Comprehensive Nursing Practice for a Patient with Uremia Complicated with Inflammatory Myopathy and Multisystem Complications

Abstract

This case report describes comprehensive nursing care for a 69-year-old woman with uremia requiring regular hemodialysis, dermatomyositis, dysphagia, lower-limb weakness, electrolyte disturbances, cardiac insufficiency, nutritional risk, and high infection risk. Dynamic assessment identified seven priority problems involving fluid and electrolyte balance, cardiac and respiratory function, infection, nutrition and aspiration, treatment pathways, falls, pressure injury, venous thrombosis, and psychosocial support. Nursing interventions integrated hemodialysis and continuous renal replacement therapy, plasmapheresis, immunosuppressive and antiviral treatment, cardiac and respiratory monitoring, PICC and nasogastric-tube care, enteral nutrition, pressure-injury and thrombosis prevention, health education, and multidisciplinary coordination. During hospitalization, vital signs remained generally stable, selected renal, electrolyte, muscle, liver, and nutritional indicators improved, and no catheter-related infection, fall, deep vein thrombosis, significant bleeding, aspiration event, or new pressure injury occurred. Sacral redness did not progress, and the patient and family demonstrated improved understanding and treatment cooperation before discharge. This single case suggests that a dynamic, multidisciplinary nursing pathway may help coordinate competing risks in complex uremic patients with inflammatory myopathy; the findings cannot establish causal effectiveness and require validation in larger case series.