HEALTH HISTORY

COMMON OR CONCERNING
SYMPTOMS
• CHEST PAIN
• SHORTNESS OF BREATH ( DYSPNEA)
• WHEEZING
• COUGH
• BLOOD, STREAKED SPUTUM (HEMOPTYSIS)
• DAYTIME SLEEPINESS OR SNORING AND DISORDERED SLEEP
 CHEST PAIN
• Complaints of chest pain or chest discomfort raise concerns about heart
but often arise from other structures in the thorax and lungs.
Initial questions must be as open-ended as possible
Do you have any discomfort or unpleasant feelings in
your chest?
OLD CARTS, or Onset, Location, Duration, Character,
Aggravating/ Alleviating Factors, Radiation, and Timing
OR
OPQRST, or Onset, Palliating/Provoking Factors, Quality,
Radiation, Site, and Timing
 SHORTNESS OF BREATH
“DYSPNEA”
• Painless but uncomfortable awareness of breathing that is inappropriate to the level of exertion.
“Have you had any difficulty breathing?”
There is no absolute scale for quantifying shortness of breath. Instead, make every effort to
determine its severity based on the patient’s daily activities.
Anxious Patients
They may describe diffificulty taking a deep enough breath, a smothering sensation with inability to
get enough air, and paresthesias, which are sensations of tingling or “pins and needles” around the
lips or in the extremities.
Wheezes- musical respiratory sounds that may be audible to the patient and to others
 COUGH
Cough is a reflex response to stimuli that irritate receptors in the larynx,
trachea, or large bronchi. These stimuli include mucus, pus, blood, as well as
external agents such as allergens, dust, foreign bodies, or even extremely hot
or cold air.
ACUTE- Less than 3 weeks
SUBACUTE- Lasting 3 to 8 weeks
CHRONIC- More that 8 weeks
 COUGH
Ask whether the cough is dry or produces sputum, or phlegm.
MUCOID SPUTUM
Translucent, white or gray and seen in viral infections and cystic fibrosis

PURULENT SPUTUM
Yellow or green and is often accompanies bacterial pneumonia

Ask the patient to describe the volume of any sputum and its color, odor, and
consistency.
“How much do you think you cough up in
To help quantify the volume: 24 hours: a teaspoon, tablespoon, quarter
cup, half cup, cupful?”
 HEMOPTYSIS
Hemoptysis refers to blood coughed up from the lower respiratory tract; it
may vary from blood-streaked sputum to frank blood.
For patients reporting hemoptysis, quantify the volume of blood produced, the setting and activity,
and any associated symptoms. Hemoptysis is rare in infants, children, and adolescents.

Before using the term “hemoptysis,” try to confifirm the source of the bleeding. Blood or blood streaked
material may originate in the nose, mouth, pharynx, or gastrointestinal tract and is easily mislabeled. If
vomited, it probably originates in the gastrointestinal tract. Occasionally, however, blood from the
nasopharynx or the gastrointestinal tract is aspirated and then coughed out.
 DAYTIME SLEEPINESS OR SNORING
AND DISORDERED SLEEP
• Patients may report excessive daytime sleepiness and fatigue. Ask about
problems with snoring, witnessed apneas , awakening with a choking
sensation, or morning headache.