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Chronic Obstructive Pulmonary Disease (COPD)

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Chronic Obstructive Pulmonary Disease (COPD) Mr. Steve Reeves ... – PowerPoint PPT presentation

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Title: Chronic Obstructive Pulmonary Disease (COPD)


1
ChronicObstructive Pulmonary Disease (COPD)
  • Mr. Steve Reeves

2
Steve Reeves
  • 60 year old male with extensive dental needs.
  • His past medical history is significant for
  • Asthma
  • Emphysema (COPD)
  • Hypertension
  • Congestive Heart Failure

3
Cardiovascular Disease
  • Signs Symptoms --gt
  • Breathing complications
  • Distended neck veins
  • Pitting edema
  • Cyanosis
  • Ascites
  • Dizziness
  • Fatigue

4
COPD
  • Signs Symptoms --gt
  • Barrel chested
  • Dyspnea
  • Orthopnea
  • Respiratory infections/ cough
  • Cyanosis

5
Major Concerns
  • Risk of asthma attack in office.
  • Risk of orthopnea during dental treatment.
  • If hypertension not under control, risk of
    congestive heart failure, ischemic heart disease,
    and cerebrovascular accident.
  • If congestive heart failure is present, risk of
    myocardial infarction cerebrovascular accident,
    arrhythmias, and cardiac arrest.

6
Questions to ask
  • History of Asthma
  • Date of Dx Age of onset
  • What type of asthma does patient have?
    (allergenic, mild --gt severe?)
  • What induces an asthma attack?
  • Level of control?
  • How frequent and how severe are the attacks?
  • What times of day do the attacks occur?
  • How are the attacks managed?
  • Has the patient ever received emergency treatment
    for an acute attack?

7
Questions to ask
  • History of emphysema (COPD)
  • Date of onset?
  • Does he smoke? If so, how many cigarettes and
    for how long?
  • Does he have trouble sleeping?
  • Respiratory Infections involved?
  • Is sputum present with his cough?
  • Orthopnea?
  • Contributing Factors to difficulty breathing
    (what activities) ?

8
Questions to ask
  • Cardiovascular Disease
  • Common symptoms of heart disease
  • dyspnea, chest pain, fatigue, weight gain/loss,
    weakness
  • Has there been a recent change in medications?
  • How long has he been on the medications?
  • Are there any side effects with his medications?
  • How frequently does he take is blood pressure,
    and what is it usually?
  • How often does he have headaches, chest pain, or
    shortness of breath?

9
Questions to ask
  • Congestive Heart Failure
  • Does he have symptoms of congestive heart
    failure?
  • Fever, Liver pain, Exercise intolerance, Swollen
    ankles
  • Are these symptoms present at rest?

10
Other information needed
  • What other information do you need? CONSULT
    PHYSICIAN
  • Asthma and Emphysema
  • Lab measures of FEV (forced expiratory volume)
  • Establish severity of disease previous tx or
    hospitalizations
  • Pre-medications
  • Congestive Heart Failure
  • Does he have any complications of congestive
    heart failure?
  • Enlargement of cardiac silhouette on chest
    radiography?
  • Any previously detected COPD - and any tx
    received for these complications?

11
Physical Evaluation for Cardiovascular Disease..
  • Vital signs blood pressure, pulse, and
    respirations
  • Does he have signs of congestive heart failure?
  • Rapid, shallow breathing
  • Heart murmur
  • Distended neck veins
  • Ascites
  • Jaundice

12
Physical Evaluation for Asthma..
  • Vital signsblood pressure, pulse, respirations
  • Recognize signs and symptoms of an asthma attack
  • Inability to finish sentences with one breath.
  • Ineffective bronchodialators
  • Tachypnea (gt25 breaths/min)
  • Tachycardia (gt110 beats/min)
  • Diaphoresis

13
Patient Assessment
  • ASA PS level III
  • COPD due to emphysema and asthma
  • Congestive heart failure?
  • prehypertensive (138/84) on medication
  • Taking six medications
  • four for COPD (azmacort, albuterol, theophylline,
    beclomethasone)
  • two for congestive heart failure (furosemide,
    captopril)

14
Patient Assessment
  • Systemic diseases interfering with Mr. Reeves
    daily activity
  • wheezing
  • difficulty breathing in supine position
  • weakness and dizziness
  • Modifications to dental treatment most likely
    required
  • ie., patient cant fully lie back in chair

15
COPD Patient Management
  • Discuss smoking and if he is currently smoking
    and if so, encourage to quit
  • Patient presents with shortness of breath and ask
    if he has had a productive cough, upper
    respiratory infection, or oxygen saturation level
    of less than 91If this is the case, reschedule
    if at all possible

16
COPD Patient Management
  • If breathing adequate, treat in semi supine
    position
  • No contraindication of anesthetics, but some
    mandibular blocks may cause some airway
    constrictions feelings in severe COPD patients -
    For this, use humidified low-flow oxygen
  • If need sedative, use low-dose oral diazepam
    (Valium). N2O used with caution and not in severe
    cases

17
COPD Patient Management
  • No narcotics or barbiturates because of
    respiratory depressant properties
  • Anticholinergics and antihistamines should be
    avoided because of dryness and increase in mucous
  • Our patient is taking theophylline so avoid
    macrolide antibiotics (erythromycin,
    azithromycin) and ciprofloxacin hydrochloride
    because of possible toxicity.
  • No outpatient general anesthesia for COPD

18
Asthma Patient Management..
  • Main goal is to prevent acute attack by learning
    history, like what kind and causative agents,
    frequency, and severity
  • Features such as shortness of breath, wheezing,
    and increased respiratory rate, emergency room
    visit within last three months and other lab
    values indicate poor control- postpone dental
    care
  • Late morning appointments for nocturnal asthma
    patients

19
Asthma Patient Management..
  • Reduce operatory odorants
  • Bring inhalers
  • Prophylactic inhalation of bronchodilator at the
    beginning of the appointment
  • Provide stress free environment (N20?)

20
Asthma Patient Management..
  • Local anesthetic without epinephrine and
    levonordefrin because sulfite preservative may
    cause an attack
  • Not advisable to give NSAIDs, no barbiturates and
    narcotics, same as above with theophylline
  • Recognize acute attack during procedure, cant
    finish sentences, more than 25 breaths a minute,
    over 110 beats a minute

21
Asthma Patient Management..
  • Use short acting beta2-adrenergic agonist
    inhaler, it is most effective and fastest acting
    bronchodilator. If severe attack, give
    epinephrine
  • Oral complications include reduced salivary flow
    from beta2 agonist inhalers, and erosion of
    enamel from GI reflux from beta agonists and
    theophylline.

22
Emergency Tx
  • Call Physician for medical history regarding
    heart disease.
  • NYHA class I or II congestive heart failure --gt
    can receive routine dental care.
  • NYHA class III or IV congestive heart failure --gt
    treat conservatively and refer patient to a
    hospital dental clinic.
  • Call Physician for medical history regarding
    COPD.
  • Dont lean patient back in chair.
  • Refer to hospital dental clinic due to patients
    extensive dental needs
  • Keep an albuterol inhaler in office in case of
    airway obstruction.
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