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45 Cards in this Set
- Front
- Back
What 7 factors influence the pediatric patient's response to dental treatment?
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-parents
-peers -doctor -staff -prior experience with health professionals -time of appointment (am is better) -office environment |
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What are the 4 goals of pediatric sedation
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-make the child cooperative and comfortable
-decrease the child's anxiety -decrease the anxiety and strain of the doctor and staff -minimize the need for hospitalization |
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What 7 sedation techniques are availabl efor the pediatric patient
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-inhalation sedation w/N2O
-oral sedation -oral + inhalation -IV w/ or w/o inhalation -IM and IV sedation -any of the above with body restraints (common w/IV) -general anesthesia |
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How does a child differ in regards to:
metabolic rate liver enzymes emptying time |
-increased in a child
-not fully functional until age 1 -not functional until age 1 (kidneys, endocrine, esophagus, GI) |
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How does a child differ in regards to:
drug redistribution BP trachea |
-decreased due to less fate and muscle mass
-driven by heart rate -more anterior |
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How does a child differ in regards to:
airway compliance functional residual capacity |
-more compliant than in adult
-reduced, decreases the amount of reserve oxygen available and leads to earlier desaturation |
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When do tonsils and adenoids reach their largest size
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-b/t ages 4 and 10
-adds to the airway obstruction problem |
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Why is the fact that a kids BP is driven by HR a problem
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-bradycardia can lead to hypotension
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Why is the fact that the trachea is more compliant in kids a problem
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-the trachea can collapse with negative pressure such as trying to overcome partial obstruction
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Why does a child's increased metabolic rate matter
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-medications are going to be metabolized at a higher rate
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What 8 factors determine a pediatric drug dosage
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-age
-weight -emotional behavior/stress -level of sedation desired -physical activity of kid -contents of stomach (PO) -time of day -ability to titrate |
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What is the standard dosing formula
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mg/kg
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What is young's rule
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age of patient/age + 12 = fraction of adult dose
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What is clark's rule
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weight in pounds/150 = fraction of adult dose
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What are 4 examples of physical restraints
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-bed sheets
-papoose board -rubber bite block -molt mouth prop |
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What 2 things must you do when using restraints
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-obtain parental informed conset prior to using
-be careful not to wrap too tightly - could potentially restrict respiration |
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Ad/Dis of oral sedation
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-no needles, medicate in office while monitoring kids, can be mixed if taste is unpleasant
-variability of drug behavior results in failure rate as high as 40% |
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What should you do when an adequate level of sedation is not reached PO
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-do NOT give more PO medication, you just proceed with less-than-ideal cooperation or reschedule
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What are 5 common oral meds used for pediatric sedation
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-chloral hydrate
-hydroxyzine -midazolam -meperidine -promethazine |
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Oral Chloral Hydrate:
available forms taste effective for what dosage administer when typical dosage provides how much working time can it be combined with N2O |
-capsule, elixir, rectal suppositories
-bitter -mild to moderate anxiety -elixir = 500 mg/5mL -45min-1hr before appointment -30-50 mg/kg -1 hour -yes |
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Oral hydroxyzine comes in what 2 forms (and their doses)
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-hydroxyzine hydrochloride (10 mg/5mL)
-hydoxyzine pamoate (25 mg/5mL) |
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Oral hydroxyzine:
effective for useful for dosage duration can you combine with N2O and opioids |
-very apprehensive, agitate or disturbed children
-hyperatcitve children and kids with autism -1-2 mg/kg 1 hour before appt -1-2 hours -yes |
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Oral pormethazine/phenergan
-used in combo with what drugs -useful for -dosage |
-chloral hydrate, hydroxyzine, meperidine
-mild anxiety when used alone -1-2 mg/kg |
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Oral midazolam
-effective for -dosage -onset -duration |
-hyperactive, mildly anxious patients
-0.5 mg/kg -takes 15-20 min to take effect -60-90 min |
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What are the two most common parenteral agents used in kids
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-midazolam and ketamine
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Parenteral midazolam:
-dose -time to effect -form commonly use |
IM - .15-.2 mg/kg
-10 min -IV than IM |
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Ketamine:
What type of anesthesia used for what Dosing onset of effects duration |
-dissociative anesthesia
-when you can't get an IV - great IM choice -IM 2-3 mg/kg -less than 5 min -15-30 min |
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T/F - when IM sedation is used you should still start an IV
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-true, incase the patient needs more sedation or an emergency arises
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What should you be aware of when giving ketamine
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-it can produce general anesthesia
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What is the max dose for lidocaine or mepivacaine
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4 mg/kg or 2 mg/lb
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What age is the beginning of the geriatric period
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age 65
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What are 8 cardiovascular changes in the geriatric patients
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-coronary artery disease
-angina pectoris -MI -dysrhythmias -decreased contractility -hypertension -renal vascular disease -cerebrovascular disease |
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What are 4 respiratory changes in the geriatric patients
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-emphysema/COPD
-interstitial fibrosis -arthritic changes in thorax -increase in airway closure capacity |
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What are three CNS changes in the geriatric patient
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-decreased number of brain cells
-cerebral arteriorsclerosis (CVA, decreased memory, emotional changes, confusion, delirium, dementia) -parkinsonism |
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What are 4 genitourinary system changes in the geriatric patient
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-decreased renal blood flow (imp b/c penicillin is excreted thru kidneys)
-decreased number of functioning glomeruli -decreased tubular reabsoprtion -benign prostate hypertrophy |
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What are 2 endocrine system changes in geriatric patients
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-decreased response to stress
-diabetes mellitus |
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What are 5 common health problems in the geriatric patient
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-arthritis
-hypertension -atherosclerosis -emphysema -glaucoma |
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What is contraindicated in a patient who has glaucoma
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-valium --> will increase pressure in eye
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What is more common in geriatric patients
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-twice as likely to develop adverse drug reactions
-tend to hyper-respond to usual doses of meds |
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What are the 4 reasons for exaggerated effect of drugs in the elderly
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-hepatic and renal dysfunction
-drug-drug interactions -decreased drug binding due to decreased albumin -lean body mass declines while fat increases which increases elimination half-life of lipid soluble drugs |
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What are 3 key factors when using oral sedation on the elderly
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-titrate by appointment
-select small dosages -BZDP w/o active metabolites are a good choice |
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What BZDP do not have active metabolites
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-lorazepam
-oxazepam -triazolam |
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IM sedation in the elderly
-good or bad and why -drug of choice -give pt |
-not recommended b/c they easily bruise and you are unable to titrate
-midazolam -supplemental oxygen as well |
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IV sedation in the elderly:
-drug of choice -good b/c -use caution -keep pt at -give pt -can be difficult |
-BZDPs
-you can titrate -when titrating - go slowly -a light level of sedation -supplemental oxygen -b/c veins tend to be fragile and have lost elasticity |
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inhalation sedation in elderly
-good for -level of sedation -provides |
-mild to moderate anxiety
-light sedation -supplemental oxygen |