Preoperative Health Status Evaluation (PART 2) Flashcards
1
Q
Cardiovascular Problems
A
- Ischemic Heart Disease
- Angina Pectoris, Myocardial Infarction - Cerebrovascular Accident (Stroke)
- Dysrhythmias
- Heart Abnormalities That Predispose to
Infective Endocarditis - Congestive Heart Failure (Hypertrophic Cardiomyopathy)
2
Q
Pulmonary Problems
A
- Asthma
- Chronic Obstructive Pulmonary Disease
3
Q
Renal Problems
A
- Renal Failure
2 Renal Transplantation and Transplantation
of Other Organs
- Hypertension
4
Q
Endocrine Disorders
A
- Diabetes Mellitus
- Adrenal Insufficiency
- Hyperthyroidism
- Hypothyroidism
5
Q
Hematologic Problems
A
- Hereditary Coagulopathies
- Therapeutic Anticoagulation
6
Q
Therapeutic Anticoagulation
A
- Seizure Disorders
- Ethanolism (Alcoholism)
7
Q
Narrowing of myocardial arteries is one of the most common
health problems that dentists encounter.
A
Angina Pectoris
8
Q
T/f
Angina Pectoris
This condition occurs
primarily in men older than age 20 years and is also prevalent in
postmenopausal women.
A
F
(This condition occurs
primarily in men older than age 40 years and is also prevalent in
postmenopausal women.)
9
Q
The basic disease process is a progressive narrowing or spasm (or both) of one or more of the coronary arteries. This leads to a mismatch between myocardial oxygen demand and the ability of the coronary arteries to supply oxygen- carrying blood.
A
Angina Pectoris
10
Q
is a symptom of reversible
ischemic heart disease produced when myocardial blood supply
cannot be sufficiently increased to meet the increased oxygen
requirements that result from coronary artery disease.
A
Angina
11
Q
The myocardium becomes ischemic, producing a heavy pressure or squeezing
sensation in the patient’s substernal region that can radiate into the left shoulder and arm and even into the mandibular region.
A
Angina Pectoris
12
Q
“a choking sensation.”
A
angina
13
Q
T/f
The patient should be questioned about
the events that tend to precipitate the angina; the frequency, duration, and severity of angina; and the response to medications or diminished activity. The patient’s physician can be consulted
about the patient’s cardiac status.
A
T
14
Q
If the patient’s angina arises only during moderately vigorous
exertion and responds readily to rest and oral _____ administration, and if no recent increase in severity has occurred, ambulatory oral surgery procedures are usually safe when performed
with proper precautions.
A
nitroglycerin
15
Q
T/f
In angina pectoris The increased oxygen demand during ambulatory oral surgery is primarily the result of
patient anxiety; thus an anxiety-reduction protocol should be used
A
T
16
Q
Angina pectoris
care should be taken to avoid excessive epinephrine administration by using proper injection techniques.
Some clinicians also advise giving no more than ___mL of a local anesthetic solution with a 1 : 100,000 concentration of epinephrine for a total adult dose of ___ mg in any 30-minute period.
A
4 mL
0.04 mg
17
Q
The use of _____ or other conscious sedation methods for anxiety control in patients with ischemic
heart disease should be considered
A
nitrous oxide
18
Q
resulting from an oxygen demand-supply
mismatch
A
ischemia
19
Q
usually occurs when an area of coronary artery narrowing has a clot form that blocks all or most blood flow
A
Myocardial Infarction
20
Q
The infarcted area of myocardium becomes nonfunctional and eventually necrotic and is surrounded by an area of usually reversibly ischemic myocardium that is prone to serve as a nidus for dysrhythmias.
A
Myocardial Infarction
21
Q
T/f
During the early hours and weeks after an MI, if thrombolytic treatment was tried but was unsuccessful, treatment would consist of limiting myocardial work requirements, increasing myocardial
oxygen supply, and suppressing the production of dysrhythmias
by irritable foci in ischemic tissue or by surgical bypass of the
blocked vessels to promote revascularization.
A
T
22
Q
T/f
Myocardial Infarction
it is recommended that elective major surgical
procedures be deferred until at least 3 months after an infarction.
A
F
(it is recommended that elective major surgical
procedures be deferred until at least 6 months after an infarction.)
23
Q
Patients who have had an MI typically take ____ or another
antiplatelet or anticoagulant to decrease coronary thrombogenesis;
A
aspirin
24
Q
T/F
In MI, Prophylactic nitroglycerin should be administered only if directed by the patient’s primary care physician,
but nitroglycerin should be readily available
A
T
25
In MI, Local anesthetics
containing epinephrine are safe to use if given in proper amounts
using an _____ technique.
aspiration
26
T/f
Before major elective surgery is performed, 3 months are allowed to elapse. If
major surgery is necessary earlier than 3 months after the coronary artery bypass grafting (CABG) the patient’s physician should be consulted.
Patients who have had CABG usually have a history of angina, MI, or both and therefore
should be managed as previously described.
T
27
T/f
Patients who have had a cerebrovascular accident (CVA) are always susceptible to further neurovascular accident
T
28
typically a result of an
embolus from a history of atrial fibrillation, a thrombus due to a
hypercoagulable state, or stenotic vessels.
Cerebrovascular Accident (Stroke)
29
Cerebrovascular Accident (Stroke)
In the case of a patient
having an embolic or thrombotic stroke, the patient is likely taking
an _____ as opposed to an ischemic stroke secondary to
stenotic vessels, in which case the patient would be taking an
______ medication
anticoagulant
antiplatelet
30
T/f
Cerebrovascular Accident (Stroke)
The patient should be treated by a nonpharmacologic anxiety-
reduction protocol and have vital signs carefully monitored during
surgery. If pharmacologic sedation is necessary, low concentrations
of nitrous oxide can be used.
T
31
manifest as uncoordinated contractions of
the chambers of the heart, secondary to the conduction deficits
initiated by either problems with impulse initiation or impulse
propagation
Dysrhythmias
32
is the most common dysrhythmia to occur in patients older than 50 years Because patients who are prone to or who have cardiac
dysrhythmias may have a history of ischemic heart disease
Atrial fibrillation
33
T/f
Pacemakers pose no contra-
indications to oral surgery, and no evidence exists that shows the need for antibiotic prophylaxis in patients with pacemakers.
T
34
Electrical equipment, such as electrocautery and microwaves, should not be used near the patient who has ?
Dysrhythmias
35
Heart Abnormalities That Predispose to
Infective Endocarditis
The INTERNAL cardiac surface, or _______, can be predisposed
to infection when abnormalities of its surface allow pathologic
bacteria to attach and multiply.
endocardium
36
occurs when a diseased myocardium is unable to
deliver the cardiac output demanded by the body or when excessive
demands are placed on a normal myocardium
Congestive Heart Failure (Hypertrophic Cardiomyopathy)
37
Frank Starling mechanism.
Congestive Heart Failure (Hypertrophic Cardiomyopathy)
38
Patients who have Congestive Heart Failure (Hypertrophic Cardiomyopathy) must Avoid using the _____ position.
supine
39
a respiratory disorder
that exhibits shortness of breath when the patient is supine, usually occurs as a result of the redistribution of blood
pooled in the lower extremity when a patient assumes the supine position (as when sleeping)
A. Orthopnea
B. Paroxysmal nocturnal dyspnea
C. Lower extremity edema
Orthopnea
40
The patient has respiratory difficulty 1 or 2
hours after lying down. The disorder occurs when pooled blood and interstitial fluid reabsorbed into the vasculature from the legs
are redistributed centrally, overwhelming the heart and producing
pulmonary edema.
A. Orthopnea
B. Paroxysmal nocturnal dyspnea
C. Lower extremity edema
B
41
which usually appears as a swelling of
the foot, the ankle, or both, is caused by an increase in interstitial
fluid.
A. Orthopnea
B. Paroxysmal nocturnal dyspnea
C. Lower extremity edema
C
42
T/f
Symptoms of Congestive Heart Failure include orthopnea, paroxysmal nocturnal
dyspnea, and ankle edema
T
43
The
edema is detected by pressing a finger into the swollen area for a
few seconds; if an indentation in the soft tissue is left after the finger
is removed, ____ edema is deemed to be present.
pedal
44
Patients with Congestive Heart Failure who are under a physician’s care are usually
following 1.____-sodium diets to reduce fluid retention and are
receiving diuretics to reduce intravascular volume; cardiac glycosides such as 2._____ to improve cardiac efficiency; and sometimes
afterload-reducing drugs such as nitrates, β-adrenergic antagonists,
or calcium channel antagonists to control the amount of work the
heart is required to do.
1. low
2. digoxin
45
T/f
Patients with Congestive Heart Failure (CHF) that is well compensated through dietary
and drug therapy can safely undergo ambulatory oral surgery.
T
46
involves the
episodic narrowing of inflamed small airways, which produces wheezing and dyspnea as a result of chemical, infectious, immunologic, or
emotional stimulation or a combination of these.
True asthma
47
These patients should be ques-
tioned specifically about ________ allergy because of the relatively high
frequency of generalized nonsteroidal antiinflammatory drug (NSAID)
allergy in those with asthma, chronic rhinitis, or sinusitis and the
presence of nasal polyps, known as Samter’s triad.
aspirin
48
Patients with severe asthma require xanthine-derived bronchodilators, such as ____, as well as inhaled corticosteroids or
short courses of high-dose systemic _____.
_______may
be used to protect against acute attacks, but it is ineffective once
bronchospasm occurs
theophylline
corticosteroids
Cromolyn
49
Inhaled β-adrenergic
agonists, such as ____, are typically prescribed for episodes of
acute bronchospasm to promote immediate bronchodilation.
albuterol
50
T/f
Asthma
Elective oral surgery should not be deferred if a respiratory tract infection or wheezing is present.
F
Elective oral surgery should BE deferred if a respiratory tract infection or wheezing is present.
51
T/f
The use of
NSAIDs should be avoided because they often precipitate asthma
attacks in susceptible individuals
T
52
Pulmonary diseases are usually grouped together under the headings of either obstructive (chronic obstructive pulmonary disease [COPD]) or ____ pulmonary disease.
restrictive
53
In the past, the terms
__________ and bronchitis were used to describe clinical manifesta-
tions of COPD, but COPD has been recognized to be a spectrum
of pathologic pulmonary problems.
emphysema
54
It is usually caused by long-term
exposure to pulmonary irritants such as tobacco smoke that cause metaplasia of pulmonary airway tissue. Airways are inflamed and
disrupted, lose their elastic properties, and become obstructed
because of mucosal edema, excessive secretions, and bronchospasm,
producing the clinical manifestations of ______
Chronic Obstructive Pulmonary Disease
55
T/f
Patients with
COPD frequently become dyspneic during mild to moderate
exertion.
T
56
T/f
Chronic Obstructive Pulmonary Disease
Patients may develop associated
pulmonary hypertension and eventual right-sided heart failure.
T
57
T/f
Bronchodilators such as theophylline, inhaled beta agonists, or
inhaled anticholinergics are usually prescribed for patients with
significant COPD
T
58
T/f
Sedatives, hypnotics, and narcotics that depress respiration should be avoided. Patients may need to be kept in an upright sitting position in the dental chair to enable them to better handle their commonly copious pulmonary secretions.
Finally, supplemental oxygen greater than their usual rate should not be administered to patients with severe
COPD during surgery unless the physician advises it.
T
59
T/f
Schedule afternoon appointments to allow for clearance of secretions for those who have Chronic Obstructive Pulmonary Disease
T
60
Patients with chronic renal failure require _____ renal dialysis.
periodic
61
Renal Failure
Chronic dialysis treatment typically requires the presence of an _____ shunt, which is a large, surgically created junction
between an artery and a vein.
The shunt allows easy vascular access and heparin administration, permitting blood to move through
the dialysis equipment without clotting.
arteriovenous
62
T/f
In renal failure,
The dentist should never
use the shunt for venous access except in a life-threatening emergency.
T
63
T/f
The blood pressure cuff should never be used on the arm
where an arteriovenous shunt is present.
T
64
T/f
Renal Failure
Elective oral surgery is best undertaken the day after a dialysis treatment has been performed, This allows the heparin used during
dialysis to disappear and the patient to be in the best physiologic
status with respect to intravascular volume and metabolic
byproducts.
T
65
T/f
Renal Failure
Relatively nephrotoxic drugs such as NSAIDs should
also be avoided in patients with seriously compromised kidneys.
T
66
T /f
Because of the higher incidence of hepatitis in patients undergo-
ing renal dialysis, dentists should take the necessary precautions.
The altered appearance of bone caused by secondary hyperpara-
thyroidism in patients with renal failure should also be noted.
Radiolucencies that occur as a result of metabolic process should not be mistaken for dental disease
T
67
________, an immunosuppressive drug administered after
organ transplantation, may cause gingival hyperplasia.
Cyclosporine A
68
What drugs to avoid in renal failure such as nonsteroidal antiinflammatory
drugs?
nephrotoxic drugs
69
T/f
Patients who have received renal transplants occasionally have
problems with severe hypertension. Vital signs should be obtained immediately before oral surgery is performed in these patient
T
70
Chronically elevated blood pressure for which the cause is unknown is called ______ hypertension.
essential
71
T/f
Management of Patient With Renal Transplant
Consider use of prophylactic antibiotics, particularly in patients taking
immunosuppressive agents
T
72
Mild to Moderate Hypertension
Systolic > ______ mm Hg;
Diastolic > _______ mm Hg
(Systolic >140 mm Hg;
Diastolic >90 mm Hg)
73
Severe Hypertension
(Systolic > _____ mm Hg;
Diastolic > _____ mm Hg)
(Systolic >200 mm Hg;
Diastolic >110 mm Hg)
74
In Management of Patient With
Hypertension, what solutions to avoid?
Avoid administration of sodium-containing intravenous solutions.
75
T(f
The patient with severe liver damage resulting from infectious
disease, ethanol abuse, or vascular or biliary congestion requires
special consideration before oral surgery is performed.
T
76
What coagulation factors that may be depressed in severe liver disease?
protein C and S
77
Hepatic Disorders
It is useful in surgery in patients with more severe liver disease who are undergoing
surgery with the potential for heavy blood loss
international normalized ratio (INR; prothrombin
time [PT]) or partial thromboplastin time
78
Portal hypertension
caused by liver disease may also cause ______ and the
sequestering of platelets, causing a relative thrombocytopenia.
hypersplenism
79
Patients with severe liver dysfunction may require
hospitalization for dental surgery because their decreased ability
to metabolize the nitrogen in swallowed blood may cause _______.
Finally, unless documented otherwise, a patient with liver
disease of unknown origin should be presumed to carry the hepatitis virus
encephalopathy
80
T/f
Management of Patient With Hepatic Insufficiency
Avoid drugs requiring hepatic metabolism or excretion; if their use is necessary, modify the dose.
T
81
caused by an underproduction of insulin, a resistance of insulin receptors in end organs to the effects of insulin, or both.
Diabetes Mellitus
82
Type _____ diabetes usually begins during childhood or adolescence. The major
problem in this form of diabetes is an underproduction of insulin,
which results in the inability of the patient to use glucose properly
Type 1
83
The serum glucose rises above the level at which renal reabsorption of all glucose can take place, causing ______. The osmotic effect of the glucose solute results in polyuria, stimulating thirst and
causing polydipsia (frequent consumption of liquids) in the patient.
glycosuria
84
Diabetes Mellitus
carbohydrate metabolism is altered, leading to fat breakdown and the production of ketone bodies. This can lead to
_______ and its attendant tachypnea with ______ and
eventually coma.
ketoacidosis
somnolence
85
T/f
Persons with type 1 diabetes must strike a balance with regard to caloric intake, exercise, and insulin dose. Any decrease in regular caloric intake or increase in activity, metabolic rate, or insulin dose
can lead to hypoglycemia, and vice versa.
T
86
T/f
Patients with type 2 diabetes usually produce insulin but in
insufficient amounts because of decreased insulin activity, insulin
receptor resistance, or both
T
87
T/f
Insulin is
required only if the patient is unable to maintain acceptable serum
glucose levels using the usual therapeutic measures.
T
88
T/f
Severe
hyperglycemia in patients with type 2 diabetes rarely produces
ketoacidosis but leads to a ____ state with altered levels
of consciousness.
hyperosmolar
89
T/f
when an
oral surgical procedure is planned, it is best to err on the side of
hyperglycemia rather than hypoglycemia; that is, it is best to avoid
an excessive insulin dose and to give a glucose source.
T
90
This device may help determine the need to treat the patient
for mild hyperglycemia.
electronic glucometer
91
T/f
If
IV sedation is not being used, the patient should be asked to eat
a normal meal and take the usual morning amount of regular
insulin and a half dose of neutral protamine Hagedorn insulin
T
92
Insulin-Dependent (Type 1) Diabetes
If the patient must not eat or drink before oral surgery and will have
difficulty eating after surgery, instruct him or her not to take the usual
dose of regular or NPH insulin; start intravenous administration of a 5% dextrose in water drip at ____ mL/h.
If allowed, have the patient eat a normal breakfast before surgery and take the usual dose of regular insulin but only half the dose of NPH insulin
150
93
T/f
Non–Insulin-Dependent (Type 2) Diabetes
If the patient must not eat or drink before oral surgery and will have difficulty eating after surgery, instruct him or her to skip any oral hypoglycemic medications that day.
If the patient can eat before and after surgery, instruct him or her to eat a normal breakfast and to take the usual dose of hypoglycemic agent.
T
94
T/f
Diseases of the adrenal cortex may cause adrenal insufficiency.
Symptoms of primary adrenal insufficiency include weakness, weight
loss, fatigue, and hyperpigmentation of skin and mucous mem-
branes.
T
95
T/f
the most common cause of adrenal insufficiency
is chronic therapeutic corticosteroid administration (secondary
adrenal insufficiency).
T
96
T/f
Adrenal Insufficiency
Often, patients who regularly take corticosteroids have moon facies (moon-shaped face), buffalo (back) humps, and thin, translucent skin
T
97
Hyperthyroidism
The thyroid gland problem of primary significance in oral surgery is ____ because it is the only thyroid gland disease in
which an acute crisis can occur
thyrotoxicosis
98
_____ is the result of an
excess of circulating triiodothyronine and thyroxine, which is caused most frequently by Graves disease, a multinodular goiter, or a thyroid adenoma
Thyrotoxicosis
99
T/f
Patients frequently, although not invariably, have exophthalmos (a bulging forward of the globes caused by increases of fat in the orbit) in hyperthyroidism
T
100
T/f
If hyperthyroidism is not recognized early, the patient can suffer heart failure.
T
101
Thyrotoxic patients are usually treated with agents that block
thyroid hormone synthesis and release, with a _______, or
with both. However, patients left untreated or incompletely treated
can have a thyrotoxic crisis caused by the sudden release of large
quantities of preformed thyroid hormone
thyroidectomy
102
T/f
Atropine and excessive amounts of epinephrine-containing solutions should
be avoided if a patient is thought to have incompletely treated
hyperthyroidism
T
103
T(f
The dentist can play a role in the initial recognition of hypothyroidism. Early symptoms of hypothyroidism include fatigue, constipation, weight gain, hoarseness, headaches, arthralgia, menstrual
disturbances, edema, dry skin, and brittle hair and fingernails. If
T
104
T/f
Patients with inherited bleeding disorders are usually aware of their problems, allowing the clinician to take the necessary precautions
before any surgical procedure.
T
105
Hereditary Coagulopathies
____ is used to test the extrinsic pathway factors, whereas a partial thromboplastin time is used to detect intrinsic pathway factors.
PT
106
Hereditary Coagulopathies
Specific factor deficiencies such as hemophilia A, B, or C or von Willebrand disease are usually managed by the perioperative administration of coagulation factor concentrates or ______ and by the use of an antifibrinolytic agent such as ______ acid (Amicar)
desmopressin
aminocaproic
107
T/f
Hematologic Problems
(Hereditary Coagulopathies)
patients who receive factor
replacement, although a rare occurrence, are at risk of contracting an infectious blood-borne disease. Universal precautions should
be employed, as with all patients, to reduce the risk of transmission
to all staff and health care providers.
T
108
T/f
Management of Patient With a
Coagulopathy
Augment clotting during surgery with the use of topical coagulation- promoting substances, sutures, and well-placed pressure packs.
T
109
T/f
Quantitative platelet deficiency may be a cyclic problem, and the hematologist
can help determine the proper timing of elective surgery
T
110
T/f
Hereditary Coagulopathies
• Above 50,000/mm³ → Usually safe for surgery.
• Between 20,000 and 50,000/mm³ → Doctors might wait to give extra platelets unless bleeding starts after surgery.
• Below 20,000/mm³ → Surgery is usually delayed, or the patient gets a platelet transfusion before surgery.
T
111
Hereditary Coagulopathies
However, platelet transfusions may be given to patients
with counts higher than 50,000/mm3 if a concurrent qualitative
platelet problem exists. Qualitative platelet disorders are typically due to the administration of antiplatelet medications (such as
aspirin or clopidogrel) but can be related to liver or splenic dysfunction as well
T
112
T/f
Hereditary Coagulopathies
Local anesthesia should be given by field blocks rather than by local infiltration to lessen the likelihood of damaging
larger blood vessels, which can lead to prolonged postinjection
bleeding and hematoma formation
F
(Local anesthesia should be given by LOCAL INFILTRATION
rather than by FIELD BLOCKS to lessen the likelihood of damaging larger blood vessels, which can lead to prolonged postinjection
bleeding and hematoma formation
113
T/f
Therapeutic anticoagulation is administered to patients with
1. People with implanted heart valves
2. Conditions with atrial fibrillation or past heart attack
3. People with history of blood clots such as recurrent pulmonary emboli or deep vein thromboses
4. or with a need for extracorporeal blood flow such as for hemodialysis
T
114
T/f
Aspirin has antiplatelet properties for secondary effect.
T
115
T/f
Drugs such as low-dose aspirin
do not usually need to be withdrawn to allow routine surgery
T
116
Patients taking heparin usually can have their surgery delayed until the circulating heparin is inactive ( ____hours if IV heparin is given, _____hours if given subcutaneously). ________, which reverses the effects of heparin, can also be used if emergency oral
6
24
Protamine sulfate
117
Warfarin is measured with a test called ____ which shows how well the blood clots.
INR (International Normalized Ratio)
118
therapeutic range for most conditions requiring warfarin administration is typically an INR of ___ to ___ and, in some cases, may be increased to 3.5.
Patients should stop taking warfarin ____ or ___ days
before the planned surgery if cessation of the medication is necessary
because of expected excessive surgical blood loss.
2 to 3
119
Coumadin
Warfarin
120
Newer blood thiners called ____ has made anticoagulant therapy more attainable for a greater
population of patients. These medications do not require routine laboratory monitoring because INR values are ineffective at
determining the efficacy of the drug. Typically these medications
have a shorter half-life if cessation is necessary; however, in most cases, cessation of these medications before routine oral surgical
procedures is not required.
direct and indirect Xa inhibitors
121
T/f
Seizures can
result from ethanol withdrawal, high fever, electrolyte imbalance,
hypoglycemia, or traumatic brain damage, or they can be idiopathic.
T
122
T/f
The
primary problems ethanol abusers have in relation to dental care
are hepatic insufficiency, ethanol and medication interaction,
electrolyte abnormalities, and withdrawal phenomena.
T
123
T/f
Ethanol abusers may undergo withdrawal phenomenon in the
perioperative period if they have acutely lowered their daily ethanol
intake before seeking dental care. This phenomenon may exhibit
mild agitation and severe hypertension, which can progress to
tremors, seizures, diaphoresis, or, rarely, delirium tremens with
hallucinations, considerable agitation, and circulatory collapse
T
124
T/f
Patients requiring oral surgery who exhibit signs of severe
alcoholic liver disease or signs of ethanol withdrawal should be
treated in the hospital setting. Liver function tests, a coagulation
profile, and medical consultation before surgery are desirable
T
125
The primary concern
when providing care for a pregnant patient is the prevention ofngenetic damage to the fetus .
Two areas of oral surgical management with the potential for creating fetal damage are
(1) ________
and (2) drug administration.
dental imaging
126
For purposes of oral surgery, the
following drugs are believed least likely to harm a fetus when used in moderate amounts:
lidocaine, bupivacaine, acetaminophen, ______,
penicillin, and cephalosporins.
codeine
127
The use of NSAIDs, such as aspirin and ____, should not be given during pregnancy, especially late in the third trimester because of its antiplatelet properties and
the potential for causing premature closure of the ductus arteriosus.
ibuprofen
128
All sedative drugs are best avoided in pregnant patients.
_____ should not be used during the first trimester but, if necessary,
may be considered in the second and third trimesters as long as
it is delivered with at least 50% oxygen and in consultation with
the patient’s obstetrician
Nitrous oxide
129
T/f
Management of Patient Who Is Pregnant
Avoid dental radiographs unless information about tooth roots or bone is
necessary for proper dental care. If radiographs must be taken, use proper
lead shielding.
T
130
Management of Patient Who Is Pregnant
Avoid keeping the patient in the supine position for long periods to prevent ______compression.
The patient may need to be in a more upright position or have her torso turned slightly to the left side during
surgery.
vena caval
131
T/f
Frequent breaks to allow the patient to void are commonly
necessary late in pregnancy because of fetal pressure on the urinary bladder.
T
132
Management of Patients During
and After Pregnancy
in general, all the drugs common in oral surgical care are safe to use in moderate doses; the exceptions are corticosteroids, aminoglycosides, and tetracyclines, which should
not be used.
T
133
Potentially Harmful Clinical
Effects in Breastfeeding Infants
Ampicillin
Aspirin
Atropine
Barbiturates
Chloral hydrate
Corticosteroids
Diazepam
Metronidazole
Penicillin
Tetracyclines
134
No Apparent Clinical Effects
in Breastfeeding Infants
Acetaminophen
Antihistamines
Cephalexin
Codeine
Erythromycin
Fluoride
Lidocaine
Meperidine
Oxacillin
Pentazocine
