Asthma, Diabetes, Allergy Flashcards
1
Q
do all patients get a medical history?
A
YES
2
Q
Common medical history topics patients “fudge”
A
oral hygiene
alchohol
smoking
drugs
3
Q
What is asthma
A
chronic inflammatory disease of the airways characterized by reversible episodes of increased airway HYPER-responsiveness
4
Q
True or False
Asthma is usually sudden onset
A
True
peak symptoms occur within 10-15 minutes
5
Q
In the US asthma prevalence has
A
more than doubled since 1960s
went from 2% –> 7%
6
Q
True or False
the severity of symptoms and attacks varies greatly among patients with asthma
A
True
7
Q
Asthma is primarily a disease of
A
children
10% if children are affected
8
Q
What is the second most common chronic disease of children?
A
Asthma
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
10
Q
Do females or males have a higher rate of asthma
A
Females
**in childhood boys have a higher prevalence
11
Q
What races have a slightly higher prevalence of asthma
A
African American and Hispanic populations
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
13
Q
2 categories of asthma
A
Extrinsic asthma
Intrinsic asthma
14
Q
what is extrinsic asthma
A
allergic asthma
occurs more often in children
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
16
Q
what is intrinsic asthma?
A
Non-allergic
17
Q
Who usually develops intrinsic asthma?
A
Adults older than 35
18
Q
What triggers intrinsic asthma?
A
non-allergic factors
respiratory infection
physical exertion
environmental / air pollution
19
Q
Can psychological and physiological stress induce an intrinsic asthma attack?
A
Yes
20
Q
asthmatics have no contraindication to what 3 things?
A
nitrous oxide
valium
oxygen
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
22
Q
What is triad asthmaticus
A
asthma
nasal polyps that recur
sensitivity to aspirin
23
Q
Who develops triad asthmatics?
A
only a small percentage of people with asthma
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
25
Asthma symptoms (6)
chest congestion
wheezing and cough
dyspnea and tachypnea
increased blood pressure
anxiety and agitation
cyanosis
26
How can a dentist be able to determine the severity and stability of asthma in a patient?
through good medical history
27
What is the underlying primary goal in dental management of patients with asthma?
prevent an acute attack
28
What are some things you could do if someone has an asthma attack in the dental chair? (7)
terminate procedure
position patient upright
calm patient
administer bronchodilator (Ventolin)
administer oxygen (if bronchodilator is unsuccessful)
summon medical assistance
adminsister epinephrine (bronchodilator and antispasmodic)
29
How should you administer ventolin to a patient having an asthma attack
if there is no improvement after 15 seconds --> administer again UP TO 3 times
30
What is mild asthma?
< 3 attacks a week
< 30 minutes duration
only w/ exercise or allergen
inhaler use is rare
usually childhood and is outgrown
31
What is moderate asthma?
3-5 attacks a week
last 30 minutes - several hours
affects sleep
occasional ER visits
inhaler use is more common
32
what is severe asthma?
Daily attacks
use inhaler daily
may use steroids
Frequent ER visits (can be hospitalized)
Limits daily activity
33
What is diabetes
complex chronic incurable illness and a growing epidemic in the US
34
according to the CDC how many Americans have diabetes?
30.3 million / 9.4%
35
How many americans are undiagnosed for diabetes?
7.2 million / 23.8%
36
How many are prediabetic?
84 million
37
What is the third leading cause of death in the US
diabetes
38
Does risk of diabetes increase or decrease with age
increase
95% are over 45 years of age
39
What is the leading cause of blindness in the US
diabetes
40
What is diabetes mellitus?
a group of metabolic syndromes resulting from low levels of the hormone insulin
41
what is characterized by a disordered metabolism of carbohydrates lipids and proteins and an abnormally high blood sugar level (hyperglycemia)?
diabetes mellitus
42
The incidence of DM II has more than ______ since 1998
doubled
43
the incidence of DM I has ______ _______ over time
remained stable
44
What can long term hyperglycemia that results from DM lead to?
damage of various organs
heart, eyes, kidneys, nervous system, vascular system, and periodontium
45
What percentage of diabetic patients have type 1 diabetes?
5%
46
What type of diabetes is more common in children and adolescents
type 1 diabetes
47
what type of diabetes is characterized by BETA CELL destruction that leads to absolute insulin deficiency?
Type 1 diabetes
48
Type 1 diabetes is typically _____ onset
abrupt
49
Who is typically affected by type II diabetes
adults usually overweight or obese
50
In what type of diabetes is ketoacidosis uncommon?
Type II
51
In what type of diabetes are sugar levels typically more stable?
Type II
52
What is gestational diabetes
any degree of abnormal glucose tolerance during pregnancy
53
what percentage of pregnant women develop gestational diabetes
5-7%
54
what is a known risk factor of gestational diabetes
obesity
55
what happens after childbirth to a woman with gestational diabetes?
mother's glycemic control usually returns to normal
have an increased risk of developing diabetes within 5-10 years
56
Does persistent elevated blood glucose levels put persons at risk for diabetes?
yes
57
What percentage of people with prediabetes developed overt diabetes each year during the average 3 years of follow up?
11%
58
What is diabetic ketoacidosis?
body produces high levels of blood acids called keytones
59
When does diabetic ketoacidosis develop?
when the body cant produce enough insulin
60
What is Kussmaul's respirations?
deep labored breathing pattern
61
True or False
ketoacidosis is rare in people with type II
true
62
what are signs and symptoms of Hyperglycemia
polyuria
polydipsia
polyphagia
dry warm skin
dry mouth
fruity smelling breath
Kussmals breathing
rapid weak pulse
confusion and altered levels of consciousness
63
What are signs and symptoms of HYPOglycemia
lethargy
changes in mood / strange behavior
nausea
tachycardia
hypertension
anxiety
sweating
blood glucose values < 50 mg / 100 ml
64
common hypoglycemia symptoms at an alert level
shakiness
irritability
confusion
hunger
65
Symptoms of severe hypoglycemia
loss of consciousness
seizures
coma
66
Many patients with diabetes are recommended to eat a meal or snack every
4-5 hours
67
How to manage hypoglycemia?
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
what does HbA1c (hemoglobin A1c) monitor?
long term glucose control over 30-90 days
69
What is the ideal HbA1c level for someone with diabetes?
6.5% or below
70
if you are at risk of developing type 2 diabetes your target HbA1c should be what?
6%
71
what should you do if the blood glucose level is < 70 mg / dL
consider deferring elective treatment or give carbohydrates
wait 15 then retest
72
what should you do if a patient doesn't know their HbA1c?
test the patient with a glucometer
73
what should you do if the blood glucose level is > 200 mg / dL
defer elective treatment and refer to physician
74
what should a fasting glucose level be?
80-130 mg / dL
75
what should a glucose level be 1-2 hours after a meal
<180 mg / dL
76
What is insulin shock?
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
What is insulin shock mild stage
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
what is insulin shock moderate stage
blood glucose drops substantially
patient becomes incoherent uncooperative and sometimes belligerent or resistant to reason
CHIEF DANGER - patients injure themselves or someone else
79
what is insulin shock severe stage
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
the reaction to excessive insulin can be corrected by...
giving the patient sweetened fruit juice, or anything with sugar in it
81
Patients in the severe stage are best treated with...
an IV-glucose solution
glucagon
epinephrine (may be used for transient relief)
82
Oral manifestations of diabetes
xerostomia
bacterial, viral, fungal infections
poor wound healing
increase incidence / severity of caries
Metformin (consider compliance - can takes metallic / give a headache)
83
oral complications of diabetes
periodontal disease
xerostomia
burning mouth syndrome
increased infections
poor wound healing
increased incidence of gingival inflammation
periodontal abscess
84
What is Allergy?
an abnormal or hypersensitive response of the immune system to a substance introduced into the body
85
what has to happen for an allergic reaction to occur?
the patient must have been previous exposed to the antigen (sensitizing dose) and the subsequent exposure (challenge dose) causes the reaction
86
It is estimated that more than ____ of all Americans demonstrate an allergy to some substance
25%
87
What is a rapid / anaphylactic allergic reaction
rapid onset (less than 1 hour)
Type 1 - TRUE IgE mediated anaphylaxis
88
What is a Type 1 hypersensitivity reaction
related to teh humoral immune system (antibody-mediated immunity)
occur after 2nd contact with antigen
89
what is anaphylaxis?
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
What is the most common cause of a type 1 hypersensitivity reaction?
antibiotics
91
what happens to the cardiovascular system during anaphylactic reactions?
capillary dilation and increased capillary permeability resulting in blushing and edema
decreased venous return
decreased blood pressure
decreased cardiac output
92
Can anaphylactic allergic reactions lead to asphyxia from upper respiratory tract obstruction?
yes
93
What is the progression of symptoms of anaphylactic reactions
skin
eyes, nose, GI
respiratory
cardiovascular
94
What are respiratory affects during anaphylactic reactions
bronchospasm
wheezing
respiratory distress
angioedema leading to airway obstruction
rhinitis
95
Affects of anaphylactic reactions on skin
urticaria (itching hives)
Erythema rash
angioedema
96
Management of a rapid allergic reaction
position patient supine
BCLS?
Oxygen
monitor vitals
epinephrine 1/10,000 3.0cc
benadryl 50mg IV or IM
97
what is the shelf life of an epi pen
16 months but FDA allows an additional 4 months
98
Where should an epi pen be administered? injected? idk
outer thigh should be used
better than front of thigh because less fat and thinner tissue
99
Allergic reaction delayed
onset > 1 hr
not life threatening
100
signs and symptoms of delayed allergic reaction
rash
pruritus (itching)
urticaria (hives)
edema
101
Management of a delayed allergic reaction
terminate procedure
position patient based on comfort
BCLS if indicated
Benadryl 50 mg - continue benadryl for 24 hours after symptoms disappear
102
what percentage of self-reports of allergy are NOT true allergies
5-10%
