The purpose of this paper is to analyze a case study about Jenny who suffers

from acute lymphocytic leukemia. The case entails applying critical reflection

to ensure the delivery of the best patient-centered care to Jenny and her

family. Jenny Coste, a nine-year-old girl who comes from a family of five, is

diagnosed with leukemia despite having no history of any chronic illness.

After several tests and specialist appointments, Jenny is set to undergo

cancer treatment. The disease process takes a huge toll on her and the

family. They struggle to keep up with the extensive information on illness and

its demands. There is a lot of medication involved, and Jenny's mom has to

quit her job to take care of her. However, despite eighteen months of

intensive treatment, Jennys condition escalates leading to a remission with

fungal pneumonia that has her hospitalized for ten days. The hospital

arranges for palliative and home-based care to improve her quality of life

and that of the family.

After experiencing mild symptoms of pain in her legs, fatigue, reduced

appetite, and pallor, Jenny is taken to Dr. Brown who notices that she is pale,

mildly febrile with an elevated respiratory rate. She orders several tests

including full blood examination, Hemoglobin level, white blood cell count,

and urea, creatinine, and electrolytes. The test results lead to a preliminary

diagnosis of Acute Lymphocytic Leukemia. The cause of ALL is still idiopathic.

However, there is a correlation between cancer and lymphoid white blood

cells. One of the risk factors associated with the cause of ALL is exposure to

radiation (Inaba, Greaves &Mullighan 2013). Others include exposure to x-

rays before birth, chromosome or genes changes, prior treatment with

chemotherapy, occurrence of genetic conditions such as Shwachman

syndrome, Down syndrome, Neurofibromatosis type 1, and Klinefelter

syndrome (Moorman et al., 2014). ALL is, however, more prevalent in males

than females (Peters et al., 2015). Caucasians are also more at risk of

developing the condition than other races (Moorman et al., 2014).

For a child with ALL such as Jenny, an excessive number of stem cells turn

into lymphoblasts, B lymphocytes, or T lymphocytes (Roberts et al., 2014).

The cells do not function as normal lymphocytes would. This means they do

not efficiently handle infections. An increase in the number of leukemia cells

in the blood leads to reduced room for healthy lymphocytes, red blood cells,

and platelets (Roberts et al., 2014). The child is susceptible to infections and

can bleed easily thus explaining Jennys pale look. Additionally, the reduced

red blood cells limit oxygen transport into muscle cells leading to fatigue as

in Jenny's case. Her diagnosis with pneumonia is an indication of an

opportunistic infection. Jenny's immune system is suppressed by the disease

making her susceptible to opportunistic infections. The pathogen infects the

lungs to cause further complications (Koo et al., 2014). In Jennys case, the

bacteria have aggravated her condition despite the fact that the intensive

medical attention she is receiving.

Pneumonia develops when a pathogen reaches the alveoli and overwhelms

the hosts immune defenses (Grandinetti, 2016). Bacterial pneumonia results

when a bacterium infects the lungs. It occurs through the inhalation of

bacteria or the activation of dormant infection. Once in the alveoli, the

bacteria multiply and grow in numbers. This invasion triggers an immune

response in an attempt to eliminate them (Grandinetti, 2016). Immune cells

(neutrophils) engulf and destroy their cells, releasing cytokines in the

process that further activate the immune system. As a result, blood flow is

diverted and increased in the lungs. Excess fluid leaks from surrounding

blood vessels to fill the alveoli (Grandinetti, 2016). This impairs gaseous

exchange leading to difficulty in breathing, productive cough, fever, chills,

fatigue and chest pain. Patients with low immunity are more susceptible to

the infection explaining why Jenny relapsed. Failure of her immune system to

produce mature immune cells as well as suppression of existing immune

stem cells by cancer treatment made Jenny susceptible to bacterial

pneumonia.

The main goal of treatment for bacterial pneumonia involves curing the

infection and preventing complication. The standard treatment includes the

completion of a full course of antibiotics. Mild infections can be treated with

oral antibiotics at home. Severe cases as Jenneys require admission for a

more intensive treatment involving intravenous antibiotic administration. The

main antibiotic used to treat bacterial pneumonia penicillin. However, in

cases of severe pneumonia, ceftriaxone is used. As a third line antibiotic,

Ceftriaxone is used to treat organisms that are resistant to the first and

second line. In addition to ceftriaxone, a patient suffering from bacterial

pneumonia should also be given cough suppressants to promote rest. Also,

strong analgesics should be given to relieve pain, especially in Jenny's case

that also had bone pain from cancer. Supportive management includes

oxygen therapy especially in Jennys case as she has reduced red blood cells

to promote oxygen saturation and relieve the difficulty in breathing.

Suctioning can also be done to remove secretions.

Ceftriaxone is a broad-spectrum antibiotic from the cephalosporin family. It

selectively and irreversibly prevents the synthesis of bacterial cell wall. It

binds irreversibly to the transpeptidases on the cell wall that catalyze the

cross-linking of peptidoglycan polymers to form the bacterial cell wall.

Additionally, ceftriaxone has a relatively longer plasma half-life of up to 9

hours. This makes it a highly effective against penicillin-resistant strains of

microorganisms. The pharmacokinetics of ceftriaxone also makes it a

suitable drug for treatment of severe bacterial infections such as Jennys. The

drug is given intravenously or intramuscularly. It is entirely absorbed leading

to higher doses in blood within a short time of administration thus preventing

further multiplication of microorganisms to cause complications. Additionally,

the distribution of ceftriaxone is quick as it quickly penetrates tissues and

body fluid to reach infection sites including the lungs in cases of pneumonia.

The drug is excreted unchanged in urine and bile thus does not need any

adjustments in case of renal or hepatic impairment.

Ceftriaxone is well tolerated despite the age of the patient. However, it has

some adverse effects that should be considered before initiating it. The most

common side effects include rash, diarrhea, nausea, vomiting and

gastrointestinal discomfort. It can also lead to dizziness, migraine, pain and

swelling of the vein or injection site. These side effects should be carefully

monitored in Jenny and efficient solutions offered. To reduce pain at the

injection site, it should be combined with lidocaine. Additionally, being a

broad spectrum antibiotic, ceftriaxone can alter the normal flora of the body

to cause the growth of opportunistic bacteria leading to candidiasis of the

vagina, mouth, and esophagus. Therefore, being immune-compromised,

Jenny should be carefully monitored for fungal infections and treated

accordingly. It is contraindicated in patients with allergic reactions to

cephalosporin.

To optimize patient outcomes, there is a need to focus on the

implementation of patient -centered care and inter-professional collaboration

among healthcare practitioners. Models of health care delivery that are

disconnected or fractured are no longer viable and do not hold precedence in

health systems. In Jennys case, her illness requires the collaboration of

different specialists to observe and manage her situation. This approach is in

line with the increasingly popular strategy that involves the implementation

of patient -centered care and inter-professional collaboration among

healthcare practitioners. According to Rose (2011), inter-professional

collaboration requires health professionals from different diverse

backgrounds working together with patients, caregivers, family and the

community working towards the best possible patient outcomes. Bridges (et

al2011) on the other hand suggests that education best backs inter-
professional collaboration between health professionals for provision high-

quality care. There are several advantages of inter-professional collaboration

between health professionals in healthcare, and this can be used to work

towards best outcomes for Jenny and her family.

Some specialists should manage Jenny with each playing a particular role. An

oncologist should help manage cancer either through surgery,

chemotherapy, or radiotherapy (Ben-Ami et al. 2013). Nurses should provide

nursing care as well as monitor the patient vitals to prevent falling into the

high risk. A pulmonologist should be available to assess the lung function

tests and treat the pneumonia infection (Ben-Ami et al., 2013). Surgical

specialists should be consulted in case Jenny needs surgery such as bone

marrow aspirate or transplant. Microbiologists have the role of testing the

susceptibility of the bacteria to the drug being used (ceftriaxone) and

evaluate for resistance. Radiologists provide imaging results for Jenny such

as chest X-rays for better management. Counselors help the Jenny and the

family to cope with the disease process. A pharmacist should contribute to

monitoring the therapeutic drug levels, survey adverse effects and drug

interactions to optimize treatment (Ben-Ami et al., 2013). Physiotherapists

should help in exercises while nutritionists should manage Jennys nutritional

requirements such as the lack of appetite.

It is important to teach the family good oral care for Jenny as this reduces

oropharyngeal microorganisms with potential respiratory pathogenicity if

aspirated (Labson, 2014). The family should also practice good hygiene,
maintain adequate nutrition, ensure adherence to the treatment regimen

and offer continued support.

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