Pedo Week 3: Medically Complex Pts

Front 1

congenital heart defect:
frequency
questions to ask physician (3)

Back 1

- .8%. fairly common

-cardiac status
-SBE prophylaxis recommendations
-precautions w/ meds

Front 2

congenital heart defects -
acyanotic defects w/ shunts:
def
possible manifestations
types (3)

Back 2

-undesirable connection btw systemic and pulmonary circulation
-heart murmurs, cardiac enlargement or congestive heart failure
-Atrial Septal Defect (ASD), VSD, Patent Ductus Arteriosus (PDA)

Front 3

congenital heart defects-
cyanotic defects:
def
types (3)

Back 3

-right to left shunting, messing up oxygenation levels
-transposition of Great Vessels, Tetrology of Fallot, Truncus Arteriosus

Front 4

congenital heart defects-
obstruction of blood flow
types (3)

Back 4

-aortic stenosis
-pulmonary stenosis
-coarction of aorta

Front 5

CHD:
symptoms (5)

Back 5

-cyanosis (hypoxemia)
-delayed dev't
-finger clubbing
-less tolerant of exercise
-pathologic murmur

Front 6

medical management of CHD (2)

Back 6

-surgical repair
-cardiac medications

Front 7

SBE prophylaxis is advised for (4)

Back 7

-synthetic materials in heart
-previous infective endocarditis
-unrepaired/incompletely repaired CHD
-6 months after CHD repair procedure
-cardiac transplant w/ problem in valve

Front 8

#1 cause of pediatric ER visits

def

Back 8

-asthma

-reactive lower airway disease

Front 9

Asthma:
classification, management

Back 9

1)mild intermittent:
- <2days/week or 2 nights/month
-brochodilator, no daily meds
2)mild persistent:
- >2 days/week or 2 nights/month
-daily low dose anti-inflammatory inhaler (corticosteroid), bronchodilator
3) moderate persistent
- daily or > 1 night/week
-daily meds (low-medium dose), long acting bronchodilator, leukotriene inhibitors
4) severe persistent
-continual and frequent
-daily high dose meds, long acting bronchodilator, leukotriene, oral steroids

Front 10

bronchodilator

Back 10

-short or long acting beta agonist inhalers

Front 11

asthma:
rescue meds
-are what
-names
controller meds
-are what

Back 11

-short acting beta agonists
-albuterol, levalbuterol

-anti-inflammatory.

Front 12

asthma controller meds:
types (6) w/ cautions

Back 12

1. 1st line: inhaled corticosteroids
-caution: adrenal insufficiency, stunted growth, oral candiasis (tell pt to rinse after use)
2. 2nd line: leukotriene receptor antagonists
-not common in kids
3. oral corticosteroids
-poorly tolerated
4. combination corticosteroid/long-acting beta agonist
5. long-acting beta agonist
6. anticholinergics bronchodilator

Front 13

asthma:
quesions to ask (5)

Back 13

-currently active, active upon stimulus, or inactive?
-meds? inhaler?
-triggers?
-last attack? severity?
-history of hospitalizations, ER visits, use of Nebulizer

Front 14

asthma:
dental triggers (4)

Back 14

-prolonged supine position
-dental instruments (suction, cotton rolls, trays, etc)
-aerosolized materials: acrylic
-stress

Front 15

asthma:
NO2?

Back 15

-okay for mild/moderate pts

-if sever, may make asthma worse

Front 16

tell pts with inhalers to ______.
why? (2)

Back 16

-rinse after

can cause:
-xerostomia
-candidiasis

Front 17

seizures:
cause
frequency

Back 17

-abnormal neuronal hyperactivity

-0.5% of children

Front 18

partial seizures:
Simple
-type
-manifestations
-conscious?
-causes

Complex
-type
-manifestations
-consciousness?

Back 18

-sensory or motor
-one limb or both limbs on 1 side
-pts remain conscious, my verbalize
-focal damage (tumor, etc)

-frequent aura
-lip smacking, chewing, salivation, picking at clothes
-loss of consciousness, amnesia

Front 19

Generalized seizures:
tonic-clonic seizures
-another name
-involves
-consciousness?
-post-seizure phase?

Back 19

-Grand Mal
-all extremities
-loss of consciousness
-yes. confusion, sleep, etc

Front 20

Generalized seizures:
absence seizures
-another name
-manifestations
-consciousness?
-post-seizure phase?

Back 20

-Petit Mal
-no aura, <30s, bland facial expression, flickering eyelids
-conscious
-none

Front 21

seizures:
effect of lidocaine

Back 21

-lowers seizure threshold

Front 22

febrile seizures:
incidence
permanent?
ages
influencing factors
risks
seizure duration

Back 22

-most common. 3% of kids
-no. rarely continues to adulthood
- 9months-5yo.
-possibly genetic
-when core temp > 39C
-short

Front 23

status epilepticus:
def
action
potential risk

Back 23

-seizure > 30min
-call 911! Emergency.
-if not treated w/in 1 hr, consciousness may not be regained

Front 24

cerebral Palsy:
def
caused by

Back 24

-grp of conditions that involve loss of movement/nerve function
-damage to brain around birth

Front 25

cerebral Palsy:
distinguished by (2)

Back 25

-location
-extent of impairment

Front 26

cerebral palsy:
dental considerations (3)

Back 26

-sensitive gag reflex
-prone to trauma, bruxism, tongue thrusting, generalized spacing btw teeth
-may want to use restraints, or general anesthesia

Front 27

cerebral palsy:
NO2?

Back 27

-might help HIGH functioning CP pts.

Front 28

Diabetes Type 1:
cause
frequency

Back 28

-from destruction of beta-cells in pancreas. No insulin.
-70% of pediatric diabetes

Front 29

Diabetes Type 2:
cause
frequency
insulin secretion levels?

Back 29

-tissue resistance to insulin
-30% of pediatric diabetes
-can be low, normal or high

Front 30

diabetes:
possible complications (3)

Back 30

-blood vessel diseases
-impaired wound healing
-higher infection risk

Front 31

diabetes:
diagnosis (2)

Back 31

-fasting blood sugar level > 126mg/dL on 2 different occasions
OR
-glucose level > 200mg/dL anytime

Front 32

diabetes:
hyperglycemia
hypoglycemia

Back 32

- > 126mg/dL
- < 60 mg/dL BUT must also have symptoms (hunger, thirst, sweating, lethargy, trembling, etc), AND symptoms must reverse when glucose is administered

Front 33

diabetes:
dental management of hypoglycemic pt

Back 33

-stop dental treatment
-feed sugar (if conscious)
-retest blood sugar
-repeat in 15 min if symptoms don't improve

Front 34

Down's syndrome:
aka, incidence

risks

Back 34

-Trisomy 21, 1/600-800 births

-risk of CHD is up 50-70%
-intestinal atresia

Front 35

Down's syndrome:
dental management

Back 35

-med consult as needed. Ask about antibiotic prophylaxis (might be necessary due to cardiac involvement).

Front 36

Autism:
dental considerations

Back 36

-know meds, interactions
-short visits
-know pt's sensory hyper-/hypo-reactivity