iHuman Case Study: John, a 50-Year-Old Male with Worsening
Dyspnea, Fever, and Cough – Comprehensive Clinical
Assessment,Differential Diagnosis & Evidence-Based Management for
High iHuman Scores
Explore a comprehensive iHuman case study of John, a 50-year-old male presenting with worsening
dyspnea, fever, and cough. Includes, focused respiratory assessment, differential diagnosis, diagnostic
testing, and evidence-based treatment strategies designed to help nursing and advanced practice students
achieve top iHuman scores.
• iHuman case study John
• 50 year old male dyspnea fever cough
• iHuman adult respiratory case
• iHuman clinical reasoning case
Patient: John M.
Age: 50 years
Sex: Male
Chief Complaint: “I’m short of breath and can’t stop coughing.”
S – Subjective Data
History of Present Illness (HPI)
John is a 50-year-old male who presents with worsening shortness of breath, productive cough, and fever for
the past 5 days. He reports that symptoms began with mild fatigue and dry cough, which has progressively
worsened. He now experiences dyspnea at rest, increased coughing with yellow-green sputum, and pleuritic
chest discomfort when coughing. Fever has ranged between 100.8°F–102°F at home and is partially relieved
with acetaminophen. He denies hemoptysis but reports chills and night sweats. No recent travel, but he reports
exposure to coworkers with respiratory illness.
Associated Symptoms
• Positive: Fever, chills, fatigue, productive cough, dyspnea, chest tightness
• Negative: Hemoptysis, wheezing history, leg swelling, palpitations, nausea, vomiting
Page 1 of 32
,Past Medical History
• Hypertension (10 years)
• Type 2 diabetes mellitus
• No history of asthma or COPD
Past Surgical History
• Appendectomy (age 25)
Medications
• Lisinopril 20 mg PO daily
• Metformin 500 mg PO twice daily
• Acetaminophen PRN fever
Allergies
• NKDA
Social History
• Former smoker (20 pack-years; quit 5 years ago)
• Occasional alcohol use
• Lives with spouse
• Works in an office setting
Family History
• Father: Coronary artery disease
• Mother: Type 2 diabetes
• No family history of lung disease
Review of Systems (ROS)
• General: Fever, fatigue, chills
• Respiratory: Cough, dyspnea, sputum production
• Cardiac: Denies chest pain unrelated to coughing
• GI: Denies nausea or vomiting
• Neuro: Denies dizziness or syncope
O – Objective Data
Vital Signs
Page 2 of 32
, • Temperature: 101.6°F (38.7°C)
• Blood Pressure: 138/86 mmHg
• Heart Rate: 108 bpm
• Respiratory Rate: 26 breaths/min
• Oxygen Saturation: 89% on room air
Physical Examination
General
Ill-appearing male in mild to moderate respiratory distress; using accessory muscles.
HEENT
• No nasal flaring
• Mucous membranes moist
Lungs
• Decreased breath sounds in right lower lobe
• Crackles (rales) noted bilaterally, worse on right
• Dullness to percussion in right lower lung field
Cardiovascular
• Tachycardic
• Regular rhythm
• No murmurs
Abdomen
• Soft, non-tender, normal bowel sounds
Extremities
• No edema
• No calf tenderness
Neurological
• Alert and oriented ×3
Diagnostic Data
• CBC: WBC 15,200/mm³ (elevated)
• Chest X-ray: Right lower lobe infiltrate
• ABG: Mild respiratory alkalosis with hypoxemia
• COVID/Influenza testing: Pending
A – Assessment
Primary Diagnosis
Page 3 of 32
, Community-Acquired Pneumonia (CAP)
• Supported by fever, productive cough, hypoxia, elevated WBC, and lobar infiltrate
Differential Diagnoses
1. Acute Bronchitis – Less likely due to hypoxia and infiltrate
2. Pulmonary Embolism – No risk factors or unilateral leg swelling
3. Heart Failure Exacerbation – No edema or cardiac history
4. COVID-19 Infection – Pending test
P – Plan
Diagnostics
• Blood cultures ×2 before antibiotics
• Sputum culture
• Repeat pulse oximetry
• COVID-19 and influenza testing
Medications
• IV Ceftriaxone + Azithromycin (empiric CAP treatment)
• Acetaminophen for fever
• Albuterol nebulizer PRN for dyspnea
Oxygen Therapy
• Start 2–4 L nasal cannula to maintain SpO₂ ≥ 92%
Nursing Interventions
• Monitor respiratory status every 2 hours
• Encourage coughing and deep breathing
• Incentive spirometry
• Strict intake and output monitoring
Patient Education
• Importance of completing antibiotics
• Smoking cessation reinforcement
• Pneumococcal and influenza vaccination education
• Warning signs requiring immediate care (increasing SOB, chest pain)
Disposition
Page 4 of 32
Dyspnea, Fever, and Cough – Comprehensive Clinical
Assessment,Differential Diagnosis & Evidence-Based Management for
High iHuman Scores
Explore a comprehensive iHuman case study of John, a 50-year-old male presenting with worsening
dyspnea, fever, and cough. Includes, focused respiratory assessment, differential diagnosis, diagnostic
testing, and evidence-based treatment strategies designed to help nursing and advanced practice students
achieve top iHuman scores.
• iHuman case study John
• 50 year old male dyspnea fever cough
• iHuman adult respiratory case
• iHuman clinical reasoning case
Patient: John M.
Age: 50 years
Sex: Male
Chief Complaint: “I’m short of breath and can’t stop coughing.”
S – Subjective Data
History of Present Illness (HPI)
John is a 50-year-old male who presents with worsening shortness of breath, productive cough, and fever for
the past 5 days. He reports that symptoms began with mild fatigue and dry cough, which has progressively
worsened. He now experiences dyspnea at rest, increased coughing with yellow-green sputum, and pleuritic
chest discomfort when coughing. Fever has ranged between 100.8°F–102°F at home and is partially relieved
with acetaminophen. He denies hemoptysis but reports chills and night sweats. No recent travel, but he reports
exposure to coworkers with respiratory illness.
Associated Symptoms
• Positive: Fever, chills, fatigue, productive cough, dyspnea, chest tightness
• Negative: Hemoptysis, wheezing history, leg swelling, palpitations, nausea, vomiting
Page 1 of 32
,Past Medical History
• Hypertension (10 years)
• Type 2 diabetes mellitus
• No history of asthma or COPD
Past Surgical History
• Appendectomy (age 25)
Medications
• Lisinopril 20 mg PO daily
• Metformin 500 mg PO twice daily
• Acetaminophen PRN fever
Allergies
• NKDA
Social History
• Former smoker (20 pack-years; quit 5 years ago)
• Occasional alcohol use
• Lives with spouse
• Works in an office setting
Family History
• Father: Coronary artery disease
• Mother: Type 2 diabetes
• No family history of lung disease
Review of Systems (ROS)
• General: Fever, fatigue, chills
• Respiratory: Cough, dyspnea, sputum production
• Cardiac: Denies chest pain unrelated to coughing
• GI: Denies nausea or vomiting
• Neuro: Denies dizziness or syncope
O – Objective Data
Vital Signs
Page 2 of 32
, • Temperature: 101.6°F (38.7°C)
• Blood Pressure: 138/86 mmHg
• Heart Rate: 108 bpm
• Respiratory Rate: 26 breaths/min
• Oxygen Saturation: 89% on room air
Physical Examination
General
Ill-appearing male in mild to moderate respiratory distress; using accessory muscles.
HEENT
• No nasal flaring
• Mucous membranes moist
Lungs
• Decreased breath sounds in right lower lobe
• Crackles (rales) noted bilaterally, worse on right
• Dullness to percussion in right lower lung field
Cardiovascular
• Tachycardic
• Regular rhythm
• No murmurs
Abdomen
• Soft, non-tender, normal bowel sounds
Extremities
• No edema
• No calf tenderness
Neurological
• Alert and oriented ×3
Diagnostic Data
• CBC: WBC 15,200/mm³ (elevated)
• Chest X-ray: Right lower lobe infiltrate
• ABG: Mild respiratory alkalosis with hypoxemia
• COVID/Influenza testing: Pending
A – Assessment
Primary Diagnosis
Page 3 of 32
, Community-Acquired Pneumonia (CAP)
• Supported by fever, productive cough, hypoxia, elevated WBC, and lobar infiltrate
Differential Diagnoses
1. Acute Bronchitis – Less likely due to hypoxia and infiltrate
2. Pulmonary Embolism – No risk factors or unilateral leg swelling
3. Heart Failure Exacerbation – No edema or cardiac history
4. COVID-19 Infection – Pending test
P – Plan
Diagnostics
• Blood cultures ×2 before antibiotics
• Sputum culture
• Repeat pulse oximetry
• COVID-19 and influenza testing
Medications
• IV Ceftriaxone + Azithromycin (empiric CAP treatment)
• Acetaminophen for fever
• Albuterol nebulizer PRN for dyspnea
Oxygen Therapy
• Start 2–4 L nasal cannula to maintain SpO₂ ≥ 92%
Nursing Interventions
• Monitor respiratory status every 2 hours
• Encourage coughing and deep breathing
• Incentive spirometry
• Strict intake and output monitoring
Patient Education
• Importance of completing antibiotics
• Smoking cessation reinforcement
• Pneumococcal and influenza vaccination education
• Warning signs requiring immediate care (increasing SOB, chest pain)
Disposition
Page 4 of 32
