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Patient Care > Patient Care Exam 2 Part 2 > Flashcards

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
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2
Q

Blood sugar and A1c

A

-HbA1c measures the average amount of sugar in your blood over the past 2-3 months

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3
Q

Asthma management

A
  • Terminate procedure
  • Position patient upright
  • Calm patient
  • Administer bronchodilator- ventolin
  • Administer O2
  • Administer epinephrine bronchodilator and antispasmodic
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4
Q

Chest pain can cause

A
  • Angina pectoris (most common)
  • Hyperventilation
  • Acute M.I (least common)
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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?

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6
Q

Diabetes Mellitus

A

Chronic systemic disease characterized by a disorder in glucose metabolism

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7
Q

Necrosis

A
  • 4-6 hours so permanent damage
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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

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9
Q

Patient preventions for asthma

A
  • Get vaccinated for influenza and pneumonia
  • Know the triggers]
  • Take meds
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10
Q

Angina pectoris treatment

A
  1. Place patient sitting up with head elevated
  2. Ensure open airways and breathing is adequate
  3. Check vitals
  4. Administer nitroglycerine
  5. Repeat every 5 mins up to 3 doses in a 15 min time period
  6. Always check BP between does (if drops below 100mm/HG no more nitroglycerin)
  7. If pain not relieved give one aspirin 325mg and call 911
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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
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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

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13
Q

Edema

A

Fluid retention
Can be mild or severe
Severe=pitting

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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
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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

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16
Q

Minor risks for CVD

A
  • Excessive alcohol use
  • Stress
  • Age
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17
Q

Delayed allergic reaction

A
  • Onset greater than an hour
  • Non-life threatening usually
  • Antibiotics
  • Analgesics
  • Narcotics
  • Preservatives in anesthetics
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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
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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
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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
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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
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22
Q

How common is asthma

A
  • 1 out of 250 deaths worldwide

- @US affecting 23 million people

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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
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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)
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25
Q

HbA1c stats

A
  • 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
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26
Q

Myocardial infarction

A
  • 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
Q

Cardiovascular disease

A

CVD

  • about 33% mortality rate
  • leading cause of death after age 65
28
Q

Epipens

A
  • cost is insane

- shelf life of epi pens are now 20 months (before only 16 months added 4 more)

29
Q

Nitroglycerin

A
  • Action in 2-4 mins
  • Duration of 30 mins
  • Side effects: pounding in head, flushing, tachycardia
  • Possible hypotension
30
Q

Stable angina

A
  • 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
Q

Type 1 diabetes

A
  • ~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
Q

Type 2 Diabetes

A
  • Milder form of diabetes (????)
  • Seen more in adults
  • ~85% of diabetics
  • Ketoacidosis uncommon
  • Patient usually obese
  • Blood sugar levels more stable
33
Q

Rapid signs and symptoms of allergic rxn

A
  • Pallor
  • Rash
  • Itching
  • Hives
  • Angio-edema
  • Hypotension
  • Dyspnes
  • GI upset
  • Bronchospasm
  • Laryngeal edema
  • Rhinorrhea
  • Circulatory collapse
  • Dysrhythmias
  • Cardiac arrest
34
Q

Management of aging pectoris

A
  • Stress reduction protocol
  • Avoid excess vasoconstrictors
  • Oxygen as necessary
  • Nitroglycerine tabs 1-2 tabs sublingual
  • 4444 if doesn’t go away *
35
Q

Rapid allergic reaction

A
  • Rapid onset, less than an hour
  • Type 1 true IgE mediated anaphylaxis
  • antibiotics
  • Analgesics
  • Narcotics
  • Preservatives in aesthetics
  • Venom of stinging insects
36
Q

Asthma

A

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
Q

Type 1 Hypersensitivity reaction

A
  • Related to humoral immune system and occurs soon after second contact with antigen
38
Q

Asthma symptoms

A
  • Chest congestion
  • Wheezing and coughing
  • Dyspnea and tachypnea
    _ Increased BP
  • Anxiety and agitation
    _ Cyanosis (because lack of airway in severe cases)
39
Q

Major risks for CVD

A
  • Smoking - the most modifiable risk
  • diabetes
  • Cholesterol
  • Hypertension
  • Obesity
  • Sleep apnea
  • Family history
40
Q

Management of hyperventilation

A
  • 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
Q

Cause of aging pectoris

A
  • 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
Q

Gender and stats

A

Men faint more than women

Women hyperventilate more than men

43
Q

Hyperventilation prevention

A
  • Medical history
  • Physical exam
  • Recognize signs of anxiety
  • Stress reduction protocol
44
Q

Diabetes oral complications

A
  • 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
Q

Asthma prevalence

A
  • 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
Q

Asthma Dental considerations

A
  • 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
Q

Hyperventilation

A
  • 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
Q

Asthma preventions

A
  • 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
Q

Diabetes mellitus prevention

A
  • 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
Q

Stages of insulin shock

A
  1. Mild stage: most common
  2. Moderate stage
  3. Severe stage
51
Q

Adverse reaction vs allergic reaction

A

~5% of self reports are not TRUE allergies

  • syncope after injection of local anesthetics
  • Nausea or vomiting after ingestion of codeine
52
Q

Rapid Management

A
  • Position patient supine
  • BCLS
  • Oxygen
  • Monitor vital
  • Epinephrine
  • Benadryl: 50 mg IV or IM
  • Obtain medical assistance and transport to hospital
53
Q

Insulin Shock stage 2

A
  • 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
Q

Allergy

A

Abnormal hypersensitivity response of the immune system to a substance introduced into the body
- 25% of Americans demonstrate some kind of allergy

55
Q

Myocardial infarction signs and symptoms

A
  • 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
Q

Blood glucose readings

A
  • <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
Q

Hypoglycemia management

A

-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
Q

Delayed signs and symptoms

A
  • Rash
  • Pruritus (itching)
  • Urticaria (hives)
  • Edema
  • Rarely-hypotension, dyspnea, coma
59
Q

Insulin Shock Stage 3

A
  • 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
Q

Gestational diabetes

A
  • 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
Q

Traid asthmaticus

A
  • Aka aspirin related respiratory disease
  • Combination of three things
    1. Asthma
    1. Aspirin sensitivity
    1. Nasal Polyps
62
Q

Aging Pectoris

A
  • 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
Q

Diabetic Ketoacidosis

A
  • 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

Patient Care (2 decks)

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