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.