Nursing care for a Patients with Ureterolithiasis and Co-morbidities with Chronic Kidney Disease, Diabetes Mellitus, and Hypertension : A Case Study.

Abstract

      This case study aims to examine nursing care for a patient with ureterolithiasis, co-morbid with chronic kidney disease, diabetes mellitus, and hypertension. The subject is a 65-year-old female with  a history of diabetes mellitus, hypertension, hyperlipidemia, and stage 3-4 chronic kidney disease. One month prior to this admission, she presented with right-sided abdominal pain radiating to the back. A urological radiological evaluation revealed a 2.5-cm staghorn calculus in the right upper ureter. Consequently, the patient was admitted as scheduled to undergo surgical removal of the calculus.

      The results demonstrated that the patient experienced critical nursing problems across distinct phases of care. In the pre-operative phase, the primary concerns included hyponatremia, hyperkalemia, hyperglycemia, early-stage urinary tract infection (UTI), anemia, and anxiety regarding surgical safety. During the 24-hour post-operative phase, the patient faced risks of fluid overload, acute heart failure, and surgical complications specific to ureterolithiasis surgery such as urine leakage and intra-abdominal hemorrhage resulting from potential injury to adjacent organs and major blood vessels. Additional post-operative challenges included pain management and the risk of surgical site and urinary tract infections. In the restorative phase, the patient experienced nutritional deficits, with dietary intake falling short of bodily requirements. Finally, during the discharge and continuity of care phase, the prominent risks identified were the recurrence of urinary tract calculi and complications secondary to her chronic co-morbidities.