Reference no: EM133249794

How does coordination and integration of care of the Picker's Principles of Patient-Centered Care apply in this case:

A 21-year-old woman presents to the emergency department of an urban hospital with a history of systemic lupus. Her complaint is dehydration, dizziness, and feeling faint. The woman also has a recent history of being dehydrated, complicated by renal involvement from the lupus, and having to receive bolus IV fluids. She is currently on multiple medications, including steroids and methotrexate. An IV is started and labs drawn. The ED physician returns to relay that the lab values are within normal limits, yet the young woman describes she feels no better. She states that she still feels dehydrated, that her blood pressure is low, and that she normally receives more IV fluids and a steroid injection. The physician indicates that he feels no need, but when she insists on more fluids, he agrees to continue them for a while and to give her an injection of steroids. The patient asks, "Do you want to give me anti-nausea medication first?" The physician states that there is no indication. Again, the patient tells him that she is always nauseated following steroids and sometimes vomits if no antiemetic is administered first. The physician argues but finally grows frustrated and walks away. The steroid injection is given, and nausea ensues. She is discharged after a few hours.

The next morning, the patient calls her rheumatologist and urologist (neither had been called when the illness occurred because of the late hour). They have her come in that same day and they repeat her labs in the office, only to find that she is severely dehydrated, and many values, including the renal panel, are outside normal limits.