#5 – Takes Blood Pressure and pulse on every patient | Dental Practice Coaching

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#5 – Takes Blood Pressure and pulse on every patient

A high blood pressure makes you 6 times more likely to have a heart attack and 7 times more likely to have a stroke.

“Blood Pressure” is the pressure exerted by the blood against the arterial walls.  It is described as the number of mm the arterial pressure can push up a column of mercury.

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

– The BP cuffs are stored in the hygiene rooms; room #1, #2, #6, #7, #9, & #10.  Each bay has an automatic Blood Pressure unit.

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

– For accurate readings – no smoking, exercise, caffeine 30 minutes before reading, rest 1 minute before reading.

                                             Blood Pressure Classification

In 2004 blood pressure standards were updated by the American Heart Association. New findings have increased the importance of systolic (the high number) blood pressure (SBP).SBPis now considered the key risk factor in cardiovascular disease (CVD). We refer all clients to their physician if their reading is above 140/90.  All adults fall into 1 of 4 categories.

          SBP            DBP        MRF        Dentist Guidelines

< 120          < 80         Yes/No         Normal

120-139      80-89       Yes/No     Routine dental treatment OK; discuss high blood pressure guidelines

140-159      90-99       Yes/No     Hypertension Stage 1: Routine dental treatment OK; consider sedation for complex dental or surgical procedures; refer for medical consult

160-179      100-109    No            Hypertension Stage 2: Routine dental treatment OK; consider sedation for complex dental or surgical procedures, refer for medical consult

160-179      100-109    Yes         Urgent dental treatment OK; refer for medical consult

180-209      110-119     No          No dental treatment without medical consultation; refer for prompt medical consult

180-209      110-119     Yes         No dental treatment; refer for emergency medical treatment

> 210          > 120         Yes/No    No dental treatment; refer for emergency medical treatment

SBP= systolic blood pressure

DBP= diastolic blood pressure

MRF=medical risk factor

Pre-hypertension – at increased risk ofCVDand should begin lifestyle modification. The risk of a stroke or heart attack doubles for every 20/10mm HG increase above 115/75.


Lifestyle Modifications to Manage Hypertension

Modification Recommendation Approximate SBP Reduction (range)
Weight Reduction Maintain normal body weight (body mass index 18.5 – 24.9 kilograms per square meter) 5-20 millimeters of mercurw/10kg weight loss
Adopt DASH Eating Plan Consume a diet rich in fruits, vegetables and low-fat dairy products with a reduced content of saturated and total fat. 8-14 mm Hg
 Salt Reduction Reduce salt intake to no more than 2.4 grams sodium or 6g sodium chloride 2-8 mm Hg
Exercise Engage in regular aerobic physical activity such as brisk walking (at least 30 minutes per day most days of the week) 4-9 mm Hg
Moderation of Alcohol Consumption Limit consumption to no more than 2 drinks (2 ounce or 30 milliliters ethanol; for example, 24 oz beer, 10 oz wine, or 3 oz 80 proof whiskey) per day in most men and no more than one drink per day in women and lighter weight people. 2-4 mm Hg

‑ Stress, medications may change systolic more than diastolic

‑ If the reading is above 200 systolic(first sound) or 100 diastolic (end of sounds) ask the patient if their doctor has checked it  recently and stop the appointment.  Place client on N2O for 5 minutes.  If numbers drop below our cut off, continue appointment.  If numbers too high, stop appointment.

‑ If they have not been to their physician recently fill the BP referral form out (these forms are located in the black bins behind op 4 & 10).

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. If the reading is still high, fill out the referral form and place it on the dentist’s desk for his signature.

– For clients over 50 the systolic (higher number) is the most important.  Clients with systolic blood pressure over 140 should be referred for evaluation.

Dental management of high blood pressure

  1. Use N20-O2
  2. Avoid local anesthetics within vasoconstrictors
  3. avoid gagging the client

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)

 

BP Procedure (client seated, sleeve rolled up loosely)

1.  Allow client to sit upright for a few minutes (5 minutes is ideal ) before taking BP.  No limbs crossed.

2.  Position  so that arm is slightly flexed at an angle ‑ arm is bare and lined even with heart level, palm up and resting on arm of chair.  Feet on the floor.

3.  Cuff should be at least 20% bigger than diameter of arm (we have several sizes)

4.  Place cuff so that the inflatable bladder is directly over the brachial artery 1 inch above the elbow joint

5.  Palpate the radial artery

6.  Close the valve and inflate cuff and note at what mm of mercury that the pulse is no longer felt, open the valve

7.  Place head of the stethoscope over the brachial artery (center of the elbow) just inferior to the cuff

8.  Once again close the valve, 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

9.   Slowly deflate cuff ‑ 2‑3 mm 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

10.  Re-pump the cuff up 15 mm higher than the top reading you took. Again slowly deflate the cuff and check your first reading.  (ALWAYS TAKE 3 READINGS and average them if concerns.)

Watch out for:

1.  If arm is tensed, BP reading will be increased.

2.  IF BP cuff is on clothing sleeve, the reading will be inaccurate.

3.  You will see the dial move before you hear the sounds.  However, it is the sounds that are important.

4.  If you get a borderline high reading, take a second reading later in the appointment.

5.  If the reading is higher than 100 diastolic, client needs to be informed of high BP.  Do tell your dentist before beginning your appointment.  S/he will recommend having your clients BP checked by a physician.

Attempt to lower the BP before starting the cleaning by use of N2O2. Retake BP after 5 minutes on nitrous.  If the BP drops below 210/120, proceed with treatment.  If the BP remains too high, abandon treatment for the day and fill out Doctor consult form for your dentist’s signature and send a physician consult on BP problem.  Encouraging client to see his physician as soon as possible.

Fill out a physician request form.  Place form and client’s folder on dentist’s desk.

Wait to reschedule any treatment until we hear from physician.

Be sure to retake the blood pressure reading at the end of the appointment.  Often, the client will have relaxed and the blood pressure will return to an acceptable level, avoiding an unnecessary visit to the physician.

If you have further questions, contact the American Heart Association, Miami Valley Division:  224-3571

Consumer Reports (Sept 2008) recommends ReliOn brand ($40) 1-800-634-4350.  These digital devices are now recommended in place of the older mercury sphygnomemometers.

Signed off by: _________________________   Date ______________