M13- Health History & Vitals PT 2

Radiation therapy (chemotherapy and cancer) considerations

physician consultation, possible immune-suppression

Blood disorders/delayed clotting

- Hemophilia:

> A-lack factor VIII

> B-lack factor IX

> C-lack factor XI

- Anti-clotting medications

- Von Willebrand disease

Infective endocarditis (IE)

bacteria enters the bloodstream, travel to the heart, & lodge on abnormal heart valves or damaged heart tissue

- Abnormal growths may form in the heart at the site of the infection

Conditions which antibiotic prophylaxis is suggested

- Prosthetic cardiac valve or material

- Previous, relapse, or recurrent IE

- CHD

- Cardiac transplant recipients who develop cardiac valvulopathy

Primary antibiotic for antibiotic prophy (AP)

single dose 30-60 mins before procedure

- Amoxicillin (2 g/ 4 tablets 50 mg)

If allergic to penicillin

- cephalexin (2 g)

- azithromycin (500 mg)

- clarithromycin (500 mg)

- doxycycline (100 mg)

AP is suggested

for all dental procedures involving gingival tissue manipulation

AP is not suggested

when taking dental radiographs

Vital signs

- Body temp

- Pulse rate

- Resp rate

- Blood pressure

- Height

- Weight

Average body temperature

98.6 F (37 C)

Normal body temperature range

96.0°F - 99.5° F

(35.5°C - 37.5°C)

Fever (pyrexia)

greater than 99.5°F

Hyperthermia

especially high fever; greater than 104°F

Hypothermia

less than 96.0°F

Pulse

result of the alternate expansion and contraction of an artery as a wave of blood is forced through the body

Pulse rate

number of heartbeats per min

Normal adult pulse rate

60-100 bpm

Normal child pulse rate

90-120 bpm

Bradycardia

less than 50 bpm

Tachycardia

more than 100 bpm

Pulse rate can increase due to

- exercise

- stimulants

- strong emotions

- extreme temperature change

Pulse rate can decrease due to

- sleep

- depressants

- fasting

- relaxation

- illness

Radial artery

where pulse is commonly felt, index and middle finger is used

When finding the radial pulse

- have patient in a comfortable position with the arm supported

- locate radial pulse on thumb side

- do NOT use thumb

Adult respiration

12-20 respirations per min

Child respiration

20-25 respirations per min

Factors to observe during respiration

- Depth: shallow/deep

- Rhythm: regular/irregular

- Quality: strong/weak/labored

- Sounds: gasping/wheezing

Increased respiration

- work

- exercise

- excitement

- nervousness

- strong emotions

- pain

- hemorrhage

- shock

Decreased respiration

- sleep

- drugs

- pulmonary insufficiency

Blood pressure

force exerted by the blood on the blood vessel walls

Blood pressure depends on

• Force of the heartbeat

• Condition of the arteries

• Volume of blood in the system

Increased blood pressure

- exercise

- stimulants

- emotional distress

- medications

Decreased blood pressure

- fasting

- rest

- depressants

- relaxation

Systolic pressure

peak or highest pressure, caused by ventricular contraction (first korotkof sound)

Diastolic pressure

lowest pressure, caused by ventricular relaxation (last korotkof sound)

Pulse pressure

difference between the systolic and diastolic pressures

Normal blood pressure

less than 120/80

Elevated blood pressure

120-129/less than 80

High blood pressure (hypertension stage I)

130-139 or 80-89

High blood pressure (hypertension stage II)

140 or higher or 90 or higher

Hypertensive crisis

>180 and/or >120

Blood pressure cuff placement

lower edge of the cuff is placed approximately 1 inch above the antecubital fossa

Stethoscope placement

placed over the palpated brachial artery pulse point

Maximum inflation level

- Palpate radial artery

- Inflate the BP cuff until the radial artery is no longer detected during palpation (pulse obliteration)

- Note pressure on the gauge & inflate the pressure 20-30 mmHg above where radial pulse was no longer felt

Obtaining blood pressure

- Release the pressure at a rate of 2-3 mmHg

- Listen for the first korotkof sound (systolic pressure)

- Continue releasing the pressure & note diastolic pressure

If the BP reading isn't obtained

wait 1 minute and repeat procedure

Primary hypertension

• 90 %

• Etiology is unknown (idiopathic)

• Predisposing risk factors

- Heredity, overweight, race, sex, age, environment, smoking, race

Secondary hypertension

• 10%

• Major underlying disease, I.e.; kidney disease

Hypertension clinical symptoms

- Headache

- Dizziness

- Shortness of breath

- Fainting

Hypertension long-term effect (sequelae)

- Hypertensive heart disease (heart attack)

- Cerebral vascular accident (stroke)

- Hypertensive renal disease (kidney failure)

- Ischemic heart disease (angina or heart attack)

Hypertension treatment

Lifestyle changes:

- Diet

- Exercise

- Smoking cessation

Antihypertensive drug therapy

Postural/orthostatic hypotension

condition in which fainting, nausea, or feeling of faintness or dizziness occur when a person sits up quickly from a supine position