research about product design | www.nursing-homeworks.com

I want someone to do a research about any topic related to product design, My professor asked to do a research, so I can present it after 2 days.
The research paper at least should have introduction background body and conclusions , but he wants it in APA style
ask me about the product design before you start writing
number of pages doesn’t matter (3 minimum) as long as it contains all the information about a specific topic of design process.

Epidemiology Unit 5 Topic 1, writing homework help

Topic 1: Complete the required Readings before posting to this Discussion. Analyzing specific examples in the text from Chapters, 7, 8 and 9, explain how types of epidemiological studies impact knowledge of diagnosis, prognosis or clinical treatment. Be sure to use vocabulary that demonstrate your understanding of epidemiological terms.

SHRM SAMPLE ASSIGNMENT Introduction Strategic human resource management is devoted to the effective.

SHRM SAMPLE ASSIGNMENT
Introduction
Strategic human resource management is devoted to the effective management of human resource understanding the fact that human resources are the key source to achieve competitive advantage. Traditionally HRM had little role in business objectives of the organization but the new perspectives identifies that practices within HRM can have major roles upon company performance and certain functions like training, incentives payments are now fused with business objectives (Emerald Group, 2004). SHRM focus on long term issues related to the people and also consider quality, ethics, culture and diversity and matching necessary resources for effective business performance.
In today’s world of global business, the competition between the businesses is fierce and organization always tries to seek competitive edge to differentiate its business with other rivals for the survival and success of business. Only recently the importance of HR competencies, capabilities and skills as the source of sustainable competitive advantage has emerged (Ellinger et al., 2002). Besides providing goods and services, organizations are now focusing on strategic human resources plans and policies for attaining and managing human resources for achieving competitive advantage.
The question may arise why so much emphasis is given to human resource though other resources are also responsible for firm’s success. Resource based view explains that resources such as human resource capabilities are critical part of organization for effective performance. Pfeffer (1994) advocates resource based view by pointing that human resource is preeminent organizational resource and key to achieve outstanding performance. Barney (1991) developed VRIO framework for achieving sustainable competitive advantage. According to which the organization can achieved competitive advantage when the resources are valuable, rare, and inimitable and have no substitute. Human intellectual unlike other resource possesses key ingredients like knowledge, skills and ability which allows human resource to create value to the organization improving individual’s efficiency and efficacy for developing sustainable competitive capabilities. Comparing to other intangible resources, HR is more likely to produce competitive because of their rarity and difficulty in imitation (Khandekar & Sharma, 2005).
Strategic human resource play vital role in competitive environment through the implementation of management practices and developing strategy to possess and deploys unique strand of resource (Barney, 1991). SHRM deals with placing right people with the right skills at the right time. According to khandekar and Sharma (2005) organization should focus on strategic focus, link between HR policies and practices, its business strategy and performance and further added supporting high commitment work perspectives that organization should include the size and composition of workforce, planning, staffing, retention and motivation, skills and competencies with effective training and development to achieve these, remuneration and compensation , fair employment practices and career planning (Khandekar & Sharma, 2005).
Bernardin and Russell (1998) describe that competitive advantage of an organization depends upon the ability to attract and retain individuals. HRM practice sustain to attract and retain valuable employees and provides motivation resulting in high profitability, high productivity, quality products, lower cost in manufacture and faster acceptation and implementation of organizational strategy (Pablos & Lytras, 2008). For the effective management of employees, organizations should adopt more strategic orientation and should possess the resource to enable employees to have greater involvement with broader organizational strategies (Tansley et al.,
2001).
Competitive advantage can be obtained through the concept of strategic target and strategic thrusts (Schuler & MacMillan, 1984). Strategic target refers to company, distributor, supplier and costumer. Company can approach forward and backward way to help in shaping the HRM practices of other companies. Pepsi-co provided training to distributor to increase sales of store as well as company whereas Nissan motors provide extensive training program to supplier to enhance the quality of products Strategic thrusts refers to cost efficiency and differentiation thrust (Schuler & MacMillan, 1984). Lincoln electric succeeded to increase productivity as well as cost reduction through HRM practices.
Source: (Barney, 1991)
Today large number of corporation are moving towards ethical philosophy in the expectation that ethical behavior by their employees will lead towards business success (Svensson & Wood, 2004). Ethical practices and fair judgments and treatment of employee reinforce the employee commitment and trust and also to attract investors. Since employee and organization are directly linked with costumer, the ethical behaviors with the customer increase the customer satisfaction and customer loyalty. The ethical practices motivate the employee towards the right direction. And also provides support to manager to make ethical decisions where there is hard to say what is right and what is wrong (Holmes, 2008), Furthermore, Stainer & Stainer (1995) claims cultural and social backgrounds, principles and personal values are the crucial factors in making decision. Ethical business values translated into management behaviors can make the difference between employees µsatisfaction and frustration and motivated employee to do their best performance (Holmes, 2008).IntroductiStrategic human resource management (SHRM) is devoted to the effective management of human resource understanding the fact that human resources are the key source to achieve competitive advantage. Traditionally HRM had little role in business objectives of the organization but the new perspectives identifies that practices within HRM can have major roles upon company performance and certain functions like training, incentives payments are now fused with business objectives (Emerald Group, 2004).SHRM focus on long term issues related to the people and also consider quality, ethics, culture and diversity and matching necessary resources for effective business performance.
SHRM and Competitive Advantage
In today¶s world of global business, the competition between the businesses is fierce and organization always tries to seek competitive edge to differentiate its business with other rival for the survival and success of business. Only recently the importance of HR competencies, capabilities and skills as the source of sustainable competitive advantage has been emerged (Ellinger et al., 2002). Besides providing goods and services, organizations are now focusing on strategic human resources plans and policies for attaining and managing human resources for achieving competitive advantage.
The question may arise why so much emphasis is given to human resource though other resources are also responsible for firm¶s success. Resource based view explains that resources such as human resource capabilities are critical part of organization for effective performance. Pfeffer (1994) advocates resource based view by pointing that human resource is preeminent
organizational resource and key to achieve outstanding performance. Barney (1991) developed VRIO framework for achieving sustainable competitive advantage. According to which the organization can achieved competitive advantage when the resources are valuable, rare, and inimitable and have no substitute. Human intellectual unlike other resource possesses key ingredients like knowledge, skills and ability which allows human resource to create value to the organization improving individuals efficiency and efficacy for developing sustainable competitive capabilities. Comparing to other intangible resources, HR is more likely to produce competitive because of their rarity and difficulty in imitation (Khandekar & Sharma, 2005).
Strategic human resource play vital role in competitive environment through the implementation of management practices and developing strategy to possess and deploys unique strand of resource (Barney, 1991).SHRM deals with placing right people with the right skills at the right time. According to khandekar and Sharma (2005) organization should focus on strategic focus, link between HR policies and practices, its business strategy and performance and further added supporting high commitment work perspectives that organization should include the size and composition of workforce, planning, staffing, retention and motivation, skills and competencies with effective training and development to achieve these, remuneration and compensation , fair employment practices and career planning (Khandekar & Sharma, 2005)
Bernardin and Russell (1998) describe that competitive advantage of an organization depends upon the ability to attract and retain individuals. HRM practice sustain to attract and retain valuable employees and provides motivation resulting in high profitability, high productivity, quality products, lower cost in manufacture and faster acceptation and implementation of organizational strategy (Pablos & Lytras, 2008). For the effective management of employees, organizations should adopt more strategic orientation and should possess the resource to enable employees to have greater involvement with broader organizational strategies (Tansley et al.,
2001).
Competitive advantage can be obtained through the concept of strategic target and strategic thrusts (Schuler & MacMillan, 1984). Strategic target refers to company, distributor, supplier and costumer. Company can approach forward and backward way to help in shaping the HRM practices of other companies. Pepsi-co provided training to distributor to increase sales of store as well as company whereas Nissan motors provide extensive training program to supplier to enhance the quality of products Strategic thrusts refers to cost efficiency and differentiation thrust (Schuler & MacMillan, 1984). Lincoln electric succeeded to increase productivity as well as cost reduction through HRM practices.
Today large number of corporation are moving towards ethical philosophy in the expectation that ethical behavior by their employees will lead towards business success (Svensson & Wood, 2004).Ethical practices and fair judgments and treatment of employee reinforce the employee commitment and trust and also to attract investors. Since employee and organization are directly linked with costumer, the ethical behaviors with the costumer increase the customer satisfaction and customer loyalty. The ethical practices motivate the employee towards the right direction. And also provides support to manager to make ethical decisions where there is hard to say what is right and what is wrong (Holmes, 2008), Furthermore, Stainer & Stainer (1995) claims cultural and social backgrounds,principles and personal values are the crucial factors in making decision. Ethical business values translated into management behaviors can make the difference between employees µsatisfaction and frustration and motivated employee to do their best performance (Holmes, 2008).
Ethical practices and code varies with the type of organization, the business they perform and place. Common ethical behavior expected by an organization are honesty, integrity, commitment and loyalty and similarly organization should consider the employees rights like freedom to speech, privacy, freedom of conscience, fairness etc (Noe, Hollenbeck, Gerhart, & Wright, 2004). Langlois & Schlegelmilch, (1990) described code of conduct as a statement that lay down corporate principles, ethics, rules of conduct, code of practice, responsibilities to employees and shareholder, consumers and the Environment and Society. Mcdonald (2009) facilitates the importance of code of conduct.
Performance is greatly influenced by how well or badly employees are treated which in turn impact the overall organizational performance. According to (Leopold, Harris, & Watson, 2005) long term perspectives of an organization directly depends upon employees, hence fair and ethical treatment of workers is an important strategic concern. High commitment strategy focuses on careful consideration of ethical choices to the employees. Further, Ferrell, Fraedrich and Ferrell (2008,) assert that ‘The more the organization is dedicated to taking care of employees the more likely it is that the employees will take care of organization´ .
Hewlett- Packard company is raked as 2010 most ethical company by Ethisphere Institute due to its ethical standards, teamwork , integrity, cultural respect leading to product innovation.
Gandtz and Hayes (1988) explains ethical challenges in the area of discrimination, psychology testing, anti union activity, work design , employment security, performance, rewards and employee discipline which is supported by Leopold et al. (2005) .
National cultural difference on business performance
Culture is basically all about what people thinks, behaves and follows which provides identity, belongings, behavior pattern of the people. Hofstede (2001) defined culture as collective programming of the mind that differentiates the member of one group from another. Besides the same cultural society, there is no uniformity on the behavior of individual, community, society and country. Culture is dynamic and slow but continual process of adapting to environment and circumstances and transmission of similar values, beliefs, skills and knowledge to subsequent generation (Moran, Harris, & Moran, 2007 ;Hofstede ,2001 ; Alder,2002). Cultural difference can be differentiated by the norms and values of group, language, religion, institution where they participate and social values.
Corporate culture is the product of daily interactions and their effects on attitudes, behavior, values and the performance (Rohm, 2006).The sources of corporate culture according to Brown (1998) are societal and national norms in which the organizations exists, vision and management style, and types of business and environment an organization engages in. Hofstede (2001) suggests the four dimensions of cultural differences between nation and clustered cultures which are power distance, uncertainty avoidance, individualist, masculine culture. Hofstede classified Greek people as low individualistic society as they expect organization to look after them as family. Some researchers claim that reinforcing national cultural values in management practices yields in high performance whereas other claim mismatch between management practices and national culture reduce performance (Kessapidou & Varsakelis, 2002).
Culture affects the human behavior, morale which in turn affects the organization productivity, values and pattern that influence attitudes and actions (Moran, Harris, & Moran, 2007).According to Khandekar & Sharma (2005). The performance of the global organisations depends upon the ability to cope with heteregeneous culture ,coordinating diverse resource, competitive environment and to leverage innovations across national boundaries.
Cultural practices exercise within the organization has greater impact on organizational goal. The good culture within organization leads organization towards success whereas negative culture leads towards degradation of company. The positive attitude, virtues and behavior are said to be valuable assets for achieving corporate goals defined by senior management (Deal and Kennedy, 1982). Individual perspective in combination with culture difference can be great assets in problem solving and task performance.
Contemporary organizations are multicultural in nature and the major factor in the success or failure of inter-cultural in management is interpersonal communication and also manager working in different culture should examine the 3Cs´ of context, content and conduct (Humphreys, 1996). The structure and functioning of the multicultural organization are not determined by universal rationale, so the firm must acquire diverse set of routines and repertoires in order to be competitive in diverse world (Kessapidou & Varsakelis, 2002).
Globalization in one hand creates opportunities to businesses, in other hand there exists formidable and unique challenges, Cultural difference often causes misunderstanding and conflict than synergy (Hofstede, 2001).While working internationally decision based on own country may be wrong in other country. Global business needs to deal with interaction between service provider of one culture with costumer of another culture which may leads to unhappy customer, frustrated provider and lost business due to difference in cultural norm and values (Sizoo et al., 2005).Difference in national culture not only effects the entry mode but also the difficulty in integrating foreign personnel in the organizations (Kessapidou & Varsakelis, 2002).
Link between equal opportunity and diversity
Anti discrimination laws are introduced so as to rectify workplace inequalities and social injustices faced by particular group like women, ethnic minorities and disabled. Diversity as defined by Hubbard (2004) is a collective mixture characterized by differences and similarities that are applied in pursuit of organizational objectives. Managing diversity is important aspect of SHRM since diversity encourages the contribution of people from different background, experiences and perspectives. Effective policy is necessary to value and manage the diversity of employees, customers, and suppliers by doing what is right for their employees and the communities they serve, thereby ensuring a competitive advantage in the global marketplace (Hubbard, 2004).
Providing equal employment opportunities is an important aspect of strategic human resource. There should not be any discrimination regarding gender, pay, disabilities, and minority ethnics groups and so on. The social justice perspective assumes that men and woman are fundamentally same and should be treated fairly. Merit approach supports social justice and also assumes that equality can be achieved through the judgments of individuals on the particular merits against same standards. Whereas, diversity approach approaches that inequality is due to the failure to accept the differences and to respond to them (Leopold, Harris, & Watson, 2005).
In today¶s world of global business, the competition between the businesses is fierce and organization always tries to seek competitive edge to differentiate its business with other rival for the survival and success of business. Only recently the importance of HR competencies, capabilities and skills as the source of sustainable competitive advantage has been emerged (Ellinger et al., 2002). Besides providing goods and services, organizations are now focusing on strategic human resources plans and policies for attaining and managing human resources for achieving competitive advantage.
The question may arise why so much emphasis is given to human resource though other resources are also responsible for firm¶s success. Resource based view explains that resources such as human resource capabilities are critical part of organization for effective performance. Pfeffer (1994) advocates resource based view by pointing that human resource is preeminent
organizational resource and key to achieve outstanding performance. Barney (1991) developed VRIO framework for achieving sustainable competitive advantage. According to which the organization can achieved competitive advantage when the resources are valuable, rare, and inimitable and have no substitute. Human intellectual unlike other resource possesses key ingredients like knowledge, skills and ability which allows human resource to create value to the organization improving individual¶s efficiency and efficacy for developing sustainable competitive capabilities. Comparing to other intangible resources, HR is more likely to produce competitive because of their rarity and difficulty in imitation (Khandekar & Sharma, 2005).
Strategic human resource play vital role in competitive environment through the implementation of management practices and developing strategy to possess and deploys unique strand of resource (Barney, 1991).SHRM deals with placing right people with the right skills at the right time. According to khandekar and Sharma (2005) organization should focus on strategic focus, link between HR policies and practices, its business strategy and performance and further added supporting high commitment work perspectives that organization should include the size and composition of workforce, planning, staffing, retention and motivation, skills and competencies with effective training and development to achieve these, remuneration and compensation , fair employment practices and career planning (Khandekar & Sharma, 2005)
Bernardin and Russell (1998) describe that competitive advantage of an organization depends upon the ability to attract and retain individuals. HRM practice sustain to attract and retain valuable employees and provides motivation resulting in high profitability, high productivity, quality products, lower cost in manufacture and faster acceptation and implementation of organizational strategy (Pablos & Lytras, 2008). For the effective management of employees, organizations should adopt more strategic orientation and should possess the resource to enable
employees to have greater involvement with broader organizational strategies (Tansley et al.,
2001).
Competitive advantage can be obtained through the concept of strategic target and strategic thrusts (Schuler & MacMillan, 1984). Strategic target refers to company, distributor, supplier and costumer. Company can approach forward and backward way to help in shaping the HRM practices of other companies. Pepsi-co provided training to distributor to increase sales of store as well as company whereas Nissan motors provide extensive training program to supplier to enhance the quality of products Strategic thrusts refers to cost efficiency and differentiation thrust (Schuler & MacMillan, 1984). Lincoln electric succeeded to increase productivity as well as cost reduction through HRM practices.
Source: (Barney, 1991)
Ethics
³Imagine a world without ethics,where we put ourselves at first place, where no one was
interested in making the environment or making things better for all and in the UK,there would be no NHS, no state education system,and our decision would be based on µwhats in it for us?¶´ (Orme & Ashton, 2003).This emphasizes how importance the role of ethics plays in our society. Business ethics tries to answer the question³what is the role of business in society?´ (Trezise, 1996). Ethics is the system of moral principles which deals with the broad perspectives about what is good for individuals and society. In the commercial world Business ethics provides the guidelines for managing acceptable behavior in the strategy formulation of an organization and day to day operation. Organization intended to provide moral guidance to employees and also with stakeholders (Langlois & Schlegelmilch, 1990).
Today large number of corporation are moving towards ethical philosophy in the expectation that ethical behavior by their employees will lead towards business success (Svensson & Wood, 2004).Ethical practices and fair judgments and treatment of employee reinforce the employee commitment and trust and also to attract investors. Since employee and organization are directly linked with costumer, the ethical behaviors with the costumer increase the customer satisfaction and customer loyalty. The ethical practices motivate the employee towards the right direction. And also provides support to manager to make ethical decisions where there is hard to say what is right and what is wrong (Holmes, 2008), Furthermore, Stainer & Stainer (1995) claims cultural and social backgrounds,principles and personal values are the crucial factors in making decision. Ethical business values translated into management behaviors can make the difference between employees µsatisfaction and frustration and motivated employee to do their best performance (Holmes, 2008).
Ethical practices and code varies with the type of organization, the business they perform and place. Common ethical behavior expected by an organization are honesty, integrity, commitment and loyalty and similarly organization should consider the employees rights like freedom to speech, privacy, freedom of conscience, fairness etc (Noe, Hollenbeck, Gerhart, & Wright, 2004). Langlois & Schlegelmilch, (1990) described code of conduct as a statement that lay down corporate principles, ethics, rules of conduct, code of practice, responsibilities to employees and shareholder, consumers and the Environment and Society. Mcdonald (2009) facilitates the importance of code of conduct.
Performance is greatly influenced by how well or badly employees are treated which in turn impact the overall organizational performance. According to (Leopold, Harris, & Watson, 2005) long term perspectives of an organization directly depends upon employees, hence fair and ethical treatment of workers is an important strategic concern. High commitment strategy focuses on careful consideration of ethical choices to the employees. Further, Ferrell, Fraedrich and Ferrell (2008, p.18) assert that³The more the organization is dedicated to taking care of employees the more likely it is that the employees will take care of organization´ .Hewlett- Packard company is raked as 2010 most ethical company by Ethisphere Institute due to its ethical standards, teamwork , integrity, cultural respect leading to product innovation.
Gandtz and Hayes (1988) explains ethical challenges in the area of discrimination, psychology testing, anti union activity, work design , employment security, performance, rewards and employee discipline which is supported by Leopold et al. (2005) .
National cultural difference on business performance
Culture is basically all about what people thinks, behaves and follows which provides identity, belongings, behavior pattern of the people. Hofstede (2001) defined culture as collective programming of the mind that differentiates the member of one group from another. Besides the same cultural society, there is no uniformity on the behavior of individual, community, society and country. Culture is dynamic and slow but continual process of adapting to environment and circumstances and transmission of similar values, beliefs, skills and knowledge to subsequent generation (Moran, Harris, & Moran, 2007 ;Hofstede ,2001 ; Alder,2002). Cultural difference can be differentiated by the norms and values of group, language, religion, instititution where they participate and social values.
Corporate culture is the product of daily interactions and their effects on attitudes, behavior, values and the performance (Rohm, 2006).The sources of corporate culture according to Brown (1998) are societal and national norms in which the organizations exists, vision and management style, and types of business and environment an organization engages in. Hofstede (2001) suggests the four dimensions of cultural differences between nation and clustered cultures which are power distance, uncertainty avoidance, individualist, masculine culture. Hofstede classified Greek people as low individualistic society as they expect organization to look after them as family. Some researchers claim that reinforcing national cultural values in management practices yields in high performance whereas other claim mismatch between management practices and national culture reduce performance (Kessapidou & Varsakelis, 2002).
Culture affects the human behavior, morale which in turn affects the organization productivity, values and pattern that influence attitudes and actions (Moran, Harris, & Moran, 2007).According to Khandekar & Sharma (2005). The performance of the global organisations
Sullivan, 2004). According to Ross and Schneider (1992) equal opportunity is very important in contemporary business in face of changing labor market, skill shortages and the necessity of attracting the best one and further added that is not only the right thing to do it is business necessity (Humphries & Grice, 1995).
The strategic advantage of investing in a strong diversity program is the creation of positive work environment that recognizes the contributions of all employees with diverse backgrounds. For diversity to be successfully integrated, diversity initiatives must continue to be guided by leadership¶s full commitment with mutual adjustment and understanding. Equal opportunity leads to diversity which is beneficial for not only individual but, ultimately, the nation and global marketplace. Baptist Health S. Florida is ranked No.1 by fortune 500 in 2007as top place to work providing employments to 71%of minority people and 75% women.
To create the required balance between employee satisfaction and customer satisfaction, the organization must employ strategies and values that promote fairness and opportunities, instill pride, and enhance safety in the workplace (Bibby, 2002).
Conclusion
To survive and thrive in this competitive environment human resource must be effectively utilized in aid with other resources since human intellectual is inimitable and most valuable one. Retaining and attracting qualified employee, providing training and development, proper job design and motivation and healthy working environment are the most important aspect of SHRM Ethics and diversity is integral part of organization which needs to be managed efficiently with effective policy so as to encourage team working for better performance. Diversity and cultural practice is an important aspect of gaining sustainable competitive advantage.
Introduction
Strategic human resource management (SHRM) is devoted to the effective management of human resource understanding the fact that human resources are the key source to achieve competitive advantage. Traditionally HRM had little role in business objectives of the organization but the new perspectives identifies that practices within HRM can have major roles upon company performance and certain functions like training, incentives payments are now fused with business objectives (Emerald Group, 2004).SHRM focus on long term issues related to the people and also consider quality, ethics, culture and diversity and matching necessary resources for effective business performance.
SHRM and Competitive Advantage
In today¶s world of global business, the competition between the businesses is fierce and organization always tries to seek competitive edge to differentiate its business with other rival for the survival and success of business. Only recently the importance of HR competencies, capabilities and skills as the source of sustainable competitive advantage has been emerged (Ellinger et al., 2002). Besides providing goods and services, organizations are now focusing on strategic human resources plans and policies for attaining and managing human resources for achieving competitive advantage.
The question may arise why so much emphasis is given to human resource though other resources are also responsible for firm¶s success. Resource based view explains that resources such as human resource capabilities are critical part of organization for effective performance. Pfeffer (1994) advocates resource based view by pointing that human resource is preeminent
organizational resource and key to achieve outstanding performance. Barney (1991) developed VRIO framework for achieving sustainable competitive advantage. According to which the organization can achieved competitive advantage when the resources are valuable, rare, and inimitable and have no substitute. Human intellectual unlike other resource possesses key ingredients like knowledge, skills and ability which allows human resource to create value to the organization improving individual¶s efficiency and efficacy for developing sustainable competitive capabilities. Comparing to other intangible resources, HR is more likely to produce competitive because of their rarity and difficulty in imitation (Khandekar & Sh

Pediatric Health Assessment Pediatric GI and GU Eval from An FNP Perspective

Please respond to at least 2 of your peer’s posts, from an FNP perspective. To ensure that your responses are substantive, use at least two of these prompts:

Do you agree with your peers’ assessment?
Take an opposing view to a peer and present a logical argument supporting an alternate opinion.
Share your thoughts on how you support their opinion and explain why.
Present new references that support your opinions.

Please be sure to validate your opinions and ideas with citations and references in APA format. Substantive means that you add something new to the discussion, you aren’t just agreeing. This is also a time to ask questions or offer information surrounding the topic addressed by your peers. Personal experience is appropriate for a substantive discussion and should be correlated to the literature.Be sure to review your APA errors in your reference list, specifically you have capitalization errors in some words of the titles. Also, be sure you are italicizing titles of online sources.
Vivek’s Response

You are managing the primary healthcare needs of a newborn who was born with Hirschprung’s disease. What will you expect to see at the 1 month well child exam? What information will you obtain from the father who has brought the baby to the appointment? When will you have the baby return to clinic to see you?

Question 1 – Hirschprung’s Disease
Hirschprung’s disease is a rare but serious birth defect in which nerve cells responsible for peristalsis in colon are missing or unable to fire. This causes problems passing stool. If a newborn infant does not pass meconium within 24–48 hours after birth, Hirschprung’s disease should be suspected (Szylberg, & Marszałek, 2014). Other symptoms include distended abdomen, diarrhea, constipation, gas, and/or vomiting. Around 80% of patients in the first months of their lives demonstrate defecation problems and, additionally, dietary problems, delayed physical development, significant flatulence, and emesis; other patients do not show any symptoms until late childhood, when the clinical symptoms include chronic constipation, malnutrition, and physical development delay (Szylberg, & Marszałek, 2014). Without proper treatment at an early age a significant group of children may suffer from severe complications later in life such as acute enteritis or toxic megacolon.
Assuming this child was not treated by surgery, at 1 month of age I may find bowel obstruction, constipation, and/or enterocolitis (Bhatnagar, 2013). Signs may include distended abdomen, bilious vomiting, fever, dehydration, lethargy, and occasionally dilated peristaltic loops visible on the per abdominal examination. Whether surgery was completed or not, I would ask the father questions pertaining to the complications mentioned. I would ask about any continuing defecation issues, trouble feeding, stool characteristics, and infant behavior. If the infant had a colostomy, I would ask about stoma care at home. According to the American Academy of Pediatrics, most infants and children can experience some constipation following the surgery (Bhatnagar, 2018). So this is something to assess for. Signs of constipation may include fussiness, bloating, difficulty passing stools, and lac of stools. Laxative can help. Health management of a newborn requires different healthcare professional including the surgeon, gastro, and primary care. If the newborn has no had surgery, a visit with the surgeon should be completed within a couple weeks. During regular PCP visits, referrals can be made to accordingly. I would advise the father to immediately reports temperature of 101° F or higher, redness or fluid at the incision, or no bowel movements in a day. During regular PCP visits, referrals can be made to accordingly.
Reference
Bhatnagar, S. N. (2013). Hirschsprung’s Disease in Newborns. Journal of neonatal surgery, 2(4), 51.
Szylberg, L., & Marszałek, A. (2014). Diagnosis of Hirschsprung’s disease with particular emphasis on histopathology. A systematic review of current literature. Przeglad gastroenterologiczny, 9(5), 264–269. doi:10.5114/pg.2014.46160

Amanda’s Response:
You have just finished assessing a 5-year-old girl for complaint of dysuria who presents with a fever of 102, nausea, and right flank pain.
What is your clinical suspicion?
Acute pyelonephritis.
In order to make a proper diagnosis a thorough history and physical exam must be performed. Cystitis is an inflammatory condition of effecting the bladder. Cystitis includes symptoms of dysuria include; foul smelling urine, painful urination, urinary urgency/frequency, hematuria, and suprapubic pain (Bitsori, & Galanakis, 2012). Pyelonephritis is an infection of the pelvis and parenchyma of the kidney (Bitsori, & Galanakis, 2012). Symptoms of pyelonephritis include; abrupt onset of symptoms, fever, chills, and flank pain (Bitsori, & Galanakis, 2012).
What testing will you order to assess the condition?
In clinic urine dipstick: To assess for leukocytes, nitrates, blood, and protein.
IF the in clinic dipstick was > +125 leukocytes, I would send the specimen for culture to confirm organism growth.
What is your plan of care including treatment recommendations and their rationale?
After reviewing this patient’s symptoms, it appears she is able to take oral medications. She has not experienced any vomiting. Depending on the patient’s allergies – I would chose a seven day course of oral Bactrim or Augmentin for treatment. A 7 day course of antibiotic treatment is recommended for the treatment of pyelonephritis (Bitsori, & Galanakis, 2012). I would initiate treatment immediately and not delay treatment pending results of the urine culture. Prompt treatment of urinary infections is believed to reduce the risk of renal scarring (Saadeh, & Mattoo, 2011). Studies have shown increased infection resolution rates with Bactrim versus a Penicillin only medication (Van Niel, 2011). This is believed to be attributed to the increased rates of e coli (Van Niel, 2011). I would identify if this was a recurrent infection for the patient. If the patient had experienced repeated urinary infections I would obtain renal imaging. Renal imaging is helpful to identify abnormalities and risk factors that can be modified and decrease infection recurrence (Saadeh, & Mattoo, 2011). Parental education is imperative to the success of the treatment plan. I would educate this patient’s parents regarding the medication schedule and importance of completing the regimen. I would provide education regarding proper urinary hygiene i.e. proper wiping. I would provide a list of concerning symptoms to return to the clinic or go to the emergency room. I would recommend the parents encouraged fluid hydration to reduce the risk of dehydration. The parents may also administer acetaminophen for fever control and discomfort. I would schedule this patient a follow up appointment in 10 days for a repeat urine dipstick to ensure the infection had resolved.
References
Bitsori, M., & Galanakis, E. (2012). Pediatric urinary tract infections: Diagnosis and treatment. Expert Review of Anti-Infective Therapy, 10(10), 1153-64.
Saadeh, S. A., & Mattoo, T. K. (2011). Managing urinary tract infections. Pediatric Nephrology, 26(11), 1967-76.
Van Niel, C., (2011). Which antibiotics are prescribed for pediatric ambulatory UTI? Journal Watch.Pediatrics & Adolescent Medicine