Vital Signs
KATHERINE JONES, RDH, BS
4 Vital Signs
BODY TEMPERATURE
PULSE RATE
RESPIRATORY RATE
BLOOD PRESSURE
Vital Signs in a Dental Office
 Patients are likely to visit their
dentist more regularly than their
physician.
 Dental services are anxietyinducing experiences for many
patients.
 Vital signs effect patient
treatment planning for example:
reappointing ill patients,
selection of appropriate local
anesthesia.
 Baseline vital signs are important
for medical emergency
situations.
1.
Body
Temperature
 What is body temperature?
A measure of the body’s ability
to generate and get rid of heat.

When you are too hot, the blood vessels in
your skin expand (dilate) to carry the excess
heat to your skin's surface. You may begin to
sweat, and as the sweat evaporates, it helps
cool your body.

When you are too cold, your blood vessels
narrow (contract) so that blood flow to your
skin is reduced to conserve body heat. You
may start shivering, which is an involuntary,
rapid contraction of the muscles. This extra
muscle activity helps generate more heat.
Under normal conditions, this keeps your
body temperature within a narrow, safe
range.
Normal
human body
temperature
 Normal adult temperature ranges from 96 to 99.6°F
 Average normal oral temperature is 98.6°F
 “Normal” varies from person to person
 A temperature above 101°F usually indicates an
active disease process & patient should be referred
to primary care physician
 A temperature above 105.8°F constitutes a medical
emergency
Variables Affecting Body Temperature
 Time of day-lowest in morning





and may rise by 1°F in early
evening
Exercise-may rise 1°F after
strenuous exercise on a hot day
Age-if 70 years old or above,
average temperature is 96.8°F
(36°C)
Environment-hot or cold
Medication
Hot or cold liquids or food-may
rise or fall for 15 minutes
 Stress-rises with increased stress
 Hormones-varies with menstrual




cycle
Smoking-increases for up to 30
minutes
Mouth breathing- if oral
measurement is taken
Rapid breathing-decreases
temperature
Infection or inflammationincreases temperature
•In the US, there is
movement away
from mercury
thermometers and
towards digital
thermometers
•In the dental office,
body temperature
can be measured
orally (under the
tongue), tympanic
(ear), on the
forehead, or axillary
(armpit).
Body Temperature Procedure
1) Wash hands and put on gloves
2) Explain to patient that you will be measuring
body temperature
3) Barrier probe with plastic sheath
4) Place under tongue
5) Turn on thermometer, wait for beep and remove
6) Record reading
 What is pulse rate?
2.
Pulse Rate
A measurement of the rhythmic expansion of an
artery each time the heart beats.
Pulse Characteristics
 Rate- the number of beats that occur during the
counting period
 Rhythm- Describes the pattern of the beats:
skipping, speeding up, slowing down
 Volume- The force of the beat, such as a strong
or weak beat
 Arteries:
 1. Radial- Inner surface of wrist
 2. Brachial- Inner fold of arm
 3. Carotid-Alongside the larynx
Pulse Rate Procedure
1. Seat patient in an upright position.
2. Extend the patient’s arm, resting it on his or her leg or on armrest of chair.
Have arm at heart level.
3. Place the tips of your index and middle fingers on the patient’s radial
artery.
4. Feel for the patient’s pulse before you begin the count.
5. Count the pulse for 30 seconds; multiply by 2 to compute for a 1 minute
reading.
6. Record pulse along with significant characteristics or continue by
measuring respiratory rate.
3.
Respiratory
Rate
 What is respiratory rate?
A measurement of the process that brings oxygen
into the body and removes carbon dioxide.
 Measured by counting the number of times a
patient’s chest rises and falls in 1 minute
Normal Respiratory Rate
 Adult—between 14 and 20 breaths per minute
 Children use their diaphragms, which requires watching the abdomen vs.
chest
Variables in Respiratory Rate
Breathing is an unconscious
function that can be brought
under voluntary control by:
Increase respiratory rate:
 Excitement
 Exercise
 Pain




Holding breath
Panting
Singing
Sighing
 Fever
Rapid rate could also
indicate a disease state:


Emphysema
Heart disease
Respiratory
Rate
Procedure
Observe for a full
minute if rate seems
irregular
Pay attention to
depth and rhythm
Procedure:
1) Assess immediately after taking pulse while
fingers are still in place on the wrist
2) Look at your watch or clock and watch the
patient’s chest out of your peripheral vision
3) Count the number of times the chest rises and
falls over 30 seconds
4) Multiply the number by 2
5) Record BOTH pulse and respiratory rates
Evaluation of Respiration
Types of Respiration
4.
Blood
Pressure
AHA – Normal Blood
Pressure is less than
120/ less than 80
What is blood pressure?
The measurement of maximum and minimum force
of blood against artery walls during contraction
and relaxation of heart muscle.
Recording
 Two readings are recorded as a fraction:
Systolic/Diastolic

Systolic is the top number- Pressure created
against the vessel walls during contraction
 Most important in management of HBP

Diastolic is the bottom number- Pressure
created against the vessel walls when the heart
relaxes before the next contraction
 Numbers stand for millimeters of mercury
regardless of which type of gauge you have
ADA Blood Pressure Recommendations
 Dental professionals have a unique opportunity to detect high blood




pressure and inform patients of the risks of hypertension.
Blood pressure assessment should be a routine part of the initial
appointment for all new dental patients
Both adults and children
Use as a screening tool for undiagnosed high blood pressure
Continue to monitor at continuing care appointments: 3, 4, 6, and 12
months
Treatment of High
Blood Pressure
•Lose weight
•Lifestyle changes
Stress
reduction
 Exercise
•Prescribed
medications
Risks of Abnormal Blood Pressure
Screening may be the only way to diagnose

Hypotension is low blood pressure


Hypertension is high blood pressure
Hypertension has no symptoms


Reading 140/90 and above

Referred to as the “silent killer”

If uncontrolled:
 Stroke
 Heart attack
 Heart failure
 Kidney failure

If pregnant:
 Seizures and death
 Premature birth and stillbirths
Variables that Effect Blood Pressure
 Age
 Race
 Anxiety
 Exercise
 Gender
 Meals
 Body position
 Tobacco
 Respiration
 Alcohol
 Emotion
 Pain
 Temperature
 Illness
 Hormones
 Medications
Blood Pressure Equipment
SPHYGMOMANOMETER
STETHOSCOPE
AUTOMATIC CUFF
Sphygmomanometer
Sphygmomanometer
 Select the correct cuff size
• Length and width affects
•

•
•
reading
Sizes are child, adult small,
adult standard, adult large,
adult thigh
Should be 20% wider than
diameter of the arm
Too narrow causes falsely
high readings
Too wide causes falsely low
readings
Stethoscope
Place stethoscope ear
pieces in canal angled
forward
Automatic Blood Pressure Cuff
Blood Pressure Procedure
1. Wash hands
2. Explain procedure to patient
3. Seat patient with arm extended at
heart level and supported on chair
arm or table.
4. If you are taking a patients blood
pressure for the first time and you
do not have a previous BP reading
to use for reference, palpate
brachial artery to feel the patients
pulse.
5. Use indicator for positioning center
bladder of sphygmomanometer
over artery. Secure 1 inch above
palpation site. Close pressure
release valve.
6. Palpate brachial artery while
inflating cuff. When pulse
disappears, add an additional 30
points to determine inflation rate.
7. Wait 30 seconds before re-inflating
8. Palpate brachial artery pulse and
place bell of stethoscope at that
point
9. Squeeze inflator bulb to predetermined mm of mercury and
gradually deflate at 2mm per
second
10. Listen for the first “throbbing”
sounds (systolic) and cessation of
all sounds (diastolic) indicating
systolic and diastolic pressure.
5 Phases of Korotkoff Sounds
Silent Auscultatory Gap
What do you think?
SHOULD VITAL SIGNS BE
MEASURED AT EVERY DENTAL VISIT?
References
Bird, D. & Robinson, D.: Modern Dental Assisting, 10th Ed. St. Louis, 2012,
Saunders.
Williams & Wilkins:Blood Pressure, Respiratory Rate & Temperature
Presentations, 2007, Lippincott.