34. A client is brought to the psychiatric clinic by

Mr Jonathan Citizen is a 70-year-old male patient admitted to ED today via MICA. The patient lives with his son. Mr Citizen was having a conversation with his son when he suddenly reported feeling dizzy and unwell. Mr Citizen became unresponsive during the conversation which alarmed his son to call the ambulance. Upon admission a head-to-toe physical examination was conducted CNS: Drowsy but rousable to painful stimuli. Glasgow Coma Score 10. Reported seeing spiders crawling on the bed and walls. Afebrile, Temperature 36.5 C, pupils are equally active and reactive to light. Pain 0/10 CVS: BP 155/70; HR 65 Beats/min; pulses are present equal bilaterally in the upper and lower extremities. Bilateral lower extremities pitting oedema. Nil Juglar vein distension. Pale but warm and adequately perfused. Respiratory: Increased work of breathing, Sats 90% on room air GI: Abdomen distended. Last bowel action cannot be ascertained. Bowel sounds are present. Renal: adequate urine output 30ml/hr Endocrine: BGL=1.5 mmol/L Integumentary: Sclera and tip of nose are yellow Psychosocial: visited by son what is his possible past medical history

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