DT L11

Vital Signs

  • Definition: Vital signs include key physiological parameters that indicate the general health of a client in dental hygiene.

  • Key Components:

    • Temperature: Indicates metabolic status.

    • Pulse Rate: Reflects heart function and overall cardiovascular health.

    • Respiration Rate: Measures breathing efficiency and gas exchange.

    • Blood Pressure: Critical for assessing cardiovascular health.

  • Importance: Vital signs outside acceptable ranges may prompt the need to terminate dental hygiene care (Kuzik).

Pulse

  • Pulse Measurement Locations:

    • Radial Artery: Commonly used for adult patients.

    • Brachial Artery: Often used in infants and in emergency scenarios.

  • Quality Statements to note:

    • Is the pulse normal, bradycardic (slow), or tachycardic (fast)?

  • Lifestage Pulse Rates (Beats per Minute):

    • Infant: 120-160

    • Toddler: 90-140

    • Preschooler: 80-110

    • School Age: 75-100

    • Adolescent: 60-90

    • Adult: 60-100 (Adapted from Darby & Walsh)

Respiratory Rate

  • Definition: The process of inhaling oxygen and exhaling carbon dioxide.

  • Normal Breathing: Approximately 500 mL of air with each breath.

  • Assessment Method:

    • Count the number of chest rises and falls in 1 minute.

  • Variations in Respiratory Rate:

    • Diaphragm use in children: watch abdomen rather than chest.

    • Increased rates due to excitement, exercise, pain, fever, and disease states (e.g., emphysema, heart disease).

    • Breathing can switch between unconscious and conscious control (e.g., holding breath, panting).

Procedures for Assessing Respirations

  • Procedure Steps:

    • Assess immediately after pulse checking while fingers remain on the wrist.

    • Use peripheral vision to observe the client’s chest for rises and falls.

    • Count for 30 seconds and multiply by 2 for the full minute rate.

Blood Pressure Assessment

  • Routine: Blood pressure should be assessed at the initial appointment for all new dental clients (Kuzik).

  • Monitoring: Continue to monitor periodically (every 3, 4, 6, and 12 months).

Blood Pressure Basics

  • Blood Flow: Every heartbeat pushes approximately six quarts of blood against vessel walls.

  • Systolic vs. Diastolic Pressure:

    • Systolic Pressure: Pressure from heart contractions.

    • Diastolic Pressure: Pressure when the heart is relaxed between beats.

  • Categories:

    • Hypertension: Abnormally high pressure (above 140/90).

    • Hypotension: Abnormally low pressure.

Treatment for High Blood Pressure

  • Lifestyle Changes:

    • Weight loss,

    • Exercise,

    • Stress reduction,

    • Diet modifications.

  • Medication: Prescription medications may be needed. Note: 50% of patients may stop taking medications within a year.

Complications of Uncontrolled Hypertension

  • Potential Risks:

    • Stroke,

    • Heart attack,

    • Heart failure,

    • Kidney failure,

    • Risks during pregnancy (seizures, premature birth).

Blood Pressure Measurement Equipment

  • Essential Tools:

    • Sphygmomanometer: Measures blood pressure.

      • Types: Aneroid, Mercury column.

    • Stethoscope: Used for auscultation.

    • Electronic/Digital Devices: Make measurements easier.

Procedure for Accurate Blood Pressure Measurement

  • Pre-measurement: Ensure client relaxes in a quiet area.

  • Cuff Placement:

    • Proper size must be selected according to arm size.

    • Place cuff with lower edge 1 inch above the antecubital fossa.

  • Measurement Technique:

    • Estimate systolic pressure by palpating brachial pulse.

    • Inflate the cuff beyond the estimated systolic pressure and auscultate.

Understanding Korotkoff Sounds

  • Definition: Sounds made by turbulent blood flow as pressure in the cuff is released.

  • Phases: There are five phases of Korotkoff sounds:

    1. Silence: No sound (no blood flow).

    2. Tapping: First sound (systolic).

    3. Swishing: Soft sounds

    4. Crisp: Clear, distinct sounds.

    5. Blowing to Silence: Final sounds leading to diastolic reading.

  • Recording Readings: Record the readings as a fraction with systolic above and diastolic below, both measured in mmHg.

Influences on Blood Pressure Readings

  • Factors that can affect blood pressure include:

    • Age,

    • Race,

    • Body position,

    • Respiration rate,

    • Emotions,

    • Temperature,

    • Anxiety,

    • Recent exercise,

    • Tobacco and alcohol use,

    • Pain level.