Cardiovascular Disease: Myocardial Infarction
Mock Case Study
Demographics:
-Patient Name: Leroy
-Gender: Male
-Age: 47
-Race: African American
-Height: 6’ 1’’
-Weight: 195
Physical Assessment:
-Patient appears to be in good health; slightly overweight
-Reports recently losing 10 pounds by going to a gym that was recently built near his home
-Blood pressure: 128/82
Mental Assessment:
-Motivated to get healthy
Social Assessment:
-Has a wife and two boys ages 14 and 16
-Works as a realtor
-Loves to be around friends and family
Medical Assessment:
-Patient had a myocardial infarction 6 months ago
-Has improved his diet and is exercising regularly to improve his lifestyle and prevent future health concerns
-Takes Diltiazem because of his recent heart attack
-Carries Nitroglycerin in the event that he should start feeling signs of a heart attack
-Takes Asprin as a precautionary measure once a day
Dental History:
-Last FMX taken one year ago, no suspicious lesions present
-Patient has generalized light sub and supragingival calculus
-Mandibular anteriors showing signs of attrition; patient reports clenching and grinding recently
Extra Oral Exam:
-General Appearance: Tired
-Face: Symmetrical
-Lips: Dry; pigmented
-TMJ: Slight bilateral clicking; asymptomatic
-Glands: Non-palpable
Intra Oral Exam:
-Buccal/Labial mucosa: Bilateral linea alba
-Salivary flow: Light/Inadequate
-Gingiva: Pigmented; fibrotic
-Gingival margin: Generalized slight rolling; marginal redness
-Papillary contour: Generalized filled embrasures; bulbous papillae
-Hard palate: 2x2mm red ulcer
-Soft palate: Vascularized
-Floor of mouth: Bilateral tori
Communication:
I asked Leroy a few questions about his health history and recent heart attack
-Is he taking any medications after having a heart attack?
-Has he received a medical clearance from his physician?
-Has he taken any medication prior to this appointment?
-Is he compliant to improve his dental health?
Answers: Leroy is currently taking Diltiazem (a calcium channel blocker) which he complains has made his mouth really dry and sometimes gets sores on the roof of his mouth. He carries Nitroglycerin at all times incase he starts to feel symptoms of a heart attack, As a precautionary measure, Leroy takes Asprin once a day. He has not been to his doctor to receive clearance to be seen by the dentist; says that his dental appointment was pre-scheduled and he didn’t think anything of it. I explained to Leroy that the dentist is to determine the risk vs. benefit of providing treatment in the office. Leroy will first need to see his medical doctor to receive medical clearance before further treatment can be resumed. He has taken his Diltiazem has been very good about taking it as prescribed. I explained to Leroy that we recommend that he bring his medication in with him for his future visits. He is compliant and is going to make an appointment with his physician as soon as possible to receive medical clearance. He expresses his gratitude and says that he is not going to neglect his medical and dental needs any longer.
Appointment Planning:
Once Leroy is cleared for treatment, appointments should be scheduled as follows:
-In the morning
-In short intervals
Client Positioning:
-Make sure patient is comfortable
Dental Hygiene Procedures:
-Take a thorough medical history at each appointment
-Make sure patient is following his medical doctors instructions regarding any/all medications prescribed
-Monitor vitals closely
Safety Precautions:
-Minimize the use of epinephrine
-Make sure medication has been taken and is brought with him to all dental appointments
-Always monitor him closely for signs of distress
-Be very thorough with medical history at each visit and inquire about medications taken
OHI and Home Care:
-Educated Leroy about improving his oral hygiene at home and the importance of brushing and flossing to remove the
bacteria in his mouth
-Show-tell-do Bass method of brushing; encouraged him to continue flossing regularly
-Discussed with Leroy that the dry mouth, ulcer on his palate and swollen, fibrotic gingiva are all side effects of the Diltiazem
-Dispensed a sample of Biotene to provide some relief from the xerostomia
-Emphasized that the health of his mouth greatly contributes to the health of his whole body
-Praised Leroy for his effort to come to his pre-scheduled dental appointment and told him that we look forward to treating
him once we have a medical clearance
Personal Reflection:
I chose to do this mock case study on myocardial infarction because I was intrigued by the lecture provided in class and because of how prevalent this disease is in the population. I was amazed that myocardial infarcts are the leading cause of death after the age of 40 and that 50% of sudden death cases showed NO previous signs of the disease. That is incredible to me and sparked my interest to learn more about the disease.
Additional Information:
Below is a link for the American Heart Association which has a lot of wonderful information:
http://www.heart.org/HEARTORG/
This YouTube video shows and describes an animation of what occurs during a heart attack:
http://youtu.be/LA2DuxCcO4g
Below is a link to a great article about myocardial infarctions by PubMed Health:
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001246/
**Images retrieved from google.com/images**
Demographics:
-Patient Name: Leroy
-Gender: Male
-Age: 47
-Race: African American
-Height: 6’ 1’’
-Weight: 195
Physical Assessment:
-Patient appears to be in good health; slightly overweight
-Reports recently losing 10 pounds by going to a gym that was recently built near his home
-Blood pressure: 128/82
Mental Assessment:
-Motivated to get healthy
Social Assessment:
-Has a wife and two boys ages 14 and 16
-Works as a realtor
-Loves to be around friends and family
Medical Assessment:
-Patient had a myocardial infarction 6 months ago
-Has improved his diet and is exercising regularly to improve his lifestyle and prevent future health concerns
-Takes Diltiazem because of his recent heart attack
-Carries Nitroglycerin in the event that he should start feeling signs of a heart attack
-Takes Asprin as a precautionary measure once a day
Dental History:
-Last FMX taken one year ago, no suspicious lesions present
-Patient has generalized light sub and supragingival calculus
-Mandibular anteriors showing signs of attrition; patient reports clenching and grinding recently
Extra Oral Exam:
-General Appearance: Tired
-Face: Symmetrical
-Lips: Dry; pigmented
-TMJ: Slight bilateral clicking; asymptomatic
-Glands: Non-palpable
Intra Oral Exam:
-Buccal/Labial mucosa: Bilateral linea alba
-Salivary flow: Light/Inadequate
-Gingiva: Pigmented; fibrotic
-Gingival margin: Generalized slight rolling; marginal redness
-Papillary contour: Generalized filled embrasures; bulbous papillae
-Hard palate: 2x2mm red ulcer
-Soft palate: Vascularized
-Floor of mouth: Bilateral tori
Communication:
I asked Leroy a few questions about his health history and recent heart attack
-Is he taking any medications after having a heart attack?
-Has he received a medical clearance from his physician?
-Has he taken any medication prior to this appointment?
-Is he compliant to improve his dental health?
Answers: Leroy is currently taking Diltiazem (a calcium channel blocker) which he complains has made his mouth really dry and sometimes gets sores on the roof of his mouth. He carries Nitroglycerin at all times incase he starts to feel symptoms of a heart attack, As a precautionary measure, Leroy takes Asprin once a day. He has not been to his doctor to receive clearance to be seen by the dentist; says that his dental appointment was pre-scheduled and he didn’t think anything of it. I explained to Leroy that the dentist is to determine the risk vs. benefit of providing treatment in the office. Leroy will first need to see his medical doctor to receive medical clearance before further treatment can be resumed. He has taken his Diltiazem has been very good about taking it as prescribed. I explained to Leroy that we recommend that he bring his medication in with him for his future visits. He is compliant and is going to make an appointment with his physician as soon as possible to receive medical clearance. He expresses his gratitude and says that he is not going to neglect his medical and dental needs any longer.
Appointment Planning:
Once Leroy is cleared for treatment, appointments should be scheduled as follows:
-In the morning
-In short intervals
Client Positioning:
-Make sure patient is comfortable
Dental Hygiene Procedures:
-Take a thorough medical history at each appointment
-Make sure patient is following his medical doctors instructions regarding any/all medications prescribed
-Monitor vitals closely
Safety Precautions:
-Minimize the use of epinephrine
-Make sure medication has been taken and is brought with him to all dental appointments
-Always monitor him closely for signs of distress
-Be very thorough with medical history at each visit and inquire about medications taken
OHI and Home Care:
-Educated Leroy about improving his oral hygiene at home and the importance of brushing and flossing to remove the
bacteria in his mouth
-Show-tell-do Bass method of brushing; encouraged him to continue flossing regularly
-Discussed with Leroy that the dry mouth, ulcer on his palate and swollen, fibrotic gingiva are all side effects of the Diltiazem
-Dispensed a sample of Biotene to provide some relief from the xerostomia
-Emphasized that the health of his mouth greatly contributes to the health of his whole body
-Praised Leroy for his effort to come to his pre-scheduled dental appointment and told him that we look forward to treating
him once we have a medical clearance
Personal Reflection:
I chose to do this mock case study on myocardial infarction because I was intrigued by the lecture provided in class and because of how prevalent this disease is in the population. I was amazed that myocardial infarcts are the leading cause of death after the age of 40 and that 50% of sudden death cases showed NO previous signs of the disease. That is incredible to me and sparked my interest to learn more about the disease.
Additional Information:
Below is a link for the American Heart Association which has a lot of wonderful information:
http://www.heart.org/HEARTORG/
This YouTube video shows and describes an animation of what occurs during a heart attack:
http://youtu.be/LA2DuxCcO4g
Below is a link to a great article about myocardial infarctions by PubMed Health:
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001246/
**Images retrieved from google.com/images**