- 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
- Diseases:
- 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