Vital Signs and Physical Assessment
Normal findings and what the abnormal ones mean
Adult vital signs
| Temperature | ~97.8–99.1°F (36.5–37.3°C) oral; fever ≥100.4°F (38°C) |
| Pulse | 60–100/min |
| Respirations | 12–20/min |
| Blood pressure | <120/<80 mmHg |
| SpO₂ | 95–100% (most adults) |
Pulse pressure = systolic − diastolic (normal ~40). MAP = (SBP + 2 × DBP) ÷ 3; ≥65 needed for organ perfusion. Count irregular pulses for a full minute; apical pulse at the 5th intercostal space, midclavicular line.
Grading scales
| Pulses | Pitting edema | ||
|---|---|---|---|
| 0 | Absent | 1+ | 2 mm, rebounds quickly |
| 1+ | Weak, thready | 2+ | 4 mm, ~10–15 sec |
| 2+ | Normal | 3+ | 6 mm, >1 min |
| 3+ | Bounding | 4+ | 8 mm, 2–5 min |
Capillary refill normal <2–3 sec. Skin turgor is unreliable in older adults (check the sternum or forehead, or rely on other signs).
Lung sounds
| Vesicular | Soft, low; most of the lungs; inspiration > expiration |
| Bronchial | Loud, high; over the trachea; expiration > inspiration. Abnormal over the lung fields → consolidation |
| Crackles | Popping (fine or coarse), usually inspiration: fluid in alveoli (HF, pneumonia, atelectasis) |
| Wheezes | Musical, high-pitched: narrowed airways (asthma, COPD) |
| Rhonchi | Low snoring sound: secretions in large airways; may clear with coughing |
| Stridor | High-pitched, inspiratory, upper-airway obstruction: emergency |
| Friction rub | Grating, with breathing: pleural inflammation |
Heart sounds
- S1 ("lub"): mitral and tricuspid valves close; loudest at the apex.
- S2 ("dub"): aortic and pulmonic valves close; loudest at the base.
- S3: after S2; volume overload, heart failure (can be normal in children, young athletes, pregnancy).
- S4: before S1; stiff ventricle (hypertension, MI).
- Murmurs graded 1–6 (4+ has a palpable thrill).
Listening points: "APE To Man"
Aortic: 2nd ICS right sternal border · Pulmonic: 2nd ICS left · Erb's point: 3rd ICS left · Tricuspid: 4th–5th ICS left lower sternal border · Mitral: 5th ICS midclavicular (apex).
Abdomen
Order: inspect, auscultate, percuss, palpate (palpating first changes bowel sounds). Normal bowel sounds ~5–30/min. Listen up to 5 min in each quadrant before calling them absent. Palpate tender areas last.
Pain assessment (OLDCARTS)
Onset · Location · Duration · Character · Aggravating factors · Relieving factors · Timing · Severity (0–10). Reassess after interventions (e.g., 30–60 min after oral, 15–30 min after IV). Pain is what the patient says it is.