Wilkins Chapter 5,6,7,8

Front 1

The requirements for preparation of the treatment area are:standard precautions

Back 1

for all patients whether or not the presence of a communicable disease is known

Front 2

The requirements for preparation of the treatment area are:Environmental Surfaces

Back 2

All contact areas are thoroughly disinfected or covered to control cross-contamination

Front 3

The requirements for preparation of the treatment area are:Instruments

Back 3

Sterile packaged instruments remain sealed until the start of the appointment.

Front 4

The requirements for preparation of the treatment area are:Equipment

Back 4

a) Prepare and make ready other materials that will be used, such as for the determination of blood pressure and patient instruction. Anticipate specific needs for procedures being delivered

Front 5

What do you do with the patient Records to prepare yourself for the patient?

Back 5

1. Review the patient's medical and dental history for pertinent appointment information, updating, and assessment.
2. Read previous appointment case records to focus the current treatment needs.
3. Anticipate examination procedures and new record making for a new patient.

Front 6

What do you do with the patient Position of Chair to prepare yourself for the patient?

Back 6

1)Upright, positioned for current patient.
2)Chair arm adjusted for access.
3)Clear pathway to chair of obstacles: rheostat, clinician's stool.

Front 7

Procedure for introducing the patient to others:

Back 7

1.A lady's name always precedes a gentleman's.
2.An older person's name precedes the younger person's (when of the same sex and when the difference in age is obvious).
3.In general, the patient's name precedes that of a member of the dental personnel.
4.An older patient is not called by the first name except at the patient's request.

Front 8

This is the initial position from which chair adjustments are made

Back 8

Upright

Front 9

Patients with certain types of cardiovascular, respiratory, or vertigo problems may need this position.

Back 9

Semi-upright Position

Front 10

1.the brain is on the same level as the heart.
2.A patient is ideally situated for support of the circulation; rarely could a patient faint while lying in a supine position.
3.Position used most for treatment procedures.

Back 10

Supine Position

Front 11

The patient is in the supine position and tipped back and down 35° to 45° so that the heart is higher than the head

Back 11

Trendelenburg position

Front 12

Contraindications for Supine Position

Back 12

Conditions that may contraindicate the supine position include:
1.congestive heart disease, 2.vertigo,
3.and a breathing difficulty such as emphysema, severe asthma, or sinusitis.

Front 13

Neutral Working Posture
I. Objectives

Back 13

Objectives concern the health of the clinician, the service to be performed, and the effect on the patient.

Front 14

? is the single most powerful tool the clinician has to reduce the risk of injury.

Back 14

Neutral working posture (NWP)

Front 15

Description of Neutral Seated Posture

Back 15

Back: in neutral postural alignment with natural spinal curves.
o Cervical lordosis
o Thoracic kyphosis
o Lumbar lordosis
•Head: on top of neutral spine with forward neck flexion between 15 and 20 degrees or less.
•Eyes: directed downward to prevent neck and eye strain; it is not necessary to bend the head down more than 15 to 20 degrees for prolonged periods of time.
•Shoulders: relaxed and parallel with the hips and floor.
•Elbows: close to the body.
•Forearms: parallel with the floor.
•Wrist: forearm and wrist are in a straight line.
•Thighs: full body weight distributed evenly on seat; comfortable space (about 3 inches) between edge of seat and back of knee.
•Knees: slightly apart.
•Feet: flat on the floor.

Front 16

dental light Maxillary arch

Back 16

chin up position; beam of light often between 60° 45° angle to floor.

Front 17

dental light Mandibular arch

Back 17

chin down position; beam of light nearly perpendicular to floor

Front 18

Magnification is needed to

Back 18

improve visualization, support neutral working posture, and enhance treatment procedures

Front 19

Ergonomics

Back 19

the study of human characteristics for the appropriate design of the living and work environment for the achievement of optimal performance with the least amount of negative effects.

Front 20

A symptomatic compression of the median nerve within the carpal tunnel
Deviations of wrist from neutral.
Pinch grasp with insufficient rest.

Numbness; tingling in the thumb, index, and middle fingers

Back 20

Carpal Tunnel Syndrome

Front 21

Painful disorder of the fingers, hand, and/or wrist from compression of the brachial nerve plexus and vessels between the neck and shoulder.

Tilting head forward.
Hunched and/or rounded forward shoulders.
Continuously reaching overhead.

Numbness, tingling, and/or pain in the hand or wrist.

Back 21

Thoracic Outlet Syndrome

Front 22

Inflammation of the bursa.

Areas of friction or impingement anywhere in the body, usually the shoulder.

Decreased range of motion. Aching.

Back 22

Bursitis

Front 23

Painful inflammation of the wrist resulting in strain.

Repeated wrist extension or palmar flexion.

Pain in the wrist, especially along the outer edges of the hand rather than through the center of the wrist.

Back 23

Tendonitis

Front 24

Displacement of the nucleus of the disc with resultant pressure on the spinal cord or peripheral nerves.

Prolonged, static postures of forward flexion, hyperextension, lateral bending, or rotation of the spine.

Can present on cervical, thoracic, or lumbar areas of the spine.

Pain, numbness, tingling of the arm, fingers, lower back, hip, or leg.

Back 24

Disc Herniation

Front 25

Self-care is built on but not limited to all safe work practices that incorporate ergonomic principles for health and well-being. This includes but is not limited to

Self-Care for the Dental Hygienist

Back 25

o Physical Fitness: Immunizations, healthy diet, adequate sleep, exercise.
o Standard Precautions: Personal protective equipment (PPE).
o Clinical Practice: Clinician/patient positioning (CPP), instrument selection and use, prevention of sharps injuries.
o Neutral Working Posture: In all activities, not only clinical practice.
o Stress Management: Reasonable patient scheduling, adequate breaks.

Front 26

. The three components of the triad

Back 26

postural integrity, physical fitness, and the challenge to manage and relinquish stress.

Front 27

Documentation in the patient's record is considered legal evidence in any legal action

Patient record entries are

Back 27

recorded promptly during or following treatment
recorded using clear, concise, subjective statements
dated
signed by the clinician

Front 28

The Written Record

Mistakes are corrected by

Back 28

placing a single line through the error, writing the correct information immediately after, and signing the entry

Front 29

The Written Record

If a late entry is necessary, the new information

Back 29

follows the most recent entry in the patient record
is noted as a late entry
includes the date and time that the late entry was made

Front 30

The Health Information Portability and Accountability Act of 1996 (HIPAA) took effect for dental practices in the United States on

Back 30

April 14, 2003

Front 31

The HIPAA is basically comprised of three key sets of rules concerning

Back 31

privacy, confidentiality, and security of patient information

Front 32

Refers to a patient's right to keep health information private and control who can access it

Back 32

Privacy

Front 33

Patients have the right to

Back 33

Receive a copy of personal health records.
Ask to change incorrect or incomplete information.
Receive a report on when, why, and with whom their health information is shared.
Free once a year.
Within 60 days of request.
Decide, in some cases (such as marketing), whether health information can be shared.
Ask to be contacted regarding health information in a specific location or by a specific method such as telephone or mail.
File a complaint with the provider, health insurer, or United States government regarding concerns about use of their health information

Front 34

Refers to the responsibility that healthcare providers have to protect patients' confidential health information

Back 34

Confidentiality

Front 35

Healthcare providers are responsible for:

Back 35

Complying with protocols that protect patient information so it is not disclosed inappropriately.

Providing patients with a “notice of privacy practices” document at the beginning of their care.

Employers are responsible for:
Educating employees about confidentiality of patient information.
Implementing security measures, policies, and formal protocols that protect patient information.
Conducting analysis of security risks and vulnerabilities.
Establishing sanctions for workforce members who fail to comply with policies.

Conducting analysis of security risks and vulnerabilities.
Establishing sanctions for workforce members who fail to comply with policies

Front 36

Refers to policies, procedures, and tools used to keep individually identifiable patient information private

Back 36

Security

Front 37

may occur in various disease conditions. Example: fever, or increase in body temperature, accompanies most infections.

Back 37

General signs and symptoms

Front 38

is unique to a particular disease and may be used to distinguish that condition from other diseases or conditions.

Back 38

A pathognomonic sign or symptom

Front 39

any abnormality that can be identified by a healthcare professional while examining a patient

Back 39

A sign

Front 40

A sign is an ____ symptom

Back 40

objective

Front 41

Examples of signs are:

Back 41

Observable changes in color, shape, or consistency of a tissue.
Abnormal findings revealed by the use of a probe, explorer, radiograph, dental pulp vitality tester, or other technical devices used to identify signs of disease.

Front 42

any departure from the normal that may be indicative of disease

Back 42

symptom

Front 43

Symptoms are subjective abnormalities that are observed by the patient. Examples are:

Back 43

pain, tenderness, or itching

Front 44

a thorough, comprehensive study is made with all the assessment parts

Back 44

complete examination

Front 45

implies a brief examination.

may be used for initial patient assessment and triage to determine priority for treatment

Back 45

Screening

Front 46

An initial survey of a group of individuals made to identify the prevalence of a particular disease or condition within a population.

Back 46

Community Screening.

Front 47

examination is made for an emergency. It may be used in the management of acute conditions

Back 47

limited examination

Front 48

a type of limited examination. It is used to observe the effects of treatment after a period of time during which the tissue or lesion can recover and heal. Indications of the need for additional or alternate treatment are apparent at a____ examination

Back 48

follow-up

Front 49

An examination is made after a specified period of time following the completion of treatment and the restoration to health

is a complete reassessment from which a new care plan is derived

Back 49

maintenance or reevaluation examination

Front 50

Visual Examination

Back 50

Direct Observation. Visual examination is made in a systematic order to note surface appearance (color, contour, size) and to observe movement and other evidence of function.

Radiographic Examination. The use of radiographs can reveal deviations from the normal not noticeable by direct observation.

Transillumination. A strong light directed through a soft tissue or a tooth to enhance examination is especially useful for detecting irregularities of the teeth and locating calculus

Front 51

is examination using the sense of touch through tissue manipulation or pressure on an area with the fingers or hand.

Back 51

Palpation

Front 52

such as the explorer and probe, are used for specific examination of the teeth and periodontal tissues

Back 52

Examination instruments

Front 53

is the act of tapping a surface or tooth with the fingers or an instrument

Back 53

Percussion

Front 54

is the use of sound. An example is the sound of clicking of the temporomandibular joint when the jaw is moved

Back 54

Auscultation

Front 55

Basic information obtained prior to the initial assessment appointment can save time and facilitate the process.
A brief telephone screening interview can help determine potential medical problems and need for premedication, and it can identify medically compromised or physically challenged patients for whom modifications in routine care may be needed.

Back 55

Preappointment Information

Front 56

vital items is obtained during an initial emergency visit;

purpose to prepare for emergency care and to learn of any condition that may contraindicate instrumentation

Back 56

Brief History

Front 57

A___ is made at the initial visit and is a combination of interview and questionnaire

is reviewed with the patient and changes are considered when planning patient care

Back 57

complete patient history

Front 58

Introduction to the Patient
what you should tell the pt why it's important to do a med history

Back 58

Educate the patient about why the information requested in the history is essential before treatment can be undertaken.
Convey the idea that oral health and general health are interrelated, without creating undue alarm concerning potential ill effects or harmful sequelae from required treatment.
To build rapport, allow children to participate in their history preparation, but most of the information will need to be supplied by a parent or legal guardian. The signature of the responsible adult is required on the record.

Front 59

System Oriented questions lead to

Back 59

Direct questions or topics that check whether the patient has had a disease of, for example, the digestive system, respiratory system, or urinary system may be used.

Front 60

Disease Oriented questions

Back 60

A typical set of questions for the patient to check may start with “Do you have, or have you had, any of the following diseases or problems?”

A listing under that question contains such items as diabetes, asthma, or rheumatic fever arranged alphabetically or grouped by systems or body organs.

Front 61

Symptom Oriented questions may lead to a suspicion of a condition, which, in turn, can provide an opportunity to recommend and encourage the patient to schedule an examination by a physician.

Examples of the symptom-oriented questions are

Back 61

Examples of the symptom-oriented questions are “Are you thirsty much of the time?” “Does your mouth frequently become dry?” or “Do you have to urinate (pass water) more than six times a day?”

Front 62

Culture Oriented questions
Questions related to the patient's cultural background can help to:

Back 62

Identify ethnic or gender-related increase in risk for systematic or oral disease.
Determine traditional culturally related health/illness behaviors that may influence dental hygiene interventions or recommendations.
Identify herbal preparations or other traditional medications used by the patient that may affect oral care or risk for disease.

Front 63

Broad in scope; useful during the interview to identify positive areas that need additional clarification.
Time-saving.
Consistent; all selected questions are included, and none is omitted because of time or other factors.
Patient has time to think over the answers; not under pressure, nor under the eyes of the interviewer.
Patient may write information that might not be expressed directly in an interview.
Legal aspects of a written record with patient's signature.

Back 63

Advantages of a Questionnaire

Front 64

Impersonal; no opportunity to develop rapport.
Inflexible; no provision for additional questioning in areas of specific importance to an individual patient.

Back 64

Disadvantages of a Questionnaire (If Used Alone Without a Follow-Up Interview)

Front 65

The basic objectives in gathering personal information about the patient are to

Back 65

Collect data essential for appointment planning and business aspects.

Identify need for approval for care of a minor patient and/or other legal requirements.
Determine the need for consultation with the patient's physician.
Determine culturally appropriate communication measures.

Front 66

Conditions That May Complicate Certain Kinds of Dental and Dental Hygiene Treatment

Back 66

Examples. Lowered resistance to infection; uncontrolled hypertension; or systemic disease that requires treatment before stressful dental procedures, particularly surgery, can be carried out.

Front 67

Diseases That Require Special Precautions or Premedication Prior to Treatment

Back 67

Example. Antibiotic coverage for the patient with a history of a congenital heart defect to prevent infective endocarditis

Front 68

Conditions Under Treatment by a Physician That Require Medicating Drugs That May Influence or Contraindicate Certain Procedures

Back 68

Examples. Anticoagulant therapy requires consultation with physician; antihypertensive drugs may alter the choice of local anesthetic used

Front 69

Gender or Ethnic/Racial Influences that Increase Risk for Systemic and Oral Disease

Back 69

Example. American Indians and African Americans have increased risk for diabetes and a related increased risk for periodontal disease.

Front 70

Allergic or Untoward Reactions

Back 70

Examples. Latex hypersensitivity; medication or material for which there was a previous adverse reaction.

Front 71

Diseases and Drugs With Manifestations in the Mouth

Back 71

Examples. Hematologic disorders; phenytoin-induced gingival overgrowth; infectious diseases such as herpesvirus.

Front 72

Communicable Diseases That Endanger the Dental Personnel

Back 72

Examples. Active tuberculosis; viral hepatitis; herpes; syphilis.

Front 73

Physiologic State of the Patient

Back 73

Examples. Pregnancy; puberty; menopause; birth control pills.

Front 74

_____ is the preferred procedure for medical consultation

Back 74

A letter of formal request

Front 75

The patient is referred for medical examination when____

Back 75

signs of a possible disease condition are apparent.

Front 76

The patient is referred for laboratory tests when recent

Back 76

test results are not available or follow-up tests are needed

Front 77

Medical Conditions that Require Antibiotic Premedication Prior to Dental and Dental Hygiene Treatment

Back 77

Prosthetic cardiac valve
Previous endocarditis
Congenital heart disease only in the following categories:
Unrepaired cyanotic congenital heart disease, including those with palliative shunts and conduits
Completely repaired congenital heart disease with prosthetic material or deviceRepaired congenital heart disease with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device Cardiac transplantation recipients with cardiac valvular disease

Front 78

ASA I:

Back 78

A patient without apparent systemic disease: a normal healthy patient

Front 79

ASA II:

Back 79

A patient with mild systemic disease.

Front 80

ASA III:

Back 80

A patient with severe systemic disease that limits activity but is not incapacitating.

Front 81

ASA IV:

Back 81

A patient with an incapacitating systemic disease that is a constant threat to life.

Front 82

ASA V:

Back 82

A moribund patient not expected to survive 24 hours with or without care.

Front 83

Determination of four vital signs——is considered standard procedure in patient care

Back 83

body temperature, pulse and respiratory rates, and blood pressure

Front 84

fifth new vital sign—

Back 84

smoking status—

Front 85

Patient Preparation and Instruction for vital signs

Back 85

Seat patient in upright position, at eye level for instruction.
Explain the vital signs and obtain consent.
Explain how vital signs can affect dental hygiene and dental treatment.
Teach the patient to refrain from eating, drinking, or smoking before the vital signs are taken.
During the process, explain each step as needed by the individual patient.

Front 86

Factors That Alter Body Temperature

Back 86

Time of Day. Highest in late afternoon and early evening; lowest during sleep and early morning.
Temporary Increase. Exercise, hot drinks, smoking, or application of external heat.
Pathologic States. Infection, dehydration, hyperthyroidism, myocardial infarction, or tissue injury from trauma.
Decrease. Starvation, hemorrhage, or physiologic shock.

Front 87

Temperature Over 41.0°C (105.8°F)
what do you do?

Back 87

Treat as a medical emergency.
Transport to a hospital for medical care.

Front 88

Temperature 37.6° to 41.0°C (99.6°C to 105.8°F

what do you do?

Back 88

Check possible temporary or factitious cause, such as hot beverage or smoking, and observe patient while repeating the determination.
Review the dental and medical history.
Postpone elective oral care when there are signs of respiratory infection or other possible communicable disease.

Front 89

An unusually fast heartbeat (over 100 beats per minute in an adult) is called

Back 89

tachycardia

Front 90

unusually slow heartbeat (below 50) is

Back 90

bradycardia

Front 91

Increased Pulse. Caused by

Back 91

exercise, stimulants, eating, strong emotions, extremes of heat and cold, and some forms of heart disease

Front 92

Decreased Pulse. Caused by

Back 92

sleep, depressants, fasting, quieting emotions, and low vitality from prolonged illness

Front 93

The pulse may be felt at several points over the body.

Back 93

Radial pulse: at the wrist

Other sites convenient for use in a dental office or clinic are the temporal artery on the side of the head in front of the ear, or

the facial artery at the border of the mandible.

Carotid pulse: used during cardiopulmonary resuscitation for an adult.
Brachial pulse: used for an infant (Figure 8-3).

Front 94

While taking the pulse, observe the following:

Back 94

Rhythm: regular, regularly irregular, irregularly irregular.

Volume and strength: full, strong, poor, weak, thready

Front 95

A pulse rate over ? is considered abnormal for an adult

Back 95

100

Front 96

The function of respiration is to

Back 96

supply oxygen to the tissues and to eliminate carbon dioxide.

Front 97

Increased Respiration. Caused by

Back 97

work and exercise, excitement, nervousness, strong emotions, pain, hemorrhage, shock

Front 98

Decreased Respiration. Caused by

Back 98

sleep, certain drugs, pulmonary insufficiency

Front 99

Factors to Observe for Observing Respirations

Back 99

Depth. Describe as shallow, normal, or deep.
Rhythm. Describe as regular (evenly spaced) or irregular (with pauses of irregular lengths between).
Quality. Describe as strong, easy, weak, or labored (noisy). Poor quality may have an effect on body color; for example, a bluish tinge of the face or nailbeds may mean an insufficiency of oxygen.
Sounds. Describe deviant sounds made during inspiration, expiration, or both.
Position of Patient. When the patient assumes an unusual position to secure comfort during breathing or prefers to remain seated upright, mark records accordingly.

Front 100

is the peak or the highest pressure. It is caused by ventricular contraction. The normal ? is less than 120 mmHg

Back 100

Systolic pressure

Front 101

is the lowest pressure. It is the effect of ventricular relaxation. The normal ? pressure is less than 80 mmHg

Back 101

Diastolic pressure

Front 102

Blood pressure depends on

Back 102

Force of the heartbeat (energy of the heart).
Peripheral resistance; condition of the arteries; changes in elasticity of vessels, which may occur with age and disease.
Volume of blood in the circulatory system.

Front 103

Factors That Increase Blood Pressure

Back 103

Exercise, eating, stimulants, and emotional disturbance.
Use of oral contraceptives; blood pressure increases with age and length of use.

Front 104

Factors That Decrease Blood Pressure

Back 104

Fasting, rest, depressants, and quiet emotions.
Such emergencies as fainting, blood loss, shock

Front 105

Normal body temperature oral?

Back 105

Normal 37.0°C (98.6°F)
Normal range 35.5° to 37.5°C (96.0° to 99.5°F)

Front 106

Normal Pulse rate?

Back 106

Normal range 60 to 100 per minute

Front 107

Respiration Normal range?

Back 107

Normal range 14 to 20 per minute

Front 108

Normal blood pressure?

Back 108

120/80

Front 109

Prehypertension

Back 109

120–139 80–89

Front 110

Hypertension
Stage 1
Stage 2

Back 110

stage 1 140–159/ 90–99
stage 2 >160/ >100

Front 111

Fever (pyrexia).

Back 111

Values over 37.5°C (99.5°F).

Front 112

Hyperthermia.

Back 112

Values over 41.0°C (105.8°F).

Front 113

Hypothermia

Back 113

Values below 35.5°C (96.0°F).