Download Describe how various systemic conditions/diseases and

Gehrig’s Patient Assessment Tutorials: A Step-by-Step Guide for the Dental Hygienist (Third Edition)
Lesson Plans
Module 4—Medical History
Goals of the Lesson:
Cognitive: Students will be able to describe the medical history form and its role in planning a patient’s dental care.
Motor: NA
Affective: Students will be able to devise a dental treatment plan for a patient based on the information provided in the medical history
form.
Learning Objectives:
The lesson plan for each objective starts on the pages shown below.
4-1 Demonstrate skills in conducting online research on medical conditions/diseases and medications. ................................... 3
4-2 Describe how various systemic conditions/diseases and medications can impact dental care. ........................................... ..4
4-3 Discuss the ways in which a clinician's choice of words can facilitate or hinder communication with patients regarding
patient assessment procedures........................................................................................................................................................5
4-4 Define and discuss the terms informed consent, capacity for consent, and informed refusal as these terms apply to patient
assessment procedures.................................................................................................................................. ..................................6
4-5 Demonstrate skills necessary to obtain a complete and thorough medical history... ............................................................. 8
4-6 Describe the types of information that should be entered in the Medical Alert Box on the medical history form. ............. 10
4-7 List the information that should be indicated on a medical consultation form. ................................................................... 11
4-8 Describe contraindications and complications for dental care presented by various medical conditions/diseases
and medications. ........................................................................................................................................................................ 12
4-9 Recognize findings that have implications in planning dental treatment. ............................................................................ 14
4-10 Provide appropriate referral to a physician or dental specialist when findings indicate the need for further evaluation. .. 15
4-11 Demonstrate the ability to apply information learned in the classroom and clinical activities to the fictitious patient cases A–E in
this module, including: reviewing completed health history forms, conducting research, formulating follow-up questions, conducting a
patient interview, and determining the medical risk of dental treatment to the patient. ............................................................. 16
You Will Need:
Gather the following materials and teaching aids for the objectives indicated:
4-1 Computers with internet connection.
4-2 Computers with internet connection.
Page 1 of 20
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Gehrig’s Patient Assessment Tutorials: A Step-by-Step Guide for the Dental Hygienist (Third Edition)
Module 4—Medical History
4-5 A mock medical history form. and copies of medical forms from different sources like websites or local dental clinics.
4-5 Samples of medical history forms with personal details of patients made illegible.
4-5 Blank samples of consultation forms and samples of medical history forms.
4-5 Several copies of observer feedback and player feedback forms.
4-5 Computers with internet connection.
4-11 Copies of a completed medical history form, observer feedback forms, blank medical consultation forms and reference books.
______________________________________________________________________________________________________
Legend: PPt: PowerPoint; TG: Test Generator; Note: All electronic ancillary assets can be found on the book’s companion
website at thePoint.lww.com.
Page 2 of 20
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Gehrig’s Patient Assessment Tutorials: A Step-by-Step Guide for the Dental Hygienist (Third Edition)
Module 4—Medical History
Objective 4-1
Demonstrate skills in conducting online research on medical conditions/diseases and medications.
Lecture Outline
Content
Text
page
 Online research:
19-20
 A sure way to obtain the most
current information on a
medical condition, disease, or
drug
PPT
slide
Figures, Tables, and
Features
Resources and
In-Class Activities
Outside Assignments and
Evaluation
Boxes
In-Class Activities
Outside Assignments
Ready Reference 4-1:
Internet Resources:
Conditions/Diseases
p. 19
Ask the students to research
and compare two common
tests for glucose levels:
a Hemoglobin A1C
b Fingerstick test
Comment on a website visit
to
http://www.islamicmedicin
e.org/history.htm
Ready Reference 4-2:
Internet Resources:
Drug References
p. 20
Materials
Computers with internet
connection.
Instructor’s Notes
Evaluation
Test Bank
TG Questions 1–12
Ready Reference 4-3:
Internet Resources:
Glucose Blood Levels
in Diabetes
p. 20
Legend: PPt: PowerPoint; TG: Test Generator; Note: All electronic ancillary assets can be found on the book’s companion website at thePoint.lww.com.
Page 3 of 20
Copyright © 2013 Wolters Kluwer | Lippincott Williams & Wilkins
Gehrig’s Patient Assessment Tutorials: A Step-by-Step Guide for the Dental Hygienist (Third Edition)
Module 4—Medical History
Objective 4-2
Describe how various systemic conditions/diseases and medications can impact dental care.
Lecture Outline
Content
 Relation between systemic health
and oral conditions:
 Systemic diseases and
conditions may have oral
implications.
Text
page
PPT
slide
3
Ch04Sec 1,
3-5
Figures, Tables, and
Features
 Medications used to treat
systemic diseases and
conditions can produce changes
in oral health.
 Systemic conditions, diseases,
or medications may necessitate
precautions to ensure that
planned dental treatment will
not be harmful to the patient’s
systemic health.
 Oral manifestations may
identify conditions that should
be evaluated by a primary care
physician.
Resources and
In-Class Activities
Outside Assignments and
Evaluation
In-Class Activities
Evaluation
Have students work in
small groups and research
common medical
conditions. They should
divide the research so that
each one looks for
something different. For
example, one student
researches symptoms,
another common
treatments, and a third the
dental implications. Have
them report findings to the
class.
Test Bank
TG Questions 1–12
Instructor’s Notes
Materials
Computers with internet
connection.
 Substances, materials, or drugs
used in dental treatment may
produce an adverse reaction in
certain patients
Legend: PPt: PowerPoint; TG: Test Generator; Note: All electronic ancillary assets can be found on the book’s companion website at thePoint.lww.com.
Page 4 of 20
Copyright © 2013 Wolters Kluwer | Lippincott Williams & Wilkins
Gehrig’s Patient Assessment Tutorials: A Step-by-Step Guide for the Dental Hygienist (Third Edition)
Module 4—Medical History
Objective 4-3
Discuss the ways in which a clinician’s choice of words can facilitate or hinder communication with
patients regarding patient assessment procedures.
Lecture Outline
Content
 Practitioner and patient
relationship is a “two-way” street
 Patient needs to feel at ease to
reveal detailed medical history
information
 Clinician can help put the
patient at ease to provide
potentially embarrassing
information
Text
page
10
PPT
slide
Figures, Tables, and
Features
Resources and
In-Class Activities
Outside Assignments and
Evaluation
Boxes
In-Class Activities
Outside Assignments
4-2: Sample
Explanation on the
Importance of a
Medical History,
p. 10
Ask the students to role
play explaining the
importance of a medical
history to a patient who
sees treatment as only
“teeth cleaning”
Patient scenario, p. 22
Instructor’s Notes
Evaluation
Test Bank
TG Questions 1–12
 Patient needs to understand the
systemic health connection to
oral health for safe treatment
Legend: PPt: PowerPoint; TG: Test Generator; Note: All electronic ancillary assets can be found on the book’s companion website at thePoint.lww.com.
Page 5 of 20
Copyright © 2013 Wolters Kluwer | Lippincott Williams & Wilkins
Gehrig’s Patient Assessment Tutorials: A Step-by-Step Guide for the Dental Hygienist (Third Edition)
Module 4—Medical History
Objective 4-4
Define and discuss the terms informed consent, capacity for consent, and informed refusal as these
terms apply to patient assessment procedures.
Lecture Outline
Figures, Tables, and
Features
Content
Text
page
PPT
slide
 Informed consent
9-10
Ch 04- Boxes
Sec 1, 4-2: Sample
10-14 Explanation on the
Importance of a
Medical History,
p. 10
 Patient needs to make a wellinformed decision concerning
assessment and treatment
procedures
 Inform patient of expected
successful outcomes
 Inform patient of unanticipated
outcomes, possible risks, and
alternative treatments
 Capacity for consent

Ability of patient to fully
understand assessment and
treatment procedures
 Informed refusal

Patient may decide to refuse
proposed treatment

Patient has a right to make
any decision regarding
treatment
Page 6 of 20
Copyright © 2013 Wolters Kluwer | Lippincott Williams & Wilkins
Resources and
In-Class Activities
Outside Assignments and
Evaluation
In-Class Activities
Outside Assignments
Ask the students to research
on Board of Dentistry
websites any violations of
informed consent that have
brought reprimands to
dental professionls.
Role play ethical dilemmas
that might occur during
information gathering
visits.
Patient scenario, p. 22
Evaluation
Test Bank
TG Questions 1–12
Instructor’s Notes
Gehrig’s Patient Assessment Tutorials: A Step-by-Step Guide for the Dental Hygienist (Third Edition)
Module 4—Medical History
Legend: PPt: PowerPoint; TG: Test Generator; Note: All electronic ancillary assets can be found on the book’s companion website at thePoint.lww.com.
Page 7 of 20
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Gehrig’s Patient Assessment Tutorials: A Step-by-Step Guide for the Dental Hygienist (Third Edition)
Module 4—Medical History
Objective 4-5
Demonstrate skills necessary to obtain a complete and thorough medical history.
Lecture Outline
Content
Text
page
PPT
slide
 Health History Form
9-13
Ch04Sec 1,
15-17
 Used to gather subjective data
about the patient and explore
past and present problems
 Assists patients in providing an
account of their health history
 Multilanguage history project
 Plan for medical history
assessment
 To conduct a thorough medical
history assessment, the dental
health care provider must have
a methodical plan for
information gathering and
review.
 The plan should prevent
oversights or omissions of
important information about the
patient’s medical history.
Figures, Tables, and
Features
Resources and
In-Class Activities
Outside Assignments and
Evaluation
Figures
In-Class Activities
Outside Assignments
4-1: History Form in
English
p. 5
1. Complete a mock
medical history form. Have
one student pose as a
patient, and interview the
student about his or her
positive responses on the
medical history form.
Demonstrate allowing time
for the patient to answer,
documenting the response,
and explaining how any
responses could affect the
patient’s dental treatment.
Patient scenario, p. 22
4-2: History Form in
French
p. 6
4-3: History Form in
Chinese
p. 7
4-4: History Form in
Farsi
p. 8
Boxes
4-1: Downloading
Copies of the
Multilanguage Forms
p. 4
 Information gathering
 Determination of medical risk
Page 8 of 20
Copyright © 2013 Wolters Kluwer | Lippincott Williams & Wilkins
2. Collect as many different
medical history forms as
possible. If required, visit
other schools’ websites and
print them out, or ask for
copies from dental offices.
Divide the class into
groups. Distribute the
medical history forms to the
groups. Have the groups
critique the forms and
respond to questions. For
example:
Evaluation
Skill Check, p. 51-52
Test Bank
TG Questions 1–12
Instructor’s Notes
Gehrig’s Patient Assessment Tutorials: A Step-by-Step Guide for the Dental Hygienist (Third Edition)
Module 4—Medical History




Do the forms all ask
the same questions
and cover the same
conditions and
diseases?
Is one more thorough
than another?
Which one is the most
user-friendly form?
Which would you
prefer to complete,
and why?
Materials
1. A mock medical history
form
2. Copies of medical forms
from different sources like
websites or local dental
clinics
Legend: PPt: PowerPoint; TG: Test Generator; Note: All electronic ancillary assets can be found on the book’s companion website at thePoint.lww.com.
Page 9 of 20
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Gehrig’s Patient Assessment Tutorials: A Step-by-Step Guide for the Dental Hygienist (Third Edition)
Module 4—Medical History
Objective 4-6
Describe the types of information that should be entered in the Medical Alert Box on the medical
history form.
Lecture Outline
Content
Text
page
11
 Information that should be
entered in the Medical Alert Box:
 Any medical condition or
disease that will alter dental
treatment
 Any medical condition or
disease that will alter drugs used
during dental treatment or
prescribed for the patient to treat
dental conditions
 Any medical condition or
disease that places the patient at
risk for medical emergency
during dental treatment
PPT
slide
Ch04Sec 1,
18-19
Figures, Tables, and
Features
Resources and
In-Class Activities
Outside Assignments and
Evaluation
Boxes
In-Class Activities
Outside Assignments
4-2: Contents of
Medical Alert Box
p. 11, PPt slide 19
Collect some samples of
medical history forms with
the personal details of the
patients illegible. Divide
the class into groups and
distribute these forms to
them. Ask each group to
identify the different items
of information entered in
the medical alert box.
Patient scenario, p. 22
 Any medical condition or
disease that could result in a
postoperative complication
Instructor’s Notes
Evaluation
Test Bank
TG Questions 1–12
Materials
Samples of medical history
forms with personal details
of patients made illegible
Legend: PPt: PowerPoint; TG: Test Generator; Note: All electronic ancillary assets can be found on the book’s companion website at thePoint.lww.com.
Page 10 of 20
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Gehrig’s Patient Assessment Tutorials: A Step-by-Step Guide for the Dental Hygienist (Third Edition)
Module 4—Medical History
Objective 4-7
List the information that should be indicated on a medical consultation form.
Lecture Outline
Content
Text
page
 Consultation form is a request for 12-15
additional information and/or
advice about the medical
implications of oral health care
treatment.
 The written request includes
various aspects of a patient’s
health history that will impact
dental treatment such as:
PPT
slide
Ch04Sec 1,
33-40
Figures, Tables, and
Features
Resources and
In-Class Activities
Outside Assignments and
Evaluation
Figures
In-Class Activities
Evaluation
4-5A: Sample
Medical Consultation
Request, Page 1
p. 14
Divide the class into
Test Bank
groups. Distribute a blank
TG Questions 1–12
sample of a consultation
form along with a sample
medical history form to
each group. Ask each group
to complete the
consultation form based on
the medical history form
they have.
4-5B: Sample
Medical Consultation
Request, Page 2
p. 15
 Medical condition or disease of
concern
 An explanation of the planned
dental treatment and the likely
systemic consequences
 A request for additional
information and/or the
physician’s professional opinion
Instructor’s Notes
Materials
Blank samples of
consultation forms and
samples of medical history
forms
 The patient’s signature
authorizing the release of
information, the dentist’s
signature, and the dental office’s
address, phone number, and fax
number
Legend: PPt: PowerPoint; TG: Test Generator; Note: All electronic ancillary assets can be found on the book’s companion website at thePoint.lww.com.
Page 11 of 20
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Gehrig’s Patient Assessment Tutorials: A Step-by-Step Guide for the Dental Hygienist (Third Edition)
Module 4—Medical History
Objective 4-8
Describe contraindications and complications for dental care presented by various medical
conditions/diseases and prescription medications.
Lecture Outline
Content
Text
page
PPT
slide
 Determining the patient’s level of 12 and Ch04
22
Sec 1,
medical risk
22-31
 A patient’s medical conditions,
diseases, and medications
determine the need for
precautionary measures before
or during dental treatment.
 ASA Physical Status
o
ASA 1
o
ASA 2
o
ASA 3
o
ASA 4
Figures, Tables, and
Features
Resources and
In-Class Activities
Outside Assignments and
Evaluation
Tables
In-Class Activities
Outside Assignments
4-1: ASA Physical
Status Implications
for Dental Treatment
p. 12, PPt slides 22–
31
1. Create a list of common
medications. Have students
work in pairs and give them
medications that are
grouped either
alphabetically or by use.
Boxes
Have them refer to drug
4-5: Through the Eyes reference books that are
of a Student
used in their clinic. They
p. 22
can report findings to the
class and answer:
a What are the
implications and
considerations for
dental treatment with
each drug?
b Will you need to alter
treatment procedures if
the patient is taking the
medication?
c If so, what would the
alterations be?
2. Tell the students to
describe in 100 words or
less how they would like
their clinician to discuss
Page 12 of 20
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Patient scenario, p. 22
Evaluation
Skill Check, p. 51-52
Test Bank
TG Questions 1–12
Instructor’s Notes
Gehrig’s Patient Assessment Tutorials: A Step-by-Step Guide for the Dental Hygienist (Third Edition)
Module 4—Medical History
their current medications:
Prozac and Lipitor. Discuss
some personality
characteristics that would
be necessary to respond to
each medical history in a
way that is positive.
Role Playing Exercises


The Bass Player
The Energized
Patient
Materials
Several copies of Observer
Feedback and Player
Feedback Forms
Resources
Module 5, Ready Reference
5-1:Common Conditions of
Concern in Dentistry;
Ready Reference 5-2:
Commonly Prescribed
Drugs
Legend: PPt: PowerPoint; TG: Test Generator; Note: All electronic ancillary assets can be found on the book’s companion website at thePoint.lww.com.
Page 13 of 20
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Gehrig’s Patient Assessment Tutorials: A Step-by-Step Guide for the Dental Hygienist (Third Edition)
Module 4—Medical History
Objective 4-9
Recognize findings that have implications in planning dental treatment.
Lecture Outline
Content
Text
page
PPT
slide
 The findings that have
implications in planning dental
treatment include:
3-4,
11-13,
16-18
Ch04Sec1,
36–43
 Patient’s medical conditions and
diseases
 Patient’s medications
 Inferences from the following
impact planning dental treatment
for a patient:
 Review of a written
questionnaire and patient
interview
 Strategies for stress reduction
Figures, Tables, and
Features
Resources and
In-Class Activities
Outside Assignments and
Evaluation
Boxes
In-Class Activities
Evaluation
4-4: Strategies for
Stress Reduction
p. 16, PPt slides 41–
49
Ask the students to visit the
website
http://www.doctorzebra.co
m/prez/g27.htm, which
gives the medical history of
President Taft. Comment
and discuss some findings
that would affect his dental
treatment if he were to be
your patient tomorrow.
Skill Check, p. 51-52
Test Bank
TG Questions 1–12
Procedures
4.1: Review of
written questionnaire
and patient interview
pp. 17-18
36–a Pent
Interview
Instructor’s Notes
Materials
Computers with internet
connection
Legend: PPt: PowerPoint; TG: Test Generator; Note: All electronic ancillary assets can be found on the book’s companion website at thePoint.lww.com.
Page 14 of 20
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Gehrig’s Patient Assessment Tutorials: A Step-by-Step Guide for the Dental Hygienist (Third Edition)
Module 4—Medical History
Objective 4-10
Provide appropriate referral to a physician or dental specialist when findings indicate the need for
further evaluation.
Lecture Outline
Content
 Consulting with the patient’s
physician is necessary if:
 There is any question or doubt
in making the best decisions
 All questions are not completely
answered through research and
the patient interview
 Consultation with the patient’s
physician includes:
Text
page
PPT
slide
13-15
Ch04Sec 1,
32-40
Figures, Tables, and
Features
Resources and
In-Class Activities
Outside Assignments and
Evaluation
Figures
In-Class Activities
Outside Assignments
4-5A: Sample
Medical Consultation
Request, Page 1
p. 14
Discuss the following case
with the students in your
class:
A patient listed diabetes,
hypertension, and HIV+ as
diseases he or she currently
has.
 Which of the three
listed conditions would
have a greater impact
on this patient’s dental
treatment?
 Which would have a
greater impact on the
clinician’s routine?
 How would they affect
other assessment
procedures, such as
taking vital signs and
doing oral
examinations?
Patient scenario, p. 22
4-5B: Sample
Medical Consultation
Request, Page 2
p. 15
 Sending request in writing
 Explaining the treatment
planned
 Outlining procedures
 Obtaining patient’s consent
 Meeting legal requirements
Instructor’s Notes
Evaluation
Test Bank
TG Questions 1–12
Legend: PPt: PowerPoint; TG: Test Generator; Note: All electronic ancillary assets can be found on the book’s companion website at thePoint.lww.com.
Page 15 of 20
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Gehrig’s Patient Assessment Tutorials: A Step-by-Step Guide for the Dental Hygienist (Third Edition)
Module 4—Medical History
Objective 4-11
Demonstrate the ability to apply information learned in the classroom and clinical activities to the
fictitious patient cases A–E in this module, including: reviewing completed health history forms,
conducting research, formulating follow-up questions, conducting a patient interview, and determining
the medical risk of dental treatment to the patient.
Lecture Outline
Figures, Tables, and
Features
Resources and
In-Class Activities
Outside Assignments and
Evaluation
Tables
Resources
Outside Assignments
Module 6: dental histories
for fictitious patients A-E
Ask the students to
complete a medical history
form of a family member or
friend.
 Patient C: Carlos Chaves
4-2: English to
Spanish Phrase List
for Medical History
Assessment
p. 24
 Patient D: Donna Doi
Figures
Content
 Medical history and medication
list for five fictitious patients:
 Patient A: Alan Ascari
 Patient B: Bethany Biddle
 Patient E: Esther Eads
Text
page
25–50
PPT
slide
Evaluation
4-6: Page 1 of the
health history form
for fictitious patient
Mr. Ascari
p. 26
4-7: Medication list
for fictitious patient
Mr. Ascari
p. 27
4-8A: Medical
History Synopsis Part
Page 16 of 20
Copyright © 2013 Wolters Kluwer | Lippincott Williams & Wilkins
Test Bank
TG Questions 1–12
Instructor’s Notes
Gehrig’s Patient Assessment Tutorials: A Step-by-Step Guide for the Dental Hygienist (Third Edition)
Module 4—Medical History
1
p. 28
4-8B: Medical
History Synopsis Part
2
p. 29
4-9: Page 1 of
Medical Consultation
Request
p. 30
4-10: Health History
form for fictitious
patient Bethany
Biddle
p. 31
4-11: Medication list
for fictitious patient
Bethany Biddle
p. 32
4-12A: Medical
History Synopsis Part
1
p. 33
4-12B: Medical
History Synopsis Part
2
p. 34
4-13: Page 1 of
Medical Consultation
Request
p. 35
Page 17 of 20
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Gehrig’s Patient Assessment Tutorials: A Step-by-Step Guide for the Dental Hygienist (Third Edition)
Module 4—Medical History
4-14A: Page 1 of the
health history form
for fictitious patient
Mr. Chavez
p. 36
4-15: Medication list
for fictitious patient
Mr. C
p. 37
4-16A: Medical
History Synopsis Part
1
p. 38
4-16B: Medical
History Synopsis Part
2
p. 39
4-17: Page 1 of
Medical Consultation
Request
p. 40
4-18A: Page 1 of the
health history form
for fictitious patient
Mrs. Doi
p. 41
4-19: Medication list
for fictitious patient
Mrs. Doi
p. 42
Page 18 of 20
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Gehrig’s Patient Assessment Tutorials: A Step-by-Step Guide for the Dental Hygienist (Third Edition)
Module 4—Medical History
4-20A: Medical
History Synopsis Part
1
p. 43
4-20B: Medical
History Synopsis Part
2
p. 44
4-21: Page 1 of
Medical Consultation
Request
p. 45
4-22: Page 1 of the
health history form
for fictitious patient
Miss Eads
p. 46
4-23: Medication list
for fictitious patient
Miss Eads
p. 47
4-24A: Medical
History Synopsis Part
1
p. 48
4-24B: Medical
History Synopsis Part
2
p. 49
4-25: Page 1 of
Page 19 of 20
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Gehrig’s Patient Assessment Tutorials: A Step-by-Step Guide for the Dental Hygienist (Third Edition)
Module 4—Medical History
Medical Consultation
Request
p. 50
Legend: PPt: PowerPoint; TG: Test Generator; Note: All electronic ancillary assets can be found on the book’s companion website at thePoint.lww.com.
Page 20 of 20
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