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CURSO DE

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CURSO DE

INGLS PARA PROFISSIONAIS DA

SADE

MDULO IV

Ateno: O material deste mdulo est disponvel apenas como parmetro de estudos para este
Programa de Educao Continuada. proibida qualquer forma de comercializao ou distribuio
do mesmo sem a autorizao expressa do Portal Educao. Os crditos do contedo aqui contido
so dados aos seus respectivos autores descritos nas Referncias Bibliogrficas.

MDULO IV
COMUNICAO EFICAZ COM OS COLEGAS DE PROFISSO

Neste mdulo o foco a comunicao eficaz com os colegas. Para isso

sero abordados tpicos relativos interao oral e escrita entre os profissionais da
sade, atravs do conhecimento de algumas estratgias comunicativas e de
nomenclaturas, abreviaturas universais e a compreenso e preenchimento objetivo
de pronturios de atendimento. Ao final deste mdulo voc ser capaz de:

1. Aplicar estratgias de comunicao para uma melhor interao entre colegas e

supervisores
2. Conhecer e se familiarizar com formulrios e fichas em ingls;
3. Compreender e utilizar abreviaes universais de procedimentos e quadros
clnicos;
4. Familiarizar-se com os procedimentos e cuidados em quadros tpicos do pr e
ps-operatrio.

4 WORKING WITH COLLEAGUES

Apesar dos profissionais de sade trabalharem a maior parte do tempo

sozinhos, eles precisam interagir com os colegas para trocar informaes sobre um
cliente, tomar decises em conjunto, ajudar uns aos outros com tarefas rotineiras, ou
enfrentar uma situao de emergncia. A comunicao entre os colegas pode ser
formal ou informal, mas precisa ser clara e assertiva.

4.1 HELPING WITH TASKS

Teamwork, ou seja, trabalho em equipe, um conceito muito importante em

um contexto mdico. Os profissionais de sade devem trabalhar juntos para prestar
assistncia ao paciente. possvel que um membro da equipe tenha muito a fazer e
precise de ajuda dos outros.
Vamos ver juntos como o nosso amigo Pedro interage com seus colegas de
trabalho e pede ajuda em um dia de trabalho muito difcil.

NURSE: Do you need some help?

PEDRO: Oh, thanks. That would be great. There is just too much going on today.
NURSE: My pleasure. Let me know which patients I can help you with.
PEDRO: The car accident client in Bed 318-A has asked for more pain meds. Could
you possibly get a doctor in to see him?
NURSE: Certainly.
PEDRO: Oh, and the gall bladder operation in 306-A has been complaining about his
bed. Do you think you can try to adjust it for him?
NURSE: I'll try.
PEDRO: And the broken leg in 309-B wants someone to fix her TV. Would you mind
calling for the technician?
NURSE: No problem.
PEDRO: And, let's see. I just found out that it's Mr. Smith's 70th birthday today. He's in
Bed 312-A. I wonder if you could call the kitchen and ask someone to include a
candle with his dessert.
NURSE: Consider it done.
PEDRO: And how about teaching me how you keep little Mary in 336 occupied. She's
a handful!
NURSE: Of course.
PEDRO: Hmmmm. After work, can you go to my house and make dinner for my
family? [smiles]
NURSE: Sure. [laughing]

4.1.1 Communicating Strategy: Requesting and Giving Help

Como vemos, quando Pedro pede a algum para fazer alguma coisa, ele
precisa ter muito cuidado para usar a forma mais adequada para fazer a request.
Vamos ver juntos alguns pedidos formais e informais.
Formal
Could / Can you please
Excuse me. Do you think that you could / can
I wonder if you could / can
Pardon me. Could / Can you
Hi, Would you mind [help]ing

Informal
Help / Teach me.
How about helping
I need you to
Tell me how to

Quando algum lhe pede para fazer alguma coisa, voc pode responder
positivamente ou negativamente. Se no puder ajudar, voc dever dizer o porqu.

Respostas positivas
All right.

No problem.

Certainly.

Of course.

I'd be glad to.

O.K.

My pleasure.

Sure.

Respostas negativas
I'm afraid I can't.
I'd like to, but I can't.
I'm sorry. I can't.

WORKER:

Can you please teach me how to sterilize the door knobs?

SUPERVISOR:

I'm sorry. I can't. I need to go to the intensive care unit. Please

ask Kristina to help you.

4.1.2 Communicating Strategy: Expressing Thank you and You're Welcome

Depois de ter pedido ajuda, Pedro entende a grande importncia de saber

expressar

gratido.

muitos

modos

de

agradecer,

tanto

formal

como

informalmente, dependendo da situao. importante saber escolher o termo

apropriado.

Formal
I'm (very/so) grateful for your help.
Thank you (so much) for your help.
Thank you very much. I really appreciate it.

Menos formal
That was nice of you. Thank you.
Thank you. You really shouldn't have.

s vezes preciso usar uma rplica quando algum lhe demonstra gratido. Como?

Formal
You're (very / quite / more than) welcome.
(It was) my pleasure.
Don't mention it.
Not at all.

Informal
Anytime.
Don't worry about it.
Forget it.

(It's) no big deal.

(It's) no problem.
Mm-hmm.
Sure.

4.1.3 Communicating Strategy: Referring to Others

Outras vezes pode acontecer de ser interpelado para ajudar em alguma

tarefa, mas no saber como fazer. Ser ento necessrio indicar outra pessoa que
tenha experincia ou habilitao. H frases especficas que voc poder usar nesse
caso.

Frases para se referir a outra pessoa

I've never done that, but has.
I don't know how to do that, but does.
I'm not an expert in that. Maybe you should ask .
I've never heard of/seen that. Let's ask .
I know someone who can answer your question/who can help.
This calls for someone with more experience than I have.
The person who can help you is .

Expresses para se referir as outros

is my point person.
is my go-to person.

Vamos ver algumas situaes onde Pedro precisou usar essas expresses.

DOCTOR: Can you assist during the tracheotomy?

PEDRO: I've never done one of those, but Ms. Richey has.

PATIENT: I'd like to know how to get information about nursing homes for my
grandmother.

PEDRO: I'm new here, but know someone who can tell you. I'll find her.

4.1.4 Communicating Strategy: Using the Telephone

Pedro j reparou a importncia da comunicao entre colegas durante o

turno. A maioria das vezes a interao face-to-face, mas tambm pode acontecer
de dever usar o telefone. Se algo no for claro, muito importante saber como pedir
mais explicaes.
As enfermeiras da maternidade do hospital onde Pedro trabalha esto muito
atarefadas. Vamos ver como Pedro se vira nos sues primeiros telefonemas em
ingls.

PEDRO: Good evening. Dallas General Hospital Maternity Ward. This is Pedro. How
may I help you?
CALLER 1: Yes, this is Dr. Sutton. I'd like to speak to Dr. Shank about a SIDS
research study I'm doing.
PEDRO: Dr. Shank is in the N.I.C.U. right now. I'll transfer you to that floor.
CALLER 1: O.K. Thanks.

DO YOU KNOW? N.I.C.U. means Newborn, or Neonatal, Intensive Care Unit, an

intensive care unit designed for premature and ill newborn babies. Less often, NICU
may refer to a Neurologic Intensive Care Unit.

Vamos ver agora outro telefonema.

PEDRO: Good evening. Dallas General Hospital Maternity Ward. This is Pedro. How
may I help you?
CALLER 2: Yes, I'm calling to find out if Zoe Cavanaugh has had her baby.
PEDRO: Cava ? How do you spell that, please?
CALLER 2: C-a-v-a-na-u-g-h.
PEDRO: I need to check and see. Hold on, please. [pause] Hello? Yes, she's had the
babies and has already been discharged.
CALLER 2: I'm sorry. Babies?
PEDRO: Yes, she had twins.

Seja para atender colaboradores, supervisores, ou o pblico em geral, a

comunicao precisa ser sempre gentil e, sobretudo, clara. Vamos analisar junto a
Pedro os quatro passos para poder atender ao telefone de forma educada.

Passo 1 - Saudao
Good morning / afternoon / evening.

Passo 2 - Nome do Centro Mdico e Departamento

University Hospital - Pathology.
Saint Thomas Hospital I.C.U. Nursing Station.
New Castle Medical Center Cardiac Recovery.

Passo 3 - Auto identificao

Pedro speaking.
This is Pedro.

Passo 4 - Pr-se disposio

How may I direct your call?
How may I help you?
May I help you?

Se o funcionrio no est capacitado para ajudar a pessoa do outro lado da

linha, em vez de anotar um recado mais de se esperar que ele tente encontrar
algum que lhe ajude. Nesse caso, dever colocar a ligao em espera. H muitos
modos para fazer isso.

Formal
Do you mind if I put you on hold?
I need to ask about that.
May I put you on hold?
Would you mind holding?

Menos Formal
Could / Can you hold, please?
Will you hold, please?
I need to check and see.

Informal
Hold on, please.
I'm going to put you on hold.

Algumas vezes voc ter que transferir a ligao para outro ramal. Voc
pode faze-lo de maneira formal ou informal.

Formal
I'll transfer you to the Chief Nursing Officer, who will be able to help you.

Menos Formal
I'll put you through the Chief Nursing Officer, who will be able to help you.

Informal
I'll connect you with the Chief Nursing Officer. He'll help you.

4.1.5 Communicating Strategy: Clarification Requests for Meaning

importante reparar que quando Pedro no entende o sobrenome da

pessoa que est ligando, pede para ela fazer o spelling. Em ingls h tambm
muitos acrnimos e abreviaes e por isso muito fcil se encontrar na situao de
no entender ou de ter dvidas sobre uma determinada palavra ou expresso.

DID YOU KNOW? An acronym is an abbreviation consisting of the first letters of

each word in the name of something, pronounced as a word: for example, AIDS is an
acronym for 'Acquired Immune Deficiency Syndrome' and SARS is an acronym for
'Severe Acute Respiratory Syndrome.'

Pedro aprendeu que h trs modos para pedir a uma pessoa se explicar
melhor ou repetir algo:

Interromper educadamente e repetir

I'm sorry. SARS?
Pardon me. SARS?
Excuse me. SARS?

Pedir para soletrar

SARS? How do you spell that?

Perguntar diretamente
SARS? What does that mean?
Uh I don't understand. Can you explain SARS?
Excuse me, what does SARS mean?

Quando o problema devido a uma dificuldade em ouvir, preciso saber

pedir com gentileza para o outro repetir.

Formal
I am sorry. Would you mind saying that again?
Pardon me / Excuse me. Could / Can you repeat that, please?

Menos Formal
Could you say that again?
I didn't get that. Can you say it again?
I didn't understand what you said.

4.2 INTERACTING WITH SUPERVISORS

Os profissionais de sade passam muito tempo com seus supervisores. No

muito fcil aprender cada nova tarefa ou habilidade apresentada pela primeira vez.

 necessrio, portanto, saber fazer perguntas para entender todos os detalhes. Se

cometer um erro ou fazer algo errado, essencial saber pedir desculpas.

4.2.1 Communication Strategy: Confirmation Checks

Pedro descobriu que quando precisa deixar claro ou confirmar que ele
entendeu determinada instruo, basta repetir o objeto principal e acrescentar uma
frase. Pode-se tambm colocar uma interrogao aps a confirmao de horrios ou
quantidades importantes. Vejamos alguns exemplos para entender melhor.

SITUATION 1
SUPERVISOR: Mr. Lindley must not have any liquids after midnight.
PEDRO: No liquids after midnight, I understand.
SUPERVISOR: And he must be ready for surgery at 8:00 AM.
PEDRO: 8:00 AM, is that correct?
SUPERVISOR: Yes.

SITUATION 2
SUPERVISOR: Give him 500 mg of his medication every six hours.
PEDRO: Every six hours, right? Anything else?
SUPERVISOR: Yes, make sure that the kitchen switches his meals to no salt.
PEDRO: No salt meal. O.K. I got it.

Resumindo,
Para confirmar informaes importantes
____________________, (is that) right?
____________________, (am I) correct?

Para confirmar outras informaes

____________________, I understand.
____________________, I got it.
____________________, O.K.

4.2.2 Communication Strategy: Soliciting Information

Se alguma coisa no pronturio do paciente no estiver clara ou parecer

incompleta importante saber solicitar mais informaes. Vamos ver como Pedro
lida com uma situao similar.

PEDRO: I read that we need to change the dressing. What kind of dressing pads
does this wound need?
SUPERVISOR: Use the largest ones we have.

Vamos ver outras frases que poderiam ser usadas em casos similares para
confirmar informaes importantes.

This says ____________________, what does that mean?

I'd like to know what this means.
Could / Can you explain ____________________?
Could / Can you explain how to ____________________?
This says ____________________. Could / Can you give an example of that?
Could / Can you tell me why it says to do this?
What kind of ____________________?

4.2.3 Communication Strategy: Apologizing

Se cometer um erro em seu trabalho ou, sem querer, incomodar/machucar

algum, de suma importncia assumir a responsabilidade e saber se desculpar
adequadamente. H muitas frases que podem ser usadas para pedir desculpas de
maneira formal ou informal, dependendo da gravidade da situao.

Formal
My apologies.
Please, accept my apologies.

Please excuse / forgive me.

Menos formal
I apologize.
I'm really / so / very sorry.

Informal
Sorry.
Sorry about that.

Tambm importante saber como aceitar as desculpas educadamente.

Don't worry about it.

No problem.
No worries.
That's all right.
That's O.K.

4.3 FILLING OUT FORMS

4.3.1 Communication Strategy: Double-Checking Information

importante ter certeza de que todos os formulrios sejam preenchidos

corretamente. Por isso aconselhvel checar duas vezes um informaes
importante antes de escrever para no correr o risco de cometer um erro.

Pedidos para checar duas vezes uma informao

I would like this to be looked at by another pair of eyes.
I'll just get confirmation on this.
Let's confirm / verify / validate this.
Let's double check this.

Perguntas sobre informaes aps elas serem checados duas vezes

Did you use the patient's own words?

Has this been double-checked?

Is this confirmed?
Is this correct?
Who else has seen / looked at this?
Who else would know?

4.3.2 Communication Strategy: Drawing Conclusions

Quando estiver revisando as informaes dos pacientes, o profissional da

sade ir tirar concluses a cerca do que deve e do que no deve ser feito. Mdicos
tm a mais alta autoridade no processo de deciso, mas enfermeiros tambm
precisam saber inferir informaes dos registros. H frases especficas para se usar
quando for tirar uma concluso.

Strong Conclusions
Based on this information,
From what we see here,
It's clear that
It's evident that

General
For the most part,
It seems that
On the whole,
We have concluded that

4.4 MEDICAL FORMS

A seguir Pedro poder visualizar exemplares de formulrios ou fichas

requeridas em vrias situaes, para registar as necessidades, tratamento ou
quadro de internao e alta. Vamos poder v-los juntamente com Pedro. Entre os
formulrios mdicos, temos vrios tipos, segundo as circunstncias de aplicao.
Vejamos alguns exemplares, samples, juntamente com os seus usos.

4.4.1 Discharge Form

FIGURA 48 - DISCHARGE FORM SAMPLE

1: Personal information; 2: Period as inpatient; 3: Procedures; 4: Drugs.

FONTE: Cambridge English for Nursing: Cambridge Press, 2008: 2.

A discharge form is used to summarize the patients care while an inpatient. It is sent
to the local doctor and/or district nurse to ensure continuity of care.

O formulrio de alta muito importante porque tambm pode servir como

documento de transferncia do paciente e a comunicao fundamental para que
esteja garantida a continuidade do tratamento, conforme temos no trecho em ingls
to ensure continuity of care.

4.4.2 Request Form

FIGURA 49 - REQUEST FORM SAMPLE

FONTE: Cambridge English for Nursing: Cambridge Press, 2008: 7.

These kinds of forms are used to order tests or exams if a patient complains of pain,
if the doctor suspects some diseases or in the pre-operative check list.

4.4.3 Cardiac Care Unit Form

Combination of Glasgow Coma Scale chart, Diabetic Chart and Vascular obs. chart used to assess blood circulation in vascular ulcers. It also notes specialized IV lines,
IV cannulas, drains and catheters.

Este pronturio que rene aspectos metablicos, circulatrios e neurolgicos o

correspondente Unidade de Cuidados Intensivos, que requer, claro, um
monitoramento mais intenso.

FIGURA 50 - CARDIAC CARE UNIT SAMPLE CHART

1: Glasgow Coma Scale Chart; 2: Diabetic Chart; 3: Vascular Observations Chart;

4:Plan of treatment; 5: Notes specialized IV lines, IV cannulas, drains, and catheters.
FONTE: Cambridge English for Nursing, Cambridge Press, 2008: 9.

4.4.4 Day Surgery Follow-Up Form

This is used to check on patients after day surgery. A phone call is made to check on
pain level, wound status and mobility.

Este tipo de formulrio pertence a uma situao peculiar e pouco

disseminada em nosso pas. Corresponde ao acompanhamento ao pacientes, aps
a alta, a partir das 24h e at 72h aps a alta hospitalar. O intuito saber como se
desenrola a recuperao no perodo ps-operatrio, levando em conta fatores como
dor, cicatrizao de inciso cirrgica e mobilidade (check on pain level, wound status
and mobility). O consentimento do paciente necessrio para a realizao deste
trabalho.

FIGURA 51 - DAY SURGERY SAMPLE CHART

FONTE: Cambridge English for Nursing: Cambridge Press, 2008: 10.

4.4.5 ECG Request Form

This is ordered if a patient complains of chest pain and it is also used in the preoperative check list as part of the anesthetic work-up.

O formulrio de solicitao de um eco cardiograma quando h suspeita de

alguma enfermidade a nvel cardiopulmonar ou bem para os exames pr-operatrios
de rotina, para viabilizar uma interveno mais segura possvel.

FIGURA 52 - ECG REQUEST FORM SAMPLE

FONTE: Cambridge English for Nursing: Cambridge Press, 2008: 3.

ACTIVITY 18: Which chart is the best option for each situation?

There is a suspect of a cardiac disease.

ECG Request form
Day Surgery Form
Discharge Form
Cardiac Care Unit Form
Heart Form

The patient is admitted after a serious car accident.

Discharge Form
Cardiac Care Unit Form
ECG Request Form
Day Surgery Follow-up Form
Casualty Form

4.5. MEDICAL ABBREVIATIONS

Abbreviations are very frequently used in medicine. Its correct use can be very
efficient among the hospital team and professionals who are involved in the patients
treatment.

Ao princpio, Pedro se chocou ao ver quo extensa era a lista de

abreviaes, no entanto o professor lhes explicou que pouco a pouco adotariam
algumas em suas rotinas e tambm por grupos, de acordo com a especificidade de
cada setor de atendimento hospitalar. Outro ponto que quis salientar o fato de
muitas delas se assemelharem ao portugus, apesar de haver aquelas que diferem
totalmente do equivalente em portugus, e tambm constatar que outras so
idnticas.
Temos, por exemplo, CVA (Cardiovascular Accident), ao invs de AVC
(Acidente Vascular Cerebral), tambm CVS (Cardiovascular System) ao invs de
SCV; como exemplos de algumas parecidas, com ordem diferente; outras que so
realmente diferentes, como BP (blood pressure) ao invs de PA (presso arterial) ou

e inclusive idnticos, como ECG (electorcardiogram para eletrocardiograma) e CA

(cancer para cncer).

Abbreviation
A&E
Abc

Ach
Af
Ai
Aids
Aj
Ap
Bb
Bcg
Bid
Bmr
Bp
Bpd
Bs
Ca
Cabg
Cad
Ccf
Cft
Chd
Chf
Chr.Cf
Cns
Coad
Csu
Ct
Cv
Cva
Cvs
Cx
Dna
Doa
Dvt
Dx
E
Ebv
Ecg
Ect
Edm

Abbreviation Meaning
Accident & Emergency
Airways, Breathing, Circulation
Increased / Raised
Decreased / Reduced
Adrenocorticotrophic Hormone
Atrial Fibrillation
Aortic Incompetence
Acquired Immunodeficiency Syndrome
Ankle Jerk
Antero-Posterior
Bed Bath; Blanket Bath
Bacille Calmette-Guerin
Brought In Dead
Basal Metabolic Rate
Blood Pressure
Bi-Parietal Diameter
Breath Sounds; Bowel Sounds
Cancer; Carcinoma
Coronary Artery Bypass Graft
Coronary Artery Disease
Congestive Cardiac Failure
Complement Fixation Test
Coronary Heart Disease
Chronic Heart Failure
Chronic Cardiac Failure
Central Nervous System
Chronic Obstructive Airways Disease
Catheter Specimen Of Urine
Computerized Tomography
Cardiovascular
Cardiovascular Accident
Cardiovascular System;
Cerebrovascular System
Cervix
Deoxyribonucleic Acid
Dead On Arrival
Deep Venous Thrombosis
Diagnosis
Electrolytes
EpsteinBarr Vrus
Electrocardiogram
Electroconvulsive Therapy
Early Diastolic Murmur

Eeg
Esr
Ett
Eua
Fb
Fb
Fbc
Fh
Fmff
Fsh
G/L
Ga
Gc
Gcft
Gcs
Gis
Gnrh
Gtt
Gu
Gus
Gyn.
Hav
Hb / Hgb
Hct / Hct
Hhv-8
Hib
Hiv
Hpv
Hr
Hs
Hvs
Ics
Icu
Id
Ig
I-M
Iq
Isq
Iv
Ivc
Ivf
Ivp
Ivu
Jvp
Kub
La
Lbp
Ldh

Electroencephalogram
Erythrocyte Sedimentation Rate
Exercise Tolerance Test
Examination Under Anesthesia
Finger Breadth
Foreign Body
Full Blood Count
Family History
Fetal Movement
Follicle Stimulating Hormone
Grams Per Liter
General Anesthetic
General Condition
Gonococcal Complement
Fixation Test
Glasgow Coma Scale
Gastro-Intestinal System
Gonadotropin-Releasing Hormone
Glucose Tolerance Test
Gastric Ulcer
Genito-Urinary System
Gynecology
Hepatitis A Virus
Haemoglobin
Haematocrit
(human) Herpes Virus 8
Haemophilus Influenzae B
Human Immunodeficiency Virus
Human Papilloma Virus
Heart Rate
Heart Sounds
High Vaginal Swab
Intercostal Space
Intensive Care Unit
Infectious Disease
Immunoglobulin
Intramuscular
Intelligence Quotient
Condition Unchanged /
In Statu Quo (Latin)
Intravenous
Inferior Vena Cava
In Vitro Fertilization
Intravenous Pyelogram
Intravenous Urogram
Jugular Venous Pressure
Kidney, Ureter And Bladder
Left Atrium; Local Anaesthetic
Low Back Pain; Low Blood Pressure
Lactic Dehydrogenase

Le
Lft
Lh
Lih
Lp
Lscs
Lvd
Lve
Lvf
Lvh
M/F
Mch
Mcl
Mdm
Mi

Lupus Erythematosus
Liver Function Test
Luteinizing Hormone
Left Inguinal Hernia
Lumbar Puncture
Lower Segment Caesarean Section
Left Ventricular Dysfunction
Left Ventricular Enlargement
Left Ventricular Failure
Left Ventricular Hypertrophy
Male / Female
Mean Corpuscular Haemoglobin
Mid-Clavicular Line
Mid-Diastolic Murmur
Mitral Incompetence / Insufficiency;
Myocardial Infarction
Magnetic Resonance Imaging
Mitral Stenosis; Multiple Sclerosis;
Musculoskeletal
Motor Neuron Disease
No Bone Injury
Normal Delivery
Neo-Natal Death
Not Palpable; Nasal Passage
Not Passed Urine
Nervous System
On Examination
On Admission; Osteo-Arthritis
Obstetrics
Organic Brain Syndrome
Otitis Media
Outpatient Department
Occupational Therapist
Pernicious Anemia
Progressive Muscular Atrophy
Premenstrual Tension
Respiratory Quotient
Sexually Transmitted Infection
Tuberculosis
Ultraviolet
Valvular Disease Of The Heart
World Health Organization

Mri
Ms
Mnd
Nbi
Nd
Nnd
Np
Npu
Ns
O/E
Oa
Obs.
Obs
Om
Opd
Ot
Pa
Pma
Pmt
Rq
Sti
Tb
Uv
Vdh
Who

ACTIVITY
CHD

19:

Match

the

abbreviations
TB

to

their

correct

meaning.

COAD
CVA
Doena Cardaca Coronariana
Tuberculose

Doena Crnica Obstrutiva de Vias

Aereas.
Acidente
Cardiovascular.

4.6. PRE AND POSTOPERATIVE CARE

Nestas etapas de cuidados com o paciente, h algumas aes fundamentais
que Pedro se familiarizar ao longo deste mdulo. O quadro clnico do paciente
diferente em cada uma destas etapas. Vamos acompanh-lo em mais esta aula que
ter no hospital em que est como estagirio.

4.6.1 Preoperative Care

Realmente, ver o paciente como ente fsico e psicolgico, requer trata-lo,

prepara-lo e preveni-lo enquanto corpo e mente. Pedro ver que os cuidados antes e
tambm depois da cirurgia s esto completos se levam em conta os mbitos fsico
e tambm psicolgico.

4.6.2 Physical Preparation

Most patients go to the surgery center or hospital the same day as the scheduled
surgery; thus, many of the steps involved in preparing for surgery will take place
within one week before the scheduled surgery. Pre-surgical testing, also called
preoperative testing or surgical consultation, includes a review of the patient's
medical history, a complete physical examination, a variety of tests, patient
education, and meetings with the health care team.

Laboratory tests may include complete blood counts and urinalysis. The
electrocardiogram is also important, especially if the patient has a history of cardiac
disease or if he or she is over 50 years old. If there is a history of some respiratory
disease, a chest X Ray is required. Part of the preparation includes assessment for
risk factors that might impair healing, such as nutritional deficiencies, steroid use,
radiation or chemotherapy, drug or alcohol abuse, or metabolic diseases such as
diabetes.

Como podemos perceber preciso uma bateria de anlises, testes e aes antes
uma cirurgia.

4.6.3 Psychological Preparation

Patients are often fearful or anxious about having surgery. It is often helpful for them
to express their concerns to health care workers. This can be especially beneficial for
patients who are critically ill, or who are having a high-risk procedure. The family
needs to be included in psychological preoperative care. Pastoral care is usually
offered in the hospital. This will help avoid stress and anxiety, which can make pain
worse.

Pain management is the primary concern for many patients having surgery.
Preoperative instruction should include information about the pain management
method that they will utilize after the surgery. Patients should be encouraged to ask
for or take pain medication before the pain becomes unbearable, and should be
taught how to rate their discomfort on a pain scale.

Preoperative teaching includes instruction about the preoperative period, the surgery
itself, and the postoperative period. It deals primarily with the arrival time, where the
patient should go on the day of surgery, and how to prepare for surgery. Instruction
about the surgery itself includes informing the patient about what will be done during
the surgery, and how long the procedure is expected to take. It is also important for
family members (or other concerned parties) to know where to wait during surgery,
when they can expect progress information, and how long it will be before they can
see the patient.
Knowledge about what to expect during the postoperative period is one of the best
ways to improve the patient's outcome. Patients, who receive proper preparation for
surgery, including physical and psychological preparation, experience less anxiety
and are more likely to make a quicker recovery at home, with fewer complications.
Patients, who perceive their surgical and postoperative experiences as positive report

that they had minimal pain and nausea, were relaxed, had confidence in the skills of
their health care team, felt they had some control over their care, and returned to
their normal activities within the expected timeframe.
Another vital part of preoperative care is the informed consent form that the patient or
his guardian (in case of children or disable patient) is asked to sign. Before signing
the form, the patient should understand the nature and purpose of the procedure or
treatment, the risks and benefits of the procedure, and alternatives, including the
option of not proceeding with the procedure. Signing the informed consent form
indicates that the patient permits the surgery or procedure to be performed. During
the discussion about the procedure, the health care providers should always be
available to answer the patient's questions about the consent form or procedure.

Nesta parte, ficou muito clara a importncia do esclarecimento do paciente

prestes a ser submetido a uma interveno cirrgica. Pontos que lhe chamaram
ateno foram o Preoperative teaching (esclarecimento pr-operatrio) e o
documento de consentimento e responsabilidade, the informed consent form. Pedro
est adorando tudo isso.

4.6.4 Postoperative Care

Postoperative care is the management of a patient after surgery. This includes care
given during the immediate postoperative period, both in the operating room and post
anesthesia care unit (PACU), as well as during the days following surgery.

The goal of postoperative care is to prevent complications such as infections, to

promote healing of the surgical incision, and to return the patient to a state of health.
Postoperative care involves assessment, diagnosis, planning, intervention, and
outcome evaluation. The extent of postoperative care required depends on the
individual's pre-surgical health status, type of surgery, and whether the surgery was
performed in a day-surgery setting or in the hospital.

The postoperative care is divided in 3 parts:

1. Immediate postoperative care (or postanesthesia care);

2. First 24 hours;
3. After 24 hours.

O fato de estar dividida em 3 partes, cuidados no ps operatrio imediato,

Immediate postoperative care, cuidados nas primeiras 24 horas, First 24 hours e
cuidados depois das 24h de cirurgia, After 24 hours, chamou a ateno de Pedro e
ficou muito curioso para constatar os cuidados e aes especficos de cada etapa do
ps operatrio. Acompanhemos ento com ele estes dados.

4.6.5 Immediate Postoperative Care

The amount of time the patient will spend in the care unit will depend on the type of
the surgery and the status of anesthesia (e.g., spinal anesthesia). The assessment
would be basically focused on the level of consciousness, vital signs and airway
patency.

O tempo (amount of time) de permanncia do paciente na Unidade

subjetivo e depende do tipo e nvel de complexidade da cirurgia e o foco de cuidados
nesta etapa basicamente o monitoramento (assessment) do nvel de conscincia
(level of consciousness), sinais vitais (vital signs) e permeabilidade de vias areas
(airway patency).

DID YOU KNOW? A sigla representativa da unidade de tratamento do ps operatrio

imediato a PACU (Postanesthesia Care Unit).

FIGURA 53 - POSTANESTHESIA CARE UNIT

FONTE: Disponvel em: http://med.stanford.edu/anesthesia/education/residency1.html Acesso em 22

jul. 2013.

4.6.6 First 24 Hours of Care

Vital signs, respiratory status, pain status, the incision, and any drainage tubes
should be monitored every one to two hours for at least the first eight hours. Body
temperature must be monitored, since patients are often hypothermic after surgery,
and may need a warming blanket. Fluid intake and urine output should be monitored
every one to two hours. If the patient does not have a urinary catheter, the bladder
should be assessed for distension, and the patient monitored for inability to urinate.

Patients who have procedures done in a day-surgery center usually require

only a few hours of care by health care professionals before they are discharged to
go home. If postanesthesia or postoperative complications occur within these hours,
the patient must be admitted to the hospital. Patients who are admitted to the hospital
may require days or weeks of postoperative care by hospital staff before they are
discharged.

acompanhamento

estreito do quadro clnico do paciente continua.

monitoramento continua fundamental e aqui acrescentamos outros dados como a

temperatura corporal (body temperature), os fluidos excretados (fluids) e o estado
respiratrio, circulatrio e neurolgico (respiratory, circulatory and neurological
status). Pedro tambm acrescenta que estes registros so feitos com uma
frequncia de uma a duas horas (one to two hours), nas primeiras 8 horas (the first
eight hours).
FIGURA 54 - FIRST 24 HOURS OF CARE

FONTE: Disponvel em: https://www.brigadamilitar.rs.gov.br/Estrutura/Hbmpa/assistencia/uti.html

Acesso em 22 jul. 2013

4.6.7 After 24 Hours Care

The vital signs can be monitored now every four to eight hours if the patient is stable.
The incision and dressing should be monitored for the amount of drainage and signs
of infection. Movement is also imperative for preventing blood clots. The hospitalized
patient should be sitting up in a chair at the bedside and ambulating with assistance
by this time. Every evidence of potential complications should be identified and
registered.

All the team must ensure that the patient is comfortable and confident in his
treatment, and that he has all he needs at that moment. A successful outcome
consists in a recovery without complications.

No cuidado depois das 24 horas de cirurgia, talvez a palavra-chave seja o

aumento paulatino de exerccios e nutrio. A frequncia de monitoramento, por
outro lado, comea a diminuir (to decrease), agora de 4 a 8h (very four to eight
hours).

FIGURA 54 - AFTER 24 HOURS CARE

FONTE: Disponvel em: http://kepter.com.mx/novedades/conceptos-basicos-de-limpieza-hospitalari/

Acesso em 22 jul. 2013

ACTIVITY 20: Choose the right answer.

Stable vital signs mean
everything is probably OK.
a change in a patients condition.
something is definitely wrong.
somebody doesn't feel well.
How often should vital signs been monitored in the first 8 hours after surgery?
Always.
every two hours.
every four to eight hours.
every one to two hours.
In which of these periods of care should the surgeon meet the patient for the
first time and discuss the details of the surgery?
Immediate Postoperative Care.
First 24 hours Care.
Preoperative Care.
After the surgery.
FIM DO MDULO IV