Priority: Hepatic vs Renal

[souleater11]

hi everyone,

I kinda confuse of which of two is an acute priority patient:

A. patient with hepatic cirrhosis s/s of confusion and hyperreflexia

B. Acute Renal Failure patient with urine out of 23 ml.

[SimonTan]

Don't take my word for it but I would think renal failure might be more important. 23ml/hr is really below normal so there is excessive waste/fluid buildup in the body leading to edema, hypervolemia which would cause complications in the heart and lungs. Let me know what the final answer is.

[schnookimz]

I would have said liver failure bc the person seems to be exhibiting signs of hepatic encephalopathy and high ammonia levels. You can always dialyze the kidney patient, and they're still producing urine so you know they have some kidney function.

[schnookimz]

Also 23ml over what period of time?? One hour? One shift? One day? Big difference.....

[Philly_LPN_Girl, LPN]

I think that I would pick A because of the s/s of the increased amonia levels. Also is the 23ml of urine output in mins/hrs/days/ etc????

[PrettyLady87]

I would have said liver failure bc the person seems to be exhibiting signs of hepatic encephalopathy and high ammonia levels. You can always dialyze the kidney patient and they're still producing urine so you know they have some kidney function.[/quote']

I agree with you completely..there is a definitive solution for the kidney patient even tho they are acute, they won't die in a day.

[souleater11]

question update.

ARF patient has urine output of 23 ml in an hour.

Note: I do not really know the correct answer since I just compose this question on my own base on studying about G.I and Hepatic disorders.

Thanks everyone for your response

[JustBeachyNurse, LPN]

question update. ARF patient has urine output of 23 ml in an hour. Note: I do not really know the correct answer since I just compose this question on my own base on studying about G.I and Hepatic disorders. Thanks everyone for your response

Since typical output is 30mL/hr in a non ARF pt, acute confusion in chronic cirrhosis would be priority as can be elevated ammonia

[souleater11]

Since typical output is 30mL/hr in a non ARF pt, acute confusion in chronic cirrhosis would be priority as can be elevated ammonia

Thanks JBN,

btw, for example i will change a different patient condition.

B. patient with Acute Pancreatitis with s/s flank bruising.

in this case, is Acute Pancreatitis, an actual acute problem Priority instead of Cirrhosis ?

[EDRN1091]

Do you know what hyperreflexia is? What the S/S are and what it causes? How it is treated? It seems to me that you're seeing "cirrhosis and renal failure" and just picking between the two chronic illnesses. Think about the outcomes for both patients and what you as the nurse would be considering and doing, then you have your most acute patient.

[EDRN1091]

http://www.nlm.nih.gov/medlineplus/ency/article/001431.htm

[atom2013]

according to kaplan, NCLEX hates confused client meaning they usually are the ones to see first because of low oxygen and we gotta remember ABC so I go for first one plus the second option is still normal b/c the normal urine output per hour is 30-50 ml/hr according to kaplan and 30-60 ml/hr based from my own knowledge in my school and the second one does not state any problems meaning potential/risk problems unlike the first one which is already confused and have hyperreflexia - it has actual problems already. Actual > Potential problems. Hope this helps a bit. I pretty much based this from my kaplan experience.