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• End-stage Kidney Disease
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SourceSectionId Section 1 News Events Section 2 FAQ Integrated Supportive Care What is one:carepath? Who is One:carepath for? Patient Symptoms About You & Your Health Conditions Managing Your Health Condition Your Shared Care Plan Your Advance Care Planning Patient Portal Home Page Provider Pathway Content Diease Area Description Confirm Comorbidities Hero Quick Access Posters Call to Action Highlighted Features Footer Navbar Integrated Supportive Care Home Interactive Clinical Assessment Patients Content Symptom Fatigue STEP 1: IDENTIFY AND TREAT POTENTIAL REVERSIBLE CAUSES Disease Area (KF) Anxiety/Depression Breathlessness Constipation Edema Kidney COPD Heart Liver Cancer Fatigue New General Symptom Management Content - Symptom 1 New Section Cause 1 Edema Step 1. General Symptom Management New Section Cause 1 Step 4. Palliative Care Consult Fatigue New General Symptom Management Content - Symptom 1 New Section Cause 1 Anxiety/Depression Step 1: General Symptom Management New Section Cause 1 STEP 2: GENERAL Non-Pharmacological Non-Pharmacological Symptom Nuances Non-Pharmacological: Disease Specific Symptom Management Cause 1 STEP 3: Pharmacological Liver Nuance Kidney Nuance Step 4: Palliative Care Consult Constipation old STEP 2: Non-Pharmacological Management STEP 3: Pharmacological Management STEP 4: Palliative Care Consult STEP 2: NON-PHARMACOLOGICAL MANAGEMENT STEP 3: PHARMACOLOGICAL MANAGEMENT HEART FAILURE CIRRHOSIS KIDNEY FAILURE ABOUT PAIN: GENERAL DESCRIPTION & DEFINITION STEP 1: IDENTIFY AND TREAT POTENTIAL REVERSIBLE CAUSES STEP 2: NON-PHARMACOLOGICAL MANAGEMENT STEP 3: PHARMACOLOGICAL MANAGEMENT KIDNEY DISEASE - NEUROPATHIC KIDNEY DISEASE - NOCICEPTIVE STEP 4: PALLIATIVE CARE CONSULT PHARMACOLOGICAL PALLIATIVE CARE END OF LIFE NEUROPATHIC PAIN PHARMACOLOGICAL PALLIATIVE CARE END OF LIFE NOCICEPTIVE PAIN Superficial pain Bone Soft Tissue Muscle Relaxants Visceral Dexamethasone Bisphosphonate – Clodronate 1600-2400 mg PO daily Denosumab 120 mg SC every 4 weeks STEP 4: PALLIATIVE CARE CONSULT Version 2 NSAID (systemic) NSAID (topical) Diazepam Baclofen Tizanidine GFR 0-7 GFR 8-15 GFR 15-30 GFR 30+ EFS Severe EFS Not Severe Other Assessment Tool EFS Severe EFS Not Severe EFS Severe EFS Not Severe Heart Failure FEV1 FEV2 EFS Severe EFS Not Severe Weight Another Tool New Measurement Level Test Disease Area Fatigue old STEP 1: Consider the Underlying Causes of Fatigue STEP 2: Non Pharmacological Management of Fatigue STEP 3: Pharmacological Management v1 - Modelled after Med Table STEP 4: Palliative Care Consult Nausea & Vomiting Step 1: Consider the Underlying Causes of Nausea & Vomiting Step 2: Non-Pharmacological Management STEP 4: Palliative Care Consult Step 3: Pharmacological Management Dexamethasone-Append-Cancer HF-Replace-Buproprion Step 3: Pharmacological Management v2 - Fewest Nodes - Better management Dexamethasone-Append-Cancer STEP 3: Pharmacological Management V3 - Will not work as this does not align with wholistic approach Heart Failure Cancer STEP 3: Pharmacological Management v4 - Most Nodes and Difficult to Manage Modafinil (Provigil) Methylphenidate (Ritalin) Bupropion Modafinil-<>HF Methyphenidate <> HF Modafinil-Cirrhosis-ReduceDose <> HF KIdney STEP 3: Pharmacological Management v5 - Using Hide Dexamethasone Reduce Dose-Cirrhosis - Need to create nuance to a nuance Modafinil Dexamethasone Methylphenidate (Ritalin) Reduce Dose Cirrhosis STEP 3: Pharmacological Management of Fatigue Bupropion Methyphenidate & Modafinil Continue with algorithm Dexamethasone Bisacodyl; Peristaltic stimulant Cancer Adjusted Dose Methyphenidate & Modafinil Rule-Hide when HF selected Bupropion  Rule-Hide when Cirrhosis selected Psyllium (Metamucil) Polyethylene glycol (PEG 3350) (LAX-A-DAY); Osmotic laxative Lactulose or Sorbitol; Osmotic laxative Sennosides (SenekotÒ); Peristaltic stimulant Glycerin Suppository Sodium-phosphate enema (Fleet Enema) Magnesium citrate or hydroxide or sulfate (Epsom salt) Methylnaltexone (RelistorÒ); Peripherally acting μ-opioid receptor antagonists (PAMORAs) Kidney Disease Dose Adjustment Naloxegol (MovantikÒ); Peripherally acting μ-opioid receptor antagonists (PAMORAs) KidneyDiseaseDoseAdjustment CirrhosisChildPughCAvoidUse Prucalopride; Prokinetics KidneyDiseaseDoseAdjustment Manual Disimpaction; for severe constipation Cholestatic Pruritus Step 1: Consider the Underlying Causes of Pruritus Step 2: Non-pharmacological Management Good Skin Care and Moisturizers Step 3: Pharmacological Management Step 4: Palliative Care Consult Is this terminal phase of life? yes Is this terminal phase of life? no Topical Treatment Pramoxine Capsaicin 0.025% or 0.075% Ointment Menthol, Camphor and Phenol are separate products that can be added to most creams, typically in the range of 0.3-1.0% Gamma-Linolenic acid (GLA) 2.2% cream Systemic Treatment Doxepin CI Precaution Comment Cholestyramine Rifampin CI Precaution Liver Cirrhosis Naltrexone CI Precaution Comment Restless Legs Step 1: Consider the Underlying Causes of Restless Leg Syndrome Step 2: Consider Non-Pharmacological Management Step 3: Pharmacological Management Gabapentin Dose CKD Dose Liver Dose Pregabalin Pramipexole (Mirapex) Rotigotine (Neupro) CI Precaution Comment CKD, Liver Dose CKD CI Precaution Comment Dose CI Precaution Comment Dose CI Precaution Comment Ropinirole (Requip) Dose CI Precaution Comment Midazolam (Versed) Dose CKD,Cir,CAN,HF COPD CI Precaution Comment CKD,HF COPD Neuropathic Pain (OLD) Step 1: Consider the Underlying Causes of Neuropathic Pain Step 2: Non-Pharmacological Management of Neuropathic Pain Step 3: Pharmacological Management of Neuropathic Pain Step 4: Palliative Care Consult Non-Opioid Treatment Step 2: Non-Opioid Opioid Treatment Acetaminophen Dose CI Precaution Comment Diclofenac Gel Dose Comment Hydromorphone Dose CI Precaution Comment Fentanyl Transdermal Patch Dose CI Precaution Comment Methadone Dose CI Precaution Comment Nociceptive Pain (backup -Old) Step 1: Consider the Underlying Causes of Nociceptive Pain Step 2: Non-pharmacological Management of Nociceptive Pain Step 3: Pharmacological Management of Nociceptive Pain Step 4: Palliative Care Consult Non-opioids (for mild pain (typically >3/10) Step 2: Moderate Pain (4-6/10) Opioids Step 5: Patient Education & Self-Care Gabapentin Dose CI Comment Pregabalin Dose CI Precaution Comment Amitriptyline Dose CI Precaution Comment Acetaminophen Dose CI Precaution Comment Hydromorphone Dose CI Precaution Comment Fentanyl Transdermal Patch Dose CI Precaution Comment Methadone Dose CI Precaution Comment Step 5 Patient Education & Self Care Step 5: Patient Education and Self Care When is an opioid indicated? Precaution General General Fatigue Step 1: Consider the Underlying Causes of Fatigue Step 2: Non-pharmacological Management of Fatigue Step 3: Pharmacological Management of Fatigue Step 4: Palliative Care Consult General - Precaution Methyphenidate Dose CI Precaution HF Modafinil Dose CI Precaution HF Dexamethasone Dose CI Precaution Constipation Step 1: Consider the Underlying Causes of Constipation Step 2: Non-pharmacological Management of Constipation Step 3: Pharmacological Management of Constipation Step 4: Palliative Care Consult Psyllium Husk Dose CI Comment General Precaution Polyethylene Glycol (PEG 3350) Dose CI Precaution Comment Sennosides Dose CI Precaution Comment Bisacodyl Dose CI Precaution Comment Cancer Glycerin or Bisacodyl Suppository Dose CI Precaution Comment KF Sodium-phosphate Enema (Fleet Enema) Dose CI Precaution Magnesium citrate or hydroxide or sulfate (Epsom Salt) Dose Precaution Methylnaltexone Dose CI Precaution Comment KF Cirrhosis General Cirrhosis Secretagogues (Linaclotide) Prokinetics (Prucalopride) Liver Renal - Precaution General - CI General - CI General - P General - CI General - P General - CI General - P COPD - P Liver - CI General General Lactulose Dose CI Precaution Comment General General General General General General General General General Dose - CKD General - CI General - Precaution General - Precaution High Mineral Oil Enema Dose CI Precaution Comment General - PI General - CI Dose - CKD General - CI Ducolax Suppository Dose CI Precaution Comment General - CI General - Precaution Demo Medication Dose CI Precaution Comment Alarm When COPD Warning when Heart Failure Hide When Cirrhosis Replace When Kidney Disease Hide When Cancer Append When Cancer Demo Symptom Step 1: Consider the Underlying Causes of Demo Symptom Step 2: Non-pharmacological Management Step 3: Pharmacological Management Step 4: Palliative Care Consult New Med 1 Dose CI Precaution Comment General - CI General - Precaution CKD - Dose CKD - Dose General - CI General - precaution Comment - HF Amitriptyline Dose CI Precaution Comment General - CI General - precaution Liver - CI Acetominophen Dose CI Precaution Comment General - Precaution Cirrhosis - CI (HIDE) Liver - CI HIDE NOT HF General General General General General General HIDE Liver CI General Non-Opioid Treatment - Accordion General Information Reference Accordion References Opioid Treatment - Accordion Opioid Considerations Initiating Opioid Therapy Opioid Titration Helpful Links Pain - Neuropathic Step 1: Consider the Underlying Causes of Neuropathic Pain Step 2: Non-Pharmacological Management of Neuropathic Pain Step 3: Pharmacological Management of Neuropathic Pain Step 4: Palliative Care Consult Reference Accordion Helpful Links References 2. Non-Opioid Therapy 3. Opioid Therapy Hydromorphone Dose CI Precaution Comment Fentanyl Transdermal Patch Dose CI Precaution Comment Methadone Dose CI Precaution Comment Opioid Treatment - Accordion Opioid Considerations Initiating Opioid Therapy Opioid Titration Gabapentin Dose CI Precaution Comment Pregabalin Dose CI Precaution Comment Amitriptyline Dose CI Precaution Comment Acetaminophen Dose CI Precaution Comment Non-Opioid Treatment - Accordion General Information CKD - Dose General - Precaution CKD - Dose General - precaution Comment - kidney/liver General - CI General - precaution General - Precaution General General General Comment - HF CKD/Cirrhosis Special Considerations for Opioid Induced Constipation (OIC) Dose - Cirrhosis Peripherally acting μ-opioid receptor antagonists (PAMORAS) HF/CKD Hide Methadone (2) Diclofenac Gel Dose CI Precaution Comment Kidney/Cirrhosis Precaution - Kidney Failure Morphine (immediate release) Dose CI Precaution Comment General CI - Cirrhosis Buprenorphine Dose CI Precaution Comment Oxycodone Dose CI Precaution Comment Cirrhosis/Kidney CI - Cirrhosis Comment - Kidney/Liver Kidney CI Dose - Cirrhosis Comment - kidney/liver Precaution - HF Cirrhosis - dose General - comment CI - liver/hepatic encephalopathy Carbamazepine Dose CI Precaution Comment General - CI CI - Cirrhosis/HF General - Precaution Dose adjust - CKD/Cirrhosis General Comment Doxepin Dose CI Precaution Comment General - CI CI - HF/Cirrhosis General - CI 1. Start with Adjuvant Therapy Pain - Nociceptive Step 1: Consider the Underlying Causes of Nociceptive Pain Step 2: Non-pharmacological Management of Nociceptive Pain Step 3: Pharmacological Management of Nociceptive Pain Step 4: Palliative Care Consult First Line Therapy (Bulk Forming Laxatives) First Line Therapy (Osmotic Laxatives) First Line Therapy (Stimulant Laxatives) Second Line Therapy (Suppositories) Third Line Therapy (Alternative Treatments) Fourth Line Therapy (Special Considerations) - Specialist referral recommended Comment Contraindication Comment General Non-Opioid Therapy Acetaminophen Dose CI Precaution Comment Cirrhosis - CI (HIDE) Diclofenac Gel Dose CI Precaution Comment Non-Opioid Treatment - Accordion Opioid Therapy Hydromorphone Dose CI Precaution Comment Kidney/Cirrhosis Fentanyl Transdermal Patch Dose CI Precaution Comment Precaution - Kidney Failure Morphine (immediate release) Dose CI Precaution Comment CI - Cirrhosis Hide - Kidney Buprenorphine Dose CI Precaution Comment Oxycodone Dose CI Precaution Comment Cirrhosis/Kidney CI - Cirrhosis Comment - Kidney/Liver Methadone Dose CI Precaution Comment Opioid Treatment - Accordion Opioid Considerations Initiating Opioid Therapy Opioid Titration CI - Liver General - CI Disclaimer Anorexia Step 1: Consider the Underlying Causes of Anorexia Step 2: Non-pharmacological Management Step 3: Pharmacological Management Step 4: Palliative Care Consult Delirium Step 1: Consider the Underlying Causes of Delirium Step 2: Non-pharmacological Management Step 3: Pharmacological Management Step 4: Palliative Care Consult Depression Step 1: Consider the Underlying Causes of Depression Step 2: Non-pharmacological Management Step 3: Pharmacological Management Step 4: Palliative Care Consult Diarrhea Step 1: Consider the Underlying Causes of Diarrhea Step 2: Non-pharmacological Management Step 3: Pharmacological Management Step 4: Palliative Care Consult Edema Step 1: Consider the Underlying Causes of Edema Step 2: Non-pharmacological Management Step 3: Pharmacological Management Step 4: Palliative Care Consult Numbness/Tingling Step 1: Consider the Underlying Causes of Numbness & Tingling Step 2: Non-pharmacological Management Step 3: Pharmacological Management Step 4: Palliative Care Consult Shortness of Breath Step 1: Consider the Underlying Causes of Shortness of Breath Step 2: Non-pharmacological Management Step 3: Pharmacological Management Step 4: Palliative Care Consult Bupropion Dose CI Precaution Comment General General General General General General General General Sleep Disturbance Step 1: Consider the Underlying Causes of Sleep Disturbance Step 2: Non-pharmacological Management Step 3: Pharmacological Management Step 4: Palliative Care Consult Helpful Links End of Life Care Step 1: General Principles of End of Life Care Step 2: Non-pharmacological Management Step 3: Medical Management Step 4: Palliative Care Consult Pregabalin Dose CI Precaution Comment DEMO Symptom - Line of Treatment Step 1: Consider the Underlying Causes of DEMO Symptom - Line of Treatment Step 2: Non-pharmacological Management Step 3: Pharmacological Management Step 4: Palliative Care Consult Pregabalin (2) Dose CI Precaution Comment HIDE for kidney/liver Pregabalin (1) Dose CI Precaution Comment Kidney Liver Helpful Links References Med 2 Dose CI Precaution Comment HF Hide HF How to use onecarepath Second Line Therapy (Stimulants) Bisacodyl Dose CI Precaution Comment Cancer - Dose General - CI General COPD Description Heart Failure Description Cirrhosis Description Advanced Chronic Kidney Disease Description Cancer Description Mild Symptoms: limited evidence exists for most medications test2 Step 4: Palliative Care Specialist Consultation Terminal Care Considerations If pain persists add a non-opioid +/- adjuvant therapy If pain persists consider adding an opioid, +/- adjuvant, +/- non-opioid End of Life Care Melatonin Dose CI Precaution Comment Mirtazapine Dose CI Precaution Comment Trazodone Dose CI Comment Doxepin Dose Precaution Comment Moderate to severe symptoms Zopiclone Dose CI Precaution Comment Gabapentin Dose CI Precaution Comment Pregabalin Dose CI Precaution Comment Precaution - HF Dose Adjustment - CKD Dose Adjustment - Cirrhosis Comment - Kidney/Liver CI - Liver HE Dose adjust - Kidney Dose Adjust - Liver comment - kidney/liver Precaution General CI Fentanyl Transdermal Patch Liver - MasterHide Liver CI Acetaminophen Liver CI - MasterHide Pain - Neuropathic Pain - Nociceptive Restless Legs Constipation Dose CI Precaution Comment Dose CI Precaution Comment med 1 for step 7 Dose CI Precaution Comment Fatigue Shortness of Breath Morphine Carbamazepine Liver Heart - MasterHide Kidney - MasterHide Liver CI Doxepin Dose CI Precaution Comment Liver Heart - MasterHide Acetaminophen Dose CI Precaution Comment Liver - MasterHide Fentanyl Transdermal Patch Dose CI Precaution Comment Liver-MasterHide Morphine Dose CI Precaution Comment Kidney - MasterHide Sodium-phosphate Enema (Fleet Enema) Dose CI Precaution Comment Kidney_Heart Failure - MasterHide Methylphenidate Dose CI Precaution Comment Modafinil Dose CI Precaution Comment Heart Failure - MasterHide Heart Failure - MasterHide Doxepin Dose CI Precaution Comment Heart Liver - MasterHide HF Liver - Hide Helpful Links References Helpful Links References Metoclopramide Dose CI Precaution Comment General Kidney precaution Kidney/Liver Dose General Domperidone Dose CI Precaution Comment Liver dose adjustment General Liver CI General Haloperidol Dose Precaution Kidney Dose Liver Dose General Kidney Precaution Contraindications Comment General Dimenhydrinate Dose CI Precaution Comment General General General Haloperidol Dose CI Precaution Comment General CI General Methotrimeprazine Liver-MasterHide Ondansetron Dose CI Precaution Comment Kidney Dose Adjustment Liver Dose Adjustment General Liver Precaution Olanzapine Dose CI Precaution Comment General Kidney CI General CINV treatment only Dose CI Precaution Comment Dexamethasone Dose CI Precaution Comment all conditions except cancer CI Dexamethasone Dose All conditions except cancer - MasterHide Precaution Comment Patient Pathway Provider Pathway Medication MasterHide Patient Pathway What is One:carepath Provider Resources Other FAQ About one:carepath Useful Links Useful Contacts Events & Newsletters Disclaimer & Privacy Quality Improvement Quality Improvement KPI's Glossary Choosing Supportive Care Provider Pathway Advance Care Planning Patient Symptom Guidelines Patient Handouts About the Provider Pathway Choosing Supportive Care Dose 1 Confirm Comorbidities and Risk Stratify Engage Specialty Care Education Materials Patient Resources For Healthcare Providers For Patient Access to Tools & Best Practice Supports Symptom & Medical Management Prepare for Care Planning With Your Healthcare Providers Better Understand Your Health Conditions Healthcare Providers Patients/Family Prepare for Conversations About Your Wishes & Needs Manage Your Health Conditions Action Plans Provider Checklists Clinical Pathways Complimentary Treatments Helpful Links References Lidocaine 2.5% cream Gabapentin Dose CI Precaution Comment CI Cirrhosis Renal + Liver Precaution Pregabalin Dose Comment ESKD Dose Adjust ESKD Dose Adjust Hide (cirrhosis med only) CI Precaution Comment Cirrhosis CI CI Precaution General Precaution Comment general Comment Liver - CI General - CI General General Renal Not indicated except for liver Renal CI General Renal Renal General General Renal Dose COPD Dose General General Liver Dose Cirrhosis Dose CI Liver + Renal CI Precautions Liver + Renal Dose Renal + Liver CI Liver + Renal Precaution Liver CI Cirrhosis precaution hide for non liver or kidney hide for non liver or kidney hide for non-liver or kidney Helpful Links References Liver CI HF Precaution General Liver Dose General Liver CI CKD, Liver Ascites Step 1: Initial Workup Step 2: Non-pharmacological Management Step 3: Pharmacological Management Step 4: Palliative Care Consult Hepatic Encephalopathy Step 1: Consider the Underlying Causes of Hepatic Encephalopathy Step 2: Non-pharmacological Management Step 3: Pharmacological Management Step 4: Palliative Care Consult Hepatocellular Carcinoma Step 1: Consider the Underlying Causes of Hepatocellular Carcinoma Step 2: Non-pharmacological Management Step 3: Pharmacological Management Step 4: Palliative Care Consult What is Worrying you right now? Your Health Conditions fgdfgdafg Your Wishes and Preferences Symptom Management Guides Your Health Plan What is Shared Care Planning? Steps in Shared Care Planning What is Advance Care Planning? Your Green Sleeve Preparing for the Final Weeks & Days of Life Your Shared Care Plan Basic fluid workup (for patients who have had a thorough fluid analysis before): Extended ascites fluid workup (for patient having a first-tine paracentesis): Mild Ascites Spironolactone Monotherapy Dose CI Precaution Comment General Precaution Amiloride (Substitute for Spironolactone) Dose CI Precaution Comment Mild to Moderate Ascites Tense Ascites Lactulose (oral) Dose CI Precaution Comment If oral intake safe/tolerated If oral intake not safe/not tolerated Lactulose (nasogastric) If improvement start secondary prophylaxis Secondary Prophylaxis Dose CI Precaution Comment If no improvement Rifaximin Dose CI Precaution Comment Patient Symptom - Pain Step 1: Consider the Underlying Causes of Patient Symptom - Pain Step 2: Non-pharmacological Management Step 3: Pharmacological Management Step 4: Palliative Care Consult Patient Symptom - Pain Step 1: What can I try at home? Step 2: What treatment choices do I have? Step 3: Pharmacological Management Step 4: Pain Resources Tailored Outputs Based on Conditions Confirm Comorbidities End Of Life Guideline End of Life Step 2: Non-pharmacological Management Step 3: Pharmacological Management Step 4: Palliative Care Consult CKD Associated Pruritus Step 1: Consider the Underlying Causes of CKD Associated Pruritus Step 2: Non-pharmacological Management Step 3: Pharmacological Management Step 4: Palliative Care Consult Good Skin Care Complimentary Treatments Topical Treatment Systemic Treatment Pramoxine Dose CI Precaution Comment Capsaicin 0.025% or 0.075% Ointment Dose CI Precaution Comment Menthol, Camphor and Phenol are separate products that can be added to most creams, typically in the range of 0.3-1.0% Dose CI Precaution Comment Gamma-Linolenic acid (GLA) 2.2% cream Dose CI Precaution Comment Lidocaine 2.5% cream Dose CI Precaution Comment Dose CI Precaution Comment Pregabalin Dose CI Precaution Comment Gabapentin Dose CI Precaution Comment ESKD Dose Adjustment Cirrhosis Dose Liver & Renal CI Liver & Renal ESKD Dose Liver Dose Risk Staging Self-Management & Lifestyle Modifications: General Establish Community Support & Referrals Advance Care Planning Palliative Care Final Weeks and Days of Life COPD Heart Failure Cirrhosis Advanced CKD Cancer COPD Heart Failure Cirrhosis Advanced CKD Cancer COPD Heart Failure Cirrhosis Advanced CKD Cancer COPD Heart Failure Cirrhosis Advanced CKD Cancer COPD Heart Failure Cirrhosis Advanced CKD Cancer Message COPD Heart Failure Cirrhosis Advanced CKD Cancer Dosing for Combination Diuretics Dose CI Precaution Comment Large-volume (≥ 5L) paracentesis AND start combination diuretics if no contraindications Dose CI Precaution Comment Diagnostic Criteria for Refractory Ascites & Management Monitoring for Patients on Diuretics How to titrate up diuretics References Helpful Links COPD Step 1: COPD Management Step 2: Pharmacological Management Heart Failure Management Step 1: Consider the Underlying Causes of Heart Failure Management Step 2: Non-pharmacological Management Step 3: Pharmacological Management Step 3: Exacerbation Management Dose CI Precaution Comment Dose CI Precaution Comment Examples of converting oral to subcutaneous administration When to Consult a Palliative Care Specialist EMS Palliative and End of Life Care Assess, Treat, and Refer (EMS PEOLC ATR) Initiative Services required for caring for patients at home, location of care and location of death Step 5: What Happens After Death? Symptom Management Near the End of Life Pain Breathlessness Fluid Management Respiratory Secretions Constipation Fatigue & Sleep Disturbance Restless Legs Syndrome Delirium & Agitation Poor Appetite & Intake Muscle Cramps Helpful Links Shared Care Plan COPD Heart Failure Cirrhosis Advanced CKD Cancer Muscle Cramps Step 1: Consider the Underlying Causes of Muscle Cramps Step 2: Non-pharmacological Management Step 3: Pharmacological Management Step 4: Palliative Care Consult Symptom Management Medical Management General Smoking  Immunization  Nutrition Exercise Social Determinants of Health  Home Care Advance Care Planning Salt Intake Fluid Intake  Alcohol   Obesity Counselling Mood and Stress Management  Resources Pulmonary Rehabilitation Calgary COPD and Asthma Program  (CCAP) Alberta Healthy Living Program  Community Paramedics (CP) Home Care (COPD homecare specific teams) Alberta Quits  Other Resources Your Support Team Palliative & End of Life Care Symptom Management for Advanced CKD Constipation What causes constipation? What you can do to help manage your constipation When you should talk to your healthcare provider Medication 1 Dose CI Precaution Comment Mona Step 1: Consider the Underlying Causes of Mona Step 2: Non-pharmacological Management Step 3: Pharmacological Management Step 4: Palliative Care Consult Medication 1 Dose CI Precaution Comment CKD Acidosis Guideline Acidosis (Metabolic) - Clinical Algorithm Dosing Chart for Sodium Bicarbonate Additional Resources: Blood Pressure Guideline Additional Resources Sodium/Fluid Statement Sodium Intake Fluid Intake Rehydration if patients are not able to drink orally Considerations at End of Life Nausea & Vomiting Accordion Container What you can do to help manage nausea & vomiting? When you should talk to my healthcare team? Links Accordion Container Links Pain Accordion Container What you can do to help manage your pain When you should talk to your healthcare team Links Shortness of Breath Accordion Container What causes shortness of breath What you can do to help manage shortness of breath When you should talk to your healthcare team Links Anemia Guideline Iron Protocol for Conservatively Managed Patients HGB/ESA Protocol & Dose Adjustment Schedule for darbepoietin (Aranesp®) Additional Resources Calcium/Phosphorus Guideline Dose Adjustment Guideline for Phosphate Binders – Recommended Initial Calcium Dosing Dose Adjustment Guideline for Non-Calcium Based Phosphate Binders (may be used alone or as an adjuvant therapy) High Calcium Clinical Guideline Lipids Guideline Additional Resources Potassium Guideline Potassium - Clinical Algorithm Additional Resources Vitamin D Statement Considerations at End of Life: Additional Resources Calcitriol (active form of vitamin D, e.g. Rocaltrol) Glossary acc1 acc item1 fasdf p1 replace Container Med1 Dose CI Precaution Comment repalce when HF hide when cancer acc no 1 Med 1 Dose CI Precaution Comment replace when HF Hide when Cancer Shared Care Planning Supportive Care Health Condition Chronic Disease Preferences Health Plan Healthcare Team Advance Care Planning or ACP Personal Directive Enduring Power Attorney Goals of Care (Designation) or GoC “Greensleeve” Palliative care End of Life Care Accordion Container Additional Resources What is Palliative Care? Accordion Container Darbepoetin starting dose when Hgb < 95 g/L and iron replete. Darbepoetin adjustment schedule if Hgb BELOW target: Darbepoetin adjustment schedule if Hgb ABOVE target or rising significantly: Dose Adjustment Schedule for epoetin alpha (Eprex ®) Glossary Symptom and Medical Management Patient Handouts Maintenance: Calcium Dosing Guideline Additional Resources What is End of Life Care? Helpful Links References Helpful Links References References Helpful Links References Helpful Links References Helpful Links References Helpful Links References Hide for non liver or kidney Not indicated except in liver Step 1: Continue Goals of Care Discussions References Hide for HF except HF General General General General General Restless Legs Lack of Appetite Depression & Anxiety Fatigue Muscle Cramps Numbness & Tingling Taste Changes Diarrhea Dehydration Itchiness Swelling Difficulty Swallowing Sleep Problems Palliative Care Accordion Container What causes restless leg syndrome What you can do to help manage your restless leg syndrome When you should talk to your healthcare team Accordion Container What causes a lack of appetite What you can do to help manage your lack of appetite When you should talk to your healthcare team Accordion container What causes depression & anxiety What you can do to help manage your depression & anxiety When you should talk to your healthcare team Accordion container What causes fatigue What you can do to help manage you fatigue When you should talk to your healthcare team Accordion container What causes muscle cramps What you can do to help manage your muscle cramps Accordion container When you should talk to your healthcare team What causes numbness & tingling What you can do to help manage your numbness & tingling When to talk to your healthcare team Accordion Container What causes taste changes? What you can do to help manage your taste changes When to talk to your healthcare team Accordion Container What causes diarrhea? What you can do to help manage your diarrhea When to talk to your healthcare team Accordion Container What causes dehydration? What you can do to help manage your dehydration When to talk to your healthcare team Accordion Container What causes itchiness? What you can do to help manage your itchiness When to talk to your healthcare team Accordion Container What causes swelling? What you can do to help manage your swelling When to talk to your healthcare team Accordion Container What causes sleep problems? What you can do to help manage your sleep problems When to talk to your healthcare team What causes nausea & vomiting? Accordion Container What you can do to help manage your difficulty with swallowing When to talk to your healthcare team What causes difficulty in swallowing? What causes nausea & Vomiting What causes pain Accordion Container what can I expect in the last weeks and days of life? What will happen if my family & friends can't care for me at home? Helpful links to learn more about palliative and end of life care in Alberta Links Links Links Links Links Links Links Links Links Links Links Links Links Cancer Management Step 1: Consider the Underlying Causes of Cancer Management Step 2: Non-pharmacological Management Step 3: Pharmacological Management Step 4: Palliative Care Consult Advance Care Planning Palliative & End of Life Access to Resources Topical Compounded Products Dose CI Precaution Comment Caution General-Caution Topical Compounded Products Dose CI Precaution Comment General Condition condition for HF & KD General CI Additional Resources Lemborexant Dose CI Precaution Comment Hide for Kidney and Cirrhosis Hide for Cancer COPD HF Sertraline Dose CI Precaution Comment CI-Genernal General CI for Cirrhosis Living with Heart Failure Living with COPD

TargetSectionId Section 1 News Events Section 2 FAQ Integrated Supportive Care What is one:carepath? Who is One:carepath for? Patient Symptoms About You & Your Health Conditions Managing Your Health Condition Your Shared Care Plan Your Advance Care Planning Patient Portal Home Page Provider Pathway Content Diease Area Description Confirm Comorbidities Hero Quick Access Posters Call to Action Highlighted Features Footer Navbar Integrated Supportive Care Home Interactive Clinical Assessment Patients Content Symptom Fatigue STEP 1: IDENTIFY AND TREAT POTENTIAL REVERSIBLE CAUSES Disease Area (KF) Anxiety/Depression Breathlessness Constipation Edema Kidney COPD Heart Liver Cancer Fatigue New General Symptom Management Content - Symptom 1 New Section Cause 1 Edema Step 1. General Symptom Management New Section Cause 1 Step 4. Palliative Care Consult Fatigue New General Symptom Management Content - Symptom 1 New Section Cause 1 Anxiety/Depression Step 1: General Symptom Management New Section Cause 1 STEP 2: GENERAL Non-Pharmacological Non-Pharmacological Symptom Nuances Non-Pharmacological: Disease Specific Symptom Management Cause 1 STEP 3: Pharmacological Liver Nuance Kidney Nuance Step 4: Palliative Care Consult Constipation old STEP 2: Non-Pharmacological Management STEP 3: Pharmacological Management STEP 4: Palliative Care Consult STEP 2: NON-PHARMACOLOGICAL MANAGEMENT STEP 3: PHARMACOLOGICAL MANAGEMENT HEART FAILURE CIRRHOSIS KIDNEY FAILURE ABOUT PAIN: GENERAL DESCRIPTION & DEFINITION STEP 1: IDENTIFY AND TREAT POTENTIAL REVERSIBLE CAUSES STEP 2: NON-PHARMACOLOGICAL MANAGEMENT STEP 3: PHARMACOLOGICAL MANAGEMENT KIDNEY DISEASE - NEUROPATHIC KIDNEY DISEASE - NOCICEPTIVE STEP 4: PALLIATIVE CARE CONSULT PHARMACOLOGICAL PALLIATIVE CARE END OF LIFE NEUROPATHIC PAIN PHARMACOLOGICAL PALLIATIVE CARE END OF LIFE NOCICEPTIVE PAIN Superficial pain Bone Soft Tissue Muscle Relaxants Visceral Dexamethasone Bisphosphonate – Clodronate 1600-2400 mg PO daily Denosumab 120 mg SC every 4 weeks STEP 4: PALLIATIVE CARE CONSULT Version 2 NSAID (systemic) NSAID (topical) Diazepam Baclofen Tizanidine GFR 0-7 GFR 8-15 GFR 15-30 GFR 30+ EFS Severe EFS Not Severe Other Assessment Tool EFS Severe EFS Not Severe EFS Severe EFS Not Severe Heart Failure FEV1 FEV2 EFS Severe EFS Not Severe Weight Another Tool New Measurement Level Test Disease Area Fatigue old STEP 1: Consider the Underlying Causes of Fatigue STEP 2: Non Pharmacological Management of Fatigue STEP 3: Pharmacological Management v1 - Modelled after Med Table STEP 4: Palliative Care Consult Nausea & Vomiting Step 1: Consider the Underlying Causes of Nausea & Vomiting Step 2: Non-Pharmacological Management STEP 4: Palliative Care Consult Step 3: Pharmacological Management Dexamethasone-Append-Cancer HF-Replace-Buproprion Step 3: Pharmacological Management v2 - Fewest Nodes - Better management Dexamethasone-Append-Cancer STEP 3: Pharmacological Management V3 - Will not work as this does not align with wholistic approach Heart Failure Cancer STEP 3: Pharmacological Management v4 - Most Nodes and Difficult to Manage Modafinil (Provigil) Methylphenidate (Ritalin) Bupropion Modafinil-<>HF Methyphenidate <> HF Modafinil-Cirrhosis-ReduceDose <> HF KIdney STEP 3: Pharmacological Management v5 - Using Hide Dexamethasone Reduce Dose-Cirrhosis - Need to create nuance to a nuance Modafinil Dexamethasone Methylphenidate (Ritalin) Reduce Dose Cirrhosis STEP 3: Pharmacological Management of Fatigue Bupropion Methyphenidate & Modafinil Continue with algorithm Dexamethasone Bisacodyl; Peristaltic stimulant Cancer Adjusted Dose Methyphenidate & Modafinil Rule-Hide when HF selected Bupropion  Rule-Hide when Cirrhosis selected Psyllium (Metamucil) Polyethylene glycol (PEG 3350) (LAX-A-DAY); Osmotic laxative Lactulose or Sorbitol; Osmotic laxative Sennosides (SenekotÒ); Peristaltic stimulant Glycerin Suppository Sodium-phosphate enema (Fleet Enema) Magnesium citrate or hydroxide or sulfate (Epsom salt) Methylnaltexone (RelistorÒ); Peripherally acting μ-opioid receptor antagonists (PAMORAs) Kidney Disease Dose Adjustment Naloxegol (MovantikÒ); Peripherally acting μ-opioid receptor antagonists (PAMORAs) KidneyDiseaseDoseAdjustment CirrhosisChildPughCAvoidUse Prucalopride; Prokinetics KidneyDiseaseDoseAdjustment Manual Disimpaction; for severe constipation Cholestatic Pruritus Step 1: Consider the Underlying Causes of Pruritus Step 2: Non-pharmacological Management Good Skin Care and Moisturizers Step 3: Pharmacological Management Step 4: Palliative Care Consult Is this terminal phase of life? yes Is this terminal phase of life? no Topical Treatment Pramoxine Capsaicin 0.025% or 0.075% Ointment Menthol, Camphor and Phenol are separate products that can be added to most creams, typically in the range of 0.3-1.0% Gamma-Linolenic acid (GLA) 2.2% cream Systemic Treatment Doxepin CI Precaution Comment Cholestyramine Rifampin CI Precaution Liver Cirrhosis Naltrexone CI Precaution Comment Restless Legs Step 1: Consider the Underlying Causes of Restless Leg Syndrome Step 2: Consider Non-Pharmacological Management Step 3: Pharmacological Management Gabapentin Dose CKD Dose Liver Dose Pregabalin Pramipexole (Mirapex) Rotigotine (Neupro) CI Precaution Comment CKD, Liver Dose CKD CI Precaution Comment Dose CI Precaution Comment Dose CI Precaution Comment Ropinirole (Requip) Dose CI Precaution Comment Midazolam (Versed) Dose CKD,Cir,CAN,HF COPD CI Precaution Comment CKD,HF COPD Neuropathic Pain (OLD) Step 1: Consider the Underlying Causes of Neuropathic Pain Step 2: Non-Pharmacological Management of Neuropathic Pain Step 3: Pharmacological Management of Neuropathic Pain Step 4: Palliative Care Consult Non-Opioid Treatment Step 2: Non-Opioid Opioid Treatment Acetaminophen Dose CI Precaution Comment Diclofenac Gel Dose Comment Hydromorphone Dose CI Precaution Comment Fentanyl Transdermal Patch Dose CI Precaution Comment Methadone Dose CI Precaution Comment Nociceptive Pain (backup -Old) Step 1: Consider the Underlying Causes of Nociceptive Pain Step 2: Non-pharmacological Management of Nociceptive Pain Step 3: Pharmacological Management of Nociceptive Pain Step 4: Palliative Care Consult Non-opioids (for mild pain (typically >3/10) Step 2: Moderate Pain (4-6/10) Opioids Step 5: Patient Education & Self-Care Gabapentin Dose CI Comment Pregabalin Dose CI Precaution Comment Amitriptyline Dose CI Precaution Comment Acetaminophen Dose CI Precaution Comment Hydromorphone Dose CI Precaution Comment Fentanyl Transdermal Patch Dose CI Precaution Comment Methadone Dose CI Precaution Comment Step 5 Patient Education & Self Care Step 5: Patient Education and Self Care When is an opioid indicated? Precaution General General Fatigue Step 1: Consider the Underlying Causes of Fatigue Step 2: Non-pharmacological Management of Fatigue Step 3: Pharmacological Management of Fatigue Step 4: Palliative Care Consult General - Precaution Methyphenidate Dose CI Precaution HF Modafinil Dose CI Precaution HF Dexamethasone Dose CI Precaution Constipation Step 1: Consider the Underlying Causes of Constipation Step 2: Non-pharmacological Management of Constipation Step 3: Pharmacological Management of Constipation Step 4: Palliative Care Consult Psyllium Husk Dose CI Comment General Precaution Polyethylene Glycol (PEG 3350) Dose CI Precaution Comment Sennosides Dose CI Precaution Comment Bisacodyl Dose CI Precaution Comment Cancer Glycerin or Bisacodyl Suppository Dose CI Precaution Comment KF Sodium-phosphate Enema (Fleet Enema) Dose CI Precaution Magnesium citrate or hydroxide or sulfate (Epsom Salt) Dose Precaution Methylnaltexone Dose CI Precaution Comment KF Cirrhosis General Cirrhosis Secretagogues (Linaclotide) Prokinetics (Prucalopride) Liver Renal - Precaution General - CI General - CI General - P General - CI General - P General - CI General - P COPD - P Liver - CI General General Lactulose Dose CI Precaution Comment General General General General General General General General General Dose - CKD General - CI General - Precaution General - Precaution High Mineral Oil Enema Dose CI Precaution Comment General - PI General - CI Dose - CKD General - CI Ducolax Suppository Dose CI Precaution Comment General - CI General - Precaution Demo Medication Dose CI Precaution Comment Alarm When COPD Warning when Heart Failure Hide When Cirrhosis Replace When Kidney Disease Hide When Cancer Append When Cancer Demo Symptom Step 1: Consider the Underlying Causes of Demo Symptom Step 2: Non-pharmacological Management Step 3: Pharmacological Management Step 4: Palliative Care Consult New Med 1 Dose CI Precaution Comment General - CI General - Precaution CKD - Dose CKD - Dose General - CI General - precaution Comment - HF Amitriptyline Dose CI Precaution Comment General - CI General - precaution Liver - CI Acetominophen Dose CI Precaution Comment General - Precaution Cirrhosis - CI (HIDE) Liver - CI HIDE NOT HF General General General General General General HIDE Liver CI General Non-Opioid Treatment - Accordion General Information Reference Accordion References Opioid Treatment - Accordion Opioid Considerations Initiating Opioid Therapy Opioid Titration Helpful Links Pain - Neuropathic Step 1: Consider the Underlying Causes of Neuropathic Pain Step 2: Non-Pharmacological Management of Neuropathic Pain Step 3: Pharmacological Management of Neuropathic Pain Step 4: Palliative Care Consult Reference Accordion Helpful Links References 2. Non-Opioid Therapy 3. Opioid Therapy Hydromorphone Dose CI Precaution Comment Fentanyl Transdermal Patch Dose CI Precaution Comment Methadone Dose CI Precaution Comment Opioid Treatment - Accordion Opioid Considerations Initiating Opioid Therapy Opioid Titration Gabapentin Dose CI Precaution Comment Pregabalin Dose CI Precaution Comment Amitriptyline Dose CI Precaution Comment Acetaminophen Dose CI Precaution Comment Non-Opioid Treatment - Accordion General Information CKD - Dose General - Precaution CKD - Dose General - precaution Comment - kidney/liver General - CI General - precaution General - Precaution General General General Comment - HF CKD/Cirrhosis Special Considerations for Opioid Induced Constipation (OIC) Dose - Cirrhosis Peripherally acting μ-opioid receptor antagonists (PAMORAS) HF/CKD Hide Methadone (2) Diclofenac Gel Dose CI Precaution Comment Kidney/Cirrhosis Precaution - Kidney Failure Morphine (immediate release) Dose CI Precaution Comment General CI - Cirrhosis Buprenorphine Dose CI Precaution Comment Oxycodone Dose CI Precaution Comment Cirrhosis/Kidney CI - Cirrhosis Comment - Kidney/Liver Kidney CI Dose - Cirrhosis Comment - kidney/liver Precaution - HF Cirrhosis - dose General - comment CI - liver/hepatic encephalopathy Carbamazepine Dose CI Precaution Comment General - CI CI - Cirrhosis/HF General - Precaution Dose adjust - CKD/Cirrhosis General Comment Doxepin Dose CI Precaution Comment General - CI CI - HF/Cirrhosis General - CI 1. Start with Adjuvant Therapy Pain - Nociceptive Step 1: Consider the Underlying Causes of Nociceptive Pain Step 2: Non-pharmacological Management of Nociceptive Pain Step 3: Pharmacological Management of Nociceptive Pain Step 4: Palliative Care Consult First Line Therapy (Bulk Forming Laxatives) First Line Therapy (Osmotic Laxatives) First Line Therapy (Stimulant Laxatives) Second Line Therapy (Suppositories) Third Line Therapy (Alternative Treatments) Fourth Line Therapy (Special Considerations) - Specialist referral recommended Comment Contraindication Comment General Non-Opioid Therapy Acetaminophen Dose CI Precaution Comment Cirrhosis - CI (HIDE) Diclofenac Gel Dose CI Precaution Comment Non-Opioid Treatment - Accordion Opioid Therapy Hydromorphone Dose CI Precaution Comment Kidney/Cirrhosis Fentanyl Transdermal Patch Dose CI Precaution Comment Precaution - Kidney Failure Morphine (immediate release) Dose CI Precaution Comment CI - Cirrhosis Hide - Kidney Buprenorphine Dose CI Precaution Comment Oxycodone Dose CI Precaution Comment Cirrhosis/Kidney CI - Cirrhosis Comment - Kidney/Liver Methadone Dose CI Precaution Comment Opioid Treatment - Accordion Opioid Considerations Initiating Opioid Therapy Opioid Titration CI - Liver General - CI Disclaimer Anorexia Step 1: Consider the Underlying Causes of Anorexia Step 2: Non-pharmacological Management Step 3: Pharmacological Management Step 4: Palliative Care Consult Delirium Step 1: Consider the Underlying Causes of Delirium Step 2: Non-pharmacological Management Step 3: Pharmacological Management Step 4: Palliative Care Consult Depression Step 1: Consider the Underlying Causes of Depression Step 2: Non-pharmacological Management Step 3: Pharmacological Management Step 4: Palliative Care Consult Diarrhea Step 1: Consider the Underlying Causes of Diarrhea Step 2: Non-pharmacological Management Step 3: Pharmacological Management Step 4: Palliative Care Consult Edema Step 1: Consider the Underlying Causes of Edema Step 2: Non-pharmacological Management Step 3: Pharmacological Management Step 4: Palliative Care Consult Numbness/Tingling Step 1: Consider the Underlying Causes of Numbness & Tingling Step 2: Non-pharmacological Management Step 3: Pharmacological Management Step 4: Palliative Care Consult Shortness of Breath Step 1: Consider the Underlying Causes of Shortness of Breath Step 2: Non-pharmacological Management Step 3: Pharmacological Management Step 4: Palliative Care Consult Bupropion Dose CI Precaution Comment General General General General General General General General Sleep Disturbance Step 1: Consider the Underlying Causes of Sleep Disturbance Step 2: Non-pharmacological Management Step 3: Pharmacological Management Step 4: Palliative Care Consult Helpful Links End of Life Care Step 1: General Principles of End of Life Care Step 2: Non-pharmacological Management Step 3: Medical Management Step 4: Palliative Care Consult Pregabalin Dose CI Precaution Comment DEMO Symptom - Line of Treatment Step 1: Consider the Underlying Causes of DEMO Symptom - Line of Treatment Step 2: Non-pharmacological Management Step 3: Pharmacological Management Step 4: Palliative Care Consult Pregabalin (2) Dose CI Precaution Comment HIDE for kidney/liver Pregabalin (1) Dose CI Precaution Comment Kidney Liver Helpful Links References Med 2 Dose CI Precaution Comment HF Hide HF How to use onecarepath Second Line Therapy (Stimulants) Bisacodyl Dose CI Precaution Comment Cancer - Dose General - CI General COPD Description Heart Failure Description Cirrhosis Description Advanced Chronic Kidney Disease Description Cancer Description Mild Symptoms: limited evidence exists for most medications test2 Step 4: Palliative Care Specialist Consultation Terminal Care Considerations If pain persists add a non-opioid +/- adjuvant therapy If pain persists consider adding an opioid, +/- adjuvant, +/- non-opioid End of Life Care Melatonin Dose CI Precaution Comment Mirtazapine Dose CI Precaution Comment Trazodone Dose CI Comment Doxepin Dose Precaution Comment Moderate to severe symptoms Zopiclone Dose CI Precaution Comment Gabapentin Dose CI Precaution Comment Pregabalin Dose CI Precaution Comment Precaution - HF Dose Adjustment - CKD Dose Adjustment - Cirrhosis Comment - Kidney/Liver CI - Liver HE Dose adjust - Kidney Dose Adjust - Liver comment - kidney/liver Precaution General CI Fentanyl Transdermal Patch Liver - MasterHide Liver CI Acetaminophen Liver CI - MasterHide Pain - Neuropathic Pain - Nociceptive Restless Legs Constipation Dose CI Precaution Comment Dose CI Precaution Comment med 1 for step 7 Dose CI Precaution Comment Fatigue Shortness of Breath Morphine Carbamazepine Liver Heart - MasterHide Kidney - MasterHide Liver CI Doxepin Dose CI Precaution Comment Liver Heart - MasterHide Acetaminophen Dose CI Precaution Comment Liver - MasterHide Fentanyl Transdermal Patch Dose CI Precaution Comment Liver-MasterHide Morphine Dose CI Precaution Comment Kidney - MasterHide Sodium-phosphate Enema (Fleet Enema) Dose CI Precaution Comment Kidney_Heart Failure - MasterHide Methylphenidate Dose CI Precaution Comment Modafinil Dose CI Precaution Comment Heart Failure - MasterHide Heart Failure - MasterHide Doxepin Dose CI Precaution Comment Heart Liver - MasterHide HF Liver - Hide Helpful Links References Helpful Links References Metoclopramide Dose CI Precaution Comment General Kidney precaution Kidney/Liver Dose General Domperidone Dose CI Precaution Comment Liver dose adjustment General Liver CI General Haloperidol Dose Precaution Kidney Dose Liver Dose General Kidney Precaution Contraindications Comment General Dimenhydrinate Dose CI Precaution Comment General General General Haloperidol Dose CI Precaution Comment General CI General Methotrimeprazine Liver-MasterHide Ondansetron Dose CI Precaution Comment Kidney Dose Adjustment Liver Dose Adjustment General Liver Precaution Olanzapine Dose CI Precaution Comment General Kidney CI General CINV treatment only Dose CI Precaution Comment Dexamethasone Dose CI Precaution Comment all conditions except cancer CI Dexamethasone Dose All conditions except cancer - MasterHide Precaution Comment Patient Pathway Provider Pathway Medication MasterHide Patient Pathway What is One:carepath Provider Resources Other FAQ About one:carepath Useful Links Useful Contacts Events & Newsletters Disclaimer & Privacy Quality Improvement Quality Improvement KPI's Glossary Choosing Supportive Care Provider Pathway Advance Care Planning Patient Symptom Guidelines Patient Handouts About the Provider Pathway Choosing Supportive Care Dose 1 Confirm Comorbidities and Risk Stratify Engage Specialty Care Education Materials Patient Resources For Healthcare Providers For Patient Access to Tools & Best Practice Supports Symptom & Medical Management Prepare for Care Planning With Your Healthcare Providers Better Understand Your Health Conditions Healthcare Providers Patients/Family Prepare for Conversations About Your Wishes & Needs Manage Your Health Conditions Action Plans Provider Checklists Clinical Pathways Complimentary Treatments Helpful Links References Lidocaine 2.5% cream Gabapentin Dose CI Precaution Comment CI Cirrhosis Renal + Liver Precaution Pregabalin Dose Comment ESKD Dose Adjust ESKD Dose Adjust Hide (cirrhosis med only) CI Precaution Comment Cirrhosis CI CI Precaution General Precaution Comment general Comment Liver - CI General - CI General General Renal Not indicated except for liver Renal CI General Renal Renal General General Renal Dose COPD Dose General General Liver Dose Cirrhosis Dose CI Liver + Renal CI Precautions Liver + Renal Dose Renal + Liver CI Liver + Renal Precaution Liver CI Cirrhosis precaution hide for non liver or kidney hide for non liver or kidney hide for non-liver or kidney Helpful Links References Liver CI HF Precaution General Liver Dose General Liver CI CKD, Liver Ascites Step 1: Initial Workup Step 2: Non-pharmacological Management Step 3: Pharmacological Management Step 4: Palliative Care Consult Hepatic Encephalopathy Step 1: Consider the Underlying Causes of Hepatic Encephalopathy Step 2: Non-pharmacological Management Step 3: Pharmacological Management Step 4: Palliative Care Consult Hepatocellular Carcinoma Step 1: Consider the Underlying Causes of Hepatocellular Carcinoma Step 2: Non-pharmacological Management Step 3: Pharmacological Management Step 4: Palliative Care Consult What is Worrying you right now? Your Health Conditions fgdfgdafg Your Wishes and Preferences Symptom Management Guides Your Health Plan What is Shared Care Planning? Steps in Shared Care Planning What is Advance Care Planning? Your Green Sleeve Preparing for the Final Weeks & Days of Life Your Shared Care Plan Basic fluid workup (for patients who have had a thorough fluid analysis before): Extended ascites fluid workup (for patient having a first-tine paracentesis): Mild Ascites Spironolactone Monotherapy Dose CI Precaution Comment General Precaution Amiloride (Substitute for Spironolactone) Dose CI Precaution Comment Mild to Moderate Ascites Tense Ascites Lactulose (oral) Dose CI Precaution Comment If oral intake safe/tolerated If oral intake not safe/not tolerated Lactulose (nasogastric) If improvement start secondary prophylaxis Secondary Prophylaxis Dose CI Precaution Comment If no improvement Rifaximin Dose CI Precaution Comment Patient Symptom - Pain Step 1: Consider the Underlying Causes of Patient Symptom - Pain Step 2: Non-pharmacological Management Step 3: Pharmacological Management Step 4: Palliative Care Consult Patient Symptom - Pain Step 1: What can I try at home? Step 2: What treatment choices do I have? Step 3: Pharmacological Management Step 4: Pain Resources Tailored Outputs Based on Conditions Confirm Comorbidities End Of Life Guideline End of Life Step 2: Non-pharmacological Management Step 3: Pharmacological Management Step 4: Palliative Care Consult CKD Associated Pruritus Step 1: Consider the Underlying Causes of CKD Associated Pruritus Step 2: Non-pharmacological Management Step 3: Pharmacological Management Step 4: Palliative Care Consult Good Skin Care Complimentary Treatments Topical Treatment Systemic Treatment Pramoxine Dose CI Precaution Comment Capsaicin 0.025% or 0.075% Ointment Dose CI Precaution Comment Menthol, Camphor and Phenol are separate products that can be added to most creams, typically in the range of 0.3-1.0% Dose CI Precaution Comment Gamma-Linolenic acid (GLA) 2.2% cream Dose CI Precaution Comment Lidocaine 2.5% cream Dose CI Precaution Comment Dose CI Precaution Comment Pregabalin Dose CI Precaution Comment Gabapentin Dose CI Precaution Comment ESKD Dose Adjustment Cirrhosis Dose Liver & Renal CI Liver & Renal ESKD Dose Liver Dose Risk Staging Self-Management & Lifestyle Modifications: General Establish Community Support & Referrals Advance Care Planning Palliative Care Final Weeks and Days of Life COPD Heart Failure Cirrhosis Advanced CKD Cancer COPD Heart Failure Cirrhosis Advanced CKD Cancer COPD Heart Failure Cirrhosis Advanced CKD Cancer COPD Heart Failure Cirrhosis Advanced CKD Cancer COPD Heart Failure Cirrhosis Advanced CKD Cancer Message COPD Heart Failure Cirrhosis Advanced CKD Cancer Dosing for Combination Diuretics Dose CI Precaution Comment Large-volume (≥ 5L) paracentesis AND start combination diuretics if no contraindications Dose CI Precaution Comment Diagnostic Criteria for Refractory Ascites & Management Monitoring for Patients on Diuretics How to titrate up diuretics References Helpful Links COPD Step 1: COPD Management Step 2: Pharmacological Management Heart Failure Management Step 1: Consider the Underlying Causes of Heart Failure Management Step 2: Non-pharmacological Management Step 3: Pharmacological Management Step 3: Exacerbation Management Dose CI Precaution Comment Dose CI Precaution Comment Examples of converting oral to subcutaneous administration When to Consult a Palliative Care Specialist EMS Palliative and End of Life Care Assess, Treat, and Refer (EMS PEOLC ATR) Initiative Services required for caring for patients at home, location of care and location of death Step 5: What Happens After Death? Symptom Management Near the End of Life Pain Breathlessness Fluid Management Respiratory Secretions Constipation Fatigue & Sleep Disturbance Restless Legs Syndrome Delirium & Agitation Poor Appetite & Intake Muscle Cramps Helpful Links Shared Care Plan COPD Heart Failure Cirrhosis Advanced CKD Cancer Muscle Cramps Step 1: Consider the Underlying Causes of Muscle Cramps Step 2: Non-pharmacological Management Step 3: Pharmacological Management Step 4: Palliative Care Consult Symptom Management Medical Management General Smoking  Immunization  Nutrition Exercise Social Determinants of Health  Home Care Advance Care Planning Salt Intake Fluid Intake  Alcohol   Obesity Counselling Mood and Stress Management  Resources Pulmonary Rehabilitation Calgary COPD and Asthma Program  (CCAP) Alberta Healthy Living Program  Community Paramedics (CP) Home Care (COPD homecare specific teams) Alberta Quits  Other Resources Your Support Team Palliative & End of Life Care Symptom Management for Advanced CKD Constipation What causes constipation? What you can do to help manage your constipation When you should talk to your healthcare provider Medication 1 Dose CI Precaution Comment Mona Step 1: Consider the Underlying Causes of Mona Step 2: Non-pharmacological Management Step 3: Pharmacological Management Step 4: Palliative Care Consult Medication 1 Dose CI Precaution Comment CKD Acidosis Guideline Acidosis (Metabolic) - Clinical Algorithm Dosing Chart for Sodium Bicarbonate Additional Resources: Blood Pressure Guideline Additional Resources Sodium/Fluid Statement Sodium Intake Fluid Intake Rehydration if patients are not able to drink orally Considerations at End of Life Nausea & Vomiting Accordion Container What you can do to help manage nausea & vomiting? When you should talk to my healthcare team? Links Accordion Container Links Pain Accordion Container What you can do to help manage your pain When you should talk to your healthcare team Links Shortness of Breath Accordion Container What causes shortness of breath What you can do to help manage shortness of breath When you should talk to your healthcare team Links Anemia Guideline Iron Protocol for Conservatively Managed Patients HGB/ESA Protocol & Dose Adjustment Schedule for darbepoietin (Aranesp®) Additional Resources Calcium/Phosphorus Guideline Dose Adjustment Guideline for Phosphate Binders – Recommended Initial Calcium Dosing Dose Adjustment Guideline for Non-Calcium Based Phosphate Binders (may be used alone or as an adjuvant therapy) High Calcium Clinical Guideline Lipids Guideline Additional Resources Potassium Guideline Potassium - Clinical Algorithm Additional Resources Vitamin D Statement Considerations at End of Life: Additional Resources Calcitriol (active form of vitamin D, e.g. Rocaltrol) Glossary acc1 acc item1 fasdf p1 replace Container Med1 Dose CI Precaution Comment repalce when HF hide when cancer acc no 1 Med 1 Dose CI Precaution Comment replace when HF Hide when Cancer Shared Care Planning Supportive Care Health Condition Chronic Disease Preferences Health Plan Healthcare Team Advance Care Planning or ACP Personal Directive Enduring Power Attorney Goals of Care (Designation) or GoC “Greensleeve” Palliative care End of Life Care Accordion Container Additional Resources What is Palliative Care? Accordion Container Darbepoetin starting dose when Hgb < 95 g/L and iron replete. Darbepoetin adjustment schedule if Hgb BELOW target: Darbepoetin adjustment schedule if Hgb ABOVE target or rising significantly: Dose Adjustment Schedule for epoetin alpha (Eprex ®) Glossary Symptom and Medical Management Patient Handouts Maintenance: Calcium Dosing Guideline Additional Resources What is End of Life Care? Helpful Links References Helpful Links References References Helpful Links References Helpful Links References Helpful Links References Helpful Links References Hide for non liver or kidney Not indicated except in liver Step 1: Continue Goals of Care Discussions References Hide for HF except HF General General General General General Restless Legs Lack of Appetite Depression & Anxiety Fatigue Muscle Cramps Numbness & Tingling Taste Changes Diarrhea Dehydration Itchiness Swelling Difficulty Swallowing Sleep Problems Palliative Care Accordion Container What causes restless leg syndrome What you can do to help manage your restless leg syndrome When you should talk to your healthcare team Accordion Container What causes a lack of appetite What you can do to help manage your lack of appetite When you should talk to your healthcare team Accordion container What causes depression & anxiety What you can do to help manage your depression & anxiety When you should talk to your healthcare team Accordion container What causes fatigue What you can do to help manage you fatigue When you should talk to your healthcare team Accordion container What causes muscle cramps What you can do to help manage your muscle cramps Accordion container When you should talk to your healthcare team What causes numbness & tingling What you can do to help manage your numbness & tingling When to talk to your healthcare team Accordion Container What causes taste changes? What you can do to help manage your taste changes When to talk to your healthcare team Accordion Container What causes diarrhea? What you can do to help manage your diarrhea When to talk to your healthcare team Accordion Container What causes dehydration? What you can do to help manage your dehydration When to talk to your healthcare team Accordion Container What causes itchiness? What you can do to help manage your itchiness When to talk to your healthcare team Accordion Container What causes swelling? What you can do to help manage your swelling When to talk to your healthcare team Accordion Container What causes sleep problems? What you can do to help manage your sleep problems When to talk to your healthcare team What causes nausea & vomiting? Accordion Container What you can do to help manage your difficulty with swallowing When to talk to your healthcare team What causes difficulty in swallowing? What causes nausea & Vomiting What causes pain Accordion Container what can I expect in the last weeks and days of life? What will happen if my family & friends can't care for me at home? Helpful links to learn more about palliative and end of life care in Alberta Links Links Links Links Links Links Links Links Links Links Links Links Links Cancer Management Step 1: Consider the Underlying Causes of Cancer Management Step 2: Non-pharmacological Management Step 3: Pharmacological Management Step 4: Palliative Care Consult Advance Care Planning Palliative & End of Life Access to Resources Topical Compounded Products Dose CI Precaution Comment Caution General-Caution Topical Compounded Products Dose CI Precaution Comment General Condition condition for HF & KD General CI Additional Resources Lemborexant Dose CI Precaution Comment Hide for Kidney and Cirrhosis Hide for Cancer COPD HF Sertraline Dose CI Precaution Comment CI-Genernal General CI for Cirrhosis Living with Heart Failure Living with COPD