Reference no: EM133590847

Case Study: W.K. is a 56-year-old general contractor who is admitted to your telemetry unit directly from his internist's office with a diagnosis of chest pain. On report, you are informed that he has an intermittent 2-month history of chest tightness with substernal burning that radiates through to the mid back off and on, in a stabbing fashion. Symptoms occur after a large meal; with heavy lifting at the construction site; and in the middle of the night when he awakens from sleep with coughing, shortness of breath, and a foul,

bitter taste in his mouth. Recently he has developed nausea, without emesis, that is worse in the morning or after skipping meals. He reports having "heartburn" three or four times a day. When this happens, he takes a couple of Rolaids or Tums. He keeps a bottle at home, at the office, and in his truck. Vital signs (VS) at his physician's office were 130/80 lying, 120/72 standing, 100, 20, 37C, Spo2 92% on room air. A 12-lead electrocardiogram (ECG) showed normal sinus rhythm with a rare premature ventricular

contraction (PVC).

Questions:

1. List and provide rationale for 5 pertinent aspects of W.K.'s HPI? 
2. What additional questions (3) would you ask W.K. to better evaluate his pain?