Chapter 59-pt w/ physcial impairment Flashcards
1
Q
What is the diagnosis and treatment of multiple Sclerosis?
A
Medications used to treat neurological and other symptoms
2
Q
What are the dental hygiene considerations for Multiple Sclerosis?
A
- Visual disturbances
- impaired motor ability
- oral and systemic effects of medications used for treatment of the condition
- orofacial manifestations, intermittent headaches, facial pain, numbness, palsy, and spasms
3
Q
progressive neurodegenerative disorder characterized by a progressive loss of motor neurons
A
ALS
4
Q
What is the incidence (occurance) of ALS?
A
approximately 3.9 per 100,000 populations
5
Q
TRUE OR FALSE: men are effected more than women, caucasians more than ethnic groups.
A
TRUE
6
Q
What age does ALS occur at?
A
60-69
7
Q
What is the diagnosis of ALS?
A
there is no diagnostic test, usually made after ruling out other disorders with similiar symptoms
8
Q
How is ALS caused?
A
unknown. 90% of cases are sporadic
9
Q
What are the two types of ALS?
A
- Spinal: about 2/3 of p.t.s Early symptoms include muscles weakness in upper and lower limbs
- Bulbar onset form
10
Q
What are the symptoms of ALS?
A
- cramps
- muscle weakness in extremities
- respiratory difficulty
- difficulty swallowing and chewing
- depression
- excessive saliva
- cognitive and behaviorial disorders can affect comliance
11
Q
ALS dental hygiene considerations:
A
- increased motor impairment over times
- need for body stabilization
- rick for respiratory difficulties
- facial paralysis
- treatment for hyper salivation
12
Q
Progressive disorder of the CNS
A
Parkinson’s disease
13
Q
What are the four primary symptoms of parkinsons disease?
A
- tremor in hands, jaw, arm, and face
- rigidity of limbs and trunk
- bradykinesia or slowness of movement
- instable posture
14
Q
Occurrence of Parkinsons Disease:
A
- Millions of middle aged in the US
- Incidence with increased age
- 1 and a half times greater incidence in men than in women
15
Q
TRUE OR FALSE: Parkinsons disease progresses in stage mild, moderate, and severe
A
TRUE
16
Q
General manifestions of parkinsons disease:
A
- Slow motion in movement and repsponses, difficulty in balancing
- Gait slow and shuffles
- Speech is monotone and slow
17
Q
Is there a cure for Parkinsons disease?
A
no, but patients with this disease can take Levodopa in combo with other meds to replenish dopamine
18
Q
Factors to consider for hygiene care for Parkinsons Disease:
A
- motor impairment
- increased drooling
- short apt
- possible cognitive deficits
- adverse drug reactions
- caregiver instructions
- poor control of eyes, lips, tongue, and swallowing
19
Q
An autoimmune neuromuscular disease characterized by weakness and fatigue of symmetrical voluntary muscles.
A
Myasthenisa Gravis
20
Q
Why does Myasthenisia Gravis have such a significance for dental professionals?
A
bc facial and oral parts served by certain cranial nerves are involved. It affects the muscles of the eyes, facial expression, mastication, and swallowing
21
Q
What is the occurrence of MG?
A
- age of onset for women is 20-30, men is 70 or older
- men affected more than women
22
Q
What are the early signs of MG?
A
Weakness of eye movement with double vision /droopy eyelids
23
Q
What are the oral and facial problems of MG?
A
- disturbed speech and expression, with a weak voice
- P.t. may not be able to convay distress
24
Q
Medical treatment of Myasthensia Gravis:
A
immunosuppressive drugs
25
Dental hygiene considerations for MG:
- Difficulty swallowing and chewing
- Risk for choking
- Speech difficulties
- Risk for myasthenic or cholinergic crisis
26
Condition that affects adults, years after recovery from initial attack of the poliomyelitis virus when they were children. Cause is unknown. Prevalence is unknown, but appears to be growing.
Post- Polio syndrome (PPS)
27
What is the treatment of PPS?
focus is mainly palliative, with exercise often prescribed to strengthen specific muscles
28
DHG considerations: for pps
- impaired motor ability
| - weakness in the respiratory and swallowing muscles
29
A condition in which injury to brain has occurred prenatally, natally, or postnatal, and has resulted in paralysis. It can occur and any age.
Cerebral Palsy
30
What can Cerebral Palsy be caused from?
- caused by anoxia during pregnancy or delivery, maternal infection during pregnancy, blood type incompatibilities, severe lack of nutrition during pregnancy, or maternal diabetes endocrine imbalance
31
What is the most common group of Cerebral Palsy?
Spasticity
32
Oral characteristics of cerebral palsy?
-Disturbance in musculature
-maloclusion
-attition and erosion
-oral injury
-caries
TQ****-PERIODONTAL INFECTIONS ARE FOUND IN A HIGH PERCENTAGE OF PTS WITH THIS CONDITION...*****
33
Used for prevention of seizures, causes gingival overgrowth
phenytoin
34
DHG care considerations for CP:
- increased risk for seizure
- compromised breathing
- involvement of muscles in head and neck
- impaired motor abilty
- uncontrolled movements
- need for body stabilization
35
Genetic myopathies characterized by progressive severe weakness and loss of use of groups of muscles. Generally the disease is limited to skeletal muscles.
Muscular Dystrophy
36
What are the two types of muscular dystrophy?
1. Duchenne type
| 2. Faciscpulohumeral MS
37
- Limited to males and transmitted by female carriers
- Condition present at birth and becomes apparent in early childhood at about 4.9 yrs old
- Enlarged muscles, weakness in hips, abdomen protrudes, waddle, increases and become helpless and dependent
DUCHENNE TYPE
38
* Males and females equally affected
-BT ages 6-20 yrs
-Mild symptoms at later ages
-facial muscles involved
-difficulty closing eyes
progression slower than for type
-Malocclusions and tmj disorders
-Scapula prominent
FACISCAPULOHUMERAL MS
39
- Most common in adults
- Affects both men and women
- Prolonged spasm after use
- Also affects CNS, heart, GI Tract, eyes and hormone producin glands
Myotonic muscualr dystrophy
40
Many diseases related to the neuromuscular system, joints, or connective tissue do what?
Leave a chronic after-effect, loss of function in the form of physical impairment.
41
Many of the neurological conditions involve what?
The death of nerve cells in the CNS.
42
The death of the nerve cells can cause what?
Partial or complete paralysis
43
Acute neurological disorders can happen when what?
Neurons are injured by trauma, biological attack, or disruption of blood flow to the Brain.
44
Complete or partial loss of motor ability, sensory perception, or cognitive function can happen when you have what?
An acute neurological disorder
45
Degenerative disorders are what?
Progressive/slower meaning it gets worse with time
46
Developmental disorders
develop early in life, around the time of birth or before the age of 18.
47
What are some other conditions that limit physical ability?
joint and connective tissue diseases, like arthritis and autoimmune diseases such as myasthenia graves, scleroderma and rheumatoid arthritis.
48
Spinal cord
Extends down the middle of the back and carries both motor and sensory nerves that branch and send messages between the brain and specific parts of the body.
49
Any type of external trauma to the spinal cord can cause what?
partial or complete loss of sensory/or motor function related to the spinal cord level and the extent of the injury.
50
More than ___________ people in the US are living with SCI (spinal cord injury).
200,000
51
More than ___ cases are a result of a vehicle accident; other falls, diving accidents, violence, and combat injuries.
1/3
52
Nearly ___ injuries are males between 16 and 30.
1/2
53
The signs and symptoms of paralysis due to SCI depends on what?
the level of injury to the SC
54
How many cervical vertebrae are there?
5
55
How many thoracic vertebrae are there?
12
56
How many lumbar vertebrae are there?
5
57
How many sacral vertebrae are there?
5
58
Each vertebrae is paired with what?
a spinal nerve
59
Complete lesion
A complete transection or compression of the spinal cord leaves no sensation or motor function below the level of the lesion.
60
Incomplete Lesion
Partial injury of the spinal cord.
61
What are other possible effects of SCI?
Impairment of bladder, bowel control and sexual function; impairment of blood vessels and body temp. regulation.
62
Patients with lesions at or above the T6 level are at greater risk for what?
Secondary complications
63
Potential Secondary Complications for SCI
- Impaired respiratory function
- Tendency for pressure sores
- Spasticity
- Body Temperature
- Vulnerable to Infection
- Cardiovascular Instability
- Neurogenic bladder and bowel
- Autonomic Dysreflexia
64
Impaired Respiratory function
- Pneumonia/reduced life expectancy for a person with SCI
| - Some quadriplegic patients are unable to have a productive cough, and may need help.
65
Tendency for pressure sores
-A pressure sore (bed sore) (decubitus ulcer) results from tissue not getting enough oxygen (anoxia) or reduced blood supply (ischemia) caused by pressure exerted on the skin.
-The ulcer can also get a secondary infection and be slow to heal; anemia and poor
nutrition may also contribute.
66
Spasticity
-Stimuli, such as pressure sores, infections, and sensory
67
Body Temperature
-High-level quadriplegic pts. are unable to regulate body temperature, requiring careful monitoring and intervention.
68
Vulnerability to Infection
-Complications related to elimination, urinary tract infections,
renal stones, secondary infections, and respiratory infections are more common in these pts.
69
Cardiovascular Instability
- Bradycardia and hypotension are common.
| - Deep vein thrombosis is another potential complication.
70
Neurogenic Bladder and Bowel
Dysfunctions in emptying bladder and bowels.
71
What is Autonomic Dysreflexia?
a life threatening emergency in which the blood pressure spikes quickly.
72
What are the symptoms of Autonomic Dysreflexia?
- Increased blood pressure w/ slow pulse rate. The blood pressure may rise to 300/160.
- Pounding headache.
- Flushing, chills, perspiration, stuffy nose.
- Restlessness; increased spasticity.
73
How can you prevent Autonomic Dysreflexia?
- Consult with physician if the patient has history of recurrent difficulties.
- Avoid abrupt changes in body position and maintain semi-upright chair.
- Monitor bladder outflow catheter tubing.
74
What is the emergency care procedure for autonomic dysreflexia?
- Position chair upright gradually.
- Monitor the blood pressure and vital signs
- Call for medical help if bp does not begin to drop within 2–3 minutes.
75
Patient's with a high-level SCI who does not have good function of hands/arms may use what?
Mouth-held appliances using the teeth for holding objects.
76
Why is Optimum OH significant In Patients with High-level SCI?
Because many functions cannot be accomplished by an edentulous mouth.
77
Why is fabrication of mouth-held appliances important?
Because it contributes to increased independence and makes possible to operate an electric wheelchair, type, or turn pages of a book.
78
What is the criteria for a mouth-held appliance?
- Doesn't harm the oral tissues.
- It is comfortable
- Can be cleaned and cared for easily.
79
What are some factors to consider when planning dental hygiene care for the patients with SCI?
- Impaired motor and sensory ability.
- Risk for secondary complications during tx.
- Risk for pressure sores, potential for spasms, poor control of body temperature.
- Use of mouth-held implements.
80
What is cerebrovascular accident also known as?
Stroke
81
What is a stroke?
It is a sudden loss of brain function from interference of blood supply to the brain.
82
Patients who has had a stroke are usually what?
Disabled by changes in motor function, communication, and perception.
83
Stroke is the ______ Leading cause of death in the US.
3rd
84
Strokes can be severe enough to cause ______ within minutes; but less severe can leave patient with______ _______.
Death; Residual effects
85
What is the etiologic factors for a stroke?
The blood flow decreases in the brain and shuts off the oxygen supply to a portion of the
Brain, resulting in cerebral infarction.
86
What are the 2 main types of stroke?
- Ischemic Stroke
| - Hemorrhagic Stroke
87
What is an Ischemic Stroke?
- Occurs when a blood vessel to the brain is blocked.
| - Can be caused by plaque build-up in a blood vessel.
88
What is a Thrombosis?
When a clot within a blood vessel of the brain or neck closes an already narrowed vessel.
89
What is an Embolism?
When a blood vessel is blocked by a clot carried through the circulation from another part of the body.
90
What is an Hemorrhagic Stroke?
Occurs when a cerebral blood vessel ruptures and bleeds into the brain tissues.
(“Brain bleed”)
91
Common Causes of Hemorrhagic Stroke
-Defects in blood vessels, such as aneurysm or malformation.
-Very high bp.
-Blood thinner meds.
-An ischemic stroke that develops a burst blood vessel
and causes bleeding.
92
What are some predisposing factors for strokes?
- Atherosclerosis
- Hypertension (the greatest risk leading to stroke).
- Hypercholesterolemia, hypertriglyceridemia (Cholesterol, Triglycerides).
- Smoking.
- Cardiovascular disease (rheumatic heart disease, congestive heart failure, history of transient ischemic attacks (TIAs).
- Diabetes.
- Use of oral contraceptives.
- Drug abuse (especially in adolescents and young adults).
93
What is a TIA?
A brief event where the blood supply to a localized area of the brain is interrupted and the patient may have signs or symptoms of a stroke. (MINI STROKE)
94
What are acute signs and symptoms of a stroke?
- Paralysis
- Articulation-Difficulty of speech
- Salivation-Difficulty to control saliva
- Increased or decreased sensation
- Visual impairment
- mental function affected
- personality change
95
What are residual or chronic effects of a stroke?
- Approximately 2/3’s who survive have some degree of permanent disability.
- Temporary or permanent loss of thought, memory, speech, sensation, or motion results.
- The side of the face and body affected is opposite that of the brain injury.
96
Patients with right hemiplegia have more difficulty with what?
verbal communication and are more apt to be cautious, anxious, and disorganized.
97
Patients with left hemiplegia have more difficulty with what?
physical coordination and may respond
| Impulsively being overconfident.
98
***Calcifications on what artery is seen on a panoramic image?
Carotid Artery
99
What do you do if you see these calcifications in a pan?
refer the patient for medical evaluation
100
Radiation therapy is associated with what?
Atheroclerosis formation and risk for stroke
101
What is the medical treatment for a stroke?
-Surgical correction of aneurysms, clots, or malformations may include removal clots in
the intracranial arteries or minute grafting to bypass blocked vessels to provide circulation.
-Physical/occupational therapy and rehab are important to the pt.’s recovery.
-Careful recording of the MH includes the listing of meds.
102
What are some factors to consider when planning DH care for a patient with a stroke disability
- Impaired motor/cognitive ability.
- Hemiplegia; particularly if the dominant hand is affected.
- Facial paralysis; decreased self-cleansing action of tongue/lips; decreased control of saliva; risk for aerosol in eye during treatment.
- Medication/anticoagulant use is common after stroke.
103
What is Bell's palsy?
Paralysis of the face muscles innervated by the 7th cranial nerve.
104
What Is the cause of Bell's palsy?
cause is unknown, possibly bacterial and viral infections (particularly herpes simplex), also trauma from tooth extraction or oral surgery.
105
Occurrence of Bell's Palsy
- In younger and women more than men.
| - After 50 more common in men.
106
What are characteristics of Bell's palsy?
-Abrupt weakness of facial muscles, without pain, occurs on one side of face.
107
Signs and symptoms of Bell's palsy
- Corner of mouth droops/uncontrolled drooling.
| - Eyelid may not close/watering and drooping of lower lid invites infection
108
When the 7th nerve is affected what is still intact?
Sensory
109
Functional problems of Bell's Palsy
Speech/mastication may be impaired
110
Prognosis of Bell's Palsy
Usually return to normal within 1 month
111
What us Multiple Sclerosis?
Disease of the nervous system characterized by progressive disability. Genetically linked in adults, with motor, sensory, cognitive, and emotional changes.
112
Occurrence of Multiple Sclerosis
- Affects approx. 400,000 people in the U.S.
- Adult onset between ages 20 and 40.
- Higher among Caucasians than ethnic.
- More in temperate climates.
113
What are the initial symptoms of Multiple sclerosis?
- Tingling of hands and feet.
- Difficulty in coordination, tremor, fatigue, and weakness.
- Visual impaired with pain.
- Sudden onset of paralysis and weakness.
114
What are the risk factors for multiple sclerosis?
- Infection
| - Pregnancy
115
What are physical symptoms of multiple sclerosis?
- Fatigue.
- Intermittent, unilateral facial numbness, pain, palsy or spasm.
- Involuntary motion of eyes; may later become partially or completely blind.
- Speech disorders
- Changes in muscular coordination and gait; loss of balance.
- Paralysis of one or more extremities.
- Urinary frequency and urgency; later incontinence.
- Susceptible to infection, particularly upper respiratory.
