Final answer:
If the stone fails to pass within 4 weeks with accompanying symptoms like fever, intolerable pain, or persistent nausea or vomiting, Percutaneous nephrolithotomy (PCNL) is indicated as the course of action.
Step-by-step explanation:
If the stone fails to pass within 4 weeks and the patient experiences fever, intolerable pain, or persistent nausea or vomiting, the indicated course of action would be Percutaneous nephrolithotomy (PCNL).
Percutaneous nephrolithotomy (PCNL) is a surgical procedure used to remove kidney stones that are too large to pass through the urinary tract. During PCNL, a small incision is made in the back and a narrow tube is inserted into the kidney. The stones are then broken up using a laser or ultrasound and removed.
If the patient experiences symptoms such as fever, intolerable pain, or persistent nausea or vomiting, it may indicate a more serious blockage or infection that requires immediate medical intervention.