Physical Evaluation Part 2.0

Transcription

1 Introduction to Physical Evaluation Part 2

2 Medical History Patient must check off each box. No lines to be drawn down a column. Obtain additional info from patient on any yes answer. Make sure that you and the patient have signed the back of the medical history form.

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7 the English translation following the Spanish

8 RED For all yes answers in the health history

9 Always answer YES Adjacent to the correct medical alert type Medical Alert type is now present in the UR ALERTS BOX

10 Review Medical History Form Review the form with the patient --- any YES answer needs follow up info. You can write comments on the paper form and then transfer them into to the comment section in AxiUm. USC has a system by system medical history form

11 At times, you may need to Update the Medical Alert box

12 Medical Alerts: to add or delete info, right click in the box most yes answers are automatically placed in the alert box for you some conditions will require you to manually place info in the box

13 Right click on computer mouse when in the medical alerts box

14 HIGHLIGHT the MEDICAL Alert and use the arrows in the center box to move from left to right move from right to left for any conditions that no longer belong in the medical alerts. This is showing that an allergy to Ibuprofen is being added to the alerts.

15 The system by system review starts off with cardiovascular

16 American Heart Association Guidelines for Prophylactic Premedication In 2007, the AHA updated their guidelines for patients who require antibiotic premedication prior to invasive dental procedures Amoxicillin 2.0 grams one hour prior to the invasive procedure is the recommended drug of choice for adults

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18 AHA Guidelines What if the person has an allergy to Penicillin? Clindamycin 600 mg one hour prior to the dental procedure

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23 CV High B/P: limit of 2 carps of Lidocaine with epinephrine Heart attack: NO SEE for 6 months Stroke: NO see for 1 month, discover what side was affected Angina: exercise or stressed induced Cholesterol: current lab level

24 CVA/Stroke If the right side of the brain is damaged, there will be paralysis on the left side of the body --- thought, memory and spatial relations may be impaired. If the left side of the brain is damaged, the right side of the body will be affected problems with speech, language and memory. This will affect how you communicate with and educate your patient.

25 If patient is on anticoagulant meds:1 minute test if bleeding is excessive stop, manage and advise patient that a medical consult may be needed meds like Plavix, Aspirin, Coumadin. PT/PTT, etc.. Lab results for INR, plts,

26 Bleeding/Clotting Labs PTT Ref range = seconds PT Ref. range = seconds INR Ref range mg/dl

27 Anticoag meds and dentistry Evidence suggests that stopping oral anticoag meds is not necessary in patients requiring low-risk dental procedures and may actually increase thrombosis risk. Local measures can be effective at controlling bleeding.

28 Endocrine Freq hunger/thirst: ask about diabetes Diabetic: type? Remind them to eat prior to all apts. Current HgbA1C? Cancer: type? HIV: when dx? Current CD4 count and viral load, on meds? Organ transplant: what kind? When? Blood transfusion: when?

29 Chemo? If a patient is on chemotherapy, a physical evaluation update is needed with phys eval faculty. A medical consult needs to be sent to the physician/oncologist. Treatment may need to be completed in the Special Patient Clinic.

30 HIV/Immunocompromised Patients Recent lab tests must be within last 3 months. Viral Load must be less than 50. Absolute Neutrophil Count greater than 500. Platelet count greater than 60,000 CD4 greater than 200 If the lab test is not current or the values fall outside the recommendations, call phys eval faculty.

31 Diabetic Patients Well Controlled? Medicines and doses? Monitor glucose levels at home? Often see MD? Hemoglobin A1C test result?

32 Hgb A1 C Results

33 Implants and Diabetics If the diabetes is well controlled, ok for implant placement but final say lies with Oral Surgery and/or Perio

34 The End of Part 2