Module 2_General Assessment

Question 1

What is the purpose of a general assessment?

Answer 1

Determine medical fitness of patient to undergo procedure (the more demanding the procedure the more vigorous the assessment)

If patient collapse assessment of vital signs allow diagnosis

Question 2

What are the key vital signs you need to be able to assess?

Answer 2

• Blood pressure
• Pulse
• Temperature
• Consciousness
• Respiration

Question 3

What instrument is used to measure blood pressure? How do you use it? How does it work?

Answer 3

-Sphygmomanometer

(sphigmo-manometer)

1. Place cuff above the elbow
2. Ensure tubing in line with antecubital fossa (pit on the elbow)
3. Ensure patient relaxed and arm level with the heart
4. Place stethoscope on the blood vessels in the antecubital fossa
5. Puff up cuff until pulse sounds disappear (cuff pressure occludes artery preventing blood flow)
6. Slowly let down cufff until the first heartbeat is heard (which is systolic blood pressure)–>once cuff pressure falls just below (roughly equal) systolic pressure blood is let through intermittently (let through when heart contracts on systolic and blocked once again when heart relaxes to diastolic) resulting in intermittent turbulent sounds as blood is forced through the narrowed artery.
7. Continue to let down until the beating stops (this is the diastolic blood pressure)–>as cuff pressure lowered sound duration increases as blood is being forced through narrow artery for longer periods. Once cuff pressure falls below diastolic pressure, artery is no longer being constricted and blood flow becomes laminar, thus no sound is heard.

(or just use automatic BP machine)

1. Apply cuff as above
2. Start machine, it will automatically inflate and measure blood pressure and pulse as the cuff starts automatically deflating

Question 4

What are the normal values for systolic and diastolic pressure?

Answer 4

Sys: 120-140 mmHg
Dias: 60-90 mmHg

Question 5

T or F?

Wider cuff is used for higher BMI and narrow cuff is used for low BMI/child patients?

Answer 5

T

Question 6

How is pulse measured?

Answer 6

• Use radial pulse (pulse of radial artery)
• Count number of pulses in 15 seconds
• Multiply by 4 for pulses per minute

Question 7

How is respiration measured?

Answer 7

• After 15 seconds of counting pulse, use next 15 seconds to count rise and fall of patient’s chest
• Multiply by 4 for breaths per minute

Question 8

What is the normal pulse range?

Answer 8

60-80 beats per minute

Question 9

What is hte normal respiration range?

Answer 9

12-16 breaths per minute

Question 10

Hyperventilation

Answer 10

More than 20 shallow breaths per minute

Question 11

How do you measure temperature with a traditional mercury thermometer?

Answer 11

• Place under tongue for 2 minutes
• Remove
• Get the reading

Question 12

When should a mercury thermometer not be used?

Answer 12

• Children
• Adults with behavioiural problems
• Risk of biting/breaking thermometer
• If patient has oral infection
• Placing it against an abscess can result in abnormally high reading that does not reflect patient condition

Question 13

T or F?

Oral temperatures are reliable

Answer 13

F

Instead use body’s core temperatures (EAM, Axilla, Groin, Rectum)

Question 14

What are some alternatives to oral thermometers?

Answer 14

-Ear or skin thermometers

cleaner, quicker, more accurate

Question 15

What is the normal range for body temperature?

Answer 15

-35.5 to 37.5 degrees celsius

Question 16

How should patient’s consciousness be assessed?

Answer 16

• Test whether responsive to surroundings (eg. speech)

- Test their knowledge and whether they are oriented in time and space

Question 17

How should you respond if your patient becomes sleepy?

Answer 17

• Firm commands accompanied with a light touch or shake

- If non-responsive can stimulate by twisting earlobe

Question 18

What is the medical measure of consciousness?

Answer 18

Glasgow Scale

Eye opening (E):

• Spontaneous 4
• To speech 3
• To pain 2
• No response 1

Best Verbal Response (V):
Oriented and converses: 5
Disoriented and converses: 4
Inappropriate words: 3
Incomprehensible sounds: 2
No response: 1

Best motor response (M):
Obeys verbal command: 6
Localises pain (to painful stimulus): 5
Flexion/withrawal (to painful stimulus): 4
Flexion abnormal (to painful stimulus): 3
Extension: 2
No response: 1

E + V + M normal range 14-15
13=mild brain damage
9-12 = moderate brain damage
8 or less= severe brain damage

Question 19

What additional medical assessments are available in addition to the vital signs?

Answer 19

• BMI

- BGL

Question 20

What is the significance of BMI?

Answer 20

Measures obesity
-Risk factor for diabetes, coronary disease, premature death

-Needs to be assessed if patient going to have sedation or GA

Question 21

How is BMI measured?

Answer 21

• Obtain patient’s height and weight
• Apply to formular BMI= weight/(height)^2
• Weight in kg, height in m

Question 22

What can confound BMI measurements?

Answer 22

-WEight could be fat or muscle

Question 23

What is the normal BMI range/categories?

Answer 23

Underweight < 18.5
Health 18.5 - 24.9 
Overweight: 25- 29.9
Obese: >30
Morbidly obese: >40

Question 24

What is used to measure BGL?

Answer 24

Glucometer

kit consists of measuring device, test strips, skin wipe and needle

Question 25

How is BGL measured?

Answer 25

1. Wipe tip of finger 2. Puncture the tip of the finger to obtain a drop of blood 3. Drop of blood placed on test strip and inserted into glucometer 4. Automatic reading obtained

Question 26

What factors affect BGL?

Answer 26

When and what patient last ate | If diabetic level of control

Question 27

What is the normal range for BGL?

Answer 27

``` In mmol/L: Hypoglycaemic: <3 Normal: 3-8 Prediabetic: 9-10 Hyperglycaemic: 11< If over 60 years 5-12 is normal *Patients are treatable in normal dental context if between 3.5-12mmol/L ``` - If abnromal advise see medical practitioner - If markedly low give sugar or glucagon - If high then may need emergency aid - If very high or low do not allow to leave office unescorted

Question 28

What occurs to the vital signs in vasovagal syncope?

Answer 28

BP: decrease Pulse: Decrease then increase Respiration: decrease Consciousness: decrease

Question 29

How should you manage a patient experiencing vasovagal syncope?

Answer 29

- Lay them flat - Talk to them - Take their pulse, initially thready but will become stronger - Get assistant to place cold towel on forehead - If vasovagal syncope then will rapidly recover

Question 30

What occurs to the vital signs in hyperventilation?

Answer 30

BP: no change Pulse: decrease respiration: increase consciousness: decrease

Question 31

When is hyperventilation most likely ot occur?

Answer 31

Prior to extractions, especially if you are not talking to or observing them

Question 32

How should you manage hyperventilation?

Answer 32

Get patient to take a few deep breaths (usually all that is needed) Can also cup hand over patient's mouth or get them to breathe into plastic bag to rebreathe expired air and increase partial pressure of carbon dioxide As hyperventilation progresses may faint--> can be mistaken for vasovagal syncope if you are not observing them

Question 33

What happens at the advanced stage of hyperventilation?

Answer 33

- Body goes rigid - Feet go numb - Back arches - Hands undergo carpopedial spasm * Keep them rebreathing and eventually they will recover * Can also give intravenous muscle relaxant such as diazepam if trained to do so

Question 34

What happens to the viutal signs in cardiac arrest?

Answer 34

- All decrease - Initial stage may mimic faint or vasovagal attack - Key difference is more profound and they don't respond

Question 35

How do you manage a cardiac arrest?

Answer 35

- Lay them flat - Talk to them - Ask if pain in chest - Check radial or carotid pulse (they have none) - Call for emergency assistance and start CPR

Question 36

What are normal haemoglobin levels for: Children Adult males Adult females?

Answer 36

C: 11-13gm/dL AM: 14-18gm/dL AF: 12-16gm/dL (dL=decilitre=1/10th of a litre= 100mL) (just remember the first number, children have a range of 1, adults a range of 4)