Health Medical Homework Help

Classmate 1: Felisa

Discuss the definitions of ASD and VSD.

Atrial septal defect (ASD) is a congenital heart defect where oxygenated blood is shunted from a high-pressured left atrium to a low pressured right atrium through an abnormal opening in the atrial septum causing increased blood flow across the tricuspid valve into the lung (Goolsby & Grubbs, 2015).Ventricular septal defect (VSD) is a congenital heart defect where oxygenated blood is shunted from a high pressured left ventricle to a low-pressure right ventricle through an abnormal opening in the ventricular septum causing increased blood flow across the pulmonic valve (Goolsby & Grubbs, 2015).

What are the symptoms and the assessment findings you may encounter among children?

In ventricular septal defect the symptoms and assessment findings seen in children may be a low-pitched middiastolic murmur at the lower left sternal border (Bickley, 2013). The child may breathe faster and harder than normal if opening is large. Infants may have trouble feeding and growing at a normal rate with symptoms not occurring until several weeks after birth (American Heart Association, 2015).

In atrial septal defect the symptoms and assessment findings seen in children is a widely split-second sound throughout all phases of respiration at the upper left sternal border (Bickley, 2013). Other signs and symptoms are frequent respiratory or lung infections, difficulty breathing, shortness of breath when being active or exercising, skipped heartbeats or a sense of feeling the heartbeat, swelling of legs, feet or stomach area and with infants tiring when feeding. (Center for Disease Control and Prevention, 2016).

What are the symptoms and physical examine findings from auscultation for each in adults?

In VSD the symptoms and findings from auscultation in adults are complaints of dyspnea on exertion (Goolsby & Grubbs, 2015). Other symptoms are pulmonary hypertension, fatigue and weakness (American Heart Association, 2016). In ASD the symptoms and finding from auscultation in adults are a visible pulsation over the second and third left intercostal spaced. Upon auscultation, a pulmonic systolic ejection murmur may be heard with a fixed splitting of the second heart sound. Symptoms are dyspnea on exertion or palpitations. Due to being asymptomatic for years, right heart failure is the first sign and may present with edema and ascites (Goolsby & Grubbs, 2015).

Briefly discuss treatment options for children and adults with ASD and VSD.

The treatment options for children with ASD depends on the age of diagnosis, the number of or seriousness of symptoms, size of the hole and presence of other conditions. Open heart surgery is recommended for a large atrial septal defect (Center for Disease Control and Prevention, 2016). The treatment option for children with VSD depends on the size of the opening. Small VSD’s often close on their own. If the opening is large, open-heart surgery may be needed. A temporary procedure called pulmonary artery banding may be done to relieve symptoms until the child is old enough to have open-heart surgery symptoms (American Heart Association, 2015). Medications such as digoxin to help increase the strength of the heart, a diuretic to help get rid of extra fluid in the lungs and sometimes medication to lower blood pressure to decrease the workload of heart. A high calorie formula or fortified breast milk (Cincinnati Children’s, 2017).

The treatment option for adults with ASD is open heart surgery for those who have many or sever symptoms (Center for Disease Control and Prevention, 2016). The treatment option for adults with VSD is by sewing a patch of fabric or pericardium over the VSD completely or by placing a plug in the hole using a special device in the catheterization lab called interventional or therapeutic catheterization (American Heart Association, 2015).

Classmate 2: Sarah

The Center for Disease Control’s current statistics show that Heart Failure (HF) affects approximately 5.7 million people, contributes to one in nine deaths, costs $30.7 billion a year in health care costs, medications to treat HF, and missed days of work, and that half of all people diagnosed with HF will die within five years of diagnosis (www.cdc.gov). These are sobering statistics, and FNPs are on the front line of preventing, diagnosing, and treating HF.

Common diagnosis that can lead to the development of HF include Cardiomyopathy, Coronary Artery Disease (CAD), Hypertension (HTN), and Diabetes (www.cdc.gov). Changeable behaviors that contribute to the development of HF are smoking, high fat/cholesterol/sodium diets, sedentary lifestyle, and obesity (www.cdc.gov).

Left sided heart failure results in fluid backing up into the lungs, leading to shortness of breath. Right sided heart failure causes fluid to back up into the abdomen, legs and feet, causing swelling. Diastolic heart failure is a filling problem, in which the left ventricle can’t relax enough for proper filling. Systolic heart failure is a pumping problem, in which the heart muscle can’t contract with enough force to completely empty the left ventricle (Buttaro, 2013, p. 541).

Patients may complain of breathlessness with activity or at rest, increased difficulty breathing when lying down, frequent waking feeling anxious or restless, cough that may or may not be productive, swelling in feet, ankles, legs, or abdomen, generalized fatigue, loss of appetite or nausea, confusion or lightheadedness, heart palpitations, frequent waking at night to urinate (Buttaro, 2013, p. 541).

Physical assessment may reveal jugular venous distension, crackles may be heard upon auscultation of the lungs, and edema of feet, ankles, legs, or abdomen may be evident (Buttaro, 2013, p. 542).

A diagnosis of Heart Failure is made primarily by the symptoms presented and a thorough history, as there is no single diagnostic tool for diagnosis (Buttaro, 2013, p. 543). That said, the diagnostic tests that are useful for determining the type of HF and severity include EKG, CXR, cardiac catheterization, MRI, PET, Exercise Tolerance Test, and blood tests (CBC, electrolytes, BUN, Creatinine, lipids, LFT, Albumin, TSH, BNP) (Buttaro, 2013, p. 545).

Treatment for HF is aimed at the causative agents and dependent on the classification of HF. Classification is done using either the New York Heart Association classification system or American College of Cardiology/American Heart Association guidelines(www.mayoclinic.org). An ACE or ARB is recommended for all stages of HF, unless contraindicated (Buttaro, 2013, p. 546).

I would consider referral to a cardiologist when the symptoms of HF were no longer being managed by the initial therapy I had prescribed, in order to stage the HF, or when hospital management is required (Cash & Glass, 2014, p. 215). Heart Failure is never the only diagnosis. I have not yet started my practicum rotation, however my experience as an RN certainly reinforces this. While there are causes of damage to the heart that may not be preventable, such as viral infections, most contributing factors are preventable (Buttaro, 2013, p. 545). I have had countless patients with HF, and they all had comorbidities like HTN, obesity, diabetes, and CAD. What this means to me as a future FNP is that HF is almost always preventable, if contributing comorbidities are either prevented, or properly managed in the primary care setting.

Both responds should invoke further discussion. Responds need to be 300 or more words per respond with at least 2 APA style references for each responses. Use students name as the heading so that I know which answer goes to which question. No title page needed seperate the references to match each responses, no outline needed. Must be completed within the next 3 hours.