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NBDHE Medical Conditions bext Study
Guide
ASA I -
โ Normal healthy patient ASA II - โ Patient with mild systemic conditions:
- allergies
- controlled hypertension
- asthma
- diabetes without systemic effects
- cigarette smoking WITHOUT chronic obstructive pulmonary disease (COPD)
- BMI of 30- 39
- Pregnancy with NO other systemic conditions ASA III - โ Patient with severe systemic diseases and some functional limitation
- Controlled disease of more than one body system
- controlled congestive heart failure (CHF)
- stable angina
- poorly controlled hypertension
- morbid obesity
- chronic renal failure
- Respiratory problems (COPD)
- BMI 40+ ASA IV -
โ Patient with severe systemic disease that is a constant threat to life
- Possible risk of death
- unstable angina
- symptomatic COPD
- symptomatic CHF
- Hepatorenal failure ASA V - โ Moribund patient not expected to survive for more than 24 hours without surgery ASA VI - โ Brain-dead patient Normal BP - โ Systolic <120 mmHg Diastolic <80 mmHg Elevated BP - โ Systolic 120-129 mmHg Diastolic <80 mmHg Hypertension stage 1 - โ Systolic 130-139 mmHg Diastolic 80-89 mmHg Hypertension stage 2 - โ Systolic >140 mmHg Diastolic >/= 90 mmHg Hypertensive crisis -
Coronary artery disease - โ - Characterized by decreased blood flow and oxygen to the heart muscles
- Caused by build-up of plaque in arterial walls Angina pectoris - โ - Chest pain due to decreased blood flow
- Most common symptom of coronary heart disease
- Pain radiates through chest, neck, jaw, back, shoulder, and arm
- Last a short time (5 minutes or less)
- Relived with rest, oxygen, or nitroglycerine
- NTG relaxes smooth vascular muscles; up to 3 tablets in 15 minutes Myocardial infarction - โ - Heart attack
- Death of parts of heart muscles caused by ischemia
- Damages are permanent
- Pain in chest, neck, jaw, shoulder, back or arm
- Sweating, nausea, weakness, irregular heartbeats, and shortness of breath
- Should last shorter than 20 minutes
- Delay dental tx for 6 months after heart attack Dental treatment should be delayed for how long after heart attack? - โ 6 months Congestive heart failure (CHF) - โ - Heart's pumping power is weaker and cannot provide enough oxygen, blood, and nutrients to the body
- Blood backs up into parts of the heart "congestive"
- Left ventricle failure: fluids from blood leak into the lungs
- Right ventricle failure: extremities (abdomen, hands, feet) start to swell
- Avoid air polishers and power scalers
- Digoxin can exacerbate gag reflex and hypersalivation
- Vasoconstrictors should be avoided in patients taking digoxin, could cause cardiac arrhythmias Meds used to treat congestive heart failure - โ Digoxin, digitalis, spironolactone, ACE inhibitors, beta-blockers, and diuretics Should be avoided in congestive heart failure - โ Power scalers and air polishers Vasoconstrictors should be avoided when taking digoxin due to it causing - โ Cardiac arrhythmias Arrhythmias - โ - Abnormal electrical conduction to heart muscles
- Heart requires pacemaker or implanted defibrillator
- Newer cardiac pacemakers are shielded; ultrasonic and piezoelectric scalers are safe
- Epinephrine can worsen arrhythmias
- Can use Lidocaine w/o epi Coronary artery bypass surgery graft (CABG) - โ Healthy blood vessels from leg, arm, chest, or abdomen are connected to arteries of the heart to bypass the diseased or blocked aarea Angioplasty-stent - โ Tiny balloon is inserted and inflated where the artery is clogged to widen it; often combined with placement of small wire mesh tube called a stent to keep the artery open Antiplatelet medications -
Thrombotic stroke - โ Blood clot (thrombus) forms in one of the arteries of the brain Embolic stroke - โ Blood clot or other debris in the body travel through the bloodstream, ends in a narrower brain artery and blocks it Hemorrhagic stroke - โ Blood vessel is ruptured in the brain Risk factors for stroke - โ Hypertension, atherosclerosis, diabetes, coronary disease, obesity Do not treat a person after stroke for how long? - โ 6 months Seizure - โ - A single occurrence where nerve cell activity in the brain becomes disrupted
- Uncontrolled electrical activity in the brain
- Produces convulsion, thought disturbance, abnormal behavior Epilepsy - โ Neurological condition characterized by two or more unprovoked seizures Petite mal seizure (generalized absence) - โ Sudden pause with the patient staring into space Usually lasts around 10 seconds Grand mal seizure (tonic-clonic) -
โ Loss of consciousness accompanied by tonic convulsions (voluntary muscles continuously contract - body becomes stiff) followed by clonic movements (intermittent muscle relaxation and contraction - body shakes) Lasts 1-3 minutes Atonic - โ Brief loss of muscle tone Lasts less than 15 seconds Stages of epilepsy - โ 1. Aura stage
- Tonic stage
- Clonic stage
- Postictal stage Depression - โ Hormone and chemical imbalance that can provoke sadness, insomnia, memory difficulty, etc Schizophrenia - โ Condition caused by excessive dopamine and serotonin levels Symptoms include: hallucinations and disordered thoughts Obsessive-compulsive disorder (OCD) - โ Unreasonable thoughts that lead to repetitive behaviors or compulsions Alcohol dependency - โ - Suffer from malnutrition, especially thiamine B-1 and folate B-9 deficiency
- Alcohol and tobacco causes increase the risk of oral cancer
- Xerostomia, taste impairment, and increased caries risk
Meth mouth - โ Term for damaged teeth and oral health Teeth are described as, "blackened, stained, rotting, crumbling or falling apart" Rampant caries Ecstasy (MDMA) - โ - Dry mouth
- Higher the dose of the drug, the more severe the dry mouth
- Cavities and gum disease
- Bruxism Marijuana - โ - Psychoactive herb
- Cavities, gum disease, oral cancer Anemia - โ Drop in oxygen-carrying hemoglobin in red blood cells Iron-deficiency anemia - โ Caused by iron deficiency Pernicious anemia - โ Caused by vitamin B-12 (cobalamin) deficiency triggered by lack of intrinsic factor "Bald" tongue Intrinsic factor is secreted by ___________ _____ of stomach and helps the absorption of vitamin B-12 in small intestine - โ parietal cells
Folate deficiency anemia - โ Caused by B-9 (folic acid) deficiency Sickle cell anemia - โ - Abnormal (sickle-shaped) red blood cells
- Get stuck in small blood vessels
- Slow/block blood flow and oxygen to the body
- Hair-on-end on radiographs due to loss of trabeculae
- Weakness, pallor, impaired memory, paresthesia of hands and feet, fatigue
- Paleness of oral tissues, ulcerations, glossitis (swollen, red, smooth tongue)
- Loss of papillae on dorsum of tongue Hemophilia - โ - Disorder in blood coagulation resulting in prolonged bleeding
- Plasma proteins involved in coagulation cascade for conversion of fibrinogen to fibrin are insufficient
- Spontaneous gingival bleeding, hematoma, and ecchymosis Von Williebrand Disease - โ - Genetic condition causes extended or excessive bleeding
- Von Williebrand factor is protein for blood clotting
- Red/blue discoloration of skin or mucosa, excessive bleeding, frequent nosebleed, easy bruising Leukemia - โ - Cancer of body's blood-forming tissues, including bone marrow and lymphatic system
- Excessive number of abnormal white blood cells
- Fatigue, unexplained bruising, infections, paleness, weight loss
- Oral conditions: gingival enlargement, necrotizing ulcerative gingivitis, bleeding gums, pallor of lips and gingiva, petechiae and ecchymosis of palate
- Events occur usually in intervals of 21 to 27 days
- Fever, malaise, sore throat, and occasional cutaneous infections
- Episodes of neutropenia will lead to severe periodontal disease (inflamed gingiva, attachment loss, bone loss, tooth mobility, and tooth loss) and ulceration
- Preventative antibiotic therapy can protect against secondary opportunistic infections Neutrophils make up to __________ of circulating white blood cells and serve as primary defense against infections - โ 60 - 70% The normal neutrophil count is ___________________ per microliter of blood - โ 1500 - 8000 Dental treatment should be initiated when circulating neutrophil count is - โ Normal Prothrombin (PT) - โ Blood test used to evaluate clotting function and monitor anticoagulant therapy with warfarin (Coumadin) Normal PT (prothrombin) - โ 11 - 13.5 seconds Partial thromboplastin time (PTT) - โ Evaluates blood clotting ability of the body Normal range for PTT is - โ 25 - 35 seconds In healthy patient, INR is -
Patient on warfarin are often treated with a therapeutic INR goal of - โ 2.0-3. MD consult recommended for INR of - โ >3. Patients with INR value of ____ and higher are at particularly high risk for prolonged bleeding - โ 3. Cerebral palsy - โ Caused by an abnormality of disruption in brain development, usually before a child is born Symptoms of cerebral palsy include - โ Lack of controlled muscle movements and involuntary muscle movements Oral conditions of cerebral palsy - โ - Drooling, gag reflex, difficulty opening mouth
- Gingival hyperplasia from seizure medications
- Trauma on oral cavity from repeated falling, bruxism, attrition
- Mouth breathing, tongue thrusting, TMJ issues
- High risk for caries and periodontal diseases Injury site C-2, C- 3 - โ limited head and neck movement, patient depends on ventilator Injury site C- 4 -
โ Latex Bell's palsy - โ - Unilateral facial muscle paralysis affecting the 7th
- Potential causes: viral infections, trauma, fever, tooth extractions Symptoms of Bell's palsy include: - โ Unilateral facial paralysis, drooling, inability to close the eye on the side affected Myasthenia gravis - โ - Autoimmune disease caused by the breakdown in the communication between the nerves and muscles
- Weakness in voluntary muscles
- Respiratory muscles can become affected causing serious breathing problems
- Drooping eyelids, slurred speech, difficulty breathing, and walking Lupus Erythematosus - โ - Autoimmune disease-causing damage to the joints, skin, kidneys, heart, lungs, blood vessels, and brain
- Triggered by ultraviolet rays, medications, viruses, stress
- A butterfly-shaped rash on the nose unfolding across both cheeks Multiple sclerosis - โ - Immune system attacks myelin sheath covering the nerves, disrupting the communication between brain and body system
- Mostly young adults
- Treat patients during remission
- Fatigue, slurred speech, muscle spasms, short-term memory loss
- Heat sensitivity
Muscular dystrophy - โ - Genetic disease which muscle fibers are unusually susceptible to damage
- Duchenne syndrome: Affects infants and young children (ages 3-5), especially males ---Weakness starts with lower body, then spreads through whole body ---Children are unable to walk by the age of 12, and life expectancy is around 25 Osteoarthritis - โ - Damage to the cartilage of the joints
- Enough damage results in bone grinding directly on bone
- Most common type of arthritis in US Rheumatoid arthritis - โ - Damage to the lining of the joint capsule
- Destroy cartilage and bone within the joint
- Joint tenderness, swelling, and stiffness that worsens with age Marfan syndrome - โ - Genetic disorder that affects the body's connective tissue
- Patients usually very thin, tall, and often have heart problems
- High palate, narrow jaw, crowding of teeth, and malocclusion ALS (Amyotrophic lateral sclerosis) - โ - Lou Gehrig's disease
- Progressive neurodegenerative disease that affects motor neurons from brain to spinal cord
- Leads to death
- Ages 40- 60
- Muscle weakness, twitching, shortness of breath, etc. Crohn's disease -
โ - Chronic inflammatory respiratory disease in which the airways narrow, swell, and produce extra mucus
- Triggered by stress, allergies, or exercise
- Mostly diagnosed in childhood/adolescence
- Symptoms: difficulty breathing, tightening of chest, wheezing, and cyanosis
- Albuterol (Ventolin, Proventil) for quick relief
- Oral conditions: oral candidiasis and xerostomia
- Avoid ultrasonic scalers and air polishers Patients with asthma have higher risk for allergy to - โ Aspirin Asthma is the only respiratory disease where.... - โ nitrous oxide is recommended chronic obstructive pulmonary disease (COPD) - โ Group of lung diseases that block airflow in the lungs
- Most common in adults and conditions are chronic
- Shortness of breath, cough, sputum, and wheezing
- Oral candidiasis and xerostomia
- Avoid ultrasonic scalers and air polishers
- Avoid nitrous oxide Chronic bronchitis - โ (Blue bloaters) Category of COPD Inflammation of bronchial tree which secretes excess mucous Emphysema - โ (Pink puffer) category of COPD
Air sacs (alveoli) at the end of the smallest air passages (bronchioles) in the lungs are gradually destroyed Barrel chest Cystic fibrosis - โ - Lungs produced abnormally thick and sticky mucous that blocks alveoli and can become infected
- Persistent coughing or wheezing, and weight loss Insulin - โ Hormone needed to convert sugar, starches, and other food into energy for daily life Produced in pancreas Type I Diabetes - โ - The body cannot produce insulin
- Autoimmune destruction of pancreatic Beta cells
- Three P's: polydipsia, polyuria, and polyphagia Ketoacidosis - โ - When the body cells do not get the glucose needed for energy, the body burns fat, which produces ketones
- Ketones are acids that circulate in blood = toxic
- Lowers pH of blood and can lead to coma or death (Normal pH is 7.4 but can lower to 7 in ketoacidosis)
- High blood sugar, low insulin level Ketoacidosis is characterized by - โ Smell of a person's breath, referred to as fruity breath Treatment for type I diabetes -
