Blood pressure flashcards

Vital Signs

  • Vital signs are used to obtain a minimum level of wellness of a patient's health status.
  • It's a basic clinical assessment of a patient's health.

Measuring Vital Signs

  • Temperature
  • Pulse
  • Respiration
  • Blood Pressure

Importance of Taking Vital Signs

  • Establish a baseline of health.
  • Unstable vital signs may affect treatment.
  • Important prior to local anesthetic.
  • Throughout an emergency situation, being able to take and record vitals signs is crucial.

PULSE

Pulse

  • The pulse rate is an indication of an individual's heart rate, indicating the speed and force of the heartbeat.
  • Normal Heart Rate ranges:
    • Infants: 100-160 bpm
    • Child: 70-120 bpm
    • Adult: 60-100 bpm
  • Rapid or slow pulse rates are not necessarily abnormal; refer to Vital Signs Guidelines

Pulse Points

  • Pulse points are the sites on the surface of the body where rhythmic beats of an artery can be easily felt.

Arteries Used to Take Pulse in a Dental Environment

  • Carotid Artery
  • Brachial Artery
  • Radial Artery
Carotid Artery (Pulse Point)
  • Located alongside the larynx.
Brachial Artery (Pulse Point)
  • The brachial artery is located in the antecubital area, on the inner fold of the arm.
Radial Artery
  • The radial artery is a branch of the brachial artery, beginning below the elbow and extending on the thumb side of the wrist into the hand.
  • Most common place to take pulse in a dental office for adults.

Pulse Observations/Characteristics

  • Rhythm: pattern of beats (note skipping, speeding up, or slowing down of a beat)
  • Volume: force of the beat (strong or weak)
  • Rate: number of beats per minute
    • Rapid pulse = Tachycardia
    • Slow pulse = Bradycardia

Patient Positioning for Taking Pulse

  • Position yourself so you are facing the patient.
  • Position patient’s arm in a palm up position and support on stable surface.
  • Position arm below or at level of heart.
  • Locate-Count for 30 seconds- multiply by 2.

RESPIRATION

Respiration

  • Process by which oxygen and carbon dioxide are exchanged.
  • Normal breathing is involuntary.
  • Respiration rate is the number of times a patient breathes in 1 minute.

Respiration Characteristics

  • Observe:
    • Rate – total number of breaths/minute
    • Rhythm – breathing pattern (irregular)
    • Depth – amount of air inhaled and exhaled (shallow, labored)
  • What affects Respiration: Age, medications, stress, exercise, altitude, gender, and body position.
  • Dyspnea = labored breathing

Respiration Measurement

  • The respiratory rate or RR in adults is measured by counting the number of times the chest rises in 1 minute.
  • Children use their diaphragm when breathing, requiring observation of the abdomen rise and fall.
  • Normal breathing is easy, quiet and regular.

Respiration Rates

  • Normal respirations:
    • Adult: 12 to 20
    • Child: 14-26
    • Infant: 30-60

Obtaining a RR on a Patient

  • Should be measured immediately after taking your patient’s pulse.
  • After determining the pulse rate, keep your fingers resting on the patient’s wrist and begin to assess respiration.
  • Observe respirations inconspicuously.
  • Count for 30 seconds and multiply by 2.

Obtaining and Recording Pulse (BPM) and Respiration (RR) Summary

  • Seat the patient in the patient chair
  • Upper arm should be at heart level
  • Locate radial pulse point.
  • Count beats for 30 seconds.
  • Multiply times 2 to achieve beats per minute/BPM.
  • Go directly to obtaining respiration rate

BLOOD PRESSURE

  • The pressure exerted by blood against blood vessel walls.
  • Blood pressure is recorded in millimeters of mercury (mmHg)

Characteristics of Blood Pressure

  • Systolic Pressure:
    • Upper Number or higher pressure
    • Heart contraction
    • The first sound you will hear
  • Diastolic Pressure:
    • Lower Number or lower pressure
    • Heart Muscle Relaxation.
    • The last sound you will hear

Blood Pressure Equipment

  • Stethoscope
  • Sphygmomanometer
Equipment: Stethoscope
  • A device that makes sound louder and transfers it to the clinician’s ears
  • Components:
    • Earpieces - placed in the ears
    • Brace & binaurals - connect earpieces to tubing
    • Amplifying device - makes sound louder
Sphygmomanometer
  • Consists of the blood pressure cuff and the manometer, also called the gauge.
Sphygmomanometer Inflation System
  • Cuff wraps around the arm (arrow over Brachial artery)
    • Either arm unless otherwise indicated
  • Bladder
    • positioned inside the cuff like an air pillow
  • Bulb
    • Inflates the bladder with air
  • Pressure Valve
    • Releases air out of the bladder

Two Types of Manometer/Gauges

  • Aneroid
    • A round dial-type gauge to indicate pressure
  • Mercury
    • Has a column of mercury that indicates pressure
    • Most accurate type of device

Automatic Blood Pressure Equipment

  • Ranges from highly calibrated types used in hospital settings to less advanced types for home use
  • Pro: easy to use
  • Con: expensive

Korotkoff Sounds

  • The inflated cuff stops the blood flow from the lower arm.
  • Korotkoff sounds are what we listen for when taking Blood pressure.

The 5 Phases of Korotkoff Sounds

  • The first sound, clear tapping (SYSTOLIC)
  • Softer swishing sounds (Ascultatory Gap / in some patients sounds may disappear for a short time)
  • Loud crisp tapping sound
  • Thumping and muting
  • Silence (DIASTOLIC)

Why Take Blood Pressure?

  • High blood pressure affects 60 million Americans.
  • Reminder to patients of the importance of regularly taking blood pressure
  • A person may not know they have high blood pressure.
  • A way to help the patient monitor HBP
  • Another name for high blood pressure: HYPERTENSION

Hypertension (High Blood Pressure)

  • Common disease-known as the “silent killer”
  • Contributing factors:
    • Age and Gender
    • Emotions/Stress
    • Heredity
    • Obesity
    • Ethnic Origin
    • Use of drugs/alcohol, including tobacco
    • Physical inactivity
    • Diet, high salt intake

Five Major Dangers of Uncontrolled Hypertension

  • Stroke: Break or blockage in a blood vessel in brain
  • Heart Failure: Heart may fail to pump blood or will pump unevenly
  • Heart Attack (Myocardial Infarction, MI): Break or blockage in a blood vessel in the heart.
  • Kidney Failure: Pressure in the blood vessels can damage the kidney.
  • Retinopathy: Damage to the arteries in the retina of the eye.

Procedure 1: Proper Preparation

  • Explains procedure to client
  • Client is sitting with legs uncrossed.
  • Have patient roll up sleeve.
  • Arm is supported on a firm flat surface, upper arm is at chest level.
  • No talking, the quieter the better.

Procedure 2: Identify the Brachial pulse

  • Locates the brachial pulse near the inner part of the arm at the antecubital space.
  • If you cannot locate the brachial pulse, place cuff arrow based upon anatomy)

Procedure 3: Cuff Application

  • Applies cuff evenly and snugly around arm
  • Centers Bladder arrow over brachial artery.
  • Cuff edge placed one inch above antecubital space.
  • Adjust the position of the gauge so it is easily visible.

Procedure 4: "STEP TWO”

  • Identifies brachial artery by the “arrow” on the cuff.
  • Places entire stethoscope circumference in the contact with skin
  • Inflates gauge to 180 mm Hg
  • Releases valve with smooth fluid like motion. Avoid dropping dial more than 5mm Hg
  • Deflates bladder at a slow steady rate (2-4mm Hg /second)
  • Correctly identifies Systolic reading
  • Correctly identifies Diastolic reading
  • Accurately records blood pressure reading.

Recording Blood Pressure Readings

  • Two readings are recorded as a fraction:
    • Systolic is the top number
    • Diastolic is the bottom number
  • Numbers stand for millimeters of mercury regardless of which type of gauge you have
  • Record what arm the pressure was taken on.