Research Topics: Cardiovascular Problems

Strategic Analysis for Pfizer Incorporated

Strategic Analysis for Pfizer Incorporated   Industry Analysis             Healthcare has been the concern of many great nations since ancient times. Plagues and illnesses have ravaged lands, causing great catastrophes and deaths. Famine and diseases have killed more people around the world than any war fought by any great empire or nation in history put together. Since these things tend to be more and more an important matter than anything else, the different countries started to take a better look at the situations concerning health. One of the movements that were advocated in the 1800’s was “Clean Living” movement. This was concerned with the control of alcohol and tobacco use and female’s reproductive health.             The industry of pharmaceutical products in the international context is in the verge of change. Constant failure of the product, expiries, and constant increase of competition has compelled many global pharmaceutical companies to cut of the cost of production but of course, kept the product at a certain degree of quality. Healthcare achieved one of its greatest heights in the year 1849, as Pfizer Inc. was founded. Charles Pfizer and his cousin Charles Ehrhardt founded Pfizer in order to give the masses better and easier access to quality medicine and healthcare. They founded the company in a redbrick building in Brooklyn, New York. In the dawning of a new century, Pfizer pioneered the mass production of citric acid from sugar using the aid of mold fermentation. In the 1950’s, they continued funding on research intent on harboring further success for the company. And so they did. The year 2000 saw the merge of Pfizer to Warner-Lambert and Pharmacia to create a faster and more efficient pharmaceutical company.   In their company statement: “Pfizer Inc, founded in 1849, is dedicated to better health and greater access to healthcare for people and their valued animals. Our purpose is helping people live longer, healthier, happier lives. Our route to that purpose is through discovering and developing breakthrough medicines; providing information on prevention, wellness, and treatment; consistent high-quality manufacturing of medicines, consumer products; and global leadership in corporate responsibility. Every day we help 38 million patients, employ more than 100,000 colleagues, utilize the skills of more than 12,000 medical researchers, and work in partnership with governments, individuals, and other payers for healthcare to treat and prevent illnesses—adding both years to life, and life to years.”             Pfizer is the leading pharmaceutical company in the world. It caters to human consumers, as well as animals. Pfizer has two main product lines: (1) human and animal pharmaceuticals; and, (2) consumer products.       Pharmaceuticals (Around 81% estimated revenues as of 2001 against the 96% estimated revenues in 1996)   “* Human Pharmaceuticals (77% of revenue) include such products as: Lipitor (an anti-cholesterol drug representing 17% of total revenue); Norvasc (hypertension and angina, 11 %); Zoloft (anti-depression, 7%); Zithromax (antibiotic, 5%); Viagra (erectile dysfunction, 5%). These, and three other leading drugs, represent nearly three-quarters of revenues from human pharmaceuticals.   * Animal Pharmaceuticals (4% of revenue) includes anti-inflammatoties, anti-parasitics, vaccines, and anti-infectives for `companion animals’ and livestock.   Consumer products (19% vs. 4%) Pfizer’s consumer products include highly-recognized brands such as Listerine (mouthwash), Benadryl (antihistamine), Zantac (anti-heartburn), Rolaids (antacid), Benylin (cough products), Efferdent (denture cleanser), and Neosporin (antibiotic ointment).   The company also sells confectionery products like Halls, Dentyne, Trident, Certs, and Clorets.” ( 2002).   Pfizer products are mostly sold in the following areas: United States (61 %   of revenues); Europe (20%); Japan (7%); and, other countries (12%).(Canadian   Shareowner Magazine Inc., 2002).   Strategic Analysis Competition, typically the most powerful external force, is increased by the advent of globalization. The number of companies and the number of countries where these companies operate and the way governments are dealing with the impacts of globalization is accelerating. The interaction of changes in government policy and business innovation has actually made globalization even faster. If a company does not become a global, it would simply be shut out of new markets. The reasons for the turmoil are numerous: a sputtering economy, increased global competition, the implementation of new technologies that displace jobs, the deregulation of certain industries, and the general consolidation of other industries, such as banking and health care. Observers will see a continuing progression in the ruinous steps which have forced the industry into a socio-politico-economic corner. The industry is likewise linked closely to the policies of governments, the earnings of banks. The industry’s approach to dealing with political institutions has not always been brilliant. It tends to be good on technical issues, although it has not always fully presented the longer-term options, in order to make the choices and their implications clear.             A competitive and complex make-up would thoroughly describe the structure of the pharmaceutical industry of today. Many companies are coming out of nowhere and are competing with some of the world’s oldest and most trusted pharmaceutical companies. The demand for high quality medicine never lessens. And so, competition is always an item. Industries strive hard to make medicine which is much more effective and cost-efficient than the rest.  But how can one address and meet the demands of people? With the use of marketing strategies. A marketing strategy, as we can clearly understand, is a way of using all the resources you have in order to gain a better marketing opportunity. Though, a person may have limited financial, or whatever resources that he has limited supply of, he can still be able to pull off a great advantage in the marketing world through good marketing strategy. A great marketing strategy is the foundation of a great marketing plan. And just what is a marketing plan? It is an overall plan on how the producer is going to tackle the different components of selling his product. A marketing plan often entails the help of a great marketing strategy. For example, “Use a low cost product to attract consumers. Once our organization, via our low cost product, has established a relationship with consumers, our organization will sell additional, higher-margin products and services that enhance the consumer’s interaction with the low-cost product or service.” (2007)             Pfizer Inc. is in the verge of the 21st century, with it, a myriad of competition that is also out to please the clients with effective products but for less. Though Pfizer has outlasted more than a century of competition and major blows to its production, it may still be of great importance to assess the environment into which Pfizer is currently included.             There are more than a hundred pharmaceutical companies in the United States alone, and over 42 large international pharmaceutical companies. Pfizer is one of the largest pharmaceutical companies in the world and has extended its reach to more than a hundred countries around the globe. It was a good move for Pfizer to establish international ties with many countries since it may strengthen their stronghold, not only in that country but globally as well, increasing its edge against other pharmaceutical giants.             Also, establishing stronghold in other countries could potentially mean new breed of clients. Also, this could help in their move to create better and higher quality medicines.             Furthermore, this can help establish and strengthen economic and international ties. By becoming a bridge between two countries, one can help bring understanding between the two and eventually establish ties that may be beneficial to both countries. Moreover, one may be able to find more potential business partners in exporting to other countries. One may find a business partner that is willing to cater to and audience of Pfizer’s pharmaceutical products from another country. According to their statement, citizenship defines their part in the international communities; therefore, it also defines their conduct, so as to help make the world better. In this statement, one can conclude that being part of an international community, for Pfizer, may help not only bring in profit but also help the world in Pfizer’s own pace and way. Environmental influences, such as diseases and illnesses form the need for pharmaceutical companies like Pfizer. Having such needs may help in strengthening the company. The constant demand for products that the company produces may increase their production rate, also their potential income. As mentioned in the theory of Supply and Demand, there is a relationship between the increase or decrease for a product and the increase and decrease for the supply of the certain good. It also includes the part played by the price.             Other environmental influences, such as competition, may fuel the company’s desire to create more and better products that could well determine their location and standing in the global market. Increase in the number of competitors for the same line of products may mean that there would be divided and unequal attention among the audience and consumers. Therefore, the company must either strive hard to create better and more effective and efficient products, or to lessen the value of each product to capture the consumer’s attention or to do both.       Environmental Scanning             Environmental scanning is a method in the area of management wherein different management teams take into consideration environmental factors that may give them better competitive edge than other companies. There are generally three ways to conduct environmental scanning; we shall employ the factors used in scanning the Macroenvironment.   Competitor Analysis             For this area in environmental scanning, we shall evaluate the four (4) potential and currents competitors of Pfizer incorporated. Ø  Bristol-Myers Squibb- a pharmaceutical company based in the United States. It produces prescription drugs, over-the-counter (OTC) drugs and products that involve therapeutic aspects. It is also the mother company of Mead-Johnson, a company that specializes in the manufacture of baby formulas and other infant and mother care products. Its healthcare revenue on 2004 (USD Millions) summed up to 47,348; its healthcare R&D in 2004 (USD millions) summed up to 5,203; its Net income/ loss in 2004 (USD millions) summed up to 8,509 while the number of its employees sum to 109,900. It ranks only second to Pfizer Inc. in this survey. Ø  GlaxoSmithKline- a pharmaceutical company based in the United Kingdom, second to Pfizer, which specializes in many products. This may include the following: anti-infectives, central nervous system (CNS), and respiratory, gastro-intestinal/metabolic, oncology and vaccines products. It is a research based company which is the product of constant change and mergers. Its healthcare revenue on 2004 (USD Millions) summed up to 37,318; its healthcare R&D in 2004 (USD millions) summed up to 5,204; its Net income/ loss in 2004 (USD millions) summed up to 7,886 while the number of its employees sum to 100,619. Ø  Sanofi-Aventis- a company based in France which specializes in the field of cardiovascular, thrombosis, oncology, diabetes, central nervous system, internal medicine and vaccines (with its subsidiary Sanofi-Pasteur). It also produces prescription and OTC products. It is a product from the merger between Sanofi-Synthélabo and Aventis in 2004. Its healthcare revenue on 2004 (USD Millions) summed up to 31,615; its healthcare R&D in 2004 (USD millions) summed up to 4, 927; its Net income/ loss in 2004 (USD millions) summed up to 6,526 while the number of its employees sum to 96, 439. Ø  Novartis- a pharmaceutical company based in Switzerland. It produces products such as dietary fiber supplements, Benefiber and the antifungal preparation Lamisil. It was a product of a merger between Ciba-Geigy and Sandoz Laboratories, both with a long history in their itineraries. Its healthcare revenue on 2004 (USD Millions) summed up to 28,247; its healthcare R&D in 2004 (USD millions) summed up to 4.207; its Net income/ loss in 2004 (USD millions) summed up to 5,767 while the number of its employees sum to 81,392. (2007). According to, there are six ways to react to an issue. These are: Ø  opposition strategy – try to influence the environmental forces so as to negate their impact – this is only successful where you have some control over the environmental variable in question Ø  adaptation strategy – adapt your marketing plan to the new environmental conditions Ø  offensive strategy – try to turn the new influence into an advantage – quick response can give you a competitive advantage Ø  redeployment strategy – redeploy your assets into another industry Ø  contingency strategies – determine a broad range of possible reactions – find substitutes Ø  passive strategy – no response – study the situation further (2007).   In the above competitor profiling, we can conclude that Pfizer has an edge over all these competitors since it ranks first in this survey and remains to be first. Consumer Analysis             In marketing, there needs to be effective lines of communication between both the company and its customers. Pfizer does this by listening to what customers need and what they think about their products/services, this is done via several different methods, such as postal questionnaires and on line surveys, the information obtained enables Pfizer to knowing what the customers want. It then communicates to the customer through advertising, sales promotions etc, aiming at a specific target market, giving consumers the information on buying their products.             But sometimes there can be a problem with making sure effective communication takes place, for example other consumer’s opinions, and critics and reviewers etc. Companies must also be aware that any impartial advice given to customers by the media or other agencies can support or damage its own marketing communications. Many types of analysis falls into this category, all employ the use of surveys. Since time and the audience is a luxury that we do not have, we shall move on to the next aspect of environmental scanning which are product innovations.   Product innovations             Pfizer’s newest products are very well received by the needing masses. An example of which is the product Spiriva. Spiriva is a product which treats chronic obstructive pulmonary disease. It is inhaled once a day.   PEST Analysis             The pharmaceutical industry must always be on the move, always on the edge and always first in creating innovations and products that help extend the life of mankind. The industry faces a need for accelerated investment, in order to deploy the new technologies, for pressing geo-political, economic, environmental and societal reasons.             Political. Observers will see a continuing progression in the ruinous steps which have forced the industry into a socio-politico-economic corner. Whether this is related to flat demand or to the industry’s creation of an ever-wider range of products that many buyers seem to care little about, there is a problem. The industry is likewise linked closely to the policies of governments, the earnings of banks. Little wonder then that so many emerging countries are keen to develop a sector that deals with the regulation of pharmaceutical products or that there is such a political pressure to protect it in the developed countries. The world’s pharmaceutical industry is currently dominated by little more than a handful of firms, each wielding colossal financial, emotional and political power. The industry’s approach to dealing with political institutions has not always been brilliant. It tends to be good on technical issues, although it has not always fully presented the longer-term options, in order to make the choices and their implications clear.             In the aspect of Pfizer Inc., it has dealt with political factors rather brilliantly. It continues to provide very satisfactory benefits and wages for its 115,000 employees. Pfizer continues to cater to the needs of their employees and their families. They provide benefits and fitting wages and overtime.             Also, Pfizer continues to recognize its responsibility to the government. As of 2004, Pfizer paid 2,665 (million) as tax.             Economic. . For much of the developed world, and increasingly for the developing world, the pharmaceutical industry is a pillar industry, a flag of economic progress. Without the existence of the pharmaceutical industry, it would be quite impossible to aid the existence of other sectors. One must remember that the aspect covered by the pharmaceutical industry is something not to be toyed with. It includes the wellbeing of all, thus, no other sector would continue to exist if this sector is annihilated from the whole of the economic world. The pharmaceutical industry has been a core industry, a unique economic phenomenon, which has dominated not only the twentieth century, but also the centuries even before modern civilization began. However, the industry now suffers from a series of structural schisms and has become riddled with contradictions and economic discontinuities. For the capital markets and the finance sector, it has lost a lot of its significance, as a result of ever declining profits and stagnant sales. The proliferation of products means that it has become hopelessly wasteful of economic resources. While all these and more sound like a very gloomy assessment of such a vast economic phenomenon, the industry is not in the end despondent. A different future is possible for the industry, a highly desirable one.             As for Pfizer Inc., Its investment in different countries can trigger different outcomes for it. The economy usually depends on stability of the economy itself and currency stability. But if the country chosen by Pfizer to host its production has minimal salary demanding workforce, it would be a great choice.             Social. The world’s pharmaceutical industry affects the society as a whole. It employs millions of people directly, tens of millions indirectly. Its products have transformed society, bringing undreamed-of levels of healing and continuous renewal of wellbeing, changing the ways people live and work. The social value of the elevated sense of health and cure that this industry brings involves the value of the people being able to live a healthier lifestyle and that those on the brink of illnesses or even death can be nursed back to health, among many others. For most of its existence the pharmaceutical industry has been a model of social discipline and control and it is not just that the pharmaceutical sector offers a ‘pillar’ of something else. There are, on the other hand, particular social issues to address in many developing countries, often those that are the result of an undertone of religious faith. The pharmaceutical has the role to play in helping develop the impairment  of such countries and it can be achieved at an acceptable social cost of the country is prepared to learn the necessary lessons from those who have traveled this route before it, and to make the necessary investments.             In the context of Pfizer, the world is in continuous need of quality medicines and healthcare products. Though the world contains varied audiences, it is impossible that none would like to live longer or healthier. No matter what concept or religion they believe, a community in need will always seek out the help of medicine. Technological. The pharmaceutical industry works on a scale so awesome and has an influence so vast that it is often difficult to see. The level and diversity of technologies that it must deploy are increasing, which imposes both new investment burdens and new uncertainties and risks. Roughly a million new products are created around the world each week – they are easily the most complex products of their kind to be mass-produced in such volumes. The industry uses manufacturing technology that is the cutting edge of science. But still, the potential for developing coordination skills, intellectual capabilities and emotional sensitivities through electronic technologies remain far from fully exploited. There are numerous additional near-term technological opportunities to adapt the automobile to changing energy availability. The possibilities suggest that pharmaceutical industry is unexpectedly robust and provides a powerful defence against energy starvation even if the real price of energy climbs steadily during the next couple of decades. Pfizer is always on the edge; always on the verge of creating new products with the intent to help the debilitating sickness that mankind succumbs to everyday. Due to the advent of new technology, it will be easier to create quality products which would aid the continuous search for immunity to diseases, even immortality. The aid of technology has brought new hope to people around the world who are down with sickness and disease.           SWOT Analysis STRENGTHS Ø  Number one, largest pharmaceutical company in the world- Due to the fact that it is the largest and one of the most successful brands in the world, this contributes greatly to its income and revenues. Ø  Popularity of its products- Since the products are popular, we can conclude that this may be one of the reasons that contribute to its spot among the pharmaceutical giants of the world. Ø  Reputation of quality   WEAKNESSES Ø  Due to being the largest pharmaceutical company in the world, it may have too many branches and many of which may not be as supervised as others. Ø  It may sacrifice the quality of its products due to the high demand. It may resort to cost-cutting and therefore, may lose the initial quality of its popular products.   OPPORTUNITIES Ø  To merge or take over potentially profitable companies in small countries. Ø  Establish a stronghold in as many countries as possible. Ø  Outnumber competitor’s production and invest more on media advertisement.   THREATS Ø  Competitors. Having many competitors for a certain product may lessen the chances of having better reception for that product. Ø  Unstable economy. An investment to a country with an unstable economy may lessen the chance of a good stronghold in that country.   As of the moment, the company has a wide range of products, from OTC drugs to prescription drugs. Since it caters to a variety of audiences around the world, it has ensured for itself a place as the top pharmaceutical company.   Company Profit             As of 2006, the company’s Net income has been , 337 (million). The amount can be located in the company’s financial statement review for the year 2006. In the financial statement:    “Performance-based contracts are with managed care customers, including health maintenance organizations and pharmacy benefit managers, who receive rebates based on the achievement of contracted performance terms for products. Rebates are product specific and, therefore, for any given year are impacted by the mix of products sold. Chargebacks (primarily reimbursements to wholesalers for honoring contracted prices to third parties) reduced revenues by .4 billion in 2006 and .3 billion in both 2005 and 2004. In addition, chargebacks were impacted by the launch of certain generic products in 2006, 2005 and 2004 by our Greenstone subsidiary.” According to the historical Revenue Profile, the increase of revenue for Pfizer has been about 17% on average per year. In the study conducted, the revenues for Pfizer shot up to 26%, but on te initial 9 months of 2001, revenues only amounted to 9%. But estimated revenues for 2001 were about 32 billion dollars, about 8% more than the year 2000.             In my opinion, the aspect of the income of the company should be greatly highlighted since it deals much with how the company would look like after a long time. The revenues of the company should be taken into consideration since this will form a part in the development of the company.             In the next five years, this aspect of the company, hopefully, should be on the verge of continuous increase. According to the previous financial statements of the company, the trend of the income should continually increase, except maybe for a few minor, uncontrollable setbacks. The company’s income should continually be monitored and if in any case the rates should go down. If the case is such, the management should look into the matter right away and should identify the key factors that made the trend fluctuate.             In the case of Pfizer, in five years time, the company income should continue to rise. And they should also be able to overcome setbacks.     Stakeholders “Stakeholders are people or groups who affect, or are affected by, Pfizer’s business activities. Our relationship with them is at the heart of our citizenship because they define what it means for Pfizer to create value. They are the ones who will determine when Pfizer fulfills its mission to become the world’s most valued company to stakeholders.” ( 2007). According to Pfizer, citizenship defines their part in the economic world. The company strives to create better services to its customer and its stakeholders. Stakeholders include the following: Our stakeholders include: •           Patients •           Health Care Professionals •           Caregivers •           Governments •           Regulatory Agencies •           Employees and Retirees •           Investors •           Business Partners •           Suppliers •           Academic Institutions •           Multilateral Organizations •           Non-Governmental Organizations •           Media             The company continues to strive to create products that meet the demands of the different stakeholders. Their definition of good corporate citizenship includes listening to, understanding, and responding to the stakeholders about matters with regards to Pfizer’s policies and operations.             According to Pfizer, they would create more value services to their stakeholders with long-term relationship in mind. Ø  First, we will be more intentional about coordinating across Pfizer’s business units to share the learnings from our many local and global partnerships. Ø  Second, we will reach out to more stakeholder groups and be ready to listen with an open ear and open mind. Ø  Third, we will seek partners who are willing to break out of the view that health care access is a “zero-sum” game, where some win while many lose. (2007). Since the topic is much concerned with the relevance of effective governance to the company’s behavior and performance, it is very wise to include the stakeholder theory in it. Stakeholder Theory is relevant to the topic since it deals mostly with the interest of the shareholders of the company, also including with it the interest of people who are part of the system. Since it helps in directing the company, it is possible that it also helps in giving out positive effects to the company’s welfare. It brings with itself the morality clause, therefore controlling and putting into perspective the behavior of every the organizations included in the system. Also, effective corporate governance is mostly concerned with the efficiency of the firms that are part of the institution.   The Future for the Pharmaceutical Industry       The pharmaceutical industry has been depended upon by other industrial sectors to provide them with means with which to optimize their investment capital because of the transfer of its technology, which basically means that the manufacturing and materials handling processes that revolve around mass medicine and product production will be, in the future, far removed from their original use through consulting engineering firms that undertake to design and equip factories. The tendency for pharmaceutical companies, then, will be to focus on competition that would become more rigorous, giving special attention to profit-gaining activities and concentrating also on arranging for financial, marketing and industrial cooperation among pharmaceutical companies.             The growing pressures of the global economy could result in the profound consolidation of car manufacturer giants. To that end, perhaps the rest of the world should hold its breath in the anticipation of what might transpire in this industry where innovation is first and foremost, the competitive edge.             The pharmaceutical companies should strive to create betters products which seek to continually inspire the need to live for others. Profit should not be the basis for making medicinal and healthcare products, but the health and wellbeing of individuals in need.             In today’s business world, the value and importance of customers is not something that should be set aside by companies. Marketing plans that includes forecasting and budgeting and strategic planning would be incomplete without paying much consideration to the customers. Customers will always be a part of the agenda in any marketing plan of any company. Because of the implications for profitability and growth, customer retention is potentially one of the most powerful weapons that companies can employ in their fight to gain a strategic advantage and survive in today’s ever increasing competitive environment (1998).             The company can strategically implement the enumerated short-term and long-term plans through specific goals and objectives. By identifying all the possible problems arising in the company, an entrepreneur can think of some solutions and in turn boost the morale of their employees to regain their trust for the company, and therefore, maintain the company’s good reputation. An employee’s motivation serves as the key when it comes to his or her performance in a certain business firm or company.    The Future for Pfizer Inc. The following assessment has been done by the Canadian Shareholder’s Magazine on 2002. Demographics. Future growth in the demand for Pfizer’s drugs is expected to come from the `demographic bubble’ of aging baby boomers who increasingly require drug treatments.   Patents. As with all drug companies, competition from generic drug manufacturers is a major consideration when patents* expire. Pipeline. Future growth is also expected to come from Pfizer’s new-product research and development (“R&D”). With an estimated R&D investment of .8 billion in 2001 (15% of revenue) the company expects to continue developing new drugs such as: 1) Geodon (an anti-psychotic drug for treating schizophrenia) to compete with Eli Lilly’s Zyprexa – Geodon has a lower incidence of side effects (in particular, a lower incidence of weight gain); and, (2) Spiriva which is used to treat chronic obstructive pulmonary disease and which is expected to generate about billion in annual sales after its launch in 2002. Core Standards. Also, recently announced new guidelines for managing cholesterol levels are expected to potentially double the market for cholesterolreducing drugs. New Applications. Pfizer also expects to increase sales through product management (e.g. developing new applications for existing drugs). ( 2002).             Though as was mentioned by Pfizer, they should continue to create strong bonds with their consumers. The basis for making quality medicine should be for the greater good, not for greater profit.  “Enterprises are recognizing that stronger and more-enduring customer relationships are critical to long-term profits. Most marketing organizations are at least conceptually well-situated to drive customer centricity, via a more-strategic approach that is focused on delivering value around customers and customer segments. To be effective, however, the marketing function must evolve from focusing on products and transactions into placing more emphasis on customers and relationships that are aligned with enterprise goals and strategies. However, most marketing organizations face several critical challenges: “   Credit:ivythesis.typepad.com

Strategic Analysis for Pfizer Incorporated

Strategic Analysis for Pfizer Incorporated Industry Analysis Healthcare has been the concern of many great nations since ...

Article Critiques

ARTICLE CRITIQUES     Newborn with a Scalp Lesion             The article presents an image of a newborn infant with a lesion and proceeds to discussing the diagnosis of the abnormality in the newborn. The article discusses the conditions, causes, complications and some forms of treatment of “aplasia cutis congenita”, the disease of the patient. The article states that this disease is a complex disorder that can sometimes involve other abnormalities in the cardiovascular, gastrointestinal, genitourinary, and central nervous systems of the person suffering from it. It has no established causes but several factors such as teratogens, genetic, trauma and compromised skin perfusion can contribute to the presence of the condition.  (2006) states that defects in the skin that develop early in gestation may heal before delivery and may occur as an atrophic or parchment-like scar while less mature defects manifest as ulcerations. Most lesions appear in the scalp vertex but defects may also manifest on the face, trunk, or limbs. Langerhans cell histiocytosis affects many organ systems and the scalp manifests scaling patches. Sebaceous nevus is characterized by yellowish and hairless lesions in the scalp or face. Neonatal herpes manifests as scalp ulceration while transient bullous dermolysis is a disease characterized by development of blisters in the epidermal layer of the skin. Focal dermal hypoplasia is common in women and is characterized by skin abnormalities. Treatment may include gentle cleansing, ointment, antibiotics, excision with primary closure, use of tissue expanders, skin and bone grafts, and complete osseous regeneration (2006). Childhood Discipline: Challenges for Clinicians and Parents                 The article tackles childhood discipline as a responsibility of both parents and clinicians. The article works on the notion that family physicians and pediatricians often fail to incorporate topics about discipline in their well-child examination sessions with parents. It also affirms that discipline is a vital element of a child’s normal development thus, it should be done properly. Accordingly, the article first explains the biological and psychological factors leading to misbehavior in children. Then, the article elaborates on the principles of discipline. It argues that discipline should be based on the age and level of understanding of the child, severity of offense and should be consistent, to be effective. Furthermore, the article identifies the methods, advantages and risks of the different types of discipline such as positive reinforcement, punishment, extinction, verbal punishment and corporal punishment. The last part of the article discusses the ways on how clinicians and parents can openly talk about discipline in children without actually imparting scrutiny and criticism of parenting skills. The article concludes that since discipline is an important element of the social and emotional development of the child, it should be an integral part of preventive health program for children.  (1989) agrees with the arguments of the article by saying that discipline is the concern of parents, educators and governments. It should not only be a response to bad behavior in children but should also be a way to teach children on how they would be able to effectively deal with life and cope with problems ().   Clinical Presentations of Parvovirus B19 Infection             The article discusses the different clinical manifestations of Parvovirus B19. Infection with the virus usually results to mild, cold-like symptoms but certain conditions are said to be associated with the virus. Erythema infectiosum, the most obvious manifestation of B19 infection, affects children aged 4 to 10 years old.  (1992) claims that this infection starts with a low-grade fever and general feeling of discomfort. Rashes would appear after 7 to 10 days starting from the cheeks and spreading to the trunk and extremities in a lacy pattern. This infection does not require any oral treatment but calamine lotion and cold water can soothe itching (). Arthropathy is a complication of erythema infectiosum which affects the knees, joints, ankles and wrists. This infection may be treated with a nonsteroidal anti-inflammatory drug. Transient aplastic crisis occurs when B19 virus infects those people with iron deficiency anemia, HIV, sickle cell disease, spherocytosis and thallassemia. This is fatal infection that requires multiple blood transfusions. Furthermore, parvovirus B19 infection can persist in those people who are unable to develop normal immune response and with the absence of antibodies. Chronic red cell aplasia may be addressed by immune globulin therapy. “Gloves and socks syndrome” mostly affects young adults and is characterized by abnormal redness and swelling of the hands and feet. Patients also suffer fever and pains in the joints. Finally, hydrops fetalis occurs when a woman infected with B19 becomes pregnant and infects the infant. The highest risk can be found in the second trimester of pregnancy because of increased hematopoiesis in the liver. Fetal blood sampling and transfusions are required when hydrops fetalis occur in the infant. Credit:ivythesis.typepad.com

Article Critiques

ARTICLE CRITIQUES Newborn with a Scalp Lesion The article presents an image of a newborn infant with a lesion and proc...

Nursing care of patient with PEG feeding

Patient Nursing Care Study Structure   Introduction             Nursing is a profession whose focus is to help the client to prevent, solve, alleviate or cope with problems associated with the activities he or she carries out in order to live. Nurses and midwives may perceive humans as having certain basic (e.g., food) and advanced (support) needs. On occasions, clients may be unable to meet these needs and staff may either assist them or teach them how to meet the needs in other ways or involve family members in meeting the person’s needs. The works (1990), appear to have been influenced by the behavioral paradigm. Within the literature there are many writers who offer the unsubstantiated opinion that using theories would help to improve the quality of care.             In the context of this paper, the activities of daily living according to this model will be applied to a client who has percutaneous endoscopic gastrostomy (PEG) tube for a long term enteral nutrition. PEG tubes may be needed for patients with swallowing disorders. Swallowing disorders are common, especially in the elderly, and may cause dehydration, weight loss, aspiration pneumonia and airway obstruction. These disorders may affect the oral preparatory, oral propulsive, pharyngeal and/or esophageal phases of swallowing. Impaired swallowing, or dysphagia, may occur because of a wide variety of structural or functional conditions, including stroke, cancer, neurologic disease and gastroesophageal reflux disease ( 2000).   Patient profile             Mrs. Valentina, an eighty-four year old lady who is placed under percutaneous endoscopic gastrostomy (PEG) tube for a long term enteral nutrition. Valentina also has moderate impairment and is dependent to maintain her personal cleansing and dressing.             Mrs Valentina was referred to a general hospital five years ago due to food refusal. She was also reported of experiencing regurgitation after eating. For weeks her condition was investigated and different textures of food and supplements were tried to see which Valentina could tolerate. Eventually she managed to take a combination of porridge mixed with supplements and fortified pudding. Still, she finds it very hard to take most solid foods. She was then discharged to a nursing home but her condition worsened which led to re-admission at the same hospital. She was then diagnosed of having oesophageal stricture and oesophagitis. Oesophageal stricture is a narrowing of the oesophagus. In order for her to achieve the best possible nourishment, a PEG was intended for a long term enteral nutrition. Since her discharge back to a nursing home, she has managed much better.   Nursing Framework Enteral nutritional support accesses the gastrointestinal tract and includes both oral supplementation and tube-feeding techniques. Enteral nutritional support should be considered when a patient has functioning intestines but cannot or will not eat. Most patients require a caloric intake of 25 to 35 kcal per kg per day. The choice of route of administration for tube feedings should be based brimarily on the anticipated length of therapy and patient comfort (1996). Percutaneous endoscopic gastrostomy is commonly used for long-term enteral nutrition. However, this approach is itself associated with increased risks of gastroesophageal reflux and aspiration pneumonia ( 2000). Allowing a patient’s nutritional state to deteriorate through the perioperative period adversely affects measurable outcome related to nosocomial infection, multiple organ dysfunction, wound healing, and functional recovery. Careful preoperative nutritional assessment should include a determination of the level of stress, an evaluation of the status of the GI tract, and the development of specific plans for securing enteral access (1999).             Deterioration of nutritional status in the critically ill patient undergoing major surgery is associated with reduced systemic immunity, exaggerated stress response, organ system dysfunction, poor wound healing, and delayed functional recovery. Weight loss, hypoalbuminemia, and other purported signs of protein calorie malnutrition have long been predictors of poor surgical outcome. In the past, perioperative nutritional support has been synonymous with total parenteral nutrition (TPN). A high rate of septic complications and negligible impact on patient outcome with this route of therapy have raised question about the overall utility of nutritional support and the risk of interfering with the normal adaptive metabolic response to injury. Increasing evidence suggests that the “motor” of the multiple organ failure sepsis syndrome is the GI tract, the integrity of which affects immune defenses, organ function, and whether the stress response is provoked or attenuated. Much more consistent and beneficial responses are being seen with the provision of perioperative nutritional support by the enteral route (1999).             Gastrostomy is performed in patients who require prolonged nutritional support and who are unable to maintain adequate oral intake. Enteral nutrition is easier to administer and less expensive than parental nutrition and may be associated with fewer side effects, such as infection and sepsis, than intravenous nutrition. Traditional open gastrostomy has a complication rate of 3 to 61 percent and a mortality rate as high as 37 percent. Percutaneous endoscopic gastrostomy has become a popular method of gastrostomy, supplanting the traditional method. Two advantages of percutaneous endoscopic gastrostomy are that it is technically easy to perform and can be done using local anesthesia (1992).             Administration of enteral tube feeding via a gastronomy tube is a procedure that can be delegated to assistive personnel after tube placement is verified by the nurse. However the nurse still has responsibilities to do. The nurse should ensure that the client is sitting upright in a chair or in bed and instruct the assistive personnel to infuse the feeding slowly. The assistive personnel should also be instructed to report any difficulty infusing the feeding or any discomfort voiced by the client.   Assessment Mrs. Valentina’s need for enteral tube feedings is first assessed. These needs include impaired swallowing, decreased level of consciousness, surgeries of upper alimentary tract, and need for long term enteral nutrition (2004). The rationale for this is that clients who need tube feedings should be identified before they become nutritionally depleted. Enteral feeding preserves the function and mass of the gut, promotes wound healing, diminishes hypermetabolism in burn injuries, and may decrease infection in critically ill clients ( 1994).   Nursing aim             The aim of the nursing care for Mrs. Valentina is to provide her enteral nutrition. Enteral nutrition refers to nutrients given via the GI tract. Enteral nutrition is the preferred method of meeting nutritional needs if the client’s GI tract is functioning by providing physiological, safe, and economical nutritional support. Enterally fed clients such as Mrs. Valentina, receive formula via nasogastric, jejunal or gastric tubes. Gastric feedings may be given to clients with a low risk of aspiration.   Nursing action             Bowel sounds should be auscultated before feeding since absent bowel sounds may indicate decreased ability of GI tract to digest or absorb nutrients. Tube placements should be verified. In a gastrostomy tube, a syringe should be attached and gastric secretions aspirated. Appearance should be observed and the pH checked. The results from pH testing and the aspirate’s appearance should be considered together. On occasion, color alone may differentiate gastric from intestinal placement. Because most intestinal aspirates are stained by bile to a distinct yellow color, and most gastric aspirates are not, the difference can often distinguish sites. The pH aspirate offers valuable data as well in tracking advancement of a feeding tube (Metheny & Titler, 2001). The aspirated contents should be returned to the stomach unless the volume exceeds 100 ml. if the volume is greater than 100 ml on several consecutive occasions, the feeding should be put on hold and the physician in charge notified (1999). Gastric residual determines if gastric emptying is delayed. Delayed gastric emptying may be indicated by 100 ml or more remaining in the client’s stomach from previous feeding ( 2004). The bed’s backrest of the patient should be kept elevated to at least 30[degrees] during continuous feedings; for intermittently tube-fed persons, a head elevated position should be maintained for one to two hours afterward. There is evidence that a sustained supine position (with the head of the bed flat) increases the probability for aspiration pneumonia (1999). When the tube-fed person is able to communicate, the nurse should ask if any of the following signs of gastrointestinal intolerance are present: nausea, feeling of fullness, abdominal pain or cramping. These signs are indicative of slowed gastric emptying that may, in turn, increase the probability for regurgitation and aspiration of gastric contents (2006).   Evaluation             Most serious problems associated with feeding tubes are preventable and include pyloric obstruction from tube migration, leakage, fasciaitis, and wound infection. These complications can rapidly result in significant morbidity and unnecessary discomfort for the resident if the cause is not determined and if corrective actions are not instituted quickly. The length of the feeding tube should be measured at regular intervals to confirm tube position. Gastric contractions can draw a feeding tube inward towards the pylorous which can result in signs and symptoms of bowel obstruction and acute protracted vomiting. If tube migration is suspected, the caregiver should deflate the balloon, pull the catheter back into the stomach, reinflate the balloon and secure the tube snugly against the abdomen. In well-healed tracts, the tube may also be completely withdrawn and reinserted ( 1993). Care for Mrs. Valentina is not complete until the nurse will evaluate outcomes not only of the health care process but her health status as well. If there are significant improvements in the client’s health, then the nurse can evaluate that Mrs. Valentina  has responded well to the procedure. One measure would be to check levels indicated above and assess them. Evaluation reinforces correct behavior in the client. The nurse can evaluate success by observing the client’s performance of each of the expected behavior or goals set (2004). The success of the nursing care highly depends on Mrs. Valentina’s ability to meet the established outcomes and goals. To provide for continuity of care for the patient after discharge, the nurse needs to consider the patient’s needs for assistance with care in the home setting. Discharge planning incorporates for an assessment of the patient’s and family’s abilities for self-care, financial resources, and the need for referrals and home health services ( 2004).   Conclusion             To ensure the continuity of care and restoration of Mrs. Valentina’s health, nurses must meet his learning needs and also those of her support people. Teaching should focus on actions to maintain comfort, to promote healing and restore wellness, and to make use of appropriate community agencies and other sources of help for Mrs. Valentina. The overall goals of nursing care during the period therefore are to promote comfort and healing, restore the highest possible level of wellness, and prevent associated risks such as infection or respiratory and cardiovascular complications.             Credit:ivythesis.typepad.com

Nursing care of patient with PEG feeding

Patient Nursing Care Study Structure Introduction Nursing is a profession whose focus is to help the client to prevent, ...

Culturally Sensitive Nursing Care

Health Assessment   Introduction             The social determinants of health are those instances, situations and environments to which humans are exposed to which causes illness or mortality. Social determinants play a huge role in molding the health of people, especially ethnic groups. According to some studies, ethnic and minority groups are more exposed to diseases and illnesses. One reason for this is the aspect of the social determinants of health. Ethnic and minority groups are more exposed to the harsh social and environmental conditions present in the world. Compared with the majority, minorities have more inclination to get sick and die. According to the Public Health Agency of Canada, some of the social determinants of health are: Income and social status, Social support networks, Education and literacy, e.g. health literacy, Employment/Working conditions, Social environments, Physical environments, Personal health practices and coping skills, Healthy child development, Biology and genetic endowment, Health services, Gender and Culture. Being exposed to different factors would often result in illnesses and even mortality. Studies have been conducted on the different socio-economic groups and the results have often pointed to the ethnicity and status of the group as the cause of the outcome.             It is no longer an enigma to us why so many people from third-world countries with low socio-economic status get sick and die more often than people from the opposite side of the scale. These people are exposed to:  little food, unclean water, low levels of sanitation and shelter, failure to deal with the environments that lead to high exposure to infectious agents, and lack of appropriate medical care. Furthermore, these people suffer from other incommunicable diseases due to the same factors. The World Bank Global Burden of Disease have identified underweight, overweight, smoking, alcohol consumption, hypertension, and sexual behaviour as the major causes of morbidity and mortality around the world.             According to the article, “ A call to action on Maori cardiovascular health” by  the research results state that further research is needed in order to come up with a way to lessen the disparities in mortality rates between the Maori and the non-Maori.  Furthermore, the authors believe that Kaupapa Maori research should be taken in order to fully address the needs of these tribes. According to the authors, when research is done in the perspective of the Maori, the needs of the tribes can be properly addressed and taken into consideration. Furthermore, the Kaupapa Maori research also advocates for the use of Maori: non-Maori comparisons and produces results that have ‘equal’ meaning and relevance to Maori as non-Maori (2004).  Also, the Maori Cardiovascular Advisory Group utilizes research techniques that address the needs of the Maori in the Maori perspective, therefore effectively addressing not only their medical needs scientifically, but socially and culturally as well. Discussion Being a part of a minority group implies a degree of inequity right away. Meaning there is an inherent disadvantage that one acquires to the moment he/she considers himself/herself a part of the minority. This has been the problem in any state with a highly diverse population. Though it is primarily seen in the United States, this situation is not restricted to its boundaries. This takes place in Europe and Asia. ( 1995, 2004) Thus, this establishes it as a universal phenomenon.             Factors that Greatly Contribute to Health Deterioration among Minority Ethnic Tribes             The factors that contribute to health deterioration among minority ethnic tribes are located in almost every exiting country, regardless of its economic status. The following are the reasons why these groups tend to develop illnesses more chronic than those of the majority.   Ø  Economic and Social Factors – The economic and social factors play a great role in determining the health status of an individual. Being in the high rung of the social and economic ladder may not mean that one is exempt from ill health. However, their placement ensures that they get a better degree of treatment for their acquired illnesses. For those who belong to the lower portion of the ladder, however, it would be difficult for them to get treatments for their illnesses. Furthermore, their constant exposure to unhealthy environments, unhealthy food and unhealthy practices can be a sure road to more illness and even mortality. Low socioeconomic may precipitate reduced access to health care, poor nutrition, lower educational levels, and hazardous environments.  Moreover, relationships with significant others involving abusive behavior, poor communication or high stress can negatively affect an individual’s health. For example, a poor aboriginal woman, who is the leader of her tribe, appears to have a successful and happy life. But in fact, she is constantly stressed by the troubles that her tribesmen face everyday, furthermore, less monetary income induces the stress.  Ø  Biological Risk Factors – Some potential health problems are related to biological health risks attributed to the race or blood-related family members. For example, a local tribesman is at risk of having the same illness as his family members, heart failure. This local tribesman is at two times more risk of developing this illness due to the fact that he is a member of a family who is at risk of having this illness than a person who doesn’t have such a family history. Awareness of such health risks may motivate this person to seek medical assistance, if such is available to him. Furthermore, this tribesman can reduce such risks by altering some behaviors that may induce such illnesses. Ø  Environmental Health Risk Factors –Environmental risk factors may be physical or socioeconomic. Physical risk factors are more clearly associated with specific health problems and are usually more amenable to change. For example, a person works with loud machinery and hearing damage is a risk. The risk can be lowered by using ear plugs. It is more difficult to identify health risk factors arising from socioeconomic factors. It may be difficult for an individual to change such socioeconomic factors. For example, consider a member of a minority group, Percival, a single, unemployed parent with four children, living below the poverty level in a rural area. He may be experiencing conditions that negatively affect health, but this may be difficult to identify and correct. Ø  Physical Health Risk Factors – these include air, water, food and noise pollution; radiation exposure; risks from unsafe products; and risks associated with certain occupations and recreational activities. Hazardous occupations may include fire fighting, surface mining, and police work, the lumber industry, working in a quarry, construction or foundry, and working with cement or clay and mineral products.  Many accidents are caused by human failure and may be due to contributing factors such as stress, poor mental health, age and alcoholism. Health assessment through Lifespan             The potential for developing certain health problems correlates with the individual’s age and sex, as well as biologic, environmental and behavioral factors. As one’s age changes, the risk of developing certain health problems also changes. For example, the risk of developing bowel cancer increases after age 50.             People may have similarities, particularly if they are the same sex, age race or cultural group, and if they share the same occupation, recreational activities, and health behavior or health problems. However, each individual also has differences, which account for the uniqueness of each person. In some circumstances, it is appropriate to look at valid and reliable research on a group’s genetic characteristics or similarities and apply these characteristic findings to an individual in the group. However, usually, such generalization is inappropriate and possibly even dangerous. This may be true of generalizations based on assumptions, limited experience or prejudice.             Assessing a person’s risk factors for future health problems and using age and sex characteristics for health screening testing are appropriate applications of group characteristics to an individual. These activities identify possible health problems. However, caution is still necessary. The person needs to understand when a health problem is potential, not inevitable.             Psychosocial information is often perceived as more personal and private than physiologic data. Some people find it difficult to disclose psychosocial information, especially if they feel that they are being “judged”. Psychologic patterns are non-physical components of human beings that are individual. Social experiences are the parts of an individual’s life, affected by or dependent on other people. The term psychosocial is used because psychologic factors and social factors are not entirely separated. In turn, psychosocial elements are not separate from the physiologic components. All components combine to form an individual. Physical health history assessment is intertwined with psychosocial health assessment. To completely assess physical health, one must learn the person’s physical history and have the person undergo physical examination. Health Assessment and Possible Intervention             Psychologic, sociologic and physiologic assessments belong together. The three areas overlap and interact so extensively that significant information is lost if they are not considered in relation to each other. Psychologic assessment involves assessing variables affecting an individual’s mind and ways that they affect behavior. Thus, psychologic assessments includes factors such as behavior, mental status, motivations, personal strengths, values, beliefs and lifestyles.             It is useful to describe behavior than to guess what a behavior might mean. For example, one must state. “xxx is crying” rather than “xxx is depressed”. Without assessment, one would not know why xxx is crying. If xxx says he or she is depressed, then that would be the time to state that xxx is depressed. Considering a person’s behavior is central to all other components of psychosocial research.             Assessing a person’s mental status involves (a) formally observing a person’s verbal and non-verbal behavior and (b) asking questions to assess the person’s sensorium. Principal areas and usual documentation format for mental examinations are: Ø  General Appearance Ø  Motor Behavior Ø  Affect Ø  Mood Ø  Speech and communication Ø  Thought processes and content             When one assesses mental status, one must always individualize his or her discussion and questions. One must always make sure that the content of the discussion is relevant to the situation of the patient being assessed. For example, while it may be appropriate to ask a teenager the name of the currently popular singer, this question may not be appropriate for an elderly person. It is not appropriate to ask mathematical questions of someone who has never studied mathematics. Also, one needs to know the correct answers to the to the questions one asks the patient.             Everyone has a basic human need for love and belonging. To fulfill this need, humans establish a social network around ourselves. One’s social network can potentially fulfill important functions for each of us, such as: Ø  Intimacy Ø  Social Integration Ø  Nurturing Behavior Ø  Reassurance Ø  Assistance             When people enter the health care system, medical staff temporarily become part of their social network. However, people are still involved in and have the right to use the ongoing social networks that are part of their established lifestyles. A health care personnel needs to know something of a person’s established social network. Credit:ivythesis.typepad.com

Culturally Sensitive Nursing Care

Health Assessment Introduction The social determinants of health are those instances, situations and environments to whic...