NURS 6512 Week 7 i-
HUmaN CaSe StUdy: Jamie
FeldmaN 100
CompReHeNSive exam
QUeStioNS WitH aNSWeRS
aNd RatioNaleS
1
,2
, Case over view
Patient: Jamie Feldman
• Age: 67 years
• Sex: Female
• Height: 5'6" (168 cm)
• Weight: 174.0 lb (79.1 kg)
• BMI: 28.1 kg/m² (Overweight)
• Chief Complaint: "I just can't catch my breath anymore"
• Setting: Outpatient clinic with laboratory and imaging capabilities
Key Presentation Features: Progressive exertional dyspnea over 2 weeks with rapid worsening over 3 days,
orthopnea, paroxysmal nocturnal dyspnea, bilateral leg edema, dry cough, and fatigue. PMH includes hypertension
and hyperlipidemia.
SECTION 1: HISTORY OF PRESENT ILLNESS (HPI) – 20 Questions
1. What is the most important initial question to ask about the onset of Jamie's shortness of
breath?
• Answer: "When exactly did the shortness of breath start, and was it sudden or gradual?"
• Rationale: Determining onset distinguishes between acute (pulmonary embolism,
pneumonia) and chronic (heart failure, COPD) conditions. Jamie reports gradual onset
over 2 weeks with rapid worsening over 3 days, suggesting acute decompensation of a
chronic process.
2. What question helps differentiate cardiac from pulmonary causes of dyspnea?
• Answer: "Does lying flat make your breathing worse?" (Orthopnea)
• Rationale: Orthopnea (dyspnea worse when supine) is a classic sign of heart failure.
Jamie reports needing to prop up with pillows, indicating orthopnea. Pulmonary causes
typically do not cause significant orthopnea.
3. What is the significance of asking about Paroxysmal Nocturnal Dyspnea (PND)?
• Answer: "Do you wake up at night gasping for air?"
3
HUmaN CaSe StUdy: Jamie
FeldmaN 100
CompReHeNSive exam
QUeStioNS WitH aNSWeRS
aNd RatioNaleS
1
,2
, Case over view
Patient: Jamie Feldman
• Age: 67 years
• Sex: Female
• Height: 5'6" (168 cm)
• Weight: 174.0 lb (79.1 kg)
• BMI: 28.1 kg/m² (Overweight)
• Chief Complaint: "I just can't catch my breath anymore"
• Setting: Outpatient clinic with laboratory and imaging capabilities
Key Presentation Features: Progressive exertional dyspnea over 2 weeks with rapid worsening over 3 days,
orthopnea, paroxysmal nocturnal dyspnea, bilateral leg edema, dry cough, and fatigue. PMH includes hypertension
and hyperlipidemia.
SECTION 1: HISTORY OF PRESENT ILLNESS (HPI) – 20 Questions
1. What is the most important initial question to ask about the onset of Jamie's shortness of
breath?
• Answer: "When exactly did the shortness of breath start, and was it sudden or gradual?"
• Rationale: Determining onset distinguishes between acute (pulmonary embolism,
pneumonia) and chronic (heart failure, COPD) conditions. Jamie reports gradual onset
over 2 weeks with rapid worsening over 3 days, suggesting acute decompensation of a
chronic process.
2. What question helps differentiate cardiac from pulmonary causes of dyspnea?
• Answer: "Does lying flat make your breathing worse?" (Orthopnea)
• Rationale: Orthopnea (dyspnea worse when supine) is a classic sign of heart failure.
Jamie reports needing to prop up with pillows, indicating orthopnea. Pulmonary causes
typically do not cause significant orthopnea.
3. What is the significance of asking about Paroxysmal Nocturnal Dyspnea (PND)?
• Answer: "Do you wake up at night gasping for air?"
3
