Health history and vitals Flashcards
what is the purpose of health history (10)
- 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
purpose of health history assessment
- 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
medical history forms 2
- Used to gather subjective data about the patients:
*Past health problems
*Present health problems
*Medications - Many different formats and lengths
barriers to effective health history 6
- Language
- Limited reading comprehension skills/literacy
- Patient understanding
- Patient honesty
- Patient embarrassment > sexual/sensitive medical condition
- Clinician tone > be friendly so patients share information
why do patients lie
- They don’t think it matters for the appointment, don’t understand the connection, embarrassment
multicultural considerations 3
- 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
methods of obtaining health history 4
- 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
describe the interview portion 2
- Establishes rapport and trust to form a positive practitioner-client relationship
- If any “yes” needs to be followed up with additional questions
what should you always ask during the interview
Always ask:
- the date of diagnosis (year is fine)
- how is the condition being managed (medication/lifestyle changes/none)
describe the information gathering phase 6
- 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
what is patient centered interviewing
a technique in which clinicians seek to elicit the patient’s emotions and personal health agenda to better understand the psychosocial context for disease
what are the 5 steps of patient centered interviewing
- Establish private setting
- Elicit patients chief complaint
- Use open-ended questions
- Use active listening
- Briefly summarize the interview for accuracy
describe the interview setting 4
- 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
verbal and nonverbal communication 2
- Observe the client’s written, verbal, and nonverbal communication
- Eye contact and listening skills enhance communication
A comprehensive health history should contain: 5
- Demographic information
- Medical history
- Social history (smoking)
- Dental history
- Chief complaint (what are your major oral health needs at this time)
legal and ethical issues 3
- The client’s health history is confidential and protected by law
- Health insurance portability and accountability act (HIPPA)
- Legal document:
since health history is a legal document, what must be done? 4
- 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)
what is the relationship between systemic and oral health 5
- 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
how do dental health care providers help? 3
- 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
what is ASA-PS 3
- 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
what are the ASA classification levels 6
- 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
describe ASA level 1 health status and modifications for safe care 4
- a normal healthy patient
- little to no anxiety about dental treatment
- green flag for dental treatment
- no modifications are necessary
describe ASA level 2 health status and modifications for safe care 5
- Mild systemic disease (well-controlled)
- Healthy person but anxious about dental treatment
- well-controlled diabetes, epilepsy, asthma, smoker
- Yellow flag
- Employ stress reduction strategies
describe ASA level 3 health status and modifications for safe care 5
- 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
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
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
what is infective endocarditis
a life-threatening infection of the tissues lining the heart and the underlying connective tissue
sometimes also called bacterial endocarditis
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
- unrepaired cyanotic congenital heart disease, including palliative shunts and conduits
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