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43 Cards in this Set
- Front
- Back
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Define the following terms:
GI reflux - Perimylolysis - |
* GI reflux - backflow of stomach contents into the esophagus * Perimylolysis - erosion of enamel and dentin as a result of chemical effects |
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List the follow-up questions that should be asked for clients who report a history of GERD or peptic ulcer. |
"Has your medication controlled the symptoms of your condition?" "can you tolerate being placed in a supine position?" |
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Identify oral changes most likely to be seen in a client with a history of GI disease. |
Erosion of teeth (perimylolysis), and increased risk of caries. |
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Identify oral changes associated with bulimia nervosa. |
perimylolysis, increased caries, restorations that appear raised or floating, xerostomia, tooth sensitivity, impaired taste sensation, and enlargement of the parotid salivary gland. |
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Describe the difference between partial and total airway obstruction. |
* Partial = wheezing can be heard as the patient attempts to breathe * Full = complete absence of sound |
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Identify ways to prevent respiratory obstruction. |
* use a saliva ejector to remove excess oral fluids; * tie dental floss to cotton rolls or clamps * close observation to ensure objects do not fall into the throat * use a rubber dam * examine restoration margins prior to scaling |
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Define the following terms: Euthyroid - Glaucoma - Hemodialysis - |
* Euthyroid - normal thyroid gland function * Glaucoma - a condition of the eye characterized by the increased pressure in the eyeball * Hemodialysis - the removal of waste and other undesirable substances from the blood by means of a medical device |
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List the symptoms of open-angle glaucoma and narrow-angle glaucoma. |
* Open-angle glaucoma = progressive loss of peripheral vision, blurred vision, difficulty adjusting to brightness and darkness, a halo surrounding a light, and mild pain. * Narrow-angle glaucoma = sudden, severe pain and abrupt, blurred vision. |
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Describe the treatment needed for a client who experiences and acute narrow-angle glaucoma attack. |
* Activate EMS/911 system to transport client to a facility where ophthalmic surgery can be performed. |
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Identify the four components that comprise the analysis of the health history information section. |
* comments on patient interview concerning HHx; * significant findings from questionnaire or oral interview; * dental management considerations * HHx update, information, and signature of patient and dentist or HCP |
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Explain why the patient signature and date of history should be included in the history form? |
* The patient signature verifies that the client or legal guardian provided the information. * The date measures current reporting of information. |
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Describe the significance of asking the client if he or she has any other disease or problem not listed on the medical history form. |
Allows an opportunity for the client to discuss any other information that was not addressed on the health history form; the significance of the information in relation to providing oral healthcare can then determined. |
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Describe the purpose of documenting the analysis of the health history. |
It demonstrates that all medical conditions have been considered in a thorough manner so that comprehensive care can be provided to the patient. |
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Case Study A Laura Davidson presents to the office for a crown preparation procedure. She reports positive responses to a history of GERD and notes that she is taking acid reduction medications for this condition. Her VS are pulse - 68 bpm, Resp. - 14 rpm, BP - 100/68mm Hg. right arm, sitting.
What is the cause of GERD? |
Stomach contents flow backward into the esophagus due to reduced function of the lower esophageal sphincter. |
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Case Study A Laura Davidson presents to the office for a crown preparation procedure. She reports positive responses to a history of GERD and notes that she is taking acid reduction medications for this condition. Her VS are pulse - 68 bpm, Resp. - 14 rpm, BP - 100/68mm Hg. right arm, sitting.
List at least three symptoms of GERD |
* Pain in the middle of the chest * Burping * Cramps * Flatulence * A feeling of fullness in the stomach |
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Case Study A Laura Davidson presents to the office for a crown preparation procedure. She reports positive responses to a history of GERD and notes that she is taking acid reduction medications for this condition. Her VS are pulse - 68 bpm, Resp. - 14 rpm, BP - 100/68mm Hg. right arm, sitting.
What emergency situation is most likely to occur in the dental office setting for this patient? |
Choking |
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Case Study A Laura Davidson presents to the office for a crown preparation procedure. She reports positive responses to a history of GERD and notes that she is taking acid reduction medications for this condition. Her VS are pulse - 68 bpm, Resp. - 14 rpm, BP - 100/68mm Hg. right arm, sitting.
What prevetion strategies should be used to avoid this emergency situation for this patient? |
* Place the patient in a simiupright position for treatment * schedule the appointment at least 3hrs after a meal * inform the patient to indicate if short breaks are needed. |
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Case Study A Arliene Davidson presents to the office for a crown preparation procedure. She reports positive responses to a history of GERD and notes that she is taking acid reduction medications for this condition. Her VS are pulse - 68 bpm, Resp. - 14 rpm, BP - 100/68mm Hg. right arm, sitting.
If the patient expeiences reflux during treatment, how would you best manage this coundition? |
* Stop the procedure and raise the head so the patient is less likely to choke * provide water to clear the throat area * let the client decide whether treatment should continue or be rescheduled |
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Case Study B Betty Kelly, 19yo, presents to the practice for caries restoration on the occlusal surface of tooth #31. She reports a history of asthma and uses an albuterol inhaler as needed. She has seasonal allergies and takes Claritin or Allegra as recommended by her family practitioner. Currently, Ms. Kelly is not taking any medications and has not used her inhaler in 1mo. her BS are pulse - 72 bpm, Resp. - 12 rpm, BP - 110/62mmHg right arm, sitting. The dentist proceeds with restorative treatment and administers an injection of lidocaine 1:100,000 vasoconstrictor. While the dentist is drilling her tooth, the client reports that she is beginning to have difficulty in breathing and feels as tho she is having an asthma attack.
What is the most likely cause of the asthma episode? |
Use of a local anesthetic with vasoconstrictor that contains a sulfite. |
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Case Study B Betty Kelly, 19yo, presents to the practice for caries restoration on the occlusal surface of tooth #31. She reports a history of asthma and uses an albuterol inhaler as needed. She has seasonal allergies and takes Claritin or Allegra as recommended by her family practitioner. Currently, Ms. Kelly is not taking any medications and has not used her inhaler in 1mo. her BS are pulse - 72 bpm, Resp. - 12 rpm, BP - 110/62mmHg right arm, sitting. The dentist proceeds with restorative treatment and administers an injection of lidocaine 1:100,000 vasoconstrictor. While the dentist is drilling her tooth, the client reports that she is beginning to have difficulty in breathing and feels as tho she is having an asthma attack.
What treatment should be administered? |
* Seat the client in an upright position * allow her to use her bronchodilatoras prescribed * provide supplemental oxygen as needed * If treatment is successful, reappoint or reschedule the client. |
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Case Study B Betty Kelly, 19yo, presents to the practice for caries restoration on the occlusal surface of tooth #31. She reports a history of asthma and uses an albuterol inhaler as needed. She has seasonal allergies and takes Claritin or Allegra as recommended by her family practitioner. Currently, Ms. Kelly is not taking any medications and has not used her inhaler in 1mo. her BS are pulse - 72 bpm, Resp. - 12 rpm, BP - 110/62mmHg right arm, sitting. The dentist proceeds with restorative treatment and administers an injection of lidocaine 1:100,000 vasoconstrictor. While the dentist is drilling her tooth, the client reports that she is beginning to have difficulty in breathing and feels as tho she is having an asthma attack.
If severe bronchoconstriction occurs even with a second dose of bronchodilator, what treatment steps should be taken? |
Activate EMS/911 system and transport the client to the hospital. |
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Case Study B Betty Kelly, 19yo, presents to the practice for caries restoration on the occlusal surface of tooth #31. She reports a history of asthma and uses an albuterol inhaler as needed. She has seasonal allergies and takes Claritin or Allegra as recommended by her family practitioner. Currently, Ms. Kelly is not taking any medications and has not used her inhaler in 1mo. her BS are pulse - 72 bpm, Resp. - 12 rpm, BP - 110/62mmHg right arm, sitting. The dentist proceeds with restorative treatment and administers an injection of lidocaine 1:100,000 vasoconstrictor. While the dentist is drilling her tooth, the client reports that she is beginning to have difficulty in breathing and feels as tho she is having an asthma attack.
What documentation should you note in the treatment record about this emergency? |
* that the emergency occurred * the cause, if known * list of medications used by the HCP * list of procedures used during the emergency * the outcome |
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Case Study B Betty Kelly, 19yo, presents to the practice for caries restoration on the occlusal surface of tooth #31. She reports a history of asthma and uses an albuterol inhaler as needed. She has seasonal allergies and takes Claritin or Allegra as recommended by her family practitioner. Currently, Ms. Kelly is not taking any medications and has not used her inhaler in 1mo. her BS are pulse - 72 bpm, Resp. - 12 rpm, BP - 110/62mmHg right arm, sitting. The dentist proceeds with restorative treatment and administers an injection of lidocaine 1:100,000 vasoconstrictor. While the dentist is drilling her tooth, the client reports that she is beginning to have difficulty in breathing and feels as tho she is having an asthma attack.
What prevention strategy should be used for future appointments? |
*Determine if the client has an allergy to sulfites and use a local anesthetic without a vasoconstrictor. |
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Case Study C Carl Rizzo presents with a history of glomerulonephritis and ESRD. He has been treated with hemodialysis and is waiting a kidney transplant. VS include Pulse - 80 bpm, Resp. - 18 rpm, BP - 180/110 mmHg right arm, sitting.
What 5 oral complications are associated with hemodialysis? |
May include: * mucosal ecchymosis * oral malodor * xerostomia * taste changes * tongue and mucosal pain |
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Case Study C Carl Rizzo presents with a history of glomerulonephritis and ESRD. He has been treated with hemodialysis and is waiting a kidney transplant. VS include Pulse - 80 bpm, Resp. - 18 rpm, BP - 180/110 mmHg right arm, sitting.
If the client has his dialysis treatment on Mon, Wed., and Fri., when during the week can his maintenance appointment be scheduled? Why? |
* On alternate days, (Tue, Thur, Sat) * The effects of heparin are no longer present and blood waste products have been removed. |
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Case Study C Carl Rizzo presents with a history of glomerulonephritis and ESRD. He has been treated with hemodialysis and is waiting a kidney transplant. VS include Pulse - 80 bpm, Resp. - 18 rpm, BP - 180/110 mmHg right arm, sitting.
If the client has a shunt in his right arm, which arm should be used for taking blood pressure? Why? |
* The left arm should be used * To avoid collapsing the arteriovenous shunt |
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Case Study C Carl Rizzo presents with a history of glomerulonephritis and ESRD. He has been treated with hemodialysis and is waiting a kidney transplant. VS include Pulse - 80 bpm, Resp. - 18 rpm, BP - 180/110 mmHg right arm, sitting.
What 7 management strategies should be used for this client? |
* Medical consult regarding antibiotic prophylaxis * encouragement of excellent oral hygiene habits * laboratory testing to determine the risk of hemorrhage * frequent continuing care appointments * avoidance of nephrotoxic drugs * monitoring of BP * avoidance of air-polishing devices |
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Case Study C Carl Rizzo presents with a history of glomerulonephritis and ESRD. He has been treated with hemodialysis and is waiting a kidney transplant. VS include Pulse - 80 bpm, Resp. - 18 rpm, BP - 180/110 mmHg right arm, sitting.
What is the leading cause of death in cases of ESRD? |
Cardiovascular disease |
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Case Study C Carl Rizzo presents with a history of glomerulonephritis and ESRD. He has been treated with hemodialysis and is waiting a kidney transplant. VS include Pulse - 80 bpm, Resp. - 18 rpm, BP - 180/110 mmHg right arm, sitting.
If this client does have a kidney transplant, when is it safe for him to return for dental hygiene care? |
6mo after an organ transplant |
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Case Study D Donna Myerson presents with a history of hypothyroidism after treatment for hyperthyroidism. VS include Pulse - 66 bpm, Resp. - 14 rpm, BP - 116/62mmHg right arm, sitting.
List the 14 signs of hyperthyroidism. |
* Bulging eyes, enlarged thyroid gland, and peripheral myxedema (Graves disease triad) * increased body temperature * intolerance to hot temperatures * sweating * weight loss * increased basal metabolic rate * tachycardia * hyperactivity * nervousness * tremors * emotional instability * hypertension |
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Case Study D Donna Myerson presents with a history of hypothyroidism after treatment for hyperthyroidism. VS include Pulse - 66 bpm, Resp. - 14 rpm, BP - 116/62mmHg right arm, sitting.
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* Reduced growth patterns in children * anemia * bradycardia * sluggishness * fatigue * edema of the tongue, face, neck, and hands * depression * weight gain * dry skin and hair * recurrent infections * intolerance to cold temeratures |
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Case Study D Donna Myerson presents with a history of hypothyroidism after treatment for hyperthyroidism. VS include Pulse - 66 bpm, Resp. - 14 rpm, BP - 116/62mmHg right arm, sitting.
If the client reports taking synthroid and demonstrates evidence of a hyperthyroid state, what medical emergency might occur? How would you treat this emergency? |
A thyroid storm * activate EMS/911 systems * place cold towel on the patient * monitor and record vital signs * provide basic life support or CPR as needed
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Case Study D Donna Myerson presents with a history of hypothyroidism after treatment for hyperthyroidism. VS include Pulse - 66 bpm, Resp. - 14 rpm, BP - 116/62mmHg right arm, sitting.
Describe the medical emergency associated with hypothyroidism and give two examples of situations that can cause this emergency. |
* Myxedema coma characterized by bradycardia, severe hypotension and swelling * Stressful situations such as cold, surgery, infection or trauma |
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Case Study G Georgia Davis, a 27yo, presents for caries restoration of tooth #30. She feels she is in good health although she recently has experienced "heartburn" and right upper quadrant pain for which she was recently diagnosed with gastritis and sludge in the gallbladder. She is currently on a low-fat diet and taking omeprazole daily. She is an occupational therapist who maintains excellent oral hygiene and this is her first caries experience. she typically has 6-months continuing care hygiene appointments. She has a history of mitral valve prolapse with minor regurgitation, and hypothyroidism, for which she takes T3 supplements. Her VS include Pulse - 68 bpm, Resp - 14 rpm, BP 116/60mmHg right arm, sitting.
Given the client's gastrointestinal history, what oral changes would you look for during oral examination? |
If patient has heart burn and frequent burping, evaluate teeth for signs of enamel erosion |
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Case Study G Georgia Davis, a 27yo, presents for caries restoration of tooth #30. She feels she is in good health although she recently has experienced "heartburn" and right upper quadrant pain for which she was recently diagnosed with gastritis and sludge in the gallbladder. She is currently on a low-fat diet and taking omeprazole daily. She is an occupational therapist who maintains excellent oral hygiene and this is her first caries experience. she typically has 6-months continuing care hygiene appointments. She has a history of mitral valve prolapse with minor regurgitation, and hypothyroidism, for which she takes T3 supplements. Her VS include Pulse - 68 bpm, Resp - 14 rpm, BP 116/60mmHg right arm, sitting.
Given the client's medical history, what notations would you make in the section entitled "significant findings from questionnaire or oral interview"? |
* Medications for seasonal allergies may cause xerostomia * gastrointestinal disease and gall bladder disease may predispose to enamel erosion. |
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Case Study G Georgia Davis, a 27yo, presents for caries restoration of tooth #30. She feels she is in good health although she recently has experienced "heartburn" and right upper quadrant pain for which she was recently diagnosed with gastritis and sludge in the gallbladder. She is currently on a low-fat diet and taking omeprazole daily. She is an occupational therapist who maintains excellent oral hygiene and this is her first caries experience. she typically has 6-months continuing care hygiene appointments. She has a history of mitral valve prolapse with minor regurgitation, and hypothyroidism, for which she takes T3 supplements. Her VS include Pulse - 68 bpm, Resp - 14 rpm, BP 116/60mmHg right arm, sitting.
Given the client's medical history, what notations would you make in the section entitled "dental management considerations"? |
* patient may require simisupine or upright position depending on extent of reflux symptoms * evaluate for signs of enamel erosion related to gastrointestinal disease |
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Case Study G Georgia Davis, a 27yo, presents for caries restoration of tooth #30. She feels she is in good health although she recently has experienced "heartburn" and right upper quadrant pain for which she was recently diagnosed with gastritis and sludge in the gallbladder. She is currently on a low-fat diet and taking omeprazole daily. She is an occupational therapist who maintains excellent oral hygiene and this is her first caries experience. she typically has 6-months continuing care hygiene appointments. She has a history of mitral valve prolapse with minor regurgitation, and hypothyroidism, for which she takes T3 supplements. Her VS include Pulse - 68 bpm, Resp - 14 rpm, BP 116/60mmHg right arm, sitting.
Give an example of using professional judgement for treatment recommendations, given the client's health history. |
* Patient with healthy gingival tissue in whom significant bleeding is not expected would not be a candidate for antibiotic prophylaxis. |
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Case Study G Georgia Davis, a 27yo, presents for caries restoration of tooth #30. She feels she is in good health although she recently has experienced "heartburn" and right upper quadrant pain for which she was recently diagnosed with gastritis and sludge in the gallbladder. She is currently on a low-fat diet and taking omeprazole daily. She is an occupational therapist who maintains excellent oral hygiene and this is her first caries experience. she typically has 6-months continuing care hygiene appointments. She has a history of mitral valve prolapse with minor regurgitation, and hypothyroidism, for which she takes T3 supplements. Her VS include Pulse - 68 bpm, Resp - 14 rpm, BP 116/60mmHg right arm, sitting.
Is the client at risk of medical emergency during this appointment? If so, what prevention strategies would you use? |
* Given the client's VS, she does not appear to be at risk of myxedema coma. * Continued monitoring of VS during appointment and limited use of local anesthetics with Epi. should be considered. |
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Case Study F Fransisco Antonio Lopez, 79yo, presents for a routine dental hygiene appointment. He has a history of coronary artery disease treated with coronary artery bypass graft surgery in 2000 and has recovered well. Recently, this client developed bradycardia and a pacemaker was placed in Dec. 2012. Within 2 weeks, the client had a mild MI and was re-hospitalized. During the course of hospitalization he developed significant arrhythmia wherein his heart would stop beating on a regular basis. The client was treated with laser surgery that corrected the problem. Also, during the course of hospitalization, the client developed facial cellulitis. An infectious disease specialist was consulted and IV antibiotics were administered. Upon being discharged from the hospital, the client was placed on oral antibiotics. Since the client was not complaining of dental pain and the cause of facial swelling was unknown, he was advised to defer any dental treatment or dental hygiene care for 1 month.
Mr. Lopez dotes that his health has improved significantly since his hospitalization and treatment, but he still fatigues easily and has mild chest pain upon exertion. He can walk upstairs to his bedroom without shortness of breath, but tires easily with grocery shopping and attending follow-up medical appointments. He has lost 20lbs. In addition, he continues to have mild facial swelling but is no longer taking antibiotics. He states that he was told he would not require antibiotic premedication for dental care. Mr. Lopez reports that he takes several medications for his heart condition as noted on his medical history form. VS include Pulse - 72 bpm, Resp. 17 rpm, BP - 130/84mmHg right arm, sitting.
What findings, if any, from the medical history would you consider significant? record your notations as if you were completing the section in HHx entitled "significant findings from the questionnaire or oral interview." |
* Patient reports history of coronary artery disease treatment with coronary artery bypass graft surgery in 2000, recent history of MI, pacemaker placed and laser surgery to correct arrhythmia; client is post 1-mo recovery period; client reports onset of concomitant facial cellulitis of undetermined etiology; treatment with IV and oral antibiotics, mild swelling persists, takes multiple medications - see med. log sheet; VS within normal limits. |
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Case Study F Fransisco Antonio Lopez, 79yo, presents for a routine dental hygiene appointment. He has a history of coronary artery disease treated with coronary artery bypass graft surgery in 2000 and has recovered well. Recently, this client developed bradycardia and a pacemaker was placed in Dec. 2012. Within 2 weeks, the client had a mild MI and was re-hospitalized. During the course of hospitalization he developed significant arrhythmia wherein his heart would stop beating on a regular basis. The client was treated with laser surgery that corrected the problem. Also, during the course of hospitalization, the client developed facial cellulitis. An infectious disease specialist was consulted and IV antibiotics were administered. Upon being discharged from the hospital, the client was placed on oral antibiotics. Since the client was not complaining of dental pain and the cause of facial swelling was unknown, he was advised to defer any dental treatment or dental hygiene care for 1 month.
Mr. Lopez dotes that his health has improved significantly since his hospitalization and treatment, but he still fatigues easily and has mild chest pain upon exertion. He can walk upstairs to his bedroom without shortness of breath, but tires easily with grocery shopping and attending follow-up medical appointments. He has lost 20lbs. In addition, he continues to have mild facial swelling but is no longer taking antibiotics. He states that he was told he would not require antibiotic premedication for dental care. Mr. Lopez reports that he takes several medications for his heart condition as noted on his medical history form. VS include Pulse - 72 bpm, Resp. 17 rpm, BP - 130/84mmHg right arm, sitting.
Mr. Lopez reports taking the following medications for his coronary artery disease: Plavix, felodipine, and metoprolol (Toprol-XL). Look up the medication in a drug reference manual and note any dental management considerations appropriate for dental hygiene care, as if you were completing the "dental management considerations" sections of the medical history form. |
* Plavix: avoid prescribing aspirin, caution in using with NSAIDs, monitor bleeding during treatment; consider local hemostasis measures to prevent excessive bleeding; medical consult on bleeding time; caution to prevent trauma when using oral hygiene aids; advise client to report any unusual or prolonged bleeding episodes post dental treatment. * Felodipine: monitor VS; use SRP to prevent stress-induced angina; have client sit more than 2min to avoid orthostatic hypotension after supine position; place on continued care appointments to monitor gingival enlargement; use vasoconstrictors in low dose and with careful aspiration; assess salivary flow, use same protocol as with Norvasc if present. * Metoprolol: same as felodipine; in clients with symptoms of blood dyscrasias, request a medical clearance for blood studies and postpone treatment until normal values are established. |
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Case Study F Fransisco Antonio Lopez, 79yo, presents for a routine dental hygiene appointment. He has a history of coronary artery disease treated with coronary artery bypass graft surgery in 2000 and has recovered well. Recently, this client developed bradycardia and a pacemaker was placed in Dec. 2012. Within 2 weeks, the client had a mild MI and was re-hospitalized. During the course of hospitalization he developed significant arrhythmia wherein his heart would stop beating on a regular basis. The client was treated with laser surgery that corrected the problem. Also, during the course of hospitalization, the client developed facial cellulitis. An infectious disease specialist was consulted and IV antibiotics were administered. Upon being discharged from the hospital, the client was placed on oral antibiotics. Since the client was not complaining of dental pain and the cause of facial swelling was unknown, he was advised to defer any dental treatment or dental hygiene care for 1 month.
Mr. Lopez dotes that his health has improved significantly since his hospitalization and treatment, but he still fatigues easily and has mild chest pain upon exertion. He can walk upstairs to his bedroom without shortness of breath, but tires easily with grocery shopping and attending follow-up medical appointments. He has lost 20lbs. In addition, he continues to have mild facial swelling but is no longer taking antibiotics. He states that he was told he would not require antibiotic premedication for dental care. Mr. Lopez reports that he takes several medications for his heart condition as noted on his medical history form. VS include Pulse - 72 bpm, Resp. 17 rpm, BP - 130/84mmHg right arm, sitting.
What follow-up questions and dental considerations are appropriate for the history of facial swelling? |
* Onset of symptoms * other oral symptoms present * other treatment provided besides antibiotic therapy * current symptoms * any other evaluations;treatment rendered for this condition |
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Case Study F Fransisco Antonio Lopez, 79yo, presents for a routine dental hygiene appointment. He has a history of coronary artery disease treated with coronary artery bypass graft surgery in 2000 and has recovered well. Recently, this client developed bradycardia and a pacemaker was placed in Dec. 2012. Within 2 weeks, the client had a mild MI and was re-hospitalized. During the course of hospitalization he developed significant arrhythmia wherein his heart would stop beating on a regular basis. The client was treated with laser surgery that corrected the problem. Also, during the course of hospitalization, the client developed facial cellulitis. An infectious disease specialist was consulted and IV antibiotics were administered. Upon being discharged from the hospital, the client was placed on oral antibiotics. Since the client was not complaining of dental pain and the cause of facial swelling was unknown, he was advised to defer any dental treatment or dental hygiene care for 1 month.
Mr. Lopez dotes that his health has improved significantly since his hospitalization and treatment, but he still fatigues easily and has mild chest pain upon exertion. He can walk upstairs to his bedroom without shortness of breath, but tires easily with grocery shopping and attending follow-up medical appointments. He has lost 20lbs. In addition, he continues to have mild facial swelling but is no longer taking antibiotics. He states that he was told he would not require antibiotic premedication for dental care. Mr. Lopez reports that he takes several medications for his heart condition as noted on his medical history form. VS include Pulse - 72 bpm, Resp. 17 rpm, BP - 130/84mmHg right arm, sitting.
What potential medical emergency should you be prepared to address during this appointment? |
* given the client's significant cardiac history an MI is the most likely medical emergency that could occur during the appointment. |
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Case Study F Fransisco Antonio Lopez, 79yo, presents for a routine dental hygiene appointment. He has a history of coronary artery disease treated with coronary artery bypass graft surgery in 2000 and has recovered well. Recently, this client developed bradycardia and a pacemaker was placed in Dec. 2012. Within 2 weeks, the client had a mild MI and was re-hospitalized. During the course of hospitalization he developed significant arrhythmia wherein his heart would stop beating on a regular basis. The client was treated with laser surgery that corrected the problem. Also, during the course of hospitalization, the client developed facial cellulitis. An infectious disease specialist was consulted and IV antibiotics were administered. Upon being discharged from the hospital, the client was placed on oral antibiotics. Since the client was not complaining of dental pain and the cause of facial swelling was unknown, he was advised to defer any dental treatment or dental hygiene care for 1 month.
Mr. Lopez dotes that his health has improved significantly since his hospitalization and treatment, but he still fatigues easily and has mild chest pain upon exertion. He can walk upstairs to his bedroom without shortness of breath, but tires easily with grocery shopping and attending follow-up medical appointments. He has lost 20lbs. In addition, he continues to have mild facial swelling but is no longer taking antibiotics. He states that he was told he would not require antibiotic premedication for dental care. Mr. Lopez reports that he takes several medications for his heart condition as noted on his medical history form. VS include Pulse - 72 bpm, Resp. 17 rpm, BP - 130/84mmHg right arm, sitting.
What strategies should you use to avoid this emergency? |
* Monitor vital signs throughout appointment * SRP * Request medical clearance to assist for adequate functional capacity *Review medications taken for drug actions and adverse effects * Observe patient for signs of MI or other cardiac problems during treatment |
