Special Care Flashcards
describe impairment
any loss or abnormality in an anatomical, physiological and psychological structure or function, abnormality in body part or function
describe disability
the inability or lack (due to an impairment) to carry out an activity that would be considered normal for a human being, concerned with the performance of activities
describe handicap
concerned with the societal impact and consequence of living with an impairment or disability, unable to fulfill a role (due to an impairment or disability) that would be normal for that individual
what types of disability are there
sensory - sight and hearing loss physical - spina bifida, arthritis intellectual - downs syndrome, autistic spectrum disorder mental - alzheimer's, dementia emotional - eating disorder, depression social - alcohol misuse, drug misuse
what legislation aims to protect disabled people
disability discrimination act 2004 - end discrimination against disabled, allow them to access services, purchase goods, purchase housing, renting
equality act 2010 - bring together legislation, equality for all, further protect disabled, ensure organisations implement protocols to remove barriers, to ensure disabled people have same access than those without a disability
what can dental practices implement to remove barriers to those with a disability
provide ground floor access
provide a ramp for wheelchair access
provide a handrail
ensure corridors and door frames are wide for wheelchair access
provide signposting for those with a sensory impairment - braille or hearing loop sign
designated parking close to premises
area for turning wheelchair
what can we do to help those with a sensory impairment
identify yourself speak using names let them know if anyone leaves the surgery let them know what we do before we do it listen to their needs and wishes respect them
what is the triage of legislation
adults with incapacity scotland 2000
mental health act 2003
human rights act 1998
what is the three point test in adult support and protection
an adult must pass the 3 points
unable to safeguard their own wellbeing
at risk of harm
have a co-exisiting disability or mental illness that makes them more vulnerable
name 4 types of inherited blood disorders
haemophilia a - factor VIII deficiency
haemophilia b - factor IX deficiency
von willebrand disease - factor VIII and platelet dysfunction
haemophilia c - factor XI deficiency
what is platelet dysfunction
lack of platelet aggregation, unable to stick together to form initial clot in coagulation cascade - alters the rest of coagulation
what is thrombocytopenia
lack of platelet’s in circulating blood, due to lack of synthesis from liver
what does apixaban inhibit
factor Xa
what does warfarin inhibit
vitamin K dependant clotting factors - 2, 7, 9 and 10
and protein C and S
what is the use of aspirin and clopidogrel
anti-platelets, reduce clotting
what blood tests would be useful if a patient was on anti-coagulants or haemophiliac
full blood count - RBC’s, platelets
PTT - prothrombin time, measures extrinsic pathway and medication, altering time to clot
APTT - activated partial thromboplasin time, measures intrinsic pathway, factors VIII, IX, XI, XII - useful for haemophiliacs
Time taken to clot
INR - ratio of PTT in patient, compared with normal level
what must the INR be in the range of to allow us to treat patient’s
must be lower than 4, 1.5-2.5 is safest
must be carried out 24 hours -72 hours before treatment, 72 only if patient is stable
what local anaesthetic should be used if patient has liver problems
articaine - only 5-10% metabolised in liver, the rest metabolised in plasma
what type of injection should a haemophiliac or liver patient receive
infiltration - except lingual infiltration
intraligamentary
block should be avoided - if absolutely necessary, should be delivered slowly, with aspirating, if high risk patient - should be at special care
vasoconstrictor should be used, and a short 27 gauge needle
what measures can be taken to achieve homeostasis
use an atraumatic technique
apply pressure for 20 minutes on site, using gauze and patient biting on area - dampen gauze so not to pull out clot when removing
pack in homeostatic dressing into socket - oxidised cellulose (surgicel)
suture the wound to aid homeostasis
avoid ibruprofen, NSAID higher chance of bleeding - paracetamol better
if patient on apixaban and simple extraction of 1 tooth is this a high risk procedure
no
if patient on apixaban twice a day and high risk of bleeding, what would be suggested
patient should miss dose in the morning, receive treatment early in the week and early in the day, then take evening dose as normal
what should the level of platelets be above
50x10^9
what score determines if patients require a liver transplant
UKELD score - takes into account INR, creatinine etc, a score higher than 49 suggests the patient requires a liver transplant or higher than 9% chance they’ll die in 1 year
