Identifying Stroke Risk in Mr. Tomasi Joni: A Case Study Analysis

This case study examines Mr. Tomasi Joni, a 56-year-old patient presenting for an annual health check, to assess his risk of stroke. The analysis utilizes the Levett-Jones’ Clinical Reasoning Cycle to evaluate his laboratory results, lifestyle, health assessment, medical and family history. Key findings include elevated blood pressure, high cholesterol, elevated fasting blood glucose, and obesity, compounded by lifestyle factors such as smoking, alcohol consumption, and a sedentary lifestyle. The study identifies stroke as a likely health complication, supported by the presence of multiple risk factors including hypertension, hyperlipidemia, and a family history of stroke. Goals are established for non-pharmacological interventions like physical exercise and dietary changes, alongside pharmacological management of hypertension. The case emphasizes the critical role of the Clinical Reasoning Cycle in patient assessment, diagnosis, and treatment, highlighting the importance of comprehensive health evaluations and targeted interventions to mitigate the risk of stroke and other health complications. The study concludes with recommendations for lifestyle modifications and medical interventions to prevent the onset of stroke.

IDENTIFICATION OF POTENTIAL HEALTH COMPLICATION: STROKE
MR. TOMASI JONI CASE STUDY
STUDENT NAME:
STUDENT ID:

introduction
 Diseases are inevitable to Human beings and as long as you living in the modern
world you are prone to several health complications.
 Morever , there are some complication more prevalent to some individuals
compared to others. Some of the increasing the prevalence of medical
conditions compared to others include genetic factors and family medical
history, past patient medical history, and lifestyles.
 The latter being common in the modern world. Lifestyle diseases are linked to
the way people live, their behaviors such as alcohol, smoking and other drug
abuse, sedentary lifestyle, occupation among other daily activities defining
oneself living.
 The script presentation represents a case study for Mr. Tomasi Joni who
presented his GP clinic for his annual health check. The preview for his
laboratory test and lifestyle assessment will be used to determine one of the
health complications he is likely to develop based on the provided information.
 The assessment for the potential health complication for Mr.Tomasi Joni will be
debated by the use of the “Levett-Jones’ (2018) Clinical Reasoning Cycle Steps

Step 1: “Consideration of the Patient’s
situation facts”
 This step involves an analysis of the current situation of the patient. According to the current
analysis of Mr. Tomasi from Joni medical clinic, the following information can be gathered.
Laboratory assessment
 Mr. Tomasi blood pressure is 142/96mmHg, heart rate is at HR 96bpm. retention rate of 22bpm and a
body temperature of 36.7
Lifestyle
 Mr. Tomasi is currently 56 years indicating he is old.is working overtime indicating his work is
stressful. He has no enough time to exercise and engages his life by drinking smoking. He takes
takeaway foods most of the times.
Health assessment
 Mr. Tomasi height is 1.7 m and weight is 93kg hence BMI. Of 32 ,Total cholesterol level is at 9.2
mmol/l , fasting BGL is 9.6mmol/L and Albumin to creatine Ratio for Mr. Tomasi is 10mg/mmol
Medical history
 Mr. Joni has a health history of hypertension, gout and Acute myocardial infarction( AMI). He is also
suffering from moderate Obstructive Sleep and takes CPAP for overnight sleep. Mr. Joni medications
include Metoprolol, Aspirin, and Allopurinol.
Family history
 Mr. Tomasi father has a history of hyperlipidemia and stroke.

Step 2: “Collection of information”
This step involves the consideration of the past medical history of the patient.
 Mr. Tomasi Joni has a 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
 His weight is 93 kilograms, height is 1.7 meters and there is evidence of
 abdominal fats being excess. The waist circumference is also 104centimeters. 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.

Continuation
 His weight is 93 kilograms, height is 1.7 meters and there is evidence of
 abdominal fats being excess. The waist circumference is also
104centimeters. 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.

 This step involves the processing of the patient’s current health status is 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, Retention Rate is 22bpm
and SpO2 96%
 His cholesterol level is also high at 9.2mmol/L since it exceeds the normal range
 His fasting blood glucose level is high at 9.6mmol/
 His Urine ACR of 10mg/mmol indicates his kidney is moderately damaged which
 signifies Microalbuminuria.
 body temperature of 36.7degree Celsius

.Step 4: “Identifying the
problem” This step involves the identification of the possible health complication for Mr.
Tomasi based on the gathered and processed patient information.
 One of Mr. Tomasi Joni’s one possible health complication is identified is Stroke
 According to research carried out by O'donnell et.al (2010) stroke risk factors
include overweight or obese, lack or reduce physical activity, alcoholism and
substance abuse such as tobacco, medical risk factors contributing to stroke
include high blood pressure, high cholesterol levels, high blood sugar, and
obstructive sleep.
 Another risk factor contributes to stroke include Age, where people aged 55 at
high risk. Sex, where men at higher risk compared to women, the race where
African-Americans have a higher risk than people of other races
 The health complication can be justified by the following evidence which includes
the causes of stroke.
 He has a high blood pressure of 142/96mmHg.
 He is obese. Obesity is a cause of stroke.
 He also engages himself in alcohol and tobacco abuse. Mr. Tomasi takes a couple
of beers every Thursday and smokes a packet of cigarettes to relieve stress from
his demanding job.

continuation
 Alcohol and tobacco have been named as a cause of stroke.
 From the case study, we are notified that Mr. Tomasi has moderate
Obstructive Sleep Apnea and hence required to use “Continuous Positive
Airway Pressure (CPAP)” for overnight sleep. Obstructive Sleep Apnea is
alsoa cause of stroke.
 MR Tomasi has a past medical history of hypertension and takes the
Metoprolol dosage which treats hypertension. Hypertension is a major
cause of stroke.
 His cholesterol level is also high at 9.2mmol/L. High. Cholesterol is also
a cause of stroke. Accumulation of cholesterol accumulate on
bloodvessel leading to the mind leading to stroke
 There is also a family medical history of stroke. Stroke is hereditary disease and since her
mother had been diagonised of stroke, Mr. Tomasi is on high risk.

Step 5: “Goals establishment”
 This step involves the identification of goals geared towards protecting MR
Tomasi from contradicting the stroke. In the consultation with Mr. Joni, we can
set the following goals to help reduce the risk of developing a stroke. The two
Identified goals as follows.
 The first non-pharmacological management for Mr. Tomasi is physical
exercise.
 The second pharmacological control is on Hypertension.

Step 6: “Take action”
 This step involves putting the identified intervention into practice to
prevent the identified health complication and to achieve the set goals.
Actions areimplemented to achieve the planned treatment goals.
 For the non-pharmacological goal, Mr. Taomi has to do some several things
with her weight. He needs to improve on his diet and more so avoid fatty
food mainly from the takeaway foods. To exercise, Mr. Tomasi should make
an effort to walk to the bus station or even cycle to his place of work. He
should set aside some few hours to go to the gym and jog along.
 For the pathological goal, MR Tomasi should be placed under the following
interventions achieve the set goal of controlling hypertension. Mr. Tomasi
can be put under one of the following medication;
 Angiotensin-converting enzyme (ACE) inhibitors. Eg Benazepril, Angiotensin
II receptor blockers (ARBs) Azilsartan (Edarbi), Beta-blockers. Metoprolol eg
(Lopressor, Toprol XL), or Calcium channel blockers eg.amlophine

Conclusion
 Clinical Reasoning Cycle Steps 1-6" has helped greatly assess Mr.
Tomasi health case and possible health has been drawn from the cycle.
From this, I have learned that the cycle plays a very important role in
the assessment, diagnosis, and treatment of patients. It saves times
and is less expensive. However, for the model to be most effective, the
findings should be backed up with laboratory findings, lifestyle audit or
the patient or family health records
 From the assessment done, MR Tomasi was assessed to be in the risk
of contracting stroke. Stoke is a killer disease all over the world and
causes death within a short time unless the condition is treated. From
the set goal, it will be advisable offer enough knowledge on the
importance of meeting the target to improve on his health and prevent
on the occurrence of more health complication; such as the prophesied
stroke attack.

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