VITAL SIGNS. Vital Signs. Where to Take Temperature: Types of Thermometers
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1 Vital Signs VITAL SIGNS Body Temperature Pulse Respiratory Rate Blood Pressure Smoking Status (considered 5 th vital sign) Why Do We Take Vial Signs? Body Temperature Overall evaluation Baseline reading Treatment planning Vitals WNL Determine patient s ability to tolerate stress Comparison for managing emergency situations Identify for medical referral Before anesthesia is administered Normal Adult Range: F (37 0 C) Range: F F Adults >70 average temp lower F Child depends on age Fever (pyrexia) over F Hyperthermia over F Hypothermia below F Can be caused by hypothyroidism, viral infections, chronic debilitating diseases, or excess alcohol intake Where to Take Temperature: Types of Thermometers Ear Axilla (armpit) Forehead Oral Rectal Electronic digital Tympanic ear canal Mercury in glass difficult to read; take for 3 minutes Disposable single use chemical strip; color change; not very accurate Tympanic Digital Mercury in glass 1
2 Factors Affecting Temperature ChSCC Policy on Temperature Time of Day lowest in morning/highest in early evening Age Exercise increases after strenuous physical exertion Hot & Cold Liquids (wait min. after drinking) Smoking (Do not take right after smoking) Stress Hormones Environment Tachypnea Infection or inflammation Take temperature on patient if: Infection Illness/fever Dismiss > F >101 0 F indicates active disease >104 F, consult with physician >105.8 F treat as emergency call EMS Pulse Pulse Points Regular, recurrent expansion & contraction of an artery produced by waves of pressure caused by ejection of blood from left ventricle as it contracts, Mosby s Dictionary, 4 th Ed. Pulse rate count that can be felt over artery for 1 min. In a dental office, where do we assess the pulse? What is the procedure for taking a pulse? Radial thumb side of wrist; (most common) Temporal artery side of head Facial artery side of mandible Carotid emergencies (CPR) Brachial child/infant *Use pads of fingers when palpating pulse (not thumb) WHY?? Normal Pulse Rates Brachial artery main artery of upper arm; divides into radial & ulnar arteries at elbow Radial artery begins below elbow & extends down forearm on thumb side of wrist into hand Adults: bpm (average is 80 bpm) No absolute normal; women slightly higher; athletes may have slower pulse rates (45 60) Abnormal >90 adults; >120 children Children: rate falls during childhood Examples: in utero 150 bpm 10 th yr 70 bpm) Factors affecting pulse: age, stress, exercise, pain, & medications If pulse is regular count for 30 sec. & multiple by 2; if irregular count full minute 2
3 Pulse Pressure Respiration A. Normal pressure is smooth B. Weak pressure is diminished; feels weak & small C. Bounding pressure is increased & feels strong & bouncing Process that brings oxygen into body & removes carbon dioxide Measured by counting # of times a chest rises in 1 min. Normal adult rate: bpm <12 abnormal; >28 accelerated Rates >60 extremely fast & dangerous Child range bpm; 44 for infants When is the best time to count respirations? Variable Respirations Blood Pressure Tachypnea rapid >20 per min. hyperventilation Lowered levels of carbon dioxide Symptoms: tingling in toes & fingers, nausea Bradypnea slow respirations; decreased rate & depth Orthopnea difficulty breathing in supine position Dyspnea difficulty breathing Hyperventilation rapid deep breathing (can occur from stress or diabetic ketoacidosis) **Things that effect respirations: age, medications, stress, exercise, altitude, gender, body position, and fever What medical conditions might cause tachypnea or bradypnea? Pressure exerted against blood vessel walls as blood flows through them Blood Pressure Depends On: Energy of heart Condition of arteries Changes in elasticity of vessels (age & disease) Volume of blood Components of blood pressure: Systolic Pressure Diastolic Pressure Pulse Pressure Systolic Pressure Diastolic Peak or highest pressure caused by ventricular contraction Normal systolic pressure is <120 mmhg 1 st sound heard (tap, tap) Record as a fraction (upper number) Lowest pressure caused by effects of ventricular relaxation Normal diastolic pressure is <80 mmhg Last distinct sound heard (tap) Record as a fraction (lower number) Systolic reading Diastolic reading 3
4 Pulse Pressure Factors That Influence BP Difference between systolic & diastolic pressures Normal <40 mmhg Respiration Emotion/stress/anxiety Chronic diseases Exercise Eating Tobacco Alcohol Medications Caffeine Dehydration Age Race Diabetes Kidney Disease Obesity/weight Pregnancy High Salt Intake Gender Oral Contraceptives Severe pain Body position Blood Pressure Hypotensive abnormally low Hypertension abnormally high (>140/90) Normotensive normal BP Pre hypertensive ; should be counseled & medical consult What are the parts of BP? Mercury sphygmomanometer BP increases larger vessels lose elasticity & small vessels constrict causing heart to pump same volume of blood through vessels with smaller diameter Complications of hypertension: Stroke, heart attack, heart failure, kidney failure What is ChSCC s policy on blood pressure? How is the ASA category vary for blood pressure? Aneroid sphygmomanometer Automatic BP Equipment Positioning of Cuff If you get an abnormally high or low reading verify with manual equipment Recommended to calibrate once a year Recommended to be within 1mm of traditional method More sensitive to movement & noise *Primary error cuff not positioned at level of heart * What is it not appropriate to use an automatic/electric BP equipment? Cuff place 1 above antecubital fossa; stethoscope place 1 below fossa or on brachial pulse Arm at level of heart, slightly bent & relaxed Arm below heart too high Arm above heart too low 4
5 Correct Arm Position: Cuff Sizes Width Too narrow overestimation Too wide under diagnosing hypertension Length Too short overestimation Too long under diagnosing hypertension Four sizes of cuffs (child, regular adult, large adult, thigh) Cuff width needs to be 20% greater than diameter of arm Korotkoff Sounds Important Facts: Sounds heard as BP in cuff is released Blood flows in spurts causing vibrations in artery walls Failure to detect a gap in K sounds potential source of error in BP measurement *Women with breast cancer take BP in opposite arm mastectomy was done; if double mastectomy do not take BP *Dialysis Patients take in opposite arm *Take on a bare arm if possible *Finger monitors & wrist monitors are not accurate *Hardest part of taking BP is releasing bladder Facts: One out of three adults have high BP & 1/3 don t know it More men then women have high BP African Americans have higher BP 43% higher then whites Children & adolescents are newest at risk population Pregnant women high risk (seizures, premature deaths, still births) 5
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