Topic 12 (Stress and Anxiety in Dental Treatment) Flashcards
(105 cards)
1
Q
It is masked by the patient through fainting.
A
Anxiety
2
Q
But may be manifested by other signs: sleep loss, hunger, pain, excessive analgesic consumption, sweating, palpitation, talkativeness, etc.
A
Anxiety
3
Q
Anxiety may be manifested by other signs:
A
- sleep loss
- hunger
- pain
- excessive analgesic consumption
- sweating
- palpitation
- talkativeness
4
Q
The body reacts in a number of ways when in an adverse or threatening:
A
- Anorexia
- Over –eating
- Gonadal functional disturbance
- Disease
- Decreased host response
- Altered pain sensitivity
5
Q
Is related to a patient’s fears and phobias, developed mainly as a result of childhood experience.
A
Stress
6
Q
The physiological responses to emotional stimulation are autonomic and controlled by a complex system involving limbic structures, especially the amygdala, hypothalamus and reticular formation.
A
Stress
7
Q
The physiological responses to emotional stimulation are ____.
A
Autonomic
8
Q
The physiological responses to emotional stimulation are autonomic and controlled by ____.
A
Complex System
9
Q
The physiological responses to emotional stimulation are autonomic and controlled by a complex system involving ____.
A
- limbic structures
- amygdala
- hypothalamus
- reticular formation.
10
Q
In stressful situations, these will increase:
A
- Catecholamine level and adrenal medullary secretion
- This is the “ flight or fight” reflex
- Vasodilation of skeletal muscle and coronary arteries
- Increased cardiac output with increased blood pressure
- Increased cerebral blood flow
- Mobilization of sugar from hepatic
glycogen storage - Increased cellular metabolism
- Increased susceptibility of the cardiac
ventricular muscle to extra systole or ventricular fibrillation
11
Q
In stressful situations, will catecholamine level and adrenal medullary increase or decrease?
A
INCREASE
12
Q
In stressful situations, the “flight or fight” reflex results with vasodilation of skeletal muscle and coronary arteries?
YES OR NO?
A
YES
13
Q
In stressful situations, the “flight or fight” reflex results will increase or decrease cardiac output with increased blood pressure?
A
INCREASE
14
Q
In stressful situations, the “flight or fight” reflex results will increase cardiac output with increased or decrease blood pressure?
A
INCREASE
15
Q
In stressful situations, the “flight or fight” reflex results will increase or decrease cerebral blood flow?
A
INCREASE
16
Q
In stressful situations, the “flight or fight” reflex results with mobilization of sugar from hepatic glycogen storage?
YES OR NO?
A
YES
17
Q
From hepatic glycogen storage there will mobilization of ____.
A
Sugar
18
Q
In stressful situation, the “flight or fight” reflex results with increase or decrease of cellular metabolism?
A
INCREASE
19
Q
In stressful situation, the “flight or fight” reflex results with increase or decrease of susceptibility of the cardiac ventricular muscle to extra systole or ventricular fibrillation?
A
INCREASE
20
Q
In stressful situations, the “flight or fight” reflex results with activation of pituitary?
YES OR NO?
A
YES
21
Q
Activation of pituitary
A
Adrenocortical
22
Q
In stressful situation, the “flight or fight” reflex results with increase or decrease of 17 hydroxycoticosteroid secretion and glucosteroid secretion?
A
INCREASE
23
Q
In stressful situation, the “flight or fight” reflex results use and mobilization of fat from storage deposits?
YES OR NO?
A
YES
24
Q
In stressful situation, the “flight or fight” reflex results with increase or decrease of muscular efficiency?
A
INCREASE
25
Patients taking steroids or whose adrenal cortices are either dormant or have undergone atrophy as a result of disease or therapy are extremely susceptible to the damaging effects of various stimuli that demand compensatory responses including:
1. Trauma
2. Hemorrhage
3. Fasting
4. Anesthetics
5. Changes in environment temperature
6. Therefore, consult with physician OF THE
PATIENT FIRST
26
Physical and emotional trauma associated with dental treatment affects:
Hypothalamus and Pituitary Activity
27
Trauma releases ____.
Corticotrophin (ACTH)
28
Trauma releases corticotrophin ( ACTH ) which enhances the production of ____.
Adrenocortical Hormones
29
What hormones is important to accommodate stressful situations.
Adrenocortical Hormones
30
The secretion of ____ is dependent on a neurohormonal substance.
Corticotrophin (ACTH)
31
corticotrophin-releasing factor ( CRF ) which is produced by ____.
Thalamus
32
41-amino-acid peptide stimulates the release of:
1. ACTH
2. Cortisol
33
Increase in cortisol starts to increase in the
____ hours.
Early morning
34
In the early morning hours, what starts to increase?
Cortisol
35
Acute trauma stimulates the secretion of:
1. Corticotrophin (ACTH)
2. B-endorphin / B lipotrophin ( B –LPH )
3. Prolaction
4. Vasopressin
36
Also produces other pituitary hormones: (which may be increased, decreased or unaffected)
1. Growth hormones
2. Thyrotrophin
3. Gonadotrophins
4. Oxytocin
37
What are the 3 stress hormones:
1. Prolactin
2. Vasopressin
3. ACTH (Corticotrophin)
38
Results from reduced blood pressure
Vasopressin
39
From reduced blood volume (in hemorrhage)
Vasopressin
40
Hypovolemia, common seen in nausea and hypoxia
Vasopressin
41
From emotional trauma, pain, various drugs including anesthetic agents
Vasopressin
42
But secretion is inhibited by catecholamines and alcohol
Vasopressin
43
Hypovolemia, common seen in ____ and ____.
Nausea and Hypoxia
44
Vasopressin secretion is inhibited by ____ and ____.
catecholamines and alcohol
45
It is released in response to all noxious stimuli
ACTH (corticotrophin)
46
if this is released, ADRENOCORTICAL steroid is produced.
ACTH (corticotrophin)
47
If ACTH (corticotrophin) is released, what is produced?
ADRENOCORTICAL steroid
48
Physical stress results in:
1. Increased ACTH
2. Increased growth hormone
3. Increased prolactin secretions
4. Inhibition of thyroid stimulating hormone
5. Inhibition of luteinizing hormone
6. Inhibition of follicular stimulating hormone
49
Physical stress results in increased of:
- ACTH
- Growth Hormone
- Prolactin secretions
50
Physical stress results in inhibition of:
- Thyroid stimulating hormone
- Luteinizing hormone
- fFollicular stimulating hormone
51
These hormones are beneficial because:
1. They increase vascular tone
2. Increase energy substrate
3. Slow down the basal metabolic rate
4. Shunt energy away from temporarily unneeded
activities
52
In non-stressful conditions the corticosteroids in our blood play an important role in regulating the release of ____?
ACTH (corticotrophin)
53
In non-stressful conditions, what steroids are in our blood that plays an important role in regulating the ACTH release?
Corticosteroids
54
In non-stressful conditions, the corticosteroids inhibits the secretion of ____ by acting on receptors found in adeno-hypophysis.
ACTH
55
In non-stressful conditions, what inhibits the secretion of ACTH?
Corticosteroids
56
In non-stressful conditions, Corticosteroids suppress the body’s normal defense mechanisms, preventing the normal responses to trauma, resulting to ____ and ____.
tissue damage and threatening homeostasis
57
It suppress the body’s normal defense mechanisms, preventing the normal responses to trauma, resulting to tissue damage and threatening homeostasis
Corticosteroids
58
ACUTE STRESS, even without trauma, can also produce a transient change.
Haemostatic Response
59
ACUTE STRESS, even without trauma, can also produce a transient change ( a few hours ) in the hemostatic mechanism, including:
1. Thrombocytosis
2. Increased clotting activity
3. Increased plasminogen activator activity
60
In the following days after injury, the hemostatic mechanism changes to hemostatic security.
Haemostatic Response
61
Platelet count increases, platelet adhesiveness increases, increase in plasma fibrogen, and formation of thrombin and fibrin occurs.
Haemostatic Response
62
In the following days after injury, the hemostatic mechanism changes to ____.
Hemostatic security
63
In heamostatic response what were the things that increases and what formation occurs?
- Platelet count increases
- Platelet adhesiveness increases
- Increase in plasma fibrogen
- formation of thrombin and fibrin occurs.
64
What happens during anxiety?
- Elevated heart rate
- Increased BP
- Increased forearm blood flow during emotional stress
- Increased palm sweating
- Decreased saliva secretion
- If associated with anger and aggression, increased
noradrenaline and adrenaline production and free fatty acids are increased associated with increase coronary artery narrowing due to plaque deposition.
- If not associated with anxiety, fear or aggression causes raised adrenaline levels, with no vascular changes.
65
During anxiety for defensive patients, will the secretion of saliva be increased or decreased?
DECREASE
66
During anxiety for aggressive patients, will the secretion of saliva be increased or decreased?
INCREASE
67
If associated with anger and aggression, there will be and increased of ____ and ____.
noradrenaline, adrenaline production
68
If associated with anger and aggression, there will be an increased or decreased of noradrenaline and adrenaline production?
INCREASE
69
If associated with anger and aggression what were the things that increased?
- noradrenaline
- adrenaline production
- free fatty acids are increased associated
- with increase coronary artery narrowing
70
The increase of coronary artery narrowing is due to ____.
Plaque Deposition
71
If not associated with anxiety, fear or aggression causes raised of ____, with no vascular changes.
adrenaline levels
72
Feelings of anxiety may often be translated to physiological manifestations:
1. Changes in facial expression
2. Trembling
3. Palmar sweating
4. Cold extremities
5. Pallor
6. Nausea
7. Palipations
8. Diarrhea
9. Micturition frequency
10. Breathlessness
73
May be defined as “the development of hypotension and brachycardia associated with typical clinical manifestations of pallor, sweating and weakness“
Vasovagal Reactions
74
This results in FAINTING OR SYNCOPE, cerebral ischaemia, loss of consciousness due to sudden severe fall of blood pressure
Vasovagal Reactions
75
This results in FAINTING OR SYNCOPE, cerebral ischaemia, loss of consciousness due to sudden severe fall of ____.
blood pressure
76
Physiologically, ____ is associated with initial sudden increase in B/P associated with apprehension.
Syncope
77
Physiologically, syncope is associated with initial sudden increase in B/P associated with apprehension...which stimulates the ____ of the aorta and ____.
baroreceptors and carotid sinuses
78
Physiologically, syncope is associated with initial sudden increase in B/P associated with apprehension...which stimulates the baroreceptors of the aorta and carotid sinuses to produce inhibition of ____
sympathetic tone
79
Physiologically, syncope is associated with initial sudden increase in B/P associated with apprehension...which stimulates the baroreceptors of the aorta and carotid sinuses to produce inhibition of sympathetic tone, leading to ____ and ____, specially in skeletal muscles.
brachycardia and anterior dilation
80
Physiologically, syncope is associated with initial sudden increase in B/P associated with apprehension...which stimulates the baroreceptors of the aorta and carotid sinuses to produce inhibition of sympathetic tone, leading to brachycardia and anterior dilation, specially in skeletal muscles. These changes result in the following:
1. Reduced cardiac output
2. Fall in total peripheral resistance
3. Hypotension
4. Syncope
81
What are the other types of syncope:
1. Carotid sinus syncope
2. Cough syncope
82
Overbreathing in anxious individuals usually starts insidiously but as rate and depth increases, increased volumes of carbon dioxide are expired through the lungs.
Hyperventilation
83
In hyperventilation, there is an increased volumes of ____ are expired through the lungs.
Carbon dioxide
84
Overbreathing in anxious individuals usually starts insidiously but as rate and depth increases, increased volumes of carbon dioxide are expired through the lungs. There is an effect:
- Fall in partial pressure of arterial carbon dioxide.
- Rise in bp resulting in respiratory alkalosis which induces cerebral arteriolar vasoconstriction.
85
Heart rate and cardiac output rise, mark fall in peripheral vascular resistance.
Hyperventilation
86
During these episodes , tetany often develops, with facial and lip stiffness, spasm of the hands and feet and increased motor nerve excitability.
The effects appear to be associated with increased blood and tissue fluid calcium ion concentrations.
Hyperventilation
87
Numbness and tingling of the extremities, together with the tetanic spasm may further increase patient anxiety levels.
Hyperventilation
88
What are the treatment of hyperventilation:
- Carbon dioxide inhalation
- By breathing into a bag or a paper cup
89
Excess carbon dioxide in the blood
Arrhythmias
90
Oxygen deficiency
Arrhythmias
91
Reflex sympathetic stimulation
Arrhythmias
92
Increased endogenous catecholamine secretion,
rendering the myocardium more excitable
Arrhythmias
93
Atropine premedication to decrease saliva production
Arrhythmias
94
Vasoconstrictor components of local anaesthetic
solutions, especially if injected directly into a vein
Arrhythmias
95
Give the signs and symptoms of nausea
- Excessive saliva production
- Sweating
- Increase heat rate
- Variations in the rate, depth, regulation of
respiration
96
What stimulates nausea?
- Anxiousness
- Fear
- Pain
- Drugs
- Hypoxia
- Stimulation of afferent nerves of the soft
palate & pharynx
97
It is feeling an urge to vomit.
Nausea
98
It is often called "being sick to your stomach."
Nausea
99
It is an act of ejecting matter from the stomach through the mouth.
Vomiting
100
Vomiting is associated with:
1. General anaesthesia due to drug reactions
2. Respiratory obstruction
3. Hypoxia
4. Postoperative blood swallowing
101
Happens if there is depression of the level of consciousness, where vomiting may result in laryngeal spasm, and vomitus enters the lungs to result in severe exudative edema and bronchospasms
Mendelson's Syndrome
102
Bronchopneumonia or lung abscess may then follow.
Mendelson's Syndrome
103
3 most important hormonal and neurorhormonal changes are:
1. Secretion of glucocorticoids
2. Secretion of catecholamines
3. Secretion of vasopressin
104
It is a potent stimulus for cortisol release
Hemorrhage
105
It increase many times above baseline within minutes of onset of hemorrhagic shock.
Nor-adrenaline and adrenaline levels
