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Medical Emergencies

Chapter 8 and 9

Antibiotic Prophylaxis use of antibiotics to prevent infection in cardiac valves caused by bacteremia
Bacteremia the presence of bacteria in the blood
Infective Endocarditis infection within tissues lining the heart or within valves of the heart, caused by bacteria within the circulating blood that infect these cardiac tissues
Parturition the act or process of giving birth to a child
Periodontopathogen bacteria responsible for periodontal disease, principally gram negative anaerobic microorganisms, including Actinobacillus actinomycetemcomitans, Prevotella species, or prophyromonas species
Teratogen any drug capable of causing a birth defect in the fetus
Valvulopathy a disorder of valve function causing a variety of cardiac disorders, such as arrhythmia, pulmonary hypertension, heart failure, and cardiogenic shock
Which trimesters of pregnancy are associated with the greatest risk for medical emergencies? A. 1st and 2nd Trimester B, 1st and 3rd Trimester C. 2nd and 3rd Trimester D, 1st, 2nd, and 3rd Trimester B. 1st and 3rd Trimesters
Which U.S. Food and Drug Administration categories of drugs are considered safe for use with pregnant clients? A. A and B B. A and D C. B and D D. C and D A. A and B
Syncope is common in the 3rd tri of preg as a result of: A. increased blood flow to the heart B. increased blood flow to the L atrium of the heart C. the weight of the fetus depressing the vena cava vein D. the weight of the fetus stim. the vena cava vein C. the weight of the fetus depressing the vena cava vein
Blood dyscrasia a pathologic condition in which any of the constituents of blood are abnormal or are present in abnormal quantities.
Carrier one who harbors disease organisms in the body, including the blood; capable of transmitting the disease to others
Ecchymosis discoloration of the skin caused by blood within the local tissue; lesions are larger than pinpoint lesions
Hemostasis the arrest or stopping of bleeding
Iatrogenic any situation caused by the clinician or operator
Idiopathic cause for condition is unknown
Petechiae small, pinpoint collections of blood under the skin or mucous membrane
Platelet aggutination clumping of platelets to cause a clot; involves adhesiveness or stickiness of platelet surface
Progeny offspring or descendants, including cells produces by cell division
Seroconvert the development of antibodies in response to vaccination
Sign the objective evidence of a disease
Symptom the subjective evidence of a disease
For those clients who use oral contraceptives and require antibiotic therapy, advise them to use a backup contraceptive: when? during the course of antibiotic therapy and for 1 week after antibiotic therapy is completed
Early signs of osteoporosis in the dental clients include: a. low back pain b. history of fractures c. periodontal attachment loss d. none of these d. none of these
Dental implications for the clients diagnosed with osteoporosis include all EXCEPT for one: a. positioning dental chair b. protect neck from excessive bending c. prescribe calcium fluoride supplements d. plaque control and perio maint. e. Ca and vit D c. prescribe calcium fluoride supplements
What condition requires prophylactic antibiotic coverage before dental treatment? prosthetic heart valve
Infective endocarditis can be cause by what? bacteremia produced during oral treatment
Ideally when should prophylactic antibiotics be taken? 30 minutes to 1 hour before the appointment
The antibiotic of choice recommended for antibiotic prophylaxis to prevent infective endocarditis is? amoxicillin
If a penicillin-allergic client requires antibiotic prophylaxis. the antibiotic of choice is what? clarithromycin or clindamycin
CASE STUDY A: Which local anesthetic agent is considered safe for using during pregnancy? Lidocaine is considered safe for use with pregnant clients
CASE STUDY A: Why would an NSAID be contraindicated for treatment of postoperative pain in this client? NSAIDA delay parturition
CASE STUDY A: Can radiographs be performed on this client? Yes. ONLY if deemed necessary to determine the extent of decay. A protective lead apron us used, and only a minimum number of x-rays are taken.
CASE STUDY A: What specific recommendation would you make concerning antibiotic coverage and use of oral contraceptives? Recommend that the client take antibiotics as prescribed until completed and that the client use a backup nonhormonal contraceptive method while taking the antibiotics and for 1 week after antibiotic therapy is completed
CASE STUDY B: What prophylactic antibiotic regimen is recommended for this client? not recommended given the client's medical history
CASE STUDY B: What other medical condition should be evaluated for this client and why? Signs of osteoporosis due to his long-term use of prednisone for systemic lupus erythematosus
Identify four side effects of birth control and hormone replacement medications that are relevant for oral health care. increase blood pressure nausea increased bleeding increase incidence of dry socket
What procedure can be used during treatment to prevent syncope in the pregnant women who is in her third trimester? place a pillow under the client's right hip to displace the weight of the fetus to the left and away from the vena cava vein
When is the safest time of to provide oral health care during pregnancy? second trimester
Sodium bicarbonate or magnesium hydroxide (milk of magnesia) rinses will what? neutralize acid in the mouth after vomiting
What local anesthetic can be used safely during pregnancy? lidocaine
What class of drugs are safe for pregnancy for oral pain? acetaminophen
What class of drugs should be avoided during pregnancy? NSAIDS, Tetracyline
What can NSAIDS do during pregnancy to the mother? delay parturition, result in premature closure of the patent ductus arteriosus, complicate delivery, and increase the risk of maternal or fetal hemorrhage
What are some safety considerations in the treatment plan for the pregnant client? short appointment, monitoring blood pressure and vital signs, semisupine chair position, place a pillow to elevate right hip, afternoon appointment due to morning sickness, and following protocol
Osteoporosis common disorder characterized by loss of calcium in bones, leaving them thing and susceptible to fracture.
What are the causes of osteoporosis? inadequate calcium, estrogen deficiencies with menopause, side effect of medications
What medications can cause osteoporosis? prednisone, hyperparathyroidism
What is the hump in the upper back called? dowager's hump
What treatment planning should be addressed for osteoporosis? plaque control procedures to reduce periodontal attachment loss and encourage increased calcium plus vitamin D consumption to increase bone density
When the client is taking warfarin which one of the following INR levels contraindicates periodontal debridement? A. INR of 2 to 3 B. INR of 3 to 4 C. INR >5 C. INR > 5
The most common inherited blood disorder is? A. hemophilia B. von Willebrand's disease C. factor IX deficiency D. thrombocytopenia B. von Willebrand's disease
Examples of inherited coagulation disorders include all of the following EXCEPT one. Which is the EXCEPTION? a. thrombocytopenia b. hemophilia A c. hemophilia B d. factor IX deficiency a. thrombocytopenia
The normal number of platelet formation is: a. 100,000-150,000 mm3 b. 100,000-300,000 mm3 c. 150,000-400,000 mm3 d. 150,000-450,000 mm3 c. 150,000-400,000 mm3
Which blood studies are prolonged in von Willebrand's disease? A. platelet and bleeding time b. bleeding time and prothrombin time c. bleeding time and partial thromboplastin time d. prothrombin time and platelet c. bleeding time and partial thromboplastin time
The mildest form of von Willebrand's disease is type: A. 1 B. 2 C. 3 D. 4 A. 1
Minor bleeding associated with simple dental extractions in those with von Willebrand's disease is best controlled by: A. NSAIDS B. DDAVP C. Sutures D. tranexamic acid B. DDAVP
Types of hepatitis that do not carry a risk to the oral healthcare clinician during treatment are: A. HAV and HEV B. HAV and HDV C. HBV and HDV D. HCV and HTTV A. HAV and HEV
The hepatitis virus that is dependent on HBV to replicate is: A. HCV B. HDV C. HAV D. HTTV B. HDV
Which of the following forms of hepatitis pose the greatest risk for occupational exposure: A. HCV B. HAV C. HEV D. HTTV A. HCV
Strategies to prevent occupational exposure to hepatitis include: A. using standard precautions B. using caution to avoid injury during treatment C. vaccination D. all the above D. all the above
The presence of which serum markers indicates a person is infectious? A. HBsAg and HBcAg B. HBsAg and HBeAg C. HBbAg and HBcAg D. HBbAg and HBeAg B. HBsAg and HBeAg
The main treatment consideration for a client with a medical history of HIVD or AIDS is to: a. prevent infection in the oral cavity b. perform regular perio debridement procedures c. recommend daily use of an antimicrobial mouth rinse d. educate clients a. prevent infection in the oral cavity
Medications used in dentistry that interact with antiviral HIV therapy include: a. sedative agents and antidepressants b. sedative agents and muscle relaxants c. sedative agents and analgesics d. analgesics and muscle relaxants c. sedative agents and analgesics
The governmental agency that regulates all healthcare facilities to ensure employee saftey is: a. OSAP b. OSHA c. CDC d. CDCP b. OSHA
Antibiotic propylaxis is recommended for the client with HIVD who has an absolute neutrophil count of: a. < 250 cell/mm3 b. <500 cell/mm3 c. <750 cell/ mm3 d. < 1,000 cell/ mm3 b. <500 cell/ mm 3
Postexposure HIV antibody testing should occur for: a. 6 weeks b. 3 months c. 6 months d. 1 year c. 6 months
Transmission of STDs can occur when: a. the operator's glove barrier becomes compromised b. infectious fluids are splashed onto the operators mucous membrane c. both a and b d. none of the above c. both a and b
What anemia represents an inherited defect of red blood cell anatomy and a defect in the hemoglobin within the cell? a. iron-deficiency anemia b. sickle cell anemia c. pernicious anemia d. thalassemia b. sickle cell anemia
The decision to proceed with oral healthcare procedures in a client with anemia involves: a. determining whether the disease is controlled b. prescribing prophylactic strategies c. using stress reduction strategies d. providing ed bout' plaque control a. determining whether the disease is controlled
The primary concern relative to a client who presents with a history of blood transfusion include: a. the cause of the transfusion b. the risk for increased bleeding during treatment c. contacting transmissible bloodborne disease d. all the above d. all the above
List the four major causes of abnormal bleeding. blood dyscrasia, bleeding disorders, liver dysfunction, and drug-induced clotting abnormalities
What are the follow-up questions for clients with blood transfusions? Why did you need to have a blood transfusion? Have you had any complications as a result from the transfusion? Have you been tested for a blood borne disease as a result of the transfusion?
CASE STUDY A CH. 9: What is the function of coumadin? inhibits the formation of vitamin k-related coagulation factors; it reduces formation of blood clots within blood vessels.
CASE STUDY A CH. 9: List three other conditions for which coumadin is prescribed. myocardial infarction, stroke, artificial heart valves, and total joint replacement
CASE STUDY A CH. 9: Which blood tests are used to measure anticoagulation in clients taking coumadin? PT and INR
CASE STUDY A CH. 9: If the client required a tooth extraction, what preventative measures should be taken to avoid a medical emergency? consulting with a physician or hematologist, PT/INR testing before treatment, therapeutic levels of coumadin or change of therapy as recommended by physician
CASE STUDY A CH. 9: After extraction, the client appears to have excessive bleeding. What strategies can be used to manage this event? rinsing with tranexamic acid or antifibrinolytic medication, local application of an absorble gelatin sponge or homeostatic agent, digital pressure, dismiss when bleeding is controlled, postoperative instructions, mild rinsing w/ cold water or tea bag
CASE STUDY B CH. 9: What type of preliminary questions would you ask this client before offering treatment? What treatment is being used for the sickle cell anemia? How long have you been in control? What problems do you have with healing? Are you having any symptoms now?
CASE STUDY B CH. 9: What symptoms would you expect to see in this client if she had uncontrolled anemia? facial pallor, fatigue, muscle weakness, shortness of breath, and sore, painful tongue, bald tongue, or loss of taste sensation
CASE STUDY B CH. 9: List four strategies that the clinician should use in treating this client. frequent, short appointments, stressing plaque control, use of low epinephrine local anesthetics, prophylactic antibiotics if oral surgery is planned, used of acetaminophen or opioid/ APAP for oral pain and use of diazepam or nitrous oxide
Created by: daisenmurray
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