Signature assignment Health, Medicine, Nursing Essay

I will attach the directions for the essay. I have written in blue exactly what needs to be written for each subheading, you will just need to revise it and write it in better wording.

Instructions for the written case study:

1.  Use APA format with all resources cited (including in text citations) and a cover page titled Signature Assignment

1. In paragraph form using medical terminology and college level writing, provide information under the following subheadings
   
   
   1. Patient Case – describe your patient as you would introduce them in your first check-in in clinic. Include vitals, and smoking status. Include ASA and hypertension stage.  You may have to create some information that would logically fit with your patient such as medications, oral conditions, etc.
   
   

   -Emily Talasazan is a 52- year old female who has not been to the dentist for the past 5 years. Her chief complaint is that she does not like the stains that are present on her teeth and has sensitivity to cold in the UL molars. Emily has been smoking for the past 35 years. Her vitals are BP: 152/92mmHg (LAS); P: 78 BPM; R:18 RPM; T: 98.2 F; SS: Current. She weights 125 lbs with a height of 5’3 and a BMI of 22.  She is classified as ASA III due to her hypertension stage 2 and her severe dental anxiety.

1. b.   Medical conditions – research the pathophysiology and discuss in detail all of the medical conditions that your patient presents with. Include appropriate questions you would ask your patient during the health history review.  
   
   
   1.   Emily presents with severe dental anxiety, cirrhosis, GERD and is currently an alcoholic.  The questions I would ask my patient are When was your last visit with your physician?
   
   
   2. When were you diagnosed with hypertension?
   
   
   3. Do you have primary or secondary hypertension?
   
   
   4. When was the last time you had your blood pressure checked?
   
   
   5. How frequently do you monitor your blood pressure?
   
   
   6. Have you taken your medication today?
   
   
   7. How long have you been prescribed this medication?
   
   
   8. Have you experienced any side effects?
   
   
   9. Are you following a specific diet and exercise regimen?
   
   
   10. How do you feel today stress of anxious?
   
   

1. Medications – describe all medications the patient is taking, any side effects and any oral conditions that could occur.  SOAP one of the medications. 

   Emily currently is on two medications. One is Furosemide which is to treat high blood pressure. She takes 40 mg once a day. There is no oral conditions that could occur with this medication however there is one adverse effect that could affect her which is orthostatic hypotension.

The second medication that she is on is Tagament is used to treat her GERD. She takes 800 mg once daily at bed time. This medication as well does not have any oral conditions that can occur.

1. Oral Manifestations – include any oral manifestations that could occur from your patient’s conditions or medications. If there are none, write N/A

Since the patient has Alcoholic Liver Disease these are the oral complications that can arise are:

Poor oral hygiene

Oral neglect: caries, gingivitis, periodontitis

Glossitis

Angular or labial cheilosis

Candidiasis

Gingival bleeding

Oral cancer

Petechiae

Ecchymoses

Jaundiced mucosa

Parotid gland enlargement

Alcohol (sweet musty) breath odor

Impaired healing

Bruxism

Dental attrition

Xerostomia

1. Medical Emergencies – describe any possible medical emergencies you should be prepared for, what steps you would take to minimize the

possibility of an emergency occurring, and the proper WCU protocol if the emergency situation were to arise.

1.One possible medical emergency that I should be prepared for is if the patient arrives overdosed on alcohol. The symptoms that I would need to look for is alcohol breath odor confused, drunk appearance. That is when I would arrange for someone to take the pt home.

2. Another medical emergency that I should be prepared for this patient would be syncope.

Symptoms: nausea, anxiety, pallor, diaphoresis (sweating), tachycardia followed by bradycardia, decreased blood pressure, loss of consciousness, papillary dilation, yawning, and convulsive movements. 

Management

Step 1: Termination of the dental procedure, stay with the patient.

Step 2: Identify the nature of the medical emergency.  Mentally refer to the patient's medical history pertaining to the current medical emergency.  Inform instructor of pertinent information from the patient's chart. 

Step 3: Assign Team Rescuer #2 

Step 4: Position Patient: Supine

Step 5: C-A-B (BLS as needed)                  

           Circulation à Monitor pulse

Airway à Maintain open airway

           Breathingà Administer oxygen

Monitor Vital signs: BP, Pulse, Resp. Continue monitoring vitals, as you await professional help

Step 6: Definitive care: loosen binding clothes such as ties, collars (which can decrease blood flow to the brain).  If after 30 seconds the patient has not regained consciousness, use a respiratory stimulant (ammonia vaporole) and allow patient to inhale it.  Activate Team Rescue (EMS) if consciousness is not attained after previous steps have been performed or if unconsciousness persists or patient does not recover completely in 15 minutes.

3.Another medical emergency that I should be prepared for this patient would be Hyperventilation.

Hyperventilation

Symptoms: Rapid, shallow breathing, confusion, dizziness, acute anxiety, vertigo (dizziness), paresthesia (numbness or tingling of extremities), carpo-pedal spasm (cramping of the hands or feet), chest tightness.
Management
Step 1: Termination of the dental procedure, stay with the patient.
Step 2: Identify the nature of the medical emergency. Mentally refer to the patient's medical history pertaining to the current medical emergency. Inform instructor of pertinent information from the patient's chart.
Step 3: Assign Team Rescuer #2
Step 4: Position Patient: comfortably, usually upright; IF UNCONSCIOUS, POSITION SUPINE
Step 5: C-A-B (BLS as needed)

Circulation Monitor pulse
Airway Maintain open airway. REMOVE MATERIALS FROM THE MOUTH Breathing DO NOT ADMINISTER OXYGEN

Monitor Vital signs: BP, Pulse, Resp. Continue monitoring vitals, as you await professional help
Step 6: Definitive care: Reassure the patient that all is well in a calm and relaxed manner. Have the patient breath slowly and regularly at a rate of about 4 to 6 breaths per minute. Instruct the patient to cup their hands in front of the mouth and nose and breath in and out of this reservoir of CO2 enriched exhaled air. Activate Team Rescue (EMS) if patient's condition deteriorates (breathing does not improve, cyanosis increases).

1. Patient management and treatment modifications – discuss all modifications you would implement for your patient who is treatment planned for 4 quadrants NSPT with local anesthesia.  Provide rationale for the modifications.

-Patient may have abnormal bleeding due to inability to store and release vitamin K

-Avoid Aspirin and NSAIDS due to cirrhosis
-No Premed Necessary
-For anesthesia I would use 2% lidocaine with 1 : 100,000 epinephrine. But I will be Cautious with lidocaine-  only use up to  2 carps is usually tolerated well.

Depending on the stage of the liver disease, med consult may be necessary

I would administer Nitrous Oxide 50%/50% concentration of N2O2  for anxiety relief relaxing autonomic nervous system.

1. Individualized care and goals – discuss individual needs your patient may have depending on their condition, medications and/or limitations.  Discuss how you can help your patient achieve goals over time to help them achieve optimal systemic and oral health. Long term goals are slow progressing, lifestyle changing habits that are achieved over time

- Give them nutritional guidance

- Have a talk about reducing alcohol intake  can help them benefit in the long run.

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