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What are the vital signs discussed in this chapter?
- body temperature
- 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?
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
no cx to tx
no contradictions to treatment
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
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?
- hot drinks
- application of external heat
How does pathologic state affect body temp?
- all affect body temp:
- myocardial infarcation
- tissue injury from trauma
What events may decrease body temp?
- physiologic shock
Where are the locations for measuring body temperature?
- medical/hospital applications: axilla or rectum
What are the different types of thermometers?
- 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
count of heart beats
Should you record irregularities of strenght, rythm, and quality of the pulse in a pts chart?
what are some factors that influence heart rate?
- increased pulse:
- strong emotions
- extremes of heat and cold
- some forms of heart disease
- decreased pulse:
- 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?
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
What are some variations that may occur in respiration?
- quality may be symptomatic of disease or emergency status
what are some factors that influence respiration?
- strong emotions
- decreased respirations
- 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?
- 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
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 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 or false. Readings taken at the start of an appointment can be significantly higher than at the end of treatment.
the peak or highest pressure; caused by ventricular contraction
the lowest pressure; it is the effect of ventricular relaxation
the difference between the systolic and diastolic blood pressures
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
what are some factors that increase blood pressure?
- stimulants (caffeine)
- emotional disturbances (stress)
- use of oral contraceptives
- age and length of use
What are some factors that decrease blood pressure?
- quiet emotions
- blood loss
what is the preferred instrument in measuring blood pressure?
a calibrated aneroid manometer or validated electronic device can be used and may be practical for home use in measuring what?
true or false. Finger monitors have been shown to be inaccurate.
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.
When would a thigh sized cuff be used?
for grossly obese persons
how will the BP read if the cuff is too narrow?
how will the BP read if the cuff is too wide?
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
what does a Stethoscope (a listening aid that magnifies sound) consist of?
- and endpiece:
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?
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?
- for pts at an increased risk for hypertension:
- family history
- weight gain
- african american
- use of oral contraceptives
- excessive alcohol consumption
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