ICD Final Flashcards
How to assess HR
Palpate radial pulse
Normal resting pulse range
60-100 bpm
Bradycardia
< 60 bpm
Tachycardia
> 100 bpm
Measurement of the pressure of the blood in the circulatory system (arteries).
Blood pressure
Closely related to the force and rate of the heartbeat and the diameter and elasticity of the arterial walls
Blood pressure
Measurement of pressure in the arteries when the heart CONTRACTS and blood is forced from chambers into the arteries
Systolic BP
Measurement of pressure in the arteries when the heart is AT REST, between contractions
Diastolic BP
“Constant pressure” in the arteries
Diastolic BP
Difference between systolic BP and diastolic BP
Pulse pressure
Normal BP
120/80
Normal pulse pressure
40 mmHg
BP recording
Indicate position, which arm, and size of cuff.
RAS (right arm sitting), LAS (left arm sitting)
What do you palpate when you take BP manually?
Brachial artery
BP variations
Anxiety
Pain
Position
Time of day
Physical activity
Full bladder
Age
Chemical substances (nicotine, caffeine)
Disease states (cardiovascular, kidney disease)
How to take respiratory rate
Observe the rise and fall of a patient’s chest
Normal respiratory rate
10-14 breaths/min
Bradypnea
< 10 RR
Tachypnea
> 20 RR
Dyspnea
Shortness of breath
Orthopnea
Shortness of breath related to recumbent position
Normal temp
98.6
Fever
> 100
Hypothermia
< 94.0
Alterations in normal body temperature
Disease process
Physical activity
Environmental temp
What do we use to take temp?
Tempadot (blue dot)
NexTemp (black dot)
What does the last dot indicate on Tempadot and NexTemp?
The temperature
How to use Tempadot and NexTemp
Place under the tongue, as far back as possible, into one of the heat pockets.
Wait 60 seconds, but less than 2 min to remove from pt and wait 10 more sec to read temp.
Normal O2 saturation/pulse ox
95-100
Types of cardiac rhythms
Regular
Regularly irregular
Irregularly irregular
Hypertension
Systolic BP > or = to 140 OR
Diastolic BP > or = to 90
To diagnose someone with hypertension, it must be recorded in ____ or more readings on ____ or more occasions
2; 2
Treatment for hypertension
Diuretics
ACE/ARB
B blockers
CCBs
Vasodilators
Centrally acting agents
Hypotension
Decrease in systolic & diastolic BP below normal with accompanying symptoms (dizziness)
Causes of hypotension
Cardiac insufficiency
Decrease blood volume (dehydration, hemorrhage)
Burns
Shock
Severe infection
Medical emergency station locations in basement
Vending machine
Medical emergency station locations in 1st floor
Oral surgery
Radiology
South hall
Emergency clinic
Medical emergency station locations in 2nd floor
Between Alpha and Bravo
Between Echo and Foxtrot
Medical emergency station locations in 3rd floor
Perio/Endo
Ortho/Pedo
One cycle of CPR
30 chest compressions
2 breaths
How long does it take to do 5 cycles of CPR if they are given at the rate of 100/min?
2 mins
CPR steps
CAB (compression, airway, breathing)
What do you do if there is a pulse but no breath?
Give 1 breath every 5 seconds
What must you do before starting CPR
Check your surroundings
When to use Nasal Cannula (O2 tank bag) and flow
Pt. can breath through nose, good for those who hate tight spaces
Flow = 1-6 LPM
When to use Ambu Bag (O2 tank bag) and flow
Pt not breathing - CPR necessary
Flow = 25 LPM (MAX)
When to use Quick Connect (Green/Black) Positive Pressure Mask (O2 tank bag) and flow
Pt is not breathing - CPR necessary
Flow = 0
*never have flow control valve running!!!!
Which O2 delivery system is ULSD’s 1st choice?
Quick Connect (Green/Black) Positive Pressure Mask (O2 tank bag)
When to use CPR Facemask and flow
Pts who can’t breathe well through nose, higher O2 content, covers mouth and nose
Flow = 6-15
In emergency kit and used for manual glucose monitoring
Glucometer
In emergency kit and used for bleeding control
Tourniquet
In emergency kit and used for reversing effects of opioid overdose; last 30 - 90 minutes
Narcan nasal spray (4mg)
In emergency kit and used for anaphylaxis/severe immediate hypersensitivity rxns; hold for 10 seconds
EpiPen 1 adult single dose (0.3mg)
In emergency kit and used for
In emergency kit and used for anaphylaxis or severe immediate hypersensitivity rxns
Epinephrine 1:1000 1mg/1ml (inject SQ/IM)
In emergency kit and used for symptomatic relief of allergic symptoms caused by histamine release (nasal allergies and allergic dermatosis); adjunct to epinephrine in anaphylaxis tx
Benadryl 50 mg/ml (inject 1ml IM)
Benadryl tabs (25mg)
In emergency bag and used for tx or prevention of angina pectoris
Nitroglycerin sublingual tabs (0.4mg)
In emergency bag and used for tx of hypoglycemia
Instaglucose gel
Glucose tabs (dextrose)
In emergency bag and used for prevention/tx of fainting
Ammonia inhalants
In emergency bag and used for tx or prevention of bronchospasm in patients with asthma or exercise-induced bronchospasm
Ventolin/Albuterol Inhaler
In emergency bag and used for ischemic stroke/attack and acute coronary syndromes
Aspirin tabs
Limp body, pale/clammy face, blue fingernails or lips, vomiting, slow breathing/heartbeat, constricted/pinpoint pupils
Opioid OD
How to treat opioid OD
Narcan, put pt in recovery position, give second dose if necessary
Passed out, loss of consciousness, BP/HR slow and weak
Syncope
How to treat syncope
Ammonia, Oxygen, supine position, loosen clothing and cool towel, monitor HR and RR, give CPR if needed
Due to anxiety or panic attack, increased RR/HR, rapid and deep breathing
Hyperventilation
How to treat hyperventilation
Make pt comfortable, calm them down, make pt breathe into a paper bag, call 911 if LOC and use Ammonia
Tightness in chest, feel constricted, dyspepsia (indigestion), pain can radiate to neck, jaw or left arm
Chest pain/angina pectoris
How to treat chronic stable angina vs an acute attack
Chronic stable angina Tx: Nitroglycerin and Oxygen if trouble breathing/pale
Acute attack Tx: call 911, Oxygen, Nitroglycerin, Aspirin
Rapid pulse, hangry, confused, normal/decreased BP, pale, dizzy, weak
Hypoglycemia
How to treat hypoglycemia
Take BS (blood sugar) (normal is 80-120), have pt eat and give Glucose gel/tabs if low
if BS> 200 is NOT hypoglycemia DO NOT give sugar they need insulin
Mild (itching, rash, nasal congestion, sneezing)
Moderate (slight face swelling, itching, no trouble breathing)
Severe (severe face swelling, hives, respiratory wheezing or trouble breathing, cardiac arrest/anaphylaxis, severe decreased BP, rapid weak pulse)
Allergic rxn
How to treat allergic rxn
Benadryl tabs/injection
Epipen (inject SQ in leg, hold for 10 secs)
Epinephrine
LOC, oozing of saliva, grand mal-tonic/clonic convulsions, eye flickering, mouth twitching
Seizure
How to treat seizures
Oxygen, CPR as needed, call 911, get pt safe and to the floor if needed, roll them to the side
Wheezing, BP is normal or slightly elevated, cyanosis, trouble breathing
Asthma attack
How to treat asthma attack
Albuterol inhaler, calm pt, if inhaler doesn’t help inject epinephrine
Facial drooping, slurred/abnormal speech, can’t hold one arm up, squeeze of hands different
Stroke
How to treat a stroke
Hospital immediately - 911, careful with Aspirin 325mg, Oxygen
T/F The flow control should NOT be adjusted when using resuscitator valve for quick connect mask, O2 is flowing directly from the tank
True
An imaginary line that is drawn across the soft palate and marks the beginning of the movement in the soft palate when the individual says “ah”
Vibrating line
Line that indicates the division between the movable and immovable portion of the soft palate
Vibrating line
Extending from one hamular notch to the other
Vibrating line
Primary sensory nerve to the face
CN V
Maxillary teeth and gingiva, palate
CN V2 (maxillary division)
Mandibular teeth and gingiva, tongue and floor of the mouth
CN V3 (mandibular divison)
Primary artery to the face
Branches of external carotid artery
Depression between the anterior border of the ramus and the temporal crest (internal oblique crest)
Retromandibular fossa/triangle
Soft tissue overlying the retromolar fossa
Retromolar pad
Depression on medial aspect of mandible
-Path of nerve to mylohyoid
-Begins near lingula
-Will travel below attachment of the mylohyoid muscle
Mylohyoid fossa (groove)
Separates the nasal cavity above from the oral cavity below; oral surface covered with oral mucosa tightly bound to underlying bone.
Hard palate
Rounded elevation distal to last maxillary molar
Maxillary tuberosity
Pterygomaxillary notch
Where maxilla meets the medial pterygoid plate of the sphenoid bone; medial pterygoid plate ends inferiorly as the hamulus
Hamular notch
Small depression between hard and soft palate; openings of common collecting ducts of minor palatine gland; inconsistent
Palatine fovea
Convergence of several muscles at the corner of the mouth
Modiolus
Arises from medial maxilla and mandible; inserts into mucous membrane of lips; surrounds mouth and closes mouth
Orbicularis oris
Contracts the skin of chin and raises lower labial sulcus
Mentalis
Attaches to lateral aspects of mandibular and maxillary alveolar processes and to the pterygomandibular raphe; compresses cheek against teeth
Buccinator
Elevates and protrudes the mandible
Masseter
Creates boundary between floor of the mouth structures and superficial neck structures; courses from internal mandible to hyoid bone; pulls on muscle for bone growth
Mylohyoid
Powder material, irreversible hydrocolloid
Alginate
Regular set alginate
Working time = 2-3 minutes
Setting time = 2-3 minutes
Fast set alginate
Working time = 1-2 minutes
Setting time = 1 minute
Alginate particles are comprised of:
Salts of alginic acid (a product of marine kelp)
Activator (ex: calcium sulfate)
Retarder (ex: sodium phosphate)
Inert filler
Flavoring
Syneresis
Lose water/dry out
Imbibition
Absorb water
What can affect the dimensional stability of an alginate impression after it sets?
Surrounding atmospheric conditions
Immersing the impression in water
Leaving it dry on the counter with no wet paper towel.
What temperature of water will slow down the reaction time of the impression, causing the need to leave the impression in the patient’s mouth longer?
Cold
NEVER pour or place the following into a drain without a trap:
-Stone powder
-Stone mixture
-Stone slurry
-Stone dust
-Stone pieces
The key to a good impression is the
fit of the tray
Purpose of Impression
accurately record the oral tissues and their spatial relationships.
Steps for making an impression
- Try in impression tray
- Always use wax on the tray! `
- Insert by retraction & rotation
- Center over the arch (R/L; Ant/Post)
- Center handle on midline (philtrum/nose)
- Seat the posterior portion of the tray first, then seat the anterior
- Adjust the lips so they are outside the flanges (on the mandible, ask them to stick their tongue gently up and out then relax)
- Disinfect the spatula & scoop prior to placing it back in the alginate
- Removing maxillary impressions: UP, then DOWN
- Removing mandibular impressions: DOWN, the UP
- Bleach only first then wrap the impression in wet paper towels and place within a bag
- Pour up the impression within 15 minutes after taking it
- Make sure the sink is cleaned out and the floor is swept
Remember: Never leave an impression in the mouth without your fingers.
What should you never ask before taking an impression?
Are you a gagger?
Do you have a bad gag reflex?
How to distract every patient when taking impression
Instruct the patient to wiggle their toes, lean forward, do random things like rotate their left wrist
Can also place salt on the tongue
What 2 other things could you do for a bad gagger?
Nitrous Oxide sedation
Topical anesthetic (last resort)
Anatomical Barriers of Good Impressions
High-Vaulted Palate “High-Arched” “Gothic Palate”
Mandibular Tori
Maxillary Torus
Buccal Exostoses
Creating the cast
Powder to water ratio = 1 pouch of quick stone + 40 ml of water
Surfactant reduces bubbles
Silly putty for tongue space
Never leave a cast in __________ overnight
alginate
If not trimming immediately, soak cast in water for ___________ prior to trimming. Why?
5-10 mins
Fast, smoother, lengthens lifespan of cutting wheel
Always do what before trimming casts?
TURN THE WATER ON
Why fluff the alginate before opening?
For proper air/particle content
T/F When measuring alginate powder, you should firmly compress the alginate into the scoop using the spatula?
False
You notice your patient becoming nervous and breathing heavily. You record their respiratory rate as 25. What is the patient currently experiencing in reference to respiration?
Tachypnea
T/F D1 students can access any patient they want in the axiUm EHR system
False
T/F According to the pre-class assignment, axiUm contains patient records including their medical history and dental history
True
T/F The ULSD axiUm mail system (Amail) is HIPPA compliant and safe to transfer patient information from one Amail address to another Amail address
True
Use _______ ________ for Dr. Schroeder’s sanity
spell check
Where is the PARTS note found?
Under treatment history tab
P
Plan - what you are doing today
A
Assessment - mhx, vitals, dx data, thoughts, dx
R
Rx - what prescription did you write/give pt
T
Treatment - specific step by step of what tx you provided
Strategy
Next visit/plans for pt
How to input codes
Tx Plans -> Planned Tx -> click on “tooth P” to add code
How to add a note
Tx Hx -> Notes -> click on “notebook with plus sign” to add note (general note, clinical coursework, no covid issue)
Paul-Elder Critical Thinking Framework
Intellectual standards→Elements of reasoning→Intellectual traits→Intellectual standards
Accuracy, precision, clarity, depth, significance, relevance, logic, fairness
Intellectual standards
Humility, perseverance, autonomy, empathy, fair-minded, integrity, courage
Intellectual traits
Intellectually disciplined process of actively and skillfully conceptualizing, applying, analyzing, synthesizing, and/or evaluating info gathered from, or generated by, observation, experience, reflection, reasoning, or communication, as a guide to belief and action
Critical thinking
You should always document any medical/dental history on _____ (diagnostic images) and receive/send out referrals in ________
chart; writing
What should you get from pt. before a procedure?
Written consent
What should you give the pt. before a procedure?
Info to make the best choice
Informed consent only protects against what?
Non-negligent treatment
Guidelines for online reviews (3)
Monitor online reputation
Be professional when replying to online reviews
Always maintain pt privacy/HIPAA
A disorder of mental and adaptive functioning
Neurodevelopmental/ Intellectual Developmental disorders.
Characteristics of Neurodevelopmental/ Intellectual Developmental disorders
Challenged by the skills they use in everyday life
Is not a disease or mental illness
Developmental disability that varies in severity
Usually associated with physical problems
It is a medical disorder affecting the neurological system (generally the brain) during the period of a person’s life in which they are experiencing rapid neurological development – from the point of conception to early adulthood
Neurodevelopmental/ Intellectual Developmental disorders.
4 categories of Neurodevelopmental/ Intellectual Developmental disorders.
Medical
Brain damage
Genetic
Psychiatric
Common disorders of Neurodevelopmental/ Intellectual Developmental disorders.
Autism (psychiatric)
Down Syndrome(genetic)
Fragile X Syndrome (genetic)
Fetal Alcohol Syndrome (medical)***preventable!!
Cerebral Palsy (brain damage)
Access to Health Care issues
Live in nursing homes, group homes, adult day programs, intermediate care facilities
Difficult to get to a dentist office
Typical oral health issues
Periodontal Disease
Dental Caries
Malocclusion
Missing Permanent Teeth and Delayed Eruption
Teeth with developmental defects (Enamel Hypoplasia)
Damaging Oral Habits
Trauma and Injury
Mental Strategies for care
Reduce distractions
Communication with Caregiver
Communication with Patient
Consistency
Active Listening
Behavior Strategies for care
Communication with Caregiver
Scheduling
Reward/Compliments
Physical Strategies for care
Maintain clear path
Wheelchair transfer
Cardiovascular Anomalies
Mitral valve prolapse
Seizures
Frequency, med control, triggers
Visual Impairments strategy for care
Pt. may use other senses to connect with
Hearing Loss and Deafness strategy for care
Adjust or turn off hearing aid, dental equipment may cause auditory discomfort
If pt. reads lips, speak in normal cadence and tone
Caregiver oral health techniques
Give oral health instruction to caregiver
Create oral hygiene education community programs
Oral Hygiene positioning when treating patients with Neurodevelopmental/ Intellectual Developmental disorders
Stand behind person with patient seated or lying down
Stabilize patient’s head
Modifications when treating patients with Neurodevelopmental/ Intellectual Developmental disorders
Inability to reach mouth: extended handle
Difficulty holding brush: use a wider handle, strap, or tennis ball
Armamentrarium for treating patients with Neurodevelopmental/ Intellectual Developmental disorders
Surround toothbrush
Collis curve brush
Suction toothbrush
Mouth props
Papoose (kid burrito)
Fluoride treatment
Appropriate communication principles for pediatric patients
Tell show do
Voice control
Positive reinforcements
Distractions
Modeling
Controlled modulation of voice to direct the patient’s behaviors; should only be done with parents permission; should never be done in anger
Voice control pediatric technique
Reward positive behavior
Social rewards (voice tone, praise)
Nonsocial rewards (tokens, prizes)
Positive reinforcement pediatric technique
Divert the child’s attention from what might be perceived as unpleasant
Visual (TV, tablet)
Auditory (story telling, music)
Distractions pediatric technique
Dentist demonstrates while sibling watches
Modeling pediatric technique
Treatment options for children
Encourage child to drink water and reduce exposure to sugary drinks
Fillings/crowns/extractions
Nonoperative treatment
Medical immobilization
Sedation
General anesthesia
Diet modification
3 month recall
Establish dental home
Establish aggressive caries prevention plan
Defined by impairments in the following areas:
Physical
developmental
Mental
Sensory
Behavioral
Cognitive
Emotional
Special needs
Child with special needs requires
Medical management
Health care intervention
Use of specialized services or programs
Behavior and behavior guidance
Ask parent questions about the child’s behavior to help determine how child may behave
Frankl behavior rating: – (1: refusal), - (2: reluctant), + (3: cautious but accepting), ++ (4: definitely positive)
What do the following describe?
Gingival recession
bone loss
root surface caries
Leukoplakia (precancerous white patch)
oral/pharyngeal cancer
periodontitis
staining
halitosis
reduction in wound healing
mouth sores
hairy tongue
altered sense of taste
Oral health effects of Tobacco use
Children exposed to secondhand smoke have greater risk of
decreased lung function
Asthma
SIDS
respiratory infection (Pneumonia, bronchitis)
ear infection
T/F Ecigs are NOT regulated by FDA; less harmful but not harmless, have fewer toxins and no tar but risk for cancer; pt used should be discouraged
True
