Content_CH 12 Vitals.pdf

Chapter 12 Vital Signs  Learning Objectives Explain vital signs Demonstrate procedures for assessing vital signs Explain factors affecting vital signs Describe equipment used to assess temperature and blood pressure Recognize normal vital signs  Prepare the Pa...

Chapter 12 Vital Signs  Learning Objectives Explain vital signs Demonstrate procedures for assessing vital signs Explain factors affecting vital signs Describe equipment used to assess temperature and blood pressure Recognize normal vital signs  Prepare the Patient Seat patient in upright position, at eye level Explain the vital signs and obtain consent Explain how vital signs can affect dental hygiene and dental treatment. During the process, explain each step as needed by the individual patient  “Why are you taking my vitals????” Contributes to the systemic evaluation in conjunction with the complete medical history. Dental hygiene care planning and appointment sequencing are directly influenced by the findings. When vital signs are not within normal, advise the patient check with the primary care provider. Referral for medical evaluation and treatment is indicated. Copyright © 2017 Wolters Kluwer All Rights Reserved 4  Normal Body Temperature Adults: The normal average temperature is 98.6°F The normal range is from 97 to 99°F Older adults: Over 70 years of age, the average temperature is slightly lower 96.8°F Children: First year—99.1°F Fourth year—99.4°F Fifth year —98.6°F Twelfth year—98°F  Temperature Variations Fever (pyrexia): values over 99.5°F Hyperthermia: values over 104°F Hypothermia: values below 96°F Factors that alter body temperature Time of day: highest in late afternoon and early evening; lowest during sleep and early morning. Pathologic states: infection, dehydration, hyperthyroidism, myocardial infarction, or tissue injury from trauma Temporary increase: exercise, hot drinks, smoking, or application of external heat Decrease: starvation, hemorrhage, or physiologic shock Copyright © 2017 Wolters Kluwer All Rights Reserved 6 Types of Thermometers  Respiration A respiration is one breath taken in and let out Variations in normal the rate, rhythm, depth, and quality Adults: range is from 12 to 20/min, slightly higher for women Children: rate decreases steadily during childhood Older Adults: shown to have a higher predictive value for serious adverse events  Respiration Influences Tachypnea: rate over 28/min Bradypnea: rate below 12/min (rates over 60 are extremely rapid and dangerous) Increased respiration: caused by work and exercise, excitement, nervousness, strong emotions, pain, hemorrhage, and shock Decreased respiration: caused by sleep, certain drugs, pulmonary insufficiency, apnea Emergency situations: Chapter 9 increase or decrease  Respiration Count the number of times the chest RISES in 30 second multiplied times 2. Respirations must be counted so that the patient is not aware, as the rate may be voluntarily altered. Depth: shallow, normal, or deep Rhythm: regular (evenly spaced) or irregular (with pauses of irregular lengths between) Quality: strong, easy, weak, or labored (noisy) Sounds: Describe deviant sounds made during inspiration, expiration, or both Arteries of the Arm USED FOR BLOOD PRESSURE USED FOR PULSE  Pulse or Heart Rate (Count of Heartbeats) Irregularities of strength, rhythm, and quality of the pulse are noted while counting the pulse rate Rhythm: regular, regularly irregular, irregularly irregular. Volume and strength: full, strong, poor, weak, thready. Adults: There is no absolute normal. The adult range is 60–100 beats per minute (BPM), slightly higher for women than for men. Children: The pulse or heart rate falls steadily during childhood.  Pulse Influences Tachycardia: an unusually fast heartbeat (over 100) Bradycardia: an unusually slow heartbeat (below 50) Increased pulse: caused by exercise, stimulants, eating, strong emotions, extremes of heat and cold, and some forms of heart disease. Decreased pulse: caused by sleep, depressants, fasting, quiet emotions, and low vitality from prolonged illness. Emergency situations: (listed in Tables 9-3 and 9-4 in Chapter 9) may increase or decrease  Pulse 1. Tell the patient what is to be done 2. Have the patient in a comfortable position with arm and hand supported, PALM DOWN; YOUR PINKY/THEIR THUMB 3. Locate the radial pulse (thumb side of the wrist) with the tips of your first three fingers 4. When the pulse is felt, exert light pressure and count for 30 seconds multiply times 2 (A pulse rate over 100 is considered abnormal for an adult and requires further investigation before proceeding with dental treatment.)  Blood Pressure Blood pressure is the force exerted by the blood on the blood vessel walls Systolic pressure: occurs during ventricular contraction. It is the highest pressure Diastolic pressure: effect of ventricular relaxation. It is the lowest pressure Pulse pressure: difference between the systolic and diastolic pressures  Blood Pressure Influence Force of the heartbeat (energy of the heart) Peripheral resistance; condition of the arteries; changes in elasticity of vessels, effected by age and disease Volume of blood in the circulatory system Increase blood pressure: exercise, eating, stimulants, and emotional disturbance Decrease blood pressure: fasting, rest, depressants, and quiet emotions. Emergencies such as fainting, blood loss, shock.  Blood Pressure Equipment Stethoscope Sphygmomanometer: pressure-measuring device (manometer) and an inflatable cuff to wrap around the arm – Cuff Size: critical to accurate blood pressure results. General rule, cuff width needs to be ¼ wider than the arm. A longer, wider cuff is required for obese or muscular individuals. Pediatric-sized cuffs available also. Selection of Cuff Size  Procedure for Determining Blood Pressure Prepare patient Apply cuff (arm heart level, palm up) Locate radial pulse Determine maximum inflation level (30 points beyond where the radial pulse was no longer felt when cuff was inflated) Position the stethoscope (over the brachial artery) Deflate the cuff gradually Note the first Korotkoff sound (“tap tap”) and the last Repeat for confirmation (wait between readings) Record (as a fraction 117/69) Blood Pressure Cuff in Position Forearm Properly Supported during Blood Pressure Assessment Placement of the Earpieces for the Stethoscope Correct Stethoscope Endpiece Placement https://www.youtube.com/watch?v=fWCh28z4f7g High Blood Pressure (Hypertension) Blood Pressure above 140/90 associated with: CVD, Stroke, Kidney failure, Premature death  Blood Pressure Follow-Up Criteria Obligation to advise and refer for further evaluation Hypertension is not diagnosed on isolated reading Normal and Elevated = Lifestyle modifications Hypertension Stage I = Inform patient to speak to their PCP Hypertension Stage II = Give a medical referral 180/120 = Seek Emergency Care NOTE OUR CLINIC CUT OFF IS 170/100