Bolivarian Republic of Venezuela

Ministry of Popular Power for Defense

National Experimental Polytechnic University of the Armed Forces

Miranda Core

Ocumare del Tuy Extension

Cycle of informative talks on tuberculosis aimed at users of the Doctor Osío de Cúa
hospital, Urdaneta Municipality, Miranda State

Author (res)

Gonzalez, Maria

Arevalo, Daniela

Tutor: Prof. Mirla Morales

Ocumare, February 2010

 Bolivarian Republic of Venezuela

Ministry of Popular Power for Defense

National Experimental Polytechnic University of the Armed Forces

Miranda Core

Ocumare del Tuy Extension

Cycle of informative talks on tuberculosis aimed at users of the Doctor Osío de Cúa
hospital, Urdaneta Municipality, Miranda State

Degree Project that is presented as a requirement to qualify for the TSU degree in
Nursing

Author (res)

Gonzalez, Maria

Arevalo, Daniela

Tutor: Prof. Mirla Morales

Ocumare, February 2010

 DEDICATIONS:

First to God; for being my strength to move forward through thick and thin,
because he is the redeemer who guides my path.

To my son Gabriel Alejandro; who is my greatest inspiration to continue on the

path, for enduring my absence all this time I was studying and his unconditional
support.

To my mother Silbina González; For your unconditional support, both moral and
financial, in addition to taking care of my son while he was studying, I will never be
able to repay you for everything you have done for me.

To my aunt Maruja Bello; for your unconditional support all this time.

To my family; which has given me support and help with my son in times when my
mother could not take care of him.

To my aunt Teresa Bello; Although you are no longer by my side, from heaven I
feel your presence because you were and will be a very special person and I will
always carry you in my heart.

To my sister Gabriela; Although you are a special person, I love you very much.

To Daniela Arévalo; my final report partner, since we have shared everything good
and bad to carry out this final project.

To Morelba Torres; who guided, supported and helped me in this stage of my life,
to complete the final report.

To my friends; From each semester I learn something positive about life from each
one of them and I will carry them in my heart.

"Maria. TO. Gonzalez.”

 DEDICATION:

To God, who is my greatest strength, my guide and who illuminates my path and
my life.

To my mother, Magola Paz, whom I love and admire; which has been my
unconditional help, my friendly hand, my refuge, my strength, my light in dark days,
my joy in sadness, my triumph in defeats, I will never be able to repay you for what
you have done for me "I love you mom."

To my father, who despite adversity has always supported me morally and

financially.

To my Aunt Yudis and José Ramos; that even though thousands of kilometers
separate us, they have always been with me, they have given me their hand when I
have needed it most, and they have shown me that distance does not defeat love.

To my brothers Daniel and Giovanni, because they have given me love and
unconditional help.

To my family, although we do not always share or be together due to distance, they

are always present in my heart.

To my friend Jordán Landaeta, although you are not by my side, I know that from
heaven I count on you because in me you will always live, there will never be a
friend, a treasure as valuable as you.

To my friends, for their support, help and presence in good and bad times.

To Morelba Torres, for her helping hand, for dedicating time to me and
collaborating with the realization of this project, for her love and understanding.

To María González, for her friendship and camaraderie throughout this study
career.
 To the Terán family, for their helping hand, for their support in the most difficult
moments.

To Rafael Ibarra for his support, for his dedication, for his love and for
collaborating with the completion of this work.

To a person who was part of my life, of my journey, with whom I shared pleasant,
good and bad moments, you were always by my side, I will never forget your
presence and the mark you left in my life even though you are no longer here. .

Daniela Arevalo

ACKNOWLEDGMENTS :
 To the greatest house of study that overcomes the shadow of failure, “National
Experimental University of the Armed Forces”, where we were able to grow both
professionally and personally, and also allowed us to live extraordinary and
wonderful experiences.

To the president of the Bolivarian Republic of Venezuela Hugo Chávez; for the
opportunity it gave us by opening the UNEFA extension in Ocumare del Tuy to the
people.

To our tutors, for guiding us to achieve our goal

To Professor Lismeri Azocar, for her help and helping hand.

To Professor Alí Díaz, for his teaching that self-esteem is a tool for life.

To Olinto Barrios and his wife Bigdalis who are one of the fundamental pillars of
our training as professionals.

To all the UNEFA professors who contributed to the growth of our knowledge, in
addition to sharing experiences, joys, sadnesses.

To Professor Morelba Torres who contributed to the preparation of this final report,
in addition to being a guide in achieving this goal.

“THANK YOU ALL VERY MUCH”

GENERAL INDEX

PP CONTENT.

DEDICATION
RECOGNITION

GENERAL INDEX

LIST OF TABLES

SUMMARY

INTRODUCTION

CHAPTER I

Diagnosis

General objective

Specific goal

CHAPTER II

Historical Review of the Dr. Osío de Cúa Hospital

Mission

Vision

Historical Review of the Lucas Hernández El Conde Outpatient Clinic

Mission

Vision

Research Background

CHAPTER III

Description of the Activities Carried Out

Theoretical Bases

Legal Bases

CHAPTER IV

Conclusions

recommendations
Bibliography

LIST OF TABLES

No. Title P

1 Organization chart of the Dr. Osío de Cúa Hospital

 2 Organization chart of the Lucas Hernández El Conde Outpatient Clinic
3 Schedule of activities
4 Hospital Activities Schedule
5 Ambulatory Activities Schedule

BOLIVARIAN REPUBLIC OF VENEZUELA

MINISTRY OF PEOPLE'S POWER FOR DEFENSE

NATIONAL EXPERIMENTAL UNIVERSITY OF THE BOLIVARIAN ARMED

FORCE (UNEFA)
Cycle of informative talks on tuberculosis aimed at users of the Doctor Osío de Cúa
hospital, Urdaneta Municipality, Miranda State.

SUMMARY

The purpose of this report was oriented to the activities carried out during the 180
hours of internships at the Dr. Osio de Cúa Hospital, and 150 hours at the Lucas
Hernández el Conde Ambulatory and the home study on tuberculosis where the
activities were described in detail. carried out during the stay in the internship period,
the Theoretical Bases that justified the study related to the pathology of tuberculosis
are described. The Legal Bases supported by the Constitution of the Bolivarian
Republic of Venezuela and the Organic Health Law and the conclusions and
recommendations were pointed out.

INTRODUCTION:

Health in Venezuela is a social right, as is the control of endemic diseases, and it is

the obligation of government entities, through the Ministry of Health, to guarantee
them, as expressed in article 83 of the Constitution of the Bolivarian Republic of
Venezuela. (1999)

“Health is a fundamental social right, an obligation of the state; which guarantees

it as part of the right to life. The state will promote and develop policies aimed at
raising the quality of life, collective well-being and access to services, every person
has the right to health protection, as well as the duty to actively participate in its
promotion, defense, and comply with the sanitary and sanitation measures established
by law, in accordance with the international treaties and conventions signed and
ratified by the Republic.”

Likewise in article 84 where the management of a National Public Health System

is guaranteed.

In the present work related to tuberculosis, which is a disease that had been
eradicated, but that currently has been showing accelerated growth, which represents
a health problem, due to its infectious pathology.

This work is structured as follows. Four Chapters, in Chapter I, Diagnosis,

Research Objective and Justification; Chapter II, the Theoretical Framework reflects,
Historical Review, Mission and Vision of the Dr. Osío de Cúa Hospital, Historical
Review, Mission and Vision of the Lucas Hernández el Conde Ambulatory,
Background of the research, Organization chart of the Hospital and Ambulatory,
Chart of Hospital and Outpatient Activities. The description of the activities carried
out is presented in Chapter III, which details the internship reports and also describes
the pathology under study, everything related to tuberculosis, and the legal bases.
 Finally, in Chapter IV, the Conclusions and Recommendations, bibliographical
references.
 CHAPTER I:

THE PROBLEM

1.1Diagnosis

Tuberculosis is a chronic contagious infectious disease; preventable and curable

that can affect any part of the human body, although the most prone is the lung, and
can affect all people without distribution of age, race or sex and is transmitted from
one person to another through inhalation of the Gothic signs of fluid from a sneeze or
cough.

Tuberculosis was previously a very widespread disease with high mortality, but
currently it has decreased thanks to a series of preventive and therapeutic measures,
according to Pons (1995) "there have been variations in frequency with respect to the
age and sex of the patients." affected individuals; Thus, while tuberculosis was more
common among women, there is currently a predominance among men. (P.638)
 Currently, tuberculosis has had a rebound, which represents a national, state and
regional public health problem. The figures continue to surprise according to the
World Health Organization, according to (2008) approximately one third of the
population. The world is infected by tuberculosis, with some nine million cases
recorded worldwide, of which three million were the cause of death in more people
than any infectious disease.

In Venezuela, according to a report (2008), there is an incidence record from the

Ministry of Health; in 1936, the incidence rate remained around 100 cases per
100,000 inhabitants. Currently, there are around 25 cases per 100,000 inhabitants with
a downward trend in 2006 from an incidence rate of 2.8 per 100,000 inhabitants,
although in Venezuela the disease is not endemic.

In the state of Miranda, in the respiratory disease report carried out by Aguilar
(2008), there were around 23 cases in the first week of January according to the
epidemiological report corresponding period issued by the entity's health corporation.
According to the Miranda Ministry of Health, in 2006 it was the 3rd entity with the
highest rate of cases.

In the Urdaneta municipality of the Miranda state, at the Doctor Osío hospital,
approximately 50 cases of tuberculosis have been reported to date, due to the tension
of respiratory cases, with studies carried out to perfection of the symptomatic.

The diagnosis of the problematic situation was determined through direct

observation for 1 week in the TB area of the Doctor Osío de Cua hospital, keeping an
observation record, where the lack of information about the disease was confirmed,
which resulted in the patient tuberculosis that had not been treated causing alarm in
the family environment; Such is the case of a 24-year-old patient who enters this
healthcare center for the first time, indicating the 1st phase of treatment based on the
diagnosis of reactive pulmonary TB. His relatives are alarmed, which is why they
went to this hospital to undergo surgery. PPD test, testing positive in one of the
members, who may suffer from the disease since the test applied measured 10mm,
she expressed distressed and depressed due to which a lack of information could be
observed.

From there comes the concern to hold talks aimed at users of the Doctor Osío de
Cúa hospital about tuberculosis.

1.2 Research Objectives .

1.2.1 general objectives:

Apply a cycle of informative talks on tuberculosis aimed at users of the Doctor

Osío de Cúa hospital, Urdaneta Municipality, Miranda State.

1.2.2 Specific Objectives:

 Determine the number of cases with tuberculosis treated at the Doctor Osío
de Cúa hospital.

 Review the theoretical aspects of tuberculosis.

 Design informative talks on tuberculosis aimed at users of the Doctor Osío de

Cúa hospital.

1.3 Justification.
 This research is important because it will allow the acquisition of knowledge that
will serve as a basis for carrying out other studies related to tuberculosis.

It is also relevant because they provided tools for the users of the Doctor Osío de
Cúa hospital that would facilitate knowledge about tuberculosis, treatment and
prevention, preventing its spread.

It is pertinent within the hospital setting since the purpose is to provide, as a

nursing intern, alternative solutions to problems in the health area.

This project is justified and legally supported by the Organic Health Law (1998) in
article 3 where it states:

“ Article 3: Health services will guarantee health protection for all inhabitants of the
country and will operate in accordance with the principles:

Principle of participation: Individual citizens in their community organizations

must preserve their health, participate in the programming of environmental
promotion and sanitation services and in the management and financing of health
facilities through voluntary contributions.

Principle of complementarity: public, territorial, national, state and municipal

organizations, as well as the different levels of care, will complement each other,
according to scientific, technological, financial and administrative capacity.
 CHAPTER II

THEORETICAL FRAMEWORK

2.1 Historical review of Dr. Rafael Osío.

Dr. Osío was born in Caracas in 1864; He was an eminent doctor who graduated
from the Central University of Venezuela, where he studied. He carried out an
outstanding job in the valleys of Tuy, since from the moment of his graduation he
moved to the town of Cúa, where he acquired a well-deserved reputation, since his
diagnosis was accurate and almost infallible; He served in this municipality until the
date of his death, in 1912.

His death was a reason for official mourning throughout the Miranda state. In
1936, the Ministry of Health and Social Assistance gave its name to the Cúa center,
popularly known as the hospitalito, which was founded in 1962.

On February 19, 2008, with the presence of the president of the Bolivarian
Republic of Venezuela, Hugo Chávez Fría, the new headquarters of the Cúa hospital,
Urdaneta municipality, Miranda state, was inaugurated. The work carried out through
the government of the entity, in charge of engineer Diosdado Cabello, was carried out
with an investment of 34 billion corresponding to infrastructure work and 5 billion
was directed to the provision of medical equipment.
 Today the distinguished doctor is honored once again, but with a work of great
magnitude, with the capacity to meet the needs of the increasingly large population of
the Tuy valleys.

This new health center will cover an area of 6,315 square meters, on a land of
16,789 square meters. It plans to serve 120 thousand people from about 200
communities monthly. It is located on José María Carreño street, Aparay sector, Cúa
Edo Miranda.

Vision and Mission of the Dr. Osío de Cúa hospital:

Vision:

Achieve optimal living conditions and reduce risk factors in patients, families and
communities in general to a minimum.

Mission:

Provide professional and permanent attention to the population that requires it,
physical, mental and social rehabilitation of people with disabilities.

Promote education for the patient, family and community in general in order to
actively incorporate it into high-quality comprehensive prevention.

Historical Review of Lucas Hernández “El Conde”

 Since 1993 there was a building in the community that was built to install a
medical clinic there but it only provided sporadic rural service, the doctors and nurses
attended once a week and only half of it due to lack of (furniture, supplies, medicines,
equipment).

Over the years and due to lack of maintenance and the indifference of the
competent organizations and authorities, the structure deteriorated in its entirety. In
2001, some neighbors concerned about the health of the community dedicated
themselves to restoring it and putting it into operation. After unsuccessfully going to
various local authorities requesting help, they finally received the attention of the
team from the social development foundation of the state of Miranda. Putting him in
contact with the state health corporation who provided support to his requests, then
complying with the guidelines of said corporation in May 2001 the civil association
was formalized giving them legal personality, then on December 11, 2001 he would
receive the first contribution from Health cooperation among one of the organizers
was Lucas Hernández who contributed to its construction. On the day the last window
was installed before its inauguration, in commemoration of him, the community gave
its name to the clinic.

Currently this health center offers:

Pediatrics

Social work

odontology

Immunization

Family planning
Blood pressure control

Comprehensive Care.

Mission and Vision of the Lucas Hernández El Conde Outpatient Clinic:

MISSION:

Satisfy the comprehensive health needs of this community, as well as ensuring that
our work effectively reaches all the sectors that comprise it, thus raising the quality
and standard of living of our neighbors.

VISION:

Promote health and prevent diseases in the community, as well as in its sectors.

2.2 Research background:

The present study assumes as background the works of other authors who, due to
their relationship with the topic discussed here, are considered relevant and serve as a
basis for this research, since they reflect diagnoses of the elements that define the
problem in the area of tuberculosis. and for this reason they are presented below.

Murzi (1996) mentions his experience in the fight against tuberculosis in Venezuela,
in the state of Táchira, finding that there is sufficient evidence that tuberculosis is
worsening in the fight against tuberculosis, and the false sense of security created by
specific medications.

Wilkins, k (1996) determines risk factors for contracting tuberculosis, finding that in
Canada in 1994 a total of 2074 people were diagnosed with tuberculosis, which is
equivalent to 7.1 cases per 100,000 inhabitants. In the same year, one person in every
1,400 died from tuberculosis and in all cases the common factors were immigration;
which results in families living in precarious conditions carrying the disease from
their country of origin, overcrowding of the home and exposure to contagion within
the home.

Connolly, M. and Nunn, P (1996) in Genoa Italy found that tuberculosis is the
cause of infections that cause death in women around the world,

Threatening their health security due to the increase in the risk and progress of this
disease during the reproductive phase. The authors found that the fear and stigma
associated with tuberculosis has a greater impact on women than on men, and they
frequently leave economic and social positions and then live precariously.

Lima, Belluoimini, Amantes (1997) They state that Brazil is experiencing a

worsening of the tuberculosis endemic, requesting a reform of the anti-tuberculosis
programs, likewise the causes are: migration, poverty, the decrease of resources for
control programs and the association of this disease with AIDS.

Sánchez-Perez H and Halperin-Frich, D. (1998) analyzed recent experiences

with tuberculosis; in order to determine the control of pulmonary tuberculosis in the
Region of Chiapas-Mexico. They found that a population at risk is one whose health
centers do not have adequate health infrastructure and, due to poverty, its indigent
people have less access to private health services.

The background presented above reflects that there is evidence of the rebound in
tuberculosis in the world, due to the growth of poverty and in part to the neglect of
the fight against tuberculosis, immigration, inadequate health infrastructures, as well
as at the global level, also at the national level. and regional.
 Organization chart of the Dr. Osío de Cúa Hospital

Address

Medical Secretary
department

administrative Personnel Nursing Medical Records Nutrition Social

department department department Department promotion

Accounting
Laboratory
Box

odontology
Store

Transport Health inspection

Maintenance
 ORGANIZATION CHART OF THE LUCAS HERNANDEZ AMBULATORY

Medical Coordinator on
Standby

Pediatrician General services

Dr Karina Ramos
odontology

Dubrasca Bande
Secretary

Nurse SR Martha Reyes

Lic Zenaida Ortiz

Waitress

Mr. Dora Rodríguez

hygienist

Iskel Velasquez
Vigilant

Carlos Guza
 BOLIVARIAN REPUBLIC OF VENEZUELA

MINISTRY OF PEOPLE'S POWER FOR DEFENSE

NATIONAL EXPERIMENTAL UNIVERSITY OF THE BOLIVARIAN

ARMED FORCE (UNEFA)

TABLE Nº 1 SCHEDULE OF HOSPITAL ACTIVITIES

Phases Description of Activities Date

Introduction Tour of the areas of the Dr. Osío de Cúa 06/10/2009

Hospital

The patients were received, treatment was 08/10/2009

given, a PPD test was performed, and
TB consultation To the
talks were given to the patients.
15/10/2009

Different wounds were cleaned, stitches 20/10/2009

were removed from postoperative patients,
Cure Room To the
lines were catheterized, treatments were
placed for medical indications, and patient 22/10/20009
records were kept.

The vaccines were prepared, the cards 27/10/2009

were collected, the patients were
Immunization To the
registered in order of arrival, a record of
vaccines administered was kept. 05/11/2009

Source: Arevalo, Gonzalez (2010).

Continuation of table No. 1Schedule of Hospital Activities

Phase Description of activities Dates

Parturients were received and registered, 10/11/2009

vital signs were measured, the area was
Delivery room To the
prepared, immediate care for the
newborn, postpartum care. 19/11/2009

Medication was quantified, the area was 24/11/2009

equipped, users were received and
Treatment Room To the
registered, medications were prepared
and administered. 03/12/2009

Service was received, a review was 08/12/2009

carried out, medication was prepared and
Pediatric To the
administered, nursing progress was
Hospitalization
carried out in a notebook and history. 15/12/2009

Patients were registered in order of 12/01/2010

arrival, vital signs were measured, weight
Cardiology To the
was measured, equipment was prepared,
Consultation
and an electrocardiogram was performed. 14/01/2010

The rooms were reviewed, vital signs 19/01/2010

were measured and recorded in the To the
Obstetrics
respective histories, treatment was
21/01/2010
prepared and labeled, and treatment was
completed.

Source: Arévalo, González (2010).

Continuation of table No. 1Schedule of Hospital Activities

Phases Description of activities Date

26/01/2010

Life Support The area was organized, the area was To the
equipped, medication was dosed.
28/01/2010

The masks were sterilized, a 0.9% 02/02/2010

solution was prepared and labeled with
Nebulization To the
date and time, users were registered,
nebulization was prepared with medical 04/02/2010
orders, and nebulization was carried out.

Sources: Arévalo, González (2010).

BOLIVARIAN REPUBLIC OF VENEZUELA

MINISTRY OF PEOPLE'S POWER FOR DEFENSE

 NATIONAL EXPERIMENTAL UNIVERSITY OF THE BOLIVARIAN ARMED
FORCE (UNEFA)

TABLE Nº 2 SCHEDULE OF OUTPATIENT ACTIVITIES

Phases Description of activities Dates

Introduction Tour of the outpatient clinic and the 05/10/2010

community.

07/10/2009

Pharmacy Delivery of medications to users with To the

their medical prescription.
15/10/2009

19/11/2009

treatment room Complete treatment by medical To the

indication and perform cures.
26/11/2009

28/11/2009

Visit to the Census of the Simoncito and the To the

community feeding house
02/12/2009

09/12/2009

Educational Day Workshop aimed at Pregnant Women To the

(Belly of Love.)
14/12/2009

Sources: Arévalo, González (2010)

Continuation of table No. 2 Schedule of Outpatient Activities

Phases Description of activities Dates

 11/01/2010

S/V Control Measure blood pressure, respiration, To the

pulse and temperature.
13/01/2010

Immunization 18/01/2010

AND Vaccinate the user and provide To the

oxygen therapy.
Nebulization 20/01/2010

25/01/2010

Educational Day Exhibition aimed at primary school To the

students at the Conde de Cua School.
27/01/2010

Sources: Arévalo, González (2010)

 CHAPTER III:

3.1 DESCRIPTION OF THE ACTIVITIES CARRIED OUT:

Activities carried out in the different areas of the Dr. Osío de Cúa Hospital

Assigned area TB Consultation:

The service is divided into two departments where the nurse is located and the file
where the record and treatments are kept, and in the other where the specialist
doctor's office is located, it also has the following materials:

Two desks

A stretcher

A shelf

a showcase

Activities to Complete:

 Maintain user registration

 Provide patient guidance

 Keep the area tidy

 Deliver the treatment to the corresponding user

 Conduct orientation talks for patients and families.

Activities Completed:
  The user was registered to provide treatment

 The user was guided regarding compliance with the treatment.

 Weekly treatment was delivered.

 A cycle of talks was held for users.

Cure Room assigned area:

Clean and orderly service is received without activities, with the following material:

 A Minor Surgery Team

 Two May Tables

 A Paraban

 Two Parallels

 A fitted shelf

 a desk

 Two chairs

 A showcase with medicines

Activities to complete:

 Prepare surgical material for minor surgery

 Maintain user registration.

 Withdraw points

 Perform wound healing

 Provide guidance to the patient

  Cauterize peripheral route

Prepare medications to deliver

Activities completed:

 The team was prepared

 User registration

 I retired period

 The wound was treated

 Patient oriented

 Peripheral catheterization

 Treatment was completed.

Assigned area Immunization:

The service is divided into two departments; In the first one is the secretary where
the record of the vaccinated children and the vaccines that arrive and are distributed
to all the clinics in the municipality are kept.

In the other are the nurses who are in charge of vaccinating the user, complying
with the vaccination schedule, and the neonatal profile is also carried out.

The service has the following material:

 Two desk

 Two refrigerators for vaccines

  Four chairs

 A table with gauze, injectors, gerdex, alcohol, soapy water

 Two cellars for vaccines

 Three shelves with service stationery

Activities to complete:

 Prepare material

 Collect vaccine cards

 Maintain user registration

 Provide user guidance

 Keep the area clean and tidy

 Perform neonatal profile

 Visit the postpartum area

Activities completed:

 Vaccines were prepared

 Users were registered in order of arrival.

 Vaccinations administered were recorded

 Mothers were guided about the vaccine and side effects and advised on what
to do if the child had the same.

 The area was kept clean and tidy.

 Neonatal profile was performed on the RN

  The postpartum area was visited to comply with the newborn's vaccination
schedule.

Assigned Delivery Room Area:

It is a room with 4 walls that contains 4 parabans, 2 blood pressure monitors, a

suction machine, an echo monitor, 4 walls, 2 May tables, a counter with medications
and supplies used in the area, 3 cubicles, 3 incubators, one for transfer and two fixed,
and one for transfer, 3 stretchers, 1 neonatal weight, 1 resuscitation crib, 3 swan
lamps.

Activities to complete:

 Measure vital signs and record in histories.

 Catheterize the route of parturients

 Prepare the area

 Provide immediate care to the newborn.

 Assessment (adgar test)

 Immediate puerperium.

Activities completed:

 Vital signs were measured and recorded in the users' respective histories.

 Catheterization was performed via a parturient

 An area was prepared with surgical equipment and supplies to be used.

  Immediate care was provided to the RN.

Treatment Room assigned area:

It is a small area with four walls and also has 1 display case, 1 shelf where the
medications and supplies go, the area also has 5 posts, 1 tray to place treatment.

Activities to complete:

 Keep the area equipped

 Quantify medications

 Catheterize via

 Prepare medications

 Administer medications

Activities completed:

 Medications were quantified

 The area was provided with gauze and gloves.

 Order was placed at supply center

 A 33-year-old user is received with medical indication, he was catheterized.

 Buscapina composita diluted in 20cc of solution was prepared and

administered intravenously.
  Practice was carried out between interns catheterizing via each other.

Assigned area Pediatric Hospitalization:

The service is received clean and orderly, with 2 pediatric patients with pending
treatment.

Activities to complete:

 Measure vital signs

 Review the rooms

 Report in the notebook and stories

 Prepare and label medications

 Check road permeability

 Catheterize via

 Administer medications

Activities completed:

 Vital signs were measured in hospitalized pediatricians

 A review was carried out in the rooms

 Nursing evolution was reported in a notebook and stories.

 A permeable pathway was verified

 He was catheterized via

 Treatment was prepared and labeled

  Treatment was completed

Cardiovascular assigned area:

It is a complete four-walled area that has an electrocardiogram machine, a weight,

and a blood pressure monitor. In Cardiovascular there is only one nurse, there are no
specialist doctors so no consultation is carried out.

Activities to complete:

 Keep the area clean and tidy

 Register patients in the control book

 Measure vital signs of users

 In case of new patients weigh

 Prepare equipment

 Perform electrocardiogram on medical orders

 Identify electrocardiogram with user name, age and vital signs

Activities completed:

 Patients were registered in order of arrival

 Vital signs were measured

 It weighs

 Team was prepared

  Electrocardiogram was performed

 Electrocardiogram was identified

 Targeted at hypertensive users

Obstetrics assigned area:

A clean and orderly service is received, with 32 patients, of which ten are
prepartum, 20 postpartum and 2 cesarean:

Activities to complete:

 Review the rooms

 Measure vital signs and record in histories

 Review treatment sheet and pending medical indications

 Prepare and label medications

 Administer medications

 Carry out a cure for cesarean patients

 Keep the area clean and tidy

 Guide users about the importance of breastfeeding.

 Carry out nursing evolution

Activities completed:

 The rooms were reviewed

 Vital signs were measured and recorded in the respective histories.

  Treatment was prepared and labeled.

 Treatment was completed

 A cure was performed on caesareans

 The area was kept clean and tidy.

 It is aimed at mothers

 Nursing evolution was carried out

Life Support assigned area:

Clean and orderly service is received with no pending activities; with the following
equipment: a sign monitor, 2 blood pressure monitors, 4 minor surgery equipment, 1
suction machine, electrocardiogram equipment, 1 resuscitator, 1 small oxygen
cylinder.

Activities to complete:

 Receive only emergencies

 Record emergencies in control book

 Sort the area

 Catheterize via

 Measure vital signs

 Prepare medications

 Administer medications

Activities completed:
  The area was organized

 The area is equipped

 A patient was received with a tracheostome who underwent suction and cure.

 A 27-year-old user was received with attempted autolysis, catheterization was

performed; By medical orders, nasogastric lavage was performed.

 Medicine was prepared and administered.

 Vital signs are monitored

 An electrocardiogram was performed on medical orders.

 recorded in control book

 A 52-year-old hypertensive user was received, vital signs were measured, and
by medical orders she was given 25mm sublingual captopril.

 It is recorded in the control book and signs are monitored

Misting assigned area:

Clean and orderly service is received with no pending activities, with the following
materials: 3 nebulizers, 1 shelf with medications and supplies, 3 chairs, 1 desk, 10
masks.

Activities to complete:

 Register users

 Keep the area clean and tidy

 Sterilize masks
  Catheterize peripheral lines to patients who require administration of 125 mg
solumedrol or 500 mg hydrocortisone.

 Prepare 0.9% solution and label it with date and time for nebulizations

 Place the doses indicated by the doctor

 Comply with nebulizations

Activities completed:

 The masks were sterilized

 A 0.9% solution was prepared and labeled with the date and time.

 User registration

 Nebulization was prepared with medical orders

 It was accomplished with nebulization

 The area was kept clean and tidy.

 Activities carried out at the Lucas Hernández El Conde Outpatient Clinic:

The internships began at the Lucas Hernández Ambulatory located in the Conde of
the town of Cúa on October 5, 2009, where a tour was carried out in order to get to
know the staff and facilities. Presentation of teacher and students to the nurse in
charge of the outpatient clinic Lic. Zenaida Ortiz, excellent acceptance by the staff
that makes up this care center, lending their collaboration to everyone to fulfill our
community internships.

A workshop was held by the Minister in charge of the Madres de Barrio project and
the Lic. Zenaida Ortiz where mothers from the community were invited in order to
guide and raise awareness about the importance of vaccines, breastfeeding and inform
about this project and the benefits it provides. In addition, we interns attended this
workshop and provided support to the aforementioned personnel. This workshop was
carried out satisfactorily, leaving us all pleased and we were proud because it helped
us integrate more with the residents of the El Conde community.

A day was held in the dining room of this community in order to weigh, size and
vaccinate the children of this sector.

At the Lucas Hernández “El Conde” outpatient clinic, the nebulization service
receives patients with medical orders to perform nebulization. It is not constant that
patients are received but the area has adequate equipment and remains equipped to
care for any patient who requires this service.

In the pharmacy area, medicines are counted, medicines that are not on the shelves
are provided and they are arranged in alphabetical order and the Cubans are separated
from the Venezuelans since the control is carried out separately. In this service,
medications are given to users after their consultation, as long as the required
medication is found, it is recorded in the control book and the prescription is kept as a
record.
 In the sign control area, elderly patients are received who attend daily to monitor
their vital signs after they leave to do their gymnastics applied by neighborhood staff
inside. Vital signs are also measured for users who go to the clinic and recorded in the
sign control sheet.

This outpatient clinic also has two consultation areas where there are two doctors,
one on the Venezuelan side and the other complying with the Barrio Adentro plan. In
these areas, patients of different ages are received, many with histories in this
healthcare center and others who are attending for the first time. to whom their stories
are told. Upon entering the area, the user's data is taken and recorded in the control
book, vital signs are measured depending on the case, the user is weighed and
measured and after this they are received by the doctor with whom they have control,
if they are patients. who frequently recur, the history is sought and given to the doctor
so that she can review and assess the patient's progress.

A census was applied in two simoncitos in the El Conde sector where it was
observed that 10 children were registered in both. This census was carried out with
the purpose of weighing, measuring and reviewing the vaccination scheme where it
was found that the majority of the children did not complied with the scheme, so the
caregivers were notified so that they could inform their representatives so that they
could go to the outpatient clinic in this sector to complete the scheme for the children.
Additionally, these two care centers were given two boxes with recreational
implements for children.

A cycle of presentations was applied to the students of the school of this

community on oral hygiene, hand washing, informative material was delivered as
well as snacks.

Practice of the rule of three, characterization of the peripheral route, was carried
out to verify correct procedure. In this way we completed our outpatient internships
on 02/01/20010 satisfactorily.
3.2 Theoretical Bases:

The theoretical bases show the theory related to the topic of tuberculosis, starting
from the definition, causes, treatments related to the pathology studied, in addition to
the legal bases.

The tuberculosis.

It is a chronic infectious disease that is located mainly in the lungs, it is identified

by the presence of tubercles and gas necrosis. This disease is caused by a bacteria
called microbacterium tuberculosis (Karch's bacillus), discovered by Robert Koch in
1822.

It is an acid-fast bacillus, which appears with the Zienhl Neelsen stain; Very sensi-
tive to sunlight , it is formed by proteins, carbohydrates and lipids . The acid-fast
property is probably attributable to the high lipid content of the wall glycolipiods.
The hemp is multiplied by direct funneling for 16-20 hours and grown in appropriate
media .

It is transmitted from a sick person to a healthy person, through saliva droplets that
are eliminated when coughing, talking, or sneezing, since they carry the Koch bacilli.
From an open transfer towards the outside or environment. It can affect anyone, man
or woman , child or adult.

The bacilli are highly resistant to drying and can remain viable in sputum for
weeks and months.

Tuberculosis constitutes a serious public and social health problem in the world. It
is the main cause of death of infectious origin in the world.
 The population, especially in developing countries, is acquiring tuberculosis infec-
tion every year. A person with baciliferous pulmonary tuberculosis infects 10 to 15
people over the course of a year.

Mycobacterium Tuberculosis.

As a single infectious cause, it produces greater mortality than any infectious

agent; a proportionate number of people who become ill with tuberculosis are racial
and ethnic minorities.

Tuberculosis causes more deaths among women worldwide than all causes of ma-
ternal mortality combined.

This tuberculous disease affects the lung parenchyma.

People who present pulmonary and extrapulmonary tuberculous lesions at the same
time constitute a case of pulmonary tuberculosis.

Main Causes of the Disease.

 The disease is spread through the air through small droplets from secretions from
the coughs or sneezes of people infected with mycobacterium tuberculosis.
 Due to frequent contact, family, or living with infected people.
 Through sporadic contact on the street, once the bacteria enters the lung, a granu-
loma is formed, which is the primary infection of tuberculosis; this process does
not produce symptoms.
 From a sick person to a healthy person, the infection causes the bacillus to spread
through the vessels of the lymphatic system to the lymph nodes. Sometimes when
the bacteria reach them, they penetrate the blood and spread to another part of the
body; In some people, bacteria go into a state of latency in the lungs and other or-
gans, only to reactivate many years later, producing progressive damage (e.g. cavi-
ties in the lungs).
Pulmonary Tuberculosis.

It is an infection that mainly affects the lung parenchyma, which can be transmitted
to other parts of the body including the meninges, kidneys, bones and lymphatic an-
odes.
It is a chronic bacterial infection characterized by the formation of granulomas in
infected tissues and cell- mediated hypersensitivity. It is regularly located in the
lungs; It is a communicable, curable, usually chronic infection. It can affect practi-
cally all organs, but the lungs are commonly the most affected.

Location of the Diseases.

Tuberculosis is a disease caused by the Kock bacillus and can affect any organ of
the human body, the preferred location being the lung.

Prevention of Tuberculosis.

Prevention is the set of interventions carried out by the PNCT with the aim of
avoiding TB infection, and if it occurs, avoiding the transition from infection to dis-
ease. Prevention is aimed at avoiding the spread of Koch bacillus in the community.

Preventive measures are:

 Avoid contagion.
 Eliminate sources of infection present in the community through detection.
 Early diagnosis and "supervised in the mouth" treatment of Bk (+) PTB cases;
When a patient with BK (+) pulmonary tuberculosis is diagnosed and treated
promptly, ten to twenty people in the family and community are prevented from
becoming infected annually.

BCG vaccination.

BCG (Bacillus Calmette-Guerin) is a live and attenuated vaccine, originally ob-

tained from Mycobacterium boris. Its application aims to provoke a useful immune
response that reduces post-primary infection tuberculous morbidity. The BCG vac-
cine will be given free of charge to newborns. Its importance lies in the protection it
provides against severe forms of childhood TB, especially tuberculous meningitis.

Contact Control.

Contacts are people who live or maintain a close relationship (work, school, etc.)
with the pulmonary tuberculosis patient. Contact control aims to detect cases of tuber-
culosis among contacts and prevent the risk of becoming ill.

Detection and Diagnosis of Tuberculosis Cases.

Case Detection.

It is the health activity aimed at early identification of people sick with tuberculo-
sis. It will be carried out permanently through the identification and immediate exam-
ination of people with a cough and cold for more than 15 days who, for any reason,
come seeking care in general health services.

To achieve successful detection, it is essential to guarantee good quality of care

and project a good institutional image in the community by offering:
 Regular business hours.
 Adequate information.
 Good deal.
 Respect for the patient's privacy (with fidelity and respect for their rights).

Abandonment Recovered.

Patient who, having interrupted treatment for one or more months, re-enters the
PCT of the Health establishment, starts anti-tuberculosis treatment again and receives
medications starting with the first dose.

Failure.

Patient with a shortened or retreatment regimen who maintains positive smears or

who, after the 4th month of retreatment, has positive smears again. There is no failure
without positive cultivation.

Critical.

Patient who continues to present or re-presents positive baculoscopy after complet-

ing a supervised retreatment regimen. Chronic cases have received two cycles of
drugs for minors and sometimes more than two cycles (complete or incomplete).
Chronic cases usually, but not always, excrete resistant bacilli (the rate of acquired re-
sistance is very high in this group of patients) and often eliminate multidrug-resistant
bacilli to determine the severity of the pulmonary tuberculosis disease and therefore
the treatment. Appropriately, the bacillary load, extent of the disease and location are
taken into account.
 According to the location, cases of extrapulmonary tuberculosis of great serenity
with a poor prognosis are considered serious: tuberculosis of the central nervous sys-
tem , tuberculosis of the central nervous system, miliary tuberculosis, genito-urinary
tuberculosis, osteoarticular tuberculosis with spinal involvement (degenerative dis-
ease). pott9 or large joints tuberculous meningitis, enteroperitoneal tuberculosis and
perdicardial tuberculosis.

The following forms of extrapulmonary tuberculosis are classified as less severe.

 Denopathy.
 Pleural effusion (unilateral).
 Bone (not spinal).
 Cutaneous and peripheral joint.

Bactenology of Tuberculosis.

Bacteriological research in tuberculosis includes performing bacilloscopes, cultures

of mycobacterium tuberculosis, sensitivity testing and typing of the mycobacteria.

Samples must be received and processed in laboratories, without exception, main-

taining biosafety measures.

Baciloscopy.

It is the fundamental routine tool for the diagnosis of tuberculosis and for monitor-
ing the treatment of patients with pulmonary tuberculosis.

It should be used in all pulmonary or extra-pulmonary samples, and for monthly

control of anti-tuberculosis treatment and retreatment and previously in any sample
that is decided to be referred for culture.
 Direct examination of sputum (smear microscopy) has greater diagnostic reliability
(specificity of 98%) and detection capacity (sensitivity of 60-80%) than clinical and
radiological criteria.

Objective of Treatment.

 Cure the patient of tuberculosis.

 Prevent the patient from dying from active tuberculosis or its complications.
 Avoid relapses.
 Reduce the transmission of tuberculosis to other people.
 Avoid resistance to anti-tuberculosis drugs.

Treatment of Pulmonary Tuberculosis.

It consists of a combination of medications that will be taken in two phases.

The first.

It lasts two months, four types of medications will be taken from Monday to Satur -
day (Rifampicin Isoniazid, Pyrozinamide and Ethambutol).

The second.

It lasts 4 months and only includes 2 medications 3 times a week (Rifampicin and
Izoniazid).

The main cause of treatment failure is abandonment, but it can also be due to irreg -
ular or inadequate treatment. If you stop taking the medications this will cause the
bacilli to multiply again and become more powerful and resistant to the medications.
In addition, you can infect other people with more serious bacilli that are difficult to
cure.

Places for medication administration are:

 Anti-Tuberculosis Health Subcenter Clinics.
 Community Health Center.
 Homes for the Sick.
 Prisons, Churches
 Nursing school.
 Occupational Health Clinic
 Dr. Alejandro Cabral Hospital and any other place considered appropriate.

Nursing Care.

It is the care provided by nursing staff directed at the patient, family and commu -
nity, with emphasis on education , control and monitoring of patients with tuberculo-
sis and their contacts.

Within the Care are:

 The interview .
 The Home Visit.
 The Organization and Administration of supervised treatment.
 Go out and look for agreements that come out positive.
 Raise awareness among the patient and family.
 Guide the patient to follow the treatment to the letter.
 That the patient is admitted to the hospital for 15 days to continue treatment.
 Be kind to the patient.
 Listen to it carefully.
 Call him by his name.
 Do not criticize or make negative judgments.
 Talk clearly and directly with the patient.
 Advise the patient that strict compliance with supervised treatment guarantees
healing.
 That it is important that you go to the health facility closest to your home to re-
ceive your treatment.
 Under no circumstances should you abandon your treatment, even if you feel bet-
ter, until the regimen that has been indicated to you is completed.
 Explain the consequence of abandoning treatment.
 Strict compliance with treatment guarantees your health.
 Treatment is free.
 The length of time the treatment lasts and the side effects it may cause.
 The phases of the treatment you will receive.
 Adopt basic hygiene measures to avoid infecting others.

Patient self-care to avoid contagion:

 Know if you have tuberculosis and finish treatment.

 Cover your mouth when coughing or sneezing.
 Spit on paper and then burn it.
 Ventilate the room and bedding.
 settle down to sleep
 The sooner the exam is done and the treatment is completed, the sooner you will
be cured and not infect other people.

Signs and Symptoms that people with tuberculosis present :

 Cough and cold for more than 15 days (most important and frequent symptoms)
 Weightloss.
 Anorexia (lack of appetite)
 Diaphoresis (Night Sweats)
 Fever
 General malaise (tiredness, lack of desire to work, study or play).
 Dyspnea (shortness of breath)
 Expectoration with Blood.
 Wasting away.
 Chest pain.
Etiology.

Mycrobacterium tuberculosis is a bacillus discovered by Robert Pick in 1882. The

name tubercle bacillus includes two species M. tuberculosis and M. Bovis, capable of
producing this disease, is a non-spurulated bacteria that requires a very long time (15-
20) hours for its multiplication and that can easily survive in the intracellular
medium, it is therefore a bacteria that requires long time (3-5 weeks) to grow in the
media cultures.

Like all microbacteria, they are characterized by having a lyalic coat, made up of
two mycolic acids . They cause that once dyed with certain dyes derived from ani-
lines (for example fenicate fuchsin), they retain this color despite being treated with
an acid or an alcohol, which is why they are called acid-resistant alcohol.

Clinical manifestations.

When a non-immune host inhales microorganisms, a primary complex develops

that affects the lung parenchyma (usually the lower and middle lobes) and the lymph
node that drains it.

In the lung this can be observed 1-2 years after primary infection in the form of
calcified lesions or chon complex. Progression of the primary complex to lung dis-
ease or miliary tuberculosis or progression of CNS granulomas Meningitis is more
common in the first year after the primary infection.

Skeletal lesions often appear 2-3 years after primary infection. Symptoms may be
absent or mild and nonspecific in the presence of active activity. Cough, when
present, has no specific characteristic; no pulmonary signs are found in the presence
of active disease. Fine persistent rales may be found in the area of the upper lobes;
they are best heard during inspiration after a slight cough.

Complication of Pulmonary Tuberculosis:

 Severe respiratory insufficiency.

 Added respiratory infections.
 Massive hemoptysis.
 Spontaneous pneumothorax.
 Rafa Grave.
 Severe malnutrition.
 Presence of diseases that, due to their severity, when associated with tuberculosis,
put the patient at risk of dying ( HIV / AIDS ), diabetes mellitus, liver and/or kid-
ney failure, or others.
 Spread of tuberculosis infection.

Risk Factors:

 Close contact with a person who has active pulmonary tuberculosis.

 Immunocompromised State (for example with HIV, Cancer).
 Transplanted organ and prolonged treatment with high doses of 4 corticosteroids.
 Substance abuse (intravenous or drug user, injectables and alcoholics.
 Any person without adequate health care.
 Pre-existing illnesses or special treatments.
 Emigration from countries with high prevalence of tuberculosis (e.g., Southeast
Asia , Africa , Latin America and the Caribbean).

3.3 Legal Bases:

THE CONSTITUTION OF THE BOLIVARIAN REPUBLIC OF VENEZUELA

(1999).

Article 83: “Health is a fundamental social right, an obligation of the state, which
will guarantee it as part of the right to life. The state will promote and develop
policies aimed at raising the quality of life, collective well-being and access to
services, every person has the right to health protection, as well as the duty to actively
participate in its promotion, defense, and that of comply with the sanitary and
sanitation measures established by law, in accordance with the international treaties
and conventions signed and ratified by the Republic.

Article 84 “To guarantee the right to health , the state will create, exercise
leadership and manage a national public health system, of an international,
decentralized and participatory nature, integrated into the social security system,
governed by the principles of free, universality. , integrality, equity, social integration
and solidarity. The national public health system will prioritize health promotion and
disease prevention, guaranteeing timely treatment and quality rehabilitation. Public
health goods and services are property of the State and may not be privatized. “The
organized community has the right and duty to participate in decision-making on the
planning, execution and control of specific policy in public health institutions.”

These articles express that health is a social and fundamental right that is the
obligation of the state to guarantee, promote and develop policies aimed at raising the
quality of life, giving priority to the promotion of health and the prevention of
diseases.

The national public health system will prioritize health promotion and disease
prevention, guaranteeing timely treatment and quality rehabilitation.

ORGANIC HEALTH LAW (1998)

“Article 3: Health services will guarantee health protection for all inhabitants
of the country and will operate in accordance with the principles:

Principle of participation: Individual citizens in their community organizations

must preserve their health, participate in the programming of environmental
promotion and sanitation services and in the management and financing of health
facilities through voluntary contributions.

Principle of complementarity: public, territorial, national, state and municipal

organizations, as well as the different levels of care, will complement each other,
according to scientific, technological, financial and administrative capacity.

This article, through its principles, will guarantee the protection of the health of
citizens both individually and their community organizations through public and
government agencies and in articles 25,28 and 29 of this same law the following is
expressed:

Article 25: “The promotion and conservation of health will aim to create a
health culture that serves as a basis for achieving the health of individuals, the family
and the community, as a primary instrument for their evolution and development.”

Article 28: “Comprehensive health care for individuals, families and

communities , includes prevention, promotion and restitution activities and
rehabilitation that will be provided in establishments that have the corresponding care
services”

Article 29: “The first level of medical care will be in charge of health sciences
personnel, and will be provided with a basic provision. This level will carry out
promotion, protection, prevention, diagnosis and treatment actions on an outpatient
basis, without distinction of age, sex or reason for consultation.
 These articles refer to health promotion, conservation and comprehensive health
care in order to create a health culture that serves as a basis for achieving health for
individuals, families and communities.

CHAPTER IV:

4.1 Conclusions.

Once this work was completed, the following conclusions were reached.
 Tuberculosis has grown in recent years, due to neglect in health control.

The lack of information about tuberculosis in the low-income population has

generated alarm about this pathology.

There is a lack of responsibility in the patient, for not complying with the assigned
treatment, causing complications and even death.

As interns, a lot of knowledge is acquired through practice.

Lack of an area where Bk sputum tests are performed at the Dr. Osío de Cúa
Hospital, which results in users being directed to another population.

4.2 Recommendations:

It is recommended that government entities focus on providing hospital centers in

areas to carry out studies to determine tuberculosis pathology.

That the necessary specialists be assigned to the hospital center.

At the Dr. Osío de Cúa hospital, greater collaboration is provided by the hospital
staff to the interns.

Teachers who are more committed to the interns are assigned to UNEFA
 To patients with tuberculous pathology, who comply with the assigned treatment
phase so that the disease is controlled again

To family members with tuberculosis patients who comply with prevention

regulations and provide moral support to the patient.

BIBLIOGRAPHY :

Constitution of the Bolivarian Republic of Venezuela. (1999).

Organic Health Law. (1998).

Pons, Agustín. (1995). Home Medical Encyclopedia. Mexico. Argos Publishing

House.
Constan. Tuberculosis. http://www. Monografía.com[accessed 2008] .

Murzi. (1996). Anti-tuberculosis fight in Venezuela. Táchira.

Willkins,K.(1996).Risk Factors for Contracting Tuberculosis. Canada.

Lima, Belluomini, Almeida and Arantes. (1997). Program reform

Anti-tuberculosis. Brazil.

Sánchez Pérez,H and Halperin Frich,D(1998). Determine control of the

Pulmonary tuberculosis in the Chiapas Region. Mexico.