Respiration Rate in Adults and Children

Chapter 14: Vital Signs

• Vital signs include temperature, pulse rate, respiration rate, and blood pressure
• Techniques used to determine vital signs are inspection, palpation, and auscultation
• Use properly functioning, appropriate equipment when measuring vital signs
• Be aware of the client's baseline measurements, health history, and any medications they are taking
• Minimize environmental factors potentially influencing the readings
• Approach the client with a calm and caring demeanor
• Use critical thinking to determine if the dentist needs to be notified about any significant issues

Week 11 Objectives

• Describe the importance of obtaining accurate vital signs from dental patients
• Demonstrate techniques for obtaining accurate vital signs
• Understand the patient record as a legal document & maintain accurate documentation

Lesson 14.1: Vital Signs

• Discuss vital signs and their role in potentially preventing medical emergencies
• Discuss the significance of body temperature; evaluate and document, and make decisions based on the reading
• Discuss the significance of pulse rate; evaluate and document, and make decisions based on the reading
• Discuss the significance of respiration rate; evaluate and document, and make decisions based on the reading
• Discuss the significance of blood pressure; evaluate and document, and make decisions based on the reading

Vital Signs: Acceptable Ranges for Adults

• Temperature: Range 36° C to 38° C (96.8° F to 100.4° F). Average oral/tympanic: 37° C (98.6° F). Average axillary: 36.5° C (97.7° F)
• Pulse: 60 to 100 beats per minute. Average: 80 beats per minute
• Respirations: 12 to 20 breaths per minute
• Blood Pressure: <120/<80 mm Hg

Assessment of Body Temperature

• Assess and record temperature readings
• Recognize significant findings needing care planning and medical referrals to ensure patient safety
• Compare baseline measurements to current readings; communicate significant changes to the client and dentist

Thermometers

• Available types include mercury-in-glass, electronic (digital), tympanic membrane (ear), and oral/axillary disposable single-use

Body Temperature Measurement Sites

• Oral, Ear, Rectal, Axilla, Forehead are sites for measuring body temperature

Body Temperature Factors

• Factors influencing body temperature include exercise, hormonal imbalances, ovulation/menopause, time of day, environment, age, smoking, stress, infection, tachypnea, and hot/cold liquids

Decision Making Based on Observed Temperature

• High temperature usually indicates an infection
• Young children at risk of febrile seizures with fever exceeding 101.8° F
• If temperature exceeds 102.2° F, evaluate for infection
• A temperature of 105.8° F is a medical emergency
• Low temperature causes include cold exposure, endocrine disorders, sepsis, alcohol intake, eating disorders, and neurological/neuromuscular disorders

Pulse

• Indicator of cardiovascular system integrity
• Tachycardia: >100 beats per minute (abnormally elevated heart rate; normal response to stress/exercise)
• Bradycardia: <60 beats per minute (abnormally slow heart rate; athletes may experience this at rest)

Pulse Measurement Sites

• Most common: radial pulse (thumb side of inner wrist)
• Clinicians use fingertips of first two fingers
• Carotid pulse (side of neck): Alternative site

Decision Making Based on Observed Pulse Rate

• <60 BPM or >100 BPM: Evaluate for cause. Refer if needed or consult with patient's physician if cause cannot be determined
• Occasional PVCs (premature ventricular contractions) common (caused by smoking, fatigue, medications, stress, caffeine, alcohol)
• Pulsus alternans may indicate ventricular failure

What Factors Influence the Pulse Rate?

• Exercise
• Temperature
• Emotions and stress
• Medications
• Hemorrhage
• Postural Changes
• Pulmonary Conditions

Recording the Pulse Rate

• Pulse recorded in beats per minute (BPM). 30 seconds x 2 or 1 full minute.
• Heart rhythm (regular/irregular)
• Pulse quality (thready, strong, bounding or weak)
• Pulse equality (palpate radial pulse on both right and left sides simultaneously)

Pulse Equality

• Palpate radial pulse on both wrists simultaneously to assess equality
• Unequal pulse force can indicate obstructions or aortic coarctation in some cases

Measuring the Radial Pulse

• Shows the strength of blood flow

Acceptable Ranges of Heart Rate (Pulse)

• Infants: 120-160 bpm
• Toddlers: 90-140 bpm
• Preschoolers:80-110 bpm
• School-age children: 75-100 bpm
• Adolescents: 60-100 bpm
• Adults: 60-100 bpm

Assessing Respiration

• Assess and record respiration rate
• Assess implications and initiate referrals for care planning if needed
• Compare current findings to baseline and communicate changes with client/dentist

Respiration Rate

• Assessed by counting the rise/fall of the chest per minute (RPM)
• Normal adult range: 12-20 RPM
• Children's range: 20-30 RPM
• Age may affect respiration rate

Decision Making Based on Respiration Rate

• Tachypnea: Rapid breathing (>20 RPM)
• Bradypnea: Slow breathing (may occur with diabetic coma)
• If respiration rate is abnormal, refer patient to physician

Taking the Respiration Rate

• Practice taking respiration rate by observing chest rise/fall without disturbing the patient
• Record the respiration rate

Taking the Different Vital Signs: Blood Pressure

• Assess and record blood pressure
• Assess implications, initiate referrals if needed
• Compare current findings to baseline; communicate changes with client/dentist

Blood Pressure (BP)

• Force exerted on arterial walls during heart contraction
• Chronic hypertension: Thicken/loss of elasticity in arterial wall (potential for heart attack, heart failure, stroke, and kidney disease)
• Hypotension: No adverse effects unless patient in shock or has condition that lowers blood pressure.

Blood Pressure (BP) (cont'd)

• Systolic: Maximum pressure in vessels during ventricular contraction (recorded as first audible sound)
• Diastolic: Minimum pressure during ventricular relaxation (recorded as last audible sound)

Factors Affecting Blood Pressure

• Age and race
• Certain diseases
• Weight and diet
• Gender
• Stress
• Pain
• Oral contraceptives and medications
• Exercise
• Time of day
• Tobacco
• Caffeine
• Alcohol Use

Decision Making Based on Observed Blood Pressure

• Hypertension is a major cause of stroke and myocardial infarction
• Patients with elevated blood pressure are generally ineligible for drug therapy
• Determine if patient's blood pressure is unknown; obtain baseline blood pressure if necessary
• Exercise caution with uncontrolled hypertensive patients before surgical procedures

Blood Pressure Equipment

• Sphygmomanometer (blood pressure cuff)
• Consists of a pressure measurement device, inflatable cuff (wraps around arm/leg)
• Stethoscope: Amplifies sound (2 earpieces, tubing, chestpiece)
• Electronic over-the-counter-type manometer (determines blood pressure automatically, used at home)

PMI's Dental Hygiene Clinic Treatment Guidelines

• Pulse guidelines
• Respiration guidelines
• Temperature guidelines
• Blood pressure guidelines
• Dental treatment with hypertension protocol
• Diabetes protocol

When to Take Vital Signs

• Every 3-4-6-12 month appointment.
• Significant change in health history
• Readings outside typical limits, monitoring by physician
• Medications
• Conditions that require ongoing monitoring (ex: pregnancy)

Blood Pressure Equipment Measurement

• Sphygmomanometer
• Stethoscope
• Electronic over-the-counter type manometer

Blood Pressure Classification for Adults

• Normal
• Prehypertension
• Hypertension Stage 1

Guidelines for Proper Blood Pressure Cuff Sizing

• Measure arm length and width

Korotkoff Phases

• Phases during blood pressure measurement (1-5 phases where sound is heard)

Legal, Ethical, and Safety Issues Concerning Recording Vital Signs

• Record vital signs on treatment records
• Refer to physician as needed.
• Disinfect stethoscope
• Never treat patients with ASA III classification risks
• "Do no harm"
• Tolerant of diverse client cultures