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Patient Care > Patient Care Exam 2 part 1 > Flashcards

Patient Care Exam 2 part 1 Flashcards

1
Q

Vital Signs include

A
  • Temperature
  • Pulse
  • Respiration’s
  • Blood Pressure
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2
Q

Benefits of taking vital signs

A
  1. Baseline of normal values to compare, recognize a medical emergency
  2. Used as a screening tool for abnormalities
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3
Q

4 signs of infection

A

Calor —> heat
Dolor —> pain
Rumor —> redness
Tumor—> swelling

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4
Q

Types of infections

A

Viral
Bacterial
Fungal
Parasitic

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5
Q

Viral infection

A

Parasitic and require a host cell

- examples of viral infection = HSV, HPV, HIV

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6
Q

Bacterial infection

A

Single-called microorganisms

Examples- strep throat, e. Coli, cellulitis, MRSA, and Turberculosis

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7
Q

Alveolar ostetitis

A

Dry socket

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8
Q

Temperature

A 
Average- 98.6
Normal at UMKC - 97-99
Lowest at 6 am
Highest from 4-6PM
Axillary= oral-1
Rectal= oral +1
Make sure to do method correctly, if taken incorrectly will generally be lower than true temp
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9
Q

Oral Temperature

A

Done under the tongue
Place as far back as comfortable (wait for beep)
Do after 20 minutes since they have eaten or drank anything

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10
Q

Digital Thermometer

A

When used correctly accurate enough to meet the daily needs

Safer than mercury thermometers

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11
Q

What is a fever?

A

Temp of 100.4 or higher (38C)
99.6-100.3 - low grade fever
Skin: redder, cheeks: flushed
Not just a fever, increase of body temp comes with inflammation
Need to look at symptoms if 99.5 but feel terrible it might be a fever

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12
Q

Pulse

A

3 places to take it
-Radia, brachia, and Corotid

Use pulse readings when automated BP is not calibrated right
Abnormal pulse rates can be a good sign of CV disorder but can also be influenced by anemia, exercise, anxiety, drugs, or fever
(White coat anxiety can have patients’ pulse rate higher than normal)

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13
Q

How to take pulse radially?

A
  1. @ thumbside on inside of the wrist
  2. Use the thumb or side of index and middle finger
  3. Take for 30 seconds multiply by 2
  4. Normal= 60-100 bpm
    (Can be higher in children and lower in athletes)
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14
Q

How to take pulse at carotid?

A

Reliable because it is a large central artery
In the meantime: watch their breathing, see if mouth breather
Rapid? Irregular? Labored?

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15
Q

Tachycardia

A

A pulse greater than 100 BPM

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16
Q

Bradycardia

A

A pulse lower than 60 bpm

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17
Q

Respiration/Count breaths

A

Normal=12-16 breaths/min
Children-higher
Athletes-lower

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18
Q

Bradypnea

A

Slow respiratory

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19
Q

Tachypnea

A

Rapid respiratory

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20
Q

Why is it important to take a pulse?

A

Half of Americans have heart disease
High BP is equal to or higher than 120/80
A lot of people have hypertension

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21
Q

Normal BP

A

120/80 mmHg

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22
Q

Elevated BP

A

121-129/80

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23
Q

Hypertension Stage 1

A

130-139/80-89

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24
Q

Stage 2 Hypertension

A

140 or higher/90 or higher

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25
Q

Hypertensive crisis

A

180/higher than 120

We don’t treat these patients, consult with doctor immediately

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26
Q

Blood pressure trends

A

Lower at night while sleeping
Starts to rise a few hours before you wake up and continues to rise during the day
Afternoon patients might have higher BP,
Take this into consideration

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27
Q

Hypertension is common with?

A

Increase in age and obesity

Prevalence varies with race and ethnicity

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28
Q

Systolic Hypertension

A

Systolic=130+ but dystolic =80-
Seen in older people by of hypertension drugs they take
Most common in the US

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29
Q

Hypertension Patient factors

A

Stress (increases BP by 6-12) goes away after 5-10 min

Distended bowel or bladder-ask patient before going to the cubicle if they need to use the bathroom first

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30
Q

Hypertension and drugs

A 
Caffeine
Tobacco
Cocaine
Amphetamines
Meth
All increase BP
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31
Q

Treating a hypertensive patient

A

Starting to sweat—> place cold paper towels on forehead
Take 2 or 3 times and average if it increases or decreases

Possible medical emergencies:angina,MI stroke etc.

32
Q

Systolic

A

The upper #
How much pressure is pushing on your blood vessel walls
Coming from chambers into arteries

33
Q

Diastolic

A

The lower #
Filling phase is dystole

Pressure in your arteries between beats

34
Q

Systolic vs Diastolic

A

Force that the heart generates each time it contracts

35
Q

Antecubital foss

A

Where you hear the beat from

36
Q

Automated BP cuffs

A

Arm and wrist

Wrist is not as accurate

37
Q

Steps on taking BP

A
  1. Remove jacket/Sweater
  2. Roll up sleeves if they can (DO not want sleeves constricting blood flow)
  3. Arm on armrest at heart level
  4. Elbow straight out as possible(fake readings occur if 3 and 4 aren’t done right)
  5. Wrap cuff around upper arm
  6. Make sure “artery” sign is slightly above antecubital region
  7. Inflate cuff 20-30 mmHG above normal
  8. Pressure release valve turned slowly having needle fall 2-3 mmHg/sec
  9. Once you hear sound- systolic pressure
  10. Continues to fade until you cannot hear a sound anymore= diastolic
38
Q

Choosing which arm to do

A

Normally the arm closest to you

Unless they have a wound, scar or bandage for lymphedema from mastectomy so do it on the opposing arm

39
Q

Common mistakes done with blood pressure

A 
Rushing through- 3 mmHG/beat 
Cuff too large or small
Small=false elevated reading
Big=false low reading
Cuff too loose or tight
Arm not at heart level or supported
40
Q

What happens when legs are crossed while taking BP?

A

Increases systolic by 7% and diastolic by 2%

41
Q

Blood pressure confirmation

A

Wait until 2 mins before taking or can also confirm on other arm

42
Q

How many life threading experiences will a dentist experience in career?

A

1-2

43
Q

Emergency

A

An unforeseen combination of circumstances that call for immediate action

44
Q

The categories of emergency

A
  1. Minor
  2. intermediate
  3. Major
45
Q

Category 1/minor

A

Simple faints

46
Q

Category 2

A

O2 + repositioning

47
Q

Category 3 or major emergencies include

A

Referral to MD or hospital

Do CPR while office manager calls 911

48
Q

Preventing of medical emergencies

A 
Why vital signs are important
BP- 120/80
HR and rhythm: 60-110
Respiratory rate: 16-18
Height and weight
49
Q

How to determine a medical risk?

A 
Medical history questionnaire (make it comprehensive not just dental)
Physical evaluation
Dialogue history
Medical consultation (if necessary)
ASA classification
50
Q

ASA physical classification

A

ASA 1-6 and ASA E

51
Q

What are the ASA classifications

A

ASA1- healthy patient, no systemic disease

52
Q

ASA 2

A

Mild systemic disease

53
Q

ASA 3

A

Severe systemic disease limiting activity

54
Q

ASA 4

A

Incapacitating systemic disease that is a constant threat to life

55
Q

ASA 5

A

Moribund patient not expected to survive 24 hours without an operation

56
Q

ASA 6

A

Brain dead, organ harvest for donation,

57
Q

ASA E

A

Emergency operation

58
Q

Which ASA classifications will we see?

A

ASA 1-3

59
Q

Different levels of consciousness

A

Awake
Altered:presyncope, TIA, (starting to slur words or not make sense)
Unconscious: syncope, orthostatic hypotension
Seizures- hyperventilation, syncope, and epilepsy

60
Q

Syncope

A

Transient vascular and neurogenic reaction

Loss of consciousness due to hypoperfusion of the brain, generalized cerebral ischemia aka fainting. Characterized by rapid onset and spontaneous resolution. Evoked by emotional stress associated with fear or pain

61
Q

What is syncope marked by?

A 
Pailor
Nausea
Sweating
Bradycardia
Rapid fall in BP
62
Q

Physcogenic factors of syncope

A 
Fright or anxiety
Pain
Emotional stress
Sight of blood
Sight of dental instruments
Unwelcomed news
63
Q

Non-physchogenic factors of syncope

A 
Upright or standing position
Hunger
Exhaustion
Poor physical condition(ASA3)
Hot,humid, crowded environment
Male sex (faint more)
Between 16-35
64
Q

Vasovagal syncope

A

Sudden rapid drop in hr and BP —> fainting
32% of syncope
First episode happens as teenager or adolescent

65
Q

Syncope Manifestations

A 
Warmth
Loss of color
Sweating
Feels bad
Nausea or feel nauseous 
BP at baseline
Tachycardia
66
Q

Syncopal episodes

A

Usually triggered by sudden, temporary drop in blood flow to the brain —> loss of consciousness and muscle control and fall
Falling allows blood to flow back to the brain

67
Q

Late syncope manifestations

A 
Yawning
Difficult breathing pupillary dilation
Cold hands and feet
Dizziness
Loss of consciousness 
Hypotension and bradycardia
68
Q

How to treat syncope

A 
Patient position: horizontal (allow blood to flow back to brain)
Airway/breathing
Circulation: vital signs
O2
Cool compress: at wrists and forehead 
Aromatic spirits of ammonia can help
Loosen clothing
Reassurance
69
Q

What to observe for breathing/airway

A 
Any obstruction
hyperventilation
Asthma
COPD, Emphysema
General difficult breathing

Observe the patient from the beginning without making it super obvious

70
Q

Cardiovascular Emergencies Include

A 
Aging= chest pain
hypo or hypertension
Dsrhymia-bradycardia, tachycardia 
MI
Cardiac arrest
71
Q

Drug related CV emergencies

A

Overdose: sedatives (like opioids) or local anesthetic (we gave too much or they are hypersensitive)

Reaction to drugs: allergy (rash, itching, airway)

72
Q

Goals of a physical evaluation

A 
Ability to psychologically tolerate stress
Ability to physically tolerate treatment
Is treatment modification indicated
Is psycho sedation indicated
Which sedation technique is indicated 
Any contradictions to premedication used
73
Q

How to recognize anxiety

A 
Increase in BP and pulse
Trembling
Diaphoresis
Restlessness 
Hyperventilation 
Dilated pupils
74
Q

protocol for stress reduction

A 
Oral sedation (@ pm and am)
Intraoperative sedation (IV or NO gas)
Effective pain control (local anesthetic)
AM appointment
Time factor: short appointments
Hot humid weather increases stress
Post op RC prn
Post op phone call to see how they’re doing
75
Q

Treatment modifications

A

Intra-OP oxygen
Sedation (oral,N20, IV)
Patient positioning (make sure they can breathe comfortably)
Antibiotic premedication
Cardiac pacemaker or defibrillation (might need medical clearance to use ultrasonic if have pacemaker)
Anticoagulant

Patient Care (2 decks)

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