Case # 1
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 lupus and having to receive bolus fluids. She was on multiple medications, including steroids and methotrexate. An intravenous (IV) line was started, and blood was drawn for labs. The emergency department physician returned to report that the lab values were within normal limits, yet the young woman felt no better. She stated that she still felt dehydrated, her blood pressure felt low, and she normally received more IV fluids and a steroid injection when she felt this way.
The physician indicated that he felt no need for this treatment, but when the patient 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. What are the critical issues in this case description?
2. Consider the six aims (STEEEP) to better ensure quality care. How might they apply to this patient?
3. Is this patient-centered care? Why or why not?
4. If you were the nurse assigned to this patient in emergency department, what could you have done?