#1 – Takes Blood Pressures

Everyone needs blood to flow through their arteries and veins. This blood flow creates pressure. The pressure is controlled by

1. Volume of blood
2. Size and elasticity of arteries
3. Force of the heart’s contraction

However, if the pressure is too high, it can cause:
1. Stroke
2. Heart attack
3. Heart failure
4. Blindness
5. Kidney problems

High blood pressure usually occurs without the client being aware of it. Dentistry is stressful. How terrible if we had an undiagnosed high blood pressure client, started a dental procedure, and pushed this person into a stroke or heart attack. Take blood pressures on new clients or thorough exams!

Take the blood pressure of every patient 16 yrs. and older at the beginning of each recall appt.

The BP cuffs are stored ____________

The extra large BP cuff is stored _______________

Tell the pt. what the reading is and what it means (high low normal)

The top number (systolic) measures the force exerted by your heart when it pumps. The bottom number (diastolic) measures your heart at rest. The more you are stressed (physical or mental) the harder r your heart will pump, and the higher your measurements will be.

Client’s arteries can become narrowed with plaque. The smaller the opening, the harder the heart must work to push blood through and the pressure goes up!

Ranges (listed according to age group)

Normal

Infants 70/45
Age 5 18 90/60 (could be lower with no problem; diastolic over 90 a problem)
Age 20 120/80
Age 50+ 150/85 90

BP for elderly upper limits:

Age Men Women
60 69 195/100 200/102 70 79 205/104 215/105
80 89 215/108 230/110

Hypotensive 95/60 and lower

Hypertensive

140/90 borderline hypertensive for age 13 and under
140/90 borderline hypertensive for under 50 yrs.
160/95 borderline hypertensive for over 50 yrs.
Emotions may change systolic more than diastolic

If the reading ( see minimum ratings for various ages above) is high ask the patient if their doctor has checked it recently. If a reading is above, 170-90 place the client on N2O for 5 minutes, and then take a new reading with a manual cuff and alert your dentist.

If they have not been to their physician recently fill the BP referral form out (these forms are located ______________ ) and wait for your dentist. He will probably stop treatment until the client’s physician brings the patient’s blood pressure to a normal level.

Many of the physicians are very “touchy” about dental personnel interpreting blood pressures. Be sure to emphasize to your client that we are only “screening” their blood pressure. We still contact their physician so they can just call their physician to arrange an appointment to have it thoroughly evaluated.

Be sure to inform the doctor while you are giving him your report on the patient so he can be aware of the problem

If BP is substantially high for them retake BP at the end of appt. to see if the first reading was false due to nervousness of patient

Pulse Procedure

1. Palpate radial artery
2. Time with second hand on a watch for 15 sec.
3. Counting beats multiply by 4 = pulse for 1 min. (This procedure is not regularly recorded in our office records)
4. 60-80 beats per minute is normal
5. 120+ beats per minute may indicate cardiovascular disease.

Temperature
1. Normal body temperature is 96-99.5 degrees Fahrenheit.

BP Procedure – Manual-Automatic

1. Position patient sitting so that arm is slightly flexed at an angle arm is bare aligned with heart level
2. Cuff should be at least 20% bigger than diameter of arm (we have several sizes)
3. Place cuff so that the inflatable bladder is directly over the brachial artery 1 inch above the elbow joint
4. Palpate the radial artery
5. Inflate cuff and note at what mm of mercury that the pulse is no longer felt
6. Place the head of the stethoscope over the brachial artery just below the cuff
7. Once again inflate the cuff, inflating about 20 30 mm beyond the point at which the radial artery was no longer felt. ex. radial pulse ceased at 120 mm pump cuff up to 140 150 mm
8. Slowly deflate cuff 10mm per sec. Listen for the first “tap” this is the systolic pressure Then listen for the point at which the “tapping” sound can no longer be heard this is the diastolic pressure
9. Repump the cuff up 15 mm higher than the top reading you took. Again slowly deflate the cuff and check your first reading.
10. If the number is high, repeat to make sure of your accuracy.

BP Procedure – Automatic cuffs
1. Automatic upper arm BP – automatic cuffs monitor with self inflating cuff (go to www.dableducational.org)
2. Client in same position
3. Take 2 or 3 readings 1 minute apart.

If your dentist had hoped to perform a dental procedure and the reading is slightly high, N20 may be used to relax the client. Often this is enough to return the BP to a normal range so the procedure can be safely accomplished. Your dentist will also limit using epinephrine.

Our office records the patients Blood Pressure for safety of the patients. If this reading is high, inform your client. When your doctor comes in, tell him and have a physician referral form ready to be filled out.

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