Med Emergency Wk 1 Q/case Studies 1-2

Front 1

Define the following term:
Blood pressure (BP) -

Back 1

- the pressure in the arteries when the heart beats and the pressure when the heart rests

Front 2

Define the following term:
Systolic BP -

Back 2

- the pressure in the arteries when the heart beats

Front 3

Define the following term:
Diastolic BP -

Back 3

- the pressure in arteries when the heart rests or between beats

Front 4

Define the following term:
Pulse -

Back 4

- the heart rate or a reflection of the heartbeat

Front 5

Define the following term:
Respiration -

Back 5

- the inhalation and exhalation of air

Front 6

Define the following term:
Functional capacity

Back 6

- the ability to complete various physical activities; a measure of cardiac risk assessment

Front 7

Define the following term:
Metabolic equivalents (METs) -

Back 7

- a measure of the ability to perform common daily tasks pulse, respiration, functional capacity, and METs.

Front 8

Why should all questions on the medical history form be answered?

Back 8

● All questions on the medical history form should be answered to help predict potential medical emergencies.

Front 9

What guidelines should be used when considering oral treatment for a client who presents with a BP of 80/100 mm Hg, right arm?

Back 9

● Recheck BP after 5 minutes when client has rested; if still elevated, inform client of readings; refer for medical evaluation if dental procedure is stressful or if anesthesia is required; provide routine treatment; consider using a stress-reduction protocol during oral health treatment; and keep appointments short.

Front 10

The majority of individuals taking antihypertensive medication continue to have insufficient BP control.

Back 10

● What is the clinical relevance of this finding? Failure to adhere to antihypertensive therapy and lifestyle changes are factors that contribute to insufficient BP control.

Front 11

According to the latest guidelines on screening for hypertension, at what age should the BP be measured in a dental office?

Back 11

● BP should be measured routinely after age 3.

Front 12

Describe the technique for taking the pulse during an emergency.

Back 12

● Palpate the carotid artery found in the middle of the neck along the sternocleidomastoid muscle.

Front 13

What information related to "quality" is needed before determining a client's respiration status?

Back 13

● Presence of sounds or noises, and depth of respirations.

Front 14

What is the risk of treating a client with an elevated body temperature?

Back 14

● Disease or infection transmission.

Front 15

Differentiate between TB infection and active TB disease.

Back 15

● TB is an infectious, inflammatory disease caused by M. tuberculosis that primarily affects the pulmonary system.
● TB infection refers to a person who has inhaled the TB bacillus and whose immune system has developed antibodies to the bacillus, but has not developed active disease.
● Active TB disease refers to a person who presents with symptoms of the disease.

Front 16

List the screening questions to identify active TB recommended by the CDC.

Back 16

● The screening questions for active TB are as follows:
○ Have you had any of the following diseases or problems:
-> active TB?
-> persistent cough for more than 3 weeks?
-> cough that produces blood?
● Other signs include night swears, recent unexplained weight loss, and close association with someone who has active TB.

Front 17

Identify three etiologies of persistent cough.

Back 17

● Etiologies of a persistent cough may include:
○ cigarette smoking
○ chronic bronchitis
○ asthma
○ respiratory infection

Front 18

Describe the criteria for determining noninfectious status in clients with active TB.

Back 18

● Criteria for determining noninfectious status in clients with active TB include:
○ effective anti-TB drugs have been taken for three or more weeks
○ three consecutive negative sputum smears are documented
○ the client is not in a coughing stage.

Front 19

Case Study A:
Mr. Farnsworth, a 48-year-old man presents for a dental examination and restorative appointment. Before performing the examination, vital signs are measured. His pulse is 72 bpm, respiration is 16 breaths per minute, and BP measures 126/86 mm Hg, right arm. His height is 5'8" and weight is 200 lbs.

1. What category of BP does Mr. Farnsworth's reading rate?

Back 19

● Prehypertension

Front 20

Case Study A:
Mr. Farnsworth, a 48-year-old man presents for a dental examination and restorative appointment. Before performing the examination, vital signs are measured. His pulse is 72 bpm, respiration is 16 breaths per minute, and BP measures 126/86 mm Hg, right arm. His height is 5'8" and weight is 200 lbs.

What health recommendations should be made on the basis of Mr. Farnsworth's vital signs?

Back 20

● Lifestyle modifications including weight management and BP control

Front 21

Case Study A:
Mr. Farnsworth, a 48-year-old man presents for a dental examination and restorative appointment. Before performing the examination, vital signs are measured. His pulse is 72 bpm, respiration is 16 breaths per minute, and BP measures 126/86 mm Hg, right arm. His height is 5'8" and weight is 200 lbs.

What dental considerations should be made when considering oral treatment for this client with his BP values?

Back 21

● Routine dental treatment can be provided; re-measure BP at continuing care appointments as a screening strategy for hypertension

Front 22

Case Study B:
Mr. Farnsworth returns for a dental hygiene appointment 1 year later. Upon updating the medical history, the clinician learns that this client had a myocardial infarction approximately 4 months ago. He is currently taking aspirin 81 mg and Norvasc daily, but he left his medication at home and cannot recall the dosage. Vital signs at this appointment are pulse 80 bpm, respiration 18 breaths per minute, temperature 97 .8°F, and BP 145/88 mm Hg, right arm. When questioned about functional capacity, Mr. Farnsworth reports that he has difficulty climbing stairs, cannot dance or play tennis without shortness of breath, and has difficulty walking the dog more than a few blocks.

What category of BP does Mr. Farnsworth's reading rate now?

Back 22

● Mr. Farnsworth presents with stage I hypertension

Front 23

Case Study B:
Mr. Farnsworth returns for a dental hygiene appointment 1 year later. Upon updating the medical history, the clinician learns that this client had a myocardial infarction approximately 4 months ago. He is currently taking aspirin 81 mg and Norvasc daily, but he left his medication at home and cannot recall the dosage. Vital signs at this appointment are pulse 80 bpm, respiration 18 breaths per minute, temperature 97 .8°F, and BP 145/88 mm Hg, right arm. When questioned about functional capacity, Mr. Farnsworth reports that he has difficulty climbing stairs, cannot dance or play tennis without shortness of breath, and has difficulty walking the dog more than a few blocks.

Which ASA classification does this client represent?

Back 23

● Mr. Farnsworth presents with ASA classification IV

Front 24

Case Study B:
Mr. Farnsworth returns for a dental hygiene appointment 1 year later. Upon updating the medical history, the clinician learns that this client had a myocardial infarction approximately 4 months ago. He is currently taking aspirin 81 mg and Norvasc daily, but he left his medication at home and cannot recall the dosage. Vital signs at this appointment are pulse 80 bpm, respiration 18 breaths per minute, temperature 97 .8°F, and BP 145/88 mm Hg, right arm. When questioned about functional capacity, Mr. Farnsworth reports that he has difficulty climbing stairs, cannot dance or play tennis without shortness of breath, and has difficulty walking the dog more than a few blocks.

Based on the client's vital signs and METs, what treatment considerations should be made?

Back 24

● Postpone elective treatment, such as a dental hygiene appointment, until his condition has improved and medical consultation verifies that he has moved to the ASA III category.

Front 25

Case Study C:

Mr. Cameron, rehabilitation aide working at a local long-term care facility for the elderly and disabled, presents for a prophylaxis. During completion of the medical history, he approaches the reception desk and reports that he often has episodes of frequent coughing. He denies coughing of blood or having flu-like symptoms.

What follow-up questions would you ask to determine more information about the significance of this finding?

Back 25

● Have you seen a physician about this condition?

● How long has the cough lasted?

● Do you have night sweats, elevated temperature, unexplained weight loss?

● Do you smoke cigarettes?

● Do you have any other chronic respiratory conditions such as bronchitis or asthma?

● Are you taking any medications for this condition?

● Is there anyone else that you work with or a resident who has the same type of cough?

Front 26

Case Study C: Mr. Cameron, rehabilitation aide working at a local long-term care facility for the elderly and disabled, presents for a prophylaxis. During completion of the medical history, he approaches the reception desk and reports that he often has episodes of frequent coughing. He denies coughing of blood or having flu-like symptoms.

If the client reports night sweats and occasional temperature of 99°F to lOO°F, would you proceed with dental treatment?

Back 26

● Elective dental care is contraindicated in clients with active TB. If you suspect active TB, refer the client for a medical evaluation.

Front 27

Case Study C: Mr. Cameron, rehabilitation aide working at a local long-term care facility for the elderly and disabled, presents for a prophylaxis. During completion of the medical history, he approaches the reception desk and reports that he often has episodes of frequent coughing. He denies coughing of blood or having flu-like symptoms.

If the client was then tested and diagnosed with active TB, what protocol would you use for determining when oral health care could be performed?

Back 27

● Utilize the criteria of the CDC:
○ not in the coughing stage
○ three consecutive negative sputum smears
○ has taken effective anti-TB medications for at least 3 weeks.
● You can also request the results of a culture-negative sputum smear after 3 weeks of drug treatment to ensure that the disease is not resistant to the medications used.

Front 28

Case Study C: Mr. Cameron, rehabilitation aide working at a local long-term care facility for the elderly and disabled, presents for a prophylaxis. During completion of the medical history, he approaches the reception desk and reports that he often has episodes of frequent coughing. He denies coughing of blood or having flu-like symptoms.

If the client was then tested and diagnosed with TB infection, what protocol would you use for determining when oral health care could be performed?

Back 28

● No contraindication to treatment, but monitor history for signs of active disease in the future.

Front 29

Case Study D:
Mary Myers presents to work having attended an Occupational Safety and Health Administration (OSHA) continuing education program. She is excited about what she has learned and suggests that the office staff have a screening test for TB. To her surprise, one of the receptionists tests positive on a Mantoux skin test.

If active disease is ruled out, is further treatment needed?

Back 29

● Even if active TB disease is ruled out, the physician may prescribe a single anti-TB drug to prevent disease from developing.

Front 30

Case Study D:
Mary Myers presents to work having attended an Occupational Safety and Health Administration (OSHA) continuing education program. She is excited about what she has learned and suggests that the office staff have a screening test for TB. To her surprise, one of the receptionists tests positive on a Mantoux skin test.

If medication was prescribed, list the most likely agent(s) and what would the duration have been?

Back 30

● The employee would likely be directed to take INH for 6 months.

Front 31

Case Study D:
Mary Myers presents to work having attended an Occupational Safety and Health Administration (OSHA) continuing education program. She is excited about what she has learned and suggests that the office staff have a screening test for TB. To her surprise, one of the receptionists tests positive on a Mantoux skin test.

When can the employee resume working?

Back 31

● If the staff member has no symptoms of active disease, she can continue working. She is not contagious and cannot transmit the disease.