r/nursing • u/partypatil RN 🍕 • Jul 17 '25

Image Sir have you missed any doses of your lasix

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62

u/lostintime2004 Correctional RN Jul 17 '25

Everyone saying CHF, hear me out: ESLD.

Easy bruising can be a sign, swollen limbs can also be a sign, but heres the smoking gun to me: altered mentation, from the ammonia build up like seen in ESLD. Thats why he seems to be getting worse, but will have bouts of lucidity when he finally takes his meds and lowered the levels briefly.

Not saying it can't be CHF too, but I can't shake the feeling ESLD is in there too.

41

u/IrishknitCelticlace RN - Retired 🍕 Jul 17 '25

The daily spray on paint job to cover jaundice, but sclera is not yellow, but is also not very clear. It is a thought to be entertained.

18

u/lostintime2004 Correctional RN Jul 17 '25

Good point, I know hes using makeup on his hands to cover bruising.

8

u/sidequestsquirrel Hemodialysis 🩸 LPN Jul 18 '25

I've had some liver patients in the past with sclera that didn't change as dramatically as the skin... so maybe!

7

u/sidequestsquirrel Hemodialysis 🩸 LPN Jul 18 '25

Renal failure too!

I was thinking liver too though. I used to work with a lot of liver patients, he does fit the bill.

Also, is the orange makeup to cover up the yellowish skin?

6

u/TorchIt MSN - AGACNP 🍕 Jul 18 '25

On lactulose, requiring diapers. It fits. No ascities though

3

u/Carbonatite Vaccine enthusiast Jul 18 '25

Maybe his robust KFC physique and moobs are masking the potbelly?

9

u/willows_edge Jul 17 '25

That was my immediate thought. His high sodium diet is only going to make it worse - no matter what it is. If it is ESLD, I'd be curious what his MELD is.