Dificuldades relacionadas ao enfrentamento da doença em pacientes cardiorrenais: uma experiência da residência em Psicologia num hospital público

INTRODUÇÃO: No contexto mundial e brasileiro as doenças cardiovasculares e renais caracterizam-se como um problema de saúde pública, pelo alto número de pessoas acometidas e o alto custo que os seus tratamentos exigem. No momento em que a disfunção cardíaca aguda ou crônica propicia a disfunção renal aguda ou crônica, caracteriza-se a Síndrome Cardiorrenal, sendo que este processo também pode acontecer de forma inversa. O tratamento dessa doença é complexo, com dietas, ampliação de repertório de hábitos de vida saudáveis, medicamentos, exames invasivos e nos casos mais agravados há a necessidade de se realizar hemodiálise e procedimentos cirúrgicos. Compreende-se que realizar o tratamento de forma eficaz requer do paciente e por vezes da família, uma série de estratégias de enfrentamento que contribuam significativamente para este processo de cuidado, visto que o mesmo se configura como uma situação de estresse, e tem implicações diretas no planejamento de vida traçado pelo sujeito, ao ter que deparar-se constantemente com vários sentimentos e emoções que não propiciam a saúde do paciente. OBJETIVO: identificar as principais dificuldades que se fazem presentes nos pacientes quando vivenciam o tratamento da Síndrome Cardiorrenal. METODOLOGIA: trata-se de um estudo com enfoque no método qualitativo, de cunho descritivo, na qual participaram 3 pacientes entre 18 de 59 anos, acometidos tanto por uma DC quanto DR, internados na Fundação Hospital de Clínicas Gaspar Vianna, no setor de clínica médica. Os dados foram coletados dos prontuários e por entrevistas semi-estruturadas. As falas dos participantes foram analisadas pela técnica de Análise de Conteúdo de Bardin (2006). ANÁLISE DE DADOS E DISCUSSÃO: A partir da coleta de dados emergiram três categorias: 1) Aspectos preventivos quanto à saúde: trata sobre o acesso ao serviço de saúde, a organização da rede, o perfil dos pacientes atendidos pela rede de saúde, entre outros; 2) Dificuldades relacionadas ao tratamento: destaca-se os impasses e complicadores existentes para a realização do tratamento eficaz, como condição socioeconômica, moraria, cultura, concepção de sujeito de direitos, entre outros; 3) Sentimentos e significados relacionados ao enfrentamento do adoecimento: tais como, angústia, medo, raiva, culpa, baixa autoestima, perda de função social, ansiedade, entre outros. CONSIDERAÇÕES FINAIS: através da pesquisa pode-se concluir que a prevenção não está sendo realizada de forma adequada nos serviços de saúde, gerando agravamento da cronicidade dos pacientes. Salienta-se que a questão de os pacientes morarem longe do serviço de referência prejudica o seu acesso e permanência no tratamento, gerando dificuldades para e ele e para o cuidado da equipe. Considera-se que as dificuldades e os sintomas emocionais e subjetivos que estão relacionados a doença, também se caracterizam como impasses para o tratamento eficaz

INTROOUCTION: In the world and Brazilian context, Cardiovascular and Kidney Diseases are characterized as a public health problem, due to the high number of people affected and the high cost that their treatments require. At the moment when acute or chronic cardiac dysfunction leads to acute or chronic kidney dysfunction, cardiorenal syndrome is characterized, and this process can also happen inversely. The treatment of this disease is complex, with diets, expansion of repertoire of healthy life habits, medications, invasive examinations and in the most aggravated cases there is a need for hemodialysis and surgical procedures. It's understood that performing the treatment effectively requires the patient and sometimes the family, a several of coping strategies that contribute significantly to this process of care, since it's configured as a stress situation, and has direct implications in the planning of life traced by the subject, having to constantly face with several feelings and emotions that do not provide the health of the patient. OBJECTIVE: to identify the main difficulties that are present in patients when they experience the treatment of Cardiorenal Syndrome. METHODOLOGY: This is a qualitative, descriptive study, in which 3 patients aged 18-59 years, who were affected by both CD and KD, were admitted to the Fundação Hospital de Clínicas Gaspar Vianna, in the sector medical practice. Data were collected from medical records and semi-structured interviews. The speeches of the participants were analyzed by the Bardin Content Analysis technique (2006). DATA ANALYSIS ANO OISCUSSION: From the collection of data emerged three categories: 1) Preventive aspects regarding health: it deals with the access to the health service, the organization of the network, the profile of the patients served by the health network, among others ; 2) Difficulties related to treatment: the existing impasses and complications for effective treatment, such as socioeconomic conditions, housing, culture, conception of subject of rights, among others, are highlighted; 3) Feelings and meanings related to coping with illness: anxiety, fear, anger, guilt, low self-esteem, loss of social function, anxiety, among others. FINAL CONSIDERATIONS: through the research it can be concluded that prevention isn't being adequately performed in the health services, generating a worsening of patients' chronicity. It should be noted that the issue of patients living away from the reference service impairs their access and permanence in the treatment, generating difficulties for him and for the care of the team. It's considered that the difficulties and the emotional and subjective symptoms that are related to the disease also are characterized like impasses for the effective treatment. Therefore, they need strategies of intervention of the psychologist, together with the other members of the health team with the objective of favoring the creation of functional coping strategies of the patient and attenuating the psychological suffering

[Treatment motivation in patients with chronic cardiorenal syndrome].

AIM: To study treatment motivation in patients with chronic heart failure (CHF) and in those with CHF concurrent with chronic kidney disease (CKD). SUBJECTS AND METHODS: A total of 203 patients (130 men and 73 women; mean age, 61.8±9.6 years) with CHF diagnosed and assessed in accordance with the National Guidelines of the All-Russian Research Society of Cardiology and the Heart Failure Society for the diagnosis and treatment of CHF (third edition, 2009) were examined. CKD was diagnosed according to the 2012 National Guidelines of the Research Nephrology Society of Russia. A group of patients with chronic cardiorenal syndrome (CRS) included those with CHF and CKD with a glomerular filtration rate (GFR) of <60 ml/min/1.73 m2. The clinical course of CHF, personality profile, and motivation for non-drug and drug treatments were assessed in patients with chronic CRS. RESULTS: CFR was 67.7±17.2 ml/min/1.73 m2; chronic CRS was observed in 89 (44%) patients. Psychological functioning assessment showed that the patients with chronic CRS as compared with those with CHF without CKD had high anxiety and maladaptive disease attitudes. CHF treatment motivation (compliance with lifestyle modification and medication) was proved inadequate and detected only in 31 (15.3%) patients with CHF regardless of the presence of CKD. The specific features of psychological functioning, which affected treatment motivation, were seen in patients with chronic CRS: those who were lowly motivated had a euphoric attitude towards their disease (p=0.03); those who were satisfactorily motivated showed an emotive accentuation of character (p=0.002). CONCLUSION: The presence of CKD aggravates the clinical course of CHF and negatively affects the psychological functioning of patients with CHF. The patients with chronic CRS are characterized by a low level of motivation for both drug and non-drug treatments, which should be taken into account when managing this cohort of patients.