Establishment Clause

The folowing post has two assignments namely;

1.Establishment Clause

Over the last two centuries, there has been an apparent erosion of the Establishment Clause. Please explain how and why this erosion has occurred, and whether you agree with the judicial rationale that has allowed this erosion to occur.

2.Hematologic and metabolic Disorder

• Review “Endocrine and Metabolic Disorders” and “Hematologic Disorders” in the Burns et al. text. • Review case study one: Case Study 1: You see a 1-week-old Asian infant for a weight check. The infant is back to his birth weight and is breastfeeding for 10 minutes every 2 hours with one 3-hour stretch a day. He is alert, has bowel movements with each feeding, and wets 8–10 diapers a day. His blood type is A+ and his mother’s blood type is A+. Coombs’ testing at birth was negative. You note slight scleral and skin jaundice. • Analyze the patient information. • Consider a differential diagnosis for the patient in the case study one. • Think about the most likely diagnosis for the patient. • Think about a treatment and management plan for the patient. Be sure to consider appropriate dosages for any recommended pharmacologic and/or non-pharmacologic treatments. Consider strategies for educating patients and families on the treatment and management of the hematologic or metabolic disorder. Diagnosis and Management of Hematologic and Metabolic Disorders In clinical settings, pediatric patients often present with hematologic and metabolic disorders such as anemia and diabetes. Many of these disorders are manageable with drug therapy and lifestyle changes, but they can pose serious complications for patients if left untreated. In your role as the advanced practice nurse, you must identify patients at risk of hematologic and metabolic disorders and provide the appropriate education for them and their families. Consider potential treatment, management, and education strategies for the patients in the case studies one. Sample 1. Case Study 1: You see a 1-week-old Asian infant for a weight check. The infant is back to his birth weight and is breastfeeding for 10 minutes every 2 hours with one 3-hour stretch a day. He is alert, has bowel movements with each feeding, and wets 8–10 diapers a day. His blood type is A+ and his mother’s blood type is A+. Coombs’ testing at birth was negative. You note slight scleral and skin jaundice. Differential Diagnoses 1. Physiologic Jaundice- Physiological jaundice peaks on day 4 or 5. It slowly goes away over 1-2 weeks. 2. Breast milk Jaundice- Due to substance in breastmilk which blocks destruction of bilirubin. 2. Hemolytic anemia- red blood cells are destroyed and removed from the bloodstream before their normal lifespan is over. 3. Gilbert’s Syndrome- Inherited condition in which the liver doesn't properly process bilirubin. 4. Acute anemia- a reduction in the number of circulating red blood cells (RBCs), the amount of hemoglobin, or the volume of RBCs. In reading the case study it appeared to be a pretty cut and dry case of newborn jaundice but I have learned during this course that children are anything but cut and dry. Where I see an easy answer I have learned to double check myself. In this case study a 1-week old Asian infant is back to birth weight and breastfeeding for 10 minutes every 2 hours which is typical with a 3-hour stretch a day. His BMs are regular and there are no crossmatch concerns. A population-based cohort study done in Washington State by Setia, Villaveces, Dhillon, and Mueller (2002) states that infants of full East Asian parentage were more likely to be diagnosed with jaundice than were white infants. Neonatal jaundice, a normal transitional phenomenon in most infants, can occasionally become more pronounced. Physiologic jaundice occurs in 50% of newborns with an onset occurring in the first two to three days of life and peaking at approximately a week and then improving by 2 weeks of life. However, in some infants it can be a symptom of an underlying pathological condition, which is important to identify. In this case, the underlying cause must also be treated (Hansen, 2017). Treatment and Management When a newborn has jaundice, it is important that bilirubin levels are monitored closely. High levels can lead to kernicterus, a condition marked by severe neural symptoms associated with high levels of bilirubin in the blood (Center for Disease Control and Prevention [CDC], 2016). If the baby does not drink enough milk, this can lead to increased bilirubin. Early, frequent, and unrestricted breastfeeding helps to eliminate bilirubin from the baby's body. Breastfeeding results in lots of soiled diapers because mother’s milk has a laxative effect. Bilirubin exits the body through the infant's stool thus lowering bilirubin levels (Burns et al., 2017) The newborn should breastfeed a minimum of eight times per day, if necessary a lactation consult can be made to assist in latching or breastfeeding. Phototherapy can be used to eliminate bilirubin through the blood. It is important to educate the parents regarding jaundice and what to look for. Instruct the parents to call the doctor if the baby has had a decrease in wet diapers (four in 24 hours); has had trouble nursing; is very hard to wake, sleepy, or hard to feed; cannot be comforted, has a shrill and high-pitched cry or both; has strange eye movements or is limp or floppy. Do not place the baby in direct sunlight as this could cause sunburn and not a safe treatment for jaundice.