Finished Treatment Lymphocytic Leukaemia †Myassignmenthelp.Com

Question: Discuss About The Finished Treatment For Acute Lymphocytic Leukaemia? Answer: Introduction CAP (community-acquired pneumonia) is the most common form of pneumonia and occurs in individuals who stay in long-term care settings or visited hospital recently (Bonten et al., 2014). Microorganisms because of the lung infection and immune system response to it and causes it. In the given case, world scenario of Jenne Coste, a nine-year old girl is re-admitted in hospital after she finished the treatment for Acute Lymphocytic Leukaemia (ALL). After her sputum culture, she was diagnosed with (CAP) and is undergoing treatment in hospital. Her assessment showed that she is suffering from Pseudomonas related pneumonia. Therefore, the aim of the paper is to explain the pathophysiology of CAP, medication management, Adverse Drug Reactions (ADRs) and life span development in Jennes middle childhood in providing her an integrated patient-centred model of care after her Leukaemia treatment. Objective and subjective data and elements of care Pneumonia can be caused by bacteria, virus or fungus and due to inhaling of irritant chemical (Walker et al., 2013). This can be of great risk in immunocompromised individuals as in Jenne who is suffering from leukaemia. It is essentially caused when the fluid traps in the lungs alveoli and impair the gaseous exchange. A potentially serious infection occurs in children between 6-12 years that results in hospitalization. Viruses cause the maximum percentage of CAP infections in children and being a major cause for hospitalization. The subjective data for pneumonia are the chills, pain, shortness of breath, increased work of breathing and nausea. The objective data in pneumonia is cough, phlegm, elevated temperature, not so common low temperature, vomiting, loose stool, changes in mental health and decrease or increase RR (Jain et al., 2015). These data are important for assessment and planning of nursing care for Jenne. As her last assessment shows, she had an elevated RR 24 and low B P of 90/60 and normal body temperature of 37.4 as monitored. Pseudomonas aeruginosa is an opportunistic bacterial pathogen that rarely invades in healthy individuals. It is associated with nosocomial infections that are life-threatening and severe causes infection in immunocompromised hosts like in Jenne case. Her immune system is compromised as she is suffering from leukemia and therefore, she was subjected to CAP due to Pseudomonas when she recently visited the hospital and resulted in re-admission. It dwells in immunocompromised hosts and complicates by causing multi-drug resistance and adverse drug reactions (ADRs) (Musher Thorner, 2014). In the given case scenario, Jenne immune system is weak and not fit enough to fight the infections due to leukemia that affected her bone marrow. As a result, she is prone to infections and bodys defense mechanism is unable to protect her from foreign bodies. For the treatment, empiric therapy is used as initial antibiotic treatment because the pathogen is rarely known at the time of diagnosis. For children with CAP, Cefotaxime (Claforan) is advised for the children between 5-12 years as empiric antibiotic therapy for bacterial CAP. In the case study, Jenne is undergoing the Cefotaxime as the empiric therapy at the dose of 100mg/25kg/day in four equal doses=625mg/dose in injectable solution of 1 gm in 20mg/mL (Prina, Ranzani Torres, 2015). There are essential elements of care required for the treatment and management of CAP in children. The care for Jenne contains the desired outcomes is to resolve the CAP infection, optimization of gaseous exchange and minimization of impact of impaired gaseous exchange. Care planning is important for Jenne to improve her condition and restore her normal functioning (Sato et al., 2016). The nursing priorities lie in the improvement and maintenance of respiratory function, conservation of energy, maintenance of proper fluid volume and adequate nutrition. As she is immunocompromised, the essential element of care is to understand the treatment and prevent the complications like adverse drug reactions. In pneumonia hospitalizations, there is ADRs witnessed with the antibiotic therapy. There is development of bacterial resistance due to overuse of this antibiotics in CAP patients. Due to its excessive administration, there is antibiotic resistance accumulation and cross-resistance between the antibiotics and might result in Multidrug-resistance (MDR) of different forms of P.aeruginosa. Therefore, it is important to study the antibiotic treatment and prevent the ADR in Jenne (World Health Organization, 2014). Elements of care for Jenne Patient-centred care is important that include the patient and his or her family in the interdisciplinary patient goals (Feo Kitson, 2016). There should be assessment of current data and documentation of the integrated patient goals. The other outcomes like improved communication and team accountability that work with satisfaction and cohesiveness providing patient safety, recovery and family satisfaction are also important (Hortmann et al., 2014). However, nursing care for paediatric pneumonia in immunocompromised children is a challenge task. It should honour and respond to the preferences, needs, goals and values of the patient in the healthcare system. Supportive care is required for Jenne as she is small and usually febrile. She might have pain in the chest, headache or pleural pain that may interfere with cough. This should be taken care of by using appropriate analgesic that is weight-appropriate. Inpatient care is important while she is in hospital and proper care is required for her. The monitoring of the clinical parameter like respiratory rate, temperature, oxygen saturation, heart rate, breathing and auscultatory findings is of paramount importance. Chest physiotherapy is also important for Jenne, although it has no effect on the length of hospital stay (Campion et al., 2016). Case management is also important to provide managed care. In the given case study, the healthcare team should provide critical care planning by the paediatric healthcare team. Managed care is a version of patient-centred care where there is team collaboration, defined interaction through effective communication channels and in achieving quality of highest care to Jenne. The patient-centred care for Jenne is to provide support and provide collaborative care in ensuring safety and fast recovery. The supportive measures required for Jenne includes oxygen therapy, monitoring of the vital parameters, adequate fluid intake and high calorie diet (Miller et al., 2014). For the restoration of Jennes well-being, proper nursing management is important that includes improvement and management of respiratory functions, prevention of complications like adverse drug reactions, supporting of the recuperative process and providing information about the disease. As Jenne is a small 9-year-old kid, her parents should be taught about pneumonia care at home after her discharge from hospital. The family need to be instructed about the pneumonia causes, symptom management, signs and symptoms in relapse conditions, importance of follow-ups and medication compliance. There should also be patient and family teaching about the ways to prevent infection and maintain hygiene to avoid relapse of CAP infections. Antibiotic management is also important for a child with CAP regarding the antibiotic treatment and avoid ADRs (Cutts, McAllister Chalmers, 2015). It involves the treatment with type of antibiotics and the route of administration. There is also requirement to keep a check on the route of medication like when to change to oral treatment or intravenous along with duration of the treatment (Huang et al., 2015). There should be improved care to provide standardized care for Jenne. There should be appropriate follow-ups and chest X-rays with routine blood culture and antibiotic therapy. There should be maintenance of hygiene to prevent further complications due to secondary infection or cross-contamination. The elements of care should be focused to provide patient-centred care and for the well-being and recovery of the patient. Inter Professional Collaboration Improved level of Inter Professional Collaboration is the principal strategy in the field of health care reforms. Such collaborations have been shown to improve the overall patient outcomes via reducing the affect of adverse drug interactions, decrease in the mortality and the morbidity rate optimizing the medication dosage (Falk, 2016; Reeves et al., 2013). Different elements of the inter professional collaboration in the therapy plan of Jenny and will eventually improve the overall disease prognosis are: Role clarity In order to attain a successful team of medical experts their must remain a role clarity. Such that in case of Jenny, the team of medical professionals must constitute one pulmonary specialist, one hematologist, medicine specialist and pediatric specialist and a group of nurses. Each doctor in the specific specialization domain with take care the betterment of Jenneys disease prognosis and the nurses will look into the spread of infection and proper infection control (Falk, 2016). Trust and confidence Trust is the crucial factor of a functional team. Built of trust leads to the development of confidence and thus leading to successful output. This trust must exist in between both the patient and the team of medical experts. If Jenny has a trust on her doctor, her physiological mindset will promote fast recovery (Falk, 2016). Ability of overcome adversity Jennys team of medical experts is dealing adverse medical situation and these is the part of the medical profession. While dealing with such challenged situations, collaboration becomes even more essential. In case of Jenny, the medical team will be built in such a way that in case of any medical challenges the team must work together and must not pass the work or the blame over others. Moreover, team diversity should be viewed as its strength (Falk, 2016). Ability of overcome personal differences It is not always feasible to get along with the very team members. However, in case of medical profession, maintaining a strict professional approach for the betterment of the patient is must (Falk, 2016). Collective leadership Collective leadership takes away the pressure from a particular team member and uniformly distributes it throughout the team. In case of Jenny, medical challenges are going to be surplus and her medical team must work in joint collaboration in order to help Jenny, the little girl to fight back against such traumatic medical condition (Falk, 2016; Laschinger Smith, 2013). Psychosocial Issues Children who are suffering from cancer have numerous psychosocial issues and demand a special approach to operationalize and conceptualize the issues they confront during the disease prognosis. The psychosocial effects lead to an increased level of depression followed by anxiety, and frequent concerns about the mortality. Delineating psychosocial functioning into several different domains is useful to assist patients and their families to conceptualize and thereby operationally define the overall psychosocial impacts of cancer. Patients can often learn to emphasize the requirement for the psychosocial and subsequent behavioral interventions and thereby directing the entire focus of their treatment. The main domains that are being affected by the psychosocial issues are physical wellbeing, emotional interface, cognitive development, and familial domains. These domains are not discrete but overlap (Wiener et al., 2015). For a pediatric patient like Jenny, the principal overlapping spheres are mostly condensed within the context of the developmental growth. Within this overlapping context of the developmental stage, each individual sphere have their own share of significance. The impact of the cancer experience on psychosocial functioning can be conceptualized by the size of the circle and the amount of overlap on the neighboring circle (Marcus, 2012). Factors affecting psychosocial functioning Disease site Research on psychosocial oncology has shown that the intensity and level of cancer's impact is largely dependent on the disease site. In case of Jenny, her body and lungs are both affected with disease, affecting critical domains of her life. Moreover, Jenny is in the midst of the developmental process and such debilitating disease can disrupt the formation of identity and have a psychological impact on self-esteem. Active multidisciplinary implementation of effective medical and psychosocial management can result in decreased morbidity and mortality and improved quality of life for affected patients and their family members (Marcus, 2012). Since Jenny is detected with debilitating disease at an early stage of her life, it is going to largely affect her life span. Such traumatic thoughts, palpitations lead to the generation of more chronic psychosocial issues. Generally, the principal concern is the physical domain because of the severity of the disease determines the patient's level of physical fitness. For instance, in case of Jenny, childhood development of Acute Lymphocytic Leukemia has its own fears, and treatment squeal that she interprets according to her developmental level. Since Jenny is affected with acute disease at an early stage of her life, she is bought to face educational and developmental issues (Marcus, 2012). A child's cognitive development is directly related to the extent to which the child can process and withstand the diagnosis. Jenny since being a 9 years old girl, affected by Acute Lymphocytic Leukemia and now by Community acquired pneumonia, will understand that she is critically ill, perhaps by experiencing discomfort from a cold or weakness at some point. However, she is unable to comprehend that the tumor or high-end treatment is making her feel bad. In the majority of the cases, she will not certainly understand the reasons for the multiple needle sticks and procedures causing her pain. She will also face difficulty in accepting disfiguring or debilitating treatments because her friends are free to play and roam without carrying the burden of painful treatment (Marcus, 2012). Parents and the extended families also have difficulties coping when their children are diagnosed with cancer. They often demonstrate increased level of anxiety with decreased coping skills. Parents of children who show relapse of the disease show higher levels of distress in comparison to the parents of children who remain cancer free after treatment. Similar theory is applicable in case of Jenny as she is facing recurrent infection, first by Leukemia and now by Pneumonia. Jennys parents are mostly like to suffer from posttraumatic stress disorder. Moreover, coping with stress is extremely difficult for the child's mother and Jennys mother is not indifferent to it. A comprehensive assessment and subsequent treatment of the familial psychosocial issues is the principal key because parent's depression is the most alarming factor associated with impairment in the family functioning (Marcus, 2012). Remedy to Improve the Quality of Life Quality of life also becomes an important endpoint measure when dealing with childhood cancer. In order to deal with such problems, Jenny and her family needs to enroll under certain dedicated family programs. Programs like a summer-camp setting provide multiple services and activities in order to uplift the quality of life of the cancer affect children and their family. On the other hand, play therapy will be useful modality and will help Jenny to over the impact of cancer (Marcus, 2012; Jacobsen Wagner, 2012). As Jenne is hospitalizedand diagnosed with CAP, there should be general management in inpatient settings. Her parents and nursing staffs should be made aware of the management of fever, prevention of dehydration, identification of deterioration signs and other serious illness, as she is immunocompromised. There is also a need to look for the complications that might occur due to ADRs and restoration of normal breathing. It is important to maintain hygiene and sterile condition to prevent infections and relapse of CAP. During the empirical antibiotic therapy, it should be important to look for the drug reactions that might occur due to antibiotic resistance. This can occur due to overdose of antibiotics and therefore, it is important to achieve the appropriateness of antibiotic therapy (Hua et al., 2014). There should be regular monitoring of the body temperature, breathing rate, respiratory rate, oxygen saturation levels and other vital parameters that can jeopardise the planned nursing care. There should be skilled paediatric nursing care which is high quality and strong recommendation. There should be cardiorespiratory monitoring and management and checking of vital signs like blood pressure, tachycardia and if required, need for pharmacologic interventions (Momma et al., 2016). As she is immunocompromised, she should be kept in a sterile condition to prevent further infections and cross-contamination that might aggravate the CAP in Jenne Conclusion CAP is one of the most common infections that are the leading cause of morality occurring in patients who stay in hospitals for long durations or visited hospital recently. In the given case, world scenario of Jenne Coste, a nine-year old girl is re-admitted in hospital after she finished the treatment for Acute Lymphocytic Leukaemia (ALL). She got diagnosed with CAP as she is immunocompromised. Her assessment showed that she is suffering from Pseudomonas related pneumonia. Viruses are the main culprit in causing the maximum percentage of CAP infections in children and being a major cause for hospitalization. Pseudomonas aeruginosa is an opportunistic bacterial pathogen that rarely invades in healthy individuals. Patient-centered care is important for recovery and well-being of Jenne. The patient-centred care for Jenne is to provide support and provide collaborative care in ensuring safety and fast recovery. There is development of bacterial resistance due to overuse of this antibiot ics in CAP patients. There should also be patient and family teaching about the ways to prevent infection and maintain hygiene to avoid relapse of CAP infections. Essential elements of care is important to provide patient-centred care for Jenne is to provide support and provide collaborative care in ensuring safety and fast recovery. References Bonten, M., Bolkenbaas, M., Huijts, S., Webber, C., Gault, S., Gruber, W., Grobbee, D. (2014). Community acquired pneumonia immunisation trial in adults (CAPITA).Pneumonia,3(Mar (913)), 95. Campion, M., Sponsel, K., Stock, A. H., Shawa, I., Need, R., Cheatham, S. C. (2016, October). Optimization of Pneumonia Treatment in an Intensive Care Unit Utilizing a Pharmacist-Driven Protocol. InOpen Forum Infectious Diseases(Vol. 3, No. suppl_1, p. 908). Oxford University Press. Cutts, A., McAllister, K., Chalmers, J. D. (2015). Empirical Antibiotic Treatment for Community-acquired Pneumonia: New Perspectives.Clinical Pulmonary Medicine,22(4), 192-198. Falk, A. L. (2016).Interprofessional Collaboration in Health Care. Linkping University Electronic Press. Feo, R., Kitson, A. (2016). Promoting patient-centred fundamental care in acute healthcare systems.International journal of nursing studies,57, 1-11. Hortmann, M., Heppner, H. J., Popp, S., Lad, T., Christ, M. (2014). Reduction of mortality in community-acquired pneumonia after implementing standardized care bundles in the emergency department.European Journal of Emergency Medicine,21(6), 429-435. Hua, L., Hilliard, J. J., Shi, Y., Tkaczyk, C., Cheng, L. I., Yu, X., ... Keller, A. (2014). Assessment of an anti-alpha-toxin monoclonal antibody for prevention and treatment of Staphylococcus aureus-induced pneumonia.Antimicrobial agents and chemotherapy,58(2), 1108-1117. Huang, X. Q., Deng, L., Lu, G., He, C. H., Wu, P. Q., Xie, Z. W., Aqeel Ashraf, M. (2015). Research on the treatment of Pseudomonas aeruginosa pneumonia in children by macrolide antibiotics.Open Medicine,10(1). Jacobsen, P. B., Wagner, L. I. (2012). A new quality standard: the integration of psychosocial care into routine cancer care.Journal of Clinical Oncology,30(11), 1154-1159. Jain, S., Williams, D. J., Arnold, S. R., Ampofo, K., Bramley, A. M., Reed, C., ... Zhu, Y. (2015). Community-acquired pneumonia requiring hospitalization among US children.New England Journal of Medicine,372(9), 835-845. Laschinger, H. K., Smith, L. M. (2013). The influence of authentic leadership and empowerment on new-graduate nurses perceptions of interprofessional collaboration.Journal of Nursing Administration,43(1), 24-29. Marcus, J. (2012). psychology issues in pediatric oncology.The Ochsner Journal,12(3), 211-215. Miller, N. P., Amouzou, A., Tafesse, M., Hazel, E., Legesse, H., Degefie, T., ... Bryce, J. (2014). Integrated community case management of childhood illness in Ethiopia: implementation strength and quality of care.The American journal of tropical medicine and hygiene,91(2), 424-434. Momma, K., Abe, S., Okuyama, H., Abe, H., Domon, M., Iwai, A., ... Morino, K. (2016, November). Proper Management Of Pneumonia Is Beneficial To Respiratory Support Services For Patients With Respiratory Failure. InRespirology(Vol. 21, Pp. 87-87). 111 River St, Hoboken 07030-5774, Nj Usa: Wiley-Blackwell. Musher, D. M., Thorner, A. R. (2014). Community-acquired pneumonia.New England Journal of Medicine,371(17), 1619-1628. Prina, E., Ranzani, O. T., Torres, A. (2015). Community-acquired pneumonia.The LaElements of care for Jennencet,386(9998), 1097-1108 Reeves, S., Perrier, L., Goldman, J., Freeth, D., Zwarenstein, M. (2013). Interprofessional education: effects on professional practice and healthcare outcomes (update).The Cochrane Library. Sato, K., Okada, S., Sugawara, A., Watanuki, Z., Tode, N., Suzuki, K., Ichinose, M. (2016). Factors For The Long-Term Survival Of Patients With Pneumonia After Completing Acute Phase Treatment In A Super-Aged Society; Retrospective Cohort Study In An Acute-Care Hospital In Japan. InA62. CLINICAL ASPECTS OF CAP, HCAP, HAP, AND VAP(pp. A2124-A2124). American Thoracic Society. Walker, C. L. F., Rudan, I., Liu, L., Nair, H., Theodoratou, E., Bhutta, Z. A., ... Black, R. E. (2013). Global burden of childhood pneumonia and diarrhoea.The Lancet,381(9875), 1405-1416. Wiener, L., Kazak, A. E., Noll, R. B., Patenaude, A. F., Kupst, M. J. (2015). Standards for the psychosocial care of children with cancer and their families: an introduction to the special issue.Pediatric blood cancer,62(S5). World Health Organization. (2014). Revised WHO classification and treatment of pneumonia in children at health facilities: implications for policy and implementation.