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Crisis Plan

My Action Plan: What to Expect as Kidney Function Worsens, and How to Be Prepared

When your kidney function gets very poor, there are some common symptoms that you might experience. These could include nausea/vomiting, itchiness, sleep difficulties, restless legs, and trouble breathing. You might have pain from other conditions as well. Your care provider can give you more information on each of these symptoms and can help you manage them.

You might start to experience other symptoms that we are not able to reverse. These include loss of appetite, muscle twitching, drowsiness, tiredness, and confusion.

Some of these symptoms may be more distressing than others. We recommend being prepared and having a plan.

  1. Having an action plan may help you manage your symptoms and stay at home if that is what you want. Please sit down with your main healthcare provider to make a plan together (see Symptom Action Plan and Medication Plan below). They may consider writing certain prescriptions so that you can quickly access medications if you need them.

  2. If you are living at home, we strongly encourage you to have homecare involved. You might not need them very often, but that relationship will be very important if you start to have trouble at home and need care quickly. This could include helping you go somewhere else, such as a long-term care facility or hospice, if you can no longer manage at home. They can also access EMS Assess, Treat, and Refer on your behalf (see below).

  3. It is also important that you have engaged in advance care planning, and that you have a personal directive and a signed Goals of Care designation form in your Green Sleeve at home.

This provincial EMS program can be accessed by community health professionals (for example: nurses, doctors, social workers, respiratory therapists) on behalf of someone who is experiencing a palliative emergency at home.

A palliative emergency might be pain that gets worse, breathing problems, agitation or nausea/vomiting. The goal is to help you and your healthcare team manage your symptoms at home.

My Health Alberta: Palliative Care EMS

  1. If a symptom is getting worse but you are still coping, take your medicine as prescribed. Keep a record of what you take, when you take it, and what your response to the medicine is. Make plans to see or talk to your care provider as soon as is reasonably possible.

  2. If a symptom is getting worse quickly or is very bad, call the number that you have been given for your homecare or supportive living team (if you have one). They might be able to give you guidance about your medicine. If needed, they can access EMS Treat, Assess, and Refer on your behalf. Or, depending on the situation, they might tell you to go to the hospital or phone 911.

  3. If you are still struggling and your symptoms are severe, phone 911.

    Tell EMS that:
    • You have end-stage kidney disease
    • You have chosen Conservative Kidney Management - you have chosen not to have dialysis of any kind.

    Have your green sleeve ready to give to EMS.

Please discuss these possible options with your main care provider.

If you are experiencing:

Pain
  • Take hydromorphone 0.5 mg every 4 hours and every 1 hour as needed.
Shortness of Breath
  • Take hydromorphone 0.5 mg by mouth every 4 hours and every 1 hour as needed.
  • Take Ativan 1 mg by mouth every 8 hours as needed for anxiety.
Nausea/Vomiting
  • Take Maxeran 2.5 mg by mouth or injection every 4 hours and every 1 hour as needed.
  • Take Zofran 4 mg by mouth/injection/wafer every 8 hours.
Restlessness/Confusion
  • Take Haldol 0.5 mg by mouth/injection every 8 hours and every 2 hours as needed.
  • Take Nozinan 5 mg by mouth or 6.25 mg by injection every 8 hours and every 1 hour as needed.

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