Health history and vitals Flashcards
1
Q
what is the purpose of health history (10)
A
- Gain insight on how overall health influences oral health and vice versa
- ID medical conditions/factors that require precautions or alteration of treatment
- Maintains legal document
- Baseline information > can compare between each appointment
- Understand client concerns and goals
- Assess general health and nutritional status
- Assess emotional and psychological factors, attitudes, and prejudices that may affect the dental hygiene appointment
- Build rapport
- ID cultural beliefs and practices that affect risk for oral disease
- ID ethnic/racial influences on risk factors influence oral diseases
2
Q
purpose of health history assessment
A
- Health status is dynamic (always changing)
- Monitored for changes at the beginning of EVERY appointment
- In axiUm: complete health history, medications page, and dental history
3
Q
medical history forms 2
A
- Used to gather subjective data about the patients:
*Past health problems
*Present health problems
*Medications - Many different formats and lengths
4
Q
barriers to effective health history 6
A
- Language
- Limited reading comprehension skills/literacy
- Patient understanding
- Patient honesty
- Patient embarrassment > sexual/sensitive medical condition
- Clinician tone > be friendly so patients share information
5
Q
why do patients lie
A
- They don’t think it matters for the appointment, don’t understand the connection, embarrassment
6
Q
multicultural considerations 3
A
- Need to find a way to assess the health history of a patient who speaks another language
- A trained dental interpreter is ideal but not practical, or family member
- Some medical history forms are available in more than one language
7
Q
methods of obtaining health history 4
A
- Questionnaire
- Interview
- Combination of both (used in clinic)
- Using the written health history questionnaire, the hygienist uses the client’s responses as starting points for the health history interview
8
Q
describe the interview portion 2
A
- Establishes rapport and trust to form a positive practitioner-client relationship
- If any “yes” needs to be followed up with additional questions
9
Q
what should you always ask during the interview
A
Always ask:
- the date of diagnosis (year is fine)
- how is the condition being managed (medication/lifestyle changes/none)
10
Q
describe the information gathering phase 6
A
- Reading thoroughly
- Prioritizing the patient’s main concern (fear of pain = top priority)
- Researching conditions/medication
- Formulating questions
- Interviewing (ask questions to clarify and obtain additional information)
Consulting
11
Q
what is patient centered interviewing
A
a technique in which clinicians seek to elicit the patient’s emotions and personal health agenda to better understand the psychosocial context for disease
12
Q
what are the 5 steps of patient centered interviewing
A
- Establish private setting
- Elicit patients chief complaint
- Use open-ended questions
- Use active listening
- Briefly summarize the interview for accuracy
13
Q
describe the interview setting 4
A
- ensures confidentiality and communicates respect
- should never be conducted in the range of others
- client should be comfortably seated upright, at eye level with clinician
- can be done over the phone, in the clinic, or in the cubicle
14
Q
verbal and nonverbal communication 2
A
- Observe the client’s written, verbal, and nonverbal communication
- Eye contact and listening skills enhance communication
15
Q
A comprehensive health history should contain: 5
A
- Demographic information
- Medical history
- Social history (smoking)
- Dental history
- Chief complaint (what are your major oral health needs at this time)
16
Q
legal and ethical issues 3
A
- The client’s health history is confidential and protected by law
- Health insurance portability and accountability act (HIPPA)
- Legal document:
17
Q
since health history is a legal document, what must be done? 4
A
- hard copy records are written in ink
- date all records
- clients or guardians must sign health history to verify the accuracy
- electronic patient records should be signed and dated electronically (please sign to acknowledge that the information you gave is accurate)
18
Q
what is the relationship between systemic and oral health 5
A
- Systemic disease may have oral implications
- Medications produce changes in oral health
- Systemic conditions may require certain precautions prior to dental treatment
- Oral manifestations may need to be checked by the primary care physician
- Substances or drugs used in treatment may produce an adverse reaction
19
Q
how do dental health care providers help? 3
A
- Examining: examining oral cavity for signs of systemic disease
- Obtain: detailed medical history (including conditions that need follow-up
- Using: using blood pressure cuffs and glucose monitors to evaluate for conditions such as diabetes and hypertension
20
Q
what is ASA-PS 3
A
- American Society of Anesthesiologists > ASA physical status classification system
- used to determine the patients level of medical risk during dental treatment
- modifications to dental hygiene care can be made accordingly
21
Q
what are the ASA classification levels 6
A
- ASA 1: Normal
- ASA 2: Mild disease (well controlled), or anxious
- ASA 3: Serve systemic disease
- ASA 4: Severe systemic disease that is a constant threat to life
- ASA 5: 24 hrs to live
- ASA 6: Braindead
22
Q
describe ASA level 1 health status and modifications for safe care 4
A
- a normal healthy patient
- little to no anxiety about dental treatment
- green flag for dental treatment
- no modifications are necessary
23
Q
describe ASA level 2 health status and modifications for safe care 5
A
- Mild systemic disease (well-controlled)
- Healthy person but anxious about dental treatment
- well-controlled diabetes, epilepsy, asthma, smoker
- Yellow flag
- Employ stress reduction strategies
24
Q
describe ASA level 3 health status and modifications for safe care 5
A
- 1 or more moderate to severe systemic diseases that limit activity
- (poorly controlled diabetes, poorly controlled hypertension, chronic renal failure, implanted pacemaker, history of stroke/heart attack (more than 3 months ago)
- yellow flag
- Employ stress reduction strategies
- Treatment modifications are needed, antibiotic premedication or medical consultation may be needed for some condition
25
describe ASA level 4 health status and modifications for safe care 5
- Patients with severe systemic disease that is a constant threat to life
- Heart attack/stroke less than 3 months ago
- Red flag
- Elective dental care should be postponed until medical condition has improved to at least a level 3
- Emergency appointments should be done in a hospital dentistry setting
26
Prophylactic antibiotic premedication (pre-med)
- A.K.A. antibiotic prophylaxis
- Taken prior to dental procedures that can create transient bacteremia (bacteria in the bloodstream)
- Transient bacteremia can cause infective endocarditis
27
what is infective endocarditis
a life-threatening infection of the tissues lining the heart and the underlying connective tissue
sometimes also called bacterial endocarditis
28
The American Dental Association and American Heart Association in 2021 stated that
"The current infective endocarditis/valvular heart disease guidelines state that the use of preventive antibiotics before certain dental procedures is reasonable for patients with:"
6 *NEED TO KNOW FOR PRACTICAL AS WELL*
- Prosthetic cardiac valves, including transcatheter-implanted prostheses and homograft's
- prosthetic material used for cardiac valve repair such as annuloplasty rings and chords
- a history of infective endocarditis
- a cardiac transplant with valve regurgitation due to a structurally abnormal valve
- congenital heart diseases:
- unrepaired cyanotic congenital heart disease, including palliative shunts and conduits
- any repaired congenital heart defect with residual shunts or valvular regurgitation at the site of or adjacent to the site of a prosthetic patch or a prosthetic device
29
Do clients need prophylactic antibiotic premedication for joint replacements? (2)
- administration of antibiotic premedication before dental treatment is controversial for joint replacement
- prosthetic joint infection (PJI) can arise from bacteremia, but the link between premed before dental intervention, and prevention of PJI remains unproven
30
what is ODU SODH's policy regarding joint replacements?
A consultation with the patient's orthopedic surgeon is required to determine if premed is needed prior to dental hygiene treatment
31
Antibiotic premedication dosage regimen guidelines 2
- before initiating dental hygiene procedures ask:
* was the prescribed antibiotic was taken?
* what does was taken?
* when was it taken?
- record this information in the services rendered note
32
Chart for antibiotic prophylaxis regimens: single dose 30-60 minutes before procedure
*NEED TO KNOW FOR PRACTICAL AS WELL*
oral > amoxicillin > 2 g adult
unable to take oral > ampicillin > 2 g IM or IV
*OR cefazolin/ceftriaxone > 1 g IM or IV
allergic to penicillin or ampicillin & can take orally > cephalexin > 2g
* OR azithromycin/clarithromycin > 500 mg
* OR doxycycline > 100 mg
allergic to penicillin or ampicillin & unable to take oral medication > cefazolin/ceftriaxone 1 g IM or IV
33
what are some additional notes to the pre med regimen chart 2
- clindamycin is no longer recommended for antibiotic prophylaxis for a dental procedure
- Cephalosporins should not be used in an individual with a history of anaphylaxis, angioedema, or urticarial with penicillin or ampicillin
34
physician consultations 4
- the physician of record is contacted in the client reveals a condition that may jeopardize safety during care
- telephone contact: request for faxed information from the doctor
- written request: physician consultation form must be in writing for legal reasons
- referral: clients are referred for medical evaluation when an undiagnosed or uncontrolled condition is suspected
35
What other conditions require a MD consultation/clearance prior to invasive dental hygiene care?
1. renal transplants/dialysis
2. immunosuppressive therapy (including but not limited to cyclosporine, corticosteroid therapy, Humira, dexamethasone, hydroxychloroquine > review all medications to determine if it is an immunosuppressant) (These medications are commonly prescribed after organ transplants and for the treatment of autoimmune disorders such as, rheumatoid arthritis, inflammatory bowel diseases such as chrons disease and ulcerative colitis, systemic lupus erythematosus, multiple sclerosis
3. diabetes *
4. sickle cell anemia
5. spina Bifida (ventriculoartial shunt)
6. chemotherapy
7. human immunodeficiency virus infection
8. anti-coagulants in the prescense of comorbidies (the simultaneous presence of two or more diabetes/medical conditions in a patient at the same time exist)
9. hemophilia
10. patients that have immunosuppressed-neutrophil counts lower than 500/cell/cu/mm
11. pacemakers (if ultrasonic scaling is indicated)
* separate diabetes medical consult form for ALL patients with diabetes
36
Diabetes medical consult form 3
- all patients with diabetes must have a "diabetes medical consultation form" completed which indicates: 1. current HbA1c value; 2. frequency of HbA1c readings (3, 6, or 12 months)
- treatment will be rendered based on physician recommendations
- if the physician indicates a HbA1c value is required every ____ months then they can not be seen unless they have documentation within that timeframe
37
describe "diabetes medical consultation" form updates
once a form is on file, any formal documentation from the SAME medical facility for updated HbA1c values at the appropriate intervals will be accepted
unless the HbA1c is 8.0 or greater, this range would require a new diabetes medical consultation form
38
describe the written request 5
- states medical condition
- explains planned dental treatment
- requests additional information
- includes patient-signed release of information form
- includes address, phone and fax numbers
39
what is the medical alert box 5
- medical conditions/diseases or medications that necessitate modifications or special precautions
- any medical condition or disease that will alter dental treatment
- any medical condition or disease that will alter drugs used during dental treatment or prescribed for the patient to treat dental conditions
- any medical conditions or disease that places the patient at risk for medical emergency during dental treatment
- any medical condition or disease that could result in a postoperative complication
*know how to find in axiUm > alert tab
40
The first step to a comprehensive pharmacologic history includes
- medication list (first step)
- prescription (including prescription toothpaste or rinse)
- over-the-counter
- herbs
- supplements
- inhalers
41
what are the 8 fundamental assessment questions of pharmacologic history
Assessment
1. Why is the client taking the medication?
2. What are the oral adverse effects of this drug (dry mouth, increased bleeding, difficulty swallowing, gingival pain, coated tongue, taste disturbance)
3. Are there any potential drug interactions
4. Do these findings suggest a problem with drug dosage? (may to too strong for kids/elderly)
5. How is a client managing their medications? > Failure to comply with medication use
Diagnosis
6. Will any oral side effects of this medication require intervention? (oral side effects that cause clients discomfort, interfere with ability to chew, swallow, digest; xerostomia/dry mouth, altered taste, hairy tongue, gingival enlargement)
7. Are the clients symptoms caused by a medical condition or are they drug side effects; known or unknown condition. (match physical findings/symptoms reported with existing medical/dental conditions; discern whether it's a side affect or a medical condition.
Planning
8. What are the risks of treating this client? (will treatment place the client in a dangerous or life threatening situation, compromise his/her health or ability to function, or compromise providers safety/comfort
42
where should client medication be listed
list all medications in the medications tab on axiUm
43
what does dental history do 6
- provides info on the patients past and present dental experiences
- allows clinician to determine whether alterations are necessary for the patients to undergo safe dental treatment
- information gathered on a dental health history is determined by the type of dental practice; (general, geriodontics, periodontic)
- provides additional information gathered during medical history
- dental health history is NEVER a substitute for a comprehensive medical health history assessment
- there is no standard format for a dental health questionaire
44
what types of information is collected during a dental history 8
- reason for todays appointment
- dental treatment received within the past year
- previous dental experiences/problems during treatment
- Level of anxiety during dental treatment
- patients dental concerns
- Existing dental conditions
- Daily selfcare routine
- Dietary concerns/habits
45
describe dental health history for children 3
- should be used to gather information from a parent about his/her childs dental history
- Additional information gathered about dietary activities and other daily habits will be helpful in treatment planning
- inquire, Is this a first dental visit, if so, treatment may need alteration
46
origin of "vital signs"
- means necessary for life
- certain key measurements that provide essential information about the person's health are referred to as vital signs
47
what are the 4 standard vital signs
- body temperature
- pulse
-respiration
- blood pressure
48
assessment of vital signs
temperature: measure of degree of heat of a living body; thermometer
pulse: measures heart rate in beats per minute; throbbing caused by contraction and expansion of an artery as blood passes; measured by touch (wrist)
respiration: breathing rate in respirations per minute; measured by watching the chest rise and fall
blood pressure: force exerted against the walls of the blood vessels as the blood flows through them; measured via stethoscope and BP cuff (sphygmomanometer)
49
describe the components of pulse 6
- as the heart beats a throbbing sensation is created (pulse)
- can be felt putting fingers over arteries
closest to skin surface
- clinician should not use their thumb because the thumb has its own pulse
- patient arm should be resting
- count for 30s then X2; count for 60s if pulse is irregular or pacemaker is used
- most common pulse point is over the radial artery in the wrist
50
what are the pulse points
brachial artery: main artery of the upper arm, divides into radial (thumb) and ulnar (pinky) arteries at the elbow
radial artery: begins below the elbow and extends down the forearm on the thumb side of the wrist and into the hand
51
what are the normal pulse rates per minute at various ages
4-5 yrs: 80-120
6-11 yrs: 75-110
>13 yrs: 60-90
adult: 60-100
52
what are the variations in pulse rate 4
- rapid or slow pulses are not necessarily abnormal
- athletes tend to have slow pulses at rest
- increased pulse rate can be a normal response to stress/exercise/pain
- factors affecting rate: age, medications, stress, exercise
53
what are the pulse patterns 5
regular: evenly spaced beats, may vary slightly with respiration
regularly irregular: regular pattern overall with "skipped" beats
irregularly irregular: no real pattern, difficult to measure accurately
normal amplitude: full, strong pulse that is easily felt
abnormal amplitude: weak pulse that is not easily felt
54
types of pulse pressure 3
normal: pulse pressure is smooth
weak: pulse pressure is diminished, feels weak/small
bounding: pulse pressure is increased and pulse feels strong/bouncing
55
how to record pulse
- beats per minute (bpm)
- record one pulse pattern (reg/irreg)
- record one pulse pressure (normal/weak/bounding)
- EX: 68 bpm (regular, weak)
56
what is respiratory rate 6
- brings oxygen into the body and carbon dioxide out
- normal breathing allows a person to inhale and exhale 500 mL of air
- measured by counting the number of times a patient's chest rises in 1 minute
- children use their diaphragms, so watch their abdomen vs chest
- count respirations after counting pulse
- the patient should be unaware > keep fingers on the wrist and use peripheral vision to count only chest rises (inhalations), not expirations
57
breathing is an unconscious function, however, it can be brought under voluntary control such as: 4
- holding breath
- panting
- singing
- sighing
58
variables in the respiratory rate can be from:
- excitement, exercise, pain, fever
- rapid heart rate can also indicate a disease: emphysema, heart disease
59
what factors affect the respiration rate 8
- age
- meds
- stress
- exercise
- altitude
- gender
- body position
- fever
60
what are the normal respiratory rates per minute
4-5 yrs: 22-34
6-11 yrs: 18-30
13+ yrs: 12-20
Adult: 12-20
61
how to we evaluate respiration 5
rhythm: regularity of respirations
ease: easy, labored, or painful
depth: deep or shallow
noise: slight, wheezing, gurgling
abnormal odor: fruity odor, alcohol
62
what are the types of respirations 5
normal: RR of 12-20 in adults
rapid shallow breathing: (tachypnea) RR is more than 20 per min; restrictive lung disease, inflammation of lungs
rapid deep breathing: (hyperpnea, hyperventilation) breathing with increased rate and depth; exercise, anxiety, metabolic acidosis
slow breathing: (bradypnea) breathing with decreased rate and depth; diabetic coma
obstructive breathing: expiration is prolonged due to narrow airways; causes include asthma, chronic bronchitis, and chronic obstructive pulmonary disease (COPD)
63
why does blood pressure matter in a dental setting? 2
- 120 million/ 1 out of 2 adult Americans have high blood pressure/hypertension (millions are unaware)
- dental health care providers can improve detection of hypertension by routinely checking blood pressure
64
T/F hypertension is symptomatic
FALSE > it is asymptomatic (has no symptoms)
- known as the silent killer
- screening (assessing bp) is the only way to diagnose hypertension
65
what are the dangers of high blood pressure 5
- stroke
- heart attack
- heart failure
- kidney failure
- pregnant women: seizures and death; premature birth and stillbirth
66
what is systolic pressure 3
- pressure created against the vessel walls when the heart beats
- systolic pressure is the most important in the management of blood pressure
- top number
67
what is the diastolic pressure 2
- the pressure between heart beats when the heart relaxes
- bottom number
68
recording bp readings 2
- two readings recorded as a fraction; systolic on top, diastolic on bottom
- numbers stand for millimeters of mercury regardless of which type of gauge you have
69
Hypo vs Hyper
Hypertension: abnormally high bp; readings increase when large blood vessels lose elasticity and smaller vessels constrict
hypotension: abnormally low bp
70
classification of BP 4
Normal: <120 mmHg AND <80mmHg; healthy lifestyle choices and yearly checks
elevated : 120-129 AND < 80; healthy lifestyle changes, reassess in 3-6 months
high stage 1: 130-139 OR 80-89; 10 yr heart disease and stroke risk assessment, if less than 10% lifestyle changes, reassess in 3-6 months; if higher lifestyle changes and medication with monthly follow-ups until bp is controlled
high stage 2: >140 OR > 90; lifestyle changes and 2 different classes of medicine, with monthly follow-ups until BP is controlled
71
what are the recommended lifestyle changes for high BP 4
lose weight
stress reduction
exercise
prescribed medications: very effective, 50% of patients stop taking their meds within a year, support from healthcare providers can encourage patients to continue taking them
72
what are the ADA recommendations for bp 3
- bp assessment should be a routine part of the initial appointment for all new dental patients
- use as a screening tool for undiagnosed high blood pressure
- continue to monitor bp at continuing care appointments at 3, 4, 6, and 12 month intervals
73
what are the influences of blood pressure 12
- age
- race
- weight
- gender
- emotional stress
- pain
- medications
- exercise
- meal and caffeine
- tobacco
- alcohol
- chronic disease
74
what is white coat hypertension 3
- bp rises above its usual rate when measured in a healthcare setting
- more common in patients who already have high blood pressure
- subsides once the patient relaxes
