Vital Signs and Patient Assessment

Vital Signs and Patient Assessment

🟢 Lite — Quick Review (1h–1d)

Rapid summary for last-minute revision before your exam.

Definition: Vital signs are objective measurements (temperature, pulse, respiration, BP, SpO₂) reflecting physiological status. Patient assessment is the systematic head-to-toe evaluation identifying health problems and guiding decisions.

Must-Know Formulas:

• MAP = [(2 × diastolic) + systolic] / 3
• Pulse Pressure = systolic − diastolic
• BMI = weight (kg) / [height (m)]²

Normal Adult Ranges: HR 60–100 bpm | RR 12–20/min | BP <120/80 mmHg | Temp 36.5–37.5°C | SpO₂ ≥95%

High-Yield Exam Points:

• MAP <65 mmHg indicates inadequate tissue perfusion → requires immediate intervention
• BP cuff size matters: bladder width = 40% of arm circumference; bladder length = 80%
• Allow 5-minute rest before BP measurement
• Primary survey follows ABCDE: Airway, Breathing, Circulation, Disability, Exposure
• Vital sign trends matter more than single isolated readings

---

🟡 Standard — Regular Study (2d–2mo)

Standard content for students with a few days to months.

Vital Signs: Measurement Details

Temperature: Core range 36.5–37.5°C (97.7–99.5°F). Methods vary in accuracy: oral reads 0.3–0.5°C lower than tympanic; rectal reads 0.5–0.8°C higher. Hypothermia <35°C; fever >38°C.

Pulse Assessment: Count rate (60–100 bpm normal), evaluate rhythm and quality. Tachycardia >100 bpm may indicate pain, hypoxia, hemorrhage, or infection. Bradycardia <60 bpm suggests beta-blocker use, hypothyroidism, or raised ICP. Always assess bilateral symmetry—absent pedal pulse with strong femoral pulse signals peripheral vascular disease.

Respiratory Rate: Count for minimum 30 seconds unobtrusively. Bradypnea <12/min and tachypnea >20/min are both clinically significant. Observe chest wall symmetry and accessory muscle use. True apnea episodes require urgent review.

Blood Pressure Interpretation: Systolic reflects ventricular contraction; diastolic reflects ventricular relaxation. Calculate MAP = [(2 × DBP) + SBP] ÷ 3. MAP <65 mmHg signals shock requiring intervention. Pulse pressure (systolic minus diastolic) >40 mmHg indicates aortic regurgitation or hyperthyroidism; <20 mmHg suggests severe aortic stenosis or heart failure.

Oxygen Saturation: SpO₂ ≥95% is normal. Values 90–94% require supplemental O₂. Below 90% is critical and demands immediate intervention. Always verify with waveform quality—low perfusion states produce unreliable readings.

Patient Assessment Framework

Primary Survey (ABCDE):

• Airway with C-spine protection
• Breathing and adequate oxygenation
• Circulation and hemorrhage control
• Disability (GCS, pupils, blood glucose)
• Exposure with environmental control

Secondary Survey: Complete head-to-toe examination establishing all injuries and baseline data.

SAMPLE History: Symptoms, Allergies, Medications, Past medical history, Last oral intake, Events preceding incident.

OPQRST: Onset, Provocation/palliation, Quality, Radiation, Severity, Timing.

Four Assessment Techniques: Inspection (visual), palpation (touch for tenderness/masses), percussion (tapping for sound differences), auscultation (stethoscope listening—perform after percussion for accuracy).

DOH Exam Strategy

DOH UAE tests: normal ranges by age, MAP calculations, hypotension/hypertension management, proper cuff selection, and primary vs secondary survey objectives. Scenario-based questions require clinical interpretation of patterns.

---

🔴 Extended — Deep Study (3mo+)

Comprehensive coverage for students on a longer study timeline.

Measurement Technique Errors

BP Cuff Errors: Using cuff too small (bladder <40% arm circumference) produces falsely elevated readings by 10–40 mmHg. Using cuff too large underestimates by 5–10 mmHg. Always measure mid-arm circumference before selecting cuff. Wrap cuff 2–3 cm above antecubital fossa; stethoscope placed over brachial artery.

Temperature Measurement: Eating/drinking falsifies oral readings if <15 minutes elapsed. Tympanic thermometers require correct probe angle—pull ear backward in adults. Rectal measurements contraindicated in immunocompromised patients or those with rectal pathology.

Respiratory Rate: Counting while patient is aware often produces artificial decrease. Observe without announcing the action—combine with pulse assessment for stealth timing.

Advanced Assessment Concepts

Glasgow Coma Scale (GCS): Eye (1–4) + Verbal (1–5) + Motor (1–6) = 3–15. GCS ≤8 indicates coma requiring airway protection. Document individual components, not just total score. Pupil size and reactivity assessed simultaneously—unequal pupils >1 mm suggest mass effect or herniation.

Age-Specific Ranges: Elderly patients may have elevated baseline BP; treat trends rather than absolute values. Pediatric respiratory rates vary: infant 30–60/min, toddler 24–40/min, school-age 18–30/min.

Factors Affecting Readings: Acute pain raises HR, RR, and BP. Anxiety produces tachycardia and tachypnea. Beta-blockers blunt heart rate response. Thyroid disorders affect temperature regulation and HR. Environmental temperature influences peripheral vasoconstriction.

Common Exam Traps

• Assuming single reading is diagnostic—correlate with patient condition
• Forgetting to recheck abnormal values with alternative method before escalating
• Missing compensatory tachycardia—BP may remain normal while HR is elevated
• Documenting without noting position (supine/sitting/standing) or technique used
• Confusing primary survey (immediate life threats) with secondary survey (comprehensive injury identification)

Practice Prompts

1. A 58-year-old patient has BP 88/56 mmHg, HR 112 bpm. Calculate MAP and state the intervention threshold. Explain two possible etiologies and your first nursing action.

2. You assess a patient complaining of chest pain. Using OPQRST, detail your subjective history questions. Then outline your primary survey sequence (ABCDE), noting what each component screens for and one finding that would trigger immediate escalation.

Content adapted based on your selected roadmap duration. Switch tiers using the selector above.