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Patient Care 1 Exam 2 > Asthma, Diabetes, Allergy > Flashcards

Asthma, Diabetes, Allergy Flashcards

1
Q

do all patients get a medical history?

A

YES

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2
Q

Common medical history topics patients “fudge”

A

oral hygiene
alchohol
smoking
drugs

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3
Q

What is asthma

A

chronic inflammatory disease of the airways characterized by reversible episodes of increased airway HYPER-responsiveness

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4
Q

True or False
Asthma is usually sudden onset

A

True

peak symptoms occur within 10-15 minutes

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5
Q

In the US asthma prevalence has

A

more than doubled since 1960s

went from 2% –> 7%

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6
Q

True or False
the severity of symptoms and attacks varies greatly among patients with asthma

A

True

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7
Q

Asthma is primarily a disease of

A

children

10% if children are affected

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8
Q

What is the second most common chronic disease of children?

A

Asthma

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9
Q

what is the first most common chronic disease of children?

A

Dental caries

1/2 of all cases develop before the age of 10

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10
Q

Do females or males have a higher rate of asthma

A

Females

**in childhood boys have a higher prevalence

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11
Q

What races have a slightly higher prevalence of asthma

A

African American and Hispanic populations

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12
Q

Asthma causes / triggers (5)

A

emotional / physical stress
allergy to foods or drugs
air pollution or irritating vapors
upper respiratory infections
exercise induced

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13
Q

2 categories of asthma

A

Extrinsic asthma
Intrinsic asthma

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14
Q

what is extrinsic asthma

A

allergic asthma

occurs more often in children

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15
Q

what triggers extrinsic asthma

A

specific allergens such as pollens dust molds allergenic foods (milk, fish, shellfish)

drugs and chemicals like penicillin, vaccines, aspirin and sulfites

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16
Q

what is intrinsic asthma?

A

Non-allergic

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17
Q

Who usually develops intrinsic asthma?

A

Adults older than 35

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18
Q

What triggers intrinsic asthma?

A

non-allergic factors
respiratory infection
physical exertion
environmental / air pollution

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19
Q

Can psychological and physiological stress induce an intrinsic asthma attack?

A

Yes

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20
Q

asthmatics have no contraindication to what 3 things?

A

nitrous oxide
valium
oxygen

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21
Q

why should asthmatics avoid aspirin and NSAIDs ?

A

arspirin causes bronchoconstriction in about 10% of patients with asthma

sensitivity to aspirin occurs in 30-40% of people with asthma who have pansinusitis and nasal polyps

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22
Q

What is triad asthmaticus

A

asthma
nasal polyps that recur
sensitivity to aspirin

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23
Q

Who develops triad asthmatics?

A

only a small percentage of people with asthma

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24
Q

What happens to patients with triad asthmaticus

A

they may have a sudden and very severe asthma attack

they do not respond to bronchodilators

considered a TRUE EMERGENCY

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25
Q

Asthma symptoms (6)

A

chest congestion
wheezing and cough
dyspnea and tachypnea
increased blood pressure
anxiety and agitation
cyanosis

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26
Q

How can a dentist be able to determine the severity and stability of asthma in a patient?

A

through good medical history

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27
Q

What is the underlying primary goal in dental management of patients with asthma?

A

prevent an acute attack

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28
Q

What are some things you could do if someone has an asthma attack in the dental chair? (7)

A

terminate procedure

position patient upright

calm patient

administer bronchodilator (Ventolin)

administer oxygen (if bronchodilator is unsuccessful)

summon medical assistance

adminsister epinephrine (bronchodilator and antispasmodic)

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29
Q

How should you administer ventolin to a patient having an asthma attack

A

if there is no improvement after 15 seconds –> administer again UP TO 3 times

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30
Q

What is mild asthma?

A

< 3 attacks a week
< 30 minutes duration
only w/ exercise or allergen
inhaler use is rare
usually childhood and is outgrown

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31
Q

What is moderate asthma?

A

3-5 attacks a week
last 30 minutes - several hours
affects sleep
occasional ER visits
inhaler use is more common

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32
Q

what is severe asthma?

A

Daily attacks
use inhaler daily
may use steroids
Frequent ER visits (can be hospitalized)
Limits daily activity

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33
Q

What is diabetes

A

complex chronic incurable illness and a growing epidemic in the US

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34
Q

according to the CDC how many Americans have diabetes?

A

30.3 million / 9.4%

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35
Q

How many americans are undiagnosed for diabetes?

A

7.2 million / 23.8%

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36
Q

How many are prediabetic?

A

84 million

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37
Q

What is the third leading cause of death in the US

A

diabetes

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38
Q

Does risk of diabetes increase or decrease with age

A

increase

95% are over 45 years of age

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39
Q

What is the leading cause of blindness in the US

A

diabetes

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40
Q

What is diabetes mellitus?

A

a group of metabolic syndromes resulting from low levels of the hormone insulin

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41
Q

what is characterized by a disordered metabolism of carbohydrates lipids and proteins and an abnormally high blood sugar level (hyperglycemia)?

A

diabetes mellitus

42
Q

The incidence of DM II has more than ______ since 1998

A

doubled

43
Q

the incidence of DM I has ______ _______ over time

A

remained stable

44
Q

What can long term hyperglycemia that results from DM lead to?

A

damage of various organs
heart, eyes, kidneys, nervous system, vascular system, and periodontium

45
Q

What percentage of diabetic patients have type 1 diabetes?

A

5%

46
Q

What type of diabetes is more common in children and adolescents

A

type 1 diabetes

47
Q

what type of diabetes is characterized by BETA CELL destruction that leads to absolute insulin deficiency?

A

Type 1 diabetes

48
Q

Type 1 diabetes is typically _____ onset

A

abrupt

49
Q

Who is typically affected by type II diabetes

A

adults usually overweight or obese

50
Q

In what type of diabetes is ketoacidosis uncommon?

A

Type II

51
Q

In what type of diabetes are sugar levels typically more stable?

A

Type II

52
Q

What is gestational diabetes

A

any degree of abnormal glucose tolerance during pregnancy

53
Q

what percentage of pregnant women develop gestational diabetes

A

5-7%

54
Q

what is a known risk factor of gestational diabetes

A

obesity

55
Q

what happens after childbirth to a woman with gestational diabetes?

A

mother’s glycemic control usually returns to normal

have an increased risk of developing diabetes within 5-10 years

56
Q

Does persistent elevated blood glucose levels put persons at risk for diabetes?

A

yes

57
Q

What percentage of people with prediabetes developed overt diabetes each year during the average 3 years of follow up?

A

11%

58
Q

What is diabetic ketoacidosis?

A

body produces high levels of blood acids called keytones

59
Q

When does diabetic ketoacidosis develop?

A

when the body cant produce enough insulin

60
Q

What is Kussmaul’s respirations?

A

deep labored breathing pattern

61
Q

True or False
ketoacidosis is rare in people with type II

A

true

62
Q

what are signs and symptoms of Hyperglycemia

A

polyuria
polydipsia
polyphagia
dry warm skin
dry mouth
fruity smelling breath
Kussmals breathing
rapid weak pulse
confusion and altered levels of consciousness

63
Q

What are signs and symptoms of HYPOglycemia

A

lethargy
changes in mood / strange behavior
nausea
tachycardia
hypertension
anxiety
sweating

blood glucose values < 50 mg / 100 ml

64
Q

common hypoglycemia symptoms at an alert level

A

shakiness
irritability
confusion
hunger

65
Q

Symptoms of severe hypoglycemia

A

loss of consciousness
seizures
coma

66
Q

Many patients with diabetes are recommended to eat a meal or snack every

A

4-5 hours

67
Q

How to manage hypoglycemia?

A

position patient comfortable

administer 100% oxygen

oral carbohydrates if conscious

unconscious - cake icing ; 50% dextrose (20 to 50 ml) IV ; glucagon 1 mg IM or IV ; epinephrine 1/1000 o.5 mg IM

medical assistance

68
Q

what does HbA1c (hemoglobin A1c) monitor?

A

long term glucose control over 30-90 days

69
Q

What is the ideal HbA1c level for someone with diabetes?

A

6.5% or below

70
Q

if you are at risk of developing type 2 diabetes your target HbA1c should be what?

A

6%

71
Q

what should you do if the blood glucose level is < 70 mg / dL

A

consider deferring elective treatment or give carbohydrates

wait 15 then retest

72
Q

what should you do if a patient doesn’t know their HbA1c?

A

test the patient with a glucometer

73
Q

what should you do if the blood glucose level is > 200 mg / dL

A

defer elective treatment and refer to physician

74
Q

what should a fasting glucose level be?

A

80-130 mg / dL

75
Q

what should a glucose level be 1-2 hours after a meal

A

<180 mg / dL

76
Q

What is insulin shock?

A

a hypoglycemic reaction caused by an excess of insulin

can be caused - if someone with diabetes fails to eat in accordance with their diabetic management plan but continue to take their regular insulin injections

77
Q

What is insulin shock mild stage

A

most common

characterized by hunger weakness trembling tachycardia pallor and sweating

can occur before meals, during exercise, or when food has been omitted or delayed

78
Q

what is insulin shock moderate stage

A

blood glucose drops substantially

patient becomes incoherent uncooperative and sometimes belligerent or resistant to reason

CHIEF DANGER - patients injure themselves or someone else

79
Q

what is insulin shock severe stage

A

complete unconsciousness

most of thees reactions take place during sleep

may also occur after exercise or alcohol ingestion if the earlier signs have been ignored

Sweating, pallor, rapid and thready pulse, hypotension, and hypothermia may be present

80
Q

the reaction to excessive insulin can be corrected by…

A

giving the patient sweetened fruit juice, or anything with sugar in it

81
Q

Patients in the severe stage are best treated with…

A

an IV-glucose solution
glucagon
epinephrine (may be used for transient relief)

82
Q

Oral manifestations of diabetes

A

xerostomia
bacterial, viral, fungal infections
poor wound healing
increase incidence / severity of caries
Metformin (consider compliance - can takes metallic / give a headache)

83
Q

oral complications of diabetes

A

periodontal disease

xerostomia

burning mouth syndrome

increased infections

poor wound healing

increased incidence of gingival inflammation

periodontal abscess

84
Q

What is Allergy?

A

an abnormal or hypersensitive response of the immune system to a substance introduced into the body

85
Q

what has to happen for an allergic reaction to occur?

A

the patient must have been previous exposed to the antigen (sensitizing dose) and the subsequent exposure (challenge dose) causes the reaction

86
Q

It is estimated that more than ____ of all Americans demonstrate an allergy to some substance

A

25%

87
Q

What is a rapid / anaphylactic allergic reaction

A

rapid onset (less than 1 hour)

Type 1 - TRUE IgE mediated anaphylaxis

88
Q

What is a Type 1 hypersensitivity reaction

A

related to teh humoral immune system (antibody-mediated immunity)

occur after 2nd contact with antigen

89
Q

what is anaphylaxis?

A

an acute reaction involving smooth muscle of the bronchi

antigen IgE antibody complexes form in the surface of mast cells - causes sudden histamine release

results in acute respiratory compromise and cardiovascular collapse

90
Q

What is the most common cause of a type 1 hypersensitivity reaction?

A

antibiotics

91
Q

what happens to the cardiovascular system during anaphylactic reactions?

A

capillary dilation and increased capillary permeability resulting in blushing and edema

decreased venous return

decreased blood pressure

decreased cardiac output

92
Q

Can anaphylactic allergic reactions lead to asphyxia from upper respiratory tract obstruction?

A

yes

93
Q

What is the progression of symptoms of anaphylactic reactions

A

skin
eyes, nose, GI
respiratory
cardiovascular

94
Q

What are respiratory affects during anaphylactic reactions

A

bronchospasm

wheezing

respiratory distress

angioedema leading to airway obstruction

rhinitis

95
Q

Affects of anaphylactic reactions on skin

A

urticaria (itching hives)
Erythema rash
angioedema

96
Q

Management of a rapid allergic reaction

A

position patient supine
BCLS?
Oxygen
monitor vitals

epinephrine 1/10,000 3.0cc
benadryl 50mg IV or IM

97
Q

what is the shelf life of an epi pen

A

16 months but FDA allows an additional 4 months

98
Q

Where should an epi pen be administered? injected? idk

A

outer thigh should be used

better than front of thigh because less fat and thinner tissue

99
Q

Allergic reaction delayed

A

onset > 1 hr
not life threatening

100
Q

signs and symptoms of delayed allergic reaction

A

rash

pruritus (itching)

urticaria (hives)

edema

101
Q

Management of a delayed allergic reaction

A

terminate procedure

position patient based on comfort

BCLS if indicated

Benadryl 50 mg - continue benadryl for 24 hours after symptoms disappear

102
Q

what percentage of self-reports of allergy are NOT true allergies

A

5-10%

Patient Care 1 Exam 2 (3 decks)

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