Comp Pt

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sthomp88
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Comp Pt
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2011-04-06 00:37:59
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chapter sixty two
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week twelve
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  1. List the 8 anatomical structures that make up the respiratory system.
    • Upper respiratory tract:
    • sinuses
    • nasal cavity
    • larynx
    • pharynx
    • Lower respiratory tract:
    • trachea
    • bronchi
    • lungs
    • pleura
  2. the respiratory tract from nasal cavity to lungs serves as a passageway for what?
    air exchange
  3. _____________: warm and filtered in the nasal cavity, and enters the lungs
    _____________: with carbon dioxide, leaves the body
    • inhaled fresh air
    • exhaled air
  4. ___________: at the cellular level, occurs in the alveoli at the ends of the bronchioles
    gas exchange
  5. functions with the respiratory system to pump oxygenated blood from the lungs to every cell in the body and deoxygenated blood back to the lungs
    cardiovascular system
  6. What part of the lungs functions to moisten inspired air, and prevents delicate alveolar walls from becoming dry? Where does this come from?
    • mucus
    • secreted from goblet cells
  7. What part of the lungs functions to assist in removing foreign material and contaminated mucus by a constant beating and wavelike motion that propels this material back into the larger bronchi and trachea where it can be coughed up and expectorated or swallowed?
    cilia
  8. What happens when the inflammatory process (of asthma and chronic bronchitis) initiates an overabundance of mucus in the lungs?
    • lack of function
    • congestion is created: preventing cilia from assisting with normal breathing
  9. What are structured communities of bacteria bound together by a carbohydrate matrix and interwoven with water channels that deliver nutrients from saliva?
    biofilms
  10. What are 3 characteristics of biofilm described in chapter 62?
    • biofilm adheres to inanimate objects or living surfaces: contact lenses, mechanical heart valves, catheters; or oral mucosa and gingiva
    • Bacteria in biofilm: are more difficult to kill with antibiotics than their 'planktonic (free floating) counter-parts
    • dental biofilm: is complex and may serve as a reservoir of infection, esp. in hospital pts
  11. What type of objects/surfaces can biofilm adhere to?
    • inanimate: contact lenses, mechanical heart valves, catheters
    • living: oral mucosa and gingiva
  12. Is bacteria harder to kill with antibiotics if it is in biofilm, or in its planktonic (free floating) form?
    if it is in BIOFILM
  13. true or false. Dental biofilm may serve as a reservoir of infection.
    true
  14. What are 8 examples of diseases/devices involving biofilms?
    • contact lenses
    • cystic fibrosis pneumonia
    • dental caries
    • intrauterine device (IUD)
    • mechanical heart valve
    • periodontitis
    • unit water lines
    • nocosomial infections: intensive care unit pneumonia, endotracheal tubes, ventilator-assisted pneumonia (VAP)
  15. Are each of the following conditions upper or lower respiratory tract diseases?
    common cold
    allergic rhinitis (hay fever)
    sinusitis
    pharyngitis/tonsillitis
    influenza
    upper respiratory tract
  16. Are each of the following conditions upper respiratory or lower respiratory tract disease?
    pneumonia
    tuberculosis
    asthma
    chronic abstructive pulmonary disease (COPD)
    chronic bronchitis
    emphysema
    cystic fibrosis
    lower respiratory tract
  17. list 3 modes of transmission of upper respiratory tract infections:
    • direct oral contact
    • inhalation of airborne droplets
    • indirectly by hands or articles freshly soiled with discharge of nose and throat of infected person
  18. true or false. It is best to delay dental and dental hygiene tx until pt is well or no longer contagious w/ the upper respiratory tract disease
    true
  19. What are 2 ways that noninfectivity of upper respiratory tract infections can be determined?
    • temperature returning to normal
    • regression of oral lesions such as erythematous lesions of the soft palate and erythema multiforme
  20. Is pneumonia an acute LRT disease, or chronic?
    acute
  21. are TB, asthma, COPD, and cystic fibrosis, acute or chronic LRT diseases?
    chronic
  22. What condition is an inflammation of the lungs, can be caused by viruses, bacteria, and rarely, fungi. Normally, host defense mechanisms eliminate these pathogens, but if the body fails to clear the contamination, this may result
    pneumonia: LRT disease
  23. Is pneumonia more often caused by viral or bacterial?
    viral
  24. Name a bacteria nosocimial gram-negative type that can be responsible for pneumonia.
    staphylococcus aureus
  25. Name a community acquired gram-positive bacteria that can be responible for pneumonia.
    streptococcus pneumoniae
  26. Are the following symptoms thos of viral or bacterial pneumonia?
    mold symptoms
    cough sputum
    mild fever
    dyspnea
    viral
  27. Are the following symptoms that of viral or bacterial pneumonia?
    sudden onset
    coughing purulent sputum
    fever
    pleuritic chest pain
    dyspnea, tachypnea
    bacterial
  28. What are 4 ways that one might make a diagnosis of pneumonia?
    • pt history
    • physical findings
    • chest radiographs
    • sputum sample: for bacterial caused only
  29. differentiate between treatment for viral and bacterial caused pneumonia.
    • bacterial: antibiotics
    • viral: supportive bed rest, drink fluids
  30. What is a fungal etiologic agent of pneumocystis pneumonia (PCP)?
    pneumocystis jirovecii
  31. susceptibility for pneumonia to be caused by what type of etiologic factor is enhanced by chronic debilitating diseases in which immunimechanisms are impaired, such as AIDS/HIV?
    fungal (pneumocystis jirovecci)
  32. What are 2 general types of pneumonia?
    • community-acquired pneumonia (CAP)
    • nosocomial pneumonia
  33. which general type of pneumonia (community or nosocomial) does no one know the predisposing factors; it is transmitted person to person?
    community
  34. Which general type of pneumonia (community or nosocomial) usually affects debilitated or chronically ill pts in hospital intensive care units or nursing homes and is the leading cause of death there? Most cases are due to aspiration of oropharungeal secretions into the lungs. Oral bacteria can be released from biofilm into salivary secretions that are then aspirated into the LRT to cause pneumonia. Most frequently bacteria cultured from the lungs are gram-negative bacilli and oral bacteria consistent with varieties often found in perio pockets
    nosocomial
  35. true or false. The oral cavity may serve as a reservoir for lung infections, especially for those in institutional settings. Improved oral hygiene can reduce the incidence of pneumonia
    both are TRUE
  36. What is the main medical treatment for pneumonia caused by each of the following agents:
    viral
    bacterial
    fungal
    • viral: supportive tx of bed rest and fluids
    • bacterial: antibiotic therapy
    • fungal: sulfa drugs
  37. dental hygienists can educate other healthcare personnel to reduce risk of nosocomial pneumonia from infecting pts by informing them of what 3 things?
    • maintainings standard precautions
    • performing daily biofilm control measures on natural teeth and dentures
    • teaching the use of an antimicrobial mouth rinse
  38. What is a chronic infectious, and communicable disease with worldwide public health significance? It is a serious disease that can involve many months and years of lost time during the active state of illness and following convalescence? The incidence of this disease has increased in population groups with a high prevalence of HIV infections.
    tuberculosis (TB): a LRT disease
  39. true or false. TB is an AIDS defining illness
    true
  40. What agent is responsible for the etiology of TB?
    mycobacterium tuberculosis
  41. What disease travels in airborne droplet nuclei from infected saliva or sputum carried during coughing, singing, or sneezing from individuals with pulmonary or laryngeal types?
    TB
  42. What are 3 ways tubercle vacilli travel in airborne droplet nuclei?
    • coughing
    • singing
    • sneezing
  43. The followin symptoms are signs of what LRT disease?
    early: low-grade fever, weight loss, fatigue, night sweats
    later: persistent cough, chest pain, hoarseness, hemoptysis (coughing up blood)
    TB
  44. The diagnosis for what LRT disease includes a chest x-ray, sputum sample culture for acid-fast bacilli, and a physical examination?
    TB
  45. What is the incubation period for TB?
    2-10 weeks
  46. What are 4 risk factors for getting TB?
    • degree of exposure: prolonged close exposure can lead to infection by contact
    • the homeless and those living in dense, over-crowded conditions
    • employees or residents in tight living settings such as: prisons, shelters, nursing homes
    • Immunosuppressed persons: HIV/AIDS, and other medical risk conditions
  47. What are the signs and symptoms for latent TB infection?
    usually none
  48. What test is done to determine latent infection of TB? Does it determine clinically active TB as well?
    • TB skin test (mantoux)
    • no
  49. What is the incubation period for latent TB?
    2-10 weeks
  50. What are 3 risk factors for LATENT TB?
    • prolonged contat with an individual with active TB
    • HIV or other medical risk conditions
    • recent immigrant from a country with high incidence of TB
  51. For clinically active TB drug therapy, multiple antituberculosis drugs are taken __________ for a minimum of ______ months
    • daily
    • 6
  52. List 5 drugs commonly taken to medically treat clinically active TB.
    • ethambutol
    • isoniazid
    • rifampin
    • rifapentine
    • pyrazinamide
  53. What type of TB is being treated by taking Isoniazid for 9 months?
    latent TB
  54. providing medications directly and observing the pt swallow the TB drugs is recommended for all TB pts and will result in what 3 things?
    • high medication compliance
    • prevention of multidrug-resistant bacterial development
    • prevention of multi-drug resistant TB, which is more sever and difficult to treat
  55. What infrequently appears in the oral cavity from pulmonary organisms brought to the mouth by coughing; most frequently seen in older individuals after the disease is far advanced or younger persons with lowered immunity from other diseases?
    oral manifestations of TB
  56. Describe the classic oral lesion seen in TB pts.
    • painful, deep, irregular ulder on the dorsum of the tongue
    • (it may also occur on palate, lips, buccal mucosa, and gingiva)
  57. What will a biopsy of a TB oral lesion reveal for diagnosis?
    acid-bast tubercle bacilli
  58. List and describe 3 factors Dental Hygiene care that are affected by TB.
    • pt history preparation: questions for history and symptoms of TB; medications and length of treatment
    • medical consultation: to determine potential for communicability
    • treatment protocol: it is imperative to recognize signs and symptoms of active disease and determine wether to treat or refer to a clinic where transmission based precautions can be followed
  59. The following signs and symptoms are seen in pts with what URT disease?
    sneezing
    nasal obstruction
    nasal discharge (coryza)
    headache
    watering eyes
    common cold: infectious rhinitis
  60. What is the etiology of the common cold?
    viral
  61. The following drugs can be used to medically treat the common cold; since it is a virus they are all used to reduce symptoms, list the function of each:
    analgesic
    anticholinergic
    oral decongestant
    antihistamine
    • analgesic: sore throat, muscle ache
    • anticholinergic: decrease nasa discharge
    • oral decongestant: decrease nasal congestion
    • antihistamine: for ithching, sneezing, or runny nose
  62. The following are oral findings that may be seen in pts with which URT disease?
    small round erythematous lesions on soft palate, enlarged tonsils, erythema multiforme, acute ulcerative gingivitis; decongestants and mouth breathing may cause dry mouth
    common cold: infectious rhinitis
  63. The following are signs and symptoms of what URT disease?
    watering, burning eyes
    sneezing
    nasal congestion
    allergic rhinitis: hay fever
  64. seasonal triggers (grass, trees, pollen, mold spores), or perennial triggers (dust mites, animal dander) result in IgE-mediated hypersensitivity reactions; is the etiology for what URT disease?
    allergic rhinitis: hay fever
  65. What are 3 ways to medically treat hay fever (allergic rhinitis)?
    • avoidance of allergen
    • pharmacotherapy: antihistamines, decongestants
    • immunotherapy: allergy injections increase tolerance to allergens and reduce symptoms
  66. Dry mouth and oral candidiasis from long-term use of topical corticosteroids, are oral findings that can be found in pts with what URT disease?
    allergic rhinitis: hay fever
  67. nasal obstruction, fever, chills, constant mid-face head pain that is more severe when lying down, palpation over sinus area with tenderness and swelling, are signs and symptoms of what URT disease?
    sinusitis
  68. bacterial infection of the epithelial lining of the sinus, triggers include upper respiratory infections, dental infections, and direct traum, are all etiologic factors for what URT disease?
    sinusitis
  69. What are 2 ways to medically treat sinusitis?
    • antibiotics
    • decongestants
  70. dry mouth; and sinus congestion creates pressure on nearby maxillary molar roots and may cause symptoms of toothache, are oral findings of what URT disease?
    sinusitis
  71. What is the main sign/symptom of pharyngitis/tonsillitis? (an URT disease)
    sore throat
  72. The etiology of which URT disease is mostly viral, rarely bacterial: group A beta-hemolytic stretpococcus infection
    pharyngitis/tonsillitis
  73. Describe how to treat viral and bacterial pharyngitis/tonsillitis.
    • viral: treat symptoms
    • bacterial: antibiotics - pt is no longer contagious after 1 day on antibiotics
  74. What are 2 oral findings in pts with pharyngitis/tonsillitis?
    • enlaged tonsils
    • erythmatous tissues
  75. Chills, fever, headache, coryza, nonproductive dry cough, myalgia, and malaise are all signs and symptoms of what common URT disease?
    influenza (flu)
  76. What is the etiology for the URT disease influenza?
    • viral
    • mode of transmission: airborne, direct contact
  77. Bed rest, analgesics, antivirals, fluids, monitor for secondary bacteria infections, are all ways to medically treat which type of URT disease?
    influenza
  78. What is an oral finding of influenza?
    dry mouth
  79. What is a chronic, inflammatory, respiratory disease of the LRT, consisting of recurrent episodes of dyspnea, coughing, and wheezing and is related to bronchial inflammation and muscle constriction?
    asthma
  80. What are 2 traditional classifications of asthma?
    • extrinsic atopic
    • intrinsic non-allergic
  81. Which type of traditional asthma is caused by allergic triggers from outside the body; exposure to an environmental allergen; allergic stimulus leads to activation of airway epithelial mast cells, steps in an IgE mediated hypersensitivity reaction take place
    extrinsic atopic
  82. What are 5 possible environmental allergens that may cause extrinsic atopic asthma?
    • dust
    • pollen
    • tobacco
    • mold
    • animal dander
  83. which type of traditional asthma is caused by nonallergic triggers from within the body; the specific trigger may not be identified; but is usually identified with adults, and endogenous factors such as emotional stress are significant?
    intrinsic-non-allergic
  84. What are the 4 categories of asthma as defined by the NAEPP classification based on severity and frequency of symptoms as well as pulmonary function assessment?
    • mild intermittent
    • mild persistant
    • moderate persistant
    • severe persistant
  85. aspirin, nonsteroidal anti-inflammatory drugs (NSAIDS), beta blockers, food substances: nuts, shellfish, milk, strawberries, and tartrazine (yellow food dye); are all factors that cause what type of asthma?
    drug- or food-induced (nonallergenic, nonatopic)
  86. Which type of asthma affects adolescents and young people, and occurs from vigorous physical activity or thermal changes during inhalation of cold air may provoke mucosal irritation and airway hypersensitivity?
    exercise induced
  87. Which type of ashtma is caused from lung infections caused by viruses, bacteria, or fungi; and the treatment of the infection will improve the breathing?
    infection-induced
  88. List 7 signs and symptoms of an asthma attack.
    • chest tightness
    • difficulty breathing, sense of suffocating
    • wheezing
    • cough
    • flushed appearance, sweating
    • confusion due to lack of oxygen
    • dilated pupils
    • inability to complete a sentence in one breath
  89. What are 5 steps to take in the emergency care of an asthma attack?
    • stop treatment
    • rule out foreign body obstruction
    • assist with pts own bronchodilator or inhaler
    • administer supplemental oxygen by nasal cannula
    • initiate emergency procedures
  90. Atopic asthma is one type of ________ mediated hypersensitivity reaction.
    IgE
  91. What is one of the 5 antibodies produced by the body that provides the primary defense against environmental allergens (pollen, tobacco smoke, and food substances)?
    Immunoglibin E (IgE)
  92. Describe the normal inflammatory reaction of IgE.
    • IgE breaks down the allergens and removes them from the body
    • normally, this activity does no produce notoceable symptoms
  93. Describe tha sthmatic hypersensitivity reaction of IgE.
    • people with asthma are believed to hyperreact, and produce more IgE antibodies than normal
    • this results in symptoms of asthma: wheezing, coughing, dyspnea
  94. What are 4 oral manifestations of asthma?
    • xerostomia
    • dental caries and gingivitis
    • enamel erosion: from increase in GI reflux with use of beta-2 agonists and theophylline
    • Oral candidiasis: with high dosage or frequency of inhaled corticosteroids
  95. What disease is caused most commonly by chronic bronchitis or emphysema? The primary etiology is the use of tobacco and exposure to occupational and environmental pollutants? Motivating the pt with this disease to begin a smoking cessation program can be one of the most rewarding aspects of dental hygiene practice.
    chronic obstructive pulmonary disease (COPD)
  96. What are 2 of the most common causes of COPD?
    • chronic bronchitis
    • emphysema
  97. What is the primary etiology of COPD? (2)
    • tobacco
    • exposure to occupational and environmental pollutants
  98. What LRT disease is characterized by excessive respiratory tract mucux production sufficient to cause a cough with expectoration (coughing up mucus) for at least 3 months of the year for 2 or more years? The obstructino is caused by narrowing of airway and mucus plugging, the person has difficulty breathing present on inspiration and expiration?
    chronic bronchitis
  99. what disease is characterized by distension of the air spaces distal to terminal bronchioles due to destructino of alveolar walls (septa)? alveolar epithelium is injured and alveolar walls are destroyed, creating large air spaces; there is a difficulty of breathing only upon expiration.
    emphysema
  100. What are 5 risk factors for COPD that poor oral health, especially periodontal involvement, may work in concert with any of the following factors to promote COPD exacerbations?
    • continuing smoking
    • environmental pollutants
    • viral infections
    • allergy
    • genetic factors
  101. The following are signs and symptoms of what LRT disease?
    chronic cough
    chronic sputum
    sedentary, overweight, cyanotic, edematous, breathing less, leading to the term "blue bloaters"
    chronic bronchitis
  102. The following are signs and symptoms of what LRT disease?
    difficulty in breathing upon exertion
    minimal, nonproductive cough (dry, no mucus)
    barrel chest due to increased use of respiratory chest muscles
    weight loss
    purses lips to forcibly expel air, leading to the term "pink puffers"
    emphysema
  103. Who does the term "blue bloaters" refer to?
    Who does the term "pink puffers" refer to?
    • chronic bronchitis
    • emphysema
  104. true or false. There is no cure for COPD. Pts are encouraged to stop smoking, have adequate nutrition, drink plenty of water, exercise regularly, and decrease exposure to pollutants.
    both are true
  105. What are 2 medical intervention strategies used to medically treat COPD?
    • pneumonia and influenza vaccines
    • bronchodilators and other medications similar to thos used for asthma
  106. Chronic smokers with COPD have an increased risk of developing what 5 oral manifestations?
    • halitosis
    • nicotine stomatitis
    • periodontal infections
    • oral cancer
    • extrinsic tooth stains
  107. What are 4 dental hygiene interventions that can be done to help COPD pts before treatment?
    • review history: for evidence of concurrent cardiovascular disease
    • avoid treating if URT infection is present
    • treatment may be performed on stable pts with adequate breathing
    • identify pts who may experience exacerbation of symptoms under emotional stress
  108. What are 4 clinical adaptations that may need to be made during a DH appointment for a pt with COPD?
    • appointment length: modify
    • chair positioning: semi supine or upright to facilitate breathing
    • local anesthesia: w/out epi
    • nitrous oxide-oxygen inhalation sedation: avoid with severe COPD and emphysema
  109. Pts who use oxygen to improve breathing function may hold a portable unit during treatment. What are 2 different types of these?
    • continuous flow: oxygen flows at a determined rate of liters per minute
    • on demand: Oxygen flows during inhalation only, increasing time between tank refills
    • Note: oxygen promotes rapid burning; keep away from heat
  110. What is a complex, genetic, life-limiting disorder that involves the pancreas, liver, and lungs? the disease is progressive and ultimately fatal? With improved multifaceted healthcare, the average survival time has increased.
    cystic fibrosis
  111. What 3 organs does the disease cystic fibrosis include?
    • pancreas
    • liver
    • lungs
  112. What are 5 early-stage clinical signs and symptoms of cycstic fibrosis?
    • persistant cough and wheezing
    • recurrent pneumonia
    • excessive appetite but poor weight gain
    • salty skin or sweat
    • bulky, foul-smelling stools (undigested lipids)
  113. What are 7 late-stage clinical signs and symptoms of cystic fibrosis with pulmonary involvement?
    • tachypnea
    • sustained chronic cough with mucus production and vomiting
    • barrel chest
    • cyanosis and digital clubbing
    • exertional dyspnea with decreased exercise capacity
    • pneumothorax
    • right herat failure secondary to pulmonary hypertension
  114. What are 4 oral manifestations of cystic fibrosis?
    • gingivitis associated with dry mouth
    • thickening and enlargement of the salivary glands with advanced disease
    • lower lip may be enlarged, swollen, and dry
    • halitosis
  115. What is the primary cause of sleep-related breathing disorders?
    obstructive resistance to airflow during respirations
  116. True or false. Those who snore may not have OSA, but those with OSA, typically snore
    true
  117. The spectrum of sleep-related breathing disorders constitues a spectrum of clinical entries with variations in sleep structure, respiration, and blood oxygen saturation. What are 5 different disorders in this spectrum?
    • Snoring: chronic heavy snoring
    • Upper airway resistance syndrome: UARS
    • Mild obstructive sleep apnea
    • Moderate OSA
    • Severe OSA: obesity hypoventilation
  118. What are 6 signs and symptoms of sleep-related breathing disorders?
    • Snoring
    • snorting
    • gasping
    • breath-holding
    • excessive daytime sleepiness
    • obesity
  119. What are 3 neurocognitive adverse health affects that can result from sleep-related breathing disorders?
    • sleepiness, decreased alertness, irritability
    • poor concentration, memory loss
    • lack of libido
  120. What are 5 Cardiovascular adverse affects that can result from sleep-related breathing disorders?
    • hypertension
    • stroke
    • CV disease, cardiac arrhythmia
    • congestive heart failure
    • pulmonary hypertension
  121. What are 7 ways to medically manage sleep-related breathing disorders?
    • weight loss
    • nasal dilator strips
    • nasal decongestant
    • topical corticosteroids
    • avoid supine position: tennis balls
    • avoid alcohol, sedatives, muscle relaxants at bed time
    • smoking cessation
  122. What does PAP stand for?
    positive airway pressure
  123. What are 4 dental related treatment indications of sleep-related breathing disorders?
    • primary snoring
    • mild-moderate OSA
    • no response to PAP
    • severe OSA: failure to have initial trial of PAP

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