Compromised Patient-AndyRDH

flashcards

patients with the following cardiac conditions are at the highest risk of infective endocarditis

heart transplant, artificial heart valves, previous history of endocarditis

Uncontrolled movement of head and limbs; forcible jaw closing and head rocking, urinary incontinence

clonic (seizure)

epinephrine should be avoided in patients who take:

chantix, lanoxin, beta-blocker

tobacco use is associated with

atherosclerosis, CV disease, cancer, COPD, hypertension, spontaneous abortion, fetal death, neonatal death, SIDS

Oral findings in geriatric patients

xerostomia and polypharmacy

Type I and II; inadequate insulin produced by pancreas; may have xerostomia, burning mouth syndrome, increase caries

diabetes

Tachycardia; exopthalmos (eyes protruded); do not use epinephrine

hyperthyroidism

Chronic, hereditary, non blistering skin disorder; use protective pillows/blankets to protect skin

epidermolysis bullosa

anticonvulsant medication that causes gingival enlargement

phenytoin/dilantin

oral manifestations of HIV

Kaposi’s sarcoma; NUG/NUP, hairy leukoplakia; angular cheilitis; papillomas; erythema multiforme; candidiasis; recurrent herpetic infections; increased caries; superinfections

Dental hygiene process

Assess, Dental hygiene Diagnosis, Plan Care, Implement, Evaluate, document (ADPIE)

Special consideration for COPD patients

short appointments; tobacco counseling; elevate head of dental chair; HVE; administer oxygen in emergency A

ADL/BADL Level II

Simulation of normal function with adaptive equipment, medication, or methods

T or F: do not sit up or place a tongue blade between the teeth of a patient having a seizure

T

Insufficient steroid production by adrenal glands; bronzing of the skin may occur; consult physician for any steroidal premedication needs

Addison’s disease

Status asthmaticus: life threatening persistent exaberaction exacerbation of asthma despite drug therapy

asthma emergency

Medications for asthma

albuterol

patients with methamphetamine addiction

increased risk heart attacks/stroke; stimulation high level of dopamine; xerostomia (meth mouth), carie, bruxism; do not use epinephrine

cardiac dose

0.04mg (2 carpules of 1:1,000,000 epinephrine)

Chronic, degenerative disease of the CNS; onset is between ages 20-40; loss of myelin sheath

Multiple sclerosis (MS)

Hypertension (silent killer)

elevation of arterial blood pressure; can be asymptomatic

elevated blood pressure/prehypertension

120-129/<80

Hypoglycemia

blood glucose is too low; insulin shock

Severe asthmatic attack that will not respond to treatment

status asthmaticus

sudden reduction or arrest of blood flow to the heart; nausea, vomiting, palpations and decreased blood pressure; risk for sudden death; postpone treatment for 6 months after due to risk of infection

myocardial infarction

A patient with mild systemic disease

ASA II

facial feature of fetal alcohol syndrome

Indistinct philtrum

ADL/ BADL (basic activities of daily living)

feeding, dressing, grooming, bathing, toileting

Stage 1 hypertension

130-139/80-89

Oral side effects of albuterol

xerostomia, candida infections, increased caries

Exophthalmos is a symptom of:

hyperthyroidism

Muscle rigidity, pupil dilation, eye roll upward or to the side, loss of conscious

Tonic (seizure)

Short, morning appointments, the higher the injury, the less the patient is able to do

spinal cord injury

Special consideration for pregnant patients

2nd trimester is safest for treatment, pregnancy gingivitis, pyogenic granuloma, daily fluoride rinses (not systemic supplements), client positioning may cause pressure on mother’s vena cava creating hypotension (turn patient to left side and place pillow under right hip)

Medications for smoking cessation that interact with epinephrine:

Bupropion (Zyban)- antidepressant (xerostomia); Chantix- nicotine agonist (xerostomia)

Macroglossia, fissured tongue, dry lips, mouth breathing, delayed eruption, congenitally missing teeth, increased periodontal disease, anterior crossbite; speak simply, positive reinforcement (Tell, Show, Do)

Trisomy 21 (down syndrome)

Special consideration for drug and alcohol dependent patients

high risk for dental caries, periodontal disease, oral cancer, infection, leukoplakia, and glossitis; xerostomia/halitosis (alcohol); IV drug users may require premedication

Hepatitis C

Blood/body fluids; needle sticks; perinatal; IV drugs; sexual contact; NO vaccine; usually asymptomatic

Contraindications for patients with COPD

air polisher; ultrasonic scaler; rubber dam; nitrous oxide/oxygen sedation

Oral manifestations of patients with intellectual disabilities:

TMD, bruxism, microdontia

Genetic exocrine gland disorder; glands over secrete (saliva, tears, sweat- thick and sticky); mucus accumulates in the lungs; elevate head to assist with breathing

Cystic fibrosis

Anomalies of heart structure; genetic; formed in utero; bleeding potential; consult physician for premedication

congenital heart disease

artificial or prosthetic heart valve requires premedication

heart valve replacement

chronic disease characterized by pain, immobility, muscle weakness; increased salivation, mouth breathing

muscular dystrophy

best time for appointment is after dialysis

renal failure

increased caries seen due to xerostomia, decrease environmental stimulation, do not feed into delusions

schizophrenia

irregular heartbeat leading to inadequate blood flow; at risk for cardiac arrest; short stress free appointments; no epinephrine

cardiac arrhythmias

Low stress tolerance; antibiotic premedication may be needed; mucosal pallor, delayed tooth eruption, atrophy of tongue papillae (smooth tongue)

sickle cell anemia

Special consideration for blind patient

pretend you are speaking with them over the phone, modify oral health instructions according to their needs, keep patient informed throughout each step of appointment, clear path of obstacles

ADL/BADL Level I

near normal functioning the

the mechanism of action of nitroglycerin is:

relaxation of vascular smooth muscle

failure of one or both ventricles (inadequate tissue perfusion); salivation and gag reflux are exacerbated by the medication digitalis; risk for cardiac arrest; elevate head of dental chair

congestive heart failure

Raynaud’s phenomenon: bluish discoloration of primarily the fingers and toes (cold temperature or stress)

Scleroderma/Systemic sclerosis

age related, progressive cartilage degeneration and loss of joint cushioning

osteoarthritis

extreme muscle; difficulty swallowing; risk of aspiration; ultrasonic scaler and air polisher are contraindicated

Myasthenia Gravis

ASA I

a normal, healthy patient

usually no premedication required

coronary bypass surgery

episodic vasoconstriction of digits due to cold temperature is a symptom of:

Raynaud’s phenomenon

ADL/BADL Level III

simulation of normal function with aid of third party (caregiver may be responsible for dental care)

Most common type of diabetes mellitus

type 2

HIV/AIDS (human immunodeficiency virus/ Acquired immunodeficiency syndrome)

avoid aerosols; avoid lacerations; frequent recare appointments; fluoride, antimicrobial rinse; physician’s direction on CD4 count and viral overload

Tobacco counseling

Ask, Advise, Assess, Assist, Arrange

Angina pectoris episodes; myocardial infarction episodes; premedications needed for unrepaired congenital defects

Coronary/Ischemic heart disease

Hypertensive Crisis

180/120

T or F: According to the Americans with Disabilities Act (ADA), in public facilities both architectural and communication barriers must be removed

true

High vaulted palate, TMJ disorder, long narrow teeth, Class III occlusion; may have congenital heart defects; may need premedication

Marfan Syndrome

Normal blood pressure

<120/80

Dysphagia: difficulty swallowing, drooling, difficulty keeping mouth open, TMJ dysfunction, tongue thrusting, mouth breathing, bruxing, attrition; give OHI to caregiver; gingival hyperplasia due to medications

cerebral palsy

Diffuse pigmentation of the skin and mucosa caused by insufficient adrenal cortical steroidal production is associated with:

Addison’s disease

Transient and reversible oxygen deficiency; risk for cardiac arrest/sudden death; nitroglycerin (relaxes vascular smooth muscle)

Angia pectoris

What consequence may be likely if a patient suffering with angina were to delay a sublingual dose of nitroglycerin?

myocardial infarction

Mucosal pallor, delayed tooth eruption, and atrophy of tongue papillae (smooth tongue) are oral manifestations of:

sickle cell anemia

bradycardia; treatment: synthroid-hormone replacement therapy

hypothyroidism

what time interval of oral hygiene maintenance should patients with autoimmune disease be placed on:

2-3 months

special considering for tobacco using patients

cigarette smoking is the #1 cause of preventable disease/death; high risk of periodontal disease (decreased vascularity); ensure a thorough oral cancer screening

excess ACTH (adrenocorticotrophic hormone) production by pituitary gland; “moon face”; “buffalo hump”

Cushing’s disease Syndrome (hypercortisolism)

development disorders that affect brain function; build rapport; know triggers; short, frequent appointments; positive reinforcement

autism

transmitted by males and carried by females; hematoma formation, bleeding after extractions

hemophillia

geriatric patients are at higher risk for:

oral cancer, caries, periodontal disease, attrition, abrasion, enamel discoloration, cracked teeth

Anitbiotic prophylaxis/premedication is recommended for:

cardiac transplant; heart valve prosthesis; chronic renal failure i

inflammation of lining of bronchial tubes; thick, heavy mucus and phlegm; more prevalent in women; “smokers’ cough”

chronic bronchitis

Stage 2 hypertension

140/90 or higher

Chronic inflammation of intestines; autoimmune disorder; appointments should be limited to periods of remission

Crohn’s disease