Week #7: Week #7 - Conditions of the Renal and Genitourinary
Systems
FILL OUT THIS TEMPLET AS YOU GO THROUGH THE I-HUMAN PATIENT MODULE SO
YOU KNOW WHAT YOU ARE DOING AS YOU GO.
YOU ARE ALL WELCOME!!!
Name: Ken Fowler
Age: 70 years
Sex: M
Ht: 5'10" (178.0 cm)
Wgt: 190 lb (86.0 kg) (BMI 27.3)
NOTES FROM i-HUMAN ASSESSMENT:
1) Observations: warm and sweaty
2) Chief complaint: Nausea and fatigue
QUESTIONS: (ask the patient up to 100 questions)
1) How can I help you today? "I went to see my doctor this morning because I
have been feeling bad for the past few days. I'm tired, with nausea & vomiting.
Well, he examined me and ordered some labs, and then told me that "kidneys
are failing," something about a big change in my creatinine and that I needed
to come to the emergency department. He told me to bring the test results
here with me. [Test results today: creatinine 3.2 mg/dL; 1 month ago Test
results 1.1 mg/dL; urine protein = 400 mg microalbuminuria] Do you
understand what all that means? I sure don't!"
2) Do you have any other symptoms or concerns we should discuss? I
also feel exhausted, probably from all the vomiting and not eating.
3) When did your nausea start? It started three days ago, I woke up feeling
nauseous and started throwing up everything I ate.
4) What are the events surrounding this start of your nausea and vomiting?
Nothing really happened that I can think of.
5) Do you have difficulty breathing? Uh… no.
6) When do you fatigue start? Just the last few days.
7) Do you have a problem with fatigue/tiredness? Yup
8) Does your fatigue come and go? No.
9) Have you gained or lost weight or intentionally, despite normal
appetite and exercise? Uh… no.
10) Have you gained weight? No.
P a g e 1 | 34
,11) Has there been a change in your urination frequency? Actually, I have been
peening less recently.
12) What is the color of urine, has it changed recently? It's usually fine, but I
have been peeing less recently
13) Does anything make your fatigue/tiredness better or worse? No.
14) Do you have pain anywhere? If so where? I hurt my back last week, but
that's fine now.
15) Have you noticed swelling in any part of your body? No
16) Can you tell me about any current or past medical problems she had? I have
high blood pressure. I take medications for that. I was told last month my
blood pressure has caused some kidney damage. Something about my
protein in my urine. Oh, about a week ago I pulled my back lifting a heavy
carton when I was cleaning out my garage. It was pretty painful so I took
something for the pain. My back is really pretty good right now, but then this
nausea vomiting began.
17) Any previous medical, surgical, or dental procedures? Yes. I had my tonsils
out as a kid and then my appendix out about 35 years ago now.
18) What treatments have you had for the pain in your back? Just Naproxen.
19) Are you taking any prescription medications? I take lisinopril, metoprolol,
and hydrochlorothiazide for BP. I have not taken anything for the last 24
hours because I feel so sick, can’t keep the pills down.
20) Do you have any pain in your back? Not anymore
21) When you urinate, have you noticed any pain, burning, blood, difficulty
starting or stopping, dribbling, incontinence, urgency during day or night, or
any changes in frequency? Uh, no. In fact, I am barely peeing at all.
22) When are the events surrounding the start of your difficulty urinating? That’s not a
problem for me.
23) When you pee, is a stream or flow of urine weak or do you dribble? No
24) Do you have problems with nausea, vomiting, constipation, diarrhea, coffee
grounds in your vomit, dark tarry stool, bright red blood in your bowel
movements, early satiety or bloating? Yes, I have already told you about my
nausea and vomiting. But none of the other stuff. My poop is normal
25) How severe is your nausea and/or vomiting? I have not eaten much of
anything in the last three days, so I am not sure how to answer that
question. Vomiting is and miserable business so for me it is bad.
26) Does anything make your nausea and/or vomiting better or worse? It
does get worse when I eat, that's why I haven't eaten much.
27) What treatments have you had for nausea and/or vomiting? Nothing
28) Do you have any problems with fatigue, difficulty sleeping, or intentional
weight loss or gain, fevers, or night sweats? Yeah I feel exhausted, but I think
it is because of my nausea… just keeps me up at night. No fevers
29) Does your fatigue/tiredness improve after a good night's rest? No
30) What does your vomit look like? Clear or residual food particles, but I
haven't eaten for over 24 hours
31) When do you nausea and/or vomiting start? It started 3 days ago, I woke up
feeling nauseous and started throwing up everything I ate.
P a g e 2 | 34
,32) Do you have diabetes? Uh… no.
P a g e 3 | 34
, 33) What are the events surrounding the start of your back pain? I picked up a
box the wrong way.
34) When was the last physical? Don't remember
35) Do you have kidney problems? Not up to now. My doctor sent me here
because he was worried about that.
HINT: 1 of 5
You have asked 10 key questions. 23 key questions
remain. You need:
4 more in Patient Orientation
4 more in Chief Complaint Sx/Sx Characteristics
3 more in Associated Symptoms
2 more in PMH
1 more in SH
9 more in ROS
Your current Hx efficiency is 9%.
36) What is your name? Ken Fowler
37) Where are you? In the Emergency Room
38) What time is it? Around 4:50 pm
39) How old are you? Didn’t you read my chart?
40) Do you leak urine (urine incontinence)? No.
41) When and what were the results of your last prostate exam? Not that long
ago. It was normal.
42) Does anything make you fatigue tiredness better or worse? No.
43) How often are you nauseous or vomiting? It’s just been the last few days.
44) What are the events surrounding your fatigue/tiredness? It started about
the same time as all the vomiting.
45) Do you have any other symptoms associated with your fatigue/tiredness?
Just a nasty I'm vomiting. I feel so weak with it
46) Do you become more weak or tired with exertion? I am so tired without
even doing anything.
47) Do you have any muscle pain or cramping? My back hurt last week, but it's
better now.
48) How much water/Floyd do you drink a day? It is hard to keep anything down,
I have not been able to drink even water.
49) Do you drink alcohol? If so, what do you drink and how many drinks per
day? I drink a glass of wine with dinner frequently once or twice per
week, but I have not done that for over a week now.
50) Do you now or have you ever smoked or chewed tobacco? I've never smoked
51) do you use any recreational drugs? If So what? Uh… no
52) Do you drink caffeine beverages or eat chocolate? Usually two cups of
coffee in the morning.
53) Do you have any allergies? No
P a g e 4 | 34
Systems
FILL OUT THIS TEMPLET AS YOU GO THROUGH THE I-HUMAN PATIENT MODULE SO
YOU KNOW WHAT YOU ARE DOING AS YOU GO.
YOU ARE ALL WELCOME!!!
Name: Ken Fowler
Age: 70 years
Sex: M
Ht: 5'10" (178.0 cm)
Wgt: 190 lb (86.0 kg) (BMI 27.3)
NOTES FROM i-HUMAN ASSESSMENT:
1) Observations: warm and sweaty
2) Chief complaint: Nausea and fatigue
QUESTIONS: (ask the patient up to 100 questions)
1) How can I help you today? "I went to see my doctor this morning because I
have been feeling bad for the past few days. I'm tired, with nausea & vomiting.
Well, he examined me and ordered some labs, and then told me that "kidneys
are failing," something about a big change in my creatinine and that I needed
to come to the emergency department. He told me to bring the test results
here with me. [Test results today: creatinine 3.2 mg/dL; 1 month ago Test
results 1.1 mg/dL; urine protein = 400 mg microalbuminuria] Do you
understand what all that means? I sure don't!"
2) Do you have any other symptoms or concerns we should discuss? I
also feel exhausted, probably from all the vomiting and not eating.
3) When did your nausea start? It started three days ago, I woke up feeling
nauseous and started throwing up everything I ate.
4) What are the events surrounding this start of your nausea and vomiting?
Nothing really happened that I can think of.
5) Do you have difficulty breathing? Uh… no.
6) When do you fatigue start? Just the last few days.
7) Do you have a problem with fatigue/tiredness? Yup
8) Does your fatigue come and go? No.
9) Have you gained or lost weight or intentionally, despite normal
appetite and exercise? Uh… no.
10) Have you gained weight? No.
P a g e 1 | 34
,11) Has there been a change in your urination frequency? Actually, I have been
peening less recently.
12) What is the color of urine, has it changed recently? It's usually fine, but I
have been peeing less recently
13) Does anything make your fatigue/tiredness better or worse? No.
14) Do you have pain anywhere? If so where? I hurt my back last week, but
that's fine now.
15) Have you noticed swelling in any part of your body? No
16) Can you tell me about any current or past medical problems she had? I have
high blood pressure. I take medications for that. I was told last month my
blood pressure has caused some kidney damage. Something about my
protein in my urine. Oh, about a week ago I pulled my back lifting a heavy
carton when I was cleaning out my garage. It was pretty painful so I took
something for the pain. My back is really pretty good right now, but then this
nausea vomiting began.
17) Any previous medical, surgical, or dental procedures? Yes. I had my tonsils
out as a kid and then my appendix out about 35 years ago now.
18) What treatments have you had for the pain in your back? Just Naproxen.
19) Are you taking any prescription medications? I take lisinopril, metoprolol,
and hydrochlorothiazide for BP. I have not taken anything for the last 24
hours because I feel so sick, can’t keep the pills down.
20) Do you have any pain in your back? Not anymore
21) When you urinate, have you noticed any pain, burning, blood, difficulty
starting or stopping, dribbling, incontinence, urgency during day or night, or
any changes in frequency? Uh, no. In fact, I am barely peeing at all.
22) When are the events surrounding the start of your difficulty urinating? That’s not a
problem for me.
23) When you pee, is a stream or flow of urine weak or do you dribble? No
24) Do you have problems with nausea, vomiting, constipation, diarrhea, coffee
grounds in your vomit, dark tarry stool, bright red blood in your bowel
movements, early satiety or bloating? Yes, I have already told you about my
nausea and vomiting. But none of the other stuff. My poop is normal
25) How severe is your nausea and/or vomiting? I have not eaten much of
anything in the last three days, so I am not sure how to answer that
question. Vomiting is and miserable business so for me it is bad.
26) Does anything make your nausea and/or vomiting better or worse? It
does get worse when I eat, that's why I haven't eaten much.
27) What treatments have you had for nausea and/or vomiting? Nothing
28) Do you have any problems with fatigue, difficulty sleeping, or intentional
weight loss or gain, fevers, or night sweats? Yeah I feel exhausted, but I think
it is because of my nausea… just keeps me up at night. No fevers
29) Does your fatigue/tiredness improve after a good night's rest? No
30) What does your vomit look like? Clear or residual food particles, but I
haven't eaten for over 24 hours
31) When do you nausea and/or vomiting start? It started 3 days ago, I woke up
feeling nauseous and started throwing up everything I ate.
P a g e 2 | 34
,32) Do you have diabetes? Uh… no.
P a g e 3 | 34
, 33) What are the events surrounding the start of your back pain? I picked up a
box the wrong way.
34) When was the last physical? Don't remember
35) Do you have kidney problems? Not up to now. My doctor sent me here
because he was worried about that.
HINT: 1 of 5
You have asked 10 key questions. 23 key questions
remain. You need:
4 more in Patient Orientation
4 more in Chief Complaint Sx/Sx Characteristics
3 more in Associated Symptoms
2 more in PMH
1 more in SH
9 more in ROS
Your current Hx efficiency is 9%.
36) What is your name? Ken Fowler
37) Where are you? In the Emergency Room
38) What time is it? Around 4:50 pm
39) How old are you? Didn’t you read my chart?
40) Do you leak urine (urine incontinence)? No.
41) When and what were the results of your last prostate exam? Not that long
ago. It was normal.
42) Does anything make you fatigue tiredness better or worse? No.
43) How often are you nauseous or vomiting? It’s just been the last few days.
44) What are the events surrounding your fatigue/tiredness? It started about
the same time as all the vomiting.
45) Do you have any other symptoms associated with your fatigue/tiredness?
Just a nasty I'm vomiting. I feel so weak with it
46) Do you become more weak or tired with exertion? I am so tired without
even doing anything.
47) Do you have any muscle pain or cramping? My back hurt last week, but it's
better now.
48) How much water/Floyd do you drink a day? It is hard to keep anything down,
I have not been able to drink even water.
49) Do you drink alcohol? If so, what do you drink and how many drinks per
day? I drink a glass of wine with dinner frequently once or twice per
week, but I have not done that for over a week now.
50) Do you now or have you ever smoked or chewed tobacco? I've never smoked
51) do you use any recreational drugs? If So what? Uh… no
52) Do you drink caffeine beverages or eat chocolate? Usually two cups of
coffee in the morning.
53) Do you have any allergies? No
P a g e 4 | 34
