Chapter 12: Vital Signs

Four Important Vital Signs

Temperature

Pulse

Respirations

Blood Pressure

Why is Temperature Important?

oral infection might be present

patient may report illness or it might be suspected

Normal Temperatures for Adults and Children

Adults → 97 to 99 degrees

Children → 1: 99.1, 4: 99.4, 5: 98.6, 12: 98

Variations in temperature

fever (pyrexia): >99.5

hyperthermia: > 104 considered a medical emergency; postpone elective care

hypothermia: < 96

Different Types of Thermometers

Oral → electric thermometer placed under the tongue

Temporal Artery → temporal artery thermometer (contact or non-contact)

Ear → tympanic thermometer placed in the ear canal

Hospital Applications → arm pit or rectal

Pulse

expansion and contraction of arteries while blood is moved through them

Normal Pulse for Adults and Children

Adults → no absolute normal but ranges from 60-100 bpm (higher for women)

Children → higher than adults but varies

Pulse Sites

Radial → wrist on thumb side

Carotid → neck

Brachial → used for infant and blood pressure

Pulse Procedure

arm and hand supported, palm down

locate radial pulse with tips of 3 fingers

count for 30 sec and multipy by 2 or count for one minute

observe rhythm and strength

record data

Respirations

supply oxygen to tissues and eliminate carbon dioxide

one breath in and out

Normal Respiration in Adults and Children

Child → decreases during childhood

Adults → 12-20 per minute, higher for woman

Respiratory Procedure

remain over radial pulse

do not tell patient you are counting respirations

count # of breaths in for 30 seconds and multiply times 2

Factors to Observe While Checking Respiration

Depth (shallow/normal/deep)

Rhythm (regular/irregular)

Sounds (wheezing)

Quality (strong/weak)

Positioning (patient seated upright)

Components of Blood Pressure

systole phase → when the left ventricle contracts

diastole phase → when the left ventricle relaxes

pulse pressure → difference between the systole phase and the diastole phase

Blood Pressure Depends on:

force of heartbeat

peripheral resistance (open arteries or closed arteries)

volume of blood

Factors that might raise blood pressure

not exercising

eating a heavy meal

stimulants (energy drinks)

use of oral contraceptives (Birth Control)

factors that lower blood pressure

fasting

resting

depressants

fainting

blood loss

Equipment for Determining Blood Pressure

sphygmomanometer → Analog (aneroid) or Digital

• Analog is manual and is the most accurate

Stethescope → used to listen to the heart beats

Procedure for Determining Blood Pressure

1. apply cuff

2. position stethoscope (ear pieces forward into the ear canal)

3. place endpiece over brachial artery

4. inflate cuff to at least 160 mm hg (maybe higher if pts last bp was higher)

5. deflate cuff gradually \

6. listen for Korotkoff sound (1st beat = systolic #, last beat = diastolic #)

7. record

Hypertension (silent killer)

high blood pressure

could be white coat related

more than one reading is advised

hypotension or postural hypotension

systolic # → <90

diastolic # - <60

observe for dizziness or fainting

Elevated Blood Pressure

systolic → 120-129

diastolic → <80

retake after 5 minutes

recommend visit with PCP and lifestyle changes

Stage 1 Hypertension

systolic → 130 to 139

diastolic → > or equal to 80-89

retake after 5 minutes

refer to PCP and employ stress reduction

Stage 2 Hypertension

systolic → greater than or equal to 140

diastolic → greater than or equal to 90

retake after 5 minutes

refer to PCP for urgent assessment

delay dental treatment until controlled

Hypertensive Crisis

systolic → over 180

diastolic → greater than 120

discontinue care

refer for immediate care / call 911 (heart attack possible)

Lifestyle Modifications to Help Hypertension

weight loss

diet

reduce sodium intake

physical activity

reduce alcohol consumption