family nurse practitioner Advanced Health & Physical Assessment

| August 29, 2015

family nurse practitioner Advanced Health & Physical Assessment

Here is the instructions: Write one paragraph common for each writer. I have 2 peer papers, please write one paragraph for each peer. I am expecting two paragraphs total from you. One paragraph separately, comment about peer # 1 AND one reference and another separate paragraph comments about peer # 2 paper and one reference for it. thank you
This question is for peer # 1 and peer # 2: NOT FOR YOU: Discuss the definitions of ASD and VSD. What are the symptoms for each in children? What are the symptoms for each in adults? Briefly discuss treatment options for children and adults with ASD and VSD.

Peer # 1 Chris
According to the Mayo Clinic (2015a) an atrial septal defect (ASD) is an opening or hole between the two upper portions of the heart which are known as the atria. Moreover, the Mayo Clinic (2015a) explains that this congenital defect is an unpreventable circumstance, but some atrial defects may resolve on their own as newborns becomes an infant or small child. If in fact a person has a large or small ASD it should try to be established early on because letting this condition persist too long often will damage the heart and lungs (Mayo Clinic, 2015a). Those who have found out they have this condition later in life often may have heart failure or even pulmonary hypertension. Carr (2014) notes that it is often very difficult to detect this condition is an infant or child because they often do not exhibit any symptoms. If there are any symptoms they often are erratic and not consistent and may include things like poor weight gain, tendency to remain small, frequent respiratory infections, or being short of breath when going to exert themselves. As for adults the clues are much more detectable for ASD and may entail shortness of breath, tiredness, swelling in the legs and feet, perpetual lung infections, heart palpitations, or a heart murmur which will exude a whooshing sound upon auscultation (Mayo Clinic, 2015a). Finally, treatment for ASD in children will depend upon how extensive the hole is between the atria and whether there are any other congenital defects affecting the heart (Mayo Clinic, 2015a). The Mayo Clinic (2015a) explains that the child’s cardiologist may want to go through a waiting period to see if the hole in the atria closes on its own. If it doesn’t and further action needs to be taken, the procedures available for both children and adults are similar. They include either undergoing a cardiac catheterization or open heart surgery. The former entails a catheter being inserted into the groin which is guided up to the heart to repair the opening in the atria, while the latter includes an incision made in the chest (Mayo Clinic, 2015a).
Unfortunately ASD is not the only possible defect, but there also may be what is known as a ventricular septal defect (VSD). This also is a congenital conditions and results in there being a hole in the septum of the heart which is responsible for keeping the right and left ventricle separate (Mayo Clinic, 2015b). This is very significant because as the Mayo Clinic (2015b) explains oxygen rich blood ends up flowing from the left ventricle through to the right ventricle so instead of being pumped out to the rest of the body, its gets diverted and goes back to the lungs. According to the Mayo Clinic (2015b) if a baby is born with this condition it may be recognizable because the baby may exhibit fast breathing patterns or breathlessness, poor eating, or becoming tired very easily. The American Heart Association [AHA] (2015) notes that if the opening between the ventricles is very small symptoms may be very hard to detect within a child. In fact, it may only be a loud murmur that gives rise to the suspicion that a child has VSD (AHA, 2015). For adults, being short of breath, having a fast irregular heartbeat, or being very weak and tired are good reason to call the doctor and suspect VSD (Mayo Clinic, 2015b). Finally, like ASD, there is a possibility that a small hole within the ventricles may close on their own, but if it doesn’t surgery is an option. Either open heart surgery utilizing a heart and lung machine will be instituted for the repair or a cardiac catheterization (Mayo Clinic, 2015b).
American Heart Association. (2015). Ventricular septal defect. Retrieved August 27, 2015 from
Carr, M. (2014). Pediatric atrial septal defect clinical presentation. Retrieved August 27, 2015 from

Mayo Clinic. (2015a). Atrial septal defect. Retrieved August 27, 2015 from
Mayo Clinic. (2015b). Ventricular septal defect. Retrieved August 27, 2015 from


PEER # 2 Prince
Definition of ASD
Atrial Septal Defect (ASD) is a defect that is located within the atria septum that allows abnormal movement of blood between the right and the left side of the heart. The end result is a left to right shunt of blood with its associated symptoms of enlargement of the right side of the heart and mixing of oxygenated and deoxygenated blood. There are four types of atrial septal defects; these are secundum atrial septal defect, primum atrial septal defect, sinus venosus defect, and coronary sinus defect (Geva et al, 2014).
Symptoms in children and adults
Symptoms of ASD worsen with advancing age, therefore most children even with large defect do not manifest symptoms of the disease until they reach adulthood (Geva et al, 2014). According to (Gena et al, 2014), adults with ASD usually present with inability to tolerate exercise. However in children with ASD, pulmonary function may be impaired. Arrhythmias such as atrial flutter and fibrillation have been reported in adults with ASD but rare in children. Adults with ASD present with pulmonary hypertension which is detected around 51 years of age, an uncommon presentation in children with ASD. Other symptoms in adults with ASD are fainting, shortness of breath, peripheral edema, increased heart rate, thromboembolism and cyanosis (Geva et al, 2014).
Treatment options of ASD in children and adults
Closure of the defect is the most effective treatment in both adults and children especially when symptoms are present. ASD’s in children can be closed by 3 to 5 years of age. Adults who are even 40 years and above benefit tremendously from closure of the defect with much improvement in symptoms (Geva et al, 2014).
Definition of VSD
Ventricular septal defect (VSD) is a common congenital cardiac defect that can be part of other congenital malformations or occur in isolation (Penny & Vick, 2011). Anatomically, the defect can be present within the septal musculature or within its margin. When present in the muscle, it usually opens into the left ventricle when viewed from the right ventricular side. The end result of VSD is left to right shunting due to higher pressures on the left side than right side of the heart (Penny & Vick, 2011).
Symptoms and treatment in children and adults
Babies born with VSD and develops pulmonary hypertension as a result experience breathlessness and failure to thrive within few weeks after birth (Penny & Vick, 2011). To treat pulmonary hypertension, low dose diuretics and inhaled nitric oxide are used. Surgery is then performed to close the defect (Penny & Vick, 2011). On the contrary, patients who do not have symptoms but have signs of overloaded left ventricle/dilation also undergo surgery to close the defect to avoid development of later symptoms due to ventricular dilation (Penny & Vick, 2011). Patients with a small defect without symptoms and no signs of left ventricular dilation can be treated conservatively without surgery (Penny & Vick, 2011). Finally, patients with Eisenmenger’s syndrome (shunting of oxygen deprived blood from the right side to the left side of the heart) can be treated with medications aimed at the endothelium such as bosentan (endothelin 1 receptor antagonist) and sildenafil (a phosphodiesterase inhibitor). Additionally, patients with VSD are prone to developing endocarditis hence appropriate antibiotic prophylaxis is used to avert this (Penny & Vick, 2011). Finally, adults with small defects with normal pulmonary and ventricular functions are able to participate in exercise (Penny & Vick, 2011).
Geva, T., Martins, J. D., & Wald, R. M. (2014). Atrial septal defects. The Lancet, 383(9932), 1921-32. doi: (13)62145-5.
Penny, D. J., & Vick, G. W. (2011). Ventricular septal defect. The Lancet, 377(9771), 1103-12. Retrieved from

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