Dental Emergencies & Records (Review: Outcome 2) Flashcards
Measuring vital signs consists of taking and recording what?
- Blood pressure
- Pulse
- Respiration
- Temperature
*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 that the patient’s health status is a t a level of well-being
Uses of vital signs information
- Used to assess the patient’s health
(appreciate the importance of accuracy in obtaining and recording data) - Know the normal ranges for blood pressure, pulse, respirations and temperature
(to better identify and flag recordings that may be abnormal for any given patient) - Be knowledgeable on how to use the most common equipment to monitor blood pressure, respiration and temperature
(with accuracy and efficiently for correct vital sign readings)
What is the importance of vital signs?
- Safely proceed with treatment
(the dentist’s choice of local anesthesia may vary as a result of vital signs obtained on a patient) - It is the DA’s responsibility to obtain vital sign readings and record these readings in the patient’s chart
- Be aware of the normal ranges
- Make sure all equipment is in good working order
- Be familiar with what factors may affect vital signs
Factors that contribute to changes in vital signs
Emotional factors
- stress
- fear
Physical factors
- illness
- drinking or eating
- exercise
Pulse
A wave of pressure that can be felt when the heart contracts and propels blood through arteries
What are the 3 types of pulse points?
Only those close to the surface of the skin can be read:
- Carotid
- Radial
- Brachial
Where and how is the patient’s pulse usually taken?
Radial artery, on the thumb side of the inner surface of the wrist, using the index and middle fingers
What is the normal pulse rate for an adult?
60 to 100 beats per minute (bpm)
What is the normal pulse rate for children?
70 to 130 beats per minute (bpm)
What are the characteristics of a pulse and the definition?
1) Rate = number of beats that occur during the counting period
- example: 70 beats per minute
2) Rhythm = pattern of beats
- example: occasional skipping, speeding up, slowing down, arrhythmic
3) Volume or quality = force of the beat
- example: strong, weak
Procedure for obtaining a pulse
- Make sure the patient is positioned with his or her arm at the same level or lower than the heart
(arm should be well supported and extended straight out) - It is difficult to detect any possible arrhythmia (irregularity) in the heartbeat in times shorter than 30 seconds
Respiration
The process of breathing, inhaling oxygen and exhaling carbon dioxide
- can be a voluntary or involuntary function as controlled by the body’s nervous system
How does a DA obtain a patient’s respiration?
- By counting the number of breaths (chest rising and falling) a patient takes in a time frame
*Patients usually change their breathing pattern when they know that their breaths are being monitored
- count a person’s respirations while your fingers are still positioned on the wrist as if taking the pulse
What is the normal respiration rate for an adult?
10 to 20 breaths per minute
What is the normal respiration rate for children?
18 to 30 breaths per minute
What are the characteristics of respiration and the definition?
1) Rate = total number of breaths per minute
- example: 15 breaths per minute
2) Rhythm = breathing pattern
- example: steady
3) Depth = amount of air that is inhaled and exhaled during a breath
- example: deep, shallow, gasping
What are the different types of respiration?
1) Normal = regular & comfortable @ rate of 12-20 breaths per minute
2) Bradypnea = slower than 12 breaths per minute
3) Tachypnea = faster than 20 breaths per minute
4) Hyperventilation (hyperpnea) = faster than 20 breaths per minute, deep breathing
5) Sighing = frequently interspersed breaths
Define Pulse oximetry and the importance
A procedure used for measuring the concentration of oxygen in the blood
- Important for measuring oxygenation and pulse rate when a patient is sedated and during the recovery phase
Temperature
A measurement of how hot or cold the internal body is
- associated with the metabolism of the body
- temperature can vary throughout the day, but illness can cause a person’s body temperature to elevate
Thermometer
The instrument used to measure body temperature
What are the different types of thermometers?
1) Digital
- battery operated, a timing system shows a digital reading after 30 seconds
- a disposable sheath slides over the probe before insertion
2) Tympanic
- an infrared signal is bounced off the eardrum and an accurate reading is provided within 2 seconds
3) Temporal scanner
- uses surface temperature of artery of forehead
4) Glass
- banned the use of mercury thermometers because of health hazards
Where is temperature commonly measured?
1) Orally - under the tongue
2) Tympanic - inside ear
3) Axillary - under arm
4) Temporally - surface of forehead
5) Rectally - in rectum
What is the normal temperature range for adults?
36.4 - 37.3 C
What is the normal temperature range for children?
36.6 - 37.3 C
What is the temperature difference between temporal and oral temperature?
Temperature taken with a temporal scanner is 0.3 - 0.6 C lower than oral temperature
What could an unusual high blood pressure mean?
- It could mean that the patient is anxious
- It could also indicate a cardiovascular condition that could lead to a heart attack or stroke
What could a low blood pressure indicate?
It could indicate that the patient is about to lose consciousness
How often should a patient’s blood pressure be taken?
Should routinely be taken at the beginning of each appointment
- if the patient is known to have a problem controlling high blood pressure, it should also be monitored pressures throughout any lengthy, invasive dental procedure
How is blood pressure measured?
- BP measures the force exerted by the blood against the walls of the arteries when the heart is contracting and again when the heart is in relaxation, between contractions
- BP reflects the amount of work the heart has to do to pump blood throughout the body
- There are 2 pressures of the heart:
1) 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
2) Diastolic = the heart muscle at rest when it is allowing the heart to take in blood to be oxygenated before the next contraction
Systolic Pressure
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
Top number of the bp reading
- example 120/80 mmHg
- 120 is the systolic pressure
Diastolic Pressure
The heart muscle at rest when it is allowing the heart to take in blood to be oxygenated before the next contraction
Bottom number of the bp reading
- example 129/85 mmHg
- 85 is the diastolic pressure
What is the unit of measurement for systolic and diastolic pressures?
Measured in millimeters of mercury (mm Hg) above atmospheric pressure
- readings are always recorded with the systolic value over the diastolic value
What is the normal blood pressure reading?
Systolic: Less than 120
Diastolic: Less than 80
What is the reading for elevated blood pressure?
Systolic: 120 - 129
Diastolic: Less than 80
What is the reading for high blood pressure (Hypertension) stage 1?
Systolic: 130 - 139
Diastolic: 80 - 89
What is the reading for high blood pressure (Hypertension) stage 2?
Systolic: 140 - 179
Diastolic: 90 -109
What is the reading for Hypertensive crisis?
Systolic: Higher than 180
Diastolic: Higher than 110
Consult your doctor immediately
List the different types of blood pressure equipment
1) Manual Device
- the clinician applies the cuff, inflates it, and listens for Korotkoff sounds with a stethoscope
2) Semi-automatic
- the clinician applies the cuff and pushes a button to inflate and deflate the cuff
- the device takes the reading
3) Fully automated
- the clinician applies the cuff and pushes a button to inflate and deflate the cuff
- the device can be programmed to obtain multiple BP measurements at specific time intervals and averages the measurements
Sphygmomanometer
Manual BP equipment
- includes BP cuff and meter
- cuff is a cloth wrap that holds an inflatable rubber bladder
- rubber bulb is attached to the cuff with rubber tubing
Proper cuff fit
- The cuff’s air bladder should encircle 75-100% of the patient’s arm (it should not wrap around itself)
- The width of the cuff should be at least 40-50% of the patient’s upper arm circumference
- The cuff should be placed on a bare arm
- Position the middle of the bladder of the cuff over the brachial artery (use the arrow on the cuff to guide you)
- Position the patient’s arm so that the cuff is at heart level
- The cuff should be snug at the top and bottom edges
What are the 5 phases of Korotkoff sounds that occur during deflation of the blood pressure cuff?
1) Phase 1: Blood is beginning to flow back into the artery and can be heard as a sharp tapping sound
- this is the systolic bp reading
2) Phase 2: The cuff is deflate slowly, with blood flowing. A swishing sound may be heard. This sound is softened and becomes prolonged into a murmur
3) Phase 3: A large amount of blood is flowing into the artery. A distinct, sharp tapping sound returns and continues rhythmically
4) Phase 4: Blood is flowing easily and the sound changes to a soft tapping, This sound becomes distinctly muffled and fainter
5) Phase 5: At this point, the artery is fully open and the sound disappears.
- this is the diastolic bp reading
How long would you have to wait to take another blood pressure reading if situations may arise?
Minimum of 10 minutes before obtaining another ready
- if taken too soon, the reading may be incorrect
For SAIT, wait for 5 minutes before taking another reading
What are some medical considerations for blood pressure?
- The stress and anxiety of a dental procedure could possibly elevate a patient’s bp
- 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
How to take a blood pressure?
- Seat the patient in an upright position that supports their back and feet
- It is best to allow the patient to sit quietly for a few minutes (3-5) prior to taking bp
- Ask the patient to keep their legs uncrossed before and during the measurement
- Support the patient’s arm so that the cuff is positioned at heart level
- The patient’s palm should be facing up and should be opened and relaxed
- Neither you nor the patient should talk during the measurement
Why are manual blood pressure devices less reliable?
- Fragile
- Require frequent calibration
- More subject to human error due to the need of manual inflate/deflate of cuff and manually listening for Korotkoff sounds
How is blood pressure documented in a patient’s record?
Record the systolic and diastolic bp
- note which arm was used
- note the type of device used
Example:
120/80 mmHg, left arm, automated device
