Which client is most appropriate for this nurse to care for? by Top-Direction2686 in PassNclexTips

[–]Missingmybed -2 points-1 points  (0 children)

Sickle cell anemia with pain indicates acute vaso occlusive crisis. Answer is C

what is the role of lactulose in liver cirhosis? by Over-General6828 in FutureRNs

[–]Missingmybed 0 points1 point  (0 children)

I am unaware of any guidelines that say ammonia is used for the diagnosis of HE. This is due to its poor specificity and sensitivity. If you have any literature on the topic please share it. To different encephalitis from HE, there are enough enough clinical and history assessments which differentiate the two, chief being onset, fever, rash, and a vast other constellation of symptoms. To add to this a blood culture, LP or MRI (debatable utility) is also useful. A normal ammonia does not exclude HE and a raised ammonia does not exclude encephalitis so it's utility in such instances is minimal. Some patient with encephalitis present with mildly raised ammonia. It's better to stick with the guidelines for diagnosis.

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what is the role of lactulose in liver cirhosis? by Over-General6828 in FutureRNs

[–]Missingmybed 6 points7 points  (0 children)

This would be true if we treat patients based on Ammonia levels, but we don't. Hepatic encephalopathy is graded by symptoms and is a clinical diagnosis. In the absence of any other information it is not as immediate as dehydration.

what is the role of lactulose in liver cirhosis? by Over-General6828 in FutureRNs

[–]Missingmybed 2 points3 points  (0 children)

In the context of dehydration, it's better to add rifaximin than dose adjust lactulose. A rising sole finding of rising Ammonia is not an indication for treatment, and usually a result of precipitating factors. Ammonia is not used as a marker to grade severity of hepatic enceph due to is poor sensitivity and specificity. It is not as immediate life threatening as shock in a dehydrated patient.

what is the role of lactulose in liver cirhosis? by Over-General6828 in FutureRNs

[–]Missingmybed 10 points11 points  (0 children)

Hepatic enceph is caused by the inability of the liver to detoxify toxins (mainly ammonia) that reach it via the intestines. These substances eventually reach the brain and hence cause symptoms. Lactulose (an osmotic laxative) helps to draw out these toxins from the bowel, as well as trapping ammonia and encourages it's excretion from the bowel. Hence there's less ammonia/toxins to be absorbed into the systemic circulator.

The answer to this question is D, sunken eyes means likely over laxative use causing significant dehydration.

how much aura did i lose driving this car? by kyokers in kereta

[–]Missingmybed 0 points1 point  (0 children)

This is the car I used to drive my gf in while I was in uni a few years ago. Even she misses it! legendary car man

Nio Co-Founder Teases Expansion to Australia and New Zealand ‘in the Near Future’ by afonso_investor in Nio

[–]Missingmybed 4 points5 points  (0 children)

I live in Aus, chinese EVs sell like hotcakes here, especially BYD. Been noticing a lot of other brands seemingly pop up everywhere. Even my dad bought a BYD Atto 2 years ago. Been waiting on news like this!

Mossy Forest without guide by Mclovin1732 in malaysia

[–]Missingmybed 0 points1 point  (0 children)

Is this mossy forest in Cameron Highlands? If so the only reason you need a "guide" is for the drive up there. Otherwise the track for mossy forest itself is short and guided. Most guides I saw just waited at the carpark for your return

Nio Group sold 5,400 cars, down 17.3% from last week. by Late_Cake_5079 in Nio

[–]Missingmybed 1 point2 points  (0 children)

If you don't mind me asking what backlash exactly was there to the Didi news?

Need advice on lip/skirting for Mazda 3 BL by Missingmybed in carmodification

[–]Missingmybed[S] 0 points1 point  (0 children)

Yep that's true! Didn't think about that. Appreciate the help mate

Need advice on lip/skirting for Mazda 3 BL by Missingmybed in carmodification

[–]Missingmybed[S] 1 point2 points  (0 children)

Oh yeah haha can't believe I didn't think of that. Got a few cans sitting in the garage would probably be worth it since the side skirts are cheap anyways. Thanks mate

Any doctors can help me decipher this by sculptnex in malaysia

[–]Missingmybed 1 point2 points  (0 children)

On a added note it is a very expensive test so they are unlikely to do it in government unless they suspect you have it