True
A pulse can be felt in various locations in the body where an artery lies close to the skin surface and can be compressed over a hard structure, such as bone or muscle tissue
True
True or False
A person’s pulse indicates the speed and force of his or her heartbeat and the expansion and contraction of an artery as blood is forced out of the heart muscle.
True
Where are the most common areas to take a pulse?
Radial (wrist)
Brachial (arm)
Carotid (neck)
In an emergency situation, where is another site to take a pulse?
Femoral pulse (groin area)
Where is the most common place to take a pulse in a dental practice?
Radial
How do you determine the rate of the radial pulse?
Have the patient rest for 10 seconds
Place the tips of the index and middle fingers along the groove at the base of the thumb on the patient’s wrist
Press against the radial artery with your index and middle fingers to block the pulse
Gradually release the pressure until pulsation are felt (do NOT use your thumb)
Count the number of times a beat is felt for 30 seconds and then multiply by 2 in order to determine the number of heartbeats per minute.
What are the normal pulse rate in well-conditioned athletes?
40-60 beats per minute
What is the normal pulse rate for babies to age 1?
80-120 beats per minute
What is the normal pulse rate for children ages 1 to 10
70-130 beats per minute
What is the normal pulse rate for children age 10+ and adults?
60-100 beats per minute
What is a rapid pulse rate of more than 100 BPM called?
Tachycardia
A person’s heart rate normally increases in response to?
Fever Exercise Nervous excitement Medications Stimulant type drugs
True or False
Tachycardia can also be a result of dizzy states such as heart failure, hemorrhage, or shock.
True
True or False
Tachycardia attempts to increase the amount of oxygen delivered to the cells throughout the body by increasing the amount of blood circulated through the blood vessels.
True
What occurs when the heart rate is less than 60 beats/minute?
Bradycardia
What drug is administered when bradycardia occurs?
Atropine (increases person’s heart rate)
An irregular pulse could be a sign of?
Arrhythmia
What is stroke volume?
Volume of blood pushing against the blood vessel walls with each heart contraction.
True or False
A strong pulse is an indication of increased stroke volume, which can be particularly dangerous if the patient has hypertension, which would increase her/his risk of cerebrovascular accident or stroke.
True
True or False
A weak pulse (thready pulse) indicates a decrease in the heart’s stroke volume.
True
What is respiration?
Process by which oxygen and carbon dioxide are exchanged within the body
What is external respiration?
Oxygen is taken into the body and carbon dioxide is eliminated via the lungs.
What is internal respiration?
Involves the use of oxygen, the production of carbon dioxide, and their exchange between cells and blood.
What is bradypnea?
Abnormally slow respiratory rate, less than 12 breaths/minute in an adult
What is tachypnea?
Abnormally fast respiratory rate above 20 breaths/minute
What is apnea?
Absence of respirations and is often described by the length of time in which no respirations occur
What happens if oxygen deprivation lasts 10 minutes or longer?
Brain damage and/or coma
What is the normal respiratory rate in newborns?
40-50 respirations/minute
What is the normal respiratory rate in infants?
20-40 respirations/minute
What is the normal respiratory rate in preschool children?
20-30 respirations/minute
What is the normal respiratory rate in older children?
15-25 respirations/minute
What is the normal respiratory rate in adults?
12-20 respirations/minute
What are some abnormal respiratory patterns?
Biot’s respirations
Cheyne-Stokes respirations
Kussmaul respirations
What are Biot’s respirations?
Cyclic breathing patterns characterized by periods of shallow breathing alternating with periods of apnea.
Seen in individuals with neurological problems, head trauma, brain abscesses, heat stroke
What are Cheyne-Stoke’s respirations?
Cyclic breathing patterns characterized by periods of respirations of increased rate and depth alternating with periods of apnea.
Seen in individuals suffering from heart failure and drug overdose
What are Kussmaul respirations?
Increased depth and rate of respirations of over 20 breaths/minute.
Seen in individuals with hyperventilation, metabolic acidosis, diabetic ketoacidosis, renal failure.
True or False
Respirations should be quiet, automatic, and effortless.
True
What is stridor?
Harsh sound made during inspiration that sounds like crowing, often associated with airway obstruction
What is wheezing?
High-pitched sound that is usually heard on expiration but may be heard on inspiration as well.
True or False
Stress can cause an increase in the strength and depth of respirations.
True
True or False
Some medications such as narcotics, will decrease respiratory rates, whereas sympathomimetic drugs that mimic the effects of organ stimulation, such as albuterol, will dilate the bronchioles leading to an increase in the patient’s ability to breathe
True
What is pyrexia?
Fever
Abnormal elevation in body temperature
What can cause a fever?
Infection Neurological disease Malignancy Heart failure Severe trauma Drugs Convulsions (may occur in children with extremely high fevers, and delirium is seen in children and adults with high fevers)
What is hypothermia?
State in which an individual’s body temperature is reduced below his or her normal range, but not below 96 dg F
What are the characteristics of hypothermia?
Mild shivering
Cool skin
Pallor
Illness, trauma, malnutrition, and medications may all cause hypothermia
What is the definition of blood pressure?
Force exerted by the blood against the blood vessel walls
Read in millimeters of mercury (mmHg)
Systolic/Diastolic (120/80)
What is systolic blood pressure?
Force of blood against the blood vessel walls during ventricular contraction (100-120 mmHg)
What is diastolic blood pressure?
Force of blood against the blood vessel walls during ventricular relaxation (60-80 mmHg)
What is pulse pressure?
The difference between systolic and diastolic
ex: 100 mmHg - 70 mmHg = 30 mmHg
True or False
The higher the diastolic reading the greater the risk for myocardial infarctions, CVAs, and kidney failure.
True
True or False
If left untreated, high systolic blood pressure can lead to a CVA, MI, heart failure, kidney damage, blindness, and other conditions
True
True or False
Blood pressure in children varies based on gender, age, and height.
True
What is normal blood pressure in children?
89th percentile or lower
ex: 89% of children of that gender, age, and height would have blood pressure below this level.
What is prehypertension in children?
Indication of child’s average systolic or diastolic blood pressure is between 90th and 94th percentile.
Ages 12-18 blood pressure exceeds 120/80 mmHg
True or False
Stage 1 hypertension in children indicates high blood pressure in which the average systolic and diastolic pressure ranges from the 95th percentile up to 5 mmHg above the blood pressure measurement at the 99th percentile.
True
What is normal body temperature?
98.6 dg F
What is Stage 2 hypertension in children?
Child’s average systolic or diastolic pressure is 5 mmHg or more above the 99th percentile for his or her gender, age, and height.
What are some factors that affect blood pressure?
Blood volume
Cardiac output
Blood viscosity
Blood vessel resistance
What is the relationship between blood volume and blood pressure?
Increase in blood volume causes increase in blood pressure and vice versa
What is the relationship between stroke volume and blood pressure?
Increase in cardiac output causes increase in blood pressure and vice versa
What is the relationship between blood viscosity and blood pressure?
Increase in blood viscosity causes increase in blood pressure and vice versa
What is the relationship between blood vessel resistance and blood pressure?
Patients suffering from thickening and calcification of lumen of blood vessel tend to have higher blood pressure
What is hypertension?
Common disorder characterized by elevated blood pressure exceeding 140/90 mmHg
What is Stage 1 hypertension in adults?
Systolic blood pressure of 140-159 mmHg or diastolic blood pressure of 90-99 mmHg
Advised to make lifestyle changes such as weight reduction, sodium reduction, appropriate physical activity, moderation of alcohol consumption
What is Stage 2 hypertension in adults?
Systolic blood pressure of 160 mmHg or higher or diastolic above 100 mmHg
True or False
Hypertension underlies most cardiovascular diseases.
True
What are the two major categories of severe hypertension?
Hypertensive urgency
Hypertensive emergency
In each case the patient presents with extremely high blood pressure reading.
What is the difference between hypertensive urgency and hypertensive emergency?
hypertensive emergency, the patient would experience some form of target end organ damage (aka malignant hypertension) - many of the patients did not recover
types of end organ damage: aortic dissection, cerebral infarction, hemorrhage, MI, renal insufficiency
Hypertensive urgency will not have any form of target end organ damage: usually newly diagnosed with hypertension
What are some signs and symptoms or hypertensive urgency?
Headache (moderate to severe) Anxiety Shortness of breath Tinnitus Edema Epistaxis with a sudden changes in blood pressure greater than 180/110 mmHg
What are some signs and symptoms of hypertensive emergency?
Sudden increase in blood pressure greater than 180/110 mmHg, but often as high as 220/140 mmHg Shortness of breath Chest pain Nocturia Dysarthria (difficulty speaking) Weakness Altered consciousness Seizures Heart failure Nausea Vomiting Coma
True or False
Treatment for hypertensive urgency in the dental office wold begin by retaking the blood pressure to ensure that the first reading was accurate.
True
True or False
A patient presenting a systolic blood pressure of 160 mmHg or diastolic pressure of 90-99 mmHg should not have dental procedures performed.
True
True or False
Patients with a systolic rating of greater than 160 mmHg have a 30% greater risk of a CVA
True
In a patient exhibiting hypotension, what would the treatment be?
Position the patient in a supine position with feet raised Assess the airway Administer supplemental oxygen Monitor vital signs If patient does not improve, contact EMS
What is orthostatic hypotension?
A sudden drop in systolic blood pressure caused by a change in body position
True or False
Orthostatic hypotension may cause a patient to lose consciousness after being repositioned from a reclined position to an upright position in the dental chair
True
What are the symptoms of orthostatic hypotension?
Dimming of vision
Decreased hearing
Lightheadedness
True or False
The clinician should assess the patient’s gait, eyes, speech and skin color, as well as significant weight gain or loss.
True
changes in any of these could indicate a medical problem warranting emergency intervention, such as CVA or MI