0914: Client presents to the ED with his wife reporting headaches, palpitations, sweating, and an occasional tremor in his upper extremities. The client states that these are 'episodes' and usually occur after the client engages in strenuous activity or is under stress. The onset of these symptoms was months ago, and the client could not identify a concrete time frame. The client says he has increased his alcohol consumption from two standard glasses of wine daily to three because of the 'stress at work.' He often wakes up with an occasional headache. He says that the episodes have been occurring more often and that the headaches are frustrating because they do not abate with over-the-counter medications such as acetaminophen. He states that he doesn't have any other symptoms, except that he has been drinking more water lately, but attributes that to his work outside setting up a garden. He reports a weight loss of 2 kilograms (4.4 pounds) over the past month. His current body mass index is 23. His medical history includes iron deficiency anemia, herpes simplex virus, and irritable bowel syndrome. His medications include docusate, valacyclovir, and iron sucrose. He reports that his mother and father had a stroke because of high blood pressure, which makes him quite concerned. On assessment, the client is alert and fully oriented. Affect is cooperative. The peripheral pulses are +2. Lung sounds are diminished bilaterally. Bowel sounds were present in all four quadrants. He says he has a headache but cannot provide a numerical rating score, stating, 'it just hurts.' Vital signs: T 97.5° F (36.4° C), P 110, RR 18, BP 161/80, pulse oximetry reading 96% on room air.