Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
45 Cards in this Set
- Front
- Back
|
What are 5 universal fears
|
pain, unknown, helplessness & dependency, body change and mutliation, death
|
|
|
What is the first step in managing patient fear
|
-recognition of the patient being scared
|
|
|
What three factors are usually the cause of M&M in dentistry
|
-inadequate pre-op evalution
-inadequate monitoring during the operative procedure -lack of knowledge of the pharmacology of administered drugs |
|
|
What is local anesthesia
|
elimination of sensation in one body region by topical application or regional injection
-other sense are maintained |
|
|
What is analgesia
|
elimination of pain in the conscious patient
|
|
|
What is sedation
|
-calming of a nervous/apprehensive patient through the use of drugs without inducing loss of conciousness
|
|
|
What is general anesthesia
|
-elimiantion of all sensation accompanies by loss of conciousness
|
|
|
What are Guedel's four stages of anesthesia?
**KNOW** |
-analgesia
-excitment -surgical anesthesia -respiratory paralysis |
|
|
Stage I - analgesia
How are the following affected? -response to commands -protective reflexes -cerebral cortex -respiratory and eye movements |
-pt can respond to commands
-reflexes intact -depression of cerebral cortex occurs with diminished intellect, memory, time and space perception, and response to noxious stimuli -normal |
|
|
Stage II - Excitement
How are the following affected? -pt response -protective reflexes -CNS -stimulation reaction -amnesia |
-unable to respond
-depressed reflexes (unconcious) -respiration is irregular and depressed -exaggerated reaction to stimulation -complete amnesia |
|
|
Stage III is known as what
|
-surgical anesthesia
-divided into 4 planes |
|
|
Stage IV: Medullary paralysis
-what happens |
-respiratory arrest with cessation of circulation
-aka reversible death -not intentially sought after |
|
|
List 5 non-drug sedation techniques
|
-iatrosedation
-hypnosis -acupuncture -acupressure -elecroanesthesia |
|
|
What is iatrosedation
|
-relief of anxiety through the doctor and staff's behavior
|
|
|
What are possible routes of drug administration
|
-topical, oral, rectal, transdermal, subcutaneous, intramuscular, inhalation, intravenous, intrathecal, intramedullary, intraperitoneal
|
|
|
eneteral vs. parenteral
-aborption |
E - absorbed from GI tract into GV compartment
P - absorbed from site of administration into CV system, bypassing GI tract |
|
|
Ad and dis of oral administration
|
ad - easily accepted, easily administered, safe
dis - long latent period, unreliable absorption, can't titrate, long duration, patient compliance |
|
|
When is rectal administration used in dentistry
|
-pediatric patients
|
|
|
Transdermal
ex |
-administer drugs to CV system while bypassing GI w/o injecting
-scopalamine, nitroglycerine |
|
|
Subcutaneous
-useful for what types of drugs -what cannot be given subq -absorption |
-nonvolatile, water or fat soluble drugs (insulin)
-irritating drugs --> valium -varies with blood supply to the tissue |
|
|
intramuscular:
ad - dis - intraoral site |
ad - rapid onset, more reliable absoprtion than enteral, can give uncooperative pt
dis - latent period, no titration, tissue injury -tongue and masseter |
|
|
Inhalation:
ad dis |
-ad - short latent period, titration possible, rapid recovery
dis - need pt cooperation, good nasal airway, size/cost of equipment, additional training and insurance |
|
|
Intravenous:
ad dis |
ad - short latent period, can titrate, amneisa capable, patient acceptance
dis - rapid allergic rxn, pt must cooperate, need extensive training |
|
|
-what is the most effective method of assuring predictable and adequate sedation
|
intravenous route
|
|
|
6 goals of physical evalution
|
determine:
-physical ability to tolerate stress -psychological ability to tolerate stress -treatment modifications to reduce stress -if need psychosedation -which type of sedation is most appropriate -contraindications or possible pharm interactions |
|
|
Categories to include in your physical assessment of the patient:
|
-ID, CC, HPI, PMH, P surg/hosp, MEDS, ALL, ROS, FH, SH, PE, RE, impression/assessment, plan or tx indicated
|
|
|
Identification - what to list
|
-pt's age, sex, referral source, general condition, level of cooperation
|
|
|
Chief complaint
|
-patients reason for seeking help, in their OWN WORDS
|
|
|
History of presenting illness
|
-history of pt's disorder
-includes: onset, duration, symptoms, location, radiation, success/fail of past treatments, eliciting factors, degree affecting lifestyle -also include stress, psychological factors, unreasonable goals |
|
|
past medical history
|
-systemic diseases pt has
-esp rheumatic fever, heart murmur, angina, MI, bleeding disorders, anticoagulant use, asthma, TB, hepatitis, HIV, diabetes, renal/liver disease, steroid use, seizures, implants, pregnancy, sickle cell |
|
|
past surgeries and hospitalizations
|
-procedures, dates, anesthetic complications
|
|
|
Meds
|
-all meds and dosages
|
|
|
allergies
|
-agent and reaction to it
|
|
|
review of systems
-general -HEENT |
-weight change, fever, chills, fatigues, weakness
HEENT - vision, hearing, vertigo, airway, nosebleeds, sinusitis, hoarseness, dysphagia |
|
|
ROS:
CV Respiratory |
-palpiatations, orthopnea, dyspnea, paroxysmal nocturnal dyspnea, hypertension, edema, claudication, chest pain
-dyspnea, wheezing, cough, sputum, hemoptysis, chest pain, astham |
|
|
GI/GU:
|
-appetite change, abdominal pain, dysphagia, jaundice, change in bowel habits, bloody stoole, N/V, dysuria, hematuria, polyuria, incontinence
|
|
|
ROS:
Neurological |
syncope, seizures, change in sensation, speech, paralysis, weakness
|
|
|
FH
SH PE |
FH - hx of heart disease, DM, cancer etc
SH - tobacco, alcohol, drugs PE - vitals, complete H&N exam **describe, don't diagnose |
|
|
What are the four means of physical examination
|
-inspection
-palpation -percussion -auscultation |
|
|
ASA Classes (I, II, III)
**ON EXAM** |
I - pt w/o systemic disease, normal, healthy
II - pt w/mild systemic disease (pg, smoker, mild HTN) III - pt w/severe systemic disease that limits activity, but is not incapacitating (IDDM, post MI, CVA, stable angina, CHF) |
|
|
ASA Classes (IV, V, E)
**ON EXAM** |
IV - pt w/incapacitating systemic disease that is a constant threat to life (unstable angina, MI in last 6 months, uncontrolled disease)
V - moribund pt not expected to live 24 hours E - emergency status, preceeds number |
|
|
What ASA classes do we work on
|
ASA I and II
|
|
|
What is the stress reduction protocol for a healthy anxious patient?
|
-recognize anxiety
-premed -morning appointment -minimize waiting time -psychosedation -adequate pain control -post-op pain/anxiety control |
|
|
What is the stress reduction protocol for a ASA II, III patient?
|
-recognize medical risk
-consult with MD -morning appointment -psychosedation -adequate pain control -shorter appointment -post-op pain/anxiety control |
|
|
SOAP note
|
S: subjective - what pt tells you
O: objective - what you observe A: assessment - diagnosis, progress comment P: plan - recommended treatment |
