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Vital Signs: User Manual
Taking a patient’s vital signs is often seen as simplistic and mundane tasks in comparison
with other more complex procedures a medical assistant may perform. This program not
only instructs the user in the basic skills needed for taking a patient’s vital signs and
measurements, but also offers information as to why the procedure is important to the
physician in diagnosing the patient.
This program was carefully designed to assist the user in building the skills necessary for
the accurate measuring and recording of patients Vital Signs. Instruction is divided into 6
steps:
Pre-Test:
Current knowledge of individual skills is measured through multiple
choice questions.
Learn It:
The text and pictures take the user step by step through the how’s and
why’s of performing each skill.
See It:
Each skill is demonstrated through video or narrated animation.
Do It:
The user is able to practice the elements of each skill, guided by feedback
at every step.
Quiz:
Knowledge gained through practice of each skill is tested by multiple
choice questions. The score is saved, available for review by the instructor
(using the Network Version of the software only), or print for permanent
documentation in the user’s file.
Case Studies: The users have an opportunity to use the knowledge gained in the Learn It,
See It, Do It and their critical thinking skills in taking a full set of Vital
Signs and mensurations on a virtual patient.
It is strongly suggested users start at the beginning, working through the instructional
steps of each skill to make the most of their learning experience.
Vital Signs: Notes for the User, page 1
Getting Started
Vital Signs for Medical Assistants is designed for easy use. The Point, Click and Drag
system allows you to navigate through the program with ease. Learning is guided with
instructional checklists, text and illustrations. Users are encouraged to take advantage of
Notes to the User for additional information, resources and references.
Log In
Users will log into the program using first and last names. The program will
automatically record user scores in the quizzes so the instructor can track their progress.
Welcome / Introduction Screens
Each screen will have instructional text. Throughout the program, the menu will continue
to be available at the top, so navigation between screens is accomplished simply by
clicking on any of the menu choices.
Selecting a skill
By rolling the mouse over the menu title Skills, a drop down menu appears. Rolling the
mouse down the menu will bring up a submenu for each skill with choices available for
Pre-test, Learn It, See It, Do It and Post Test. Roll the mouse over the selected skill and
click to bring up the corresponding screen.
Each screen contains instructional text to assist the user in navigation of the program. To
move forward to the next screen, select the NEXT button. To review the previous
screens, select the PREVIOUS button. For the most effective experience, it is strongly
suggested the instructor guide the user through each skill in order, beginning with the Pre
Test to measure current knowledge, and then move on to Learn It, See It and Do It prior
to attempting the case studies.
Pre-Test
The quizzes are multiple-choice and designed to test the users current knowledge of each
individual skill. There will be one question per screen. Answers are selected by clicking
on the circle next to the user’s choice, then clicking on NEXT to bring up the next
question. When the last question has been answered, a pop up screen will present the
score. Clicking on OK to closes the box. The score of this test and that of any previous
tests are automatically saved and can be viewed or printed out for the instructor. The
details of each score are available by clicking on the link VIEW DETAILS. The scores
can be printed for your records by clicking on PRINT. To move on to the next step, roll
the mouse over SKILLS to bring up the drop down menu. Follow the menu to the Learn
It activity and click.
Learn It
Vital Signs: Notes for the User, page 2
Learn It provides step by step instruction for performing the skill. Throughout the text are
italicized terms. Users are encouraged to become familiar with these terms and
understand their meanings. It would be helpful to have available a medical dictionary
such as the Taber’s Dictionary to assist the users in looking up unfamiliar terms.
An introductory screen offers general information about the skill. Move forward by
clicking NEXT. To review a previous screen, select PREVIOUS. When the user has
completed the skill, return to the main menu to select the next step.
See It
In See It, the skill is demonstrated so users can hear and see the skill performed. Once
they have seen the skill they may select the next step from the main menu. To repeat the
demonstration, the user can simply re-select the See It from the main menu.
Do It
The Do It section allows the user to put into practice the knowledge gained from the
Learn It and See It. As with Learn It, navigation between screens is accomplished by
selecting the NEXT or PREVIOUS buttons.
With each screen, users are instructed to first select
to receive
instructions for performing each step. They can check off their progress as each step is
completed by clicking on the square next to each step. Feedback is also provided along
the way to guide the users’ successful performance of the skill.
Case Studies
The Case Studies offer users an opportunity to use their new skills and to employ a higher
level of critical thinking.
Point and click on the Case Studies drop-down menu. Case studies are set up as a day’s
list of patients and a summary of their history. Users are asked to take the vital signs and
measurements on each of the day’s patients. Each patient has a different history which
varies from an annual physical to a patient who has collapsed in the office. Rolling the
mouse over the patient highlights the selection. Just click to begin.

Hints for completing the Case Study exercises
A blank patient chart can be found for each Case Study by clicking on the button at the
bottom of the screen:
Vital Signs: Notes for the User, page 3
Users are asked to document in the patient’s record, just as in a clinical practice, with the
date, patient’s name, age, and chief complaints. After each mensuration is performed, the
user will return to this screen and record the results on the patient’s chart.
After reading the patient’s history, the user must select the most appropriate method for
taking their vital signs and mensurations by clicking on the link. This will take the user to
a virtual examining room where they will begin taking measurements. A negative
feedback screen will appear, with an explanation, if they make an incorrect choice Just
as in the Do It section, there are CHECKLIST buttons that will provide instructions in
navigating the skill.
Once the user has taken the selected measurement, and has returned to record the findings
on the patient’s chart, they may choose another vital sign or mensurations. Once all
measurements are completed and recorded, the user may select another patient by
selecting Case Studies from the main menu.
General Information
Four recurrent themes are reinforced throughout every skill:
 Patient identification
 Infection control
 Consent
 Charting of results
The importance of identifying the patient is emphasized with every skill throughout the
program and in accompanying Notes to the User. Many offices, in the spirit of HIPAA
regulations, now call patients from the reception room using only the patient’s first or last
name. Users are instructed to ask the patient to repeat their name and/or the birth date to
confirm the identity of the patient and to counter check the patient name and birth date
with the chart.
The most common transmission of infectious pathogens from host to recipient is through
unwashed hands. Hand washing prior to contact with a patient is emphasized with every
skill. There are additional ways of creating barriers to the transmission of infectious
pathogens is also discussed throughout the program.
Implied consent is given when a patient willingly cooperates with a procedure. The
instructional text reminds users of the need to communicate clearly with the patient about
what procedure will be performed and to offer patients the opportunity to ask questions.
It is emphasized that a patient may feel more willing to cooperate and give consent when
a procedure is explained to them.
The patient chart is a legal record of tests, exams, treatments, and patient contacts.
Simply said, “If it is not in the chart, it didn’t happen”. Recording results, and recording
Vital Signs: Notes for the User, page 4
them correctly, is reinforced in multiple ways throughout the program. Users are shown
correct charting in Learn It and See It, and asked to record results with each completed
skill in Do It. The Case Studies ask them to record results on a virtual chart.
Resources
Resources for additional study and information are listed in the User Notes and in the
Instructor Notes. With each skill, specific references are listed so the user can easily find
more information about that particular skill. At the end of the Instructor notes, there is a
list of resources used in the development of this program.
Users are asked to keep in mind that, in real-life experience, every medical office has its
own procedures for taking a patient’s vital signs and mensurations which may differ
slightly from what is found in this program. Equipment may be different, methods may
not be exactly as seen here, or the preferences of recording the results may vary. Users
are reminded that it is normal and to be expected. The goal of this program is to give a
basic understanding of how to take a patient’s vital signs and measurements. Future
clinical experiences will shape and fine-tune the medical assistant’s skills.

Helpful References, available from Thomson Delmar Learning
Body Structures & Functions, Tenth Edition by Ann Scott and Elizabeth Fong
Clinical Handbook for the Medical Office, Second Edition by Heller & Krebs
Comprehensive Medical Assisting: Administrative and Clinical Competencies, Third
Edition by Lindh, Pooler, Tamparo, Dahl
Fundamentals of Anatomy and Physiology, Second Edition by Donald C. Rizzo
Medical Assisting: Administrative and Clinical Competencies, Fifth Edition by Keir,
Wise, Krebs
Medical Terminology for Health Professions, Fifth Edition by Ann Ehrlich
Vital Signs: Notes for the User, page 5
Tips for using Vital Signs
Adult Height and Weight
Height (or stature) is generally measured when measuring a patient’s weight. The most
common scale is that of a balancing scale with a measuring bar as shown here. Though
digital scales are available, it is important for the user to know how the basic balancing
scale works.
Ask the user to start with the Pre-Test to evaluate their current knowledge of the skill.
Once they have completed the three steps of Learn It, See It and Do It, taking the PostTest will evaluate the user’s progress.

Hints for completing the Adult Height and Weight Do It exercises
You will note for measuring Height and Weight, we have chosen a female figure in the
Patient Instruction screen, which is consistent throughout the Do It, and Case Studies
section. The instructions are nonetheless universal in that the patient, male or female,
should set aside anything they may be carrying which may affect the weight reading, and
remove anything which may affect the height reading.
Instruct users to use the decimal system when entering their measurements in the answer
box.
Example: instead of 6 ½, type 6.5.
When weighing the patient, there is a window above the top of the balance bar which
enlarges the top bar numbers, making it easier to read when moving the larger weight.
Infant Weight
In a clinical setting, the user will encounter many types of infant scales: scoop digital,
digital scales built into the examining table and the scoop scale balance bar. This
program will teach the basic scoop scale with balance bar.
The differences in weighing an adult and an infant are emphasized to the user. Obviously,
an infant is weighed either sitting or laying down on the scoop scale. The scale is also
prepared differently. An infant scale is balanced before and after placing the barrier towel
on the scale. In Notes to the User, users are given information regarding the different
ways in which a child may be prepared for weight measurement. For example, some
offices or clinics may ask the parent to provide a clean dry diaper to be placed on the
scale when balancing. Then the parent may re-diaper the baby before placing him or her
onto the scoop base. Other offices will ask the baby to be completely undressed and
Vital Signs: Notes for the User, page 6
balance the scale with only a utility towel. Though either is correct, for this learning
program we have chosen the latter.
It would be helpful to have available examples of the various charts used in pediatric
practice for recording a child’s growth. Although information about charting a child’s
growth on a chart is included, at this time, actual practice marking the growth chart is not
available within the program

Hints for completing the Infant Weight Do It exercises
To balance the scale, the user must click on the balance bar. A pop up window allows
them to click on the screw at the far left of the balance bar to balance the weights, or, to
use “click and drag” to move the weights until the scale is balanced when weighing the
baby.
Click and drag is used to move the baby and towel to the scale.
The user must perform the steps in the correct order. If a mistake is made, a pop up
window will offer feedback to guide them in the correct direction.
If this, or any, skill was difficult for a user, at the end they will find a
button. This will take them back to the beginning to practice again.
Infant Length & Head Circumference
Length (or stature), and head circumference are important measurements in observing the
growth patterns of an infant. Measurements outside the normal range may be indications
of illness or disorders.
There are different ways to measure a child’s length. There are 2 ways discussed in this
program, marking the table paper at head and heel, then measuring the distance between
marks and using the measuring strip at the back edge of the examining table. Alternate
methods are described in Notes to the User, such as some pediatric examining table
papers have hash marks in quarter inches printed on the paper, therefore a measuring tape
is not required. The Do It practice uses the measuring strip at the back of the table edge.
It would be helpful to have available examples of the various charts used in pediatric
practice for recording a child’s growth. Although information about charting a child’s
growth on a chart is included, at this time, actual practice marking the growth chart is not
available within the program.

Hints for completing the Infant Length & Head Circumference Do It
exercises
Infant Length: Preparing the patient
Vital Signs: Notes for the User, page 7
Ask the user to look at the picture. The user may check off those instructions he or she
feels would be necessary to weigh an infant.
Infant Length & Head Circumference: Entering measurements
Remind the user to record the results using the decimal system, then to click on
Feedback will guide them through the skill.
Example: instead of 6 ½, type 6.5.
Temperature
Users will learn four methods to measure temperature: Oral, axillary, rectal, and aural
(tympanic). The thermometers that will be taught in this program include electronic, selfcontained digital, disposable Tempa-dot, and aural (tympanic). Mercury thermometers
are being phased out due to the dangers of breakage and mercury exposure, therefore
these thermometers will not be taught in this program, nor will be the type of
thermometer that is held against the skin.
Users are again reminded the equipment encountered in clinical practice may vary in
appearance or ease of use. This program will teach the basics of how to use each method.
In actual practice users will easily adapt to any differences in equipment.
Oral Temperature (Disposable Thermometer)
Disposable thermometers, although not quite as accurate as other methods, are
convenient for taking a patient’s temperature in most circumstances. They are available
for both oral and rectal use. An advantage of using disposable thermometers is that any
possibility of cross contamination between patients is eliminated. They do have to be
placed properly and do require timing for accuracy. In Do It exercises, the user will have
the opportunity to time both the measurement, and the stabilizing times when using a
disposable TempaDot thermometer.

Hints for completing the Oral Temperature (Disposable Thermometer) Do It
exercises
An oral temperature will be measured with the disposable thermometer in this program.
Users are asked to choose necessary supplies, correctly place the thermometer, and time
the measurement precisely to obtain an accurate reading.
Disposing of the thermometer is most correct in a biohazard container as the thermometer
is contaminated with bodily fluids. Not all offices do for disposable thermometers, but for
this program, biohazard containers are the correct answer.
Vital Signs: Notes for the User, page 8
Oral Temperature (Electronic Thermometer)
Users will practice measuring an oral temperature with an electronic thermometer. The
design of the equipment may differ but they all function very similar. Electronic
thermometers are accurate, easy to use, and measure the temperature in about 15 seconds.
Electronic thermometers are portable, can run on rechargeable batteries, or remain
plugged into an outlet. Electronic thermometers are equipped with a timer which signals
when the maximum temperature is reached. It will turn off automatically if not used in a
pre-set time frame. Probe covers are stored in the unit for convenience and the colorcoded probes are easily changed for taking oral or rectal temperatures. The probes are
designed so the medical assistant’s hand touches only the probe collar and not the actual
probe. When the measurement is completed, the probe cover is easily ejected into the
proper container.

Hints for completing the Oral Temperature (Electronic Thermometer) Do It
exercises
Users are asked to choose the proper supplies, select the proper color probe, use a probe
cover for safety, and position the probe tip properly to obtain the desired reading. When
the signal is heard, they must read the measurement and enter the answer in the box.
In order to
, the user must click on the probe to remove it from the
patient’s mouth. As in the previous discussion about disposable thermometers, disposal
of the probe cover into the biohazard container is correct.
Axillary and Rectal Temperature
Self-contained digital thermometers are popular in clinical practice. They are small,
convenient and easy to use. They vary slightly in style but all run on battery, show the
reading in an LCD window, have memory of the last temperature taken and take
approximately 60 seconds to read the temperature. Though probe covers for digital
thermometers have a paper strip that is peeled back when the thermometer is slipped into
the cover, in this program, for simplicity, it is sufficient for the user only to select a probe
cover for use prior to measuring the patient’s temperature.
Users will practice measuring an axillary and rectal temperature using a digital
thermometer. The Learn It sections describe instances when it is, and is not, appropriate
to take an axillary or rectal temperature.

Hints for completing the Axillary Temperature Do It exercises
When preparing the patient for taking an axillary reading, the user must first use click and
drag to prepare the axilla with a towel, if done properly, a pop up window with feedback
will instruct them to either close or next. They must select close to place the
thermometer.
Vital Signs: Notes for the User, page 9
When clicking on the thermometer, the towel will disappear and the user will be able to
drag the thermometer to the axilla. The feedback window will guide the next step.
Before entering the rectal or axillary reading, the thermometer must be removed from the
patient’s axilla or rectum.

Hints for completing the Rectal Temperature Do It exercises
The user must first select the proper supplies for taking an infant’s rectal temperature.
Clicking
takes allows them to select the correct picture for positioning of
patient and thermometer. The child’s buttocks must be spread, the thermometer must be
on, and inserted to the correct depth.
When the signal is heard, the user must click on the thermometer to remove it from the
rectum, type the reading in the answer box then click
to receive feedback.
Aural Temperature
The hypothalamus maintains homeostasis or the body’s status quo, which includes
temperature. The hypothalamus and the tympanic membrane share the same blood supply
Therefore, when done correctly, an aural, or tympanic, measurement is the most accurate
representation of the patient’s temperature. An aural thermometer is very convenient as it
is not affected by food or drink temperature, access is usually available, and within 2
seconds, you have a reading. The disadvantage is that if there is excessive cerumen or the
probe tip is not pointing at the tympanic membrane, the temperature measurement will be
inaccurate. Users will learn when it is, and is not; appropriate to take a pt’s temperature,
as well as the importance of proper tip angle.

Hints for completing the Aural Temperature Do It exercises
The tip must be removed from the patient’s ear before clicking
If the user
receives an incorrect answer feedback, they may have chosen an incorrect thermometer
position in the previous screen, and must go back to re-select the correct positioning.
Pulse
Users will learn to take a radial, apical and carotid pulse and the reasoning for each. The
user will need to asses the patient and the situation to decide the correct pulse point to
use. Users will also be instructed in the proper recording of results for the different pulse
points. Also discussed, though not in detail, are the TPR ratio and pulse deficit. The
instructor may need to provide further information in that regard.
Radial Pulse
Vital Signs: Notes for the User, page 10
Users are instructed when it is appropriate to measure the radial pulse and where to find
the pulse point. The program allows the user to measure the pulse for 15, 30 or 60
seconds, just as they will find in clinical practice. An allowance of plus or minus 2 beats
is made for the correct answer.

Hints for completing the Radial Pulse Do It exercises
As it is impossible to actually feel a pulse in a computer program, the pulsations are
simulated with a visible artery pulsing in the patient’s wrist. It is a bit more difficult, and
takes a little practice, to watch the pulsing and the timing of the pulse than it is to actually
measure the pulse in a real clinical situation. It may require a bit more practice on the
user’s part to count the pulse in this manner. An extra session allowing the users to find
each other’s pulse, or even their own, will allow the users to experience the variations in
volume and rhythm while measuring a patient’s pulse.
Apical Pulse
An apical pulse is generally measured in adults when the radial pulse is irregular, or in
patients with known cardiovascular disease or in patients who are taking cardiac
medications. This may be an excellent time to teach more in depth about a pulse deficit.
Users are instructed to find the apical pulse point by palpating the ribs or by
approximating the position by placing the medical assistant’s hand on the chest. The
pulse point can be approximated using either hand. Both are correct. The right hand is
chosen for this learning program.
In a baby, obviously, the medical assistant’s hand is far too large to use in approximating
the apical pulse point. The pulse is heard just below the left nipple.
Carotid Pulse
In an emergency, the carotid artery is the best site to assess the patient’s pulse. It is
usually only counted for 15 seconds checking quickly for rate or irregularities.

Hints for completing the Carotid Pulse Do It exercises
Again, as it is impossible to actually feel a pulse in a computer program, the pulsations
are simulated with a visible artery pulsing in the patient’s neck. It is a bit more difficult,
and takes a little practice, to watch the pulsing and the timing of the pulse than it is to
actually measure the pulse in a real clinical situation. It may require a bit more practice
on the user’s part to count the pulse in this manner. An extra session allowing the users to
find each other’s pulse, or even their own, will allow the users to experience the
variations in volume and rhythm while measuring a patient’s carotid pulse.
Respirations
Vital Signs: Notes for the User, page 11
Respirations are normally measured when the patient is unaware that his or her breathing
is being observed. Users are instructed that although they practice it as a separate skill in
this program, in clinical practice, they will count the pulse for 30 seconds and count
respirations for the following 30 seconds. A tip for remembering the pulse while counting
respirations is given for counting both vital signs, which can be reinforced while users are
practicing on each other.
Blood Pressure
When measuring blood pressure, users are taught to measure the palpatory systolic
pressure prior to the auscultory pressure. The palpated systolic pressure can be measured
either at the radial artery or at the brachial artery pulse point. Both are correct and both
methods are shown. For simplicity and continuity, the user will practice taking the
palpated systolic pressure at the brachial artery site, since they will need to know the
location of the brachial pulse point for placement of the diaphragm when taking the
auscultory blood pressure.

Hints for completing the Blood Pressure Do It exercises
When taking the palpated systolic pressure, the pulse will be simulated by a beating heart.
Again, it is a bit more difficult having to watch both the beating heart and the pressure
gauge than in clinical practice where the brachial pulse is felt while watching the gauge.
Individuals normally will see and hear just slightly different, therefore it is acceptable to
obtain a reading within a range of plus or minus 2 mm of Hg.
When taking the auscultory pressure, the pulse is audible. Again, as individuals hear and
see at a slightly different rate, the same range of plus or minus two is allowed for the
correct answer.
Vital Signs: Notes for the User, page 12