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Case #2 

Mr. Smith 

Regarding the patient’s available history, he is at high risk for a reoccurrence of a stroke. A detailed plan of care would include controlling any possible risk factors. This would be a lifestyle modification for Mr. Smith that included his family as support.  Evidence-based recommendations in the prevention of future strokes of those who have survived a previous stroke include: “...antiplatelet therapy and effective strategies for the treatment of hypertension, atrial fibrillation (AF), arterial obstruction, and hyperlipidemia.” (Kernan et al., 2014). A detailed plan for Mr. Smith include: 

• “Goals for target BP level or reduction from pretreatment baseline are uncertain and should be individualized, but it is reasonable to achieve a systolic pressure <140 mm Hg and a diastolic pressure <90 mm Hg.” (Kernan et al., 2014). 
• Statin therapy with intensive lipid-lowering to reduce cholesterol and assist in reducing his risk of future stroke. 
• Diabetic screening and testing with that of fasting plasma glucose, HbA1c, or an oral glucose tolerance test.  
• Weight loss and physical activity programs that include nutritional guides. Examples include a low-fat diet or a Mediterranean diet.  
• Routine supplements  
• Sleep studies and treatment of sleep apnea if needed. May include CPAP. 
• If a smoker he will need to quit. 
• If a heavy drinker, he will need to cut down on his alcohol intake. 
• Other recommendations may include Extracranial Carotid Intervention 
• Close follow up and treatment studies may include imaging.