GROUP IV

TUTOR : dr. Dina Fadhilah Monika

ANDRIANO (4517111045)
AYU IRIANI IDI (4517111020)
ANISA LUMALIN (4517111043)
NOVIA DEA RABA’ (4517111019)
DESTRI NELI ARIS (4517111041)
JAKSEN BOBONGGOI(4517111018)
NUR AZIZAH PRATIWI (4517111042)
FERDINAN TANDI RURA (4517111017)
JELITA ARUNG PALOBO (4517111044)
PUTRI CAHYANI DAHUNA (4517111016)
 I. SCENARIO
A 50-years-old woman suffering from terminal stage of
breast cancer with metastases. She has been resistant to
chemotherapy and radiation treatment. The woman has
severe bone pain which can not be longer overcome by
intravenous morphine. It was shown by the groaning even
when she takes a rest and the pain becomes more severe
when she changed her position. Although the patient is
able to sleep but she often asks for analgesic, and her
family asks for raise the dosage of analgesic medication.
During the discussion, doctor explained about the addition
of analgesic drugs can accelerate the death of the patient.
 II. SEVEN JUMPS METHOD

• 1. Clarification of difficult words

• 2. Determining problems / keywords
• 3. Discussion problems
• 4. Analysis of problems
• 5. Set out learning objective
• 6. Learn to be independent
• 7. Reporting of self-learning results
 A. DIFFICULT WORDS

1. Breast Cancer
2. Terminal Stage
3. Metastases
4. Chemotherapy
5. Analgesic
 B. MAIN PROBLEM

1. In this case , why doctor being dilemma?

2. Why the family of patient asks for raise
dosage of analgesic medication?
3. How does the doctor’s actions deal with
patient family?
4. What the concequences that the doctor got if
doctor accept the family’s request?
 C. DISCUSSION PROBLEMS

> Difficult Words

1. Breast Cancer
Cancer is a neoplastic disease with a fatal
natural course. Breast cancer perception of
illness could influence preferences in decision
making. This cancer must commonly affects
woman. Although men also have the potential
to be affected by a very small ratio of in 1000.
 next
This cancer occurs because under conditions
where it is damaged and normally normal,
rapid and rapidly uncontrolled, or breast
cancer action malignant neoplasm the disease
originating from parencym.
2. Terminal Stage
At this stadium cancer cells through a phase of
the metastases. That is the spread of cancer
cells into body tissues are increasingly wide
spread. The speared of cancer cells will spread
to lymph nodes and a much nastier such
cancer cells can spread to the bone, brain,
lungs and heart.
3. Metastasis
Transfer of disease from one organ or other
body parts not directly to it, either due to
transfer of pathogenic microorganism or
transfer of cells. (Dorland’s Pocket Medical
Dictionary, 2015).
4. Chemotherapy
Is one way of cancer treatment by giving
something substance or medicine that serves
to kill cancer cells.
5. Analgesic
Drugs that relieve pain without causing loss of
consciousness.
 D. ANALYSIS PROBLEMS

1. In this case , why doctor being dilemma?

Doctor dilemma because the side of the
patient's family asked to raise the dose of
analgesic medication. But on the other hand if
raising the dose of analgesic drugs will
consequently accelerate the patient's death.
2. Why the family of patient asks for raise dosage
of analgesic medication?
Because patients not only have end-stage
breast cancer but also have severe bone pain
that can’t be overcome with intravenous
morphine, even when resting patients feel
pain. This makes the patient's family unable to
bear to see this woman and ask to raise the
dose of the medicine.
3. How does the doctor’s actions deal with
patient family?
Doctor provide understanding to the family
that they understand and know the impact of
raising the dose of analgesic drugs can
accelerate death.
4. What the consequences that the doctor got if
doctor accept the family’s request?
The doctor violated Article 5, paragraph 2,
about the explanation and guidance of the
implementation of KODEKI and Article 7
concerning the doctor's certificate.
 E. LEARNING OBJECTIVES

1. We will choose the best action for patient,

2. Train us to critics and professional think,
3. We know about the danger of breast cancer,
and
4. As a doctor, we can give information and
education about the condition of the patient.
 III. CONCLUSION
Breast cancer is the most common invasive
cancer in women, and the second main cause
of cancer death in women, after lung cancer.
Breast cancer is the most common cancer
among women.
Symptoms include breast lumps or thickening,
and changes in the skin or nipple. Risk factors
can be genetic, but some lifestyle factors, such
as alcohol intake, make it more likely to occur.
Thank you…