Respond to a peer’s post. Be sure to include current (within the past 5 years) , peer-reviewed references to support your responses.
Ventricular Septal Defect (VSD)
Pathophysiology: With VSD in the pediatric patient, blood is shunted from the right ventricle to the left ventricle via an opening between the two ventricles. The ventricles are made up of five parts; the membranous, muscular, infundibular, atrioventricular, and the inlet. If any of these parts fail to fuse during development, it will result in the child being born with a VSD (Dakkak & Oliver, 2023).
Clinical findings: This condition is usually not noticed until about the 2nd -8th week of life and typically closes by age four (Burns’, 2020). Before closure a loud murmur can be heard which prompts the pediatrician to evaluate further. When auscultating the heart, you may hear harsh, high pitched, low pitched, rumbling or a thrill. The child may start to have signs/symptoms of congestive heart failure (CHF), in which case, a gallop may be heard (Burns’, 2020).
Preventative Measures: None
Potential complications: CHF, arrythmias, endocarditis, embolization, Eisenmenger syndrome, and/or Aortic insufficiency due to prolapse of the aortic valve leaflet are some potential complications of VSD (Dakkak & Oliver, 2023).
Appropriate screenings/diagnostic test: Screenings and/or test for VSD include chest radiography, ECG, echocardiography, and/or cardiac cauterizations.
First line treatment/management: If the defect is small and no signs of CHF, monitoring of the defect is done every 6 months, for the first year, then twice a year until the defect closes, if it closes. According to the Burns’ textbook, “Larger defects with signs of CHF are managed as follows: Lanoxin, diuretics, ace inhibitors, or [beta] blockers may be prescribed by cardiology” (Burns’, 2020). Nutrition, weight monitoring, education about s/s CHF are ongoing for families with children born with VSD. Some require surgery or percutaneous device closure (Burns’, 2020).
Bronchiolitis
Pathophysiology: The Burns’ text books states, “The pathophysiology in bronchiolitis is due to shedding of bronchiole epithelium and alveolar epithelial cells (AED), types I and II, airway edema, and resultant dysfunction of the cilia” (Burns’, 2020). Erickson, et al. states, “Bronchiolitis occurs as a result of the inflammation of the lining of the epithelial cells of the small airways in the lungs causing mucus production, inflammation and cellular necrosis of those cells. It is the inflammation of these cells that can obstruct the airway and ultimately result in wheezing” (Erickson, et al, 2023).
Clinical findings: Clinical findings for bronchiolitis can include upper respiratory infections, respiratory distress, coughing, tachypnea, retractions, wheezing, fever, appetite decrease, apnea, conjunctivitis, pharyngitis, nasal flaring, crackles, grunting, cyanosis, and abdominal distention (Burns’, 2020).
Preventative Measures: Preventative measures include a vaccination against RSV, limit exposure to child care places, good hand hygiene, wearing face masks, and avoid exposing child to 2nd hand smoke (Burns’, 2020).
Potential complications: The Burns’ text states complications that can arise include “apnea, respiratory failure, aspiration, and secondary bacterial infections” (Burns’, 2020). Death can occur but rare.
Appropriate screenings/diagnostic test: Chest x-rays are done only in severe cases, and nasal swabs can be done to screen for bronchiolitis. A history and physical exam are the most important screening/diagnostic tool.
First line treatment/management: Supportive care such as, controlling fever, hydration, nutrition, and nasal suctioning is the first line treatment/management for bronchiolitis (Burns’, 2020).
References
Dakkak, W. & Oliver, T. (2023 January 16). National Library of Medicine: Ventricular Septal Defect. https://www.ncbi.nlm.nih.gov/books/NBK470330/#:~:text=The%20main%20pathophysiologic%20mechanism%20of,VSD%2C%20and%20pulmonary%20vascular%20resistanceLinks to an external site..
Erickson, E., Bhakta, R., & Mendez, M. (2023 June 26). National Library of Medicine. Pediatric Bronchiolitis. https://www.ncbi.nlm.nih.gov/books/NBK519506/#:~:text=Bronchiolitis%20occurs%20as%20a%20result,and%20ultimately%20result%20in%20wheezingLinks to an external site..
Maaks, D., Starr, N., Brady, M., Gaylord, N., Driessnack, M., & Duderstadt, K. (2020). Burns’ Pediatric Primary Care. 7th Edition. Elsevier.
