PE - CVA and Diabetes Flashcards
Other type of stroke (besides most common)
Hemorrhagic infarcts
20% of all CVA’s
Wall of cerebral vessel ruptures (aneurysm)
Develops abruptly (following anything that suddenly increases bp)
40% mortality rate within 30 days
60% mortality rate within 1 year
What is the most common type of stroke?
Thromboembolic infarct (60-80%) (thrombo emboli --> thrombosu = blood clot, embolus = foreign body plug) Thromboembolism = blood clot that gets displaced and plugs a vessel 10% mortality within 30 days
Most common signs and symptoms of a CVA
- sudden numbness or weakness
- sudden dimness or loss of vision
- sudden dizziness or loss of balance
- sudden severe headache
- confusion or difficulty speaking
Residual effects of a CVA
- paralysis or paresthesia
- spatial-perceptual deficits
- difficulty with motor tasks
- impulsive behaviors
- thought impairment
- memory deficits
- language and speech problems
Medical Treatments for CVA’s
Reduce risk factors (smoking, diet, exercise, hypertension, diabetes)
Anticoagulant therapy (Coumadin)
Antiplatelets (aspirin)
Antihypertensives
Surgery to remove obstruction (stents, etc.)
Rehabilitation (physical therapy, etc.)
Oral manifestations of CVA’s
Stroke-in-evolution -slurred speech/difficulty speaking, difficulty understanding speech, loss of vision, unilateral paralysis of orofacial muscles, loss of sensation in oral tissues, difficulty swallowing Increased bleeding -from anticoagulants/antiplatelets Xerostomia -from diuretics, ACE inhibitors
ASA PS II (for CVA patients)
Are at low risk for having a recurrent CVA at appointment
- history of a CVA more than a year ago
- no TIAs within the last year
- minor or no neurological deficits
- well controlled risk factors (diabetes, hypertension, hyperlipidemia, nonsmoker)
ASA PS III (for CVA patients)
Moderate risk for having a CVA at dental appt.
- history of a CVA less than one year but more than 6 months ago
- TIAs within the last year but more than 6 months ago
- some neurological deficits
- moderately well controlled risk factors
ASA PS IV (for CVA patients)
High risk for having a CVA during dental appt.
- history of having a CVA within the last 6 months
- TIAs within the last 6 months
- severe neurological deficits
- poorly controlled risk factors
Main Functions of Insulin (3)
- Lowers blood glucose concentration
- Facilitates transmembrane movement of glucose, enhancing its absorption into fat and muscle cells
- Stimulates glycogen formation in the live
What are some possible reasons that the incidence of diabetes mellitus is rising?
- due to the increasing obesity problem in the U.S.
- populations of ethnicities that are more susceptible to diabetes are increasing
Characteristics of Type 1 Diabetes Mellitus
previously called insulin-dependent diabetes
- 10% of patients with diabetes
- immunologically mediated destruction of pancreatic beta cells
- leads to absolute insulin deficiency
- onset before age 20 (juvenile)
- patients with Type 1 usually have a family history
- thin body build
- pancreas produces little or no insulin
- daily injections of insulin required
- more severe, greater fluctuations in blood glucose levels, more complications and results in a shorter life span than patients with Type 2 diabetes
Characteristics of Type 2 Diabetes Mellitus
previously called non insulin-dependent
- accounts for 90% of people with diabetes
- altered sensitivity of peripheral tissues (especially fat and muscle cells) to insulin
- relative insulin deficiency
- develops gradually after age 40
- stronger genetic basis than Type 1 diabetes
- usually associated with obesity
- normal or elevated levels of insulin and excess glucagon released pancreas
- usually treated with diet and/or oral hypoglycemic drugs but ~ 25% of patients need insulin
- less severe complications, associated with 30% decrease in life span
Clinical Findings for Type 1 Diabetes
- hyperglycemia
- glucosuria (glucose in urine)
- polyuria (increased urinary output) and/or nocturia (urination at night)
- polydipsia (increased thirst) and/or polyphagia (increased hunger)
- weakness or weight loss
- ketoacidosis (acetone breath, nausea/vomiting, depressed cognitive function, cardiovasc. insufficiency)
- micro- or macro-angiopathy (associated with micro: retinopathy and renal failure; associated w/ macro: atherosclerosis)
- peripheral neuropathy (numbness/parasthesia, anesthesia, pruritis/itching, burning pain; can lead to -> amputations)
- autonomic insufficiency (orthostatic hypotension, impotence, urinary incontinence, diarrhea or constipation)
- susceptibility to infection (complications: gangrene, poor response to infections)
Clinical Findings of Type 2 Diabetes
- symptoms and signs are often innocuous and longstanding before the diagnosis is made
- polyuria, polyphagia, polydipsia, weight loss (all less common than in DM 1)
- retinopathy or neuropathy (but usually not until later in the course of disease)
- ketoacidosis and renal disease occur less frequently than in Type 1
