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Oral Surgery 1 > Medically Compromised Pt > Flashcards

Medically Compromised Pt Flashcards

1
Q

_______ BP guideline: Less than 120 and Less than 80

A

Normal

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2
Q

_______ BP guideline: 120-129 and Less than 80

A

Elevated BP

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3
Q

_______ BP guideline: 130-139 or 80-89

A

Hypertension (Stage I)

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4
Q

_______ BP guideline: ≥ 140 or ≥ 90

A

Hypertension (Stage II)

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5
Q

What is the absolute cutoff for bp?

A

180/110

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6
Q

HTN _____: If BP elevated (can get above 200s systolic and130s diastolic) and patient feels normal →postpone dental treatment
AND go see PCP for evaluation and treatment

A

HTN urgency

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7
Q

HTN ________:
• END ORGAN DAMAGE!! → GET PATIENT TO EMERGENCY DEPARTMENT NOW!!!!
• Headache, fatigue, blurry vision, numbness, chest pain, dyspnea, anuria
• Higher risk for stroke and uncontrolled bleeding

A

HTN emergency

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8
Q

_____ hypertension
• Greatest % of hypertensive pts
• > 95% idiopathic

A

• Primary (essential)

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9
Q

______ hypertension

• 5% with underlying condition: renal/endocrine disorders

A

• Secondary hypertension

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10
Q
  • The following are Risk Factors for _________

* Obesity, Smoking, EtOH, hypercholesterolemia, DM, LVH

A

hypertension

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11
Q

• Decreased oxygenated blood to myocardium
• Due to narrowing or incomplete blockage of coronary artery(ies)
• NO MYOCARDIAL DAMAGE
• Rx: stent, angioplasty, CABG, meds
• If patient has NO restrictions and NORMAL EKG after above procedure, then patient
can be categorized as ASA II

A

ISCHEMIC HEART DISEASE

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12
Q

• Symptom of IHD due to discrepancy of myocardial oxygen demand and the ability of the
coronary arteries to supply oxygenated blood
• Causes:
• Narrowing of coronary arteries (LAD a. = “widow-maker”)
• Spasm of coronary arterial wall (Prinzmetals angina)
• Symptoms:
• Chest pain w/ radiation
• Nausea, sweating, dyspnea, HTN
• Bradycardia, Impending sense of doom

A

ANGINA

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13
Q 
\_\_\_\_\_ angina:
• Pain on exertion
• Infrequent episodes
• One nitro tab controls pain
• ASA III
• Medical Consultation prior to treatment
A

Stable angina

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14
Q 
\_\_\_\_\_ angina:
• Pain at rest
• Frequent episodes
• Increasing nitro for pain relief
• ASA IV
• Likely requires inpatient care
A

Unstable angina

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15
Q

What asa is stable angina?

A

ASA 3

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16
Q

What asa is unstable angina?

A

ASA 4

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17
Q
  • Potent vasodilator: reduces myocardial oxygen demand
  • Low doses →VENO-dilator
  • High dose →VENO-dilator plus ARTERIO-dilator
  • Dosage:
  • 0.4 mg metered dose spray (oral/sublingual)
  • 0.4 mg/tab, bottle of 25, light protected
  • Give every 3-5 min, no more than 3 doses
  • Watch the blood pressure!
A

Nitroglycerin

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18
Q

how long should you generally defer elective procedures after MI?

A

6 months

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19
Q

• With advent of neovascularization procedures
• If patient has NO restrictions and NORMAL EKG after above procedure, dental work can resume after___
months post MI

A

2 months

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20
Q

WHAT TO DO FOR EMERGENCIES IN PATIENTS
WITH HISTORY OF ________ :
• Limit Epi (0.04 mg)
• Have Nitro in office and available
• Make certain the patient is taking medications
• More often than should, patients do not take their medications prior to dental treatment
• Monitor blood pressure throughout procedure
• Contact cardiologist that day prior to procedure, if possible
• Reduce anxiety
• Walk patient through procedure
• Reassure constantly
• Change location to hospital setting

A

HEART ATTACK

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21
Q 
\_\_\_\_\_\_\_\_; is the failure of the heart as a basic pump
• Symptoms:
• Dyspnea
• Orthopnea
• Paroxysmal nocturnal dyspnea
• Weakness/fatigue
• Extremity edema
A

• Congestive heart failure

22
Q

______ VENTRICULAR FAILURE
• Jugular venous distention (JVD)
• Peripheral edema
• Hepatomegaly

A

RIGHT Ventricular Failure

23
Q

__-__ VENTRICULAR FAILURE
• Pulmonary edema
• Dyspnea
• Paroxysmal nocturnal dyspnea

A

LEFT ventricular failure

24
Q

(Stroke patient)
• Symptoms < 24 hours
• With return to normal functioning

A

TRANSIENT ISCHEMIC ATTACK

• TIA

25
Q 
(Stroke patient)
• Symptoms > 24 hours
• Limited return to “normal” functioning
• Ischemic (80%)
• Embolic and Thrombotic
• Hemorrhagic (20%)
• Aneurysm and/or vascular malformation
A

CEREBROVASCULAR ACCIDENT

• CVA

26
Q
  • Deferral of treatment for 6 months post-stroke due to increased incidence of recurrence
  • Always send medical consultation to PCP/Neurologist regarding elective care
  • Call PCP/Neurologist that day for emergent procedures
  • Check medical list:
  • Anticoagulants
  • Antiplatelets
  • Monitor BP
  • Anxiety reduction
A

Stroke

27
Q

How long should wait for elective treatment post stroke?

A

6 months

28
Q 
• Onset usually early
• Associated with allergens, cold air, 
anxiety, exercise
• A reversible process
• First line tx: 
• Inhaled short-acting beta agonist 
(Albuterol)
A

ASTHMA

29
Q
  • Onset usually 4th decade and up
  • H/o smoking or chronic respiratory infections
  • An irreversible process
  • First line tx:
  • Bronchodilators
  • β2-adrenergic agonist (Salbutamol, salmeterol)
  • Anticholinergic (Ipraropium, tiotropium)
A

COPD

30
Q

Can you give nitrous to asthmatic pts?

A

yes

31
Q 
If \_\_\_\_\_\_\_ (severe attack not responsive to standard medication)
• Epinephrine: 0.3 mg SubQ Q15 - 20 min x 3 doses
• Supplemental oxygen: 1-3 L/min
A

STATUS ASTHMATICUS

32
Q
  • Barrel chested
  • Exertional dyspnea
  • Non-productive cough
  • Thin body habitus
A

Emphysema

33
Q
  • Cyanotic
  • Frequent respiratory infections
  • Chronic PRODUCTIVE cough
  • Obese body habitus
A

BRONCHITIS

34
Q
  • Easily fatigued
  • Frequent respiratory infections
  • Use of accessory muscles to breathe
  • Chronic cough
  • Pursed-lip breathing
  • Digital clubbing
  • Orthopneic
  • Wheezing
  • Barrel chested
  • Prolonged expiratory time
  • Thin appearance
  • Increased sputum (bronchitis)
A

CHRONIC OBSTRUCTIVE PULMONARY DISEASE

35
Q

_______. patient
• If not well controlled there are significant potential difficulties in treatment
• Prone to infection
• Hyperglycemia adversely affects WBC diapedesis and demarginalization
• Delayed in wound healing, possible chronic wound
• Hyperglycemia
• Hypoglycemia
• More problematic if it occurs

A

Diabetic patient

36
Q

What do you want HbA1c level to be?

A

6%

37
Q

What should you instruct patient to do regarding insulin dose before intravenous sedation?

A

Decrease dose by 50%

38
Q
  • Substituted Valine for Glutamate on Hb molecule
  • Hb A converted to Hb S
  • Autosomal recessive inheritance pattern
  • Sickle Cell Trait: no treatment modifications
  • Sickle Cell Anemia: concern is the prevention of acute crises
  • Hemolysis of RBCs →anemia
  • Splenic sequestration of RBCs →splenomegaly, anemia →asplenia
  • Increased risk of infection by encapsulated organisms
A

Sickle cell disease

39
Q

How much for how long should you consider stress dosing for steroids?

A

20 mg for 3 weeks

40
Q

In a pt with thyroid disease should you defer treatment until it is under control or can you procede as normal?

A

Defer until controlled

41
Q
  • Progressive destruction of thyroid tissue
  • Autoimmune (Hashimoto’s thyroiditis)
  • Surgically (removed thyroid tissue to treat hyperthyroidism)
  • Medically (lithium, propylthiouracil (PTU), radioactive iodine, methimazole)
  • Symptoms:
  • Fatigue, unintended weight gain, cold intolerance, constipation, AMS
A

Hypothyroidism

42
Q
  • Increased presence in thyroid stimulating antibodies

* Graves disease

A

HYPERTHYROIDISM

43
Q

• Associated symptoms:
• Jaundice, itching, easy bruising, ascites, gynecomastia, hepatic encephalopathy, spider
telangiectasia, palmar erythema

A

Liver disease

44
Q
  • Viral contagion of dentist and other patients
  • Increased risk of bleeding
  • Altered metabolism of drugs
  • Can cause toxicity or no effect from drug
A

Liver disease

45
Q

Do you want a pt with kidney disease to be scheduled during or after dialysis?

A

After dialysis so that heparinized blood is leveled out

46
Q

• Strict adherence to sterile technique
• THIS SHOULD BE DONE FOR ALL PATIENTS NO MATTER IF DISEASED OR NOT DISEASED
• Pre-op tests as mentioned earlier to determine extend of liver damage as well as infectivity
(viral load)
• Avoid drugs primarily excreted in liver

A

Liver disease

47
Q

• Patients can’t excrete normally, thus drug metabolites and filtrate usually excreted
remains in blood serum
• Be careful with medications with active metabolites (Demerol, codeine, ASA, valium)
• Avoid nephrotoxic medications (NSAIDs, Amphotericin B, ACE-Inhib, MTX, acyclovir, B-
lactam antibiotics, etc…)

A

Renal Insufficiency

48
Q
  • Replaces the kidneys as the filtration system in body
  • Also can remove excess fluid from system (reducing BP)
  • Due to tortuosity of dialysis machine, the blood is HEPARINIZED
  • Prevents clotting in machine, and then transfer of clot to venous system
  • Usually requires dialysis shunt for long term dialysis
  • Schedule patient on days AFTER Dialysis
  • Heparinized blood, clots poorly
  • Consult PCP concerning antibiotic prophylaxis
A

Hemodialysis

49
Q

If on Coumadin/Warfarin: INR below ____ is acceptable to surgery

A

3

50
Q

• Elective procedures best to perform at what 2 times?

A

after delivery or in 2nd trimester

51
Q

Which trimester can dental work be done in?

A

2nd trimester

52
Q
  • Avoid teratogenic medications
  • Tetracycline, corticosteroids, aminoglycosides
  • Lay patient on left side if prolonged appointment
  • Prevents occlusion of inferior vena cava
  • Allow frequent bathroom breaks
A

Pregnant patient

Oral Surgery 1 (11 decks)

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