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Clinical history
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Male, 65, brown skin, with sigmoid carcinoma unresponsive to chemotherapy. The patient underwent surgery (colectomy left for obstructive acute abdomen with colostomy bag placement). Started with chemotherapy (CT) neoadjuvant (before surgery QT) and then started adjuvant (after surgery); but despite the removal of the tumor, he had a relapse and started a "stronger" QT; however there was no response, and the tumor began to grow rapidly. Since then he started with palliative CT at home. |
Female, 55, African-Brazilian, has cerebral encephalopathy along with ischemic injuries resulting from cardiac arrest. The patient is bedridden, unresponsive, supported by tracheostomy, indwelling urinary catheter (SVD) and nasogastric tube (SNE). Presence of sacral pressure ulcers, infected. Taking enalapril, valproic acid and Hidantal. She is attended by the Family Health Support Unit Team ("Núcleo de Apoio à Saúde da Família " - NASF): physical therapist, dietitian, speech therapist, physical educator. |
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Description of the PC performed
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The health team has conducted several home visits, in the form of the Family Health Strategy ("Estratégia de Saúde da Família" - ESF) for low and medium complexity care, mainly related to the manipulation of the colostomy bag, blood pressure measurement, guidance on medications and dressings , and unspecified allergic reaction that the user presented with pruritus symptom. There were visits by the professional staff of the private health insurance service, which also follows the user in chemotherapy (medical staff, nursing, social work, occupational therapy). The patient has high blood pressure and makes use of hydrochlorothiazide. Also uses promethazine, Tamarine and dimethicone. EFA and health insurance teams operate separately, without reference nor counter reference between them. |
The ESF team makes home visits provided for in this type of PHCS with care limited to guidance on how best to proceed with the change of position, the care of the SVD and the SNE, even if this requires more than three weekly visits home. The UBS team does not make the exchange of SVD or maintaining SNE; when this is necessary, the user has to either be taken to the ER by the family, or to pay a professional or resort to a neighbor who works in nursing, to do the procedure at home using materials provided by the health unit. The UBS also provides the material for the dressing, as well as exchange of SVD and maintenance of SNE. The patient requires constant care such as diaper changes, changing positions every 3 hours, control of SVD, administration of enteral nutrition; therefore the family was organized, with their own resources, so that the patient would not be helpless at any time of the day |
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Conditions of family
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Own home, there is no information about family income in the chart; however, according to the community health agent (ACS), the family has no financial difficulties. The property has water, electricity, telephone and septic tank. Six people live in the house: the patient, his wife and four children. The wife, hypertensive, diabetic and dyslipidemic is the caregiver. One son, 34, has moderate to severe mental disabilities, is retired for disability and is under monitoring by the Center for Psychosocial Care (CAPS) and psychiatric service, given his history of seizures; according to information from medical records, he is "agitated, confused, disoriented in time and space". |
Own home with running water, electricity, garbage collection and septic tank. Four people live in the house: the patient, a daughter, a son in law and a grandson. The caregiver during the day is another daughter who does not reside in the house. At night the daughter who lives in the house is the caregiver. The family has consulted several neurologists, including private doctors, seeking a second opinion, but all of them said the situation is virtually irreversible. The patient makes treatment both at the UBS and through private health insurance. According to annotations in the medical record, the family still has hope that the patient will one day recover |
