Short of breath
  Too tired
  The dwindles
  Weight loss
  Mom to be
  Very sociable
   Thanks To
 Mark W. Braun, MD

   Nutrition and Diagnosis-Related Care



Mr. Ruben James is an 84 year-old man who collapsed at home and was brought by ambulance to the hospital.
  • His wife indicates he had become very short of breath and then collapsed.
  • He has a 1 year history of congestive heart failure (CHF).
  • He has a history of hypertension, coronary atherosclerosis and myocardial infarction 5 years ago.
  • Physical exam:
    • Elderly man in acute distress
    • Height = 70", weight = 150#
    • T = 98F, pulse = 110, R = 28 (labored), PB = 90/70.
    • Rales in lung fields bilaterally.
      • Rales (RALLS) tend to be heard at the end of inspiration and sound like crackling leaves or hairs rubbing together.
      • They reflect the water in the alveolar spaces and are thought to be the sound of the collapsed alveoli snapping open.
    • Third heart sound is present
    • Jugular venous distension, liver is enlarged
    • Skin is moist and gray, 3+ pedal edema

Mr. James wife indicated her husband has had a poor appetite over then past 6 months, but she didn't think he had lost much weight. His difficulty with eating was due to nausea and shortness of breath.

When asked, Mr. James says: “I get enough to eat, I am just not very hungry.”

He was admitted to cardiac care and started on dopamine drip and IV diuretics.

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