos formais para avaliação e orientações ao paciente, tanto na fase pré-operatória quanto pós-operatória, deve ser considerada, visando atender às expectativas e necessidades dos pacientes como demonstrado neste estudo.
This study, carried through in a general and private hospital, aimed at identifying problems presented by the surgical patients after being released from the hospital, connecting them with the perioperative assistance and discuss possible nursing actions for the improvement of the patients´ evolution after hospital release. The population was composed of 112 patients submitted to elective surgeries in the period from March to May, 2004. The data had been obtained from the patients´ records and from interviews with the patients, searching information on the problems presented and aspects of the assistance given referring to: surgery, anesthesia, preoperative preparation, pre and after operative periods of hospital staying, pre and after daily visits from the professionals related to the surgical process, time of the visits, guidances received for hospital release, among others. The results had shown that 69.6% of the patients presented problems, related to the emotional and physiological alterations and doubts. The most frequent referred to the surgical wound, which corresponded to most of the related complaints. Amongst the problems, 5.3% demanded re-hospitalization. The results concerning the perioperative assistance indicate a relation of some factors with the stated problems. The releasing guidances had revealed incomplete. In most of the cases it was considered that the pre and after operative periods of hospital staying are short and do not support formal moments and places for the preparation, evaluation and guidances to the patient. The after surgical period is still shorter, due to the time demanded for the anesthetical recovery which, in this study, the most complex ones had predominated. There was a significant association between the after operative period and type of anesthesia. In those phases, not all the patients had received visits from the professionals directly involved with surgical process and, amongst those who received, most of them were carried through only in the operating room, mainly amongst the anesthesiologists. The problems presented after the release that demanded hospitalization had occurred in patients who had not received preoperative and the anesthesiologist´s daily visit. The patient only come back to the hospital when complications had already occurred. Therefore, the surgical process release occurs in the surgeon's office, and the hospital has no conditions to take part into preventing the problems after the release. With the advance of the technology, the operative process has been altered. Surgical interventions have been faster over and over, allowing the recovery in lesser time. On the other hand, the surgical process has been carried through in some places, besides the hospital, being able to determine the "chasms" in the perioperative assistance stages, and fomenting problems, not only during the transoperative period, as well as during the after surgical one. The need for new assistencial strategies was noticed, which would guarantee the completeness of this process. And nursing can be one of those strategies, as a link of integration between patient/family/hospital/surgeon. The determination of the patient´s formal moments for evaluation and guidances, not only during the pre and after surgical phases, must be considered, aiming at answering the patients´ expectations and needs as shown in this study.