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32 Cards in this Set
- Front
- Back
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1. Define the following term:
Hyperventilation - |
- excessive intake of oxygen and exhalation of carbon dioxide.
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Define the term:
Vasodepressor syncope - |
- fainting.
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Explain why oxygen is contraindicated when managing hyperventilation.
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● During hyperventilation the client is inspiring excessive oxygen, and providing additional oxygen would compromise the situation further.
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Describe the significance of the client's chief complaint.
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● The client's chief complaint reflects the client's primary reason for seeking oral health care and their oral health concerns, which may be different from the concerns of the clinician.
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Identify four strategies for reducing a client's stress during oral health treatment.
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● Strategies for reducing stress include:
○ discussing topics to occupy the client's mind ○ ensuring adequate pain control ○ considering the use of nitrous oxide conscious sedation ○ prescribing an antianxiety medication. |
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List the signs and symptoms of pre-syncope, syncope, and post-syncope.
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● Signs and symptoms of pre-syncope include: facial paleness, perspiration or feelings of warmth, nausea, and increased pulse rate.
● Signs and symptoms of syncope include: yawning, dilated pupils, feeling cold, dizziness, and hypotension. ● Signs and symptoms of Post-syncope include: facial pallor, nausea, weakness, and disorientation. |
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6. List the patient selection criteria for dental radiographs.
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● A clinical examination should precede the decision to take dental X-rays.
○ Exposures should be limited to the fewest number needed for diagnosis. ○ Factors to consider: age, dental developmental stage (primary dentition, transitional dentition, adolescent with permanent dentition, dentate adult, partially edentulous adult, or edentulous adult) ○ Clinical circumstances (symptomatic or asymptomatic) ○ New patient or continuing care (recall) patient ○ Risk factors for caries or dental disease |
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Explain the significance of the medical history questions "Are you now under the care of a physician?" and "Have you had a recent hospitalization?"
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● If a client is under the care of a physician, consider whether there is a risk for medical problems arising during treatment, whether there might be drug side effects relevant to a medical emergency from those medications being taken, and the potential] for cross contamination from the medical condition being treated.
● A recent history of hospitalization must be investigated for the same reasons. |
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Define the following term:
Thrombocytopenia - |
- a decrease in the number of platelets in circulating blood
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Define the following term:
Leukopenia - |
- a reduction in the number of leukocytes in the blood with the count being 5,000 or less
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Define the following term:
Agranulocytosis - |
a dramatic decrease in the production of granulocytes
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Define the following term:
Neutropenia - |
- a diminished number of neutrophils in the blood
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List the major types of side effects that can represent a risk for medical emergencies.
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● The major side effects that can represent a risk for medical emergency include:
○ postural hypotension ○ bleeding ○ hypertension/tachycardia/ arrhythmia ○ nausea/vomiting/gastrointestinal (GI) reflux ○ and leukopenia/blood dyscrasias. |
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Identify examples of supplements and herbal medications that can cause adverse effects during oral health care.
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● Adverse effects can occur from herbal or dietary supplements such as:
○ Niacin can cause postural hypotension ○ Kava, valerian, and St. John's wort can cause interference with sedative drugs ○ Ephedrine can cause hypertension and tachycardia ○ Ginkgo, ginseng, and garlic supplements have been known to cause increased bleeding. |
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List five criteria used to investigate prescription and nonprescription medications.
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● Criteria used to investigate medications include:
○ the action of the drug ○ the dose ○ side effects relevant to oral changes or to treatment modification ○ interactions between the client's drug and drugs used during treatment ○ and dental treatment considerations for both the medical condition or disease the drug is being used for and the relevant side effects of the drug. |
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Describe how vital signs can be used to determine side effects of medications.
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● Vital signs can identify hypotensive and hypertensive states and abnormal values of pulse rhythm that may predispose the client to a medical emergency during oral health care.
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Case Study A:
Harry Carpenter, a 13-year-old client, presents to the dental office for a prophylaxis. The client grips the arms of the dental chair tightly during the oral examination and while radiographs are performed. As the dental hygienist begins the prophylaxis, she notices that John's breathing is rapid and shallow. His pulse is 80 bpm, respiration is 40 breaths/min, and blood pressure is 100/60 mm Hg, sitting, right arm. What is the most likely diagnosis for the rapid breathing of the client? |
● Hyperventilation
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Case Study A:
Harry Carpenter, a 13-year-old client, presents to the dental office for a prophylaxis. The client grips the arms of the dental chair tightly during the oral examination and while radiographs are performed. As the dental hygienist begins the prophylaxis, she notices that John's breathing is rapid and shallow. His pulse is 80 bpm, respiration is 40 breaths/min, and blood pressure is 100/60 mm Hg, sitting, right arm. If the rapid breathing is left untreated, what condition may result next? |
● Syncope
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Case Study A:
Harry Carpenter, a 13-year-old client, presents to the dental office for a prophylaxis. The client grips the arms of the dental chair tightly during the oral examination and while radiographs are performed. As the dental hygienist begins the prophylaxis, she notices that John's breathing is rapid and shallow. His pulse is 80 bpm, respiration is 40 breaths/min, and blood pressure is 100/60 mm Hg, sitting, right arm. List two techniques for treating this client's condition. |
● Cup hands over mouth, or have client breathe into a paper bag.
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Case Study A:
Harry Carpenter, a 13-year-old client, presents to the dental office for a prophylaxis. The client grips the arms of the dental chair tightly during the oral examination and while radiographs are performed. As the dental hygienist begins the prophylaxis, she notices that John's breathing is rapid and shallow. His pulse is 80 bpm, respiration is 40 breaths/min, and blood pressure is 100/60 mm Hg, sitting, right arm. Describe what information should be placed in the dental record regarding this emergency situation. |
● Record:
○ the incident ○ vital signs ○ treatment sequence and response ○how long before normal breathing was restored ○and the client's decision to continue or postpone treatment |
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Case Study B: Bradford Johnson, a 35-year-old client, presents for periodontal treatment. Initial vital signs include pulse 76 bpm, respiration 22 breaths/min, and blood pressure 120/80 mm Hg, right arm, sitting. A graft procedure is planned for the mandibular facial incisor area. As the dentist begins to apply a topical anesthetic in preparation for administration of local anesthesia, he notices that the client has become pale, is perspiring, and is breathing rapidly. The dentist inquires whether the client is anxious about receiving an injection, and the client responds in the negative. The dentist proceeds to pick up the needle, turns to the client, and notices that the client has lost consciousness.
What is the name for the loss of consciousness the client experienced? |
● Vasodepressor syncope |
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Case Study B:
Bradford Johnson, a 35-year-old client, presents for periodontal treatment. Initial vital signs include pulse 76 bpm, respiration 22 breaths/min, and blood pressure 120/80 mm Hg, right arm, sitting. A graft procedure is planned for the mandibular facial incisor area. As the dentist begins to apply a topical anesthetic in preparation for administration of local anesthesia, he notices that the client has become pale, is perspiring, and is breathing rapidly. The dentist inquires whether the client is anxious about receiving an injection, and the client responds in the negative. The dentist proceeds to pick up the needle, turns to the client, and notices that the client has lost consciousness. What is the most likely cause of this loss of consciousness? |
● Anxiety: fear of injection
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Case Study B:
Bradford Johnson, a 35-year-old client, presents for periodontal treatment. Initial vital signs include pulse 76 bpm, respiration 22 breaths/min, and blood pressure 120/80 mm Hg, right arm, sitting. A graft procedure is planned for the mandibular facial incisor area. As the dentist begins to apply a topical anesthetic in preparation for administration of local anesthesia, he notices that the client has become pale, is perspiring, and is breathing rapidly. The dentist inquires whether the client is anxious about receiving an injection, and the client responds in the negative. The dentist proceeds to pick up the needle, turns to the client, and notices that the client has lost consciousness. What is the physiologic cause of this loss of consciousness? |
● Lack of blood flow to the brain or cerebral ischemia as a result of hypotension
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Case Study B:
Bradford Johnson, a 35-year-old client, presents for periodontal treatment. Initial vital signs include pulse 76 bpm, respiration 22 breaths/min, and blood pressure 120/80 mm Hg, right arm, sitting. A graft procedure is planned for the mandibular facial incisor area. As the dentist begins to apply a topical anesthetic in preparation for administration of local anesthesia, he notices that the client has become pale, is perspiring, and is breathing rapidly. The dentist inquires whether the client is anxious about receiving an injection, and the client responds in the negative. The dentist proceeds to pick up the needle, turns to the client, and notices that the client has lost consciousness. What emergency treatment would you provide given this situation? |
● Place the client in the supine positon with the feet elevated
● monitor vital signs ● record incident in dental chart ● determine with client whether treatment should continue or be postponed after recovery ● and observe client for signs of recurrent syncope should treatment continue. |
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Case Study B:
Bradford Johnson, a 35-year-old client, presents for periodontal treatment. Initial vital signs include pulse 76 bpm, respiration 22 breaths/min, and blood pressure 120/80 mm Hg, right arm, sitting. A graft procedure is planned for the mandibular facial incisor area. As the dentist begins to apply a topical anesthetic in preparation for administration of local anesthesia, he notices that the client has become pale, is perspiring, and is breathing rapidly. The dentist inquires whether the client is anxious about receiving an injection, and the client responds in the negative. The dentist proceeds to pick up the needle, turns to the client, and notices that the client has lost consciousness. Why is the Trendelenburg position contraindicated for treatment of this condition? |
● The Trendelenburg position has been shown to restrict respiration and diminish the effects of breathing. It is more appropriately used to manage airway obstruction.
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Case Study C:
Mr. Garcia, a 59-year-old client, presents to the office for a routine prophylaxis. On review of the medical history, the client reports that he is 3 weeks after placement of two stents in his heart as a result of a myocardial infarction . The client states that he is participating in a cardiovascular rehabilitation program and takes Plavix, antihypertensives, and anticholesterol medications daily. In addition, Mr. Garcia notes that his recent health experience has caused him to start taking multivitamins, one "baby" aspirin, and ginseng to improve his health. The client denies any other medical problems, reports he can now return to running and physical activities, and denies any oral health complaints. His vital signs are pulse 70 bpm, respiration 18 breaths/min, and blood pressure 146/86 mm Hg, right arm. Is it safe to perform a prophylaxis at this time? |
● Elective oral health care should be postponed for 1 month after the myocardial infarction and the functional capacity determined to meet the 4 MET level, before elective care is provided. A medical clearance with a cardiologist is advised.
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Case Study C:
Mr. Garcia, a 59-year-old client, presents to the office for a routine prophylaxis. On review of the medical history, the client reports that he is 3 weeks after placement of two stents in his heart as a result of a myocardial infarction . The client states that he is participating in a cardiovascular rehabilitation program and takes Plavix, antihypertensives, and anticholesterol medications daily. In addition, Mr. Garcia notes that his recent health experience has caused him to start taking multivitamins, one "baby" aspirin, and ginseng to improve his health. The client denies any other medical problems, reports he can now return to running and physical activities, and denies any oral health complaints. His vital signs are pulse 70 bpm, respiration 18 breaths/min, and blood pressure 146/86 mm Hg, right arm. Is there a need to obtain laboratory values prior to treatment? |
● The clinician should request the most recent prothrombin time or international normalized ratio data prior to providing oral health care.
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Case Study C:
Mr. Garcia, a 59-year-old client, presents to the office for a routine prophylaxis. On review of the medical history, the client reports that he is 3 weeks after placement of two stents in his heart as a result of a myocardial infarction . The client states that he is participating in a cardiovascular rehabilitation program and takes Plavix, antihypertensives, and anticholesterol medications daily. In addition, Mr. Garcia notes that his recent health experience has caused him to start taking multivitamins, one "baby" aspirin, and ginseng to improve his health. The client denies any other medical problems, reports he can now return to running and physical activities, and denies any oral health complaints. His vital signs are pulse 70 bpm, respiration 18 breaths/min, and blood pressure 146/86 mm Hg, right arm. After consulting a dental drug reference, what adverse effects, if any, would you expect to find with the medications the client is using? What about those being used to self-treat? |
● The combination of Plavix, aspirin, and ginseng may result in increased bleeding.
● Antihypertensive medications frequently have postural hypotension as a potential side effect. |
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Case Study C:
Mr. Garcia, a 59-year-old client, presents to the office for a routine prophylaxis. On review of the medical history, the client reports that he is 3 weeks after placement of two stents in his heart as a result of a myocardial infarction . The client states that he is participating in a cardiovascular rehabilitation program and takes Plavix, antihypertensives, and anticholesterol medications daily. In addition, Mr. Garcia notes that his recent health experience has caused him to start taking multivitamins, one "baby" aspirin, and ginseng to improve his health. The client denies any other medical problems, reports he can now return to running and physical activities, and denies any oral health complaints. His vital signs are pulse 70 bpm, respiration 18 breaths/min, and blood pressure 146/86 mm Hg, right arm. On completion of treatment, the client is seated upright and asked to remain in that position for several minutes. What is the rationale for this recommendation? |
● Allowing an upright, seated position for a few minutes before dismissing the client provides time for vasoconstriction of blood vessels and prevents postural hypotension from occurring.
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Case Study B:
Mrs. Berkowski, a 45-year-old client, presents for restorative dental care. She reports that she recently underwent an endoscopy procedure and was diagnosed with erosive esophagitis and a hiatal hernia. Nexium 40 mg daily for 4 weeks was prescribed. The client notes that she has had some improvement with this medication, but still experiences episodes of nausea and reflux, particularly in the morning and at bedtime. To help relieve these symptoms, the client states that she sleeps with the upper portion of the bed elevated and drinks ginger tea as needed. This client's vital signs are pulse 72 bpm, respiration 15 breaths/min, and blood pressure 118/70 mm Hg, right arm. What chair position would most likely provide comfort to the client? |
● Given that the client sleeps with the bed elevated, she would most likely be comfortable in a semi-upright or semi-supine position.
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Case Study B:
Mrs. Berkowski, a 45-year-old client, presents for restorative dental care. She reports that she recently underwent an endoscopy procedure and was diagnosed with erosive esophagitis and a hiatal hernia. Nexium 40 mg daily for 4 weeks was prescribed. The client notes that she has had some improvement with this medication, but still experiences episodes of nausea and reflux, particularly in the morning and at bedtime. To help relieve these symptoms, the client states that she sleeps with the upper portion of the bed elevated and drinks ginger tea as needed. This client's vital signs are pulse 72 bpm, respiration 15 breaths/min, and blood pressure 118/70 mm Hg, right arm. After consulting a dental drug reference, what adverse effects, if any, would you expect to find with the medication the client is taking? |
● Nausea, GI discomfort, and gas are the most common GI side effects. Dry mouth is the most common oral side effect.
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Case Study B:
Mrs. Berkowski, a 45-year-old client, presents for restorative dental care. She reports that she recently underwent an endoscopy procedure and was diagnosed with erosive esophagitis and a hiatal hernia. Nexium 40 mg daily for 4 weeks was prescribed. The client notes that she has had some improvement with this medication, but still experiences episodes of nausea and reflux, particularly in the morning and at bedtime. To help relieve these symptoms, the client states that she sleeps with the upper portion of the bed elevated and drinks ginger tea as needed. This client's vital signs are pulse 72 bpm, respiration 15 breaths/min, and blood pressure 118/70 mm Hg, right arm. If on examination you note that the client has evidence of moderate to severe gingivitis with minimal plaque present and had a healthy clinical presentation at the previous appointment, what adverse drug reaction would you suspect? |
● The client may be presenting with leukopenia or neutropenia, both rare side effects, but which occurred in some patients in clinical trials. These side effects can result in increased infection.
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