Behavious Management Flashcards
When do you see children
See at age 1
How to classify cognitive development in kids
0-2y= sensory motor, pre-cooperative, sensation and motor skills
2-7y= preoperational stage, communication with symbols, gestures, work
Centration: focus on one aspect at one time
Egocentrism: assumes other people experience the world exactly the same
Animism: believe inanimate objects have human feelings and intention
7-11y= concrete-operational stage, operational and logical reasoning rather than intuitive thought
11y= formal operational stage
Language development in children
Tougher to understand before 4
4-5: use adjective
5-6: fluent speech
Physical development of children
Teach parents OHI
Children can brush teeth when they’re about 7 year old
Classification of child temperament
Thomas chess birch
Easy (40%): routine, happy, adapts easily
Difficult (10%): irregular, negative, intense, slow to adapt- structured treatment, firm commands, confident dentist
Slow to warm up (15%): inactive, mild, negative mood, slow- longer time to adjust, more happy visits, calm dentist
Classification of parenting styles
Baumrind, maccoby and martin Authoritative: high control high warmth Authoritarian: high control, Low warmth Permissive: high warmth Low control Uninvolved: Low warmth Low control
how long does attachment last
form attachment to primary caregiver: 8 month to 5 years
verbal domains of behavioural management
tell-show-do- describe whats going to happen, demonstrate, carry out
modelling- older siblings, flip charts, videos
distraction- keep talking about something, television
non-verbal
body language- smile, reassuring touch
desensitization- repeated exposure, increase systematically, oral desensitization eg. electric tooth brush,
rewards
*positive reinforcement- increasing desirable behaviour by providing wanted stimulus, physical rewards and esp verbal rewards, be specific DO NOT bribe cos bribery has to increase in size over time
negative reinforcement- increasing desirable behaviour by removing unwanted stimulus, punishment, scolding, giving contingency escape
aversive
parental exclusion- (for defiant, not for separation anxiety), require parent consent and cooperation
voice control- change in tone and volume, regain control of situation, need warn parents you need to raise your voice
hand over mouth- not really done le, not used as punishment, to establish communication in a child who has lost control but parents dont like
physical
active restrain- by parent or assistant, for precooperative child, knee to knee, emergency (extraction on precooperative child), a bit danger
passive restrain- device and wrap, good for autistic children, under sedation, mouth prop, (require consent)
who made up behaviour assessment
Frankl
whats the frankl scores
++/4: definitely positive, happy anything
+/3: cooperative, but somethings dont like, need to make a note to say what they dont like
-/2: crying but some form of ytreatment
–/1: extreme cannot
what to do first dental visit
history, have plan, dont be ambitious
pharmacological:
anxiolysis: minimal sedation
conscious sedation: moderate
deep sedation
general anesthesia
anxiolysis: responsiveness, airway, spon ventilation, cardio
everything ok
moderate sedation/analgesia/conscious sedation: responsiveness, airway, spon ventilation, cardio
purposeful response
no airway intervention
deep sedation/analgesia: responsiveness, airway, spon ventilation, cardio
purposeful response following repeated or painful stimulation
may required airway intervention, may have inadequate ventilation
usually maintain CV
GA: responsiveness, airway, spon ventilation, cardio
no response ever, airway intervention, inadequate ventilation, may impair CV
drugs
midazolam
sedation and dose
sedation not defined by specific medication or dose but by patient response
Whats American Society of Anesthesia levels
low risk
I: normal healthy patient
II: patient with mild systemic disease
high risk
abnormal airway, asthma, apnea, obesity, respiratory compromise, aspiration risk, poorly controlled seizures, liver disease
III: severe systemic
IV: severe systemic constant threat to life
V: not expected to survive wo operation
VI: brain dead and organ removal
how to classify tonsil size
Brodsky: reduces transvere section of airway 0=surgically removed 1= hidden behind tonsil pillar 2= extending to pillar 3= beyond pillar 4= midline
classify soft palate
mallampati:
vertical dimension, position of tongue and soft palate
I/II/III/IV
NPO status
how long to fast
solid and non clear liquids 6-8hour
breast milk- 4 hour
clear liquid- 2 hour
nitrous oxide
sweet smelling, non-irritating colourless gas
flow rate of 5-6L/min
non less than 30% oxygen regarding at all times
advantage: tolerance for longer appt, depress gag reflex, rapid onset and recovery and titratable
disadvantage: lack of potency, patient breathe through nose, nausea and vomitting (tell patient to not drink/eat, dont titrate like crazy), can suppress airway reflex at 50%,
*diffusion hypoxia- more soluble in blood than nitrogen, blood saturated of nitrous oxide, when you stop, nitrous fills up lungs, hypoxia, need to stop nitrous then give 100% O2
nitrous oxide contraindications
severe COPD
upper respiratory infection
1st trimester pregancy?
bleomycin sulfate treatment (cancer drug affects folate for respiratory replicating cells)
methylenetetrahydrofolate reductase deficiency (risk of developing abnormal plasma homocystein concentrations)
drug related dependancies, severe otitis media, severe asthma
hydroxyzine
gen 1 antihistamine vistaril: 25mg/5cc atarax: 10mg/5cc dose: 2-4mg/kg, max 75mg/dose onset in 30min, duration 3-6 hours, potentiates opioids, babiturates, antiemetic (anti vomiting), sedative, anti-cholinergic
midazolam
benzodiazapine
dose: oral 0.5mg/kg, nasal: 0.2mg/kg
onset 20min, peak plasma level 30min, half life 1 hour
3-4x more potent than diazepam, anterograde amnesia
diazepam
0.2-0.5mg/kg
onsent 45min
peak plasma 2hr
duration 6-8 hours (no driving risk of resedation)
half life 20-70hours of active metabolites
give adults to take 1 hour before coming
ketamine
NMDA receptor antagonist
anesthesia, only in children <8 older then more vivid very hard
oral 6-8mg/kg, IV 0.5-2mg/kg
onset: 20-30min
merperidine
weak opioid dose: oral 1-2mg/kg CNS/CV/resp depression onset 30min peak 1-2 hours, pulmonary complications, head trauma, seizures, hepatic renal disease
max dose of LAs
lidocaine:
risk of lidocaine toxicity
1 in 400000
biphasic effect on CNS and CVS, excitation followed by depression, CNS more sensitive than CVS, lowers seisure threshold
malignant hypothermia
1:5000, 1:65000
genetic predisposition to hypermetabolic reaction in muscle after introduction of certain volatile gaseous inhalation anesthetics
halothane, enflurane, isoflurane, sevoflurane
tachycardia, tachypnea, skeletal muscle rigidity, sweating, dilated pupils
treatment: supportive, sodium dantrolene
whats the difference for pediatric respiration
higher respiratory rates
50-20 times/minutes
smaller tidal volume
more airway resistance, larger tongue and epiglottis
significant lymphoid tissue, larger head to body size, mandible less developed
most common adverse events: respiratory arrest/respiratory depression
whats naloxone
reversal for opiods, IV or sublingual
0.1mg/kg, repeat after 2-3 min to max of 2mg
half life 1-1.5 hours
what is flumazenil
reverse benzodiazepine
IV 0.02mg/kg over 15 sec, repeat every 5 min to max dose of 1mg total
half life 20-30min
whats a precordial stethoscope
put at neck and monitors breathing
whats a capnography
how much CO2 you breathing out, but harder to use cos nasal hood, but more real time, for GA
pulse ox
sigmoidal oxygen dissociation curve, so interruption to respiration is discovered later
when can you discharge the patient
vital signs and airway stable
oriented
walk talk and head support
hydrated
