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Clinical Dental Hygiene II > Chapter 59-pt w/ physcial impairment > Flashcards

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

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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
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3
Q

progressive neurodegenerative disorder characterized by a progressive loss of motor neurons

A

ALS

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4
Q

What is the incidence (occurance) of ALS?

A

approximately 3.9 per 100,000 populations

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5
Q

TRUE OR FALSE: men are effected more than women, caucasians more than ethnic groups.

A

TRUE

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6
Q

What age does ALS occur at?

A

60-69

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7
Q

What is the diagnosis of ALS?

A

there is no diagnostic test, usually made after ruling out other disorders with similiar symptoms

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8
Q

How is ALS caused?

A

unknown. 90% of cases are sporadic

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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
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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
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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
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12
Q

Progressive disorder of the CNS

A

Parkinson’s disease

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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
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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
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15
Q

TRUE OR FALSE: Parkinsons disease progresses in stage mild, moderate, and severe

A

TRUE

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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
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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

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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
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19
Q

An autoimmune neuromuscular disease characterized by weakness and fatigue of symmetrical voluntary muscles.

A

Myasthenisa Gravis

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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

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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

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22
Q

What are the early signs of MG?

A

Weakness of eye movement with double vision /droopy eyelids

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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

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24
Q

Medical treatment of Myasthensia Gravis:

A

immunosuppressive drugs

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25
Q

Dental hygiene considerations for MG:

A
  • Difficulty swallowing and chewing
  • Risk for choking
  • Speech difficulties
  • Risk for myasthenic or cholinergic crisis
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26
Q

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.

A

Post- Polio syndrome (PPS)

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27
Q

What is the treatment of PPS?

A

focus is mainly palliative, with exercise often prescribed to strengthen specific muscles

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28
Q

DHG considerations: for pps

A
  • impaired motor ability

- weakness in the respiratory and swallowing muscles

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29
Q

A condition in which injury to brain has occurred prenatally, natally, or postnatal, and has resulted in paralysis. It can occur and any age.

A

Cerebral Palsy

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30
Q

What can Cerebral Palsy be caused from?

A
  • 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
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31
Q

What is the most common group of Cerebral Palsy?

A

Spasticity

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32
Q

Oral characteristics of cerebral palsy?

A

-Disturbance in musculature
-maloclusion
-attition and erosion
-oral injury
-caries
TQ-PERIODONTAL INFECTIONS ARE FOUND IN A HIGH PERCENTAGE OF PTS WITH THIS CONDITION…*

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33
Q

Used for prevention of seizures, causes gingival overgrowth

A

phenytoin

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34
Q

DHG care considerations for CP:

A
  • increased risk for seizure
  • compromised breathing
  • involvement of muscles in head and neck
  • impaired motor abilty
  • uncontrolled movements
  • need for body stabilization
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35
Q

Genetic myopathies characterized by progressive severe weakness and loss of use of groups of muscles. Generally the disease is limited to skeletal muscles.

A

Muscular Dystrophy

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36
Q

What are the two types of muscular dystrophy?

A
  1. Duchenne type

2. Faciscpulohumeral MS

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37
Q
  • 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
A

DUCHENNE TYPE

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38
Q
  • 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
A

FACISCAPULOHUMERAL MS

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39
Q
  • Most common in adults
  • Affects both men and women
  • Prolonged spasm after use
  • Also affects CNS, heart, GI Tract, eyes and hormone producin glands
A

Myotonic muscualr dystrophy

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40
Q

Many diseases related to the neuromuscular system, joints, or connective tissue do what?

A

Leave a chronic after-effect, loss of function in the form of physical impairment.

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41
Q

Many of the neurological conditions involve what?

A

The death of nerve cells in the CNS.

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42
Q

The death of the nerve cells can cause what?

A

Partial or complete paralysis

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43
Q

Acute neurological disorders can happen when what?

A

Neurons are injured by trauma, biological attack, or disruption of blood flow to the Brain.

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44
Q

Complete or partial loss of motor ability, sensory perception, or cognitive function can happen when you have what?

A

An acute neurological disorder

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45
Q

Degenerative disorders are what?

A

Progressive/slower meaning it gets worse with time

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46
Q

Developmental disorders

A

develop early in life, around the time of birth or before the age of 18.

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47
Q

What are some other conditions that limit physical ability?

A

joint and connective tissue diseases, like arthritis and autoimmune diseases such as myasthenia graves, scleroderma and rheumatoid arthritis.

48
Q

Spinal cord

A

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
Q

Any type of external trauma to the spinal cord can cause what?

A

partial or complete loss of sensory/or motor function related to the spinal cord level and the extent of the injury.

50
Q

More than ___________ people in the US are living with SCI (spinal cord injury).

A

200,000

51
Q

More than ___ cases are a result of a vehicle accident; other falls, diving accidents, violence, and combat injuries.

A

1/3

52
Q

Nearly ___ injuries are males between 16 and 30.

A

1/2

53
Q

The signs and symptoms of paralysis due to SCI depends on what?

A

the level of injury to the SC

54
Q

How many cervical vertebrae are there?

A

5

55
Q

How many thoracic vertebrae are there?

A

12

56
Q

How many lumbar vertebrae are there?

A

5

57
Q

How many sacral vertebrae are there?

A

5

58
Q

Each vertebrae is paired with what?

A

a spinal nerve

59
Q

Complete lesion

A

A complete transection or compression of the spinal cord leaves no sensation or motor function below the level of the lesion.

60
Q

Incomplete Lesion

A

Partial injury of the spinal cord.

61
Q

What are other possible effects of SCI?

A

Impairment of bladder, bowel control and sexual function; impairment of blood vessels and body temp. regulation.

62
Q

Patients with lesions at or above the T6 level are at greater risk for what?

A

Secondary complications

63
Q

Potential Secondary Complications for SCI

A
  • Impaired respiratory function
  • Tendency for pressure sores
  • Spasticity
  • Body Temperature
  • Vulnerable to Infection
  • Cardiovascular Instability
  • Neurogenic bladder and bowel
  • Autonomic Dysreflexia
64
Q

Impaired Respiratory function

A
  • Pneumonia/reduced life expectancy for a person with SCI

- Some quadriplegic patients are unable to have a productive cough, and may need help.

65
Q

Tendency for pressure sores

A

-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
Q

Spasticity

A

-Stimuli, such as pressure sores, infections, and sensory

67
Q

Body Temperature

A

-High-level quadriplegic pts. are unable to regulate body temperature, requiring careful monitoring and intervention.

68
Q

Vulnerability to Infection

A

-Complications related to elimination, urinary tract infections,
renal stones, secondary infections, and respiratory infections are more common in these pts.

69
Q

Cardiovascular Instability

A
  • Bradycardia and hypotension are common.

- Deep vein thrombosis is another potential complication.

70
Q

Neurogenic Bladder and Bowel

A

Dysfunctions in emptying bladder and bowels.

71
Q

What is Autonomic Dysreflexia?

A

a life threatening emergency in which the blood pressure spikes quickly.

72
Q

What are the symptoms of Autonomic Dysreflexia?

A
  • 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
Q

How can you prevent Autonomic Dysreflexia?

A
  • 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
Q

What is the emergency care procedure for autonomic dysreflexia?

A
  • 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
Q

Patient’s with a high-level SCI who does not have good function of hands/arms may use what?

A

Mouth-held appliances using the teeth for holding objects.

76
Q

Why is Optimum OH significant In Patients with High-level SCI?

A

Because many functions cannot be accomplished by an edentulous mouth.

77
Q

Why is fabrication of mouth-held appliances important?

A

Because it contributes to increased independence and makes possible to operate an electric wheelchair, type, or turn pages of a book.

78
Q

What is the criteria for a mouth-held appliance?

A
  • Doesn’t harm the oral tissues.
  • It is comfortable
  • Can be cleaned and cared for easily.
79
Q

What are some factors to consider when planning dental hygiene care for the patients with SCI?

A
  • 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
Q

What is cerebrovascular accident also known as?

A

Stroke

81
Q

What is a stroke?

A

It is a sudden loss of brain function from interference of blood supply to the brain.

82
Q

Patients who has had a stroke are usually what?

A

Disabled by changes in motor function, communication, and perception.

83
Q

Stroke is the ______ Leading cause of death in the US.

A

3rd

84
Q

Strokes can be severe enough to cause ______ within minutes; but less severe can leave patient with______ _______.

A

Death; Residual effects

85
Q

What is the etiologic factors for a stroke?

A

The blood flow decreases in the brain and shuts off the oxygen supply to a portion of the
Brain, resulting in cerebral infarction.

86
Q

What are the 2 main types of stroke?

A
  • Ischemic Stroke

- Hemorrhagic Stroke

87
Q

What is an Ischemic Stroke?

A
  • Occurs when a blood vessel to the brain is blocked.

- Can be caused by plaque build-up in a blood vessel.

88
Q

What is a Thrombosis?

A

When a clot within a blood vessel of the brain or neck closes an already narrowed vessel.

89
Q

What is an Embolism?

A

When a blood vessel is blocked by a clot carried through the circulation from another part of the body.

90
Q

What is an Hemorrhagic Stroke?

A

Occurs when a cerebral blood vessel ruptures and bleeds into the brain tissues.
(“Brain bleed”)

91
Q

Common Causes of Hemorrhagic Stroke

A

-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
Q

What are some predisposing factors for strokes?

A
  • 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
Q

What is a TIA?

A

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
Q

What are acute signs and symptoms of a stroke?

A
  • Paralysis
  • Articulation-Difficulty of speech
  • Salivation-Difficulty to control saliva
  • Increased or decreased sensation
  • Visual impairment
  • mental function affected
  • personality change
95
Q

What are residual or chronic effects of a stroke?

A
  • 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
Q

Patients with right hemiplegia have more difficulty with what?

A

verbal communication and are more apt to be cautious, anxious, and disorganized.

97
Q

Patients with left hemiplegia have more difficulty with what?

A

physical coordination and may respond

Impulsively being overconfident.

98
Q

***Calcifications on what artery is seen on a panoramic image?

A

Carotid Artery

99
Q

What do you do if you see these calcifications in a pan?

A

refer the patient for medical evaluation

100
Q

Radiation therapy is associated with what?

A

Atheroclerosis formation and risk for stroke

101
Q

What is the medical treatment for a stroke?

A

-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
Q

What are some factors to consider when planning DH care for a patient with a stroke disability

A
  • 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
Q

What is Bell’s palsy?

A

Paralysis of the face muscles innervated by the 7th cranial nerve.

104
Q

What Is the cause of Bell’s palsy?

A

cause is unknown, possibly bacterial and viral infections (particularly herpes simplex), also trauma from tooth extraction or oral surgery.

105
Q

Occurrence of Bell’s Palsy

A
  • In younger and women more than men.

- After 50 more common in men.

106
Q

What are characteristics of Bell’s palsy?

A

-Abrupt weakness of facial muscles, without pain, occurs on one side of face.

107
Q

Signs and symptoms of Bell’s palsy

A
  • Corner of mouth droops/uncontrolled drooling.

- Eyelid may not close/watering and drooping of lower lid invites infection

108
Q

When the 7th nerve is affected what is still intact?

A

Sensory

109
Q

Functional problems of Bell’s Palsy

A

Speech/mastication may be impaired

110
Q

Prognosis of Bell’s Palsy

A

Usually return to normal within 1 month

111
Q

What us Multiple Sclerosis?

A

Disease of the nervous system characterized by progressive disability. Genetically linked in adults, with motor, sensory, cognitive, and emotional changes.

112
Q

Occurrence of Multiple Sclerosis

A
  • 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
Q

What are the initial symptoms of Multiple sclerosis?

A
  • Tingling of hands and feet.
  • Difficulty in coordination, tremor, fatigue, and weakness.
  • Visual impaired with pain.
  • Sudden onset of paralysis and weakness.
114
Q

What are the risk factors for multiple sclerosis?

A
  • Infection

- Pregnancy

115
Q

What are physical symptoms of multiple sclerosis?

A
  • 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.

Clinical Dental Hygiene II (14 decks)

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