Lecture 6 - ODM 814

• Patient Evaluation III covers vital signs.
• Vital signs include blood pressure, pulse, temperature, and respirations.

Blood Pressure

• Blood pressure is the pressure of blood in the vessels when the heart beats, known as systolic pressure, and the pressure between beats when the heart relaxes, known as diastolic pressure.
• Normal blood pressure is less than 120/80 mmHg, where mmHg stands for millimeters of mercury.
• Blood pressure is the pressure exerted by blood against the interior walls of the arterial system.
• Sounds produced by turbulent blood flow are called Korotkoff sounds, coming from a Russian physician who described the technique in 1905.
• The first sounds are the systolic pressure and occur in Phase 1.
• Complete disappearance of sounds indicates diastolic pressure and marks Phase 5.

Blood Pressure Equipment

• Blood pressure equipment includes sphygmomanometers.
• The Auscultatory Method using a mercury sphygmomanometer is considered the gold standard, however is decreasing in use due to the likelihood of mercury spill.
• The Auscultatory Method using an aneroid sphygmomanometer measures BP via a mechanical system of metal bellows that expands with cuff pressure.
• The Auscultatory Method using a hybrid sphygmomanometer combines features from both electronic and auscultatory devices.
• Automatic devices are available in standard, wrist, and finger models (wrist models must be at heart level; finger models not recommended).

Steps for BP Measurement

• Patient preparation: avoid exercise, nicotine, or alcohol consumption, properly position the arm, reduce muscle tension, avoid talking, remove clothing and ensure the patient is seated comfortably with legs uncrossed and back & arm being are supported.
• Choice of device: gold standard or aneroid/hybrid sphygmomanometer.
• Cuff size: use a properly sized cuff.
• For adults, the bladder should encircle 80% of the arm.
• For children, the bladder should encircle 100% of the arm.
• Select a 'small adult' cuff for an arm circumference of 22-26 cm, an 'adult cuff' for 27-34 cm, and a 'large adult' cuff for 35-44 cm; use an 'adult thigh' cuff for 45-52 cm.
• Inflation/deflation: inflate the cuff at least 30 mmHg above the point where the radial pulse disappears.
• Important points: the patient should be seated comfortably with a supported back, baring the upper arm, while not having their legs crossed.
• To continue the procedure; the arm should be supported at heart level, the bladder encircling at least 80% of the arm circumference.
• During deflation, the mercury column should be deflated at 2 to 3 mm/s to measure systolic and diastolic pressure to the nearest 2 mm Hg.
• Refrain from talking during the measurement.
• Position the cuff so the bladder is over the artery and 1-2cm above the antecubital fossa.
• Position the stethoscope over the brachial artery, just above the antecubital fossa.
• Inflate to 70 mm Hg and increase by 10 mm until the radial pulse disappears, then inflate 30 mm Hg more to overcome an auscultatory gap.
• Next, slowly release the valve.
• First sounds indicate systolic pressure.
• The point at which the sound disappears indicates diastolic pressure.

Hypertension (HTN) Info

• Hypertension is persistently elevated blood pressure, defined as greater than or equal to 130/80.
• Measurement of blood pressure is the only way to detect it.
• Clinical features involve an insidious disease and may remain completely asymptomatic for many years.
• It is classified into categories such as normal (less than 120 mm Hg systolic and less than 80 mm Hg diastolic), elevated (120-129 mm Hg systolic and less than 80 mm Hg diastolic), and hypertension stage 1 and 2. Hypertensive Crisis:
• Defined as SBP greater than 180 and/or DBP greater than 120.
• Requires prompt changes in medication if there are no clear indications of issues.
• Immediate hospitalization is required if there are signs of organ damage. White Coat Hypertension:
• Occurs when office blood pressure is substantially higher (>140/90) than daytime ambulatory blood pressure (<135/85).
• Diagnosed through a reliable out-of-office reading.
• It is present in the majority of hypertensive patients.
• For patients with hypertension: elective dental care may proceed without modification if BP is below 160/100.
• If BP measures >160/100, repeat the measurement and proceed if lowered or within written guidance from a physician.
• If confirmed, no elective dental tx and pt should seek consultation with a physician.

Hypertension and Emergency Dental Care:

• For patients with hypertension: emergency dental care may proceed without modification if BP is below 160/100.
• If BP between 160-180 mmHg and/or diastolic pressure 100-109 mmHg, initiate emergency care with blood pressure monitoring.
• Monitor blood pressure every 10-15 minutes, consider anxiety reduction techniques.
• If systolic pressure >180 mmHg and/or diastolic pressure >109 mmHg, seek physician consultation before proceeding.

Pulse

• Palpate the radial artery using the middle and index fingers
• Count the pulses for 15 to 30 seconds then multiply or count for 1 minute.
• Normal adult heart rate is 60-100 beats per minute.

Respiration

• Seat the patient in a quiet, comfortable environment.
• Count the number of times the chest rises and falls for 30 or 60 seconds.
• The average number of respirations is between 14 and 20 per minute.
• Bradypnea is a rate slower than 14/minute.
• Tachypnea is considered a respiration rate is persistent over 20/minute.

Temperature

• Temperatures can be taken through oral means, which is 37°C or 98.6 F.
• Axillary readings area lower.
• Rectal readings are higher.
• Readings can be measured though infra-red.

Screening Tools

• Screening tools can be used detect those who may have the disease (or rule it out) early in the process.
• Sensitivity: the ability to identify those with the disease includes high sensitivity and low false negatives.
• Specificity: ability to identify those without the disease includes high specificity and low false positives.