Chapter 27 Vital Signs

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 2

Factors That Affect Vital Signs  Emotional factors ➢ Stress ➢ Fear  Physical factors ➢ Illness ➢ Drinking or eating ➢ Exercise 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 4

Temperature Readings  Thermometer is the instrument used to measure body temperature ➢ Temperature readings are calibrated according to the Fahrenheit (F) or the Celsius (C) scale ➢ The thermometer can be placed under the tongue, in the ear (tympanic area), under the arm (axillary area) or in the rectum (rectal area) ➢ Oral and tympanic temperature readings will read normally at 98.6*F  Average range of oral temperature of a resting person is 97.6° F to 99° F ➢ The average body temperature is higher in infants and younger children than in adults 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 ➢ Uses an infrared signal to provide an accurate reading within 2 seconds  Glass ➢ Many states have banned the use of mercury thermometers because of health hazards 6

Digital Thermometer 7

Tympanic Thermometer 8

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, the most common anatomic site for taking a patient’s pulse ➢ Brachial artery: Inner fold of the upper arm, is used when taking a patient’s blood pressure ➢ Carotid artery: Alongside the larynx, most commonly used to take a pulse when performing cardiopulmonary resuscitation 9

Locations of the Radial and Brachial Arteries 10

Location of the Carotid Artery 11

Pulse Characteristics  Rate: The number of beats that occur during the counting period  Rhythm: Describes t he 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 12

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 13

Respiration  The process of inhaling and exhaling, or breathing  Respiration characteristics that are noted in the patient record include ➢ 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  Bradypnea is an abnormally slow respiration rate 14

Blood Pressure  Blood pressure reflects the amount of labor the heart must exert 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. Blood pressure is recorded with systolic pressure being the point at which a sharp tapping sound is heard ➢ Diastolic: The heart muscle at rest when it is allowing the heart to take in blood to be oxygenated before the next contraction 15

Blood Pressure Classification for Adults 16 A normal blood pressure for adults is 120 over 80 mm HG

Blood Pressure Equipment  Sphygmomanometer ➢ Instrument used for measuring a patient’s blood pressure in the arteries ➢ Includes the blood pressure cuff and meter ➢ The cuff is a cloth wrap that holds an inflatable rubber bladder ➢ A rubber bulb is attached to the cuff with rubber tubing ➢ To get an accurate reading, it is important to use the appropriately sized cuff ➢ Using a cuff that is too small or too large can give a false reading. 17

Place the cuff pressure cuff around the patient’s arm approximately 1 inch above the antecubital space, making sure to center the arrow over the brachial artery The correct tightness of the blood pressure cuff around the patient’s arm is tight enough to squeeze only one finger between cuff and arm 18

Types of Sphygmomanometers 19

Stethoscope 20

Blood Pressure Equipment (Cont.)  Stethoscope ➢ Used to amplify Korotkoff sounds, which are 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 21

Five Phases of Korotkoff Sounds in Blood Pressure Measurement 22

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 23

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 24

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 25

Pulse Oximetry  Pulse oximetry is used to measure the arterial oxygen saturation of the blood  This procedure is of particular importance for monitoring oxygenation and pulse rate throughout anesthesia and during the recovery phase 26

How The Pulse Oximetry Works  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% 27

Electrocardiogram  A procedure that measures the electrical activity of the heartbeat ➢ In dentistry, the ECG can be used as a preventive measure when a patient is undergoing general anesthesia or IV sedation in a hospital or outpatient setting  The chest leads are placed on the patient at specific locations ➢ The machine then amplifies the natural electrical currents generated by the electrical impulses of the heart and the pattern is traced on graph paper 28

Electrocardiogram (Cont.)  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 29

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 30