Patient Care Exam 2 Part 2 Flashcards
1
Q
Diabetes hyperglycemia
A
- Polyuria
- Polydipsia
- Polyphagia
- Dry,warm skin
- Kussmaul’s respiration’s
- Fruity breath odor
- Rapid weak pulse
- Altered level of consciousness
2
Q
Blood sugar and A1c
A
-HbA1c measures the average amount of sugar in your blood over the past 2-3 months
3
Q
Asthma management
A
- Terminate procedure
- Position patient upright
- Calm patient
- Administer bronchodilator- ventolin
- Administer O2
- Administer epinephrine bronchodilator and antispasmodic
4
Q
Chest pain can cause
A
- Angina pectoris (most common)
- Hyperventilation
- Acute M.I (least common)
5
Q
MI and Dental Treatments
A
- Can’t have dental treatment within 8 weeks of MI
- more than 8 weeks, dental treatment possible but need medical consultation
Questions to ask: Patient’s cardiac status? Is the condition stable? Any heart failure? What’s ejection fraction?
6
Q
Diabetes Mellitus
A
Chronic systemic disease characterized by a disorder in glucose metabolism
7
Q
Necrosis
A
- 4-6 hours so permanent damage
8
Q
Anaphylaxis
A
An acute reaction involving smooth muscle of the bronchi —> antigen IgE antibody complexes —> mast cells in surface —> release histamine from cells —> results in acute respiratory compromise and cardiovascular collapse
9
Q
Patient preventions for asthma
A
- Get vaccinated for influenza and pneumonia
- Know the triggers]
- Take meds
10
Q
Angina pectoris treatment
A
- Place patient sitting up with head elevated
- Ensure open airways and breathing is adequate
- Check vitals
- Administer nitroglycerine
- Repeat every 5 mins up to 3 doses in a 15 min time period
- Always check BP between does (if drops below 100mm/HG no more nitroglycerin)
- If pain not relieved give one aspirin 325mg and call 911
11
Q
Orthostatic Hypotenstion
A
Seen in elderly patients Decrease in systolic BP of 20 mmHG OR Decrease in diastolic BP of 10 mmHG within 3 minutes of standing when compared to baseline Increases with age
12
Q
Medical history
A
All patients get a medical history even if healthy
Patients do not recognize the significance of it but its very important
13
Q
Edema
A
Fluid retention
Can be mild or severe
Severe=pitting
14
Q
Hyperventilation Symptoms
A
- Tightness in chest: suffocation
- Rapid respiration:rapid pulse
-Light headedness: apprehension - Lump in throat: precocial pain (thinking having heart attack)
-Rapid and shallow breathing
-Confusion
Dizziness
-Cold hands - carpal pedal spasms; can lead to seizures
-Tingling or numbness of hands or lips - Patients between 15-40
15
Q
Insulin shock
A
-If fail to eat with their diabetic management plan but continue to take regular insulin injections maybe —> hypoglycemic reaction by of excess insulin
Shock has 3 stages
16
Q
Minor risks for CVD
A
- Excessive alcohol use
- Stress
- Age
17
Q
Delayed allergic reaction
A
- Onset greater than an hour
- Non-life threatening usually
- Antibiotics
- Analgesics
- Narcotics
- Preservatives in anesthetics
18
Q
Insulin shock stage 1
A
- Mild
- Characterized by hunger, weakness, trembling, tachycardia, pollor and sweating
- Maybe before meals, during exercise or when food has been omitted or delayed
- Can be corrected with giving patient something sweet- fruit juice, cake icing
19
Q
Risk factors for heart disease
A
- Heredity
- Sex (men develop earlier than women)
- Race (African Americans are more at risk)
- Age
- Factors that cannot be changed
20
Q
Asthma causes/triggers
A
- Emotional or physical stress
- Allergy to foods or drugs
- Air pollution or irritating vapors
- upper respiratory infections
- Exercise induced
21
Q
Delayed management
A
- Terminate procedure
- Position patient upon comfort
- Benadryl 50 mg PO or IM q 4 h depending upon severity of symptoms
22
Q
How common is asthma
A
- 1 out of 250 deaths worldwide
- @US affecting 23 million people
23
Q
Diabetes hypoglycemia
A
- Pale moist skin
- weakness, dizziness
- Shallow respiration’s
- Headache
- Altered level of consciousness
- Onset very sudden
- Glucose values <50mg/100ml
24
Q
Warning signs and symptoms
A
- Extreme fatigue
- Nasea
- Chest pain
- Difficulty breathing
- Constant dizziness or lightheadednesss
- Fast HR
- Irregular heart beat
- Pitting edema (edema in ankles sign for venous insufficiency, press down on swollen areas and if indentation remains)
25
HbA1c stats
- Diabetics level should be 6.5% or below
- If at risk for type 2 level should be 6%
- If patient doesn’t know their HbA1c, test with a glucometer
26
Myocardial infarction
- MI aka heart attack
- Death of cardiac muscle due to inadequate blood oxygen supply
- Can progress into cardiac arrest
- Basic management goal: minimize size of infarction and prevent death from lethal arrhythmias
- Early administration of aspirin is recommended with 160-325 mg being chewed and swallowed to decrease platelet aggregation and limit thrombus formation
- With unresponsive patients indicate CPR, and AED
27
Cardiovascular disease
CVD
- about 33% mortality rate
- leading cause of death after age 65
28
Epipens
- cost is insane
| - shelf life of epi pens are now 20 months (before only 16 months added 4 more)
29
Nitroglycerin
- Action in 2-4 mins
- Duration of 30 mins
- Side effects: pounding in head, flushing, tachycardia
- Possible hypotension
30
Stable angina
- new-onset pain, increasing in frequency or intensity
- Can also occur at rest
- Cannot be relieved with nitroglycerin
- Key feature is the increasing intensity or pattern of pain
- Patients do not have good prognosis and experience an acute MI within a short time
31
Type 1 diabetes
- ~5% of all diabetic patients
- More common in adolescents but can develop in adults
- No circulation insulin
- Beta cells destroyed, cannot respond to stimuli (high blood sugar)
- Requires exogenous insulin
32
Type 2 Diabetes
- Milder form of diabetes (????)
- Seen more in adults
- ~85% of diabetics
- Ketoacidosis uncommon
- Patient usually obese
- Blood sugar levels more stable
33
Rapid signs and symptoms of allergic rxn
- Pallor
- Rash
- Itching
- Hives
- Angio-edema
- Hypotension
- Dyspnes
- GI upset
- Bronchospasm
- Laryngeal edema
- Rhinorrhea
- Circulatory collapse
- Dysrhythmias
- Cardiac arrest
34
Management of aging pectoris
- Stress reduction protocol
- Avoid excess vasoconstrictors
- Oxygen as necessary
- Nitroglycerine tabs 1-2 tabs sublingual
- 4444 if doesn’t go away *
35
Rapid allergic reaction
- Rapid onset, less than an hour
- Type 1 true IgE mediated anaphylaxis
- antibiotics
- Analgesics
- Narcotics
- Preservatives in aesthetics
- Venom of stinging insects
36
Asthma
A chronic inflammatory disease of airways characterized by reversible episodes of increased hyper responsiveness resulting in recurrent episodes of dyspnea, coughing and wheezing .
Inadequate treatment results in ER visits in 25% of patients
37
Type 1 Hypersensitivity reaction
- Related to humoral immune system and occurs soon after second contact with antigen
38
Asthma symptoms
- Chest congestion
- Wheezing and coughing
- Dyspnea and tachypnea
_ Increased BP
- Anxiety and agitation
_ Cyanosis (because lack of airway in severe cases)
39
Major risks for CVD
- Smoking - the most modifiable risk
- diabetes
- Cholesterol
- Hypertension
- Obesity
- Sleep apnea
- Family history
40
Management of hyperventilation
- Terminate procedure
- position comfortably-usually upright
- Reassure patient
- NO OXYGEN
- Breathe into paper bag or headrest cover
- Count to ten between breaths
- Valium 5mg IM or IV for severe cases
- Can tell them to breathe into their hands over their mouth
41
Cause of aging pectoris
- Blood supply to the cardiac muscle is insufficient for oxygen demand
- Angina episodes precipitated by stress, anxiety, or physical activity
- Vital signs are normal, no hypotension, sweating, or nausea occur
42
Gender and stats
Men faint more than women
| Women hyperventilate more than men
43
Hyperventilation prevention
- Medical history
- Physical exam
- Recognize signs of anxiety
- Stress reduction protocol
44
Diabetes oral complications
- Preiodontal disease
- Bidirectional hyperglycemia affects oral healthy while periodontitis affects glycemic control
- Xerostomia
- Increased infections and poor wound healing
- Burning mouth syndrome
- Increased incidence and severity of gingival inflammation
- Periodontal abscess
45
Asthma prevalence
- Mostly in children (~10%)
- Females higher rate than males but in children more common in boys than girls
- Occurs in all races but slightly higher in African Americans
- Slightly lower in hispanics
46
Asthma Dental considerations
- Avoid aspirin and NSAID -aspirin (causes bronchoconstriction in ~10% of patients with asthma)
- Triad asthmaticus:
— NO contraindication to Nitrous oxide
— NO contraindication to Valium
47
Hyperventilation
- To breathe at an abnormally rapid Rate
- Increasing the rate of removal of carbon dioxide from blood
- Partial pressure of CO2 in blood decreases
- Respiratory alkalosis ensues
48
Asthma preventions
- Primary goal - prevent an acute attack
- With good medical history can determine severity and stability
- Frequency and severity of attacks mostly 2night
- How attacks are usually managed
- Have they received emergency care for an acute attack
- Ask them to take a puff from inhaler before starting treatment
49
Diabetes mellitus prevention
- Treat uncontrolled patient only with consultation with physician
- Decrease insulin on day of treatment if patient will be eating less
- Consider chronic complication such as infection
- Early morning appointments
- Good medical history
50
Stages of insulin shock
1. Mild stage: most common
2. Moderate stage
3. Severe stage
51
Adverse reaction vs allergic reaction
~5% of self reports are not TRUE allergies
- syncope after injection of local anesthetics
- Nausea or vomiting after ingestion of codeine
52
Rapid Management
- Position patient supine
- BCLS
- Oxygen
- Monitor vital
- Epinephrine
- Benadryl: 50 mg IV or IM
- Obtain medical assistance and transport to hospital
53
Insulin Shock stage 2
- Moderate
- Blood glucose drops so much patient is: incoherent, uncooperative, and sometimes belligerent or resistant to reason or restraint
- Judgement and orientation are defective
- Can cause damage to themselves or someone else
- Can be corrected with giving patient something sweet
54
Allergy
Abnormal hypersensitivity response of the immune system to a substance introduced into the body
- 25% of Americans demonstrate some kind of allergy
55
Myocardial infarction signs and symptoms
- Chest pain, more severe than angina and longer lasting
- Not relieved by nitroglycerin in a conscious patient
- Cyanotic, pale, ashen appearance, weakness, cold sweat, nausea, vomiting, air hunger
- Different symptoms between men and women
- Women experience more fatigue and dyspnea
56
Blood glucose readings
- <70mg/dL: consider deferring treatment or give carbs
- >200 mg/dL defer treatment and refer to physician
- Fasting (8-12 hours)
- Glucose levels: 80-130 mg/dL
- 1-2 hours after a meal: <180mg/dL
- A major goal is to prevent insulin shock (very low blood glucose)
57
Hypoglycemia management
-Position patient comfortably
- administer 100% oxygen
- Oral carbohydrates if conscious
- If UNconscious
—> Cake icing, 50% dextrose (20-50 ml)IV, Glucagon 1 mgIM or IV, Epinephrine 1/1000 0.5 mg IM,
Medical assistance
58
Delayed signs and symptoms
- Rash
- Pruritus (itching)
- Urticaria (hives)
- Edema
- Rarely-hypotension, dyspnea, coma
59
Insulin Shock Stage 3
- Severe
- Complete unconscious with or without muscular movements
- Most take place during sleep when first two went unrecognized
- can occur after exercise, alcohol and if signs were ignored
- Sweating, pallor, rapid and thread pulse, hypertension and hypothermia may be present
- Best treated with an IV-glucose solution, glucagon or epinephrine may be used for transient relief
60
Gestational diabetes
- Any degree of abnormal glucose tolerance during pregnancy
- 5-7% of pregnant women
- Obesity during pregnancy is a risk factor
- Glycemic control back to normal after childbirth but has increased risk 5-10 years after
61
Traid asthmaticus
- Aka aspirin related respiratory disease
- Combination of three things
- 1. Asthma
- 2. Aspirin sensitivity
- 3. Nasal Polyps
62
Aging Pectoris
- Sensation of aching, heavy, squeezing pressure
- Tightness in the mid chest region
- Discomfort may radiate to the left or right arm, neck or mandible
- Chest pain is most important symptom
63
Diabetic Ketoacidosis
- Body produces high levels of blood acids = ketones
- Happens when body cannot produce enough insulin
- Can be triggered by infection of other illness
- Rare in type 2
- Kussmaul’s respiration’s= deep and labored breathing pattern
