A 62-year old man presented with cerebrovascular accident secondary to hypertension. He had a history of non-compliance with antihypertensive medications and alcohol and tobacco use. He was initially unresponsive but regained consciousness after treatment. His blood pressure fluctuated above normal levels during treatment. He received nutritional counseling and was placed on an oral fluid diet, which along with medications helped control his blood pressure and recovery. At follow-up two weeks later, his health status was satisfactory with normal vital signs and anthropometric measurements. Medical nutrition therapy played an important role in his recovery from cerebrovascular accident.
2. CASE STUDY
Age: 62years old
Sex: Male
Marital status: Married
Ward: Male
Diagnosis: Cerebrovascular Accident
2° hypertension
3. CASE OVERVIEW
Cerebrovascular accident commonly called stroke is the sudden
death of some brain cells due to lack of oxygen when the blood
flow to the brain is impaired by blockage or rapture of an artery to
the brain.
Most CVA´s are as a result of atherosclerosis, hypertension or a
combination of both. A Fall in blood pressure during sleep can lead
to a marked reduction in blood flow in the narrowed vessel
causing ISCHEMIC CVA in the morning .Conversely a sudden rise
in blood pressure due to excitation during the daytime can cause
tearing of the blood vessel resulting in intracranial
HEMORRHAGIC CVA.
Hypertension also known as high blood pressure is a chronic
medical condition in which the blood pressure is in the arteries is
elevated. It is expressed by two measurements the systolic and
the diastolic pressure respectively. Hypertension is present if the
blood pressure is persistently at or above 140/90.
4. FAMILY/SOCIAL HISTORY
A 62yr old man first in a family of 3 siblings, married with
five children(four boys& A girl).A Christian of catholic
denomination who work in the civil service but is retired
now, hails from Awaka Owerri North L.G.A in imo state. He
takes alcohol, and smoke often.
PAST MEDICAL HISTROY
•A known hypertensive, not compliance with his drugs
was admitted about 13 months ago and managed for
severe HTN.
•Not a known diabetics.
•Had a past surgical history of appendicitis
•Had no drug allergy
5. Present medical history
A 62yr old man presented to the facility by his
children on account of irresponsiveness to call
of about 12 hours duration, after he took a walk
round his village and after haven took a binge
of alcohol 24hrs prior to the incident. He was
duly managed for the aforementioned
diagnoses before been referred to the dietitian
for expert medical nutritional management 2/7
after admission.
6. MEDICAL NUTRITION THERAPY
ASSESSEMENT
The anthropometry assessment of the patient was taken on
10/6/2015 after the patients regained consciousness.
Weight:62
Height: 1.65
BMI: 22.77Kg/m²
Hip circumference=82
BAI(body adiposity index):20.7(13–25)
Using Broca’s index ideal body weight is 65
CLINICAL ASSESEMENT
O/E :Grunting elderly looking man, Not responding to calls ,but
moving the right upper and lower limb mildly,
sleeping with naso gastric tube and urinary catheter. Mildly
pale, afebrile(37.2ºc),anicteric, acynosed,dehydrated,nil
pedal edema.
Bp: 200/110mmhg.
7. BIOCHEMICAL
ASSESSMENT
Table showing the S/E/U/Cr test result
CT SCAN: Cerebral atrophy.
FBS on admission: 96mg/dl.
TEST RESULT
mmol/l
NORMAL
mmol/L
MAKER
UREA 8.8 1.7-9.1 Normal
SERUM
CREATININ
E
1.0 0.7-1.5 normal
SODIUM 145 130-150 Normal
CHLORIDE 106.2 96-108 Normal
POTASSIU
M
3.7 3.0-5.0 Normal
9. DIETARY ASSESSEMENT
Dietary assessment was done using diet history and
24hours dietary recall.
24hour dietary recall before his presentation revealed
that he took about 160g of alcohol as his lunch after
taking 6 slice of bread with a bag of Lipton and about 2
exchange of peak milk as his breakfast.
Diet history was taken to ascertain patient food intake
and feeding pattern, findings revealed that the patient
does not eat much due to his addiction to alcohol and
smoking.
Patient had no nutritional knowledge prior to counseling.
Food models and household measures was used to
assist memory and portion size estimation and food.
His estimated caloric intake was about 1800kcal/day
using a 24 dietary recall.
10. ANALYSIS
Patient BMI as normal but not according to his
ideal body weight.
Constant fluctuation of blood pressure above
normal.(120/80mmhg).
Consumes a lot of alcohol.
Biochemical assessment taken on S/E/U/Cr
indicates normal.
Brain CT scan indicates cerebral atrophy.
FBS on admission shows no evidence of
diabetics.
11. ACTION
Patient was placed on NG fluid diet of about 2000kcal of 2 liters
administered five times daily 4
hourly,7am,11am,3pm,7pm,11pm,400mls/feed.
Patients NG tube was removed and patient diet was changed
to oral fluid diet of about 2000kcal.
He was counseled after regaining consciousness on need to
stop alcohol, smoking and was placed on LFLS diet of about
2000kcal.
DIETARY COUNSELING.
patient was counseled on need to reduce salt intake.
Reduce intake of fatty foods
Eat enough vegetables
Dietary fallacies/misconceptions were cleared.
Eat food that are food in selenium
Increase protein intake especially plant protein.
12. A DAY SAMPLE MENU OF MY PATIENT
BREAKFAST: A bag of lipton,4 slice of
bread, a scoop of glucose, 3 scoops of
milk and a vegetable sauce.
LUNCH: vegetable soup,45g of fish and
400g of garri .
DINNER: Porridge plantain and 45g of
fish.
13. DRUGS GIVEN TO MY
PATIENTDRUGS FUNCTIONS SIDE EFFECT
aminophylline Relaxes smooth
muscles and
stimulates
respiration.
, Nausea
dizziness
,vomiting and fast
heart rate.
amlodipine A calcium
antagonist used
to treat
hypertension and
angina pectoris
Headache
,dizziness
,fatigue, nausea
and fluid
retention.
diclofenac An anti-
inflammatory
drug used to
relieve point
pains in
ostearthritis,
rheumatiod
arthritis and
ankylosoing
syondylitis.
Abdominal pain,
nausea and
diarrhoea
14. DRUGS CONTD
ciprofloxacin a broad specturm
quinoline antibiotic that
can be given orally and
is particularly useful
against gram negative
beteria as
psuedomonas,that are
resistant to all other
antibotics.
Nausea,diarrhoea,abdo
monal pains and
headache.
15. DISCHARGE
Patients state was satisfactory. clinical vital signs was within
normal range, nil occurance of seizure and condition was
stable on discharge.
Anthropometry on discharge
Weight 64kg
Height 1.65m
BIM 23.5kg/m²
Hip circumference 82cm
BAI 20.7
Patient to visit the facility again in 2 weeks time for check up.
Other health professional involved in the monitoring and
management of the patient were: Physician, cardiologist,
medical laboratory scientist, and nurses.
16. FOLLOW UP
The patient visited the facility again after two
weeks time as advised for check up.
Bp 130/90mmhg.
Test undergone: FBS 84(60120mg/dl)
Anthropometry measurement
Weight 64kg
Height1.65m
BMI 23.5(normal)
HIP CIRCUMFERENCE– 82
BAI 20.7(13-25)
Patient has fully recovered with health status
showing satisfactory
17. CONCLUSION
"You are what you eat" medical nutrition therapy is
indispensible in the management of
cerebrovascular accident which could leave its
victim unconscious, for a drug to work, it requires
energy which is still ascertain from the food we
eat, so the fluid diet given to the patient went a
very long way in helping the drug been
administered to work effectively.
RECOMMENDATION
I suggest that doctors who are managing cases of
CVA and other related health condition should
consider it important to invite the service of the
dietitian for the improved and swift health care.
