Emergencies & Records - Vital Signs - Outcome 2

Question 1

What is Pulse?

Answer 1

Pulse is a wave of pressure that can be felt when the heart contracts and propels blood through arteries. Although every artery in the body has a pulse, only those close to the surface of the skin can be read. These are known as pulse points.

Question 2

Common Pulse Point - Carotid Pulse

Answer 2

Location:
- In the neck, under the anterior edge of the sternocleidomastoid muscle
- to locate, find your Adam’s apple with your index, middle, and ring finger. Slide your fingertips into the grooves at the side of the patient’s neck closest to you.

Use: in emergency situations (i.e. cardiac and unconscious states)

Question 3

Common Pulse Points: Radial Pulse

Answer 3

Location:
-Located on the lateral side of each wrist (thumb side of each wrist)

Use:
-Non-urgent situations or routine assessments
-if a radial pulse is not detected in one wrist, immediately try to palpate the carotid pulse in an emergency situation

Question 4

Common Pulse Points: Brachial Pulse

Answer 4

Located on the medial side of the upper arm in the antecubital fossa (a hollow or depressed area)

Use - To assess blood pressure

Question 5

Characteristics of a Pulse

Answer 5

-Rate: is the number of beats within a time frame

• Rhythm: is the pattern of beats such as occasional skipping, speeding up, or slowing down
  -Quality or Volume: is the force of the beat, such as a strong or weak beat

Question 6

Resting Pulse Rates

Answer 6

The normal pulse rate for a person over 10 years of each (including seniors) is 60 to 100 beats per minute (bpm). An active adult may have a lower resting pulse rate - ranging from 40 to 60 bpm.

In children and infants, the normal resting pulse rates varies with age. It is usually more rapid than the adult range, ranging from 70 to 150 bpm.

Question 7

Respiration

Answer 7

Respiration is the process of breathing, inhaling oxygen, and exhaling carbon dioxide. It can be a voluntary or involuntary function as controlled by the body’s nervous system

Question 8

Characteristics of Respiration

Answer 8

Breathing is usually not noticeable unless the individual is experiencing problems. When assessing breathing, the following respiratory characteristics should be noted:

Rate: is the total number of breaths per minute
Rhythm: is the breathing pattern (slow or fast)
Depth: the amount of air being inhaled and exhaled in one breath

Question 9

Normal Rates of Respiration

Answer 9

Resting Adult (19+): between 12 to 20 breaths per minute

Children (6-12): 18-30 bpm

Teenagers (12-18): 12 to 16 breaths per minute

Question 10

Pulse Oximetry

Answer 10

Pulse oximetry is a procedure used for measuring the concentration of oxygen in the blood.This procedure is important for measuring oxygenation and pulse rate when a patient is sedated and during the recovery phase. A fit healthy person should have an oxygen saturation level between 95% and 99%

Question 11

What is Blood Pressure?

Answer 11

Blood pressure (BP) is the pressure exerted by the blood on the wall of any blood vessel. It is recorded by the use of two readings.

Question 12

Systolic Pressure (upper number)

Answer 12

It is a measurement of the pressure on the arteries when the left ventricle contracts.
It is the period where the pulse can be felt (it indicates how much pressure the blood is exerting against the artery walls when the heart beats)

Question 13

Diastolic Pressure (lower number)

Answer 13

It is a measurement of the pressure on the arteries when the left ventricle is at rest.
During this period the heart is filling with blood and preparing for its next pumping action.
This would be the period where no heartbeat would be felt (indicates how much pressure the blood is exerting on the artery walls when the heart is resting between beats).
The diastolic pressure is constantly present on the arterial walls and directly indicates blood vessel resistance. Therefore, this is the pressure of most concern to a healthcare professional

Question 14

Why Blood Pressure is taken?

Answer 14

Measurements taken in a dental setting are important to determine if a patient’s BP is of concern before the initiation of dental care. Screening patients for hypertension can help reduce the risk of a dental emergency (such as heart attack or stroke) by providing additional treatment planning information for the dentist and dental hygienist so that appropriate treatment modifications and possible referral and consultation can be made

Question 15

Blood Pressure Categories

Answer 15

Normal BP for a resting adult is less than 120 mm HG systolic and less than 80 mm HG diastolic.

BP varies with age, sex, and height in children and, therefore, BP values should be compared with norms for age, sex, and
height.

Question 16

Blood Pressure Equipment

Answer 16

1. Manual Device: The clinician applies the cuff, inflates it, and listens for Korotkoff sounds.
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 measurement

Question 17

Steps for taking Accurate Blood Pressure Measurements

Answer 17

1. Properly prepare and position the patient.

Preparation - Explain the procedure to the patient.

Position
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 blood pressure.
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 the hand should be opened and relaxed.
Neither you nor the patient should talk during the measurement (Hypertension Canada, 2018).

2. Use the proper technique.

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 (Hypertension Canada, 2018).
Proper Device

Evidence supports using fully automated or semi-automated devices for evaluating blood pressure in an office setting.
Manual devices are less reliable due to fragility and they require frequent calibration. Because of the need to manually inflate/deflate the cuff and to manually listen for the Korotkoff sounds manual devices are more subject to human error (Hypertension Canada, 2018; Whelton, et al, 2017).

3. Take the proper number and type of measurements.

On the first visit blood pressure should be taken on both arms, document the arm that had the higher reading.
Subsequent measurements should use the arm with the higher reading (Hypertension Canada, 2018; Whelton, et al, 2017).

4. Properly document the blood pressure readings.

Record the systolic and diastolic blood pressure in the patient’s chart, note which arm was used, and the type of device used.

Question 18

What is Temperature?

Answer 18

Temperature is a measurement of how hot or cold the internal body is. A healthy person’s temperature can vary throughout the day within a normal range. Illness can cause a person’s body temperature to elevate.
Measurements taken in a dental setting are important to determine if a patient’s temperature is of concern before the initiation of dental care.

Question 19

Types of Thermometers

Answer 19

Digital
Tympanic
Temporal Scanner
Glass

Question 20

Types of Temperature Measurements

Answer 20

Orally - under the tongue
Tympanic – inside the ear
Axillary - underarm
Temporally - the surface of the forehead
Rectally -in the rectum

Question 21

Normal Temperature Ranges

Answer 21

A body’s normal oral temperature range is 36.4-37.3 degrees celsius.
The area of the body used to obtain the reading should also be considered and may vary from the normal oral range.
Normal body temperatures will be higher in infants and young children than in adults

Question 22

Procedure for Obtaining a Temperature Reading (Temporally)

Answer 22

1. Press the button on the temporal thermometer while you position the thermometer across the patient’s forehead (parallel to the eyebrows, and halfway between the hairline and the eyebrows).
2. Listen for a beep and a red light to signal that the thermometer has measured the patient’s temperature.
3. Record the reading in the patient’s chart.