SOB History

  • CC:
    • Onset: first time? When? Sudden\gradual? Continuous\intermittent? What were you doing?
    • Duration: how long does it last?
    • Timing: specific time of the day\night? How frequent?
    • Aggravating\relieving factors: rest vs exertion? Medications?
    • Severity: 1-10 scale? Wakes you up from sleep? Interfering w\ ADL? Able to lay flat? How may pillows do you use at night? How far can you walk before you get SOB?
  • Associated sx:
    • Constitutional: fever, wt loss, loss of appetite, night sweats, chills, lymphadenopathy?
    • Resp: orthopnea, PND, cough, chest pain?
    • Cardiac: sweating, palpitation, loss of consciousness?
    • VTE: history of immobilization, leg swelling?
    • GI: abdominal pain, N\V, heartburn, change of BM?
  • PMHx:
    • Diseases:
      • Chronic ds (HTN, DM, DLP)
      • Heart or lung diseases
      • Prev heart attacks or strokes
      • Infections, malignancy
    • Medications: antihypertensive agents (diuretics), anticoagulants, home oxygen\inhalers
    • Surgery (prev cath or CABG), hospitalization, trauma
    • Blood transfusions, IV drug use, tattoos
    • Allergies
  • FMHx:
    • Similar complaint?
    • Same diseases as in PMHx?
    • Family Hx of premature CAD?
    • Family Hx of sudden cardiac death?
  • Social Hx:
    • Occupation, marital status, children?
    • Smoking, alcohol, recreational drugs?
    • Travel Hx, contact with sick pts
    • Diet, exercise
      • If already on heart failure meds, ask about compliance to fluid and salt intake

 

Question: The patient is taking ACEI and diuretics, if the patient presented with elevated BUN and hyperkalemia, what medication changes will you consider?

  • Change the ACEI to hydralazine and nitrates

 


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