Discuss your assessment and priorities of care for Mr Green prior to and during his first dialysis session.

Mr Green is a 58-year-old gentleman, who presents to his GP complaining of experiencing, breathlessness, nausea, fatigue, chronic headache and short term memory loss.
Mr Green lives with his wife in a medium sized country town. He has been married for 25 years and has three adult children. The children have relocated to the city for employment purposes. Mr Green has been enjoying life since retiring as a truck driver. Mr Green has a mild deformity of his non-dominant hand and this results in slight impairment of two of his fingers. He has no other relevant past medical history. Prior to commencing RRT, blood was taken for biochemistry and full blood count.

The results are as follow:
Sodium 130 mmol/L
Potassium (K) 6.0 mmol/L Chloride 96 mmol/L
Bicarbonate 16 mmol/L
Urea 42 mmol/L
Creatinine 1.00 mmol/L
Calcium 1 .99 mmol/L
AIbumin 21 g/ L
Phosphate 1.94 mm/L
Hb 10.0 g/dl
PLT 164 thou/mcl
HCT 34%
APTT 48 secs

Mr Green is transferred to a large hospital under the care of a nephrologist.
A renal biopsy is performed and the diagnosis of end stage renal failure (ESRF) secondary to glomerular nephritis (GN) is made.
It has been decided that for the interim Mr Green will be commenced on HD.
Question 1 (approx 800-900 words)
Discuss your assessment and priorities of care for Mr Green prior to and during his first dialysis session. Consider within your discussion:
• evaluation and rationalisation of all pathology results
• rationale for current clinical symptoms (include but not exclusively pathology)
• essential requirements/ interventions prior to initial dialysis
• justification of dialysis modality for Mr Green at this time
• formulation and justification at a physiological level of an appropriate introductory dialysis regime for Mr Green. (this will require (not exclusively) some exploration of disequilibrium syndrome DES)

Question 2 (approx. 500 words)
It takes some time to effectively determine an ideal dry weight (IDW) for patients commencing on dialysis, explore the meaning of IDW and discuss the factors that will assist/ impact in determining an IDW for Mr Green.

Question 3 ( approx 1000 words)
It is possible that Mr Green may need to have a permanent vascular access created. Discuss the different forms of vascular access available for HD.
Ensure that you consider access/site selection/mapping, advantages, disadvantages and potential complications for each option, as well as risk reduction strategies relating to sustaining vascular access patency

Question 4 (approx 900 words)
Identify a minimum of 10 HD related complications a patient may experience whilst undergoing a treatment session and then discuss, the possible clinical manifestations, causes, immediate management and risk reduction strategies for four of the ten potential complications (this may not include D.E.S)

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