Patient Evaluation PDF

PATIENT EVALUATION III Marcia Rojas/Thamer Musbah, BDS Assistant Professors Division of Oral Medicine, Oral Diagnosis and Oral Radiology ODM 814 Vital Signs VITAL SIGNS BLOOD PRESSURE 01 PULSE...

PATIENT EVALUATION III Marcia Rojas/Thamer Musbah, BDS Assistant Professors Division of Oral Medicine, Oral Diagnosis and Oral Radiology ODM 814 Vital Signs VITAL SIGNS BLOOD PRESSURE 01 PULSE 02 TEMPERATURE 03 RESPIRATIONS BLOOD PRESSURE  PHYSIOLOGY of BLOOD PRESSURE Pressure exerted by the blood against the interior walls of the arterial system Sounds produced by turbulent blood flow are called Korotkoff sounds, after Russian physician who described technique in 1905 1st sounds are the systolic pressure -> Phase 1 Complete disappearance of sounds is diastolic pressure -> Phase 5  BLOOD PRESSURE EQUIPMENT (Sphygmomanometer) Auscultatory Method (Mercury Sphygmomanometer) **Gold Standard It’s use is decreasing mainly because the likelihood of mercury spill Auscultatory Method (Aneroid Sphygmomanometer) The BP is measured by a mechanical system of metal bellows that expands as the cuff pressure increases Auscultatory Method (Hybrid Sphygmomanometer) Combine features from both electronic and auscultatory devices www.practicalclinicalskills.com/blood-pressure-measurement.aspx  BLOOD PRESSURE EQUIPMENT (Sphygmomanometer) Automatic Devices Standard Wrist !! **Only at heart level Finger !! **Not recommended www.practicalclinicalskills.com/blood-pressure-measurement.aspx  Steps for BP Measurement 1. Patient Preparation: - Exercise, nicotine or alcohol consumption - Positioning of the arm, muscle tension, talking, clothing - Seated comfortably, legs uncrossed, the back and arm supported 2. Choice of Blood Pressure Measurement Device - Gold standard - Aneroid/ hybrid sphygmomanometer 3. Cuff size - Make sure to use a properly sized blood pressure cuff - Adult – The bladder should encircle 80% of the arm - Children – The bladder should encircle 100% of the arm Selection Criteria for BP Cuff Size for Measurement of BP in Adults Arm Usual Cuff Size Circumference 22–26 cm Small adult 27–34 cm Adult 35–44 cm Large adult 45–52 cm Adult thigh  Steps for BP Measurement 4. Inflation/deflation of the device - The cuff should initially be inflated to at least 30 mm Hg above the point at which the radial pulse disappears Sphygmomanometer Manual  Position the cuff so the bladder is over the artery and the cuff is 1-2cm above the antecubital fossa Place 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 Note this level and inflate the cuff -30 mm Hg more to overcome an auscultatory gap  Then release the valve slowly First sounds heard will be the systolic pressure Continue deflating the cuff until the sound disappears which marks the diastolic pressure Automatic Devices When Should you measure BP? - All new patients - At recall appointments Why? - ID undiagnosed hypertension - Monitor control/compliance and severity - Risk assessment  HYPERTENSION - HTN Persistently elevated blood pressure Current standards ≥ 130/80 Categories of BP in Adults* know for exam BP Category SBP DBP Normal 140/90) than the daytime ambulatory blood pressure (100 ………? Automatic Devices Respiration Seat the patient in a quiet comfortable environment Count the number of times the chest rises and falls for 30 or 60 seconds Average number of respirations 14 – 20/minute Bradypnea – Slower that 14/minute Tachypnea - Persistent over 20/minute Temperature ORAL (37 ℃ - 98.6 F) AXILLARY - LOWER RECTAL – HIGHER Infra-red Bladder/Cuff/Arm Relationship Take it Correctly Screening tools Ability to detect those who may have the disease (or rule it out) early in the process. Sensitivity: Ability to identify those with the disease. High sensitivity (low false negatives) Specificity: Ability to identify those without the disease. High specificity (low false positives)