NR 603 Advanced Clinical Diagnosis and
Practice Across the Lifespan ACTUAL
EXAM | Week 2 Case Discussion Pulmonary
Part One | Complete Case Analysis & Study
Guide | Chamberlain University | Verified
Q&A | Pass Guaranteed - A+ Graded
PART 1: CHIEF COMPLAINT AND HISTORY OF PRESENT
ILLNESS (HPI)
Chief Complaint (CC)
"I've been coughing for 3 weeks and getting more short of breath, especially when I climb stairs or
carry groceries."
History of Present Illness (HPI) – OLDCARTS Framework
Table
,Component Assessment Findings
Onset Gradual onset over past 3 weeks; initially noticed mild cough,
progressively worsening
Location Chest, bilateral lungs; symptoms diffuse, not localized to one side
Duration Constant dry cough throughout day; dyspnea occurs with exertion and
when lying flat
Characteristics Dry, hacking, non-productive cough; dyspnea described as "can't catch
my breath"; no wheezing audible to patient
Aggravating Physical exertion (walking >1 block, climbing stairs, carrying groceries),
Factors lying flat (orthopnea – currently uses 2 pillows), cold air exposure, talking
for extended periods
Relieving Factors Rest, sitting upright or leaning forward, warm humidified air, avoidance of
activity
Timing Cough worse at night (awakens patient from sleep 2-3 times nightly);
dyspnea worse with afternoon/evening activity
, Severity Dyspnea: 6/10 at rest, 8/10 with exertion; Cough: 5/10; Impact: Unable to
complete usual 30-minute walk, requires stops when climbing single flight
of stairs, sleep disrupted
Associated Symptoms
Table
Present Absent (Pertinent Negatives)
Fatigue, decreased exercise No fever, chills → less likely acute bacterial infection
tolerance
Mild ankle swelling by evening No hemoptysis → less likely TB, lung cancer,
bronchiectasis
5-pound unintentional weight loss No chest pain → less likely PE, pericarditis,
over 1 month pneumothorax
Occasional morning headache No wheezing → less likely acute asthma exacerbation
No stridor → less likely upper airway obstruction
, No sputum production → less likely bacterial pneumonia,
bronchiectasis
💡 CHAMBERLAIN NOTE: The combination of progressive dyspnea on exertion, orthopnea, and dry
cough with absence of fever, chest pain, and wheezing should raise suspicion for interstitial lung
disease, heart failure with preserved ejection fraction (HFpEF), or early COPD rather than acute
infectious processes.
PART 2: PAST MEDICAL HISTORY, FAMILY HISTORY,
SOCIAL HISTORY
Past Medical History (PMH)
Table
Condition Clinical Relevance
Hypertension (diagnosed 5 years ago, poorly Risk factor for heart failure, diastolic
controlled) dysfunction
Type 2 Diabetes Mellitus (HbA1c 8.2% 3 months Increases risk of infections, cardiovascular
ago) disease
Practice Across the Lifespan ACTUAL
EXAM | Week 2 Case Discussion Pulmonary
Part One | Complete Case Analysis & Study
Guide | Chamberlain University | Verified
Q&A | Pass Guaranteed - A+ Graded
PART 1: CHIEF COMPLAINT AND HISTORY OF PRESENT
ILLNESS (HPI)
Chief Complaint (CC)
"I've been coughing for 3 weeks and getting more short of breath, especially when I climb stairs or
carry groceries."
History of Present Illness (HPI) – OLDCARTS Framework
Table
,Component Assessment Findings
Onset Gradual onset over past 3 weeks; initially noticed mild cough,
progressively worsening
Location Chest, bilateral lungs; symptoms diffuse, not localized to one side
Duration Constant dry cough throughout day; dyspnea occurs with exertion and
when lying flat
Characteristics Dry, hacking, non-productive cough; dyspnea described as "can't catch
my breath"; no wheezing audible to patient
Aggravating Physical exertion (walking >1 block, climbing stairs, carrying groceries),
Factors lying flat (orthopnea – currently uses 2 pillows), cold air exposure, talking
for extended periods
Relieving Factors Rest, sitting upright or leaning forward, warm humidified air, avoidance of
activity
Timing Cough worse at night (awakens patient from sleep 2-3 times nightly);
dyspnea worse with afternoon/evening activity
, Severity Dyspnea: 6/10 at rest, 8/10 with exertion; Cough: 5/10; Impact: Unable to
complete usual 30-minute walk, requires stops when climbing single flight
of stairs, sleep disrupted
Associated Symptoms
Table
Present Absent (Pertinent Negatives)
Fatigue, decreased exercise No fever, chills → less likely acute bacterial infection
tolerance
Mild ankle swelling by evening No hemoptysis → less likely TB, lung cancer,
bronchiectasis
5-pound unintentional weight loss No chest pain → less likely PE, pericarditis,
over 1 month pneumothorax
Occasional morning headache No wheezing → less likely acute asthma exacerbation
No stridor → less likely upper airway obstruction
, No sputum production → less likely bacterial pneumonia,
bronchiectasis
💡 CHAMBERLAIN NOTE: The combination of progressive dyspnea on exertion, orthopnea, and dry
cough with absence of fever, chest pain, and wheezing should raise suspicion for interstitial lung
disease, heart failure with preserved ejection fraction (HFpEF), or early COPD rather than acute
infectious processes.
PART 2: PAST MEDICAL HISTORY, FAMILY HISTORY,
SOCIAL HISTORY
Past Medical History (PMH)
Table
Condition Clinical Relevance
Hypertension (diagnosed 5 years ago, poorly Risk factor for heart failure, diastolic
controlled) dysfunction
Type 2 Diabetes Mellitus (HbA1c 8.2% 3 months Increases risk of infections, cardiovascular
ago) disease
