Patient can not do Biopsychosocial case formulation

At the first time she visited the daily activity and

outpatient of palliative care and pain
free department Soetomo General
Hospital, her condition was so frail,
irritable, moderate anxiety, sad, and
frustration
Severe chronic
nociceptive visceral
and somatic non bone
and peripheral
neuropathic pain
her previous job
The patient thought that her
illness is a form of
punishment from God or the
“karma” because she was
arrogant to her sister
She received chemotherapy …..
times and external radiation 35
times, 3 months after that she
suffered from rectovaginal
fistula
Physical changes:
Cachexia, general
weakness, and frail
Anxiety and sadness,
feeling of helplessness,
feeling of hopelesness,
frustration, poor sleep
Too much suffering:
Pain, rectovaginal fistula
that can not be repaired
(it would be permanent),
no support from her
husband, jobless.
Disability: limitation of
mobility

z Cervical cancer, The therapeutic pain medications:

adenosquamous cell
morphine oral immediate release
carcinoma stage IIIb +
(MOIR) 4 x 7,5 mg and paracetamol There is no side
rectovaginal fistula
4 x 500 mg, amitriptyline 1 x 12,5 mg effect caused by the
(vaginal hygiene using NaCl 0,9 % + use of pain
metronidazole; chlor-trimeton + medication but
ciprofloxacin orally in a week it is increased quality of
not a pain killer but can reduce the life (she can eat and
local inflammation reduce pain) sleep normally, walk,
improvement of
mood)

Patient formerly had a job but

since about 1 year she quits this
makes financial stress but now she
is funded by her family. There is
also a family stress because less of
Misconceptions of therapeutic medication, husband’s support.
for example chemotherapy, narcotic
medicines, food restriction
 When the patient first visited palliative care and pain free department she felt pain around the area of perineal, inguinal, and proximal of
her upper legs/thighs

 Cachexia adalah keadaan malnutrisi yang ditandai dengan:

- Severe loss of weight  BMI ……
- Muscle atrophy
- Asthenia
- Chronic nausea
- Anaemia  Hb ……

 Cancer stadium IIIb:

- The cancer has grown into the walls of the pelvis and/or is blocking one or both ureters causing kidney problems (called
hydronephrosis). It has not spread to nearby lymph nodes. It has not spread to distant sites.

 Misconceptions about:
- Chemotherapy causes extreme hair loss and nausea
- Narcotic medicine such as opioid causes addiction
- Food restriction  cancer patients can not eat sugar, red meat, egg, et cetera
Cervical cancer, adenosquamous cell carcinoma stage IIIb + rectovaginal fistula