JR Patient Encounter 1
JR Patient Encounter
Linh Chau
NSG 502
Oct 1st, 2018
Professor: Danielle Patrick
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JR Patient Encounter 2
Mrs. Janet Riley is a 79-year-old Caucasian female who presents today with her daughter,
Ann, who is concerned about Mrs. Riley’s progressive cognitive and memory deficits, emotional
lability and behavioral changes for about 3 to 4 years now, especially the last few months those
symptoms have been worst. Mrs. Riley’s daughter reports that she has noticed changes in Mrs.
Riley’s personality, and behavior. Mrs. Riley has been noted that she is unable to complete her
activities of daily living, and lack of interest in previous activities and friends. She also mixes up
words, forget names of familiar people, and gets angry when help is offered.
It was difficult to assess Mrs. Riley since she is not cooperating and often time stated,
“it’s time to leave. I’m not going to answer you,” and so on. Mrs. Riley presents today as
unkempt and has obvious malodorous body odor. She is alert and oriented times two (person and
place). Unintentional weight loss about 8 lbs. Daughter stated patient has not been able to cook
for herself anymore, and this has been going on for about two three months now. She recently
fell at home related to trip and fall. Had head trauma history due to the fall and ended up in the
ER for observation. Mrs. Riley has history of HTN, high cholesterol, and CAD with stent
placement.
Her geriatric depression scale is 3/15, and her MMSE score is 19/35. Test ordered for
Mrs. Riley are blood work, a brain MRI, urinalysis, EEG, CSF analysis, and a brain MRI. As the
results for CBC and B12 show normal limits, patient doesn’t have sleep obstructive sleep apnea,
UA is negative, and CSF is normal. However, the MRI does show generalized cortical atrophy
and a reduced hippocampal volume, as well as the EEG shows cortical dysfunction. Atrophy of
the cortex is indicative of Alzheimer’s disease, and per Vemuri & Jack (2010), brain atrophy is
measure on MRI, and it is a helpful test to determine the intensity of neurodegenerative process
of Alzheimer’s disease. The cerebral cortex plays an important part in memory, attention,
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JR Patient Encounter 3
thought, and language. Mrs. Riley’s MRI has shown an atrophy of th [Show Less]