Paediatric Pneumonia: A Comprehensive Report on Patient Care

This report presents a comprehensive analysis of a paediatric pneumonia case, focusing on a nine-year-old girl named Jenne Coste who was re-admitted to the hospital after completing treatment for Acute Lymphocytic Leukaemia (ALL) and diagnosed with community-acquired pneumonia (CAP) caused by Pseudomonas aeruginosa. The report explores the pathophysiology of CAP, detailing the role of bacteria, viruses, and fungi in causing lung infections, particularly in immunocompromised individuals. It examines the subjective and objective data associated with pneumonia, including symptoms like chills, shortness of breath, and elevated temperature, as well as the importance of these data in assessing and planning nursing care. The report discusses the use of Cefotaxime as an empiric therapy, including dosage and administration, and emphasizes the essential elements of care, such as optimizing gaseous exchange and minimizing the impact of impaired respiratory function. Furthermore, it highlights the importance of patient-centered care, interprofessional collaboration, and addressing psychosocial issues that arise in children with cancer, focusing on the need for supportive care, monitoring of clinical parameters, and family education to prevent complications and ensure a safe and effective recovery. The report also examines the role of interprofessional collaboration, emphasizing role clarity, trust, and the ability to overcome adversity within the healthcare team, and it addresses the psychosocial issues associated with cancer, including the impact on physical, emotional, cognitive, and familial domains.

Running head: PAEDIATRIC PNEUMONIA
Paediatric pneumonia
Name of the Student
Name of the University
Author note

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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 Jenne’s 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

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her last assessment shows, she had an elevated RR 24 and low BP 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 body’s 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

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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

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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 Jenne’s 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

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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 Jenney’s
disease prognosis and the nurses will look into the spread of infection and proper infection
control (Falk, 2016).
Trust and confidence

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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
Jenny’s 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).

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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

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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).
Age
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.
Impact of Psychosocial Issues
Physical Concerns
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).
Cognitive Development
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

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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).
Impact on parents
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. Jenny’s parents are mostly like to suffer from posttraumatic stress disorder.
Moreover, coping with stress is extremely difficult for the child's mother and Jenny’s 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

10PAEDIATRIC PNEUMONIA
other hand, play therapy will be useful modality and will help Jenny to over the impact of cancer
(Marcus, 2012; Jacobsen & Wagner, 2012).
Recommendations
Site-of-care management
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.

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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 antibiotics 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.

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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 (9–13)), 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. In Open 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. Linköping 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

13PAEDIATRIC PNEUMONIA
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). Psychosocial 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

14PAEDIATRIC PNEUMONIA
Services For Patients With Respiratory Failure. In Respirology (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
Lancet, 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. In A62. 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).

15PAEDIATRIC PNEUMONIA
World Health Organization. (2014). Revised WHO classification and treatment of pneumonia in
children at health facilities: implications for policy and implementation.