Emergencies & Records - Week 6 PP Flashcards
Vital Signs in Dental Care
Attention toward a patient’s immediate health should be the first
priority of every healthcare provider
a) by taking a patient’s vital signs on a routine basis prior to dental treatment - confirming the patient’s health status is at a level of well-being
b) Vital signs consist of taking and recording a person’s temp, pulse, respiration, and blood pressure
Hypertension rate in Canada
Approximately 7.5 million people in Canada have hypertension, so it is
important to take patients’ blood pressure
Factors that Can Affect Vital Sign Readings
- Emotional Stress
a) Stress
b) Fear - Physical Factor
a) Illness
b) Drinking or eating
c) exercise
If a patient were to come directly to a dental appointment from a workout at
the gym, what changes would you expect to see in the patient’s vital signs?
Temperature increase
Pulse Increase
Respiration Increase
Blood Pressure increase
Role of the Dental Assistant and Vital Signs
One of your roles as a dental assistant is to inquire about and recognize these situations and help the patient relax before taking his or her vital signs.
You may need to take these measurements more than once.
If you think the patient is abnormally anxious, provide reassurance, wait
several minutes (5 minuets) , and then repeat the procedure.
Pulse Readings
Pulse is your heart rate, or the number of times your hear beats in 1 minute. A pulse rate varies from person to person and will reads lower when at rest. Will read higher when exercising.
3 Places you can take Pulse Reading
Radial Artery (Most Common) - Located on the inner surface of the wrist (thumb side). To take the pulse, place your index and middle fingers lightly on the patient’s wrist between the radius (bone on the thumb side) and the tendon. This measures about 1 inch from the base of the thumb.
Brachial Artery (Blood Pressure) - Located on the inner fold of the arm,
it is also referred to as the antecubital area of the elbow. This artery is used
when a patient’s blood pressure is taken.
Carotid Artery (CPR) - To detect the carotid pulse, place two fingers alongside the patient’s larynx 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 determine a pulse.
Normal resting Heart rate by age range
Newborn: 100-160 bpm
Infants: (0-5months old): 90-150 bpm
Infants: (6-12months old): 80-140 bpm
Children (1–3 years): 80–130 bpm
Children (3-5 years): 80-120 bpm
Children (6–15 years): 70-100 bpm
Young Adults- Adults: 60-bpm
Arrhythmia (Irregularity in heart beat)
However, it is best not to count for less than 30 seconds, because it is
difficult to detect any possible arrhythmia (irregularity) in the
heartbeat in times shorter than 30 seconds
(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.)
Rapid Heartbeat - tachycardia
A rapid heartbeat, or tachycardia is a condition in which the heart is beating fast (more than 100bpm). A rapid heartbeat can be normal, or it can result from a disease, disorder, or condition.
Considerations that can cause or contribute to a fast heart rate include age, exercise, stress or anxiety, smoking, certain medications, high blood pressure, heavy alcohol use, heavy caffeine use, body size.
Slow Heart Rate
A slow heartbeat, or bradycardia is a condition in which the heart is beating slow (less than 60bpm). A slow heartbeat can be normal, or it can result from a disease, disorder, or condition.
Equipment & Supplies for Taking a Patient’s Pulse
- Watch or clock with seconds hand
- Patient’s Record to document
- Black Pen
Procedure Steps - for taking a Patient’s Pulse
- Seat Patient in upright position
- Extend the patients arm, resting it on the arm rest of the chair. (heart level)
- Place the tips of your index and middle fingers on the patient’s radial artery.
Note which arm you used to take the pulse - Feel for the patient’s pulse before beginning to count
- Count the pulse for 30s they multiply by 2 (1-min)
- Record the rate, along with any distinct changes in rhythm
Pulse Characteristics
When taking a patient’s pulse, look for any distinct changes. The following
characteristics must be noted in the patient’s dental record when
documenting a patient’s pulse:
- Rate: Number of beats that occurs during the counting period
- Rhythm: Pattern of the beats, such as an occasional skipping, speeding up,
or slowing down of a beat - Volume: Force of the beat, such as a strong or a weak beat
Respiration
- The process of inhaling and exhaling, or breathing
- Respiration characteristics
a) Rate: Total number of breaths per minute
b) Rhythm: Breathing pattern
c) Depth: Amount of air inhaled and exhaled - Respiration readings
a) Adult: 12 to 20 breaths per minute
b) Children and teenagers: 12 to 30 breaths per minute
Respiration Readings
AGE RANGE Rate ( In Breaths Per Minute)
Infants: (Birth to 1 year old): 30-60
Toddler (1–3 years): 24-40
Preschooler (3-6 years): 22-34
Children (6–12 years): 18-30
Young Adults (12-18 years): 12-16
Adults (19+): 12-20
Equipment & Supplies for Taking a Patient’s Respiration
Equipment and Supplies
1. Watch or Clock with second hand
2. Patient Record to document
3. Black Pen
Procedure Steps - for Taking a Patient’s Respiration
- Seat Patient in upright position
- The Patient should be aware you are observing their breathing.
- Count the rise and fall of the patient’s chest for 30s, multiple by 2 to
compute the reading for 1-min - Record the rate, rhythm and quality in the patients record.
Respiration Characteristics
Rate - The total number of breaths per minute (ex. 15 breaths per min) - Normal
Rhythm - Refers to breathing pattern (ex. Steady)
Depth - Deep, Shallow, or Gasping
Bradypnea
Slower than 12 breaths per minute
Tachypnea
Faster than 20 breaths per minute
Hyperventillation
Faster than 20 breaths per minute, deep breathing
Sighing
Frequently interspersed deeper breaths
What is Blood Pressure
BP refers to the amount of blood your heart pumps and the amount of resistance to blood flow in your arteries. Normal blood pressure is vital to a person’s well being because it delivers oxygen and nutrients throughout your circulatory system and white blood cells and antibodies for our immunity and hormones such as insulin.
High Blood Pressure
The more blood your heart pumps and the narrower the arteries, the
higher your blood pressure reading. A patient who has been diagnosed
with high blood pressure or hypertension should be under the care of a
physician. The higher the blood pressure, the more risk there is for other
health problems, such as heart disease, heart attack, and stroke.
Two Pressures of the Heart
- Blood pressure reflects the amount of work the heart has to do to
pump blood throughout the body - Two pressures of the heart
a) 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
b) Diastolic: The heart muscle at rest when it is allowing the heart to take in
blood to be oxygenated before the next contraction
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.
Equipment used when taking blood pressure
The equipment used when taking a patient’s blood pressure are the sphygmomanometer and the stethoscope
Sphygmomanometer
a) Includes the blood pressure cuff and meter
b) The cuff is a cloth wrap that holds an inflatable
rubber bladder
c) A rubber bulb is attached to the cuff with
rubber tubing
Cuff Sizes
To get an accurate reading, it is important to use the appropriately sized cuff
a) Arm circumference 8 to 10 inches— “small adult” cuff
b) Arm circumference 10½ to 13 inches— “adult” cuff
c) Arm circumference 13½ to 17 inches— “large adult” cuff
d) Arm circumference 17½ to 20 inches— “adult thigh” cuff
Automated Blood Pressure Equipment
- An automated electronic blood pressure device is used in many practices today to simplify and speed up 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
Medical Considerations when taking blood pressure
- The stress/anxiety of a dental procedure could possibly elevate a patient’s blood pressure
a) 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 physical during a treatment regimen
Seat the patient with the arm extended at heart level and supported on the chair arm or on a table.
PURPOSE The patient’s arm should be at the same level as the
heart. If possible, roll up the patient’s sleeve. PURPOSE Tight clothing can interfere with accurate measurement and reading
Place the blood pressure cuff around the patient’s arm approximately 1 inch above the antecubital space, making sure to center the arrow over the brachial artery. PURPOSE Pressure must be applied directly over the artery for a correct reading.
Use the Velcro closure to hold it in place to tighten the cuff. NOTE Make sure that the cuff is tight enough that you can place only a finger between the cuff and the arm.
Place the earpieces of the stethoscope into your ears so they are facing toward the front. PURPOSE This position of the earpieces is most comfortable and blocks out distracting noises while you are taking blood pressure. Place the stethoscope disc over the site of the brachial artery, using slight pressure with the fingers.
Grasp the rubber bulb with the other hand, locking the valve. Inflate the cuff to the
noted reading. NOTE: You will have to inflate the bulb quickly. Slowly release the valve and listen through the stethoscope. The first sound heard is the systolic pressure reading
Slowly continue to release the air from the cuff until you hear the last sound. This is the diastolic pressure reading. Record the reading and indicate which arm is used.
Blood Pressure Categories
Category - Systolic mm Hg (upper) - Diastolic mm Hg (Lower Number)
Normal - Less than 120 - Less than 80
Elevated - 120-129 - Less than 80
High Blood Pressure (Hypertension) Stage 1 - 130-139 - 80-89
High Blood Pressure (Hypertension) Stage 2- 140 and higher - 90 or higher
Hypertensive Crisis (Consult Dr. Immediately) - Higher than 180 - Higher than 120
Temperature
Body temperature is the degree of hotness or coldness of the body’s
internal environment. The process of physical and chemical changes that
take place in the production of the body’s heat is called metabolism.
A healthy person’s temperature will vary slightly throughout the day because of the quantity of stimuli that it encounters.
A person’s lowest body temperature occurs in the early morning hours, and
the highest temperature occurs in the evening.
Normal Temperature Range
the normal rage of oral temperature of a resting adult is 97.6 F to 99F. (36.4C to 37.3C)
A normal body temp will run higher in infants and younger children than in adults
Body Sites to Take Temperature
Body Site - Taken Average Temperature
Oral - temperature is 98.6°F or 37°C.
Rectal temperature -typically runs higher than an oral temperature
(0.5°F to 1°F or 0.3°C to 0.6°C).
Ear (tympanic) -temperature typically runs higher than an oral temperature
(0.5°F to 1°F or 0.3°C to 0.6°C).
Armpit (axillary) -temperature typically runs lower than an oral temperature
(0.5°F to 1°F or 0.3°C to 0.6°C).
Forehead (temporal) - temperature typically runs lower than an oral temperature
(0.5°F to 1°F or 0.3°C to 0.6°C)
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
Pulse oximetry is used for measuring the concentration of oxygen in the blood
The pulse oximeter works by passing a beam of red and infrared light through a pulsating capillary bed
The oximeter detects the pulse, and then subtracts the intensity of color detected when the pulse is absent
A fit, healthy person should have an oxygen saturation level between 95% and 99%
What are vital signs?
Certain test, such as blood pressure, temperature, pulse and respiration, that can help you determine a person’s conditions.
When should the clinical assistant take and document a patient’s vital signs?
After a patient’s first visit, at the 6th month recall visit, or in an emergency situation
What is a base line?
a starting point or condition against which future changes are measured
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 at a level of well being - may have to assist the patients condition for physical or mental factors that would affect a patient’s vital signs.. wait for a few minutes before taking if required
- vital signs consist of taking and recording a person’s temperature, pulse, respirating and blood pressure
Normal Ranges for Adults!!
Temperature
Blood Pressure
Respirations
Pulse Rate
