NRSG265 Case Study: Assessing Stroke Risk for Mr. Tomasi Joni

This case study examines Mr. Tomasi Joni, a patient with multiple health concerns, and assesses his risk of developing a stroke. The analysis utilizes the Levett-Jones' Clinical Reasoning Cycle to evaluate the patient's current health status, past medical history, and lab results, including high blood pressure, cholesterol, and fasting glucose levels. The study identifies stroke as a potential health complication, considering factors such as obesity, atherosclerosis, obstructive sleep apnea, smoking, and family history. Goals are established to reduce cholesterol and control hypertension, followed by a discussion of interventions, including dietary changes, weight loss, smoking cessation, and stress management. The study emphasizes the importance of lifestyle modifications and medical interventions to mitigate stroke risk.

STROKE
Mr. Tomasi Joni Case Study
Student Name:
Student ID:
Introduction
 People are likely to develop health complications
in their daily lives.
 Factors determining possible health complications
include lifestyle, one’s past medical history,
occupation and the family medical history among
others.
 Identification of the possible health complication
to be developed by Mr. Tomasi Joni has been done.
 The identified potential health complication has
been discussed using the “Levett-Jones’ (2018)
Clinical Reasoning Cycle Steps 1-6”.

Step 1: “Consideration of the facts from
the patient situation”
 Under this step, the patient current situation is
analyzed (Hunter & Arthur, 2016). Considering
the current health status of Mr. Tomasi Joni, the
following information has been drawn.
 He has a high blood pressure of 142/96mmHg.
 His heart rate is 96bpm.
 His retention rate is 22bpm, body temperature
is 36.7 Degree Celsius and SpO2 96% on RA.
Retention rate, body temperature and SpO2 on
RA are all ranging within the normal gap.

Step 2: “Collection of information”
 In this step, the patient past history of medication, his or
her current treatment plan and the obtained results after
investigation are considered (Nyangaresi, 2018).
 Mr. Tomasi Joni had suffered from hypertension, gout, Acute
Myocardial Infarction (AMI) and Moderate Obstructive Sleep
Apnea (OSA).
 Currently he has medications of Metoprolol, Aspirin and
Allopurinol.
 He has a body weight of 93 kilograms, a height of 1.7
meters, waist circumference of 104 centimeters and excess
abdominal fats.
 His level of cholesterol is high at 9.2mmol/L.
 His fasting level of glucose is 9.6mmol/L which is risky
since it exceeds the normal level of 7.0mmol/L.

Step 3: “The gathered information processing”
 Under this step, the gathered
information about the patient
current health status is processed
while considering pathophysiology
and pharmacology in order to
make the best decision.
 Mr. Tomasi Joni blood pressure is
considered to be high at
142/96mmHg.
 Mr. Tomasi Joni is also obese.
 His cholesterol level of 9.2mmol/L
is also high. This signifies that Mr.
Tomasi Joni is at risk of
Atherosclerosis (Hansson &
Hermansson, 2011).
 His fasting blood glucose level is
also high at 9.6mmol/L.

Step 4: “Identifying the problem”
 Under this step, the patient
potential health
complication is identified
considering the patient
gathered and processed
information regarding his or
her health.
 One potential health
complication for Mr. Tomasi
Joni is Stroke.
 His cholesterol level is high
at 9.2mmol/L meaning that
he is likely to develop
Atherosclerosis which
involves the blockage of
arteries by cholesterol and
fatty deposits which build up
on artery walls.
 He is also obese and
obesity causes stroke
(Vemmos et al, 2011).
 His blood pressure is high
at 142/96mmHg and
takes Metoprolol dosage.

Step 4: Continuation...
 He also has Obstructive Sleep Apnea and this is another
cause of stroke.
 He also smokes cigarettes and smoking causes stroke
since it raises blood pressure after nicotine use.
 Considering the family medical history, Mr. Tomasi Joni’s
father suffered from stroke in 2015.
 The consequences that stroke might have on Mr. Tomasi
Joni is the interference of blood supply to the brain.
Supply of blood to his brain is likely to be reduced due to
blockage or rupture of blood vessels which supply blood
to the brain. This means that oxygen and nutrients to
part of his brain may be reduced and make brain cells
die. Stroke can lead to Mr. Tomasi Joni’s death if not dealt
with immediately.

Step 5: “Goals establishment”
 Under this step, goals are
identified in order to help
treat the patient. Goals which
are aimed at helping Mr.
Tomasi Joni to minimize the
risks of developing stroke
have been set as follows.
 One goal that can help Mr.
Tomasi Joni is cholesterol
reduction and maintenance
within the healthy gap.
 The second goal is that Mr.
Tomasi Joni should work
towards controlling his
hypertension.

Step 6: “Take action”
 Under this step, interventions to be used to achieve the set
goals are discussed (Husebø, O'Regan & Nestel, 2015). It
involves an implementation of actions to be undertaken in order
in order to achieve the planned goals for the patient treatment.
 The following interventions should be undertaken in order to
achieve the first goal of cholesterol reduction and maintenance
within the healthy limit of 5.0mmol/L or below.
 Firstly, Mr. Tomasi Joni should eat foods with little contents of
fats, cholesterol and saturated fat.
 Secondly, he should consider eating vegetables and fruits on a
daily basis.
 Thirdly, he should work towards losing weight since he is obese.
 Fourthly, he should avoid smoking since smoking raises
cholesterol levels and is a major cause of stroke.

Step 6: Continuation...
 The second goal of controlling hypertension can
be achieved by Mr. Tomasi Joni using the
following interventions.
 Firstly, he should try to quit smoking since
smoking causes stroke.
 Secondly, he should avoid stress.
 The following are the images for the take action
discussion:

Conclusion
 Human beings are faced with the risks of
developing medical complications which are
determined by factors such as their lifestyles,
occupation and family medical history among
others.
 Considering the case study, Mr. Tomasi Joni one
potential health complication is stroke. This is
evidenced by the gathered and processed
information regarding his health using the “Levett-
Jones’ (2018) Clinical Reasoning Cycle Steps 1-6”.
 Goals and interventions aimed at helping Mr. Tomasi
Joni to avoid the risk of developing stroke have also
been discussed

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