Care of Patients with Rectal Cancer Surgery, Essays (university) of Nursing

Download Care of Patients with Rectal Cancer Surgery and more Essays (university) Nursing in PDF only on Docsity! 1 Table of CONTENTS CHAPTER I INTRODUCTION..........................................4 CHAPTER II. PURPOSE AND MOTIVATION...................................5 CHAPTER III. SCIENTIFIC DATA ABOUT THE DISEASE...............6 1.1. Frequency............................................6 1.2. Etiology.............................................6 1.3. Location............................................7 1.4. Pathology...............................7 1.5. The extension of rectal cancer.........................8 2. RANKING....................................9 2.1 Squamous non-invasive (in situ)..................10 2.2 Invasive carcinoma...............................10 3. SYMPTOMS..........................11 3.1 Their debut stage.....................................11 3.2 the Phase of a shape .....................................11 3.3 terminal....................................11 4. DIAGNOSIS................................12 4.1 A positive diagnosis..............................12 4.2 Diagnosis, differential...........................13 4.3 Evolution.............................................14 5. THE COMPLICATIONS OF RECTAL CANCER, IS 14. 6. THE TREATMENT OF RECTAL CANCER...15 7. COMPLICATIONS......................................20 8. LOOKING POSTOPERATORI...................20 9. PREVENTION.......................................21 10. PROGNOSIS......................................21 CHAPTER IV. THE METHODS AND WAYS OF WORKING..................22 CHAPTER V. CASE STUDY...........................................23 CHAPTER VI. CONCLUSIONS:.................................................48 REFERENCES.............................................49 CHAPTER: 2 INTRODUCTION The term of the cancer, recall, since, the idea of progress done, and painful jalonata of the treatment is long and complicated. The idea is to just true, because, as with any disease, it is most likely the the success of the. Play an important role in the early detection of the disease on the education of thethe health of the population, and, last but not least the increase in the level of quality consciousness of thethe medical consultation. It's a pity, as it may be, in 50% of the time diagnosed by digital examination, it is revealed by a delayed an average of 6 months. The education of the health of the population, we need to point out permanently that as a cancer, and, in particular, cancer of the colon, they can be to some degree prevented, and that in the most severe cases, it is possible to obtain the survival of the longthe duration, if it is not treated in its early stages. The patient is in a special way frightened of the possible consequences of the surgical treatment of the fear of it, sometimeson top of myself, to be the bearer of an anus, the artificial. In order to combat the the fear, those who are called to care for such patients, they are obligated to explain that thesome of the easy ways that the hygiene of the local area, but the food can be re- integrate the patient into thethe company. It is not necessary that, at the time of diagnosis, the patient is to beinformed of the objective of all of the possibilities for therapeutic purposes, but mostly for the chance which of these procedures is offered. Only after the consent of the patient and his family will move to the the application of their own. CHAPTER II PURPOSE AND MOTIVATION 5 creatiforma irregular. - The shape of the infiltrativa-stenozanta in the formation appears as a card and paininfiltrating coat the rectal wall, and with the trend of the development of anulara. 6 - The shapes of the microscopic characteristics of rectal cancer, the most common areepitelioame of various types: adenocarcinoma, squamous carcinoma multiple epiteliomul mucipar. 1.5 EXTENSION OF RECTAL CANCER It is accomplished by the propagation of the local government, through the invasion, lymph node dissectionthe regional and, through the figure. The local area is evolving a little bit slow in the lengthwise direction of the infinitefast, circular, and in-depth. In the vertical direction, the release but it is moderate; and after a few months of a cancer is the highest of the 3 - to 4-inch.Infor the cross-section in the 9 to 12-month disorder inside the close in the near-to above, the woman I'm interested in my vagina, and the isthmus of the uterus, and the the men, the prostate gland and the bladder, the higher is the inside bottom of the bagDouglas. The lymphatic circulation is made upward and laterally, and backward it does not exceed the5 to 6 cm. The path vein, it is possible, when the cancer has surpassed the sheath of the rectus. The dissemination of the artery following the more often, the way of the portal veinwhich leads to metastasis to the liver, pleuro-pulmonary and bone lesions. The other way of thedistribution: perineurala, peritoneal moves surgery. 7 2. THE CLASSIFICATION OF COLORECTAL CANCER AFTER THE SYSTEM OF THE OFFICIAL APP. T-primary tumor T0, the tumor is clinically undetectable T1 = tumor limited to the mucosa or submucosa of the T2 = the invasion of the muscular wall, or of the serum T3 = the invasion of the entire wall of the colon, with the structures or the adjacent organs without fistula T4 = the presence of a fistula associated with any of the levels of penetration of thetumor 5 = stage T3 or T4, with the straightforward to the other structures of the T6 = the depth of the extension, non-specific N = the solitary, regional N0= no adenopati N1= solitary the distal face of the origin of the arteries of the ileo-colic,, colic, rightmezocolica and mesenteric inferior No = not specified M = distant metastasis. M0= metastases are absent M1= metastases are present Mx= not specified 2.1 cell Carcinoma non-invasive (in situ) 8 Stage 0 – carcinoma in situ, which is demonstrated by the histological examination of the tissue.'Tis No Mo. 2.2 invasive Carcinoma The first stage. T1 No Mo – the mass invades the mucous membrane of the T2 No Mo – the tumor has invaded the muscle of its own The stage II. T3, No, Mo – tumor invades subseroasa and tissues pericolice T4, No, Mo – the mass is extended beyond that of adjacent organs Stage III.... – refers to any degree of invasion of intramurally with N1-1- 3,the lymph nodes regional to any of the T1-2, N1-3 And Mo-N3: metastasis in any of the nodesregionally, any T4, N1-3, Mo. In stage IV. - refers to any degree of invasion of intramurally, with or without lymph node metastases, but metastases to the distance to any T any NM1. 3. SYMPTOMS: In the development of colon cancer are distinguished three periods of time: 3.1 - the debut 3.2 – play status 3.3 – the terminal 11 4.3 the EVOLUTION of Cancer of the rectum treated it leads to is easy in 12 to 18 months. The young, the evolution of theit is much faster. 12 There are 4 stages of evolution for the establishment of operabilitati, treatment, andthe prognosis of late-like this: The STAGE of the Condition favorable for the surgery of exereza radical THE STAGE II. strongly in favor of surgery for exereza radical change in 55% of cases, and theoperating comfort STAGE III. affordable surgery exereza radical change in 16% of cases, and in the then it's all about the surgeries, palliative radiotherapy, and derivatives to foreignIN STAGE IV. –only accessible to the surgical removal associated with radiation therapy. The tumor invaded a body away and induce metastasis to lymph nodes, and of the liver. 5. THE COMPLICATIONS OF RECTAL CANCER Besides the extension of the local, the regional, and the distance a patient can make a number of complications: Massive blood loss –produced by ulceration of tumors, the erosion of a vessel, breaking theone of the polyp. Bleeding in the case of polyps degenerate to determine the installation of theyou're anemic. 5.1 Bite by hold –it occurs mostly in cancer rectosgmoidiene 5.2 Peritonitis by perforation diastazica is a serious complication of what requires operation in a series, his first act is that of the resolve of peritonitis and the obstruction colorectului, and at the time of the world to come step in to the underlying disease. 6. THE TREATMENT OF RECTAL CANCER 13 6.1 PREPARATION BEFORE SURGERY The choice of the-operator is a tough problem at times due to the risk of the operator, the sea. The preoperative preparation necessary to correct the existing imbalancein order to improve the general condition of the patient. The signs of failure, coronary artery disorders of the rhythm, high blood pressure, clearpreparation of the patient by dilating coronary artery, and vitamins a, B, C, solutions glucose and tonicardiac. The Anemia will be corrected by the administration of bloodunder the control of the hematocrit and the hemograme .Hypoproteinemia is correctblood and plasma amino acids. The balance of the function of the respiratory tract is made by clinical,x-ray, and through the testing of a functional respiratory system. If needed, they will given: antihistamines, expectorants and bronchodilators. To assess the function of the function of the liver will carry out the probe from thedysproteinemia, Tc and Ts,’ index, prothrombin, protein, making it a training for the protection of the liver with glucose, the extracts of the liver, such as vitamins, amino acids, antibiotics. The function of the kidney will be assessed through the examination of the urine, the urea in blood,she's strong enough, urography, clearance; the deficits will be corectatecu spirit,glucose, hypertonic, as recommended. The deficiency metabolic rate will be adjusted by proteins, carbohydrates, and lipids administered orally or parenterally. The imbalance of the hydro-mineral, it will be corrected after the determinationssuccessive of. The patient will not be balanced, mentally, to: barbiturates, sedatives, tranquilizers. The training of the mental has a great importance, most especially to those who are going to haveoperations, mutilating, followed by a prolapsed rectum. The preparation of the local colorectului it is very important to having in view theas septicitatea colic, and the complete removal of the tumour is a factor in aggravating tono complications. The patient will receive in the days before the surgery, a diet rich 14 in the build-up. Deliver, administer the soup of the meat is rich in protein, eggs, dairy products,and natural juices. The evacuation of the colorectului is achieved by the administration of purgatives, andan enema (2 to 3 in the day before the surgery; with 24-hours prior to the surgery, then it is going toto administer a dose of 2 grams. Neomycin/os.) 6.2 SURGICAL TREATMENT The treatment of rectal cancer, is considered today the treatment the complex, in which the surgery, he is the role of the president. To get the best results can be obtained through the exereza surgery, a largeincluding the rectum and the tissue of the peritoneo-celulo-limfo-node, used in the in the early stages of cancer of the rectum. The extent exerezei on top of the tumoryou have to be 15 cm below the tumor, 6 cm. Surgery for cancer of the rectum methods can be used with the intention ofradical oncological; resection and amputation, and paleativa:colostomia. For cancer of the rectum and the upper of the junction rectosigmoidiene is recommended resection of the rectosigmoidiana on the path of the abdomen anterior to the type of Dixon,followed by the colorectoanastomoza terminoterminala. For cancer of the ampulare higher in the early stages, lying to them a minimum of 7-8 cm from the anal opening, it is recommended to resect the rectosigmoidiana,abdominoperineala or endoanala with the descent of the transsfincteriala of the the proximal jaw. For cancer of the ampulare middle and lower extremities, and for all of the tumorsfor bulky and invasion, circumferential, the procedure recommended and accepted by the the majority of the schools of surgery is the amputation rectosigmoidiana abdomino-peritonealaco the colostomy closed. In the opinion of the Congress of the century of the surgeon in Romania (1935), the Dr. Nastaafirma as amputation rectosigmoidiana the kind of Miles it isthe operation that corresponds most closely to the principles of cancer in breast canceranal. If an exploratory laparotomy showing a tumor is inoperable due to the extensionlocal or metastatic intraperitoneal routes, the patient is being threatened by the stenosis is less than, it will proceed to an operation paleativa in the direction of the colostomiithe final on the colon, rectum and sigmoid in the iliad to the left. 17 7. COMPLICATIONS 18 The shock to the operator, it is one of the complications to be feared in the elderly patients. Post-surgery bleeding can occur when care is poor or less light to quantitative and qualitative analyses. Infection is the most common complication encountered after surgery. The death rate ranging from minor infections of the surgical wound, operators, up to the sepsis, with septic shock and the failure of the organic. Ileusul paralysis is a normal situation for the first 3 to 4 days after the surgery.Patients present with abdominal pain, distension, nausea, and vomiting. Hernia in the area of the colostomy. Cellulitis of the pelvis occurs when you have not been complied with, the terms of thean aseptic technique, the sick and prepare the local level for the operation. 8 CARE AND POST-OPERATIVE Immediately after the surgery and after the administration of the premedicatiei, it will be clearthe bladder via the mictiune wild, and the men will not let her probe Adeneure. Postoperative care will be made at the service of the intensive care unit. The patient will have the four-probe: the probe to the aspiration of gastric probe very convenient for oxygen, the well bladder for the control of urine and emptyingthe bladder and the port for infusion and transfusion of blood. They will carry out thesuccession: hemograme, ionograme, packed cell volume, blood glucose, urine protein, book alkaline. The sick man will be dressed with care, protect it is the plague of the laparatomie withgauze soaked in collodion, when there is an a-hole of the abdomen. Deliver manage your spectrum antibiotics parenterally, and by the drainage tubes are placed 19 rectoperitoneal in the swimming pool. In patients with a stoma education is necessary in order to you know take care of you after the surgery. 9 PREVENTION The props include the shares of the mass and the individual. Thanks the scarcity of the fiber, of the excess of fat and of protein the role of the demonstrated epidemiologically indicated the adoption of a diet prudential, which was under the administration of a supplement of dietary fiber, reducing the intake of animal fat and a decrease in the rate of the protein. 10. PROGNOSIS The results of the complex treatment can lead to the survival of over 5 years old for the following reasons: in the 0 - 96% in the stage of I - 90% in stage II, the -76% in stage III, 48% - stage IV: 6% The prognosis is made on the basis of age, duration of evolution of the diseasethe volume of the tumor, extent of invasion, lymphatic and the type of tratamentuluiadoptat.The discovery of the early course of the disease is of the utmost importance: thecancer is the top-positioned, the better the prognosis is good. CHAPTER IV 20 THE METHODS AND WAYS OF WORKING The data collection consists of the collection of information the identification of the problems of the patients current health status, response to the treatment and care that has been provided. The information you've gathered in a number of ways: - History: I have discussed this with the patient's admission about the disease ... ...the signs and symptoms of published data with respect to the 14 needsfundamentals necessary in the preparation of the plan of care. - The observation of a patient; I was being watched carefully, the sick,thethe behaviour in time of the disease, and what kind of attitude they have picked up the girlof the disease. - The study of the sheets from the observation, the clinic of the patient. - Lab.They collected blood and urine samples. - The results are: ESR= 4-6 mm in blood glucose levels= 96 mg %, and nitrogen = 20 mg% , L = 3800 mm, Ht = 30 %, Ty = 3, LP = 16”, TH = 1’35”, J = 10,4%, Tr = 200.000 mm, APZ = negative, urea= 22mg%. Make the following inquiries: -rectal examination; -rectoscope with a biopsy - echo - irigrografie - ecg. CHAPTER V CASE STUDY CASE NO. 1 First AND last NAME: V. AGE: 56 years old 23 24 6. The need to get dressed and undressed After the surgery has been struggling to close. Before the surgery the surgical dressing and undressing herself, without any help. Like clothes, casual wearbut you are elegant. I like to keep it clean and arranged. 7. You need to keep your body temperature within the normal range (36,7 C ). 8. The need to be clean, to keep the skin clean In the beginning, the sick and he can't make the only hygiene of the body, andneed help for the first few days. The skin is normally colored, it shows disruption at the level of the perineum, and the fossa iliac left. 9. The need to avoid the dangers of the He's just afraid of the appearance of complications, the prognosis of the disease, it is nervous in the case of post-operative pain. It is able to avoid the dangers of she knows how keep away from the source that I could be doing the wrong thing. 25 10.The need to communicate She was communicative, understanding, is directed from the point of views of time and space. He has friends in the lounge to chat about the disease 't. The family visits often. 11.You need to practice the religion of Read the day from the Bible and prayer books. When it's time to go to the church. It is catholic. 12.The need to succeed It is the troubled because of the outcome of the disease that prohibit some of the activities, but take comfort in the fact that is not the situation before the of the operation. 13 .Need to recreate it He likes long walks, watching tv with his grandchildren, and cook a a lot. 14Need to learn how to maintain the health of the Want to learn how to cure hygiene and diet, and your life will follow; ask for information about the disease. 26 In the wake of the balance sheet, of the independence-dependence we setthese ne ds are damaged, the patient, in order of importance: 1). The need to avoid the dangers of the pain - the alteration of self-image - the alteration of the integrity of the natural 2). The need to feed and hydrate: - nutrition and hydration are inadequate from the point of view of the qualitative and the quantitative point of view. 3). The need to remove: - changes in urinary and fecal matter. The problem of the patient Goals Interventions nurse autonomous The interventions of the nurse to the delegated Rating 1. Pain The patient will have pain improved after about an hour , and I will be present to the pain after 3 days. I assured her, still kind of intea-comings of the patient, a living room nicely, and I have placed the patient in a position of co- fashion on the bed in the flat dor- sal's thighs easy, flec- n of the abdomen, with the help of a coa- the number of beds made of rolled up and placed under the region of the popli- tee. I'm quiet as a patient, I've had a talk with her about the pain that I have, and I've explained to you that it will To indication doctor I've taken painkillers Day – 1. Fortral Day –2x1-f Fortral the Day of the ILL-2x1-f Fortral About an hour later, your pain it has imp oved, and after 3 days of sick you don't have any pain. 29 30 To make the following inquiries: - rectal examination - rectoscopy and biopsy -echo -irigografie ✦ The largest ECG library They collected blood and urine samples. The results of the examination of the blood, they are: J = 14,8 g% Glucose = 100 mg% L = 4800 mm Nitrogen = 23mg% Tr = 195000 mm = negative Ts = 2’30” P = negative, Tc = 7 And Z = negative Ago the talks with the sick on the first day after the surgery, I set out bilantulde independence –dependence. 1. The need to breathe, and to have a good circulation Normal breathing, with 18 r/ min, and the type of rib superior, is the region of thetoracala course is developed, the movements of the air system, the value of the the pulse rate is 60 m/ min and d= 150/80 mm hg. 2. The need to feed and hydrate 31 It is fed and hydrated via intravenous infusion of glucose, aminoplasmal andsaline solution. It shows an older, good, do not have tooth decay, and gum they are pink in color and sticky to the teeth. The skin shows any signs of the dewatering process. The deglutition is present. 3. The need to remove the She has a probe, urethral, there is a tube at the level of the fossa iliac left andtwo of the tubes of the tube at the level of the perineum. The quantity of the urine, as issued, is for the1500 ml/ 24hr color of yellow in an open, clear, A,P,and Z is negative. The transit of gas and fecal matter is closed; after 24 hours, occurring greenhouse gases. 4. The need to move to have a proper posture Shows the motion in part, to the nivalul of the vertebral column are not pathological changes, the bone's integrity, while the tone of the muscle is a good one. 5. The need for sleep and rest She couldn't sleep because of the pain, waking up frequently at night, the music; it is a superficially, he's gone very, very hard. It is restless and has a temper being motivated. 6. The need to clean and protect the skin At first, she didn't she could make, the only hygiene of the body, and need help. The skin is clean, normal, color. The integrity of the 32 the skin is cut off at the level of the perianal fossa iliac left, at the level of the pipes, the drain pipe where it is dressing up, thanks to the interventionsurgery. She loves to be and make it simpta clean and tidy. 7. You need to keep your body temperature within the normal range It has a temperature of 36, 4* C – afebrile 8. The need to get dressed and undressed Has a difficult time getting dressed and undressed my clothes, and for this reason call for help. Before the surgery, they put on depending on the temperature of theenvironment and depending on the time of year. 9. The need to avoid the dangers of the Afraid of the complications, the evolution of the wrong, and it is anxious and uneasy because of the pain, sometimes impossible, for him to bear. 10. The need to communicate. Is focused on the temporal, spatial, has a verbal-very good developed for the cooperative, watching very carefully what's going on around them, it issociable person, and the explanation that they must be accompanied by the gesticulatii 11. You need to practice the religion of Features of the orthodox faith, and he says he's going to church 35 1 2 3 4 5 36 3 the Failure of a to it is alimanta oral - thanks to the intervention of the digestive system Ill they will supply in terms of quantity and quality - normal in a period of 72 hours. I licked my lips with a cold compress barren and covered with the tea, and I've run amount of the small tea neandulcit from 2 to 2 hours. After the appearance of the gas in 24 hours, we have received a diet hydro-diet- diabetes mellitus; smaller quantities of tea, sweetener, and you can walk from the kitchen, up on the day of the 3, and then to feed the pireuri, meat low cooked, cottage cheese, cheese. To directions doctor I have installed every single day for 3 days, a little infusion of 1500 ml. Glucose, 10 %, 500 ml. Ser saline 0,9% and aminoplasmal a 500-ml., at a ra e to 50 bit/min. After 3 days, ill fed corespunzat or a quantitatively and qualitatively. 4 Remove not knowna d the material of the fecalthrough the probe, respectively, through the anus, the ileum. Ill will remove the urine and faeces faeces in quantity and as a normal person. I have followed the patient chair collected in a bag collection and it was , in the amount of 600 gr./a day with the appearance and the consistency is soft. I have changed the bag, how many times it was needed. I follow the amount of urine per 24 hours, which is normal: 1200 ml./day. I wrote it on a daily basis in the F. O. By observing the daily routinethe urine and the material of feces,I have found that they can be removed in the amount of a normal person. 5 Insomnia Sick, you will benefit from the sleep corespunzato r in the the next 3 days ago We have provided an environment conducive to the great hall. I asked ill to practice technicalto r lax: read a book favorite to listen to the music.I have advised the patient to drink a cup of hot tea before bed. On the first day, he slept for 4 hours in a 2 day, 6 hours, and on the 3rd day of 8 hours. 1 2 3 4 5 37 The issue of a potential risk for the onset of the infection on the level: the probe urethra, the tube of the tube, and an operator. During the period of hospitalization, sick there will be the presence of complications such as:infection of the urinary tract, infection, at the level of the pipes of the drain, the infection of the wound care operators. I helped with the carrying out of the toilet, I have provided an nvironment that respects th privacy of the patient I took care to keep her hygiene the local planning of the surgical wound , changing the dressing of how many times she's needed in terms of the scrub , perfect to the level of the perineum, where the sick presents the pipes of the drain pipe. Day I performed the disinfection of the skin with alcohol sodium iodate.I have checked that the permeability of the probe, haematuria, renal impairment, a bag collector by introduction to ser saline by gavage. To directions doctor we've taken an antibiotic: Ampicillin 1 g in 6 hours.me. During the period of hospitalization , sick doesn't it did the nfection. The plague of surgery, he had a an evolution of smooth with the collection of more and more reduced in quantity by on the brink of extinction. The suppression of the pipes, the drain pipe it was made in 10 days the post the controller according to the instructions of the doctor. CASE NO. III Last name AND first NAME: M. i. A. 38 AGE: 62 years old HOME: Bistrita, Str. The field-no. 24 OCCUPATION: retired NATIONALITY: Romanian Languages SPOKEN: English REASONS for ADMISSION: pain, anal, accented to the defecation, rectoragii, the feeling of defecation, incomplete, back pain, weight loss. DIAGNOSIS: Cancer rectal The HISTORY of the DISEASE: the Patient charge back pain, pain in the anal to the defecation, rectoragii, weight loss (ca. 2 Kg/month), and the reason for that is check, the next couple of months ago at the hospital for investigation and treatment ofliterature. It indicates the surgery, amputation of the rectum. It has been made on the 07. 03. 2007, at 11 o'clock, under a general anaesthetic. PERSONAL HISTORY: he denies A family HISTORY of COLLATERAL damage: negate To make the following inquiries: Rectal exam Rectoscope with a biopsy Blood Echo Blood tests The examination of the urine The results of the examination of the blood: J =13.7 per cent Glucose = 90 mg% L = 4900 mm. Urea = 22mg% Tr = 200000mm. A = negative T ... = 2’40” P = negative , Etc. = 6’10” D = negative Cholesterol = 180 mg% After discussion with the patient, but on the first day after the surgery, I set outthe balance of the independence-dependence. 41 11.You need to practice the religion of 42 It is the religion of the catholic and goes to church on holidays. 12.The need to succeed It is homework for the prognosis of the evolution of the reactions to the disease. 13.Need to recreate it She likes to walk, I love the game of football. 14.Need to learn how to keep your sanity. Ask your questions about the disease, the best treatment, hygiene, and dietand for the life to come. 43 In the wake of the balance sheet, of the dependence-independence, we have established that thethe 14 needs are not met. 1. The need to avoid the hazard: - the alteration of self-image - the alteration of the integritati natural - pain 2. The need to feed and hydrate: - nutrition and hydration are the insufficient quality and quantity. 3. The need for a remove: - the changes to remove the urinary and fecal. 4. The need to move on and to have a good posture: - the risk of the occurrence of thecomplications thrombo-embolitice. The problem of the patient Goals Interventions of the nurse to the autonomous Interventions the nurse delegated to the Rating 1. Pain The sick man will be healed of pain after 1 hour, and stop this pain I have given you a position, convenient in bed: the flat dorsal side with your hips slightly flexed on the abdomen with the help of thea beds set under region e. To indication doctor I've taken pain killers: Piafen 2x1-f/day.me. for about 3 days. After an hour , the pain was improved, and after 3 days the patientno more of this pain. 3 days ago 2. The loss of the image to self-esteem. T patient will not accept the change of its images I explained to him that the anus is exhibited in the iliac , left, is a direct consequence of the illness, and there is no other The patient accepts the image to body and 44 within a period of 3 weeks. solution. I-I-I related to someone else with the same condition, where they wereadapted to thek the disability acquired, and that they were up to their role in family and society. We've talked about it with his family, with his wife, educating her to have an optimistic attitude in the relationship with her husband. he hopes that it will come back to status or before that. Family we encourage you and to discuss the open and be effective with it. 3. The issue of the potential: risk of to appearancethe infection at the level of the probe urethral, as an operator. During the period of hospitalization, the patient is not going to present the infection of the urinary tractand even infection of thewound care operators. We have provided in the carrying out of the toilet, a medium of which to follow the privacy of a pa ient. I've changed a daily basisdre sing in sta e taken through the whole in the juril an actual alcohol, sodium iodate. I verified day permeabi-of probe urethral and to strings header by introduction to ser saline To indication doctor I have taken antibiotics: Ampicillin 1 g, 6-h i.me. Flagyl-f 3 10,05% The during the hospital stay the patient was submitted to an infection. The wound surgery to taken an evolution of the good. 1 2 3 4 5 4. The inability of theto they feed into the oral after surgery , the surgical The patient's will power in terms of quantity and qu lity after 2 days. I licked my lips with a cold compress sterile soaked in tea, and I gave him a small amount of tea neandulcitdin 2 in 2nd class. After the appearance of the gas in 24 hours, I received a procedurehydro-protective effect of diabetes mellitus: a small amount of tea, sweetener, and you can walk to On the medi- ain in the first 2 days, I got fed and hydrated on a patient with a: normal saline solution for 9% of 500ml., glucose 10% 500 ml., Aminoplasmal A 500 - ml., i the rate of 50 bit/min. I'm insta- After 2 days, the patientit supplies the proper quality and a quantitative point of view. In the first one the day after th surgery were discharged to 50 ml of the as- vegetables up her food large: boiled lean meat, cottage cheese , cottage smoothies. down for a probe of the aspi- ration naso-gastric, and we cleared the secretion of the stomach through the aspi- ration with a syringe. you feeding a 24 - hour, su- ape sonda naso-gastric 5. Remove the urine and the material fecal by the probe. The patient will remove the app but there mate- display of feces in the amount and as normal , within 2 days ago Piss and teriile feces were eli- wired in the amount of normal urine 1700 ml./24 hours a chair- 200 g/24 hours.