Vital Signs

Bowen DM, Pieran JA. Darby & Walsh Dental Hygiene Theory and Practice — Chapter 14 (2114 #5)

Vital Signs

Low Risk
< 120 mm Hg / < 80 mm Hg

Moderate Risk
120 - 139 mm Hg / 80 - 89 mm Hg
Check BP at SPT or note change in MHx
Advise of BP reading & seek MD consult.

Elevated Risk
140 - 159 mm Hg / 90 - 99 mm Hg
Check BP at every appt
Advise of BP readings (verbal & written) & seek MD consult.
Blood Pressure (BP)
Medical Referral to MD
160 - 179 mm Hg / 100 - 110 mm Hg
Re-check BP in 5 minutes
Consult MD before DH care
Non-invasive DH care only
NO INVASIVE DH CARE UNTIL BP IS CONTROLLED

Hypertensive Crisis
> 180 mm Hg / > 120 mm Hg
Re-check BP in 5 minutes
Refer for immediate medical consult.
NO DH CARE UNTIL BP IS CONTROLLED

Adult — 60 - 100 BPM

Child — 80 - 120 BPM
Athlete — 45 - 60 BPM

Pulse Points — Radial, carotid, & brachial

Pulse Feel with two fingers; NOT thumb
[ 30 seconds ] x 2
If irregular beat, check for 60 seconds

Bradycardia — < 60 BPM

Tachycardia — > 100 BPM

Adult — 12 - 20 RPM
Child — 20 - 30 RPM

1 RPM = 1 inspiration + 1 expiration

Respiration Listen for breath sounds — note if unusual
[ 30 seconds ] x 2
 Adult — 36 - 38 degrees C
(96.8 - 100 degrees F)

Temperature Sites — Oral, ear / tympanic, rectal, axilla & forehead

If over 39 degrees C, refer to MD
Body Temperature
( > 102.2 degrees F)

Fever / Pyrexia — > 38 degrees C

Hypothermia — < 35.5 degrees C

Potential DH consid. if underweight / obese

Risk during dental Tx
Poss. LA compli.
Weight & Height
Inc. sensit. to drugs

Note any unexplained weight loss / gain

 Learning Outcomes

Vital Signs — Indic. of pt.’s cardiovas. & overall health

Outside Acceptable Range — may indic. health prob. / undiag. cond.
Postpone dent. tx or ref. to MD
Includes:
Blood Pressure (BP)
Pulse
Respiration
Body Temperature
Explain the significance
Height
of obtaining vital signs
Weight

Significance of Vital Signs

Part of comprehensive assessment
Baseline data
ID. devi. from normal med. cond.
Referral for med. eval.
Client education

Blood Pressure — Measures force exerted by blood on b. vessel walls

Systolic Pressure — Peak / highest pressure; ventricle contraction

Diastolic Pressure —Lowest pressure; ventricle relaxation
Cuff on upper arm & bottom of cuff abt. 1 inch from cubital fossa
Tubes from cuff bottom

Pulse — Intermittent heart beat felt through walls of artery

Pulse Points — Radial, carotid & brachial

Two fingers on pulse point to feel pulse; NOT thumb

Respiration — Counting the rise & fall of pt. chest (inspiration & expiration)

Explain the correct
techniques required to
obtain accurate blood Body Temperature — Regul. by hypothalamus
pressure, pulse,
respiration, and
temperature readings
Assessed b/f or after pulse rate — don’t let pt. know otherwise hard to ck
Temp. Sites — Oral, ear / tympanic, rectal, axilla & forehead
Oral — Caution if hot / cold foods & drinks taken within 20-30 mins
Ear / tympanic — Accessible & comfortable
Rectal — Most reliable
Axilla — Safest; not invasive
Forehead — Safe, comfortable & not invasive
 Factors that FX Blood Pressure
Describe factors found
in clients' general and
oral health history
which may relate to
variances in blood
pressure, pulse rate,
respiration, oral
temperature, height and
weight readings
Age
INC. — Inc. w. age
Race
INC. — Higher in African, Hispanic & Native Americans
Weight
INC. — If overweight / obese
Gender
INC. — Post-menopausal women vs. men
INC. — Preeclampsia; abnormal hypertens. during preg.
DEC. — Post-puberty women vs. men
Emotions & Stress
INC. — Sympathetic stim.; inc. cardiac output & vasoconstriction
Severe Pain
DEC. — If severe, can cause shock
Oral Contraceptives
INC. — Small, but noticeable inc.
Exercise
INC. — Inc. for first 30 minutes & then dec.
Eating
DEC. — 5-10 mm Hg dec. for seniors abt. 1 hour after eating
Medications
INC. / DEC. — Rev. each meds. at appt to deter. FX on BP
Diurnal Variation
INC. — In late afternoon & early evening
DEC. — Lowest in morning
Chronic Disease
INC. — Dis. that FX cardiac output, b. vol., b. viscos., arterial elas.
Tobacco, Alcohol & Caffeine
INC. — Tobacco, alcohol & caffeine
High Fat & Saturated Fat Intake
INC. — High b. choles., high low-density lipoprotein (LDL) choles., & high
triglycerides cause atherosclerosis
Dehydration
INC. — W. sudden posture change; cause orthostatic / postural hypoten.
White-coat Hypertension
INC. — 15-20% of pt. may inc. BP if sees HCP / MD
Body Position
DEC. — Lying down
Orthostatic Hypotension — Sudden drop in BP when standing after lying
Factors that FX Pulse

Exercise
INC. — Short-term exercise
DEC. — Athlete w. long-term exercise
Temperature
INC. — Fever & heat
DEC. — Hypothermia
Emotions & Stress
INC. — Acute pain & anxiety; sympathetic stim.
DEC. — Relaxation & unrelieved severe pain; parasympathetic stim.
Medications
INC. — Positive chronotropic drugs (ex. epinephrine)
DEC. — Negative chronotropic drugs (ex. beta blockers, Ca+ blockers)
Hemorrhage
INC. — Loss of blood; sympathetic stim.
Postural Changes
INC. — Standing / sitting
DEC. — Lying down
Pulmonary Conditions
INC. — Dis. w. poor oxygenation (ex. asthma, COPD)
Premature Ventricular Contractions (PVC) — Break in rhythm of beats
Common & caused by smoking, fatigue, meds., stress, caff., & alcohol
Pulsus Alternans — Alternating strong & weak heartbeats; poss. ventr. fail.

Sympathetic Nervous System (SNS) — Signals body to alert

Parasympathetic Nervous System (PNS) — Signals body to relax

Factors that FX Respiration

Age
DEC. — Dec. w. age
Tachypnea — Rapid breathing > 20 RPM; indic. lung restric. / inflam.
Diabetic Ketoacidosis — Deep, laboured breathing
Obstructed Breathing — Poss. asthma, chron. bronchitis, congestive heart
dis., & COPD
INC. — Poss. physical exercise, anxiety, & metabolic acidosis

Respiratory Acidosis — Excess CO2 (acid) in body

Factors that FX Body Temperature

Recent Oral Ingestion

INC. — Recent ingestion of hot foods / drinks
DEC. — Recent ingestion of cold foods / drinks
Fever / Pyrexia
INC. — Body fighting infxn; poss. dental infxn

Factors that FX Unintentional Weight Changes

Mental Health Conditions — DEC. w. depression, anxiety, eating disorders &

obsessive compulsive disorder (OCD)
Digestion Problems — DEC. w. celiac disease & irritable bowel syndrome
Other Health Conditions — DEC. w. hyperthyroidism, type II diabetes, &
heart failure

Explain the significance
of vital sign readings
that fall out of the
"normal range" and
explain their
significance to dental
hygiene care
Guidelines for Vital Signs
Explain medical,
physical, and oral
conditions which may
modify, precaution, or
contraindicate obtaining
vital signs
Explain significant
information to be
presented to the client,
guardian, care-givers
and interdisciplinary
team members and
when a referral would be
required
Outside “normal range” may indic. health problems / undiag. cond.
Poss. need MD referral
Poss. need to postpone DH care
VS may be influ. by illness, age, gender, meds., temp., altitude, body
position, phys. exert., diet, stress, improper & unreliable equip.
Analyze readings to make decisions
If abnormal, ask abt. poss. causes & re-ck VS
Advise pt. of readings; rec. MD consult if needed
Use properly functioning equip. for size & age of pt.
Be familiar with pt. baseline measur., health status, & pharma. hx
Min. environ. factors that may FX VS
Use systematic approach for each procedure
Approach in calm, caring manner while demo. competence in measuring VS
Use critical thinking to deter if need MD consult
Advise pt. of abnormal readings & re-ck after 5 minutes if needed
Provide verbal & written record of reading for pt.
Rec. to seek MD consult
May defer DH care & tx
Document all findings, communication & referrals