Vital Signs Chapter 14 PDF

Chapter 14 Vital Signs  Week 11 Objectives Describe the rationale of obtaining accurate vital signs of dental patients and demonstrate related techniques.* Recognize the patient record as a legal document and maintain accurate documentation. * **...

Chapter 14 Vital Signs  Week 11 Objectives Describe the rationale of obtaining accurate vital signs of dental patients and demonstrate related techniques.* Recognize the patient record as a legal document and maintain accurate documentation. * ** 2  Learning Objectives Lesson 14.1: Vital Signs Discuss vital signs and the importance of minimizing risk of a medical emergency via vital signs assessment. Discuss the significance of body temperature, assess and record body temperature, and make decisions based on observed body temperature. Discuss the significance of pulse rate, assess and record pulse rate, and make decisions based on observed pulse rate. 3  Learning Objectives Lesson 14.1: Vital Signs Discuss the significance of respiration rate, assess and record respiration rate, and make decisions based on observed respiration rate. Discuss the significance of blood pressure, assess and record blood pressure, and make decisions based on observed blood pressure. 4  Vital Signs Temperature, pulse rate, respiration rate, and blood pressure Inspection, palpation, and auscultation are techniques used to determine vital signs: – Use properly working and appropriate equipment – Be familiar with client’s baseline measurements, health status, pharmacologic history – Minimize environmental factors that may affect vital signs – Use a systematic approach for each procedure – Approach the client in a calm, caring manner – Use critical thinking skills to determine when the dentist should be notified 5 Vital Signs: Acceptable Ranges for Adults Adapted from Potter PA, Griffin AG, Stockert P, et al: Fundamentals of nursing, ed 8, St Louis, 2012, Mosby. 6  2. Do the following regarding the assessment of body temperature, including: Assess temperature and record these vital signs measurements. Recognize findings that have implications for care planning and initiate medical referrals for the health and safety of the client. Compare baseline measurements with current findings and communicate significant changes to the client and dentist. 7  THERMOMETERS TherTmometers Four types of thermometers are available: – Mercury-in-glass – Electronic (digital) – Tympanic membrane (ear) – Oral and axillary disposable, single-use 8  Body Temperature Measurement Sites Five sites are used: – Oral – Ear – Rectal – Axilla – Forehead 9  Body Temperature No single temperature is normal for all people; range 96.8 degrees to 100.4 degrees F Factors that may affect body temperature: – Exercise – Hormonal imbalances – Ovulation and menopause – Time of day variations – Environment – Age – Smoking – Stress – Infection – Tachypnea – Hot and cold liquids 10  Decision Making Based on Observed Temperature Usually a high body temperature indicates body is fighting infection Young children are at risk of febrile seizures if fever exceeds 101.8 degrees F If temperature exceeds 102.2 degrees F, look for infection and cause Medical emergency – temperature of 105.8 degrees F Causes of low temperatures: Cold exposure, endocrine disorders, sepsis, alcohol intake, eating disorders, neurologic and neuromuscular disorders 11  Lesson 14.1 Taking the Different Vital Signs 3. Discuss the significance of the pulse and do the following: Assess the pulse rate and record these vital signs measurements. Recognize findings that have implications for care planning and initiate medical referrals for the health and safety of the client. Compare baseline measurements with current findings and communicate significant changes to the client and dentist. 12  Pulse Indicator of the integrity of the cardiovascular system Tachycardia: above 100 beats per minute – Abnormally elevated heart rate – Normal response to stress or physical exercise Bradycardia: below 60 beats per minute – Abnormally slow heart rate – Athletes may be bradycardic at rest as a result of physical conditioning 13 Pulse Measurement Sites Most common site: radial pulse – Thumb side of inner wrist, where radial artery can be felt – Clinician’s fingertips of first two fingers are used to feel for pulse Carotid pulse: located on side of neck – Alternative site 14 Decision Making Based on Observed Pulse Rate 100 BPM: evaluate patient for causative factors; refer if needed – If no cause can be determined, medical consultation with patient’s physician should be conducted Occasional premature ventricular contractions (PVCs) are common – Can be caused by smoking, fatigue, certain medications, stress, caffeine, and alcohol Pulsus alternans may indicate ventricular failure 15  What factors could influence the Pulse Rate? Exercise Temperature Emotions and stress Medications Hemorrhage Postural Changes Pulmonary Conditions 16 Recording the Pulse Rate The pulse is recorded in beats per minute (BPM) 30 seconds times 2 or 1 full minute Heart Rhythm – regular or irregular Pulse Quality – thready, strong, bounding or weak Pulse Equality can be assessed by palpating the radial pulse on the right and left side at the same time. 17  PULSE EQUALITY Palpate the Radial Pulse on the right and left wrist at the same time and compare whether the pulse force is equal. Pulse equality can provide data about conditions such as obstructions or aortic coarctation (birth defect of a narrowing of the artery which carries the blood) NEVER palpate the carotid pulses at the same time as this can decrease and /or compromise cerebral blood flow. 18 19 Measuring the Radial Pulse 20 Measuring the Radial Pulse From Potter PA, Griffin AG, Stockert P, et al: Fundamentals of nursing, ed 8, St Louis, 2012, Mosby. 21 Acceptable Ranges of Heart (Pulse) Rate Adapted from Potter PA, Griffin AG, Stockert P, et al: Fundamentals of nursing, ed 8, St Louis, 2012, Mosby. 22  Lesson 14.1 Taking the Different Vital Signs 4. Discuss the assessment of respiration, including: Assess the respiration rate and record these vital signs measurements. Recognize findings that have implications for care planning, and initiate medical referrals for the health and safety of the client. Compare baseline measurements with current findings and communicate significant changes to the client and dentist. 23  Respiration Rate Assessed by counting the rise and fall of patient’s chest Recorded as respirations per minute (RPM) Normal adult range: 12-20 RPM Children’s range: 20-30 RPM Advancing age produces variations in the respiration rate 24  Decision Making Based on Respiration Rate Tachypnea: rapid breathing (>20 RPM) Bradypnea: slow breathing; can occur with diabetic coma If abnormal respiratory rate is detected, dental hygienist refers patient to physician of record 25  Respiration Rate Let’s practice taking the Respiration Rate Place your hand on the patient’s wrist in the proper area to assess the pulse. Carefully watch the patient’s chest rise and fall as you assess the respiration rate without them noticing. Record the reading. 26  Lesson 14.1 Taking the Different Vital Signs 5. Do the following regarding the assessment of blood pressure, including: Assess the blood pressure and record these vital signs measurements. Recognize findings that have implications for care planning, and initiate medical referrals for the health and safety of the client. Compare baseline measurements with current findings and communicate significant changes to the client and dentist. 27  Blood Pressure (BP) (Slide 1 of 2) The force exerted by the blood against the arterial walls when the heart contracts Chronic hypertension causes thickening and loss of elasticity in arterial wall – Heart attack (myocardial infarction) – Heart failure – Stroke – Kidney disease Hypotension: No adverse effects unless 28 patient is in shock or has condition that  Blood Pressure (BP) (Slide 2 of 2) Systolic blood pressure measures maximum pressure occurring in the blood vessels during cardiac ventricular contraction (systole) – Number on the sphygmomanometer when the first heart sound is heard 29  Blood Pressure Diastolic blood pressure measures minimum pressure occurring against the arterial walls as a result of cardiac ventricular relaxation (diastole) – Number on the sphygmomanometer when the last heart sound is heard 30  Some Factors That Affect Blood Pressure Age and race Time of day Certain diseases Tobacco Weight and diet Caffeine Gender Alcohol Use Stress Pain Oral contraceptives and medications Exercise 31  Decision Making Based on Observed Blood Pressure Hypertension is major cause of stroke; contributing factor for myocardial infarction Patients who have elevated blood pressure are usually not candidates for drug therapy If patient’s blood pressure is unknown, a baseline blood pressure should be obtained Caution should be taken with uncontrolled hypertensive patients before any surgical procedure 32  Blood Pressure Equipment and Measurement Sphygmomanometer (blood pressure cuff) – Consists of a pressure-measuring device called a manometer and an inflatable cuff that wraps around the arm or leg Stethoscope – Instrument used to amplify sound; consists of two earpieces, plastic or rubber tubing, and a chestpiece Electronic over-the-counter-type manometer – For home use; determines blood pressure automatically without the use of a stethoscope 33  PMI’s Dental Hygiene Clinic Treatment Guidelines See the Clinic Manual pages 39-42 for Pulse Guidelines Respiration Guidelines Temperature Guidelines Blood Pressure Guidelines Dental Treatment with Hypertension – PMI Protocol Diabetes – PMI Protocol (Level &Dental Treatment Modifications 34 When to Take Vital Signs 35 Blood Pressure Equipment and Measurement Sphygmomanometer (blood pressure cuff) – Consists of a pressure-measuring device called a manometer and an inflatable cuff that wraps around the arm or leg Stethoscope – Instrument used to amplify sound; consists of two earpieces, plastic or rubber tubing, and a chestpiece Electronic over-the-counter-type manometer – For home use; determines blood pressure automatically without the use of a stethoscope 36 37 Location of Brachial and Radial Arteries 38  Blood Pressure Classification for Adults National Institutes of Health (NIH): The seventh report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure, Bethesda, Md, 2004, NIH. 39  Guidelines for Proper Blood Pressure Cuff Size From Potter PA, Griffin AG, Stockert P, et al: Fundamentals of nursing, ed 8, St Louis, 2012, Mosby. 40 Korotkoff Phases 41  Legal, Ethical, and Safety Issues Concerning Recording Vital Signs Always record client’s vital signs on the treatment records Refer client to physician for medical consultation as needed Disinfect earpiece of stethoscope before and after Never provide dental care to client with medical risk greater than ASA III classification Measure vital signs during medical emergency “Do no harm” Demonstrate tolerance by being sensitive to diverse client cultures and beliefs 42 QUESTIONS 43