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Systemic Lupus: Case Study

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Chapter 12 Case Study (Finklelman & Kenner, 2013, p. 394) This case study involves a 21-year-old woman with a history of systemic lupus. She presented to the hospital with symptoms of dehydration. She had a recent history of dehydration with renal impairment. After receiving IV hydration in the emergency department, the physician told her her labwork was normal, but she was not feeling any better. She told him that normally, she had to receive additional IV fluids and a steroid injection. The physician told her that a steroid injection and more IV fluids were not indicated. He finally agreed to more IV hydration and the steroid at her insistance. She told him that normally, she requires an antiemetic prior to administration of steroids because she always becomes nauseated from the steroids. The physician argued with her and ultimately walked away. The patient received the steroid, and promptly became nauseated. She followed up with her own doctor the next day and had her labs redrawn only to discover that she was severely …show more content…

The patient felt light-headed and dizzy which are signs of dehydration. She had recently been in the emergency department with the same issues, and was dehydrated at that time. Her labwork that was drawn at the hospital was normal, but the next day, it indicated severe dehydration with renal involvement. The likely cause for this was human error or system error. Either the lab tubes were mislabeled or there was an error in the lab. Given her symptoms though, they should have thought to redraw the labs. The Institute of Medicine (IOM) core competency, “apply quality improvement” directs us to recognize errors, and change policies and procedures to improve quality of care. (Finklelman & Kenner, 2013, p. 264). Perhaps in this case, an error occurred as a result of a system error. If this can be identified, perhaps it can be improved

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