Physical Evaluation Flashcards
What are the components of physical evaluation?
- medical history questionnaire
- dialogue history
- physical examination
- risk assessment
What seeks to determine the significance of any reported medical disorder to the proposed dental treatment plan?
dialogue history
- dentist review completed history with patient
- specific follow-up questioning for pertinent positives
If a patient say “YES” to asthma or chest pain for example, what should you consider next?
- follow-up questioning
- additional information needed?
- change in dental treatment based on this information
Match the following symptoms as either allergy or side effect.
- mild: itching, rash, hives
- headache
- N/V
- serious: swelling of lips/tongue, difficulty breathing
- palpitations
1 & 4 = allergy
2, 3, & 5 = side effect
What should be considered when reviewing medications?
- prescription medications, over-the-counter medications, supplements, vitamins, herbals
- dose & frequency
- recent changes to prescription medications
- non-compliance with prescription medications
- review for potential dental drug interactions (epocrates, lexicomp, etc.)
What questions should you ask in the dialogue wrap-up?
“Do you have any other medical/dental problems that you think I should know about?
Is there anything that you wish to discuss with me in private?”
What is included in vitals?
BP
Pulse (rate and rhythm)
Respiratory Rate
This is an indicator of body mass composition used to assess risk for other health problems.
BMI (height & weight)
What does a BMI>25 put one at risk for?
HTN Dyslipidemia Type II diabetes coronary artery disease stroke gallbladder disease osteoarthritis OBSA cancers
T/F. Functional capacity is the ability to engage in normal physical activity without becoming SOB or fatigued.
True.
What does METs stand for?
Metabolic equivalents of tasks
it quantifies the body’s use of oxygen
If someone answers YES to “Are you able to climb a flight of stairs without getting chest discomfort or short of breath? What is their METs?
Yes = METs >4 No = METs
What should be included in the patient summary?
age, race, gender
status of chronic medical conditions
contraindications to care/concerns with proceeding
ASA I
Health patient:
- major organ systems healthy
- BP
ASA II
Mild systemic disease:
- Healthy patients with extreme anxiety
- > 60 yo
- BP 140-159/90-94
- well-controlled DM II
- smoker
- Pregnancy
ASA III
Severe systemic disease:
- stable angina, >6 mo post-MI, exercise-induced asthma, controlled DM I
- Signs of distress with activity
- angina, SOB, fatigue
ASA IV
• Unstable angina, uncontrolled seizures, pulmonary edema due to uncompensated CHF • Signs of distress at rest • Angina, shortness of breath, fatigue • Cannot tolerate any additional stress
What are the indications for medical consultation?
‣ Concern for previously undiagnosed disease
‣ Poor historian
‣ Specific lab values or diagnostic tests that may influence
dental management
‣ Uncontrolled disease preventing elective care
What is the point of medical consultation?
to gather relevant medical data to guide dental care
physician provides the info…the dentist make the treatment decisions!
What do you ask the during medical consult?
• Brief description of how the medical concern
might influence the dental treatment
• Be specific in what assistance is requested
• Do not ask for “medical clearance”
