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Oral Med
Pickett Chapter 2, 4 and New Slides
| Question | Answer |
|---|---|
| Most emergencies in the dental setting can be avoided by what? | Taking a detailed Mix |
| What is MET a measure of? | How much 02 it takes to complete a task. |
| What does MET help determine? | Cardiac risks by analyzing patients functional capacity. |
| ASA V/5 | Pt. not expected to live with or without an operation. |
| ASA VI/6 | Pt. declared brain dead and organs are being saved for donation. |
| What is a risk factor? | An attribute or exposure that increases probability of disease. |
| Adequate functional capacity is being able to perform activities which meet what level of MET? | a MET of 4 or higher. |
| If pt. does not meet at least a MET 4 what are they more at risk for? | Heart attack |
| What things contribute to a patient having a risk factor? (3) | Personal behavior, environmental exposure, inherited or not inherited medical issues. |
| What step of the DH process of care identifies risk factors? | Care plan |
| What are the 5 steps to creating a care plan? | Write date and appt # Identify the problem, is it dental, medical, phycological? What is causing the problem? Identify patient's risk factors. Create a measurable patient goal AKA SMART goal Intervention, Identify how you as a DH can help reach a solu |
| Why is it important to take vitals? (3) | It helps the clinician to detect medical conditions that may require an immediate action. Monitoring may reveal trends over time. If an emergency arises, monitoring vitals can assist the clinician in evaluating emergency treatments. |
| What is BP effected by< | Blood volume, artery size, artery elasticity, cardiac muscle contractions. |
| BP is diurnal. What does this mean? | It fluctuates over 24 hours. |
| What is Systolic BP based on? | The contraction phase of the heart. |
| What is diastolic BP based on? | |
| Is the top part of BP diastolic or systolic? | Systolic |
| How can hypertension effect the course of dental treatments? | Decreased ability to manage stress/pain during treatment, which leads to Increased risk of medical emergencies because heart rate can raise even higher. |
| When a BP reading measures between two categories, how should you classify the reading? | By the higher number/category. |
| Why is initial reading of BP in a child pt important? | Increased cases of child obesity. |
| What happens if a wrong sized cuff is used to take BP? | A cuff that is too small can overestimate your BP, while a cuff that is too large can underestimate it. Leads to improper diagnosis & treatment decisions. |
| What is a normal range for pulse? | 60-100 BPM |
| What pulse rate is concerning and needs a physician referral? | 120 BPM or higher. |
| How is respiration rate measured? | Counting how many times the chest rises in 1 minute. |
| What is a normal range for respiration rate? | 12-20 respirations/min |
| How does respiration rate change for children as they age? | It decreases. |
| What 4 medication types are not approved by the FDA? | Vitamins, herbal remedies, dietary supplements, and homemade compounds. |
| What 5 things must you know about a patient's medication? | MOA ~ mode of action Dosage Side Effects Dental Interactions (with other meds and with other conditions/diseases) Dental Treatment Considerations (with drugs used for dental treatments and potential medical emergency risk) |
| What are 6 common drug side effects? | Postural Hypotension/Syncope Increased Bleeding Blood Dyscrasias (blood cell alterations) Hypertension, all types of arrhythmias Nausea, vomiting, GI reflux xerostomia |
| Define fainting | Loss of consciousness due to lack of blood/oxygen to the brain. |
| What are the 2 types of fainting? | Syncope and postural hypotension |
| How is syncope usually triggered? | Anxiety, pain, fear, dehydration, low blood sugar, low BP |
| How is postural hypotension usually triggered? | slow body response, standing too quickly. Can be due to medicine side effects. |
| What is the most common dental emergency? | Syncope |
| Is syncope usually caused by a medication side effect? | NO |
| What is the most common cause of syncope at dentist? | Fear and anxiety of dental procedures. |
| What is the 4 step process to syncope? | 1. Body diverts blood to skeletal muscles. 3 When muscles are not used (seated in a dental chair), blood pools in extremities, cardiac output slows in response to a lack of venous blood return to the heart 4 Vasodialation, bradycardia and lack of o2 |
| How does the CNS cause syncope? | Its a sympathetic reaction to fight or flight. |
| How can we prevent syncope with stress reduction protocols? | Talk and distract pt. with directed Q.s, consider sedation, prevent pt. seeing Local Anesth. Prep and administration, consider anti-anxiety pre-medication |
| What are the 3 steps to complete after syncope happens? | 1.) Place patient in supine position 2.)Administer O2 3.) take vitals & record them |
| What causes postural hypotension? | Changes in BP |
| 2 Steps to an episode of postural hypotension? | 1.) Pt moves from supine to upright too quickly 2.) Blood pressure does not keep up with the brain's demand. |
| What 3 drugs increases the chances of postural hypotension? | Antihypertensives, CNS depressants and diuretics |
| What to do in the event of postural hypotension? | Place the pt. in the Trendelenburg position, then supine to semi-supine as flow to brain is achieved (briefly), then supine to semi-supine as pt. recovers Provide Oxygen 4-6L/m & check vitals Once conscious, place semi-upright & allow pt. to recover |
| Many drugs cause hemorrhaging as a side effect. This can happen because of what? | The drug may cause platelet inhibition, reduction of the formation of clotting factor, and thrombocytopenia. |
| What is thrombocytopenia? | A condition where fewer platelets are made in the bone marrow. |
| What are the 4 steps to preventing a hemorrhage? | 1.) Contact pt's physician or cardiologist. 2.) Ask if the pt is safe to treat on their anticoagulant med 3.) Ask for pt's INR or PT number. 4.) If the score is 3.5 or lower, the pt can get treatment. |
| What must be done before treating a pt on an anticoagulant? | Communicating with their doctor! |
| If increased bleeding is noticed during treatment, what should you do? | Apply digital pressure to the area and hold the pressure to initiate clotting. |
| How can certain medications create thrombocytopenia? | By decreasing the production of blood cells being made in the bone marrow, including platelets which are essential for clotting. |
| How should treatment be modified for someone who has thrombocytopenia? | Treat with caution, start with 1-2 teeth. Work in small areas and assess the amount of bleeding that occurs. |
| What should be done if there is a strong aggregation effect? (3) | 1.) Apply digital pressure to the site using thumb and forefinger. 2.) Apply Gelfoam (absorbable gelatin sponge) 3.) Inject Local Anesthetic w/ epinephrine 1:50,000 to stimulate hemostasis. (one cartridge only) |
| What 3 terms mean that the bone marrow is making fewer white blood cells? | Leukopenia, agranulocytopenia & neutropenia |
| What can leukopenia, agranulocytopenia & neutropenia cause? | Decreased healing, increased chance of infection. |
| How to manage leukopenia? | Look at intraoral tissues for signs of infection or increased biofilm. If infection present, refer to physician for a blood panel workup and evaluation &possible adjustment of medication |
| Should dental treatment be delayed if someone has WBC levels that are low? | YES |
| What are some common cardia drug side effects? | Hypertension, hypotension, arrhythmia, bradycardia, tachycardia, and tachyarrhythmia. |
| What is tachyarrythmia the #1 precursor for? | Heart attack |
| Based on the severity and degree of the patient’s cardiac drug side effects the hygienist should: (4) | Evaluate the signs & symptoms Determine the present risk Decide on the course of treatment Potentially delay treatment & refer to physician |
| What needs to be determined if pt has nausea or vomiting or reflux? | If it is induced by medication or illness. |
| How should the DH manage pt who has nausea/vomiting/reflux? (3) | Ask if pt took meds on empty stomach, offer soda crackers or ginger. Treat patient in semi-supine position. Have kidney dish ready. |
| What are the negative side effects of xerostomia on pt's oral cavity? | Increased risk of carries and candidiasis (oral diseases) |
| What else is xerostomia a risk factor for? | Dentinal hypersensitivity and halitosis. |
| True or False: Foreign born people have highest incidence of tuberculosis | True |
| What are the early signs and symptoms of tuberculosis? (5) | Chills/fever Loss of appetite Weight loss Weakness/fatigue Sweating at night |
| What are the late signs of tuberculosis? (3) | Persistent cough, hemoptysis, chest pain |
| True or False: TB is a respiratory disease | True |
| Describe latent TB infection? | After initial infection takes place, the body's immune system can prevent the further progression of the bacilli and they can lay dormant in the lungs for up to 20 yrs. |
| True or False: a person with latent TB is infectious. | False. |
| When does TB disease occur? | When the immune system can not contain the bacilli and they begin to multiply, so the disease becomes active. |
| How can we stop the spread of TB? | Identifying those who have latent TB infection and treating them until they're cured. |
| Can a person with latent TB be treated at the dentist? | Yes. |
| What two methods prove if someone has been exposed to TB? | The Mantoux TB skin test (TST) andInterferon Gamma-Release Assay test (IGRA) or chest x-ray. |
| When do healthcare workers need to be tested for TB? | When hired and after exposure. |
| Do healthcare workers need vaccinated against TB? | No. |
| What are some risk factors for contracting TB? (5) | Being exposed to person that has TB, being immunosuppressed, HIV+ people, foreign travelers and foreign persons who live in places with high incidence of TB. |
| How is latent TB treated? | 4 treatment regimens recommended by the CDC. |
| How long does it take to treat latent TB with the 4 regimens? | 3-4 months |
| What are the two phases of treatment for TB disease? | Initial phase and continuation phase |
| How long does it take to complete the two phases for TB disease treatment? | 6-9 months |
| What can TB orally manifest as? | Lesions such as ulcers, raised fissures, and nodules on the dorsum of tongue, pharynx, palate, lips and gingiva. |
| What is the overall Prevention & Treatment Protocol for TB (3) | 1.) Detection of infectious patients. (using MHx & follow up questions) 2.) Use the Universal Precautions like PPE 3.) Treatment of the LTBI and TBD patients (refer them to a physician for testing) |
| If patient marks yes on their MHx to having a persistent cough for longer than 3 wks and a cough that produces blood, what two things must be done? | The pt. must seek medical care to investigate their symptoms and postpone treatment until TB disease is ruled out. |
| When can a person with active TB disease be treated at the dentist? | At hospital for emergency treatments or after 3 weeks on medication with 3 or more negative sputum smears, no coughing and clearance from doctor. |
| Identify risk factor, SMART goal, and intervention for diabetes? | Risk factor: high sugar intake SMART goal: Reduce number of sugary drinks in a day. Intervention: Give recommendations of better drinks to replace. |
| What is HBA1C | Blood test that measures the average blood glucose (sugar) level over the past 2-3 months |
| What does INR determine? | How long it takes blood to clot |
| When should you ask for patient's INR | When on blood thinners. |
| What is an acceptable INR | 3.5 |
| What is prothrombin time? | Blood test that measures how long it takes for blood to clot |
| Difference between aspirin and Tylenol? | Aspirin is an NSAID that inhibits blood clotting. Tylenol is neither. |
| Should you prescribe aspirin to patient with blood clotting disorder? | NO, Prescribe Tylenol (acetaminophen) instead |
Created by:
Saylorlee5