health status evaluation

Question 1

result of Medical advances on population

Answer 1

• Longer life span →“The aging of America”
• Increase in the number of dental patients
• Oral health related to systemic health
• Key to success
• Thoughtful risk assessment prior to treatment

Question 2

HISTORY AND PHYSICAL
* enables?
* aids in?
* helps with?

Answer 2

• Enables all practitioners to have an organized format in which to IMPROVE
  COMMUNICATION and gather important PATEINT INFORMATION
• Aids in relating to dental and medical colleagues
• Helps in altering and modifying treatment when applicable

Question 3

INITIAL PATIENT CONTACT

what to do

Answer 3

• Treat the patient the way you would want to be treated
• Listen, don’t judge
• Be sincere, not mechanical
• Be truthful
• Speak in easily understood language

Question 4

• THE MOST IMPORTANT FACTOR IN MALPRACTICE LITIGATION:

Answer 4

• LACK OF DOCUMENTATION AND INADEQUATE NOTES

Question 5

MEDICAL HISTORY REVIEW
* Established when?
* Single most important source of?
* Depth of inquiry tailored to each patient, based on?

Answer 5

• Established initial doctor-patient relationship
• Single most important source of information about this patient
• Depth of inquiry tailored to each patient, based on:
• Age
• Medical condition
• Extent of planned surgery

Question 6

MEDICAL HISTORY
* Conduct where/why?
* Update history?

Answer 6

• Conduct interview chairside in dental operatory
• Not in public place
• Ensure ease of flow of information when in privacy
• Update history at EACH NEW patient encounter

Question 7

SOAP format

Answer 7

S- subjective
O- objective
A- assessment
P- plan

Question 8

COMPONENTS OF HEALTH HISTORY

Answer 8

• Chief complaint
• History of present illness
• Review of systems
• Past medical history
• Current medications
• Allergies (meds and environmental)
• Past surgical history
• Social history: Alcohol, llicit drug use, Tobacco (smoke and smokeless)

Question 9

CHIEF COMPLAINT (CC)

Answer 9

• Reason why the patient is in your office
• Must be in patient’s own words
• Usually within quotations

Question 10

HISTORY OF PRESENT ILLNESS (HPI)

Answer 10

• Delve deeper into patient’s symptoms: pain/swelling/foul smell/drainage
• Location and Radiation
• Onset (when first started)
• Duration (acute vs chronic)
• Change in symptoms (feels better, feels worse, feels same)
• Severity (scale 1-10, “1 is me throwing marshmallow at you, 10 you are engulfed in flames”)
• Character of pain (sharp, dull, throbbing, electric shock)
• Exacerbating factors
• Alleviating factors

Question 11

HPI breif or in depth

Answer 11

• Can be brief
• i.e. two day pain from erupting third molar
• Can be much more in depth
• i.e. non healing extraction site from outside office, with a patient that has a history of radiation
  to mandible/maxilla

Question 12

PAST MEDICAL HISTORY

Answer 12

• “What has your physician/doctor diagnosed you with?”: Heart, lung, liver, kidney, abdomen, blood, brain, bones, skin
• Questions tailored to quick view health history form answers
• Major illnesses and diseases: When diagnosed, what treatment currently under
• Hospitalizations: When, what for, follow up with PCP
• Operations: What, when, any anesthetic complications
• H/O malignant hyperthermia (Important for IV sedation candidates)

Question 13

PMH REQUIRING ANTIBIOTIC PREMEDICATION scenarios

Answer 13

• Previous h/o IE
• Prosthetic cardiac valve or prosthetic material used for cardiac valve repair
• Congenital heart disease (CHD):
• Unrepaired cyanotic CHD, including palliative shunts and conduits
• Completely repaired CHD with prosthetic material or device, whether placed by surgery or by catheter intervention,
  during FIRST SIX MONTHS after procedure
• Repaired CHD with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device
• Cardiac transplant who develop cardiac valvulopathy
• Immunocompromised population
• Grafted shunts (dialysis shunts, hydrocephalus shunts)
• Total joint replacements (Continuing controversy)

Question 14

MEDICATIONS

Answer 14

• Review all medications patients are taking
• Prescription meds from PCP
• Over the counter medications
• Medications patient received from friends/family
• Herbal supplements (!Drug-herbal interactions!)
• List dosing information (amount and frequency)

Question 15

herbal-drug interactions

Answer 15

Decrease drug affect: (St. Johns Wort, garlic, fibers, laxatives)
Increase drug affect: (Echinacea, ginger, cayenne, grapefruit juice, licorice, gingko (increase bleeding), kava, ginseng

Question 16

COMMON HEALTH CONDITIONS TO INQUIRE
ABOUT:

Answer 16

• Angina
• MI
• Heart murmurs (current or previous)
• Rheumatic fever
• Bleeding disorders
• Anticoagulant use
• Asthma
• Hepatitis
• Hypertension
• Kidney disease
• Diabetes
• Corticosteroid use (20 mg Prednisone equiv x 3 weeks)
• Seizure disorder
• Implanted prosthetic devices
• Pregnancy
• Breast feeding post-partum
• Lung diseases (TB, CA, OSA, COPD)
• Osteoporosis

Question 17

ALLERGIES

Answer 17

• List any allergy with associated reaction
• If patient has none, document No Known Drug Allergies (NKDA)

Question 18

SOCIAL HISTORY
forms?

Answer 18

• Behavior that can be detrimental to long term health and wound healing
• Tobacco
• Smoking or smokeless
• Measured in pack years (packs per day x years smoked) as well as when first started
• Alcohol
• What kind, how much (one cup to me is 8 oz, could be 72 oz for others)
• Alcohol Use Disorder Low Risk: MEN: ≤ 4 units per day for men or ≤ 14 units in one week
  WOMEN: ≤ 3 units per day for women or ≤ 7 units in one week
• Illicit drug use
• Marijuana, meth (snort/smoke/IV), crack, cocaine, heroin, PCP, LSD, psillicybin, mescalin, bath salts, flakka
• How often, when quit, etc..

Question 19

REVIEW OF SYSTEMS
* Direct questioning of?
* May reveal?
* Aids in?
* Tailor towards?
* example findings

Answer 19

• Direct questioning of patient regarding all systems
• May reveal undiagnosed or hidden medical conditions
• Aids in assessing patients’ current physical status
• Tailor toward patients’ medical history
• HA, fever, chills, nausea, vomiting, diarrhea, constipation, chest pain, shortness of air/breath, change in vision, change in hearing, change in speech, LOC

Question 20

• Cardiovascular system review

Answer 20

• Chest pain
• Palpitations
• Blood pressure problems
• low/high, unable to control w/ current medications
• Shortness of air/breath
• Orthopnea
• Edema
• Leg pain (claudication)

Question 21

• Respiratory system review

Answer 21

• Shortness of air/breath (SOB vs SOA)
• Cough
• Wheezing
• Hemoptysis
• Use of inhalers
• Supplemental oxygen

Question 22

• Nervous system review

Answer 22

• HA
• Change in vision/speech/hearing
• Seizures
• Loss of consciousness
• first two may indicate mass

Question 23

• Disease-specific questions:
• Diabetes
• Cancer
• Thyroid dysfunction

Answer 23

• Diabetes
• Drinking a lot of water, peeing more frequently, tremors, numbness of extremities, hospital admissions
• Cancer
• Loosing weight unintentionally, loss of appetite
• Thyroid dysfunction
• Temp dysregulation (feel hot when other cold, feel cold when others hot), tremors, proptosis, neck swelling (swallowing difficulty, hoarseness)

Question 24

objective findings

Answer 24

found by us, head and neck exam

Question 25

PHYSICAL EXAMINATION limited to? tools?

Answer 25

* Limited to the Head & Neck * Four tools for physical exam: * Inspection * Palpation * Percussion * Auscultation

Question 26

PHYSICAL EXAMINATION components

Answer 26

* Vital signs * Head, Eyes, Ears, Nose (HEEN) * Oral evaluation and TMJ evaluation * Neck examination * Cranial Nerve Examination

Question 27

how does ASA classification work?

Answer 27

only assesses preoperative risk

Question 28

ASA CLASSIFICATION OF PHYSICAL STATUS

Answer 28

Question 29

radiographic exam notes

Answer 29

* Type of radiograph used (Orthopantomogram {PANO}, FMX, CT scan) * Date it was taken * Evaluations of all structures seen (condyle, glenoid fossa, sinus, teeth, IA canal)

Question 30

ASSESSMENT

Answer 30

* Condition diagnosis as well as assessment of the patient /condition * done after Hx and physical exam

Question 31

components of the plan tx? location? anesthesia? timing?

Answer 31

Question 32

med complex pts tx planning can include:

Answer 32

* Any necessary pre-operative lab results, diagnostic testing results * Medical consultation required

Question 33

medications to be given on tx day

Answer 33

* Post-op pain medications, ABX * Pre-op antianxiety medication

Question 34

OBTAINING PATIENT CONSENT | pt requirements?

Answer 34

* Must be 18 years old or older * Under 18 and emancipated (pregnant or married) * If under 18 not emancipated requires legal guardian or parent

Question 35

Severe dementia or neurologic disorder pt consent

Answer 35

* Severe dementia or neurologic disorder, requires legal guardian or durable power of attorney * One can not assume the patient can or can not consent to surgery * Just ask if the patient signs their own consent, if caregiver with the patient ask the caregiver

Question 36

when is informed consent

Answer 36

MUST BE DONE PRIOR TO TREATMENT!!

Question 37

what to discuss with informed consent

Answer 37

* Why the surgical procedure is to be performed (the nature of the problem) * All treatment options available, including do nothing, and what is to be done today * Risks/Benefits/Alternatives (RBA) of the proposed procedure * Possible complications of proposed procedure * Always allow the patient to ask questions

Question 38

pt signature for informed consent

Answer 38

* E Signature to chart, as well as document in patient record (treatment note that day)

Question 39

SUMMARY OF PATIENT EVALUATION AND RISK ASSESSMENT

Answer 39

* Review Med Hx: engage in direct dialogue on relevant issues (allergies, Social HX, Recent hospitalizations) * Identify all medications * Examine patient’s signs and symptoms * Review/obtain lab results or images * Medical consultation

Question 40

POTENTIAL ISSUES/QUESTIONS OF CONCERN: A's

Answer 40

* Antibiotics: Will pt need it (prophylaxis vs therapeutic) * Analgesics: Is pt taking them already? With they need it? Older/younger pt (decrease amount) * Anesthesia: Potential concerns, best anesthetic, use of vasoconstrictor? * Allergies: Medications vs seasonal vs food vs latex * Anxiety: Will pt need anxiolytics vs sedation

Question 41

POTENTIAL ISSUES/QUESTIONS OF CONCERN: B's

Answer 41

* Bleeding: Is abnormal hemostasis a possibility? * Breathing: Difficulty currently? Dyspnea when sitting back in chair? Fast/slow/normal? * Blood pressure: Normotensive/hypotensive/hypertensive? Controlled or uncontrolled?

Question 42

POTENTIAL ISSUES/QUESTIONS OF CONCERN: C

Answer 42

* Chair position: * What is comfortable to patient? * What tooth extracting?

Question 43

POTENTIAL ISSUES/QUESTIONS OF CONCERN: D

Answer 43

* Drugs: Adverse effects, allergies, drug interactions? * Devices: Prosthetic devices (heart, extremities), therapeutic devices (defibrillator, pacemaker)

Question 44

POTENTIAL ISSUES/QUESTIONS OF CONCERN: E

Answer 44

* Emergences: are there any urgencies/emergencies anticipated vs prevented with care modification? * Equipment: Instruments working correctly (suction, surgical drill), special devices indicated (pulse oximeter, EKG, BP monitor)

Question 45

POTENTIAL ISSUES/QUESTIONS OF CONCERN: F

Answer 45

* Follow-up indicated, and when if indicated/requested * Should patient be contacted at home to assess response to treatment?

Question 46

radiographic exam notes

Answer 46

* Type of radiograph used (Orthopantomogram {PANO}, FMX, CT scan) * Date it was taken * Evaluations of all structures seen (condyle, glenoid fossa, sinus, teeth, IA canal)