Evaluation of Medically Compromised Patient Flashcards
recording of Korotkov sounds?
when taking blood pressure
record when you first hear sounds and record when you first do not hear sounds
extraoral component of head and neck exam
- note any asymmetry
- lymph nodes
- trachea/thyroid
- eyes
- TMJ
4 general things in head and neck exam
- observation
- palpation
- percussion
- auscultation (listening)
intraoral compoenents of head and neck exam
- tongue
- palate
- pharynx
- floor of mouth
- gingiva
- teeth (notice how at bottom of the list)
Consultation can include what?
- to discuss management
- to evaluate a new symptom
- to control an uncontrolled problem
labratory tests are based on what
When indicated:
- medical history
- procedure planned
ASA 1 =
normal healthy patient
ASA II =
- mild systemic disease that does NOT INTERFERE with daily activity
- may or may not need dental management alterations
examples of ASA II
mild hypertension, well-controlled asthma, well-controlled epilepsy, HIV+, smoking, obesity
ASA class III=
- moderate to severe systemic disease that is not incapacitating but which may alter daily activity
- generally require dental management alterations
examples of ASA class III patients
- IDDM
- stable angina
- AIDS
- hemophilia
ASA class IV =
- severe systemic disease that is a contant threat to life
2. definitely require dental management alterations
examples of ASA Class IV
severe cardiac disease, end-stage renal or liver failure, advanced AIDS, unstable angina
three problems associated with stress / triggered by it
1 . cardiac disease
- asthma
- epilepsy
coronary artery disease characteristics
- narrowing or spasm of coronary vessels
- myocardial oxygen demand > supply
- myocardial infarction (MI) - cellular death due to ischemia
- angina- chest pain or pressure
angina with or without cellular death
without – it is a symptom associated with myocardial ischemia with chest pain or pressure
stress reduction protocol can include what?
- recognition of stress
- pre-medication night before and day of treatment (valium)
- morning appointment
- minimize their waiting period when they arrive
- sedation during treatment? (nitrous oxide)
- adequate pain control
- variable length of appointment (dont over extenuate)
- adequate post-op pain management
management of patient with coronary artery disease
- consult patient’s physician
- stress-reduction protocol
- have nitroglycerin available (pre-med)
- consider N20 sedation
- achieve profound local anesthesia but limit the epi (2 cartridges of 1:100,000 epi)
6 monitor vital signs during
defer elective tx in coronary artery disease to how long?
defer tx 6 months after an MI and check if patient is on anticoagulants
3 main characteristics in asthma patients
- increased bronchial smooth muscle spasm
- increased mucous secretions
- increased bronchial wall edema
overall HYPERACTIVITY OF TRACHEOBRONCHIAL TREE
asthma triggers
- stress
- allergy
- bronchial infections
- histamine releasing drugs like meperidine, barbiturates
defer tx in asthma patient if? how to manage these patients
if it is non well controlled defer tx
manage:
- listen to chest with stethescope with wheezing
- follow stress reduction protocol
- keep bronchiodilator inhaler nearby
- note if ASA or NSAID sensitivity
if pt is using steroids chronically, what do you treat them as?
adrenal insufficiency
management of renal insufficiency and dialysis /
- consult patient’s physician
- avoid or modify drugs which depend on renal metabolism / excretion
- avoid nephrotic drugs (NSAIDS)
- TX the DAY AFTER dialysis
best day to treat patients on dialysis
DAY AFTER dialysis
what patients should you look for secondary signs of hyperparathyroidism
renal insufficiency and dialysis
- b/c with renal failure you are loosing calcium and could pose as hyperparathyroidism
who should you consider doing prophylactic antibiotics for arteriovenous (A-V) shunt
managing renal insufficiency and dialysis patients
do not give tylenol to which patients?
managing patients with liver failure
- avoid drugs which require hepatic metabolism
screen for bleeding disorders in who?
patients with liver failure
management of patients with epilepsy
- question patient about frequency, type, duration of seizures
- consider checking drug levels
- stress-reduction protocol
management of pt. who is pregnant?
- defer until after delivery if possible – if not like to tx in middle trimester
- consult patients obstetrician
- avoid x-rays if possible; especially in 1st trimester and used proper shielding
- monitor vital signs
- avoid teratogenic medications
aspirin during pregnancy?
like to try and keep away from
avoid what position when treating pregnant patient?
avoid supine position for long periods of time = vena cava compression
general effects of epinephrine
- HR and cardiac output increase
- potential arrhythmias
- changes in blood pressure depending on health status of patient
- stroke volume
- bronchodilation
absolute contraindications for epinephrine
- uncontrolled hyperthyroidism
- sulfite sensitivity; steroid-dependent asthma
- pheochromocytoma
- recent cocaine abuse
what cardiovascular symptoms are absolute contraindications for epi
- unstable angina
- recent MI
- recent coronary artery bypass graft
- refractory arrhythmias
- uncontrolled hypertension
- uncontrolled congestive heart failure
epi relative contraindications
- NON-SELECTIVE beta blockers
- tricyclic antidepressants
- MAO inhibitors
- phenothiazine compounds
how many mg of hydrocortisone are the adrenal glands capable of producing during stressful situations
300 mg
adrenal supression can be seen in who?
those taking exogenous steroids
stress response usually regained within what time period?
2 weeks
signs of an adrenal crisis?
- hypotension
- nausea
- vomiting
- weakness
- headache
dose of meds in extensive or anxious patient taking steroids?
double the normal dose
100 mg
IDDM is what type
type 1 - insulin dependent diabetes
describe Type 1 diabetes
- insulin dependent
- juvenile onset
- easrly AM, short appointments
- taje usual insulin and eat regular meal
- IV anesthesia? – take 1/2 insulin, give dextrose IV
- keep 100-200 ml/l of blood sugar
what type of diabetes are less prone to hypo-or hyperglycemia?
type II diabetes
IV anesthesia in type I and type II diabetes
type I - take 1/2 insulin and give dextrose IV
type II- skip medication
chronic effects of diabetes
- primary damage is to SMALL BLOOD VESSELS
- increased atherosclerosis
- progressive renal failure
- coronary artery disease
- retinopathy
- peripheral vascular disease
- peripheral neuropathy
- increased risk of infection
Coumadin AKA?
type of drug and what it works on? how to reverse it?
Warfarin and is an ANTICOAGULANT
- decreases formation of factors II, VII, IX, X – effects the extrinsic pathway
reverse with vitamin K
INR less than you can treat
less than 3 we can do normal treatment
if INR greater than 3 – discuss the tx
how long must coumadin must be discontinued for?
48-72 hours
how to handle patient if they must be taken off an anticoagulation medicine?
heparinize in hospotal, or consider bridging technique
