Vital Signs & Patient Assessment

Vital signs are the most fundamental clinical measurements in healthcare. As a medical assistant, you will measure vital signs at nearly every patient encounter. Understanding normal values, proper technique, and clinical significance is essential for the CMA exam and daily practice.

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The Five Vital Signs

1. Temperature

Key facts:

• Fever (pyrexia): Oral temp above 100.4F (38.0C)
• Hypothermia: Below 95.0F (35.0C)
• Hyperthermia: Dangerously elevated temperature (heatstroke)
• Normal body temperature varies with time of day (lowest in early morning, highest in late afternoon)

2. Pulse

Pulse points and their uses:

Key pulse facts:

• Count radial pulse for 30 seconds x 2 if regular; count for full 60 seconds if irregular
• Apical pulse must always be counted for a full 60 seconds
• Pulse deficit = apical rate minus radial rate (indicates ineffective heartbeats)

3. Respirations

Abnormal respiratory patterns:

4. Blood Pressure

Blood pressure is the force of blood against the walls of the arteries.

• Systolic pressure: Pressure during ventricular contraction (top number)
• Diastolic pressure: Pressure during ventricular relaxation (bottom number)

Blood Pressure Classification (2017 ACC/AHA Guidelines):

Blood pressure measurement technique:

1. Patient seated, arm supported at heart level, feet flat on the floor
2. Apply cuff 1 inch above the antecubital space with the artery marker over the brachial artery
3. Cuff size: Bladder should encircle 80% of the arm circumference (too small = falsely high reading)
4. Inflate to 20-30 mmHg above the palpated systolic pressure
5. Deflate at 2-3 mmHg per second
6. First Korotkoff sound = systolic pressure
7. Last Korotkoff sound (disappearance) = diastolic pressure

5. Oxygen Saturation (SpO2)

Factors affecting accuracy:

• Cold extremities / poor circulation
• Nail polish (especially dark colors)
• Carbon monoxide poisoning (falsely normal reading)
• Patient movement
• Anemia

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Patient Assessment Process

Patient Intake

1. Greet the patient and verify identity (two identifiers: name + DOB)
2. Obtain vital signs (T, P, R, BP, SpO2)
3. Measure height and weight
4. Document chief complaint — the reason for the visit in the patient's own words
5. Update medical history — medications, allergies, past medical/surgical history
6. Update social history — smoking, alcohol use, exercise
7. Review of systems (ROS) — systematic inquiry about each body system
8. Document all findings in the medical record before the provider enters

Anthropometric Measurements

• Height: Measured standing (adults) or recumbent (infants)
• Weight: Measured on a calibrated scale; ask patient to remove shoes and heavy clothing
• BMI (Body Mass Index): Weight (kg) / Height (m)^2
  • Underweight: <18.5
  • Normal: 18.5-24.9
  • Overweight: 25.0-29.9
  • Obese: 30.0+
• Head circumference: Measured on infants at each well-child visit

Pediatric and Geriatric Vital Signs

Pediatric Normal Vital Sign Ranges

Key pediatric vital sign facts:

• Children have higher heart rates and faster respiratory rates than adults
• Blood pressure increases with age
• Use age-appropriate cuff sizes — too small = falsely high; too large = falsely low
• Measure infant pulse at the brachial artery (not radial)
• Weigh infants in kilograms for medication dosing accuracy

Geriatric Vital Sign Considerations

• Elderly patients may have naturally lower baseline heart rates due to decreased SA node function
• Orthostatic hypotension is common in the elderly — measure lying, sitting, and standing BP
• Wide pulse pressure (large difference between systolic and diastolic) may indicate arterial stiffness
• Decreased sensitivity to pain and temperature changes may mask symptoms
• Polypharmacy (multiple medications) may affect vital sign readings

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Pain Assessment

Pain Scales

Pain Assessment Questions (OPQRST)

• Onset: When did it start?
• Provocation/Palliation: What makes it better or worse?
• Quality: What does it feel like? (sharp, dull, throbbing, burning)
• Radiation: Does the pain spread anywhere else?
• Severity: Rate on a scale of 0-10
• Timing: Is it constant, intermittent, or only at certain times?

Fifth Vital Sign

Pain is often referred to as the "fifth vital sign" because it should be assessed and documented at every patient encounter along with the traditional four vital signs.