VITAL SIGNS Chapter 27 Copyright © 2012, 2009, 2005, 2002, 1999, 1995, 1990, 1985, 1980, 1976 by Saunders, an imprint of Elsevier Inc. All rights reserved. 1

INTRODUCTION  Attention toward a patient’s immediate health should be the first priority of every healthcare provider.  By taking a patient’s vital signs on a routine basis prior to dental treatment, the dental team is confirming the patient’s health status is at a level of well-being.  Vital signs consist of taking and recording a person’s temperature, pulse, respiration, and blood pressure.  Not all dental practices take vitals signs  At a minimum blood pressure should be taken as a baseline for all dental treatment  Oral surgery offices that sedate patient will have more monitoring equipment than the general dentistry office Copyright © 2012, 2009, 2005, 2002, 1999, 1995, 1990, 1985, 1980, 1976 by Saunders, an imprint of Elsevier Inc. All rights reserved. 2

FACTORS THAT AFFECT VITAL SIGNS  Emotional factors  Stress  Fear  Physical factors  Illness  Drinking or eating  Exercise Copyright © 2012, 2009, 2005, 2002, 1999, 1995, 1990, 1985, 1980, 1976 by Saunders, an imprint of Elsevier Inc. All rights reserved. 3

TEMPERATURE  Degree of the hotness or coldness of the body’s internal environment  The process of physical and chemical changes that takes place in the production of the body’s heat is called metabolism  During an illness, a person’s metabolism increases for the purpose of elevating the body’s temperature  Most bacteria and viruses cannot survive in excess heat, and this is the body’s way of defending against such diseases Copyright © 2012, 2009, 2005, 2002, 1999, 1995, 1990, 1985, 1980, 1976 by Saunders, an imprint of Elsevier Inc. All rights reserved. 4

TEMPERATURE READINGS  The thermometer is the instrument used to measure body temperature  Temperature readings are calibrated according to the Fahrenheit (F) or the Celsius (C) scale  Different areas of the body can be used:  Oral: placed under the tongue; 98.6° F  Tympanic: placed in the ear; 98.6° F  Axillary: placed under the arm; 97.6° F  Rectal: 99.6° F  Average range of oral temperature of a resting person is 97.6° F to 99° F or 36.4°C to 37.3° C  The average body temperature is higher in infants and younger children than in adults. Copyright © 2012, 2009, 2005, 2002, 1999, 1995, 1990, 1985, 1980, 1976 by Saunders, an imprint of Elsevier Inc. All rights reserved. 5

TYPES OF THERMOMETERS  Digital  Battery operated, a timing system shows a digital reading after 30 seconds  A disposable sheath slides over the probe before insertion  Tympanic  An infrared signal is bounced off the eardrum, and an accurate reading is provided within 2 seconds  Glass  Many states have banned the use of mercury thermometers because of health hazards Copyright © 2012, 2009, 2005, 2002, 1999, 1995, 1990, 1985, 1980, 1976 by Saunders, an imprint of Elsevier Inc. All rights reserved. 6

FIG A DIGITAL THERMOMETER. Copyright © 2012, 2009, 2005, 2002, 1999, 1995, 1990, 1985, 1980, 1976 by Saunders, an imprint of Elsevier Inc. All rights reserved. 7

FIG A TYMPANIC THERMOMETER. (COURTESY OF WELCH ALLYN, SKANEATELES FALLS, NY.) Copyright © 2012, 2009, 2005, 2002, 1999, 1995, 1990, 1985, 1980, 1976 by Saunders, an imprint of Elsevier Inc. All rights reserved. 8

Glass Thermometer Oral Thermometer.

PULSE  The pulse is the rhythmic expansion of an artery each time the heart beats.  The pulse may be taken at various sites:  Radial artery: inner surface of wrist  Brachial artery: inner fold of the upper arm  Carotid artery: alongside the larynx on the neck Copyright © 2012, 2009, 2005, 2002, 1999, 1995, 1990, 1985, 1980, 1976 by Saunders, an imprint of Elsevier Inc. All rights reserved. 10

LOCATION OF THE RADIAL ARTERY. Copyright © 2012, 2009, 2005, 2002, 1999, 1995, 1990, 1985, 1980, 1976 by Saunders, an imprint of Elsevier Inc. All rights reserved. 11

LOCATION OF THE BRACHIAL ARTERY. Copyright © 2012, 2009, 2005, 2002, 1999, 1995, 1990, 1985, 1980, 1976 by Saunders, an imprint of Elsevier Inc. All rights reserved. 12

LOCATION OF THE CAROTID ARTERY. Copyright © 2012, 2009, 2005, 2002, 1999, 1995, 1990, 1985, 1980, 1976 by Saunders, an imprint of Elsevier Inc. All rights reserved. 13

PULSE CHARACTERISTICS  Rate: the number of beats that occur during the counting period  Rhythm: the pattern of the beats, such as an occasional skipping, speeding up, or slowing down of a beat  Volume: the force of the beat, such as a strong or a weak beat Copyright © 2012, 2009, 2005, 2002, 1999, 1995, 1990, 1985, 1980, 1976 by Saunders, an imprint of Elsevier Inc. All rights reserved. 14

PULSE READINGS  Make sure the patient is positioned with his or her arm at the same level or lower than the heart  The arm should be well supported and extended straight out  The normal pulse rate in resting adults: 60 to 100 beats per minute  In a child: 70 to 120 beats per minute  It is difficult to detect any possible arrhythmia (irregularity) in the heartbeat in times shorter than 30 seconds Copyright © 2012, 2009, 2005, 2002, 1999, 1995, 1990, 1985, 1980, 1976 by Saunders, an imprint of Elsevier Inc. All rights reserved. 15

RESPIRATION  The process of inhaling and exhaling, or breathing  Check respiration while you are checking pulse; watch and count the amount of times the chest rises and falls in the given time  Don’t tell the patient you are checking their respiration  Respiration characteristics  Rate: total number of breaths per minute  Rhythm: breathing pattern  Depth: amount of air inhaled and exhaled  Respiration readings  Adult: 10 to 20 breaths per minute  Children and teenagers: 18 to 30 breaths per minute 16

BLOOD PRESSURE  Blood pressure reflects the amount of work the heart has to do to pump blood throughout the body.  Two pressures of the heart:  Systolic: Reflects the amount of pressure it takes for the left ventricle of the heart to compress or push oxygenated blood out into the blood vessels.  Diastolic: The heart muscle at rest when it is allowing the heart to take in blood to be oxygenated before the next contraction. Copyright © 2012, 2009, 2005, 2002, 1999, 1995, 1990, 1985, 1980, 1976 by Saunders, an imprint of Elsevier Inc. All rights reserved. 17

FIG TYPES OF SPHYGMOMANOMETERS. A, ANEROID (WITHOUT LIQUID) DIAL SYSTEM. B, ANEROID FLOOR MODEL. (FROM YOUNG A, PROCTOR D: KINN’S THE MEDICAL ASSISTANT: AN APPLIED LEARNING APPROACH, ED 11, ST LOUIS, 2011, SAUNDERS.) A B Copyright © 2012, 2009, 2005, 2002, 1999, 1995, 1990, 1985, 1980, 1976 by Saunders, an imprint of Elsevier Inc. All rights reserved. 18

STETHOSCOPE. Copyright © 2012, 2009, 2005, 2002, 1999, 1995, 1990, 1985, 1980, 1976 by Saunders, an imprint of Elsevier Inc. All rights reserved. 19

BLOOD PRESSURE EQUIPMENT  Place the cuff around the patient’s arm approximately 1” above the antecubital space with arrow over the brachial artery  Cuff should be snug so only a finger can slide between it and the arm  Stethoscope is placed over the site of the brachial artery using slight pressure  To get an accurate reading, it is important to use the proper size cuff  Arm circumference 8 to 10 inches – ‘small adult’ cuff  Arm circumference 10½ to 13 inches – ‘adult’ cuff  Arm circumference 13½ to 17 inches – ‘large adult’ cuff  Arm circumference 17½ to 20 inches – ‘adult thigh’ cuff Copyright © 2012, 2009, 2005, 2002, 1999, 1995, 1990, 1985, 1980, 1976 by Saunders, an imprint of Elsevier Inc. All rights reserved. 20

BLOOD PRESSURE EQUIPMENT  The stethoscope is used to amplify Korotkoff sounds  A series of sounds produced by the blood rushing back into the brachial artery, which has been collapsed by the pressure of the blood pressure cuff  As the pressure in the cuff is slowly released, the stethoscope picks up a distinct thumping sound that grows louder and then softens to a murmur  Five phases of Korotkoff sounds occur during deflation of the blood pressure cuff Copyright © 2012, 2009, 2005, 2002, 1999, 1995, 1990, 1985, 1980, 1976 by Saunders, an imprint of Elsevier Inc. All rights reserved. 21

BLOOD PRESSURE

FIVE PHASES OF KOROTKOFF SOUNDS IN BLOOD PRESSURE MEASUREMENT Copyright © 2012, 2009, 2005, 2002, 1999, 1995, 1990, 1985, 1980, 1976 by Saunders, an imprint of Elsevier Inc. All rights reserved. 23

BLOOD PRESSURE EQUIPMENT  An automated electronic blood pressure device is used in many practices today to simplify and speed the taking of blood pressure  Wrist blood pressure monitors can be accurate if used exactly as directed  These devices are extremely sensitive to body position  The arm and wrist must be at heart level, with the patient quiet and still Copyright © 2012, 2009, 2005, 2002, 1999, 1995, 1990, 1985, 1980, 1976 by Saunders, an imprint of Elsevier Inc. All rights reserved. 24

BLOOD PRESSURE READINGS  A situation may arise in which it is necessary to take several pressure readings to obtain an accurate or average reading  If this occurs, allow the deflated blood pressure cuff to remain on the patient for a minimum of 10 minutes before you obtain another reading  If taken too soon, the reading may be incorrect Copyright © 2012, 2009, 2005, 2002, 1999, 1995, 1990, 1985, 1980, 1976 by Saunders, an imprint of Elsevier Inc. All rights reserved. 25

MEDICAL CONSIDERATIONS  The stress and anxiety of a dental procedure could possibly elevate a patient’s blood pressure  Many drugs have adverse effects that can interfere with dental treatment  A patient who has been diagnosed with hypertension should be under the care of a physician during a treatment regimen Copyright © 2012, 2009, 2005, 2002, 1999, 1995, 1990, 1985, 1980, 1976 by Saunders, an imprint of Elsevier Inc. All rights reserved. 26

ADVANCED MONITORING PROCEDURES  Additional patient monitoring techniques are being introduced into dental surgical procedures as a standard of monitoring a patient’s health status in a noninvasive way  Monitoring patients during the preoperative, operative, and postoperative phases can occur as an expanded function once the certified dental assistant has completed a board-approved course in these procedures Copyright © 2012, 2009, 2005, 2002, 1999, 1995, 1990, 1985, 1980, 1976 by Saunders, an imprint of Elsevier Inc. All rights reserved. 27

PULSE OXIMETRY  Pulse oximetry is used for measuring the concentration of oxygen in the blood  This procedure is of particular importance for monitoring oxygenation and pulse rate throughout anesthesia and during the recovery phase Copyright © 2012, 2009, 2005, 2002, 1999, 1995, 1990, 1985, 1980, 1976 by Saunders, an imprint of Elsevier Inc. All rights reserved. 28

PULSE OXIMETRY  The pulse oximeter works by passing a beam of red and infrared light through a pulsating capillary bed  Oxygenated blood is a bright red color and deoxygenated blood is more blue-purple  The oximeter detects the pulse, and then subtracts the intensity of color detected when the pulse is absent  The remaining intensity of color represents only the oxygenated red blood  A fit, healthy person should have an oxygen saturation level between 95% and 99% Copyright © 2012, 2009, 2005, 2002, 1999, 1995, 1990, 1985, 1980, 1976 by Saunders, an imprint of Elsevier Inc. All rights reserved. 29

PULSE OXIMETER PULSE OXIMETER

ELECTROCARDIOGRAM  With each beat, an electrical impulse or wave travels through the heart  The ECG records a series of waves that move above or below a baseline value  This wave causes the muscle to squeeze and pump blood from the heart  Each deflection corresponds to a particular part of the cardiac cycle Copyright © 2012, 2009, 2005, 2002, 1999, 1995, 1990, 1985, 1980, 1976 by Saunders, an imprint of Elsevier Inc. All rights reserved. 31

PATIENT EDUCATION  It is estimated that 50 million Americans have high blood pressure  Approximately one fourth of that population is not aware of their medical condition  By taking a patient’s blood pressure at every visit, not only are you gathering vital information for their treatment that day, but you may also be saving that person’s life Copyright © 2012, 2009, 2005, 2002, 1999, 1995, 1990, 1985, 1980, 1976 by Saunders, an imprint of Elsevier Inc. All rights reserved. 32