1. Vital Signs
Chapter 27
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2. Chapter 27 Lesson 27.1
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3. Learning Objectives Pronounce, define, and spell the Key Terms.
List the four vital signs commonly taken in the dental office.
Describe how metabolism affects a patient’s vital signs.
Discuss three types of thermometers.
Take an oral temperature reading with the use of a digital thermometer.
(Cont’d)
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4. Learning Objectives (Cont’d) List the sites used for taking a pulse.
Describe the characteristics of patient’s pulse that you would look for.
Take a patient’s pulse.
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5. Introduction
Attentiveness to a patient’s immediate health should be the first priority of every healthcare provider.
Vital signs can provide you with a means of determining a patient’s health status. They include temperature, pulse, respiration, and blood pressure.
What are vital signs? (Certain tests, such as blood pressure, temperature, pulse, and respiration, that can help you determine a person’s condition.)
When should the clinical assistant take and document a patient’s vital signs? (After patient’s first visit, at the 6-month recall visit, or in an emergency situation.)
What is a baseline? (A starting point or condition against which future changes are measured.)
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6. Factors Affecting Vital Signs
Emotional factors
Stress
Fear
Physical factors
Illness
Drinking or eating
Exercise
How can a patient’s vital signs be affected by his or her current status? (The human body is influenced by both emotional and physical factors.)
How can the dental assistant ensure that vital signs are not adversely affected by the patient’s current status? (Help the patient relax before taking vital signs. If the patient is normally calmer, provide reassurance, wait several minutes, and then retake the measurements.)
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7. Temperature Degree of the hotness or coldness of the body Readings
Average range for an adult: 97.6° to 99° F
Normally higher in infants and children than in adults.
Thermometer types
Electronic
Tympanic
How are temperature readings calibrated? (In the Fahrenheit [F] scale, which is most frequently used in the United States, or the Celsius [C] scale, which is most frequently used in Canada and Europe.)
What is a fever? (Fever, also known as pyrexia, is a medical symptom consisting of an increase in temperature to a level higher than normal [37° C or 98.6° F].)
What are “goosebumps”? (When a person has a fever, blood vessels closest to the surface of the skin constrict, causing goosebumps. The body shivers, beginning a chain reaction that causes the body to produce internal heat for warmth.)
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8. Fig. 27-1 Digital thermometer.
How does a digital thermometer differ from a glass thermometer? (It has a timing system that shows a digital reading after 30 seconds rather than a line of mercury that rises along a marked scale. Most digital thermometers beep”to indicate completion. The reading then appears on the digital screen.)
What can cause an inaccurate reading on a digital thermometer? (A low battery.)
How do you maintain infection control with a digital thermometer? (With a disposable plastic sheath that slides over the probe before insertion.)
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9. Fig. 27-2 Tympanic thermometer
Fig Tympanic thermometer. (Courtesy of Welch Allyn, Skaneateles Falls, N.Y.)
How does a tympanic thermometer work? (By means of a small probe that is gently inserted into the ear canal; an infrared signal is bounced off the eardrum, and a reading is provided within 2 seconds.)
What factors do not influence the tympanic temperature reading? (Open mouth, hot or cold drinks, nasal congestion.)
This approach is very popular with children. The rapid measurement may be more accurate because of less patient movement.
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10. Pulse
The pulse is a 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
What does the pulse represent? (The pulse represents the beating of the heart, specifically the ejection of blood from the left ventricle into the general circulation of the body.)
Which site is the most common for taking a patient’s pulse in the dental office? (Radial artery.)
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11. Fig. 27-4 Location of the radial artery.
How is the radial artery pulse taken? ([1] Place the tips of your index and middle fingers lightly on the patient’s wrist between the radius [bone on the thumb side] and the tendon. This is about 1 inch from the base of your thumb. [2] Feel for the patient’s pulse before beginning to count. [3] Count the pulse for 30 seconds, then multiply by two to compute the rate for a 1-minute reading.)
Can you locate and feel the pulse of your radial artery?
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12. Fig. 27-5 Location of the brachial artery.
Do not use your thumb to detect the patient’s pulse. Your thumb has a fairly strong pulse of its own, and it may keep you from obtaining an accurate reading.
Where is the brachial artery located? (On the inner fold of the arm, also referred to as the antecubital area of the elbow.)
This artery is also used to take a patient’s blood pressure.
Can you locate and feel the pulse of your brachial artery?
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13. Fig. 27-6 Location of the carotid artery.
When is the carotid pulse commonly taken? (During cardiopulmonary resuscitation.)
How is the carotid pulse taken? (Place two fingers alongside the patient’s larynx [Adam’s apple] on the side of the neck nearest you. Move your fingers slowly down the groove to the soft area above the clavicle [collarbone] and then palpate this area gently to find a pulse.)
Can you locate and feel the pulse of your carotid artery?
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14. Pulse Characteristics
Rate: umber of beats
Rhythm: pattern of beats
Volume: force of beats
(Cont’d)
The pulse represents the variation in blood pressure from diastole to systole. During diastole, blood pressure falls; pressure increases after systole, when the heart pumps more blood into the arteries.
When taking a patient’s pulse, look for any distinct changes.
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15. Pulse Characteristics
(Cont’d)
Readings
Adult resting: 60 to 100 beats per minute
Child: 70 to 120 beats per minute
Irregularity
Arrhythmia: an irregularity in the force or rhythm of the heartbeat
Arrhythmia is not uncommon. It can occur in a healthy heart and be of minimal consequence. However, it may also indicate a serious problem and lead to heart disease, stroke, or sudden cardiac arrest.
The term “tachycardia” refers to a heart rate of more than 100 beats per minute.
The term “bradycardia” describes a heart rate of less than 60 beats per minute.
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16. Chapter 27 Lesson 27.2
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17. Learning Objectives
Describe the characteristics of respiration and how they affect a patient’s breathing.
Discuss the best way to obtain accurate readings of respiration.
Take a patient’s respiration.
Explain the importance of taking a patient’s blood pressure.
Differentiate the Korotkoff sounds heard when taking a patient’s blood pressure.
Take a patient’s blood pressure.
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18. Respiration The process of inhaling and exhaling, or breathing
Characteristics
Rate: total number of breaths per minute
Rhythm: breathing pattern
Depth: amount of air inhaled and exhaled
Readings
Adult: 10 to 20 breaths per minute
Children and teenagers: 18 to 30 breaths per minute
How should a patient’s respiration be assessed?
What is the normal respiration rate for an adult?
Is the respiration rate for a child or teenager lower or higher than an adult’s?
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19. 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.
How is blood pressure measured and recorded? (Systolic and diastolic pressures are measured in millimeters of mercury [mm Hg]. The reading is recorded with the systolic value over the diastolic value.)
What is the range of a normal blood pressure reading for an adult?
How important is accuracy in the measurement of blood pressure?
What is a “white coat reading”? (A reading that is high as a result of patient anxiety because of the actual situation of a healthcare professional taking a blood pressure.)
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20. Table 27-1 Blood Pressure Classifications for Adults
If two or three blood pressure readings are needed to obtain an accurate or average reading, wait a minimum of 10 minutes before obtaining another reading. If taken too soon, the reading may be incorrect.
What can increase a patient’s blood pressure? (The stress and anxiety of a dental procedure.)
What should the dental assistant do if high blood pressure is noted in the medical history?
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21. Blood Pressure Equipment
Sphygmomanometer
Blood pressure cuff
Meter
Rubber bulb
Stethoscope
Amplifies sounds
What blood pressure device is similar to the sphygmomanometer without the stethoscope? (Automated electronic blood pressure device.)
What might cause an inaccurate reading with the electronic blood pressure meter?
What are Korotkoff sounds?
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22. Fig. 27-8 Types of sphygmomanometers
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 9, St Louis, 2003, Saunders.) A B
The size of the inflation system can affect the accuracy of blood pressure readings. Choose the appropriate size cuff on the basis of the circumference of the patient’s bare upper arm. The bladder (inside the cuff) should encircle 80% of an adult’s arm and 100% of the arm of a child younger than 13 years. It is advisable to have a full range of cuff sizes available to accommodate dental-office patients.
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23. Fig. 27-9 Stethoscope. Name the parts of the stethoscope. 23
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24. Table 27-2 Five Phases of Korotkoff Sounds in Blood Pressure Measurement
How are Korotkoff sounds used for blood pressure readings? (Systolic pressure is registered as the pressure at which the sounds are first heard [phase 1], and diastolic pressure is registered as the pressure at which the sounds disappear [phase 5].)
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25. Additional Techniques
Electrocardiography: tracing of the heart’s activity, set forth in an electrocardiogram (ECG)
Commonly performed in the hospital setting
Amplifies the natural electrical currents generated by the impulses of the heart
Records a series of waves
Each deflection corresponds to a particular part of the cardiac cycle
What is an electrocardiogram (ECG) used for in dentistry?
The ECG traces the pattern of the heartbeat on graph paper as it records a series of waves that move above or below a baseline.
In most cases, a basic ECG takes 5 to 10 minutes to complete; it can be done in a doctor’s office, in a laboratory, or in a hospital.
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26. Fig. 27-11 The cardiac cycle on the ECG.
What are the most common parts of the cardiac cycle that are observed?
What is considered a normal ECG?
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