Vital Signs to be Tested at a Medical Visit
The traditional vital signs that should be measured at every medical visit include temperature, heart rate, respiratory rate, blood pressure, and oxygen saturation, with supplemental assessments of pain and mental status often included. 1
Core Traditional Vital Signs
The Society of Critical Care Medicine identifies the following as traditional vital signs that represent the simplest, cheapest, and most widely accepted signs of clinical change 1:
- Temperature - Should be measured at every visit 1
- Heart rate (pulse rate) - Should be measured at every visit 1
- Respiratory rate - Should be measured at every visit 1
- Blood pressure - Should be measured at every visit 1
- Oxygen saturation - Should be measured at every visit 1
Supplemental Vital Sign Assessments
Beyond the traditional five vital signs, additional parameters are frequently included in comprehensive vital sign assessment 1:
- Pain assessment - Should be routinely evaluated 1
- Mental status/level of consciousness - Should be assessed as part of routine monitoring 1
Context-Specific Considerations
For Hospitalized Patients
Ward staff should strive to acquire a complete and accurate set of vital signs when ordered and when there is additional cause for concern, escalating significant abnormalities urgently. 1 This represents a good practice statement from the Society of Critical Care Medicine 1.
For Diabetes Patients
The American Diabetes Association recommends the following vital sign measurements 1:
- Height, weight, and BMI calculation - At every visit 1
- Blood pressure determination - At every visit 1
- Orthostatic blood pressure measures - When indicated 1
For Long-Term Care Facility Residents
Nursing assistants should measure the following vital signs for residents with suspected infection 1:
For Oxygen Therapy Patients
The British Thoracic Society recommends that oxygen saturation should be checked by trained staff using pulse oximetry in all breathless and acutely ill patients, with the inspired oxygen device and flow rate recorded 1.
Important Clinical Caveats
Accuracy and Documentation
Complete and accurate vital sign measurement is essential, as numerous studies demonstrate that incomplete and/or incorrect vital sign measurement is common and leads to failure to detect clinical deterioration. 1 The importance of education, audits, and feedback to encourage proper measurement techniques and accurate documentation cannot be overstated 1.
Limitations of Vital Signs for Pain Assessment
Vital signs (heart rate, blood pressure, respiratory rate, oxygen saturation, and end-tidal CO2) are NOT valid indicators for pain in critically ill adults and should only be used as cues to initiate further assessment. 1 When vital signs change during procedures, they should prompt use of appropriate validated pain assessment methods such as patient self-report or behavioral scales 1.
Measurement Reliability
Clinicians should recognize that vital sign measurements have inherent interobserver variability and should interpret them with appropriate caution 2. Even trained observers can have significant differences in measurements, particularly for respiratory rate (expected range of agreement ±35.5%) and blood pressure (expected range of agreement ±19-26%) 2.
Frequency of Measurement
While vital signs should be obtained at intervals appropriate for a patient's level of acuity 1, the optimal frequency of vital sign measurement has not been well-established through research 3. The frequency should be determined based on the patient's clinical condition and the setting of care 1.