Patient Care Exam 2 part 1 Flashcards
1
Q
Vital Signs include
A
- Temperature
- Pulse
- Respiration’s
- Blood Pressure
2
Q
Benefits of taking vital signs
A
- Baseline of normal values to compare, recognize a medical emergency
- Used as a screening tool for abnormalities
3
Q
4 signs of infection
A
Calor —> heat
Dolor —> pain
Rumor —> redness
Tumor—> swelling
4
Q
Types of infections
A
Viral
Bacterial
Fungal
Parasitic
5
Q
Viral infection
A
Parasitic and require a host cell
- examples of viral infection = HSV, HPV, HIV
6
Q
Bacterial infection
A
Single-called microorganisms
Examples- strep throat, e. Coli, cellulitis, MRSA, and Turberculosis
7
Q
Alveolar ostetitis
A
Dry socket
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
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
10
Q
Digital Thermometer
A
When used correctly accurate enough to meet the daily needs
Safer than mercury thermometers
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
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)
13
Q
How to take pulse radially?
A
- @ thumbside on inside of the wrist
- Use the thumb or side of index and middle finger
- Take for 30 seconds multiply by 2
- Normal= 60-100 bpm
(Can be higher in children and lower in athletes)
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?
15
Q
Tachycardia
A
A pulse greater than 100 BPM
16
Q
Bradycardia
A
A pulse lower than 60 bpm
17
Q
Respiration/Count breaths
A
Normal=12-16 breaths/min
Children-higher
Athletes-lower
18
Q
Bradypnea
A
Slow respiratory
19
Q
Tachypnea
A
Rapid respiratory
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
21
Q
Normal BP
A
120/80 mmHg
22
Q
Elevated BP
A
121-129/80
23
Q
Hypertension Stage 1
A
130-139/80-89
24
Q
Stage 2 Hypertension
A
140 or higher/90 or higher
25
Hypertensive crisis
180/higher than 120
| We don’t treat these patients, consult with doctor immediately
26
Blood pressure trends
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
27
Hypertension is common with?
Increase in age and obesity
| Prevalence varies with race and ethnicity
28
Systolic Hypertension
Systolic=130+ but dystolic =80-
Seen in older people by of hypertension drugs they take
Most common in the US
29
Hypertension Patient factors
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
30
Hypertension and drugs
```
Caffeine
Tobacco
Cocaine
Amphetamines
Meth
All increase BP
```
31
Treating a hypertensive patient
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
Systolic
The upper #
How much pressure is pushing on your blood vessel walls
Coming from chambers into arteries
33
Diastolic
The lower #
Filling phase is dystole
Pressure in your arteries between beats
34
Systolic vs Diastolic
Force that the heart generates each time it contracts
35
Antecubital foss
Where you hear the beat from
36
Automated BP cuffs
Arm and wrist
| Wrist is not as accurate
37
Steps on taking BP
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
Choosing which arm to do
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
Common mistakes done with blood pressure
```
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
What happens when legs are crossed while taking BP?
Increases systolic by 7% and diastolic by 2%
41
Blood pressure confirmation
Wait until 2 mins before taking or can also confirm on other arm
42
How many life threading experiences will a dentist experience in career?
1-2
43
Emergency
An unforeseen combination of circumstances that call for immediate action
44
The categories of emergency
1. Minor
2. intermediate
3. Major
45
Category 1/minor
Simple faints
46
Category 2
O2 + repositioning
47
Category 3 or major emergencies include
Referral to MD or hospital
| Do CPR while office manager calls 911
48
Preventing of medical emergencies
```
Why vital signs are important
BP- 120/80
HR and rhythm: 60-110
Respiratory rate: 16-18
Height and weight
```
49
How to determine a medical risk?
```
Medical history questionnaire (make it comprehensive not just dental)
Physical evaluation
Dialogue history
Medical consultation (if necessary)
ASA classification
```
50
ASA physical classification
ASA 1-6 and ASA E
51
What are the ASA classifications
ASA1- healthy patient, no systemic disease
52
ASA 2
Mild systemic disease
53
ASA 3
Severe systemic disease limiting activity
54
ASA 4
Incapacitating systemic disease that is a constant threat to life
55
ASA 5
Moribund patient not expected to survive 24 hours without an operation
56
ASA 6
Brain dead, organ harvest for donation,
57
ASA E
Emergency operation
58
Which ASA classifications will we see?
ASA 1-3
59
Different levels of consciousness
Awake
Altered:presyncope, TIA, (starting to slur words or not make sense)
Unconscious: syncope, orthostatic hypotension
Seizures- hyperventilation, syncope, and epilepsy
60
Syncope
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
What is syncope marked by?
```
Pailor
Nausea
Sweating
Bradycardia
Rapid fall in BP
```
62
Physcogenic factors of syncope
```
Fright or anxiety
Pain
Emotional stress
Sight of blood
Sight of dental instruments
Unwelcomed news
```
63
Non-physchogenic factors of syncope
```
Upright or standing position
Hunger
Exhaustion
Poor physical condition(ASA3)
Hot,humid, crowded environment
Male sex (faint more)
Between 16-35
```
64
Vasovagal syncope
Sudden rapid drop in hr and BP —> fainting
32% of syncope
First episode happens as teenager or adolescent
65
Syncope Manifestations
```
Warmth
Loss of color
Sweating
Feels bad
Nausea or feel nauseous
BP at baseline
Tachycardia
```
66
Syncopal episodes
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
Late syncope manifestations
```
Yawning
Difficult breathing pupillary dilation
Cold hands and feet
Dizziness
Loss of consciousness
Hypotension and bradycardia
```
68
How to treat syncope
```
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
What to observe for breathing/airway
```
Any obstruction
hyperventilation
Asthma
COPD, Emphysema
General difficult breathing
```
Observe the patient from the beginning without making it super obvious
70
Cardiovascular Emergencies Include
```
Aging= chest pain
hypo or hypertension
Dsrhymia-bradycardia, tachycardia
MI
Cardiac arrest
```
71
Drug related CV emergencies
Overdose: sedatives (like opioids) or local anesthetic (we gave too much or they are hypersensitive)
Reaction to drugs: allergy (rash, itching, airway)
72
Goals of a physical evaluation
```
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
How to recognize anxiety
```
Increase in BP and pulse
Trembling
Diaphoresis
Restlessness
Hyperventilation
Dilated pupils
```
74
protocol for stress reduction
```
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
Treatment modifications
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
