In 1997, a line of H5N1 avian influenza was transmitted to a child in Hong Kong who died with respiratory problems. This was the first of successive recorded cases of transmission of this virus from birds to humans breeding.

Since then, the world worried accompanies the movement of this virus. Though related to severe cases in humans, this type of influenza can also cause severe symptoms in birds. So, he is classified into two types, or HPAI highly pathogenic, causing thousands of deaths in wild and domestic birds, and serious health problems in humans and the little pathogenic or LPAI, which infects birds and is asymptomatic. The highly pathogenic H5N1 cause various health complications in humans, with nerve damage and liver, besides the respiratory treatment. Nonetheless, it is not efficiently transmitted between humans, being made by those who have direct contact with poultry or close.

Currently, we know that H5N1 is now circulating in birds established and created in Asia. The virus was detected in several countries in Asia, Europe and Africa, being carried by migratory birds and often pollute local poultry.

The highly pathogenic H5N1 has a number of uncommon features that concern us. The most obvious is the fatality, no other Influenza can kill such a large portion of those infected. More than half of those confirmed as contracted, died. And a number of complications ranging from the more common and more severe respiratory problems and rare and neurological complications. Of 442 cases reported to WHO until today, 262 were fatal. It is worth remembering that the lethality must be less than recorded once and everyone is looking for hospitals, mainly in asymptomatic cases.

It is not just human cases that concern us. Breeding animals are also severely affected. Estates where many losses had occurred anchored by infection excluding cases of animals are slaughtered to prevent the spread of the virus, usually all the local and neighborhood. In the wild environment, wild animals often are found dead and tested positive for the virus. Like eagles and geese.

Another concern is the breadth of hosts that H5N1 can infect. Besides a large variety of birds – geese, swans, turkeys and even flamingos, among others – several animals that are not normally associated with influenza and were found with the virus, including big cats such as tigers and leopards that fed on chickens in a zoo in Thailand. A cat was infected after eating a pigeon in 2004, also in Thailand.

To date, only one case of human to human transmission was confirmed in 2005, and some remain suspicious but unconfirmed. A sick child transmitted the virus to her mother, probably have a very close contact in between. This lack of transmission events between individuals indicates a low efficiency of the virus to spread between humans.

Although it is not transmitted between humans, scientists, health workers and governments monitor suspicious movement of H5N1. In the next text, we will see what characteristics of the virus may contribute to that he is not properly transmitted and what can explain its pathogenesis, and what does it cause for concern.

Why is it so dangerous H5N1?

Of the 112 subjects who were infected by the H5N1 strain of bird flu, more than half (57) died, representing a mortality rate of 55%, a percentage exceeding in the three major epidemics of flu that humanity has experienced, including the Spanish flu of 1918.

These deaths have been located in rural areas of four Asian countries: Vietnam, Thailand, Cambodia and Indonesia. However, both the FAO (United Nations Organization for Food and Agriculture) and the World Health Organization (WHO) explain that cases of human infection are rare and that the virus does not spread easily from birds poultry to humans. But H5N1 has some special characteristics.

Although scientists still do not quite understand why this virus is so lethal, some experts suggest what may be the primary keys of the dangerous H5N1.

Flu viruses tend to invade the cells of the throat and trachea, where they multiply and cause an inflammation that is opposed by the immune system. In some cases, the organism can reach the lungs and cause pneumonia.

However, unlike their ‘similar’, the avian influenza virus has the ability to multiply in many other parts of the body as well as in the throat and trachea, and the liver, intestines or brain. So what would ordinarily be a respiratory disease may become widespread infection throughout the body.

Furthermore, the close coexistence of millions of people, chickens and pigs, as in China, has encouraged the rapid spread of avian influenza from Southeast Asia and has allowed two different influenza viruses are in the same organism, a Indeed, rare, resulting in a new strain of virus.

Finally, the more times a virus multiplies more possibilities of the emergence of a mutation can be passed from person to person. Thus, many scientists say the elimination of outbreaks of H5N1 in birds, which can be replicated many times a day is an essential step in preventing the spread between humans.

The WHO warning

The World Health Organization has warned several times about the importance of being prepared for a likely outbreak of bird flu. The program manager for the flu, Klaus Stohr, said that “despite warnings in recent years that a new pandemic is inevitable and the need for countries to have prepared contingency plans, only 50 out of 200 countries they have been drafted.

Along the same lines express members of the international scientific community because they believe there is a high risk of occurrence of another flu epidemic similar to the years 1918, 1957 and 1968, which ended the lives of over 100 million people in the world.

So far, the H5N1 avian flu virus is the only one of the 15 types of virus can be lethal to humans.

Causes a decrease in the amount of blood that leads to the various organs, causing injuries to them. The diseases that can lead to atherosclerosis are:
- Angina pectoris and myocardial infarction.
- Arteriosclerosis of the extremities (cold hands and feet, difficulty in walking.
- Cerebral Arteriosclerosis (impaired memory, disorientation, etc …)

General care to prevent atherosclerosis :

1 .- Diet appropriate, to minimize the excess cholesterol foods (eggs, butter, sausages, offal, pork, beef, lamb and game, seafood, cheeses and semi-dried, whole milk) and triglycerides of saturated, increasing unsaturated (olive oil, seeds, fish, blue or white).
2 .- If you are overweight, the diet should be low in calories.
3 .- If it is hypertension, diet should be low in salt.
4 .- Reduce your consumption of snuff.
5 .- Reduce alcohol consumption.
6 .- Perform moderate physical exercise on a regular basis
7 .- Take medication:
- Take medications at the same time.
- Put them in the light, lest we forget.
- Remember the Time.

Nursing is designed training priorities within healthcare organizations and within the framework of the Autonomous Communities. Considering the need and relevance of such training from the social, professional and institutional, justifies the accreditation is performed by entities who are familiar with the industry.

The criteria used for accreditation of continuing education in nursing by accredited may be common in its general aspects with those of other professions. However, they must be adapted to different types and forms of training its own nurses. The Encomienda Management, assigned to the General Nursing Council, which facilitates these adjustments are carried out in accordance to the needs of the profession because they are made from the deep knowledge of the interests and training needs of nursing.

Surgical nursing care is the responsibility of professional nurses, or university education, with growing demand for specialized studies, which have under his charge or supervision to a variety of professional, technical and administrative functions has important management directly or indirectly to the patient.

The nurse plays a leadership, coordinating and example, and she is really determined by the level of care of a surgical service.

Also, because the nurse is the one who really cared for in a permanent and continuous patient, and because it is she who keeps the most intimate contact, becomes the person that best conveys the image and spirit of a hospital. It is recognized that a high level of hospital nursing actions are those that have deeper impact, ultimately, the quality of care, and those that are best perceived by the community, represented by the pa-tion and their associates, or their behavior is interpreted, more than any other of the participants as an indicator of excellent quality.

That is why nursing should be recognized in the modern hospital as a fundamental human element to the success of your operation. And that’s why the nurses, perhaps more than any other female profession, it will be increasingly sought and will quickly climb the career ladder of importance in society, emerging as one of the greatest development in the near future.

The nurse is part of the health team, fulfilling an important role in the care of the person and family, helping the individual in meeting their needs in order to adapt to the circumstances of life in a harmonious and healthy.According to a study that will be announced shortly, the nurse is primarily a professional vocation, a professional who prefers the safety and welfare of patients to their own.

One aspect worth noting is the responsibility of the nurse feels towards their patients, feeling that it will not abandon them or leave them without treatment, or fail to visit them at home but there are risks and feelings of helplessness in certain situations.

This dedication and responsibility sometimes leads to not use any protective measure to safeguard the peace of the patient, for example, home visits carried in a container for needles and syringes discarded in the health center to avoid the patient may puncture, or for example, do not wear the mask so as not to scare patients and promote a loss of confidence and a widening gap between the professional and the patient.

The nursing profession is subject to a number of risks specific to the work that is often not conscious society, where the experience and confidence of the nurse has changed the mechanics of its working habits, automatic behavior, meaning a risk of their profession. The accidental punctures and cuts, the risks engendered by home visit, the spread of some diseases, are just some of the risks they face daily profesionales.

Stress and psychological pressure by multiple factors, such as timetable changes, need for more staff, rush, etc.. And even the feeling of helplessness they feel when making home visits or at the health center in certain situations .

The stress generated by the work, the rush, the feeling of vulnerability, as in any other profession, can mean an increased risk of accidents. For the nurse this increased risk translates into a greater likelihood of accidental puncture, cutting, pollution or contamination at the time of making a cure, and so on. This causes stress, too, that sometimes does not end up using the existing security measures.

Alzheimer’s disease is a progressive brain disorder characterized by degenerative changes in cortical nerve cells and brain nerve endings. This process produces an irreversible deterioration of memory and destruction of intellectual functions. The causes are unknown, the most common causes are shuffled autoimmune disease, a virus, genetic disease and neurotransmitter deficiency. The main risk factor is age, the onset is insidious, it can affect individuals of up to 40 years, the disease will progress to total disability.

Rating:
The occurrence and severity of symptoms varies among individuals, is characterized by memory loss, intellectual deterioration and personality change. is classified into three stages: Beginner, intermediate and final phase. The initial indicators are mild, but the main sign is the loss of short-term memory, the diagnosis may take years or even diagnosed in the next stage of the disease. In the half-stage patients have trouble recognizing objects and things, to perform activities or to launch or skills she used to communicate. In the final stage are absent memory and intellectual capacidd. In the final stage the patient is in a vegetative state.

Memory:
Initially the loss is mild, usually consisting of an inability to retain newly acquired information. The individual may forget dates and losing things, how to use common tools and objects, while maintaining coordination to implement them. The individual may be lost in the home or family environments, and gradually losing the ability to recognize or name objects or remember the names of their relatives.

Objectives of Nursing: Helping the caregiver / aa monitor the patient’s behavior caused by mental deterioration, and to take measures to compensate for dementia.

Nursing interventions:
1 .- To provide the patient a consistent environment and routine, to help work with their limited capacities.
2 .- Avoid redirect the patient more than once in every encounter with him, to avoid the frustration that can lead to being unable to remember.
3 .- Allow patient behaviors, such as the objects and vagrancy acaparación always taking place in a safe environment.
4 .- To evaluate the patient for signs and symptoms of depression.
5 .- To avoid the turmoil and unrest of the patient must maintain the structured environment, consistent and easy to follow a routine for the patient can make an album of pictures to remember the past, promoting physical activity and art therapy .
6 .- Place labels with the names of objects and rooms, to help remember your name and function.
7 .- To provide clues to the identity of objects and tasks.
8 .- Put a clock and a calendar in his room and place an “X” days gone by, to help you remember the correct date.
9 .- Make a list of daily activities.

* Deterioration of verbal communication relcionado with cognitive deterioration in the state:
Nursing Goals: Establish a verbal and nonverbal communication as efficient as possible and understand their needs as his dementia increases and deterioration of verbal skills.
Posts:
1 .- Go to the patient in an open, friendly and relaxed.
2 .- Discuss with the patient tone of voice low and clear.
3 .- Identify and always look directly at the patient.
4 .- To provide a relaxed and heartening, to avoid noise and distractions.
5 .- Rate nonverbal behavior, facial expression, body language, posture, gestures, etc …
6 .- Explain this activity using short sentences. When giving instructions to ensure splitting the tasks into small units and understandable. Use simple gestures, point to objects or use the show if possible.
7 .- Be sure to have your attention.
8 .- Listen to the patient and included in the conversation.
9 .- Identify behaviors agendas, namely the realization of a certain behavior to ask for something, write to better understand its significance for the patient.
10 º .- Encourage the patient to describe past situations or stories.

* High risk of injury related to lack of awareness of environmental hazards secondary to cognitive deficits:
Nursing Goal: To ensure patient safety as it loses its ability to control potential hazardous environmental factors.
Nursing interventions:
1 .- Guiding the patient on the surrounding environment.
2 .- Place the bed rails.
3 .- Keep him unhindered environment, ensure that there is enough light to prevent falls in the dark.
4 .- Avoid using space heaters, stoves, etc …
5 .- Use of shoes with nonslip soles.
6 .- Watch for signs of pain issued by the patient.
7 .- Maintain a calm and without major changes.

* Faecal incontinence associated with memory loss:
Nursing Goal: Reduce the number of episodes of fecal incontinence and continence aumertar of sphincters.
Nursing interventions:
1 .- Showing the location of the toilet, if it is necessary to identify the door with a drawing of a toilet to help you find it.
2 .- Assess bowel habits, take him to the bathroom at the same time every day often defecate.
3 .- To assess the non-verbal indicators of the patient before the need to defecate.
4 .- After removal help clean the perianal area.

* Disruption of patterns of urinary elimination related to memory loss:
Nursing objectives: To evaluate the existence of the acute symptoms of incontinence and, if necessary, a scheme of bladder retraining.
Nursing interventions:
1 .- To evaluate the patient for causes of acute incontinence, infection, retention, or delirium.
2 .- Make sure the patient knows the toilet situation, if necessary put in the closet door with a drawing to help locate the patient.
3 .- To evaluate the presence of non-verbal codes that indicate the need to urinate.
4 .- To evaluate the model of patient evacuation and use the information to plan an evacuation plan.
5 .- Limiting fluid intake at night.
6 .- After verifying that urination is dry the perianal area to help maintain skin integrity.
7 .- To evaluate the type of incontinence and infection ruled out and see if it is treatable.
8 .- Starting bladder retraining.

* Disruption of sleep pattern associated with anxiety and confusion secondary to cognitive deficits:
Nursing Goals: To reduce the sleep disorder.
Nursing interventions:
1 .- Space activities throughout the day interspersed rest periods.
2 .- Avoid that patients fall asleep during the day, using short trips, planned activities.
3 .- The patients who sleep during the day should endeavor to do so sitting in the chairs instead of the bed to remind them that there should not be sleeping.
4 .- Avoid the use of restraints because they often increase the fiscal turmoil.
5 .- Provide a quiet, no noise and no lights at night.
6 .- Admin when anxiolytics and sedatives may be prescribed.
7 .- Establish a bedtime routine, and ensuring compliance.
8 .- To teach the patient how to perform relaxation techniques.

* Lack of self in the elimination, grooming, hygiene, clothing and evacuation-related weakness, impairment of motor control and memory loss.
Purpose of Nursing: Helping the patient to perform the tasks themselves.
Nursing interventions:
1 .- To evaluate the failure of dressing, feeding, bathing, etc …
2 .- To evaluate the physical and cognitive patient.
3 .- Teach the family and the caregiver to provide care.
4 .- To provide care to the patient totally dependent on aid and not be totally dependent.
5 .- Provide step by step instructions for the patient to make the maximum number of tasks on its own.
6 .- In the bath use a stool in the shower, to promote self-care.
7 .- To dress and undress the patient is recommended shoes without laces, or loose clothing presndas closures with pressure, with Velcro closures and elastic waistband, avoid buttons and belts.
8 .- To assist the patient to dress, putting the clothes in the order they should wear.
9 .- To assist the patient at mealtimes, allowing her to eat alone, providing straws, special cups, cutlery with large handles adequate.
10 .- An outline plan of escape to avoid urinary incontiencia.

* Alteration of processes due to family crisis caused by the chronic illness of a family, disruption of family life and changing roles within the family:
Nursing Goal: Reduce family conflict and increase the capacity of the caregiver
Nursing interventions:
1 .- Encourage the carer and family to express their feelings, frustrations and problems.
2 .- Provide support, understanding and safety to their families.
3 .- To assist the caregiver to learn the responsibilities that just assume.
4 .- To refer to the family to social services to help with home care.
5 .- Encourage the carer to use the services of home help.
6 .- Advise relatives or friends to interpret their behavior as a reflection of the disease process.
7 .- Advise caregivers to continue to keep his friends and attending social events.
8 .- Advise family participation in a self-help group local or national.

* Social isolation (patient and family) related to the anxiety felt by the disability and loss of memory and the impossibility of leaving alone:
Nursing Goal: Avoid social isolation of the patient and family.
Nursing interventions:
1 .- To evaluate the patient’s ability to communicate and the level of social isolation of the family.

2 .- Discuss with the patient’s family the opportunity to have friends that offer support and help.
3 .- Identify alternative systems of support for the family so the caregiver can maintain a social life.

* Anxiety-related changes or real or perceived threats:
Nursing Goal: The patient will decrease their anxiety.
Nursing interventions:
1 .- Give the patient time to express their fears, escuchalo with respect.
2 .- To help reduce anxiety by establishing a fluid communication, avoid changing room and provide an environment with few changes.
3 .- During hospitalization ask relatives to bring familiar objects.
4 .- Help to find lost objects.
5 .- avoid forcing too many tasks to perform.
6 .- Avoid limited visiting hours for relatives.

* High risk of violence associated with irritability, frustration and confusion secondary to degeneration of cognitive thought:
Nursing Goal: Patient will demonstrate control of their behavior in the absence of violence.
Nursing interventions:
1 .- Ask the caregiver to explain how to behave and that is usually done to calm down.
2 .- Monitor the patient for signs of increased anxiety.
3 .- Reduce environmental stimuli such as noise and light.
4 .- To document the signs, symptoms, precipitating factor, time, etc …

Conceptual definition of nursing diagnosis.
A theoretical and conceptual framework is a list of concepts interrrelacionados provides a way of thinking about:
- The concept of customer (individual and environment)
- Goal of nursing.
- Nursing Interventions

Methodological definition of nursing diagnosis
The idea of methodological concept tells us how to get to a diagnosis through the nursing hierarchy of needs “phenomenon” and the actions of the nursing care.
The methodological concept of nursing diagnosis is the conclusion of the assessment that allows the design and construction plan of care through the collection of information, interpretation of data …
Campbell defines the nursing diagnosis from a methodological point of view as the identification of subjective responses, and the establishment of the changes that you must enter the nurse for the changes occurring.

In summary, the diagnosis comes from the Greek word dia-gignoskein, which is known through, analyze the nature of a situation. Thus we can define the diagnosis as the identification of the nature of a situation or health problem and the possible cause of it. Clinical trial on a response from the person to life processes and health problems. A necessity is that the individual must meet in order to remain within a state of health or within normality.

One problem is the result of an unmet need to which the person responds in different ways, is what we call symptoms (emotional, physical, verbal or not).

One hypothesis is an assumption, assumption, conjecture, or starting point of an argument that should be supported by a body of theoretical knowledge or approved by science, must be comparable and possible to prove scientifically.

Structure of nursing diagnosis
The essential components of nursing diagnoses are based on the PES format, the following:
1. Health problem, is the title or label, is the concise description of the problem.
2. Etiology, the factors that contribute to this cause the problem.
3. Signs and symptoms are the manifestations that are often in the diagnosis in particular.

The child immunization programs are in place to eliminate or reduce the risk of various diseases and as a result, morbidity and infant mortality. Compliance with programs of health care in the child population is as important as varied and requires that professionals engage in it and are professionally trained.

Discussions are at present on new nursing specialties. It seems that the current specialty of pediatric nursing as such disappears and appears in Advanced Clinical Nursing. It is clear that the assessment of training for the doctors is very clear, everyone has their specialty, but if we speak of the infirmary, except for certain specialties, are assigned the care of the general population (community nurse) without considering other factors.

Studies have been made to physicians and pediatricians, there are several articles on the need for nurses attending children must have adequate preparation to meet the peculiarities of this population segment.
A pediatric nurse who has the same quota that allows a pediatrician and a joint action, if there is a continuation in time, can form a cohesive team to provide comprehensive care to pediatric care. The pediatric nurse is an important part in the primary care team, is also a figure close and accessible for children and a reference for the different groups with whom they usually worked.

Seeks to lead the training of professionals nursing who also know the reality of the country’s health, be able to relate to political, social, cultural and economic transformation in order to propose actions aimed at improving the quality of people’s lives. Prepare nursing professionals with a solid scientific, ethical and humanistic, with the ability to lead programs that help improve the health situation of the country, any institution or place to play.

The nursing school offers a program to anyone who proves the admission requirements and that freedom of choice, aiming at a personal, professional and on going growth in the work of own discipline in order to contribute effectively in solving problems affecting the health and welfare of individuals and society.

* To provide nursing care to individuals, families and groups, taking into account the conditions of its external and internal environment.
* Leading the nursing care to individuals, families and groups in the various organizations where he is promoting the transformation of the environment to improve the quality of life.
* Implement the process and communication strategies in different fields of their professional practice.
* Demonstrate in their professional behavior consistent with ethical principles, within the framework of respect, freedom, truth, justice and solidarity.
* Participate in the search for truth, through the updating and deepening knowledge of the discipline itself, to ensure the quality of care and the strengthening of interdisciplinary work.

Stimulate future nursing professionals seeking the truth, updating and deepening of knowledge that contribute to their own personal development, training and improving the quality of care with an attitude of solidarity and social commitment.

The hospital is therefore a scientific and humanist profession, whose role take care of ensuring the continuity of these from the critical care unit to home care.

In Chile the number of not enough nurses to meet the health needs of the population. It is a flaw in the profession, there are 3 physicians per nurse, with an expected inverse relationship.

Health policies aim to develop the areas in which nurses serve, so it is a profession with great prospects and future.

The nurse is part of the health team, fulfilling an important role in the care of the person and family, helping the individual in meeting their needs in order to adapt to the circumstances of life in a harmonious and healthy.