CMA

Every patient encounter begins with intake: measuring vital signs, interviewing the patient, and documenting what you find in precise medical language. This section covers vital signs, medical terminology, the patient interview and documentation, health promotion and screening, complementary and alternative therapies, and nutrition. It corresponds to subcategory A of Clinical Competency, the exam's largest category.

Vital signs are objective measurements of the body's basic physiological functions. Medical assistants must measure, record, and report them accurately because they provide critical baseline data for patient assessment.

VitalSign	NormalAdultRange	KeyTerms
Temperature(oral)	97 .6–99 .6°F (36 .4–37 .6°C);	Fever(pyrexia)above1004°F(38°C);hyperthermiaabove104°F; .
	average986°F(37°C) .	hypothermiabelow95°F(35°C);febrilevs afebrile .
Pulse	60–100beatsperminute	Tachycardiaabove100bpm;bradycardiabelow60bpm
Respiration	12–20breathsperminute	Tachypneaabove20;bradypneabelow12;apnea(absenceof
		breathing)
Bloodpressure	Lessthan120/80mmHg	Elevated stage1andstage2hypertension(seebelow) ,
Pulseoximetry	SpO 95–100% 2	Below90%indicateshypoxemiarequiringintervention

Temperature

Body temperature reflects the balance between heat production and heat loss, and it varies with measurement site, time of day, activity level, and hormonal factors.

Site	Characteristics
Oral	Mostcommonsiteforadults
Axillary	Leastaccurate;readsabout1°Flowerthanoral
Rectal	Mostaccurate;readsabout1°Fhigherthanoral
Tympanic	Measuresinfraredenergyfromthetympanicmembrane
Temporalartery	Non-invasive; measures heat from blood flow through the temporal artery

Fever patterns include intermittent (fluctuates between normal and elevated), remittent (fluctuates but never returns to normal), continuous (remains elevated with minimal variation), and relapsing (febrile periods alternate with normal periods over days).

Pulse

The pulse is the pressure wave created when the left ventricle contracts and forces blood into the aorta. The radial artery on the thumb side of the wrist is the most common site for routine assessment. The apical pulse, heard over the apex of the heart at the fifth intercostal space at the midclavicular line, gives the most accurate heart rate. Assess rate (beats per minute), rhythm (regular or irregular), and quality or volume (weak, thready, bounding, or normal).

Respiration

Respiration is the exchange of oxygen and carbon dioxide between the atmosphere and body cells; one respiration equals one inhalation plus one exhalation. Assess rate, rhythm, and depth, ideally without the patient's awareness (for example, while appearing to continue counting the pulse). Dyspnea is difficult or labored breathing, and orthopnea is difficulty breathing while lying flat.

Pattern	Description
Eupnea	Normal unlaboredbreathing ,
Cheyne-Stokes Kussmaul Biot	Alternatingperiodsofapneaandhyperventilation Deep rapidbreathingassociatedwithdiabeticketoacidosis , Irregularbreathingwithperiodsofapnea

Blood Pressure

Blood pressure is the force exerted by blood against the arterial walls. Systolic pressure (the top number) reflects ventricular contraction, and diastolic pressure (the bottom number) reflects ventricular relaxation. Pulse pressure equals systolic minus diastolic pressure.

Adultbloodpressurecategories(Acc/Aha)

Category	Systolic(mmHg)		Diastolic(mmHg)
Normal	Lessthan120	and	Lessthan80
Elevated	120–129	and	Lessthan80
Stage1hypertension	130–139	or	80–89
Stage2hypertension	140orhigher	or	90orhigher
Severe(crisisrange)	Higherthan180	and/or	Higher than 120 — report to the provider immediately

When systolic and diastolic readings fall in different categories, the patient is classified by the higher category. A reading of 128/92 is stage 2 hypertension because the diastolic value is 90 or higher.

Korotkoff sounds are the five phases heard during measurement. Phase I, the first clear tapping sound, marks the systolic pressure; phase V, the disappearance of sound, marks the diastolic pressure in adults. The auscultatory gap is a silent interval that may occur between systolic and diastolic sounds, common in hypertensive patients; palpating the systolic pressure first prevents missing it.

Factors affecting blood pressure include age, weight, stress, medications, body position, arm position, cuff size, and recent activity. The cuff bladder should encircle about 80% of the arm circumference. A cuff that is too small produces a falsely high reading; a cuff that is too large produces a falsely low reading.

Pulse Oximetry, Pain, and Measurements

Pulse oximetry measures the oxygen saturation (SpO2) of hemoglobin in arterial blood. Accuracy is affected by nail polish, cold extremities, poor circulation, carbon monoxide poisoning, anemia, and excessive movement.

Pain is often called the fifth vital sign. Assessment tools include numeric rating scales (0–10), visual analog scales, the Wong-Baker FACES scale for children, and the FLACC scale for nonverbal patients. Documentation includes location, quality, intensity, onset, duration, aggravating factors, and relieving factors.

No pain Mild Moderate Severe Worst possible

Height, weight, and body mass index (BMI) are measured at intake. For infants and children, length or height, weight, and head circumference are plotted on growth charts to track development over time.