Clinic II: Nitrous Oxide and Oxygen Case Study

by | Aug 1, 2024 | Dentistry

 

Clinic II: Nitrous Oxide and Oxygen Case Study
Today you are presenting your dental hygiene care plan for four-quadrant, initial therapy, periodontal debridement to Mr. Shizoka. You will ask the patient to sign an informed consent form before you begin your treatment. Mr. Shizoka, does not have much previous dental experience. When you were collecting assessment data for the care plan, he appeared to be very nervous. He asked many questions about what you were doing and stopped you frequently when you were trying to probe because he was concerned about whether he would feel pain.

1. Mr. Shizokas medical history indicates that he has iron-deficiency anemia and takes a daily ferrous iron supplement. He has hypertension and takes an antihypertensive medication; but he tells you that whenever he is highly stressed, he gets a headache. Write a dental hygiene diagnosis statement related to Mr. Shizokas anxiety about receiving dental hygiene treatment.

2. In the dental hygiene care plan you have developed, you plan to used nitrous oxide-oxygen for pain and anxiety control during Mr. Shizokas four scaling and root planning appointments. Explain to Mr. Shizoka what nitrous oxide-oxygen sedation is and how it works. Also explain the advantages and disadvantages so that he can be completely informed about the use of this pain and anxiety control measures?

3. Mr. Shizoka agrees to try the nitrous oxide-oxygen sedation for at least his first dental hygiene appointment to see if he is comfortable with it. Create a service rendered entry that documents that you have fully informed Mr. Shizoka and that he has agreed to the use of nitrous oxide analgesia during his dental hygiene treatment.

4.At his next appointment, the dentist carefully titrates the nitrous oxide-oxygen combination for Mr. Shizoka, and he shows all the signs of ideal sedation. When you begin the injection of local anesthesia into the area where you will be providing care, Mr. Shizoka becomes agitated and starts moving his arms and legs. His rate of respiration increases significantly, he starts to sweat, and his eyes tear up. You immediately stop injection the local anesthesia. He says he feel sick to his stomach and wants to sit up. Discuss two possibilities for what is happening in this scenario?

5.What will you do next in the situation that is described in question #4?

6.Write a services rendered entry that documents what happened today at Mr. Shizokas dental hygiene appointment.

7.How much time is usually required for primary saturation of blood to occur?

8.What is the minimum amount oxygen flow that is maintained by the gas delivery system for patient safety?

9.List contraindications for the use of nitrous oxide during dental hygiene treatment.

10.What are the potential health hazards for clinicians who are exposed to excessive levels of nitrous oxide? How can these hazards be prevented?

11.Summarize the steps to administer nitrous oxide for the patient above. For each step, where appropriate, indicate the time frame and the mount of oxygen or nitrous flow including titration of nitrous oxide gas during administration.

12.Identify at least three advantages and three disadvantages of using conscious sedation (such as nitrous oxide) to reduce patient pain and anxiety during dental hygiene treatment.

Sample solution

Dante Alighieri played a critical role in the literature world through his poem Divine Comedy that was written in the 14th century. The poem contains Inferno, Purgatorio, and Paradiso. The Inferno is a description of the nine circles of torment that are found on the earth. It depicts the realms of the people that have gone against the spiritual values and who, instead, have chosen bestial appetite, violence, or fraud and malice. The nine circles of hell are limbo, lust, gluttony, greed and wrath. Others are heresy, violence, fraud, and treachery. The purpose of this paper is to examine the Dante’s Inferno in the perspective of its portrayal of God’s image and the justification of hell. 

In this epic poem, God is portrayed as a super being guilty of multiple weaknesses including being egotistic, unjust, and hypocritical. Dante, in this poem, depicts God as being more human than divine by challenging God’s omnipotence. Additionally, the manner in which Dante describes Hell is in full contradiction to the morals of God as written in the Bible. When god arranges Hell to flatter Himself, He commits egotism, a sin that is common among human beings (Cheney, 2016). The weakness is depicted in Limbo and on the Gate of Hell where, for instance, God sends those who do not worship Him to Hell. This implies that failure to worship Him is a sin.


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God is also depicted as lacking justice in His actions thus removing the godly image. The injustice is portrayed by the manner in which the sodomites and opportunists are treated. The opportunists are subjected to banner chasing in their lives after death followed by being stung by insects and maggots. They are known to having done neither good nor bad during their lifetimes and, therefore, justice could have demanded that they be granted a neutral punishment having lived a neutral life. The sodomites are also punished unfairly by God when Brunetto Lattini is condemned to hell despite being a good leader (Babor, T. F., McGovern, T., & Robaina, K. (2017). While he commited sodomy, God chooses to ignore all the other good deeds that Brunetto did.

Finally, God is also portrayed as being hypocritical in His actions, a sin that further diminishes His godliness and makes Him more human. A case in point is when God condemns the sin of egotism and goes ahead to commit it repeatedly. Proverbs 29:23 states that “arrogance will bring your downfall, but if you are humble, you will be respected.” When Slattery condemns Dante’s human state as being weak, doubtful, and limited, he is proving God’s hypocrisy because He is also human (Verdicchio, 2015). The actions of God in Hell as portrayed by Dante are inconsistent with the Biblical literature. Both Dante and God are prone to making mistakes, something common among human beings thus making God more human.

To wrap it up, Dante portrays God is more human since He commits the same sins that humans commit: egotism, hypocrisy, and injustice. Hell is justified as being a destination for victims of the mistakes committed by God. The Hell is presented as being a totally different place as compared to what is written about it in the Bible. As a result, reading through the text gives an image of God who is prone to the very mistakes common to humans thus ripping Him off His lofty status of divine and, instead, making Him a mere human. Whether or not Dante did it intentionally is subject to debate but one thing is clear in the poem: the misconstrued notion of God is revealed to future generations.

 

References

Babor, T. F., McGovern, T., & Robaina, K. (2017). Dante’s inferno: Seven deadly sins in scientific publishing and how to avoid them. Addiction Science: A Guide for the Perplexed, 267.

Cheney, L. D. G. (2016). Illustrations for Dante’s Inferno: A Comparative Study of Sandro Botticelli, Giovanni Stradano, and Federico Zuccaro. Cultural and Religious Studies, 4(8), 487.

Verdicchio, M. (2015). Irony and Desire in Dante’s” Inferno” 27. Italica, 285-297.

 

 

 

Clinic II: Nitrous Oxide and Oxygen Case Study

1. Dental Hygiene Diagnosis Statement

Dental Hygiene Diagnosis: Anxiety related to anticipated dental procedures, as evidenced by Mr. Shizoka’s nervousness, frequent questioning about pain, and concern for discomfort during periodontal debridement.

2. Explanation of Nitrous Oxide-Oxygen Sedation

What is Nitrous Oxide-Oxygen Sedation?
Nitrous oxide-oxygen sedation, commonly referred to as “laughing gas,” is a method used to help patients feel more relaxed and comfortable during dental procedures. It involves inhaling a mixture of nitrous oxide (N2O) and oxygen (O2) through a small mask placed over the nose.

How it Works:

– Nitrous oxide is a colorless, odorless gas that induces a state of relaxation and euphoria.
– Upon inhalation, nitrous oxide enters the bloodstream and quickly reaches the brain, where it acts on neurotransmitters to reduce anxiety and pain perception.
– The effects are rapid, and patients typically feel the sedation within minutes.

Advantages:

– Rapid Onset and Recovery: The effects wear off quickly once the gas is no longer inhaled, allowing patients to resume normal activities almost immediately.
– Anxiolytic Properties: Reduces anxiety and discomfort associated with dental procedures.
– Analgesic Effect: Provides some pain relief, making procedures more tolerable.

Disadvantages:

– Variable Effectiveness: Not all patients respond equally; some may feel little to no relief.
– Potential Side Effects: Some patients may experience nausea or dizziness after the procedure.
– Requires Monitoring: Continuous monitoring of the patient’s vital signs is necessary during administration.

3. Services Rendered Entry for Mr. Shizoka

Services Rendered Entry:
“During today’s appointment, I thoroughly explained the use of nitrous oxide-oxygen sedation to Mr. Shizoka, including its mechanism, advantages, and disadvantages. Mr. Shizoka expressed understanding and agreed to the use of nitrous oxide analgesia during his dental hygiene treatment. Informed consent was obtained.”

4. Discussion of Possible Scenarios

In the scenario where Mr. Shizoka becomes agitated during the injection of local anesthesia, two possible explanations for his reaction are:

1. Anxiety or Panic Attack: Despite the sedation, Mr. Shizoka may have experienced a surge of anxiety or a panic attack triggered by the sight of the needle or the anticipation of pain associated with the local anesthesia injection.

2. Over-sedation: It is possible that the nitrous oxide-oxygen combination was titrated too high, leading to over-sedation, which can cause discomfort and feelings of nausea or agitation in some patients.

5. Next Steps in the Situation

In response to Mr. Shizoka’s agitation during the injection of local anesthesia:

1. Stop the Injection: Immediately discontinue the administration of local anesthesia.
2. Calm the Patient: Speak to him in a calm and reassuring manner to help alleviate his anxiety.
3. Adjust Nitrous Levels: Reduce or stop nitrous oxide delivery while continuing oxygen flow to ensure he receives adequate oxygenation.
4. Assess Vital Signs: Monitor his vital signs closely for any abnormalities.
5. Positioning: Assist Mr. Shizoka into a more comfortable sitting position if he requests it.
6. Evaluate Symptoms: Ask him about his symptoms and provide reassurance that they are likely temporary.

6. Services Rendered Entry Documenting Today’s Appointment

Services Rendered Entry:
“During today’s appointment, nitrous oxide-oxygen sedation was initiated for Mr. Shizoka’s dental hygiene treatment. The patient exhibited signs of ideal sedation initially; however, upon beginning the local anesthesia injection, he became agitated, increased his respiratory rate, and expressed feelings of nausea. The local anesthesia injection was immediately stopped, nitrous oxide levels were reduced, and patient comfort was prioritized. Vital signs were monitored throughout the episode.”

7. Time Required for Primary Saturation of Blood

Primary saturation of blood with nitrous oxide typically occurs within 3 to 5 minutes after inhalation begins.

8. Minimum Oxygen Flow for Patient Safety

The minimum oxygen flow that should be maintained by the gas delivery system during nitrous oxide administration for patient safety is typically around 2 to 3 liters per minute (L/min).

9. Contraindications for Use of Nitrous Oxide

Contraindications for the use of nitrous oxide during dental hygiene treatment include:

– Pregnancy (especially in the first trimester)
– Severe respiratory conditions (e.g., COPD)
– Recent ear surgery or tympanic membrane perforation
– History of substance abuse
– Certain psychiatric disorders or conditions that may exacerbate anxiety

10. Potential Health Hazards for Clinicians Exposed to Excessive Nitrous Oxide Levels

Potential health hazards for clinicians exposed to excessive levels of nitrous oxide include:

– Neurological effects such as headaches and dizziness
– Long-term exposure can lead to vitamin B12 deficiency and neurological disorders
– Reproductive health issues in pregnant women

Prevention Measures:

– Use scavenging systems to capture excess nitrous oxide.
– Ensure proper ventilation in treatment areas.
– Regularly monitor air quality in dental operatories.
– Conduct training on safe handling practices for staff.

11. Steps to Administer Nitrous Oxide

1. Patient Assessment (Before Treatment):

– Review medical history and contraindications.
– Explain the procedure and obtain informed consent.

2. Equipment Setup:

– Prepare the nitrous oxide delivery system.
– Ensure proper functioning of equipment.

3. Baseline Vital Signs:

– Record baseline vital signs (blood pressure, heart rate, respiratory rate).

4. Initial Oxygen Flow (0-2 minutes):

– Start with 100% oxygen at 6 L/min for approximately 2 minutes.

5. Introduce Nitrous Oxide (2-5 minutes):

– Gradually titrate nitrous oxide beginning at 20-30% concentration, increasing as needed based on patient comfort.

6. Monitor Patient Response (5+ minutes):

– Continuously assess the patient’s comfort level and vital signs.
– Adjust nitrous oxide levels based on feedback.

7. Maintain Sedation (Throughout Procedure):

– Ensure that at least 50% oxygen flow remains throughout administration.
– Titrate nitrous oxide as necessary based on patient response.

8. Post-Sedation Recovery (After Procedure):

– Administer 100% oxygen for 3-5 minutes after stopping nitrous oxide.
– Monitor recovery until the patient returns to baseline state.

12. Advantages and Disadvantages of Using Conscious Sedation

Advantages:

1. Reduction in Anxiety: Helps patients feel more relaxed during dental procedures.
2. Pain Control: Provides analgesic properties that can minimize discomfort during treatment.
3. Quick Recovery: Patients typically recover rapidly after cessation of nitrous oxide, enabling them to resume normal activities.

Disadvantages:

1. Variable Efficacy: Not all patients respond positively to nitrous oxide; some may not achieve desired sedation levels.
2. Potential Side Effects: Possible side effects include nausea, dizziness, or agitation during administration.
3. Requires Monitoring and Training: Proper training for staff is essential to safely administer nitrous oxide and monitor patient responses effectively.

This comprehensive examination aims to ensure that all aspects of using nitrous oxide in dental hygiene practices are well understood by both practitioners and patients alike, promoting safe and effective care delivery.

 

 

 

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