Priority: Hepatic vs Renal

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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.

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.[/quote']

thanks atom,

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 because of hemorrage ?

Specializes in Complex pedi to LTC/SA & now a manager.

Acute pancreatitis doesn't usually cause bleeding especially flank. Flank is usually kidney

Acute pancreatitis doesn't usually cause bleeding especially flank. Flank is usually kidney

hi JBN,

i juat want to confirm.

isnt grey turner's sign (flank brusing) an indication for abdominal bleeding?

Specializes in Complex pedi to LTC/SA & now a manager.

Acute pancreatitis isn't usually associated with acute abdominal bleed. Hemorrhagic pancreatitis or acute pancreatic injury/pancreatic rupture...yes. Acute pancreatitis often associated with alcoholism or blocked biliary duct/complication of choleycystitis

I think you are getting fantastic in your scenarios and over complicating your NCLEX prep

But yes flank bruising is associated with an abdominal bleed or even retroperitoneal bleed.

Acute pancreatitis isn't usually associated with acute abdominal bleed. Hemorrhagic pancreatitis or acute pancreatic injury/pancreatic rupture...yes. Acute pancreatitis often associated with alcoholism or blocked biliary duct/complication of choleycystitis

I think you are getting fantastic in your scenarios and over complicating your NCLEX prep

But yes flank bruising is associated with an abdominal bleed or even retroperitoneal bleed.

Thanks a lot, JBN,

I think I was mislead by my study materials because it doesnt specifically distinguish between an Acute Pancreatitis and Acute Hemorrhagic Pancreatitis.

Excerpt from Wikipedia:

Grey Turner's sign refers to bruising of the flanks, appearing as a blue discoloration.[1]

This sign takes 24–48 hours. It can predict a severe attack of acute pancreatitis,[2] with mortality rising from 8-10% to 40%.[citation needed]It is a sign of retroperitoneal hemorrhage.

I would say output of 23 ml in an hour would be priority over hepatic issue if this is a deviation from baseline. When output is this low perfusion is compromised and this leads to shock and death. If they are chronic renal failure than not priority. Hepatic encephalopathy pts can be confused for days on end and it takes awhile to correct, from safety stand pt you may want to check on them first see that they are safe then deal with low output.

Thanks a lot, JBN,

I think I was mislead by my study materials because it doesnt specifically distinguish between an Acute Pancreatitis and Acute Hemorrhagic Pancreatitis.

Excerpt from Wikipedia:

Grey Turner's sign refers to bruising of the flanks, appearing as a blue discoloration.[1]

This sign takes 24–48 hours. It can predict a severe attack of acute pancreatitis,[2] with mortality rising from 8-10% to 40%.[citation needed]It is a sign of retroperitoneal hemorrhage.

I would never study for NCLEX from Wikipedia. I do occasionally cite it here IF and ONLY IF I have looked at the references it gives personally to be sure they are real, reliable, and accurate. Just read a funny story where a few med students made a "correction" in a Wikipedia entry mentioning an imaginary diagnosis named after a classmate; it not only remained there for some months, the classmate found his namesake disease cited in other papers. Word to the wise.

You will likely not be asked to make the differential diagnosis between acute pancreatitis and acute hemorrhagic pancreatitis at any time in your nursing career. I agree your questions are getting a little fantastic (in the original sense of the word) and encourage you to back off and study the rationales for the answers to the study questions in your review texts.

I'm in the middle of reviewing for my NCLEX and just reading this honestly made me feel even more overwhelmed. :(

You're confusing yourself more than you need to.

NCLEX priority questions, aka who to see first, are about who is MOST unstable or most at-risk.

You need to analyze what would be expected for a given condition and what may be new onset/ unexpected.

23 mL output in 1 hour sounds expected for ARF. Not saying it's good, but it goes along with.

Confusion is most patients is a sign of a change. Could be O2, other changes. They would need to be assessed first.

Become familiar with these types of questions, about 1/4 or more of my 75 questions on nclex were priority qs

You're confusing yourself more than you need to.

NCLEX priority questions, aka who to see first, are about who is MOST unstable or most at-risk.

You need to analyze what would be expected for a given condition and what may be new onset/ unexpected.

23 mL output in 1 hour sounds expected for ARF. Not saying it's good, but it goes along with.

Confusion is most patients is a sign of a change. Could be O2, other changes. They would need to be assessed first.

Become familiar with these types of questions, about 1/4 or more of my 75 questions on nclex were priority qs

Thanks JmiraRN and everyone for their great feedbacks.

Pls correct me if I am wrong, my test taking strategy in prioritization is asking myself "as an RN, which of these patients" will die first if i didnt intervene properly " ?

is that way my way of thinking appropriate ?

Close enough, but realistically you will not see a lot of questions that are like that, and they certainly won't be as ambiguous as the original post, AND they won't be asking what a physician would do, but what a nurse would do.

Thanks jmiraRN! That's good advice. Gonna have to remember that.

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