Reference no: EM133522391
You are seeing John (age 70) 2 weeks after starting him on Citalopram. He says he has been feeling better "about things" and has met with a psychotherapist this past week. His son, Jim, reports that his father felt dizzy twice in the past 2 days. When you ask John what the dizziness felt like, he states that it is worse in the evening. He also reports feeling that the room is spinning, and sometimes feeling like he might faint. He reports never losing consciousness. He also complains of nausea and vomiting in the evening. He advises you about a new problem of feeling a choking sensation when he swallows food. He also advises you of a new problem of frequent urination with pain and a feeling of not being able to empty his bladder. He reveals to you that he is very afraid and experiences anxiety about having a fall.
PMH: PTSD, Depression, Osteopenia (right pelvis)
Social History: Lives alone in a 2 story home, widowed x 3 years, veteran, 1 son who lives in another state and visits once a month for a day
Medications: Daily multi-vitamin, Citalopram 20mg qd, St. John's Wort occasionally when feeling especially down, Advil prn for joint stiffness
What additional Review of Systems (ROS) questions would you want to ask?
What would you want to include in his physical exam? What diagnostics tests?
What are some possible reasons for dizziness?
What are possible reasons for the new bladder issues?
How might you want to manage him? What medications might you consider for his new symptoms? What interactions in medications would you want to consider?
What additional assessments would you consider for the complaints of difficulty swallowing?
What interventions, medication and otherwise, would you suggest for the nausea and vomiting?