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Case Study A 21-year-old woman presented to the em

Case Study A 21-year-old woman presented to the emergency department of an urban hospital with a history of systemic lupus. Her complaint was dehydration, dizziness, and feeling faint. The woman also had a recent history of being dehydrated, complicated by renal involvement from the lupus, and having to receive bolus fluids. She was on multiple medications, including steroids and methotrexate. An intravenous (IV) line was started and blood drawn for labs. The emergency department physician returned to pronounce the lab values within normal limits, yet the young woman felt no better. She stated that she still felt dehydrated, that her blood pressure felt low, and that she normally received more IV fluids and a steroid injection when she felt this way. The physician indicated that he felt no need, but when she insisted on more fluids, he agreed to continue them for a while and to give her an injection of steroids. The patient asked, “Do you want to give me anti-nausea medication first?” The physician stated that there was no indication. The patient told him that she was always nauseated following steroids and had sometimes vomited if no antiemetic were administered first. The physician argued but finally grew tired and walked away. The steroid injection was given, and nausea ensued. When the patient got home a few hours later, the patient called her rheumatologist and urologist (neither had been available when the illness occurred because of the late hour). They repeated her labs the next day, only to find that she was severely dehydrated, and many values, including renal panel, were outside normal limits. Case Questions 1. Describe the critical issues in this case description. Assess whether this was patient-centered care 2. Analyze the six aims that the IOM recommends to better insure quality care and how each might they apply to this patient. 3. Describe four tools and methods that could be used to improve care in the future. 4. If you were the nurse assigned to this patient in emergency department, explain what you could have done differently. Illustrate how you could have impacted quality of care and safety for this patient.

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