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Patient Care 1 Exam 2 > Medical HX & Systemic Diseases > Flashcards

Medical HX & Systemic Diseases Flashcards

1
Q

Dx

A

diagnosis

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2
Q

Hx

A

History

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3
Q

N/A

A

next appt or not applicable

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4
Q

FM

A

Full mouth

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5
Q

HBV

A

Hepatitis B virus

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6
Q

HIV

A

Human immunodeficiency virus

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7
Q

Prn

A

as needed

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8
Q

BID

A

twice a day

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9
Q

TID

A

three times a day

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10
Q

did

A

four times a day

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11
Q

Pt

A

Patient

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12
Q

Rx

A

prescription

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13
Q

TMJ

A

Temporomandible joint

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14
Q

TB

A

tuberculosis

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15
Q

Medical history

A

all pts get a medical history even if you appear apparently healthy. pts often dont realize or recall the significance of this. look for the most common diseases first. pt sometimes forget or “fudge” - oral hygiene, alcohol or drugs. make sure pt can understand ur questions - speak at the patients level of understanding - language barriers

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16
Q

Asthma

A

A chronic inflammatory disease of the airways characterized by reversible episodes of increased airway hyper responsiveness resulting in recurrent episodes of hyspnea, coughing and wheezing.
Usually sudden onset with peak symptoms with 10-15 mins.
Inadequate treatment results in ER visits for about 25% of patients

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17
Q

Asthma - causes/triggers

A 
emotional or physical stress
Allergy to foods or drugs-ingestion of nuts, shellfish, aspirin, non steroidal anti-inflammatory drugs (NSAID's)
Air pollution or irritating vapors
upper respiratory infections
exercise induced
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18
Q

Asthma - dental considerations

A

avoid aspirin and NSAIDs-asiprin causes bronchoconstriction and sensitivity is common
Triad asthmatics - if patients have this they may have a very sudden and very severe asthma attack
No contraindication to N2O
No contraindication of valium

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19
Q

Asthma - symptoms

A 
chest congestion
wheezing and cough
dyspnea and tachypnea
increase BP
anxiety and agitation
cyanosis
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20
Q

Asthma - prevention

A

Prevent an acute attack
Through a good medical history - should be able to determine severity and stability of the disease
Frequency & severity of attacks, time of day
any current or past problems with attacks
how are attacks usually managed
has the pt ever received emergency care for an acute attack

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21
Q

Asthma - management

A 
terminate procedure
postion patient - upright
calm pt 
administer bronchodilator - Ventolin
administer O2
summon medical assistance 
administer epinephrine-bronchodilator and antispasmodic
22
Q

Asthma - prevention again

A

get vaccinated for influenza and pneumonia
know your asthma triggers - smoke, exercise, animals
take medication as prescribed
risk assessment - through a good medical history
may want pt to take a puff from their inhaler prior to starting treatmetn

23
Q

Diabetes mellitus

A

chronic systemic disease characterized by a disorder in metabolism of fats, protein, and the structure and function of blood vessels.
- disorder of glucose metabolism

24
Q

Type 1 diabetes

A

IDDM
More common in adolescents, may develop in adults, circulating insulin absent, beta cells fail to respond to stimuli, requires exogenous insulin

25
Q

Type II Diabetes

A 
NIDDM 
Milder form of diabetes
usually seen in adults
usually obese
ketoacidosis uncommon
clinical onset slow
blood sugar levels much more stable
26
Q

Diabetes - gestational

A

any degree of abnormal glucose tolerance during pregnancy
obesity during pregnancy is a know risk factor
After childbirth the mother’s glycemic control usually returns to normal, but these women have an increased risk of developing diabetes within 5-10 years

27
Q

Persistent elevated blood glucose levels put a person at risk of

A

diabetes

28
Q

Diabetic ketoacidosis

A

Body produces high levels of blood acid called ketones
Develops when your body can’t produce enough insulin
Kussmauls respirations-deep and labored breathing pattern
can be triggered by infection or other illness
rare in ppl with type 2

29
Q

Hyperglycemia

A 
polyuria
polydipsia
polyphagia 
dry, warm skin
kussmauls respirations
fruity breath odor
rapid, weak pulse
altered level of consciousness
30
Q

Hypoglycemia

A 
pale, moist skin
weakness, dizziness 
shallow respirations
headache 
altered level of consciousness
onset very sudden
blood glucose values , 50 mg/100ml
31
Q

Hypoglycemia - management

A 
position patient comfortable - ABC
Administer 100% O2
Oral carbohydrates if conscious 
Unconscious 
- cake icing 
- 50% dextrose 
- glucagon 1mg IM or IV
- epinephrine 1/1000 0.5 mg IM 
medical assistance
32
Q

Blood sugar and A1c

A

Self test - perform with a blood glucose meter - tells you what your blood sugar level is at that point in time
A1c - measures the average amount of sugar in your blood over the past 2-3 months

33
Q

Diabetic patients

A

hbA1c (hemoglobin A1c) - monitors long term glucose control over 30-90 days
if you have diabetes an ideal HbA1c level is 6.5% or below
if you are at risk of developing type 2 diabetes, your target HbA1c should be 6%
If patient doesn’t know their A1c, test the patient with a glucometer

34
Q

Blood glucose readings

A

<70mg/dl-consider deferring elective treatment or give carbohydrates
>200mg.dL-defer elective treatment and refer to physician
Fastinging (8-12 hours) glucose level - 80-130mg/dL
1-2 hours after a meal < 180 mg/dL
A major goal is to prevent insulin shock (very low blood glucose). pt skips a meal but takes their insulin

35
Q

Insulin shock

A

Patients who are treated with insulin must closely adhere to their diet. If they fail to eat in accordance with their diabetic management plan but continue to take their regular insulin injections, they may experience a hypo-glycemic reactions caused by an excess of insulin
Rxn or shock caused by excess insulin occurs in three well-defined stages, each more severe and dangerous than the one preceding

36
Q

Insulin shock - mild stage

A

Characterized by hunger, weakness, trembling, tachycardia, pallor, and sweating; paraesthesia may be noted on occasion
It may occur before meals, during excercise or when food has been omitted or delayed

37
Q

Insulin shock - moderate stage

A

Blood glucose drops substantially, the pt becomes incoherent, uncooperative, and sometimes belligerent or resistant to reason or efforts at restraint; judgement and orientation are defective. - almost like drunk
The chief danger during this stage is that patients may injure themselves or someone else

38
Q

Insulin shock - severe stage

A

Complete unconsciousness with or without tonic or clonic muscular movements.
Moves of these rxns take place during sleep, after the first two stages have gone unrecognized.
May also occur after exercise or alcohol ingestion if the earlier signs have been ignored.
Sweating, pallor, rapid and thready pulse, hypotension, and hypothermia may be present

39
Q

Insulin shock - treatment

A

The rxn to excessive insulin can be corrected by giving the patient sweetened fruit juice or anything with sugar in it.
Patients in the severe stage (unconsciousness) are best treated with an Iv-glucose solution; glucagon or epinephrine may be used for transient relief

40
Q

Diabetes Mellitus (prevention)

A

Treat uncontrolled patient only with consultation with physician.
Decrease insulin on day of treatment if pt will be eating less.
Consider chronic complications.
Early morning appts - cortisol is at its highest.
Good medical history

41
Q

Diabetes - oral complications

A

Periodontal disease is commonly seen.
Bidirectional-hyperglycemia affects oral health while periodontalitis affects glycemic control (increased HbA1c)
Xerostomia
Increased infections and poor wound healing
burning mouth syndrome
increased incidence and severity of gingival inflammation
periodontal abscess

42
Q

Allergy - Epidemiology

A

an Abnormal or hypersensitive response of the immune system to a substance introduced into the body

43
Q

Allergic rxn - rapid

A 
rapid onset-less than one hour
type 1 - true IgE mediated anaphylaxis 
antibiotics
analgesics
narcotics
preservatives in anesthetics - articaine
venom of stinging insects
44
Q

Type 1 hypersensitivity rxn

A

Related to humoral immune system and usually occur soon after second contact with an antigen; many ppl have repeated contacts with a specific drug or material before they become allergic to it

45
Q

Anaphylaxis

A

an acute rxn involving smooth muscle of the bronchi in which antigen-IgE antibody complexes form in the surface of mast cells which causes sudden histamine release from these cells. The potential end result is acute respiratory compromise and cardiovascular collapse

46
Q

Allergic rxn: rapid signs/symptoms

A

pallor, rash, itching, hives, angio-edema, hypotension, dyspnea, GI upset, bronchospasm, laryngeal edema, rhinorrhea, circulatory collapse, dysrhythmias, cardiac arrest - there are diseases linked to these common symptoms

47
Q

Allergic rxn: rapid - management

A 
position patient supine
BCLS
oxygen
monitor vital
call 911
Epinephrine 1/10,000 3.0 cc IV or Epi 1,000 0.3 cc IM/SC
Benadryl 50mg IV or IM
Obtain medical assistance and transport to hospital
48
Q

EPI Pen

A

Expensive - go find info

49
Q

Allergic rxn - delayed

A

Onset greater than 1 hour, usually non-life threatening, antibiotics, narcotics, preservatives anesthetics
Signs/symptoms - rash, pruritus (itching), urticaria (hives), edema, rarely - hypotension, dyspnea, coma

50
Q

Allergic rxn: delayed - management

A

Terminate procedure
position patient based upon comfort
BCLS if indicated (usually not)
Benadryl 50 mg PO or IM q 4 h depending upon severity of symptoms
continue Benadryl for 24 hours after symptoms disappear

Patient Care 1 Exam 2 (4 decks)

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