The Janet Riley iHuman case study is a critical component of the NR 601 Week 6 curriculum, providing students with an interactive way to apply their clinical knowledge in a real-world setting. Janet Riley, a 79-year-old female, presents a challenging case of cognitive and memory deficits, behavioral changes, and a complex medical history, allowing nursing students to refine their diagnostic, assessment, and management skills.
Performance Overview Report
The performance overview report for Janet Riley indicates a thorough examination of her medical history, physical exams, and diagnostic tests. Here’s a detailed summary of the performance across different sections:
| Case Section | Status | Your Score | Time Spent |
| History | Done | 100% | 23 min 43 sec |
| Physical exams | Done | 96% | 18 min 29 sec |
| Key findings organization | Done | 100% | 4 min 33 sec |
| Problem statement | Done | 100% | 2 min 0 sec |
| Differentials | Done | 100% | 2 min 57 sec |
| Differentials ranking | Done | 100% | 0 sec |
| Tests | Done | 100% | 3 min 23 sec |
| Diagnosis | Done | 100% | 58 sec |
| Management plan | Done | 100% | 11 sec |
| Exercises | Done | 100% | 1 min 51 sec |
This summary indicates a high level of proficiency in understanding the case, with nearly all sections completed successfully.
History and Presentation
Janet Riley presents with her daughter, who expresses concerns about her mother’s progressive cognitive deficits, behavioral changes, and emotional lability over the past year. The daughter reports notable changes in personality, including increased argumentative behavior and difficulties with personal hygiene, impacting her ability to perform activities of daily living (ADLs).
Attempted History Questions
The assessment includes 57 questions, of which 41 were answered correctly. Some of the critical questions that provided insight into Janet’s condition include:
- What is your name?
- Do you feel confused at times?
- Have you noticed a decline in your thinking?
- Do you have trouble remembering things?
- How would you describe your mood?
These questions shed light on Janet’s cognitive function and emotional state, revealing significant concerns regarding her memory and orientation.
Key Findings
The medical problem list for Janet Riley highlights several key findings, including:
- Impaired Memory: The most pressing issue, characterized by progressive cognitive decline.
- Behavioral Changes: Personality changes, including increased argumentative behavior.
- Physical Health Concerns: Notable issues like hypertension and coronary artery disease.
- Difficulty with ADLs: Struggles with maintaining personal hygiene and engagement in previously enjoyed activities.
In elderly patients, it’s crucial to consider the potential overlap of these symptoms with various underlying medical conditions. The case of Janet Riley emphasizes the importance of comprehensive assessments that look beyond isolated symptoms.
Problem Statement
The problem statement for Janet Riley is as follows:
“Janet Riley is a 79-year-old widow with hypertension and coronary artery disease who has developed progressive cognitive and memory deficits, emotional lability, and behavioral changes over the past year.”
This statement encapsulates her overall health status and identifies the key issues requiring further investigation and management.
Differential Diagnosis
The differential diagnosis for Janet Riley includes various types of dementia and other potential underlying medical conditions:
- Alzheimer’s Dementia
- Frontotemporal Dementia
- Lewy Body Dementia
- Vascular Dementia
- Mixed Dementia
- Occult Infection
- Hypothyroidism
- Vitamin B12 Deficiency Anemia
- Medication-Induced Delirium
This comprehensive differential diagnosis underscores the need for targeted testing and evaluation to determine the exact cause of Janet’s cognitive decline.
Diagnostic Tests
The following tests were ordered to further investigate Janet’s condition:
- Brain MRI
- Complete Blood Count (CBC)
- Comprehensive Metabolic Panel (CMP)
- Serum Folate
- Free Thyroxine (FT4)
- Homocysteine Level
- HIV Antibody Test
- Rapid Plasma Reagin
- Thyroid-Stimulating Hormone (TSH)
- Urinalysis
- Vitamin B12 Level
These diagnostic tests are essential to identify any underlying health issues contributing to Janet’s symptoms and to guide appropriate treatment plans.
Electronic Health Record (EHR)
Janet’s EHR highlights significant past medical history, including:
- Hypertension diagnosed at age 55.
- Coronary Artery Disease with a stent placement at age 65.
- Hypercholesterolemia also diagnosed at age 55.
- Bilateral Sensorineural Hearing Loss, managed with hearing aids.
Understanding her medical history is crucial for evaluating her current health challenges.
Social and Family History
Janet’s social history indicates she worked as an elementary school teacher for 35 years and is now retired. Her husband passed away two years ago, adding emotional strain. She has two adult children and two grandchildren, indicating some level of familial support, which can play a crucial role in her care.
Review of Systems
The review of systems highlights various domains of her health:
- General: Reports difficulty with recent events and spatial orientation.
- HEENT: No significant issues noted beyond hearing loss.
- Cardiovascular: No chest pain or shortness of breath reported.
- Neurologic: Denies significant memory problems, although assessments indicate otherwise.
Physical Exam Findings
The physical examination revealed:
- General Appearance: Janet appeared disoriented and less cooperative.
- Skin: Unkempt appearance with excessive body odor.
- Neurologic Exam: Disorientation noted; more thorough assessments indicated cognitive deficits.
These physical exam findings reinforce the concerns raised during the history-taking process and guide further diagnostic testing and management.
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