Potential Health Complication: Stroke Case Study PPT 2022

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Mr. Tomasi Joni Case Study
Potential Health Complication: Stroke
Student Name:
Student ID:
Introduction
 Human beings are prone to health complications. The
complications likely to be developed in daily lives are
determined by several factors. Some include family
medical history, past patient medical history, lifestyles
and occupation.
 For this presentation, an analysis of Mr. Tomasi Joni Case
Study has been done to determine one of the health
complications he is likely to develop based on the
provided information.
 A discussion of the potential health complication for Mr.
Tomasi Joni has been discussed by the use of the “Levett-
Jones’ (2018) Clinical Reasoning Cycle Steps 1-6”.
Running head: MR. TOMASI CASE
STUDY

MR. TOMASI CASE STUDY 2
Step 1: “Consideration of the facts
from the patient situation”
 This step involves an analysis of the current situation of
the patient. The current analysis of Mr. Tomasi Joni
medical status reveals the following information.
 His blood pressure is 142/96mmHg. Blood pressure refers
to the exerted force on the blood vessels walls by the
circulating blood (James et al, 2014). It is generally
referred to as the arterial pressure. The heart rate is HR
96bpm.
 A normal heart rate should range from 60bpm to 100bpm
(Billman, 2011).
 A retention rate of 22bpm and a body temperature of
36.7 degree Celsius are normal.
 SpO2 96% on RA is also normal since it should range
between 95% and 100% normally.

MR. TOMASI CASE STUDY 3
Step 2: “Collection of information”
This step involves the consideration of the past medical history of a patient,
the current plan for treatment and the results obtained based on the
investigations done (Hunter & Arthur, 2016).
Mr. Tomasi Joni has a past history of hypertension, gout, Acute Myocardial
Infarction (AMI) and Obstructive Sleep Apnea (OSA).
His medications include Metoprolol, Aspirin, and Allopurinol.
The current investigation reveals the following results for Mr. Tomasi Joni.
His weight is 93 kilograms, height is 1.7 meters and there is evidence of
abdominal fats being excess. The waist circumference is also 104
centimetres. This means that he is obese.
His total level of cholesterol is 9.2mmol/L. This is a high level of cholesterol
since the normal cholesterol level should be 5mmol/L or less for healthy
adults (Cook, 2015).
His fasting blood glucose level is 9.6mmol/L. A high fasting blood glucose
level above 7.0mmol/L is considered to be risky.
His Urine Albumin-to-Creatinine Ratio (Urine ACR) is 10mg/mmol. This Urine
ACR level signifies Microalbuminuria.

MR. TOMASI CASE STUDY 4
Step 3: “The gathered information processing”
 This step involves the processing of the patient’s current health status
gathered information considering the patterns of pharmacology and
pathophysiology in order to come up with a relevant decision.
 Based on the gathered information, the following conclusions about Mr.
Tomasi Joni’s current health status can be drawn.
 His blood pressure is high at 142/96mmHg.
 His heart rate 96bpm, RR 22bpm, SpO2 96% on RA and body
temperature of 36.7 degree Celsius are normal (Nunan, Sandercock &
Brodie, 2010).
 He is also obese. This is because his body mass index of 32.18 exceeds
30 which is considered to be obese.
 His cholesterol level is also high at 9.2mmol/L since it exceeds the
normal cholesterol level which should be 5.0mmol/L or below.
 Also, his fasting blood glucose level is high at 9.6mmol/L since it is above
the normal level of 7.0mmol/L.
 His Urine ACR of 10mg/mmol indicates his kidney is moderately damaged
which signifies Microalbuminuria.

MR. TOMASI CASE STUDY 5
Step 4: “Identifying the problem”
 This step involves the identification of the possible health complication based
on the gathered and processed patient information.
 From the gathered and processed data, Mr. Tomasi Joni’s one possible health
complication is Stroke. This health complication results when the blood
supply to the brain is interfered with reducing oxygen and nutrients supply to
the brain tissues (Epshtein, Ofek & Wexler, 2010).
 The health complication can be justified by the following evidence which
includes the causes of stroke.
 Mr. Tomasi Joni’s blood pressure is high at 142/96mmHg.
 He is obese. Obesity is a cause of stroke.
 He also smokes to relieve stress from his demanding mechanical engineering
job. Cigarette smoking or even the second-hand smoke is a cause of stroke.
 He has moderate Obstructive Sleep Apnea and hence required to use
“Continuous Positive Airway Pressure (CPAP)” for overnight sleep. Obstructive
Sleep Apnea is also a cause of stroke.
 He has a past medical history of hypertension and takes the Metoprolol
dosage which treats hypertension. Hypertension is a major cause of stroke.

MR. TOMASI CASE STUDY 6
Step 4: Continuation...
 His cholesterol level is also high at 9.2mmol/L. High
cholesterol is also a cause of stroke.
 There is also a family medical history of stroke.
 The consequences of a stroke to Mr. Tomasi Joni are the
likelihood of the blood supply interference to the brain. A
reduction in blood supply to the brain reduces oxygen
and nutrients supply to the brain tissue and this makes
the brain cells to start dying. Stroke may cause death if
not treated immediately.
 Therefore, from the above-discussed causes which
include obstructive sleep apnea, smoking, obesity,
hypertension and high cholesterol level, one potential
health complication which Mr. Tomasi Joni is prone to, is
Stroke.

MR. TOMASI CASE STUDY 7
Step 5: “Goals establishment”
 This step involves the identification of goals aimed at
treating the patient. Two goals to help Mr. Tomasi reduce
the risk of developing stroke have been identified under
this step as follows.
 The first goal is the control of high blood pressure
(hypertension). Hypertension is a major cause of stroke.
Mr. Tomasi Joni should aim at minimizing the risk factors
which cause hypertension such as stress and smoking.
 The second goal is to minimize the weight to a healthy
limit. One major cause of stroke is overweight or obesity
(Lavie et al, 2018). Overweight or obesity contributes to
stroke risk factors such as hypertension. Overweight
occurs when the body mass index is above 25. Mr. Tomasi
has a body mass index of 32.18 and is therefore obese.

MR. TOMASI CASE STUDY 8
Step 6: “Take action”
 This step involves a discussion of the interventions undertaken to achieve the set
goals. Actions are implemented in order to achieve the planned treatment goals.
 In order for Mr. Tomasi to achieve the set goal of controlling hypertension, the
following interventions should be observed.
 First, he should avoid smoking once stressed by his job because smoking itself is a
cause of stroke (Warlow et al, 2011).
 He should try to manage his time well and take some time to relax each day to
avoid stress (Glynn et al, 2010).
 He should also set realistic goals of what he can do every day and avoid much
straining.
 In order to achieve the set goal of losing weight to around 70 kilograms by Mr.
Tomasi Joni, the following interventions should be observed.
 He should spend at least 30 minutes doing physical exercise for at least four days
per week (Cornelissen & Smart, 2013).
 He should consume 25 to 30 grams of fibre on daily basis.
 He should drink enough water (6 to 8 glasses every day).
 He should eat foods with low-fat content, refined sugar and cholesterol.
 He should also consider eating calories during the first half of the day.
 His weight loss should be realistic. Sometimes he may not lose weight but he
should work in the right direction.

MR. TOMASI CASE STUDY 9
Step 6: Continuation...
 The following are the images for the take
action step:
Avoid Smoking, manage stress and enough
exercise.

MR. TOMASI CASE STUDY 10
Conclusion
 Human beings are prone to health complications which
are determined by various factors such as lifestyles,
occupation, family medical history and the patient past
medical history.
 From the provided case study, one of the potential
health complications likely to be developed by Mr.
Tomasi Joni has been identified to be stroke based on
the “Levett-Jones’ (2018) Clinical Reasoning Cycle
Steps 1-6”. Evidence for the above health complication
has been clearly drawn from the case study.
 A discussion of the goals to help Mr. Tomasi to reduce
the risk of developing stroke and interventions to
achieve the set goals has also been done.

MR. TOMASI CASE STUDY 11
References
 Billman, G. E. (2011). Heart rate variability–a historical perspective. Frontiers in physiology, 2, 86.
 Cole, T. J., & Lobstein, T. (2012). Extended international (IOTF) body mass index cut‐offs for thinness,
overweight and obesity. Pediatric obesity, 7(4), 284-294.
 Cook, R. P. (Ed.). (2015). Cholesterol: chemistry, biochemistry, and pathology. Elsevier.
 Cornelissen, V. A., & Smart, N. A. (2013). Exercise training for blood pressure: a systematic review
and meta‐analysis. Journal of the American Heart Association, 2(1), e004473.
 Epshtein, B., Ofek, E., & Wexler, Y. (2010, June). Detecting text in natural scenes with stroke width
transform. In 2010 IEEE Computer Society Conference on Computer Vision and Pattern
Recognition (pp. 2963-2970). IEEE.
 Glynn, L. G., Murphy, A. W., Smith, S. M., Schroeder, K., & Fahey, T. (2010). Interventions used to
improve control of blood pressure in patients with hypertension. Cochrane database of
systematic reviews, (3).
 Hunter, S., & Arthur, C. (2016). Clinical reasoning of nursing students on clinical placement: Clinical
educators' perceptions. Nurse education in practice, 18, 73-79.
 James, P. A., Oparil, S., Carter, B. L., Cushman, W. C., Dennison-Himmelfarb, C., Handler, J.,... &
Smith, S. C. (2014). 2014 evidence-based guideline for the management of high blood pressure in
adults: report from the panel members appointed to the Eighth Joint National Committee (JNC
8). Jama, 311(5), 507-520.
 Lavie, C. J., Laddu, D., Arena, R., Ortega, F. B., Alpert, M. A., & Kushner, R. F. (2018). Reprint of:
Healthy weight and obesity prevention: JACC Health Promotion Series. Journal of the American
College of Cardiology, 72(23), 3027-3052.
 Marshall, I. J., Wolfe, C. D., & McKevitt, C. (2012). Lay perspectives on hypertension and drug
adherence: systematic review of qualitative research. Bmj, 345, e3953.

MR. TOMASI CASE STUDY 12
References:
Continuation...
 Nunan, D., Sandercock, G. R., & Brodie, D. A. (2010). A
quantitative systematic review of normal values for short‐
term heart rate variability in healthy adults. Pacing and
clinical electrophysiology, 33(11), 1407-1417.
 Warlow, C. P., Van Gijn, J., Dennis, M. S., Wardlaw, J. M.,
Bamford, J. M., Hankey, G. J., ... & Rothwell, P.
(2011). Stroke: practical management. John Wiley &
Sons.