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Theory DH 2 Test 2
Theory of Dental Hygiene Test 2 (Cancer-Psycohological)
| Question | Answer |
|---|---|
| what is the treatment for fungal infections? | diflucan- 2 tablets on day one and then one tablet for 6-13 days sporonox- swish and swallow 200 mg for 7-14 days nystatin- 4 ml taken 4-5 times daily for two weeks |
| where do viral infections happen? | can occur on non keratinized as well as keratinized tissue |
| what are the antiviral drugs? | acyclovir, famcicolovir, valacyclovir |
| patients must be pre-medicated with antibiotics if absolute neutrophil count is less than | 2000 mm3 |
| when does permanent xerostomia result? | doses greater than 3000 gray |
| what fluoride should be avoided in radiation caries fluoride treatment? | APF |
| what is stage I cancer? | localized and confined to the organ of origin |
| what is stage II cancer? | disease is regional, affecting nearby structures |
| what is stage III cancer? | disease extends beyond the regional site, crossing several tissue planes |
| what is stage IV cancer? | disease is widely disseminated |
| in the maxilla how long should you wait until initiation of chemotherapy before extraction | 5 days |
| in the mandible how long should you wait until initiation of chemotherapy before extraction | 7 days |
| what does mucositis produce? | red, raw and tender oral mucosa with epithelial sloughing similar to a severe oral burn |
| how do you manage a patient with mucositis? | bland mouth rinse to keep ulcerated areas as clean as possible topical anesthetics or antihistamine to provide pain control antmicrobial rinse such as chlorhexidine diet consisting of soft foods |
| what is the most common type of candida found in cancer patients? | pseudomembranous candidiasis, white plaques that are easily scraped off and leave behind petechial hemorrhages |
| what are the high risk sites of the mouth for cancer? | floor of the mouth, lateral portion of the tongue, ventral portion of tongue, soft palate |
| where do sites have a greater risk of metastasizing from? | floor of mouth, tongue and posterior sites macillary region |
| what is radiation therapy? | once or twice per day, five days per week, over 6-7 weeks damages cancer cell DNA and chromosomes needed for cell replication |
| what is chemotherapy? | series of cycles, intensive treatment over several days with period of rest and recovery |
| when should third molars be extracted before chemotherapy? | 10 days |
| what are the oral complications seen in chemo and radiation therapy? | mucositis, infection, xerostomia, rampant decay, taste alterations |
| what is the WHO grad O oral mucositis assessment? | no changes |
| what is the WHO grade 1 oral mucositis assessment? | soreness with erythema |
| what is the WHO grade 2 oral mucositis assessment? | erythema, ulcers, can eat solids |
| what is the WHO grade 3 oral mucositis assessment? | ulcers, liquid diet only |
| what is the WHO grade 4 oral mucositis assessment? | alimentation not possible (can't eat or drink) |
| what is the only FDA approved agent for mucositis prevention? | Kepivance (Palifermin) 60 mcg/kg/d |
| at what absolute neutrophil count does AHA recommend antibiotic prophylaxis? | 1000-2000 mm3 |
| When does spontaneous mucosal bleeding occur? | platelet count is below 20,000 mm3 |
| when is it safe to do routine dental care for platelet count? | 75,000 |
| how is saliva altered after radiation therapy? | reduced in volume, altered in consistency, pH, immunoglobulin concentraiton |
| what can you coat your lips with? | vitamin E oil, bees wax, aloe vera gel, hydrous lanolin, coca butter, avoid petrolatum |
| how long should fluoride be applied to cancer patient's teeth? | must be applied to the teeth daily for the rest of the patient's lifespan |
| what type of fluoride should you avoid when treating a cancer patient | APF |
| what are the more potent bisposponates? | pamidronate and zoledronate |
| how often do you need to see a cancer patient after therapy? | first 2 years every 1-3 months three or more years- every 3-6 months |
| what is the recall interval for someone who went through radiation therapy? | three month recall forever |
| what is the recall interval for someone who went through chemo therapy | three month recall until stable |
| what is a stroke? | caused by the interruption of blood supply and oxygen to the brain as a result of ischemia or hemorhage |
| what is the most important risk factor for intracerebral hemorrhagic stroke? | hypertension |
| what is a transient ischemic attack? | mini stroke that is caused by a temporary disturbance in blood supply to a localized area of the brain associated with numbness of face, arm or leg on one side the of the body (hemiplega) |
| what is a ischemic neurologic deficit? | similar to a transient ischemic attack but does not clear within 24 hours |
| what is stroke in evolution | neurologic condition that is caused by occlusion or hemorrhage of a cerebral after that has been present for several hours and continues to worsen |
| what characterizes right sided brain damage? | paralyzed left side, spatial perceptual deficits, impaired through process, quick impulsive behavior, inability to use a mirror, difficulty performing tasks, memory deficits for generalized things, neglect left side |
| what characterizes left sided brain damage? | paralyzed right side, language and speech problems, decreased auditory memory, slow, cautions behavior, memory deficits that are language based, anxiety |
| what are the risk factors for stroke? | hypertension, congestive hurt failure, diabetes mellitus, age 75 or greater, hypercholesterolemia, coronary atherosclerosis, smoking |
| what is a good INR ration for noninvasive dental procedures? | 3.5 or less |
| when does an ischemic event occur by thrombosis? | occurs when a blood clot forms in an artery and blocks blood flow to the brain, plaque blocks and clot forms symptoms within 72 hours |
| when does embolism occur? | blood clot or a piece of plaque which formed in another vessel in the body, breaks away and flows through the bloodstream to the brain, lodges and blocks symtoms occur within 10-30 seconds |
| when does a hemorrhagic stroke occur? | an artery in the brain tears or bursts causing bleeding int the brain tissue |
| what causes a transient ischemic attack? | micro emboli that breaks off from atherosclerotic plaque lesions |
| what is aphasia? | affects all a sects of communication difficulty speaking, understanding, reading and writing |
| what is sensory or fluent aphasia? | loss of ability to comprehend written printed or spoken words |
| what is motor or confluent aphasia? | inability to write or make sounds of speech |
| what is apraxia? | client can conceive or conceptualize the content of the message to send to the muscles but motor patterns but motor patterns cannot be reconstructed, instructions do not reach the limb from brain |
| what is agnosia? | inability to recognize familiar objects through the sense, sees object but is unable to recognize or attach meaning to it |
| what is dysarthria? | imperfect articulation that causes difficulty in speaking, weakness or paralysis of the muscles of the lips, tongue and larynx understands language but has difficulty pronouncing words and may slur or enunciate poorly |
| what is homonymous hemianopia? | visual loss in the same half of the visual field of each eye, client only has half or normal vision, cannot see past the midline without turning the head |
| do you need a medical consult for Plavix? | No |
| Plavix is also know as | clopidogrel |
| When might a med consult be warranted on a patient taking Plavix? | if patient has a deposit classification of C or D and gingival tissue bleeds easily and has severe gingivitis |
| what is the safest local anesthetic to use on a cardiovascular patient? | Mepivacaine or Carbocaine |
| what is the epinephrine dosage you would use on cardiovascular patient? | 1:100,000 1:200,00 avoid gingival retraction cord impregnanted with epinephrine |
| what can you not prescribe for patients taking warfarin? | arestin, metronidazole, tetracycline, minocycline, these all will increase INR by inhibiting metabolism of warfarin |
| what is pradaxa? | anticoagulant that needs a medconsult |
| what is an intracerebral hemorrhagic stroke? | occurs when there is bleeding in brain tissue itself |
| what is an subarachnoid hemorrhagic stroke? | bleeding into the subarachnoid space |
| where is the atherosclerotic plaque located if found in a radiograph? | C3-C4 about 45 degrees angle to the mandible |
| complete lesion | complete transection or compression of the spinal cord leaves no sensation or motor function below the level of the lesion |
| incomplete lesion | partial transection or injury of the spinal cord leaves some evidence of sensation of motor function below the level of the lesion |
| what happens in an injury of C1-C3 | neck and facil muscles, use a ventilator for breathing |
| what happens in an injury of C4 | upper trapezius diaphrgam, may or may not be a ventilator |
| what happens in an injury of C5 | biceps, independence with personal oral care is possible with assistance |
| what happens in an injury of C6 | ability to extend wrists and straighten elbows, wrist extensors, needs less adaptive aids for oral self care, assists in wheel chair transfer |
| what happens in an injury of C8 | strong grip, no precision finger movement, finger flexors can manage oral care without assistance or adaptive aids |
| what happens in an injury of T1-T6 | has finger abductors, full use of upper extremities, lack abdominal muscles |
| what happens in an injury of T7-T12 | partial to full abdominals, trunk control better sitting balance |
| what is ASA I | no stroke factors, no modifications needed |
| what is ASA II | one or more stroke risk factors, refer to physician for medical treatment |
| what is ASA III | history of one or more TIAs or stroke at least 6 months before dental treatment |
| what is ASA IV | history of multiple TIA's or stroke within 6 months of dental treatment |
| what is the normal prothrombin time? | 12-14 seconds over 35 seconds need possible modification |
| what should you avoid administering with warfarin or coumadin | metronidazole, teracycline, erythromycin, doxycycline, bactrim may increase INR by inhibiting the metabolism of Coumadin |
| what antibiotics is it okay to use with coumadin or warfarin | amoxicillin, penicillin and clindamycin |
| when should ASA III or ASA IV stroke prone patients be seen? | during mid morning |
| is there a relationship between periodontal disease and hemorrhagic stroke? | no causal relationship but there is a relationship between ischemic strokes |
| what is an L1-L2 injury? | may be able to ambulate using orthotic and other devices |
| what are the five levels of complete/incomplete spinal cord injury | A: complete injury B: might have a little bit of sensation below level of injury C: have to have if they want to walk again, some movement and some sensation D: more movement and sensation E: no injury |
| what level of injury can autonomic dysreflexia happen on | T6 |
| when a patient has a neurogenic bowel, when should you schedule a dental appointment | 24 hours after bowel program |
| how often should patients shift their weight to prevent pressure sores? | 15-30 minutes |
| what is stage 1 pressure sore | superficial damage to epidermal and dermal layers |
| what is stage 2 pressure sore | damage to epidermal and dermal layers, adipose tissue |
| what is stage 3 pressure sore | damage to epidermal and dermal layers adipose tissue and muscle |
| what is stage 4 pressure sore | damage to soft tissue to depth of bone, may include bone |
| where is the cough inadequate in spinal cord injuries? | T8 or higher |
| when do you not use a trophy jet or ultrasonic for a spinal cord injury? | C4 and above |
| what level is tetraplegia at | T1 |
| what level is paraplegia at | T2 |
| what is a normal field of vision | 50 superior 90 laterally 70 inferiorly 60 medially |
| what is considered legally blind? | 20/200 visual field is 20 degrees or less |
| what is myopia? | near sightedness, see objects more clearly when they are close to the eye while distant objects appear blurred |
| what is hyperopia? | far sightedness, an abnormal condition of the eye in which vision is better for distant objects than for near objects |
| what is presbyopia? | inability to accommodate for near vision |
| what is astigmatism? | uneven curvature of the cornea, light rays in the horizontal and vertical planes do not focus at the same point |
| what is diplopia? | double vision |
| what is glaucoma? | eye condition that develops when too much fluid pressure builds up inside of the eye causing intraocular pressure that damages the optic nerve |
| what is the incidence of glaucoma? | higher in black individuals, 45-65 years of age hypertension, diabetes, obesity and trauma |
| what is the signs and symptoms of glaucoma? | increased ocular pressure, decreased peripheral vision, colored halos around lights |
| what are cataracts? | clouding or opacity of the lens, leads to gradual painless blurring and loss of vision primary cause of reduced vision and blindness worldwide |
| what is the incidence of cataracts? | age related, occurs around age 50, not preventable tranatic or secondary (systemic disease) |
| what is macular degeneration? | degenerative process that affects the macula and surrounding tissues wet form and dry form, results in central visual deficits |
| what is the most common cause for blindness for people over age 65 | macular degeneration |
| what is wet macular degeneration? | brittle vessels break down and new abnormal vessels grow under the macula called choroidal neovascularization these vessels leak blood and fluid and leads to damage of the macula |
| what is the dry form of macular degeneration? | occurs when the blood vessels under the macula become thin and brittle drusen (small, yellow deposits) form under macula and they create a blurred central vision |
| what is the signs and symptoms of macular degeneration? | loss of central vision, see dark spots, missing areas, or distorted wavy lines, decreased ability to distinguish colors |
| what are the signs and symptoms of cataracts? | gradual painless blurring and loss of vision, peripheral vision affected first, near vision improves, glare at night and in bright light, halos around lights, loss of ability to discriminate between color |
| what is diabetic retinopathy? | result of damage caused by diabetes to the small blood vessels located in the retina, blood vessels are weakened causing mcroanuerysm to protrude from the vessel wall and leak blood onto back of eye and blocks vision |
| what are the signs and symptoms of diabetic retinopathy? | blacks spots or floaters, complete loss of vision, eventual decrease in central vision |
| what is conductive hearing loss? | interference of sound transmission through the external ear and middle ear sound is perceived as faint or distant but relatively clear and can be corrected by medical treatment |
| what is sensorineural hearing loss? | impairment o the function of the inner ear, the 8th cranial nerve or the brain sound is distorted and faint usual permanent and cannot be corrected with medical or surgical treatment |
| what are people who have conductive hearing loss like? | voice quality soft voice, environmental noise hearing improved, speech discrimination good, ability to hear on telephone good |
| what are people who have sensorineural hearing loss like? | voice quality is loud, environmental noise hearing made worse, speech discrimination is poor, ability to hear on telephone is poor |
| what patient use hearing aids | conductive hearing loss |
| what is meniere's disease? | caused by excess amounts of clear intracellular fluid in the vestibular and semicircular canals most common manifestation is vertigo |
| what is otitis extern? | bacterial or fungal infections of the external ear |
| what is otitis media? | most prevalent disorder of the middle ear |
Created by:
Chobchi
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