What are the vital signs discussed in this chapter?
body temperature
pulse
respiratory rate
blood pressure
smoking status
describe patient preparation and instruction in taking vital signs
seat patient upright and at eye level
explain the vital signs and obtain consent
explain how vital signs can affect dental treatment
teach the pt to refrain from eating, drinking, or smoking before the vital signs are taken
explain each step as needed
Can we treat a pt if their vital signs are not normal?
no
What does recording vital signs contribute to?
the proper systemic evaluation of a pt in conjunction with the complete medical history
How are vitals recorded in treatment record?
Date: HHX: No cx to tx P:__________ R:_______
BP: LA _________ SI CII
HHX
health history exam
no cx to tx
no contradictions to treatment
P:______
pulse
R:_______
respiration
BP:__________
blood pressure
Why is it important to have proper sequencing of vital signs? And what is the proper sequence/
dental hygiene care planning and appointment sequencing are directly influenced by the findings
pulse - respiration - blood pressure
What should you do if the vital signs of a patient are not within normal?
advise patient to check with a physician
referral for medical evaluation and treatment as indicated
What are the indications for taking a patients body temperature?
all new patients
complete examination during a maintenance appointment
When oral infection is known to be present:
necrotizing ulcerative gingivitis or periodontitis
apical or periodontal abscess
acute pericoronitis
with other vitals prior to administration of local anesthetic
with any reported illness or if there's a suspected infection
Why should we take a pt's temperature if they report illness or if there is a suspected infection?
to protect the health of the healthcare personnel and patients or families who may be exposed secondarily
special significance during epidemics when community exposures are at risk
for patients referral for medical care when indicated
What are some factors that alter body temperature?
time of day
temporary increase
pathologic state
decrease
describe time of day altering body temp
highest: late afternoon and early evening
lowest: during sleep and early morning
What events may temporarily increase body temp?
exercise
hot drinks
smoking
application of external heat
How does pathologic state affect body temp?
all affect body temp:
infection
dehydration
hyperthyroidism
myocardial infarcation
tissue injury from trauma
What events may decrease body temp?
starvation
hemorrhage
physiologic shock
Where are the locations for measuring body temperature?
oral
forehead
ear
medical/hospital applications: axilla or rectum
What are the different types of thermometers?
electronic
tympanic
mercury in glass
chemical strip
describe the use of an electronic thermometer with a digital readout.
conver with disposable protective sheath
place under tongue; short time required
read on the digital display
describe the use of the tympanic thermometer.
cover with protective sheath
insert gently into ear canal
short exposure (2-5 seconds) before record appears on digital unit
describe the use of a mercury in glass thermometer.
oral = blue tip
rectal = red tip
used less becuase of danger for breakage with mercury spill that mut be cleaned up using specified procedures
sheath cover used for infection protection
takes longer time before reading than other types
more difficult to see and read mercury column
describe the use of a chemical strip thermometer
it's disposable
apply to appropriate skin area, usually the forehead
color changes to denote temperature
What should you do if a pt presents with a temperature over 41*C (105.8*F)?
call 911
treat as a medical emergency and transfer to hospital
What should you do if a pt presents with a temperature 37.6-41*C (99.6-105.8*F)?
wait a few minutes and then retake it, if it's still high, send them home
postpone treatment if there are also signs of respiratory infection or other possible communicable disease
Alternate expansion and contraction of an artery as a wave of blood is forced out from the heart; and intermittent throbbing sensation felt when the fingers are pressed against an artery
pulse
Pulse rate:
count of heart beats
Should you record irregularities of strenght, rythm, and quality of the pulse in a pts chart?
yes
what are some factors that influence heart rate?
increased pulse:
exercise
stimulants
eating
strong emotions
extremes of heat and cold
some forms of heart disease
decreased pulse:
sleep
depressants
fasting
quieting emotions
low vitality from prolonged illness
emergency situations
Describe the sequence for pulse
obtained following body temperature
can be counted while taking body temperature if mercury in glass thermometer is used
What is a depressant that may cause bradycardia?
alcohol
What are some sites that one may determine pulse rate?
radial pulse: at wrist
temporal artery: on side of head infront of ear
facial artery: at border or the mandible
carotid pulse: used during cardiopulmonary resuscitation for an adult
brachial pulse: used for an infant
describe how to prepare the pt for determining pulse rate.
tell the patient what is to be done
have pt in a comfortable position with arm and hand supported and palm down
locate the radial pulse on the thumb side of the wrist with the tips of first three fingers
why should you not use your thumb to determine a pulse?
because it contains a pulse of its own
What should be observed while taking a pts pulse?
rhythm: regular, irregular, irregularly irregular
volume and strength: full, strong, poor, weak thready
functions to supply oxygen to the tissues and to eliminate carbon dioxide (CO2); one breath taken in and let out
respiration
What are some variations that may occur in respiration?
rate
rhythm
depth
quality may be symptomatic of disease or emergency status
what are some factors that influence respiration?
increased:
work
exercise
excitement
nervousness
strong emotions
pain
hemorrhages
shock
decreased respirations
sleep
certain drugs
pulmonary insufficiency
emergency situations
Describe the procedure for observing respirations
make the count of respirations immediately following counting the pulse
maintain the fingers over the radial pulse
count so that the patient is not aware, as the rate may be voluntarily altered
count the number of times the chest rises in 1 clocked minute, or 30 seconds
How is the depth of the respiration observed?
as shallow, normal, or deep
How is the rhythm of respiration recorded?
regular (evenly spaced)
irregular (with pauses of irregular lengths in between)
How is the quality of respiration recorded?
strong
easy
weak
labored (noisy)
poor quality may have an effect on body color; a bluish tinge of the face or nailbeds may mean insufficiency of oxygen
How are sounds of respiration recorded?
deviant sounds made during inspiration, expiration, or both
How should the patient positioning be recorded when measuring respiration?
when the pt assumes an unusual position to secure comfort during breathing or prefers to remain seated upright, mark records accordingly
forces exerted by the bood on the blood vessel walls; when the left ventricle of the heart contracts, blood is forced out into the aorta and travels through the large arteries to the smaller arteries, arterioles, and capillaries; the pulsations extedn from the heart through the arteries and disappear in the arterioles; during the course of the cardiac cycle, the blood pressure is changing constantly
blood pressure
true or false. Screening for blood pressure in dental offices has been shown to be an effective health service for all ages, since many patients are unaware that they have hypertension?
true
true or false. to establish a baseline reading and determine the need for pt referral for medical attention, several readings are needed, especially at the close of appointments when the pt is relaxed.
true
true or false. Readings taken at the start of an appointment can be significantly higher than at the end of treatment.
true
the peak or highest pressure; caused by ventricular contraction
systolic pressure
the lowest pressure; it is the effect of ventricular relaxation
diastolic pressure
the difference between the systolic and diastolic blood pressures
pulse pressure
what are some factors that influence blood pressure?
force of or energy of the heartbeat
peripheral resistance
volume of blood in circulatory system
condition of the arteries; changes in elasticity of vessels, which may occur with age and disease
peripheral resistance
what are some factors that increase blood pressure?
exercise
eating
stimulants (caffeine)
emotional disturbances (stress)
use of oral contraceptives
age and length of use
What are some factors that decrease blood pressure?
fasting
rest
depressants
quiet emotions
fainting
blood loss
shock
what is the preferred instrument in measuring blood pressure?
mercury sphygmomanometer
a calibrated aneroid manometer or validated electronic device can be used and may be practical for home use in measuring what?
blood pressure
true or false. Finger monitors have been shown to be inaccurate.
true
what does a sphygmomanometer (blood pressure machine) consist of?
inflatable cuff
2 tubes
pressure hand control bulb
pressure gauge
made up of nonelastic material and fastened by a velcro overlap; the inflatable bladder is located within it; the diameter of the arm, not the age of the pt, determines the size selected; the width that is used needs to be 20% greater than the diameter of the arm to which it is applied, and needs to cover about 2/3rds of the upper arm.
cuff
When would a thigh sized cuff be used?
for grossly obese persons
how will the BP read if the cuff is too narrow?
too high
how will the BP read if the cuff is too wide?
too low
marked with long lines at each 10 mmHg; with shorter lines at 2-mm intervals between each long line; the level of the column of mercury of this is at eye level for accurate reading and must not be tilted
mercury manometer
what does a Stethoscope (a listening aid that magnifies sound) consist of?
and endpiece:
bell-shaped
flat
earpieces
what is the bell shaped stethoscope end piece used for?
medical examinations, particularly for the chest examination
Describe the procedure for determining blood pressure
tell pt. what is going to be done. Avoid detailed explanations
seat pt comfortably with arm slightly flexed with palm up, and whole forearm supported on a level surface at the level of the heart
used either arm unless otherwise indicated. Repeat blood pressure determinations should be made on same arm
take pressure on bare arm
What happens when the arm rests on the arm of a dental chair, higher than the heart, in determining blood pressure?
a small but significant increase in diastolic pressure occurs
How long should you wait before inflating the cuff for the next reading? Why are more than one blood pressure reading necessary?
30 seconds
to determine an average and ensure a correct reading
How is blood pressure recorded?
data and arm used
recorded as a fraction, with systolic/diastolic
would diagnosis of hypertension ever be made or treatment stared on the basis of an isolated reading?
no
how often does blood pressure need to be checked if it is within the normal range? (120/80)?
within 2 years
when is rechecking of blood pressure within one year recommended?
