Vital Signs

Procedure

-Explain procedure to patient -Choose proper cuff size -Have patient relax with palm up -Position cuff on bare arm, with lower edge of cuff 1 inch above antecubital fossa

Process of taking temperature

-Explain the Procedure -Cover Thermometer with a Sheath -Position Bulb under Tongue -Read the Temperature

Sequence of Sounds

-First tapping sound is the systolic reading -Continue with soft swishing sounds -May be a gap of silence -Return of thudding sounds -Distinct muffling of sounds -Complete disappearance of sounds is the diastolic reading

Enhancement Techniques

-Have subject open/close fist 8-10 times AFTER the BP cuff is inflated above the systolic level—Take BP normally -Elevate subject's arm for a few seconds BEFORE inflation, then Inflate cuff WHILE arm is still elevated. LOWER arm and deflate cuff in normal manner.

Accurate Reading

-Have the patient relax for a short period before assessing blood pressure -This may occur while you are updating the personal medical history

Cuff Placement

-Landmark antecubital fossa is used as a reference for cuff placement -Lower edge of the cuff should be 1 inch above the fossa -Fossa should be at the patient's heart level

Equipment needed for taking the temperature

-Mercury-free thermometer -Tissue -Disposable sheath -Watch or clock with second hand -Pen or computer keyboard for recording

Vital Signs: Temperature

-Most common method is with a glass thermometer -Liquid inside the thermometer expands when exposed to body heat -Liquid column should be below 94°F to begin -Use a rapid snapping motion with the wrist

Procedure

-Observe for a full minute if rate seems irregular -Pay attention to depth and rhythm -Record BOTH pulse and respiratory rates

Pressure on Vessels

-Occurs when blood is pushed through the arteries by a contraction -Pressure created against the vessel walls is called the systolic pressure -Most important in management of HBP. -When the heart relaxes before the next contraction, the lower pressure is called the diastolic pressure

Arm Position

-Patient should be seated with back supported -Clinician supports patient's arm by holding under elbow -Clinician supports weight of arm so patient doesn't tense -Arm is horizontal with antecubital fossa -False readings if fossa is above or below heart level

Procedure (Cont'd)

-Pay attention to sounds -Take note of when you first hear the throbbing sounds (systolic) and cessation of all sounds (diastolic) -Record as a fraction -Inform the patient and explain the significance

Procedure before taking temperature

-Question patient about having had anything hot or cold to drink within 30 minutes of assessment -Wash hands -Explain procedure to patient -Shake liquid level to below 94°F -Place sheath over thermometer -Place thermometer bulb under patient's tongue -Leave in place for 3 to 5 minutes -Remove thermometer from mouth -Discard sheath -Read thermometer to nearest 10th of a degree -After reading, place thermometer on a barrier in a safe place -Wash hands -Record reading -Report abnormal findings

Not "One Size Fits All"

-Selecting the correct cuff size -Length and width affects reading -Sizes are child, adult small, adult standard, adult large, adult thigh

Bladder Width

-Should be 40% wider than diameter of the arm -Too narrow causes falsely high readings -Too wide causes falsely low readings

Equipment for taking blood pressure

-Sphygmomanometer -Gauges -Aneroid -Mercury column -Stethoscope -Electronic/digital

Bladder Length

-Too short causes falsely high readings -Too long causes falsely low readings

Recording Blood Pressure Readings

-Two readings are recorded as a fraction -Systolic is the top number -Diastolic is the bottom number -Numbers stand for millimeters of mercury regardless of which type of gauge you have

Korotkoff Sounds

-Vibrations in the artery walls heard through a stethoscope -Auscultation is the act of listening for sounds in the body with a stethoscope

Maintenance of Thermometer

-Wash in lukewarm soapy water -Rinse in cold water -Dry -Disinfect -Place in storage container

Measuring the Radial Pulse

1. Explain purpose and procedure to patient 2. Use watch with second hand 3. Patient in sitting position, elbow at 90°, support lower arm on armrest of chair 4. Place first two fingers of your hand along the radial artery and lightly compress against it 5. Obliterate the pulse initially and then relax pressure so pulse is easily palpable

Impact of Temperature on Dental Treatment

A temperature above 101°F usually indicates an active disease process Patient should be referred to primary care physician

Variables in Respiratory Rate

Children use their diaphragms, which requires watching the abdomen vs. chest Excitement, exercise, pain, and fever increase the rate Rapid rate could also indicate a disease state: -Emphysema -Heart disease

Procedure (Cont'd)

Establish Correct Arm Position

Procedure (Cont'd)

Grasp the Air Pump Bulb

Enhancement Techniques

Have subject open/close fist 8-10 times AFTER the BP cuff is inflated above the systolic level—Take BP normally. Elevate subject's arm for a few seconds BEFORE inflation, then Inflate cuff WHILE arm is still elevated. LOWER arm and deflate cuff in normal manner.

High and Low BP

Hypertension & Hypotension

Asymptomatic

Hypertension has no symptoms Referred to as the "silent killer" Screening may be the only way to diagnose

Respiratory Rate

Process that brings oxygen into the body and removes carbon dioxide Normal breathing allows a person to inhale and exhale 500 mL of air Measured by counting the number of times a patient's chest rises and falls in 1 minute

What is Pyrexia

Pyrexia, or fever, is any reading over 99.5 degrees F OR 37.5 degrees C

Pulse

The PULSE is the intermittent beat of the heart that is felt through the walls of an artery, an indicator of the integrity of the cardiovascular system.

ADA Recommendations

Blood pressure assessment should be a routine part of the initial appointment for all new dental patients Both adults and children Use as a screening tool for undiagnosed high blood pressure Continue to monitor at continuing care appointments: 3, 4, 6, and 12 months

Controlling Respirations

Breathing is an unconscious function Can be brought under voluntary control -Holding breath -Panting -Singing -Sighing

Palpation of the brachial or radial pulse during cuff inflation:

ensures that the auscultatory gap is not mistaken for the phase I sounds

Hypertension

is abnormally high blood pressure -Above 140/90 -Readings increase when large blood vessels lose elasticity and smaller vessels constrict

Hypotension

is abnormally low blood pressure

When to take Vital Signs

- Before the administration of a local anesthetic agent or nitrous oxide-oxygen analgesia -Before during, and after surgical procedures -If the client reports symptoms that indicate a potential emergency situation or when a medical emergency is in progress

Procedure (Cont'd)

-Adjust gauge for easy reading -Place stethoscope ear pieces in canal angled forward -Support patient's arm by holding elbow -Have antecubital fossa at midsternum level

Influences on Blood Pressure

-Age -Race -Body position -Respiration -Emotion -Temperature -Anxiety -Exercise -Meals -Tobacco -Alcohol -Pain

Procedure

-Assess immediately after taking pulse while fingers are still in place on the wrist -Look at your watch or clock and watch the patient's chest out of your peripheral vision -Count the number of times the chest rises and falls over 30 seconds -Multiply the number by 2

Estimating Blood Pressure

-Avoid falsely low systolic readings -Palpate brachial pulse while inflating the cuff -Continue to assess until pulse disappears -This is the estimated systolic reading -Deflate cuff and wait 15 seconds -Perform steps of blood pressure assessment, pumping 30 mm Hg over estimation

White-Coat Hypertension

-Blood pressure rises above its usual rate when measured in a health care setting in which the clinician may be wearing a white coat or clinic attire -More common in patients who already have high blood pressure -Subsides once the patient relaxes

Procedure (Cont'd)

-Close the bulb valve Squeeze bulb rapidly to inflate bladder 30 mm Hg above estimated systolic reading -Open valve slowly to release pressure; gauge should drop about 2 mm per second

Educate/Encourage/Explain

-Educate patient when abnormal vitals are present and initiate referral when appropriate [remember - we are screening, not diagnosing] -Encourage compliance with referrals and medications to control abnormal vitals -Explain risk factors. Patients with high BP may have no overt symptoms, yet the condition increases their risk of cardiac arrest and stroke

Procedure (Cont'd)

-Estimate using brachial pulse -Open valve, deflate cuff rapidly, and wait 15 seconds -Place amplifying device above antecubital fossa toward the inner arm

A temperature above _______ constitutes a medical emergency

105.8°F

Measuring the Radial Pulse

6. When pulse is felt regularly, use the watch's second hand to time the rate 7. If pulse is regular, count for 30 seconds and multiply total by 2 [if irregular count for full minute] 8. Record heart rate (BPM) in chart with date. Note quality of beat if irregular, thready, weak, bounding, etc.

Pulse

Acceptable ranges of pulse data Infants 120-160 BPM Toddlers 90-140 Preschoolers 80-110 School-agers 75-100 Adolescents 60-90 Adults 60-100* *if under 60 or above 110BPM, evaluate for causative factor or conditions. No cause = medical consultation

Normal Respiratory Rate:

Adult—between 12 and 20 breaths per minute

Procedure (Cont'd)

Inform the Patient

Treatment

Lose weight Lifestyle changes Stress reduction Exercise Prescribed medications 50% stop taking medications within a year

Procedure (Cont'd)

Position Amplifying Device

Normal Breathing

Practice breathing normally for the next minute and count your own respirations

Body Temperature

No single temperature is normal for all people Range= 96.0 - 99.5° Fahrenheit 35.5 -- 37.5 ° Celsius

What is Normal?

Normal ADULT temperature is: Anywhere from 96 to 99.6°F OR 35.5 to 37.5°C Average normal oral temperature is 98.6°F or 37°C "Normal" varies from person to person

Procedure (Cont'd)

Note Systolic and Diastolic Pressure

Body Temperature Measurement Sites

Oral cavity [under tongue] Alternate sites = ear [tympanic membrane] = axilla [ armpit]

Procedure (Cont'd)

POSITION ARM CUFF

Procedure (Cont'd)

POSITION EAR PIECE

Overview

Six quarts of blood push against vessel walls with each heart beat Blood flows to the ends of our bodies with each beat: fingers, toes, and head

Variables Affecting Temperature

Stress—rises with increased stress Hormones—varies with menstrual cycle Hot or cold liquids—may rise or fall for 15 minutes Smoking—increases for up to 30 minutes Rapid breathing—decreases temperature Infection or inflammation—increases temperature

If uncontrolled:

Stroke Heart attack Heart failure Kidney failure If pregnant: Seizures and death Premature birth and stillbirths

Vital Signs include:

Temperature, pulse, respiration rate, and blood pressure which are indicators of health status.

Pulse Measurement Sites

Thumb side of the inner wrist - Radial Pulse; Use the fingertips of the first two fingers to feel for the pulse NEVER use the thumb to feel for the pulse *if radial pulse cannot be felt, the carotid pulse is an alternative Pulse is recorded in beats per minute (BPM)

Variables Affecting Temperature

Time of day—lowest in morning and may rise by 1°F in early evening Exercise—may rise 1°F after strenuous exercise on a hot day Age—if 70 years old or above, average temperature is 96.8°F (36°C) Environment—hot or cold

Measurement of vital signs provides baseline data on :

the patient's state of health & identifying undiagnosed medical problems