Health Assessment Chief Complaint: Shortness of Breath Allergies: NKDA History of Present Illness: 32 year old female appears

stated age and well groomed. Patient is sitting upright in chair and appears short of breath. Patient is alert and oriented to person, place, and time. PERRL. Speech clear, but needs frequent breaks in speech to breath. Temperature 98.4, pulse 88 and regular, blood pressure 136/68, respirations 22 and labored, O2 saturation 93%. Patient presents with shortness of breath. Patient states that onset of symptoms occurred one week ago. Patient has dry, nonproductive cough. Shortness of breath increases with activity. She rates her shortness of breath at a 9/10 and has trouble speaking in full sentences. This patient has been to the ER for asthma exacerbations twice in the past week. Medications: Pulmicort 180mcg 2 inhalations daily. Ibuprofen 400mg PO q6h PRN for pain, denies use of other OTC medication and herbal supplements. Past Medical History: asthma, pneumonia, anemia Past Surgical History: denies surgical history Family History: Maternal breast cancer, COPD; Paternal cystic fibrosis Social History: denies smoking, alcohol, and recreational drugs. Support system comprised of husband and three children. Review of Symptoms: Skin is pink, dry, and warm. Lips pink with moist mucus membranes. No rash, lesions, sores, bruises, or wounds noted. Nail beds are pink with capillary refill <2 seconds. No clubbing of nails noted. Eyes are blue and pupils are equal, round, and reactive to light. Conjunctivae pink. Denies pain. Lung sounds are diminished bilaterally throughout with wheezes in the upper lobes bilaterally. Patient has a dry, non-productive cough. Heart rate is regular with a pulse of 88. Abdomen is soft, tender, and non-distended. Bowel sounds noted in all four quadrants. Denies pain, burning, or difficulty voiding. Last BM was 4 hours ago. Movement of all four extremities is fluid without pain. Gait is steady.