ppt 2

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SPECIAL PATIENT CARE
Chronic Obstructive Pulmonary Disease

Marge Buehner, RDA, RDH, MHSA

EXAMPLE PPT

Demographics

  • 68 year old African American female
  • Lives at home with husband
  • Patient 25 pounds over weight
  • Pre-diabetic using diet to control
  • Blood pressure 145/95 ras

Medical History

  • History of Rheumatic fever at age 9
  • Heart murmur with valvular regurgitation, mitral valve prolapse
  • Mitral valve replaced with “pig” valve 3 years ago
  • History of high blood pressure for 35 years
  • Mild stroke 2 years ago
  • Allergic to penicillin and codeine

Medical History

  • History of smoking for 40 years; smoke free for the last ten. Her history of smoking caused Chronic Obstructive Pulmonary Disease (COPD)
  • Physician prescribed patient to use supplemental oxygen constantly, patient chooses to use only while at home.

Medical Concerns

  • Mitral valve replacement need premed
  • Patient allergic to amoxicillin- must use Clindamycin 600mg , 30-60 minutes prior to appointment
  • High blood pressure-need to monitor at every appointment
  • Use of oxygen during every appointment

Medical Concerns

  • Chronic obstructive pulmonary disease (COPD) is comprised primarily of two related diseases - chronic bronchitis and emphysema. In both diseases, there is chronic obstruction of the flow of air through the airways and out of the lungs, and the obstruction generally is permanent and progressive over time.

Medical Concerns

  • Hypertension: Is an abnormal elevation of arterial pressure that can be fatal if sustained and untreated.
  • Excess body fat can play a role in severity and progression.
  • Stress and anxiety may increase BP

Medications

  • Vasotec (enalapril)
  • Capoten (captopril)
  • Lasix (furosemide)
  • Slow K (potassium chloride)
  • Lopressor (metoprolol)
  • Proventil (Albuterol)
  • Nitrostat (nitroglycerin)
  • Coumadin (warfarin)

Medications

  • Vasotec (enalapril)-angiotensin-converting enzyme (ACE) inhibitor
  • Capoten (captopril) -ACE inhibitor

ACE inhibitors blocks vasoconstriction mainly on arterioles which help lower blood pressure. Must monitor BP; possible orthostatic hypotension, syncope or dizziness.

Medications

  • Lasix (furosemide)-loop diuretic; Acts on loop of Henle to decrease the reabsorption of chloride and sodium with resultant diuresis. Dry mouth, orthostatic hypotension.

  • Slow K -supplemental potassium to prevent electrolyte imbalance while on loop diuretics.

Medications

  • Lopressor (metoprolol)-slective beta blocker; xerostomia, diarrhea, be careful when prescribing NSAID’s longer than 3 weeks
  • Beta blockers, also known as beta-adrenergic blocking agents, are a class of drugs that works by blocking the neurotransmitters, norepinephrine and epinephrine, from binding to receptors.
  • Proventil (Albuterol) inhaler -Beta 2 Agonist; xerostomia, taste alterations, discolors teeth

Medications

  • Nitrostat (nitroglycerin)- Artery and venous dilator; reduces left ventricular pressure, systemic vascular resistance
  • The principal pharmacological action of nitroglycerin is relaxation of vascular smooth muscle.

  • Coumadin (warfarin)- anticoagulant; mouth ulcers, taste disturbance
  • Anticoagulants act by inhibiting the synthesis of Vitamin K dependent clotting factors

Local Anesthesia Considerations

  • Patients with mild to moderate elevations in systolic or diastolic pressure are acceptable risks for dental care including use of local anesthetics with vasopressors.
  • The administration of vasopressors in patients with beta blockers increases the likelihood of a serious elevation of the blood pressure.

Nitrous Oxide Considerations

  • Medical consults for cardiac and pulmonary conditions.
  • N20 should not be used in severe COPD

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Dental History

  • Patient has a full upper denture and lower partial denture which she refuses to leave out at night.
  • Multiple lesions on hard and soft palate- denture stomatitis
  • Missing teeth: all maxillary teeth as well as #17, 29, 31 and 32
  • Lower anterior teeth are misaligned
  • Last perio maintenance was 4 years ago

Pictures

Radiographs

Periodontal Chart

Periodontal Charting

  • Heavy plaque
  • Heavy calculus and heavy bleeding upon probing
  • Moderate advanced periodontitis on remaining teeth
  • Remaining teeth have 4-5 mm pockets

Hygiene Care Plan

  • Root planing and scaling lower arch; re-eval in 4 weeks
  • Information and instructions on denture care
  • Modified Bass technique, flossing and use of end tuft brush for linguals of mandibular anteriors

Activity of Daily Living

  • Level 0-patient has the ability to perform ordinary daily tasks without assistance

OSCAR- Oral

  • Moderate supra and sub-g calculus
  • 25-50% bone loss on radiographs
  • Lower arch RP/S with anesthesia, w/o epinephrine
  • Denture stomatitis

ASA Classification

  • ASA III-systemic disease which limits activity but is not incapacitating

OSCAR-Systemic

  • Medical Diagnosis
  • Mitral valve replacement
  • COPD
  • Hypertension
  • Medication allergies
  • Stroke-hx of

  • Pharmacologic Agents
  • Loop diuretic
  • Beta Blocker
  • Vasodialator
  • Beta 2 agonist
  • ACE inhibitor
  • Anticoagulant
  • Premed antibiotic
  • Electrolyte

OSCAR-Capability

  • Patient can function and contributes to self care
  • No problems with mobility

OSCAR-Autonomy

  • Patient cans make decisions for herself, is not dependent on a caregiver and can transport herself to the dental office

OSCAR-Reality

  • Patient is able to afford dental treatment and is medically stable, although brittle, for dental treatment.

Hygiene Care Delivery Considerations

  • Medical consult needed before treatment begins
  • Question MD about
  • Coumadin reduction
  • Antibiotic pre-med
  • Deliver care in semi-upright sitting position
  • Be sure oxygen tank is connected and patient is removed from personal equipment

References

  • GageTW, Pickett FA, (2003) “Dental Drug Reference”, Mosby, St. Louis, MO
  • Little JW, Falace DA, Miller CS, Rhodus NL, (2008), “Dental Management of the Medically Compromised Patient”, Mosby, St. Louis, MO
  • Wynn RL, Meiller TF, Crossley HL, (2007), “Drug Information Handbook for Dentistry, Lexi-Comp, Hudson, OH

References