Vital Sign Assessment
PTA 101 Intro to Clinical Practice 1

Instructional Use Statement

The following information is used for instructional purposes for students enrolled in the Physical Therapist Assistant Program at Lane Community College. It is not intended for commercial use or distribution or commercial purposes. It is not intended to serve as medical advice or treatment.

Contact howardc@lanecc.edu for permissions

Vital Sign Basics

Lesson Objectives

Identify the vital signs (blood pressure, heart rate, respiration rate, and temperature)
Describe equipment and landmarks used in vital sign assessment
Describe the expected normal and abnormal changes in blood pressure, heart rate, and respiration rate resulting from exercise and other factors.
Recognize normal and abnormal body temperature
Define common medical terms associated with vital sign assessment and documentation
Compare and contrast attributes of standardized instruments to assess pain
Recognize when to monitor vital signs during a patient encounter

Blood Pressure Tutorial

Click here to test your understanding of blood pressure measurement rationale and procedures

Now Test Yourself

Test measure 1
Test measure 2

Pain and Assessment Tools

How we think about pain is changing. In the recent past, pain was referred to as the "fifth vital sign". With the development of pain science knowledge, more providers are considering pain as an experience that can be complex, measured and treated in multiple ways. This diagram from Dr. Cuccaro represents cognition, sensation, and emotions as the fuel for the "pain experience".

Pain triangle

Image from https://straightshothealth.com/what-do-pain-fire-have-in-common-and-why-it-matters/?hvid=3vZakQ

This video provides a five-minute summary of explaining pain as an experience and may expand your understanding of how physical therapy providers and others are talking about pain:

There is a variety of general-to-specific methods of measuring and documenting pain. Next week, you have an essay on the clinical application of pain scales. A few are included in your text, and I have linked some additional, standardized assessment tools for pain in the table below. Standardized measures can be very powerful tools to document changes in quality of life and in functional activities as a result of physical therapy. Progress and declines (regressions) are easily supported by changes in pain measures.

You can prepare for your essay assignment and for the exam/lab by completing the following table

Note taking table for comparing/contrasting pain scales
Assessment Tool	Advantages	Disadvantages
Visual Analog Scale (VAS)
Faces Pain Rating Scale
Mc Gill Pain Questionnaire
Oswestry Disability Questionnaire

When you were observing therapists at the clinic, how did therapists gather information about pain? Think about age, culture, cognition (thinking), time, relevance, and function. (links to podcast) All of the assessment tools listed above are used to collect data about pain. Could you explain to your supervising PT why you selected a particular tool? Critical thinking wtih decision-making is demonstrated by your ability to provide a rationale for your choice that is patient-specific and evidence-based.

Documentation

Podcast on documenting vital signs

Vital signs are objective data that provide information about physiological status and responses to stress. Ideally, vital signs are collected before engaging in physical activity, particularly in the deconditioned population. When vital signs are abnormal, the PTA may need to modify treatment approaches or consult with their supervising PT or nursing staff. Documenting vital signs taken throughout the physical therapy session provide evidence of ongoing patient assessment and monitoring.

PTAs make informed decisions when selecting exercises and other interventions by interpreting vital sign measures prior and during treatment. Document findings using consistent terminology and include patient position/situation (lying, sitting, standing) so that the data is transferable and can be interpreted by a multidisciplinary team. Pain documentation may include a rating, location, and other information about its quality and should include its impact on activity and participation. Events or other contextual factors that may contribute to the pain experience are also considered.

Vital Sign	Documentation
Heart Rate (HR)	# bpm
Respiratory Rate (RR)	# / min
Blood Pressure (BP)	systolic (mm Hg)/ diastolic (mm Hg)
Temperature (temp)	°C or °F
Oxygen Saturation (O2 sat)	# %

Sample chart note excerpt

S: Pt lying with HOB elevated. Eager to work on getting OOB. Slept better last NOC. Agreeable to in bed exs.

O: Pain 2/10 ache R hip, VS â Rx: BP 146/82, HR 74bpm, RR 14/min, O2 sats 95%

{additional treatment information would follow here, including any additional VS measures collected during the session}

Role of the PTA

PTAs select the correct equipment to ensure accurate measures (cuff size, stethoscope, etc.)
PTAs measure vital signs and make comparisons from previously collected, baseline data. PTAs also use observation skills to monitor for signs and symptoms of an abnormal temperature, HR, BP, RR, or pain response before, during, and after therapy.
PTAs confirm that it is safe to proceed with activity.
PTAs document responses to treatment and make decisions about treatment progressions and modifications by integrating findings from vital sign measurements
PTAs are a part of an interdisciplinary team which integrates pain assessment and pain management into every treatment plan across settings and across the life span
PTAs select appropriate pain assessment tools based on the abilities and condition of the patients
PTAs promote health and wellness education by providing community members resources and advice on tips for maintaining a healthy blood pressure. This includes informing clients about what they can control (e.g. lifestyle habits)

Exam Success

Can you recall normal and abnormal values for the vital signs?
Can you use correct medical terminology to describe/document an abnormal finding?
Can you describe lifestyle factors which may impact vital sign measures?
Do you understand the benefits and challenges of pain assessment tools covered in this unit?
Can you describe typical pain patterns specific to involved structures?
What is the point of maximum intensity (PMI) when assessing HR?
Where can you measure a pulse?

Self Checks

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