Materiały źródłowe

• #1 Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Guide for Nurses

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7539539/

  Nurses are central to the care of patients with Stevens-Johnson syndrome and toxic epidermal necrolysis. Patients with these conditions present with nuanced symptoms and have complex nursing care needs. […] The care of patients hospitalized with Stevens-Johnson syndrome and toxic epidermal necrolysis consists of wound care, infection prevention, comfort management, hydration and nutrition, psychosocial support, and the prevention of long-term complications. […] Nursing care in SJS and TEN is central, as management focuses on wound healing, hydration, nutrition, infection prevention, comfort, and the prevention of long-term complications. […] The purpose of this article is to describe the process of identifying and diagnosing SJS and TEN in patients of all ages, review the pathophysiology and common causes, describe nursing-specific clinical management, and consider the prognosis for SJS and TEN patients.

• #2 Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Guide for Nurses – PubMed

  https://pubmed.ncbi.nlm.nih.gov/32866260/

  Nurses are central to the care of patients with Stevens-Johnson syndrome and toxic epidermal necrolysis. Patients with these conditions present with nuanced symptoms and have complex nursing care needs. […] The care of patients hospitalized with Stevens-Johnson syndrome and toxic epidermal necrolysis consists of wound care, infection prevention, comfort management, hydration and nutrition, psychosocial support, and the prevention of long-term complications. […] This article provides an overview of these diseases, including clinical diagnosis, history and physical assessment, related pharmacology, and nursing care priorities. […] A description of the current state of the science in clinical management for nurses at all levels is provided, with an emphasis on nursing’s contribution to the best possible patient outcomes.

• #3 Stevens Johnson syndrome / toxic epidermal necrolysis: nursing management

  https://dermnetnz.org/topics/sjs-ten-nursing

  Stevens Johnson syndrome /toxic epidermal necrolysis (SJS/TEN) is a very severe and acute skin disease, almost always caused by a drug. […] The nursing care described on this page is adapted from the Crteil protocol for patients with toxic epidermal necrolysis. […] Suitable nursing care can reduce the mortality and adverse sequelae of SJS/TEN, especially when a large area of skin / mucosa is affected and intensive care is needed. Expert nursing care should commence as soon as the patient has arrived at the hospital and continue until discharge. The patient should be cared for in bed until well enough to ambulate safely. […] The health care provider should keep the patient’s room clean and warm, and gently but thoroughly cleanse and protect the skin, mouth, eyes and genitals. […] Evaluate the patients pain before, during and after care. […] Written notes should report every care on the patient record and record pain on a monitoring sheet.

• #4 Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis – Straight A Nursing

  https://straightanursingstudent.com/sjs-ten/

  Epidermal necrolysis refers to severe cutaneous reactions that cause extensive necrosis of tissue and detachment of the epidermis. It encompasses three conditions which are on a continuum of severity and how much of the body’s surface area is affected: […] Epidermal necrolysis is a rare and painful condition that causes areas of the skin and mucus membranes to blister, peel, and detach. Much like a burn, this causes significant fluid losses and puts the individual at high risk for infection and other life-threatening complications. […] Epidermal necrolysis typically develops a few weeks after taking the triggering medication. It begins with prodromal symptoms that usually last two to three days before the skin becomes affected. […] Factors that increase an individual’s risk of dying from epidermal necrolysis include older age, sepsis, greater BSA affected, delayed transfer to a specialty center, and granulocytopenia (a decrease in a specific type of white blood cell). In general, the mortality rate of TEN is 25 to 30%, while SJS has a mortality rate of 1 to 5%.

• #5 Stevens-Johnson Syndrome (SJS): Causes, Rash & Treatments

  https://my.clevelandclinic.org/health/diseases/17656-stevens-johnson-syndrome

  Hospitalized treatment includes stopping the problem medication, replacing electrolytes, applying skin dressings, and providing pain medications and antibiotics. […] Treatments for Stevens-Johnson syndrome include: stopping the medication that has caused the problem, replacing electrolytes with intravenous (IV) fluids, using non-adhesive dressings on the affected skin, using high-calorie food, possibly by tube-feeding, to promote healing, using antibiotics when needed to prevent infection, providing pain relief medications, treating you in a hospital, possibly even in an intensive care or burn unit, using specialist teams from dermatology and ophthalmology (if your eyes are affected), and in some cases, treating you with IV immunoglobulin, cyclosporine, IV steroids, or amniotic membrane grafts (for your eyes). […] The most severe complication of SJS and TEN is death. Death happens in about 10% of cases of SJS, and about 50% of TEN. Other complications could include pneumonia, sepsis (massive bacterial infections), shock, and multiple organ failure.

• #6 Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis – Straight A Nursing

  https://straightanursingstudent.com/sjs-ten/

  The patient’s signs and symptoms will vary depending on the phase of the illness and the presence of any specific complications. In the prodromal phase, signs and symptoms are flu-like and include fever, chills, body aches, red eyes and headache. […] The condition progresses to involve cutaneous and possibly also extracutaneous symptoms somewhere between 4 and 28 days after exposure to the triggering agent. […] The patient will also be in significant pain and can exhibit a wide range of complications depending on which areas of the body are affected. […] Pain management is essential as SJS/TEN are extremely painful, and opioids are commonly utilized. […] Meticulous wound care is vital for patients with SJS/TEN and may involve surgical debridement, manual scrubbing of the affected skin, or hydrotherapy which helps clean wounds while removing dead tissue.

• #7 Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis – Straight A Nursing

  https://straightanursingstudent.com/sjs-ten/

  The patient’s signs and symptoms will vary depending on the phase of the illness and the presence of any specific complications. In the prodromal phase, signs and symptoms are flu-like and include fever, chills, body aches, red eyes and headache. […] The condition progresses to involve cutaneous and possibly also extracutaneous symptoms somewhere between 4 and 28 days after exposure to the triggering agent. […] The patient will also be in significant pain and can exhibit a wide range of complications depending on which areas of the body are affected. […] Pain management is essential as SJS/TEN are extremely painful, and opioids are commonly utilized. […] Meticulous wound care is vital for patients with SJS/TEN and may involve surgical debridement, manual scrubbing of the affected skin, or hydrotherapy which helps clean wounds while removing dead tissue.

• #8 Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis – Straight A Nursing

  https://straightanursingstudent.com/sjs-ten/

  The patient’s signs and symptoms will vary depending on the phase of the illness and the presence of any specific complications. In the prodromal phase, signs and symptoms are flu-like and include fever, chills, body aches, red eyes and headache. […] The condition progresses to involve cutaneous and possibly also extracutaneous symptoms somewhere between 4 and 28 days after exposure to the triggering agent. […] The patient will also be in significant pain and can exhibit a wide range of complications depending on which areas of the body are affected. […] Pain management is essential as SJS/TEN are extremely painful, and opioids are commonly utilized. […] Meticulous wound care is vital for patients with SJS/TEN and may involve surgical debridement, manual scrubbing of the affected skin, or hydrotherapy which helps clean wounds while removing dead tissue.

• #9 EM@3AM: Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis – emDocs

  https://www.emdocs.net/em3am-stevens-johnson-syndrome-and-toxic-epidermal-necrolysis/

  Stevens-Johnson Syndrome (SJS)/Toxic Epidermal Necrolysis (TEN) is a potentially fatal cutaneous reaction characterized by epidermal blistering and necrosis leading to skin sloughing over extensive areas of the body, typically affecting mucocutaneous sites. […] Diagnosis is primarily clinical, based on history, through physical examination including of the oral mucosa and genitals, timeline, presence of a known trigger, the appearance of the rash, and potential prodrome. […] Supportive care includes high caloric enteral feeding, if possible, rather than parenteral nutrition which has been demonstrated to have higher fatality rates. […] Transfer to a dedicated burn center may be indicated for expert wound care.

• #10

  https://www.nursingcenter.com/journalarticle?Article_ID=4744250&Journal_ID=646631&Issue_ID=4744102

  Stevens-Johnson syndrome is a rare, yet life-threatening, delayed-type hypersensitivity reaction characterized by mucocutaneous epidermal necrolysis. […] This case highlights the importance of prompt identification and diagnosis of Stevens-Johnson syndrome and underscores the need for emergency providers to have a comprehensive knowledge of adverse cutaneous drug reactions.

• #11 Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Guide for Nurses

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7539539/

  Nurses are central to the care of patients with Stevens-Johnson syndrome and toxic epidermal necrolysis. Patients with these conditions present with nuanced symptoms and have complex nursing care needs. […] The care of patients hospitalized with Stevens-Johnson syndrome and toxic epidermal necrolysis consists of wound care, infection prevention, comfort management, hydration and nutrition, psychosocial support, and the prevention of long-term complications. […] Nursing care in SJS and TEN is central, as management focuses on wound healing, hydration, nutrition, infection prevention, comfort, and the prevention of long-term complications. […] The purpose of this article is to describe the process of identifying and diagnosing SJS and TEN in patients of all ages, review the pathophysiology and common causes, describe nursing-specific clinical management, and consider the prognosis for SJS and TEN patients.

• #12 Stevens-Johnson syndrome – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/stevens-johnson-syndrome/diagnosis-treatment/drc-20355942

  Treating Stevens-Johnson syndrome requires hospitalization, possibly in an intensive care unit or a burn unit. […] Supportive care you’re likely to receive while in the hospital includes: […] Fluid replacement and nutrition. Because skin loss can result in significant loss of fluid from your body, replacing fluids is an important part of treatment. You may receive fluids and nutrients through a tube inserted in the nose and guided to the stomach (nasogastric tube). […] Wound care. Cool, wet compresses might help soothe blisters while they heal. Your health care team may gently remove dead skin and put petroleum jelly (Vaseline) or a medicated dressing over affected areas. […] Eye care. You may also need care from an eye specialist (ophthalmologist). […] Medications used in the treatment of Stevens-Johnson syndrome include:

• #13 Stevens Johnson syndrome / toxic epidermal necrolysis: nursing management

  https://dermnetnz.org/topics/sjs-ten-nursing

  Stevens Johnson syndrome /toxic epidermal necrolysis (SJS/TEN) is a very severe and acute skin disease, almost always caused by a drug. […] The nursing care described on this page is adapted from the Crteil protocol for patients with toxic epidermal necrolysis. […] Suitable nursing care can reduce the mortality and adverse sequelae of SJS/TEN, especially when a large area of skin / mucosa is affected and intensive care is needed. Expert nursing care should commence as soon as the patient has arrived at the hospital and continue until discharge. The patient should be cared for in bed until well enough to ambulate safely. […] The health care provider should keep the patient’s room clean and warm, and gently but thoroughly cleanse and protect the skin, mouth, eyes and genitals. […] Evaluate the patients pain before, during and after care. […] Written notes should report every care on the patient record and record pain on a monitoring sheet.

• #14 Stevens Johnson syndrome / toxic epidermal necrolysis: nursing management

  https://dermnetnz.org/topics/sjs-ten-nursing

  Stevens Johnson syndrome /toxic epidermal necrolysis (SJS/TEN) is a very severe and acute skin disease, almost always caused by a drug. […] The nursing care described on this page is adapted from the Crteil protocol for patients with toxic epidermal necrolysis. […] Suitable nursing care can reduce the mortality and adverse sequelae of SJS/TEN, especially when a large area of skin / mucosa is affected and intensive care is needed. Expert nursing care should commence as soon as the patient has arrived at the hospital and continue until discharge. The patient should be cared for in bed until well enough to ambulate safely. […] The health care provider should keep the patient’s room clean and warm, and gently but thoroughly cleanse and protect the skin, mouth, eyes and genitals. […] Evaluate the patients pain before, during and after care. […] Written notes should report every care on the patient record and record pain on a monitoring sheet.

• #15 Stevens-Johnson syndrome | Nursing Times

  https://www.nursingtimes.net/archive/stevens-johnson-syndrome-25-04-2006/

  – Treatment of Stevens-Johnson syndrome is mainly supportive. It may include the following: […] – Monitoring of airway and haemodynamic stability; […] – Replacement of electrolytes and fluid; […] – Management of the underlying cause, including discontinuing any complicating medication; […] – Pain control; […] – Mouthwashes and topical anaesthetics to reduce pain and allow eating and drinking; […] – Immunoglobin therapy; […] – Antibiotics to control secondary skin infections; […] – Steroids to reduce the risk of severe infection, although their use has been associated with increased complications. […] – Skin lesions should be treated as burns.

• #16 Stevens-Johnson Syndrome Treatment & Management: Approach Considerations, Supportive Systemic Therapy, Infection Control

  https://emedicine.medscape.com/article/1197450-treatment

  Management of patients with Stevens-Johnson syndrome usually is provided in intensive care units or burn centers. No specific treatment of Stevens-Johnson syndrome is noted; therefore, most patients are treated symptomatically. In principle, the symptomatic treatment of patients with Stevens-Johnson syndrome does not differ from the treatment of patients with extensive burns. […] Paramedics should recognize the presence of severe fluid loss and should treat patients with Stevens-Johnson syndrome as they would patients with thermal burns. […] Patients should be treated with special attention to airway and hemodynamic stability, fluid status, wound/burn care, and pain control. Care in the ED must be directed to fluid replacement and electrolyte correction. Treatment is primarily supportive and symptomatic.

• #17 Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Guide for Nurses

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7539539/

  Diligent daily wound care and cleansing of surrounding skin is the best prevention technique. […] The use of prophylactic antibiotics is not recommended; antibiotics are only recommended for a known infection. […] Fluid administration should cover the insensible fluid loss that results from sloughing and essential hydration in patients who are not taking food or fluids by mouth. […] Early enteral nutrition is associated with improved outcomes and faster wound healing. […] Pain management can be one of the most challenging aspects of caring for a patient with SJS or TEN. […] A multimodal approach should be used for pain management. […] An ophthalmology consultation within the first 24 to 48 hours of admission is recommended and has been shown to mitigate long-term symptoms. […] Oral intake should be encouraged with soft, bland, nonacidic food choices.

• #18 Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Guide for Nurses

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7539539/

  Treatment of SJS and TEN is largely nursing care focused and supportive, revolving around fluid replacement, comfort management, nutrition support for wound healing, infection prevention, and wound care of the affected areas. […] A summary of these recommendations and their rationale is provided in Table 4. […] Daily head-to-toe assessments and areas of rash and slough establish disease progression and healing. […] Implement pressure injury prevention measures to prevent additional skin breakdown. […] Leave denuded skin in place for a conservative approach, as it acts as a biologic infection barrier and reduces insensible fluid loss. […] Daily wound care using nonadherent gauze to cover sloughed areas allows for daily skin assessment, improves re-epithelialization, and reduces fluid loss.

• #19 Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Guide for Nurses

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7539539/

  Treatment of SJS and TEN is largely nursing care focused and supportive, revolving around fluid replacement, comfort management, nutrition support for wound healing, infection prevention, and wound care of the affected areas. […] A summary of these recommendations and their rationale is provided in Table 4. […] Daily head-to-toe assessments and areas of rash and slough establish disease progression and healing. […] Implement pressure injury prevention measures to prevent additional skin breakdown. […] Leave denuded skin in place for a conservative approach, as it acts as a biologic infection barrier and reduces insensible fluid loss. […] Daily wound care using nonadherent gauze to cover sloughed areas allows for daily skin assessment, improves re-epithelialization, and reduces fluid loss.

• #20 Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Guide for Nurses

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7539539/

  Treatment of SJS and TEN is largely nursing care focused and supportive, revolving around fluid replacement, comfort management, nutrition support for wound healing, infection prevention, and wound care of the affected areas. […] A summary of these recommendations and their rationale is provided in Table 4. […] Daily head-to-toe assessments and areas of rash and slough establish disease progression and healing. […] Implement pressure injury prevention measures to prevent additional skin breakdown. […] Leave denuded skin in place for a conservative approach, as it acts as a biologic infection barrier and reduces insensible fluid loss. […] Daily wound care using nonadherent gauze to cover sloughed areas allows for daily skin assessment, improves re-epithelialization, and reduces fluid loss.

• #21 Stevens-Johnson Syndrome Treatment & Management: Approach Considerations, Supportive Systemic Therapy, Infection Control

  https://emedicine.medscape.com/article/1197450-treatment

  Skin lesions are treated as burns. Areas of denuded skin must be covered with compresses of saline or Burow solution. […] Patients with Stevens-Johnson syndrome are at a high risk for infection. Sterile handling and/or reverse-isolation nursing techniques are essential to decrease the risk for nosocomial infection. […] Several skin care approaches have been described. Extensive debridement of nonviable epidermis, followed by immediate cover with biologic dressings, are among the recommended treatments. […] The use of systemic steroids remains controversial. Some authors believe that they are contraindicated, especially because there may be some question about the diagnosis. […] The rationale for the use of IVIG is the most appealing. Based on in vitro and clinical data, IVIG can block the Fas receptors on the surface of the keratinocytes, thus interfering with the Fas-Fas ligand mediated apoptosis. […] Treatment of acute ocular manifestations usually begins with aggressive lubrication of the ocular surface. […] In the case of mild chronic superficial keratopathy, long-term lubrication may be sufficient. […] Patients with SJS require regular monitoring of their medications and status.

• #22 Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Guide for Nurses

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7539539/

  Treatment of SJS and TEN is largely nursing care focused and supportive, revolving around fluid replacement, comfort management, nutrition support for wound healing, infection prevention, and wound care of the affected areas. […] A summary of these recommendations and their rationale is provided in Table 4. […] Daily head-to-toe assessments and areas of rash and slough establish disease progression and healing. […] Implement pressure injury prevention measures to prevent additional skin breakdown. […] Leave denuded skin in place for a conservative approach, as it acts as a biologic infection barrier and reduces insensible fluid loss. […] Daily wound care using nonadherent gauze to cover sloughed areas allows for daily skin assessment, improves re-epithelialization, and reduces fluid loss.

• #23 Stevens Johnson syndrome / toxic epidermal necrolysis: nursing management

  https://dermnetnz.org/topics/sjs-ten-nursing

  Stevens Johnson syndrome /toxic epidermal necrolysis (SJS/TEN) is a very severe and acute skin disease, almost always caused by a drug. […] The nursing care described on this page is adapted from the Crteil protocol for patients with toxic epidermal necrolysis. […] Suitable nursing care can reduce the mortality and adverse sequelae of SJS/TEN, especially when a large area of skin / mucosa is affected and intensive care is needed. Expert nursing care should commence as soon as the patient has arrived at the hospital and continue until discharge. The patient should be cared for in bed until well enough to ambulate safely. […] The health care provider should keep the patient’s room clean and warm, and gently but thoroughly cleanse and protect the skin, mouth, eyes and genitals. […] Evaluate the patients pain before, during and after care. […] Written notes should report every care on the patient record and record pain on a monitoring sheet.

• #24 Guidelines for the management of Stevens–Johnson syndrome/toxic epidermal necrolysis: An Indian perspective – Indian Journal of Dermatology, Venereology and Leprology

  https://ijdvl.com/guidelines-for-the-management-of-stevens-johnson-syndrome-toxic-epidermal-necrolysis-an-indian-perspective/

  Cyclosporine (3-5 mg/kg/day) for 10-14 days may also be used either alone, or in combination with corticosteroids. […] Owing to the systemic nature of the disease, a multidisciplinary approach in the management of these patients is helpful. […] The management essentials include early recognition of the condition, cessation of suspected drug(s) if any, prompt institution of supportive therapy, referral if required, initiation of specific therapy, management of complications and prevention of future episodes. […] Supportive treatment is essentially the same as for burn patients. […] Environmental temperature maintenance at 30-32C helps to prevent a hypercatabolic state by reducing caloric losses through the skin. […] Frequent monitoring of vital signs is an essential part of management as they offer the first sign of a worsening systemic condition.

• #25 Stevens-Johnson Syndrome Treatment & Management: Approach Considerations, Supportive Systemic Therapy, Infection Control

  https://emedicine.medscape.com/article/1197450-treatment

  Skin lesions are treated as burns. Areas of denuded skin must be covered with compresses of saline or Burow solution. […] Patients with Stevens-Johnson syndrome are at a high risk for infection. Sterile handling and/or reverse-isolation nursing techniques are essential to decrease the risk for nosocomial infection. […] Several skin care approaches have been described. Extensive debridement of nonviable epidermis, followed by immediate cover with biologic dressings, are among the recommended treatments. […] The use of systemic steroids remains controversial. Some authors believe that they are contraindicated, especially because there may be some question about the diagnosis. […] The rationale for the use of IVIG is the most appealing. Based on in vitro and clinical data, IVIG can block the Fas receptors on the surface of the keratinocytes, thus interfering with the Fas-Fas ligand mediated apoptosis. […] Treatment of acute ocular manifestations usually begins with aggressive lubrication of the ocular surface. […] In the case of mild chronic superficial keratopathy, long-term lubrication may be sufficient. […] Patients with SJS require regular monitoring of their medications and status.

• #26 Guidelines for the management of Stevens–Johnson syndrome/toxic epidermal necrolysis: An Indian perspective – Indian Journal of Dermatology, Venereology and Leprology

  https://ijdvl.com/guidelines-for-the-management-of-stevens-johnson-syndrome-toxic-epidermal-necrolysis-an-indian-perspective/

  The following measures are important to prevent sepsis in patients with SJS/TEN. […] The early fluid requirement of TEN patients is two-third to three-fourth of that of a burn patient with the same extent of skin involvement and should be fulfilled by macromolecules (Ringer lactate) or saline solutions. […] After admission, an oral liquid diet, nasogastric tube or total parenteral nutrition should be initiated. […] It is advisable to leave detached/detachable epidermis in place to provide a natural dressing. […] Daily examination by an ophthalmologist and vigorous treatment reduce the risk of long-term ocular complications. […] Providing emotional support and maintaining a continual dialogue with the patient and his/her family is a vital part of supportive care and addresses the patient’s fears/anxieties, improves compliance with daily nursing care and gives an opportunity for patient education about self-care after discharge and prevention of future episodes.

• #27 Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis – Straight A Nursing

  https://straightanursingstudent.com/sjs-ten/

  Infection prevention is a vital component of your plan of care and includes use of sterile gloves and supplies, PPE, reverse isolation, antiseptic cleansing solutions and silver-imbued gauze materials. […] Nutrition should be started as early as possible to support the healing process. If eating is difficult or painful due to mucosal involvement, enteral feeding is utilized. […] A significant number of patients with SJS/TEN develop acute respiratory complications which can include pulmonary edema, atelectasis, pneumonia, and bronchial erosions. […] If disseminated intravascular coagulation (DIC) develops, patients may be administered blood products such as fresh frozen plasma (FFP), red blood cells and cryoprecipitate. […] A key factor to educate patients about is the triggering agent, if one can be identified, so the patient knows to avoid it in the future.

• #28 Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Guide for Nurses

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7539539/

  Diligent daily wound care and cleansing of surrounding skin is the best prevention technique. […] The use of prophylactic antibiotics is not recommended; antibiotics are only recommended for a known infection. […] Fluid administration should cover the insensible fluid loss that results from sloughing and essential hydration in patients who are not taking food or fluids by mouth. […] Early enteral nutrition is associated with improved outcomes and faster wound healing. […] Pain management can be one of the most challenging aspects of caring for a patient with SJS or TEN. […] A multimodal approach should be used for pain management. […] An ophthalmology consultation within the first 24 to 48 hours of admission is recommended and has been shown to mitigate long-term symptoms. […] Oral intake should be encouraged with soft, bland, nonacidic food choices.

• #29 Stevens Johnson Syndrome / Toxic Epidermal Necrolysis. SJS/TEN

  https://dermnetnz.org/topics/stevens-johnson-syndrome-toxic-epidermal-necrolysis

  Care of a patient with SJS/TEN requires: […] Hospital admission preferably immediately to an intensive care and burns unit with specialist nursing care, as this improves survival, reduces infection and shortens hospital stay […] Pain relief as pain can be extreme […] Examine daily for the extent of detachment and infection (take swabs for bacterial culture). […] Daily assessment by an ophthalmologist […] Psychiatric support for extreme anxiety and emotional lability […] Regular assessment for staphylococcal or gram negative infection […] The appropriate antibiotic should be given if an infection develops; prophylactic antibiotics are not recommended and may even increase the risk of sepsis. […] The role of systemic corticosteroids (cortisone) remains controversial. Some clinicians prescribe high doses of corticosteroids for a short time at the start of the reaction, usually prednisone 12 mg/kg/day for 35 days. However concerns have been raised that they may increase the risk of infection, impair wound healing and other complications, and they have not been proven to have any benefit. […] Other options include:

• #30 Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Guide for Nurses

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7539539/

  Diligent daily wound care and cleansing of surrounding skin is the best prevention technique. […] The use of prophylactic antibiotics is not recommended; antibiotics are only recommended for a known infection. […] Fluid administration should cover the insensible fluid loss that results from sloughing and essential hydration in patients who are not taking food or fluids by mouth. […] Early enteral nutrition is associated with improved outcomes and faster wound healing. […] Pain management can be one of the most challenging aspects of caring for a patient with SJS or TEN. […] A multimodal approach should be used for pain management. […] An ophthalmology consultation within the first 24 to 48 hours of admission is recommended and has been shown to mitigate long-term symptoms. […] Oral intake should be encouraged with soft, bland, nonacidic food choices.

• #31 Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis – Straight A Nursing

  https://straightanursingstudent.com/sjs-ten/

  Infection prevention is a vital component of your plan of care and includes use of sterile gloves and supplies, PPE, reverse isolation, antiseptic cleansing solutions and silver-imbued gauze materials. […] Nutrition should be started as early as possible to support the healing process. If eating is difficult or painful due to mucosal involvement, enteral feeding is utilized. […] A significant number of patients with SJS/TEN develop acute respiratory complications which can include pulmonary edema, atelectasis, pneumonia, and bronchial erosions. […] If disseminated intravascular coagulation (DIC) develops, patients may be administered blood products such as fresh frozen plasma (FFP), red blood cells and cryoprecipitate. […] A key factor to educate patients about is the triggering agent, if one can be identified, so the patient knows to avoid it in the future.

• #32 Guidelines for the management of Stevens–Johnson syndrome/toxic epidermal necrolysis: An Indian perspective – Indian Journal of Dermatology, Venereology and Leprology

  https://ijdvl.com/guidelines-for-the-management-of-stevens-johnson-syndrome-toxic-epidermal-necrolysis-an-indian-perspective/

  The following measures are important to prevent sepsis in patients with SJS/TEN. […] The early fluid requirement of TEN patients is two-third to three-fourth of that of a burn patient with the same extent of skin involvement and should be fulfilled by macromolecules (Ringer lactate) or saline solutions. […] After admission, an oral liquid diet, nasogastric tube or total parenteral nutrition should be initiated. […] It is advisable to leave detached/detachable epidermis in place to provide a natural dressing. […] Daily examination by an ophthalmologist and vigorous treatment reduce the risk of long-term ocular complications. […] Providing emotional support and maintaining a continual dialogue with the patient and his/her family is a vital part of supportive care and addresses the patient’s fears/anxieties, improves compliance with daily nursing care and gives an opportunity for patient education about self-care after discharge and prevention of future episodes.

• #33 Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Guide for Nurses

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7539539/

  Diligent daily wound care and cleansing of surrounding skin is the best prevention technique. […] The use of prophylactic antibiotics is not recommended; antibiotics are only recommended for a known infection. […] Fluid administration should cover the insensible fluid loss that results from sloughing and essential hydration in patients who are not taking food or fluids by mouth. […] Early enteral nutrition is associated with improved outcomes and faster wound healing. […] Pain management can be one of the most challenging aspects of caring for a patient with SJS or TEN. […] A multimodal approach should be used for pain management. […] An ophthalmology consultation within the first 24 to 48 hours of admission is recommended and has been shown to mitigate long-term symptoms. […] Oral intake should be encouraged with soft, bland, nonacidic food choices.

• #34 Stevens Johnson syndrome / toxic epidermal necrolysis: nursing management

  https://dermnetnz.org/topics/sjs-ten-nursing

  Stevens Johnson syndrome /toxic epidermal necrolysis (SJS/TEN) is a very severe and acute skin disease, almost always caused by a drug. […] The nursing care described on this page is adapted from the Crteil protocol for patients with toxic epidermal necrolysis. […] Suitable nursing care can reduce the mortality and adverse sequelae of SJS/TEN, especially when a large area of skin / mucosa is affected and intensive care is needed. Expert nursing care should commence as soon as the patient has arrived at the hospital and continue until discharge. The patient should be cared for in bed until well enough to ambulate safely. […] The health care provider should keep the patient’s room clean and warm, and gently but thoroughly cleanse and protect the skin, mouth, eyes and genitals. […] Evaluate the patients pain before, during and after care. […] Written notes should report every care on the patient record and record pain on a monitoring sheet.

• #35 Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Guide for Nurses

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7539539/

  Diligent daily wound care and cleansing of surrounding skin is the best prevention technique. […] The use of prophylactic antibiotics is not recommended; antibiotics are only recommended for a known infection. […] Fluid administration should cover the insensible fluid loss that results from sloughing and essential hydration in patients who are not taking food or fluids by mouth. […] Early enteral nutrition is associated with improved outcomes and faster wound healing. […] Pain management can be one of the most challenging aspects of caring for a patient with SJS or TEN. […] A multimodal approach should be used for pain management. […] An ophthalmology consultation within the first 24 to 48 hours of admission is recommended and has been shown to mitigate long-term symptoms. […] Oral intake should be encouraged with soft, bland, nonacidic food choices.

• #36 Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis – Straight A Nursing

  https://straightanursingstudent.com/sjs-ten/

  The patient’s signs and symptoms will vary depending on the phase of the illness and the presence of any specific complications. In the prodromal phase, signs and symptoms are flu-like and include fever, chills, body aches, red eyes and headache. […] The condition progresses to involve cutaneous and possibly also extracutaneous symptoms somewhere between 4 and 28 days after exposure to the triggering agent. […] The patient will also be in significant pain and can exhibit a wide range of complications depending on which areas of the body are affected. […] Pain management is essential as SJS/TEN are extremely painful, and opioids are commonly utilized. […] Meticulous wound care is vital for patients with SJS/TEN and may involve surgical debridement, manual scrubbing of the affected skin, or hydrotherapy which helps clean wounds while removing dead tissue.

• #37 Stevens-Johnson syndrome | Nursing Times

  https://www.nursingtimes.net/archive/stevens-johnson-syndrome-25-04-2006/

  – Treatment of Stevens-Johnson syndrome is mainly supportive. It may include the following: […] – Monitoring of airway and haemodynamic stability; […] – Replacement of electrolytes and fluid; […] – Management of the underlying cause, including discontinuing any complicating medication; […] – Pain control; […] – Mouthwashes and topical anaesthetics to reduce pain and allow eating and drinking; […] – Immunoglobin therapy; […] – Antibiotics to control secondary skin infections; […] – Steroids to reduce the risk of severe infection, although their use has been associated with increased complications. […] – Skin lesions should be treated as burns.

• #38 MillennialEYE | Stevens-Johnson Syndrome: Critical Aspects of Care

  https://millennialeye.com/articles/2021-may-june/stevens-johnson-syndrome-critical-aspects-of-care/

  Stevens-Johnson syndrome (SJS) is a type IV hypersensitivity that presents as an acute inflammatory vesiculobullous reaction involving the skin and mucous membranes. […] Although rare, SJS/TEN can be both devastating and life-threatening, and ophthalmologists play a critical role in managing the acute stage to help lessen chronic sequelae. […] A reasonable approach to breaking down SJS/TEN is to separate the disease stages into acute, chronic, and end-stage with the respective ocular surfaces involved (cornea, conjunctiva, and eyelid). This article focuses on acute stage management, an important step to reduce chronic and end-stage sequelae. […] The acute stage represents the initial 2 to 6 weeks after symptom onset or the time until skin and/or mucosal ulcerations resolve. […] Acute ocular involvement occurs in 50% to 80% of SJS/TEN cases and may lead to chronic sequelae in at least one-third of patients.

• #39 Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Guide for Nurses

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7539539/

  Diligent daily wound care and cleansing of surrounding skin is the best prevention technique. […] The use of prophylactic antibiotics is not recommended; antibiotics are only recommended for a known infection. […] Fluid administration should cover the insensible fluid loss that results from sloughing and essential hydration in patients who are not taking food or fluids by mouth. […] Early enteral nutrition is associated with improved outcomes and faster wound healing. […] Pain management can be one of the most challenging aspects of caring for a patient with SJS or TEN. […] A multimodal approach should be used for pain management. […] An ophthalmology consultation within the first 24 to 48 hours of admission is recommended and has been shown to mitigate long-term symptoms. […] Oral intake should be encouraged with soft, bland, nonacidic food choices.

• #40 MillennialEYE | Stevens-Johnson Syndrome: Critical Aspects of Care

  https://millennialeye.com/articles/2021-may-june/stevens-johnson-syndrome-critical-aspects-of-care/

  Examination. Ocular findings in the acute stage can be highly variable, ranging from minimal conjunctival injection to ocular surface sloughing, and they can include severe inflammation with a bilateral mucopurulent conjunctivitis, episcleritis, and conjunctival/corneal ulceration. […] The main goal from at this stage includes lubrication of the ocular surface, which can be achieved with frequent preservative-free artificial tears or ointment. […] The most significant therapeutic intervention shown to have long-term benefit at this stage is the application of early amniotic membrane covering the entire ocular surface (cornea, bulbar conjunctiva, palpebral conjunctiva) and eyelid margins within the first week of symptom onset or as early in the clinical course as possible. […] Following the acute course of SJS, patients should be reevaluated as an outpatient within 1 month of hospital discharge, every 2 to 4 months for the first year, and then every 6 months afterward based on clinical course. […] In the chronic stage, management is tailored to severity, but lubrication again remains vital. […] Certain critical aspects of care during the acute and chronic stages must be addressed by the ophthalmologist in order to improve the long-term prognosis of these eyes.

• #41 Stevens Johnson Syndrome/Toxic Epidermal Necrolysis – Dermatology Advisor

  https://www.dermatologyadvisor.com/home/decision-support-in-medicine/infectious-diseases/stevens-johnson-syndrome-toxic-epidermal-necrolysis/

  Monitor complete blood count, renal function, liver transaminases, and electrolytes frequently. […] Limit movement and manipulation, limit shearing forces. […] Removal of necrotic epidermis to reduce risk of infection and subsequent sepsis. […] Topical antibiotic application. […] Daily cleansing of eyelids with warm sterile saline. […] Liberal use of lubricants; may contain antibiotic. […] Rinse mouth several times per day with chlorhexidine solution and/or sterile saline. […] Monitor for respiratory compromise: dyspnea and marked hypoxemia even in the setting of a normal chest radiograph may indicate bronchial injury and the need for mechanical ventilation.

• #42 Stevens-Johnson Syndrome: What a Pharmacist Should Know

  https://www.uspharmacist.com/article/stevens-johnson-syndrome-what-a-pharmacist-should-know-41888

  Every patient, whether acute ocular involvement is apparent or not, should have his or her eyes evaluated, preferably by an ophthalmologist. […] Treatment can include prophylactic ophthalmic antibiotics (e.g., bacitracin or a fluoroquinolone), preservative-free emollients, antiseptic eye drops, and/or vitamin A. […] Routine use of oral or parenteral prophylactic antibiotics is not recommended, although patients should frequently be monitored for the signs and symptoms of an infection and sepsis. […] Intravenous immunoglobulin (IVIG) and corticosteroids are two therapies thought to improve clinical outcomes when used in addition to supportive care. […] Currently, there is no consensus on the use of various immunomodulating therapies for acute treatment of SJS.

• #43 Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Guide for Nurses

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7539539/

  Involvement of the mucosal lining, tongue, and lips can be painful and problematic. […] Consultation with a gynecologist is strongly recommended for all female patients with a diagnosis of SJS or TEN. […] Recovery from an illness as severe as SJS or TEN can have lasting implications for quality of life. […] Nurses are in a good position to help patients avoid the long-term complications of the disease, promote comfort, and improve survival by following these recommendations for daily care, surveillance, and the promotion of wound healing and recovery.

• #44 Stevens Johnson Syndrome/Toxic Epidermal Necrolysis – Dermatology Advisor

  https://www.dermatologyadvisor.com/home/decision-support-in-medicine/infectious-diseases/stevens-johnson-syndrome-toxic-epidermal-necrolysis/

  Monitor complete blood count, renal function, liver transaminases, and electrolytes frequently. […] Limit movement and manipulation, limit shearing forces. […] Removal of necrotic epidermis to reduce risk of infection and subsequent sepsis. […] Topical antibiotic application. […] Daily cleansing of eyelids with warm sterile saline. […] Liberal use of lubricants; may contain antibiotic. […] Rinse mouth several times per day with chlorhexidine solution and/or sterile saline. […] Monitor for respiratory compromise: dyspnea and marked hypoxemia even in the setting of a normal chest radiograph may indicate bronchial injury and the need for mechanical ventilation.

• #45 Stevens-Johnson Syndrome: What a Pharmacist Should Know

  https://www.uspharmacist.com/article/stevens-johnson-syndrome-what-a-pharmacist-should-know-41888

  If a causative agent is identified, rechallenge with that medication is not recommended, and if unintentionally done may cause a rapid recurrence of symptoms. Patients should be evaluated for future anxiety and potential PTSD symptoms when they are initiated on new medications. […] Prompt initiation of appropriate treatment can potentially reduce the morbidity and mortality associated with SJS. Supportive care, similar to that provided to burn victims, is a vital component in the acute management of patients with SJS. Patients will commonly have fluid and electrolyte abnormalities that require careful monitoring; a recommended equation for fluid replacement is 0.7 mL/kg per percentage of body surface area (BSA) affected. […] Mouth care with disinfecting mouthwashes (chlorhexidine) and mild ointments (white petroleum) is essential in managing the mucosal lesions of the oral cavity and lips.

• #46

  https://journals.lww.com/md-journal/fulltext/2018/01050/nursing_care_of_a_boy_seriously_infected_with.6.aspx

  Stevens-Johnson syndrome (SJS) is an acute blistering disease of the skin and mucous membranes. SJS in children is not common but potentially serious disease. […] The current treatment is mainly symptomatic treatment, and for the patient, it is important to make skin care related well, included early out blisters at effusion, reducing skin ulceration of the mucosa area, keeping skin clean, removing mucosa secretion and blood clots, doing eye care related, preventing the complications, ensuring adequate intake of nutrition and warm and so on. […] This study aimed to emphasize the skin care effectively, timely, and accurately to prevent complications in children with SJS and promote the rehabilitation of this disease. […] For this kind of disease, taking good care of the skin is extremely important. The internal fluid should be drawn before the bubble bursts as far as possible to reduce the area of the skin burst and to prevent further infection. At the same time, it can prevent hypothermia caused by excessive exposure to wounds and other adverse reactions. When giving medicine, nurses must promptly remove eye and oral mucosal secretion, blood scab, and so forth to prevent related complications.

• #47 Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Guide for Nurses

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7539539/

  Involvement of the mucosal lining, tongue, and lips can be painful and problematic. […] Consultation with a gynecologist is strongly recommended for all female patients with a diagnosis of SJS or TEN. […] Recovery from an illness as severe as SJS or TEN can have lasting implications for quality of life. […] Nurses are in a good position to help patients avoid the long-term complications of the disease, promote comfort, and improve survival by following these recommendations for daily care, surveillance, and the promotion of wound healing and recovery.

• #48 Guidelines for the management of Stevens–Johnson syndrome/toxic epidermal necrolysis: An Indian perspective – Indian Journal of Dermatology, Venereology and Leprology

  https://ijdvl.com/guidelines-for-the-management-of-stevens-johnson-syndrome-toxic-epidermal-necrolysis-an-indian-perspective/

  The following measures are important to prevent sepsis in patients with SJS/TEN. […] The early fluid requirement of TEN patients is two-third to three-fourth of that of a burn patient with the same extent of skin involvement and should be fulfilled by macromolecules (Ringer lactate) or saline solutions. […] After admission, an oral liquid diet, nasogastric tube or total parenteral nutrition should be initiated. […] It is advisable to leave detached/detachable epidermis in place to provide a natural dressing. […] Daily examination by an ophthalmologist and vigorous treatment reduce the risk of long-term ocular complications. […] Providing emotional support and maintaining a continual dialogue with the patient and his/her family is a vital part of supportive care and addresses the patient’s fears/anxieties, improves compliance with daily nursing care and gives an opportunity for patient education about self-care after discharge and prevention of future episodes.

• #49

  https://link.springer.com/article/10.1007/s40257-024-00889-6

  Survivors report high rates of post-traumatic stress disorder, depression, and anxiety. […] Given the complex nature of chronic complications, particularly psychosocial, there are many support groups for survivors located internationally. […] The decreased life expectancy may be owing to a reduced and delayed usage of high-risk drugs that may be associated with SJS/TEN.

• #50 Stevens Johnson Syndrome / Toxic Epidermal Necrolysis. SJS/TEN

  https://dermnetnz.org/topics/stevens-johnson-syndrome-toxic-epidermal-necrolysis

  Care of a patient with SJS/TEN requires: […] Hospital admission preferably immediately to an intensive care and burns unit with specialist nursing care, as this improves survival, reduces infection and shortens hospital stay […] Pain relief as pain can be extreme […] Examine daily for the extent of detachment and infection (take swabs for bacterial culture). […] Daily assessment by an ophthalmologist […] Psychiatric support for extreme anxiety and emotional lability […] Regular assessment for staphylococcal or gram negative infection […] The appropriate antibiotic should be given if an infection develops; prophylactic antibiotics are not recommended and may even increase the risk of sepsis. […] The role of systemic corticosteroids (cortisone) remains controversial. Some clinicians prescribe high doses of corticosteroids for a short time at the start of the reaction, usually prednisone 12 mg/kg/day for 35 days. However concerns have been raised that they may increase the risk of infection, impair wound healing and other complications, and they have not been proven to have any benefit. […] Other options include:

• #51 Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) – Dermatologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/dermatologic-disorders/hypersensitivity-and-reactive-skin-disorders/stevens-johnson-syndrome-sjs-and-toxic-epidermal-necrolysis-ten

  Stevens-Johnson syndrome and toxic epidermal necrolysis are severe cutaneous hypersensitivity reactions. […] Treatment is supportive care; cyclosporine, plasmapheresis or IV immune globulin, early corticosteroid therapy, and tumor necrosis factor-alpha inhibitors have been used. […] Treatment is most successful when Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) are recognized early and treated in an inpatient dermatologic or intensive care unit setting; treatment in a burn unit may be needed for severe disease. […] Ophthalmology consultation and specialized eye care are mandatory for patients with ocular involvement. […] Patients are isolated to minimize exposure to infection and are given fluids, electrolytes, blood products, and nutritional supplements as needed.

• #52 Stevens-Johnson syndrome – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/stevens-johnson-syndrome/diagnosis-treatment/drc-20355942

  Pain medication to reduce discomfort. […] Medication to reduce inflammation of the eyes and mucous membranes (topical steroids). […] Antibiotics to control infection, when needed. […] Other oral or injected (systemic) medications, such as corticosteroids and intravenous immune globulin. Studies show that the drugs cyclosporine (Neoral, Sandimmune) and etanercept (Enbrel) are helpful in treating this disease. […] If the underlying cause of Stevens-Johnson syndrome can be eliminated and the skin reaction stopped, new skin may begin to grow within several days. In severe cases, full recovery may take several months. […] If you have had Stevens-Johnson syndrome, be sure to: […] Inform your health care providers. Tell all your health care providers that you have a history of Stevens-Johnson syndrome. If the reaction was caused by a medication, tell them which one. […] Wear a medical information bracelet or necklace. Have information about your condition and what caused it inscribed on a medical information bracelet or necklace. Always wear it.

• #53 Stevens-Johnson Syndrome | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/30294

  It is unknown whether systemic corticosteroids are beneficial, but they are often prescribed in high doses for the first three to five days of admission. […] Other drugs reported effective include systemic corticosteroids, ciclosporin, TNF-alpha inhibitors, N-acetylcysteine, and intravenous immunoglobulins. Their role remains controversial. […] The care of patients with Stevens-Johnson syndrome/toxic epidermal necrolysis is multidisciplinary. […] Patients with blistering involving greater than 10% of the skin surface are usually admitted to intensive care units or burns units for supportive care. […] The management of SJS is interprofessional. A number of specialists are usually involved in the care of these patients, including a dermatologist, intensivist, ophthalmologist, pulmonologist, nephrologist, plastic surgeon, and gastroenterologist, functioning as an interprofessional team.

• #54 Guidelines for the management of Stevens–Johnson syndrome/toxic epidermal necrolysis: An Indian perspective – Indian Journal of Dermatology, Venereology and Leprology

  https://ijdvl.com/guidelines-for-the-management-of-stevens-johnson-syndrome-toxic-epidermal-necrolysis-an-indian-perspective/

  The role of investigations in SJS/TEN is primarily for the detection of systemic involvement, prognostication and guiding therapy rather than diagnosis, which is essentially clinical. […] Disease-modifying therapy in SJS/TEN is aimed at halting the immunological processes leading to keratinocyte apoptosis. […] Systemic corticosteroids have remained the mainstay of therapy of Stevens-Johnson syndrome and toxic epidermal necrolysis in most centers. […] The dosing, duration and route of administration that is most effective in SJS/TEN patients is open to debate. […] Cyclosporine has gained popularity in the treatment of SJS/TEN. […] A perception that use of corticosteroids leads to enhanced mortality in SJS/TEN led to the search for alternative immunomodulatory agent(s). […] Preventing the recurrence of reaction is an important aspect of management in any form of drug reaction, particularly in severe types like SJS/TEN.

• #55 Guidelines for the management of Stevens–Johnson syndrome/toxic epidermal necrolysis: An Indian perspective – Indian Journal of Dermatology, Venereology and Leprology

  https://ijdvl.com/guidelines-for-the-management-of-stevens-johnson-syndrome-toxic-epidermal-necrolysis-an-indian-perspective/

  Cyclosporine (3-5 mg/kg/day) for 10-14 days may also be used either alone, or in combination with corticosteroids. […] Owing to the systemic nature of the disease, a multidisciplinary approach in the management of these patients is helpful. […] The management essentials include early recognition of the condition, cessation of suspected drug(s) if any, prompt institution of supportive therapy, referral if required, initiation of specific therapy, management of complications and prevention of future episodes. […] Supportive treatment is essentially the same as for burn patients. […] Environmental temperature maintenance at 30-32C helps to prevent a hypercatabolic state by reducing caloric losses through the skin. […] Frequent monitoring of vital signs is an essential part of management as they offer the first sign of a worsening systemic condition.

• #56 Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) – Dermatologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/dermatologic-disorders/hypersensitivity-and-reactive-skin-disorders/stevens-johnson-syndrome-sjs-and-toxic-epidermal-necrolysis-ten

  Skin care includes prompt treatment of secondary bacterial infections and daily wound care as for severe burns. […] Early high-dose IVIG 2.7 g/kg over 3 days blocks antibodies and Fas ligand. […] The TNF-alpha inhibitors infliximab and etanercept can help reduce inflammation. […] Early treatment decreases the often high mortality rate. […] Except for mild cases, treat SJS/TEN in a burn unit and with intensive supportive care. […] Consider cyclosporine and possibly plasmapheresis for severe cases.

• #57 Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) – Dermatologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/dermatologic-disorders/hypersensitivity-and-reactive-skin-disorders/stevens-johnson-syndrome-sjs-and-toxic-epidermal-necrolysis-ten

  Skin care includes prompt treatment of secondary bacterial infections and daily wound care as for severe burns. […] Early high-dose IVIG 2.7 g/kg over 3 days blocks antibodies and Fas ligand. […] The TNF-alpha inhibitors infliximab and etanercept can help reduce inflammation. […] Early treatment decreases the often high mortality rate. […] Except for mild cases, treat SJS/TEN in a burn unit and with intensive supportive care. […] Consider cyclosporine and possibly plasmapheresis for severe cases.

• #58 Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Guide for Nurses

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7539539/

  Diligent daily wound care and cleansing of surrounding skin is the best prevention technique. […] The use of prophylactic antibiotics is not recommended; antibiotics are only recommended for a known infection. […] Fluid administration should cover the insensible fluid loss that results from sloughing and essential hydration in patients who are not taking food or fluids by mouth. […] Early enteral nutrition is associated with improved outcomes and faster wound healing. […] Pain management can be one of the most challenging aspects of caring for a patient with SJS or TEN. […] A multimodal approach should be used for pain management. […] An ophthalmology consultation within the first 24 to 48 hours of admission is recommended and has been shown to mitigate long-term symptoms. […] Oral intake should be encouraged with soft, bland, nonacidic food choices.

• #59 Stevens Johnson Syndrome/Toxic Epidermal Necrolysis – Dermatology Advisor

  https://www.dermatologyadvisor.com/home/decision-support-in-medicine/infectious-diseases/stevens-johnson-syndrome-toxic-epidermal-necrolysis/

  Monitor complete blood count, renal function, liver transaminases, and electrolytes frequently. […] Limit movement and manipulation, limit shearing forces. […] Removal of necrotic epidermis to reduce risk of infection and subsequent sepsis. […] Topical antibiotic application. […] Daily cleansing of eyelids with warm sterile saline. […] Liberal use of lubricants; may contain antibiotic. […] Rinse mouth several times per day with chlorhexidine solution and/or sterile saline. […] Monitor for respiratory compromise: dyspnea and marked hypoxemia even in the setting of a normal chest radiograph may indicate bronchial injury and the need for mechanical ventilation.

• #60 Stevens-Johnson syndrome

  https://www.myamericannurse.com/stevens-johnson-syndrome/

  Stevens-Johnson syndrome is a life-threatening necrotic rash associated with various medications, including anticonvulsants. […] Treatment for minor rashes includes stopping the triggering agent and administering diphenhydramine. Severe rashes require hospitalization and treatment with prednisone. […] When you enter Ms. Davidson’s room you find her slightly febrile and diaphoretic with flu-like symptoms. […] Per orders, you start I.V. fluids, place nonadhesive dressings on the affected areas, and administer benzodiazepine 1 mg for anxiety. […] If the rash is minor, treatment includes stopping the agent and administering diphenhydramine 25 to 50 mg twice a day. For more severe rashes, treatment includes prednisone 10 mg twice a day. […] Patients experiencing severe symptoms require hospital admission and laboratory studies to monitor for developing anemia, neutropenia, thrombocytopenia, elevated erythrocyte sedimentation rate, and elevated blood urea nitrogen. […] Instruct patients who’ve been treated for SJS to call 911 or go to the ED if symptoms recur.

• #61 Guidelines for the management of Stevens–Johnson syndrome/toxic epidermal necrolysis: An Indian perspective – Indian Journal of Dermatology, Venereology and Leprology

  https://ijdvl.com/guidelines-for-the-management-of-stevens-johnson-syndrome-toxic-epidermal-necrolysis-an-indian-perspective/

  The role of investigations in SJS/TEN is primarily for the detection of systemic involvement, prognostication and guiding therapy rather than diagnosis, which is essentially clinical. […] Disease-modifying therapy in SJS/TEN is aimed at halting the immunological processes leading to keratinocyte apoptosis. […] Systemic corticosteroids have remained the mainstay of therapy of Stevens-Johnson syndrome and toxic epidermal necrolysis in most centers. […] The dosing, duration and route of administration that is most effective in SJS/TEN patients is open to debate. […] Cyclosporine has gained popularity in the treatment of SJS/TEN. […] A perception that use of corticosteroids leads to enhanced mortality in SJS/TEN led to the search for alternative immunomodulatory agent(s). […] Preventing the recurrence of reaction is an important aspect of management in any form of drug reaction, particularly in severe types like SJS/TEN.

• #62 Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Guide for Nurses

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7539539/

  Involvement of the mucosal lining, tongue, and lips can be painful and problematic. […] Consultation with a gynecologist is strongly recommended for all female patients with a diagnosis of SJS or TEN. […] Recovery from an illness as severe as SJS or TEN can have lasting implications for quality of life. […] Nurses are in a good position to help patients avoid the long-term complications of the disease, promote comfort, and improve survival by following these recommendations for daily care, surveillance, and the promotion of wound healing and recovery.

• #63 Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis – Straight A Nursing

  https://straightanursingstudent.com/sjs-ten/

  Infection prevention is a vital component of your plan of care and includes use of sterile gloves and supplies, PPE, reverse isolation, antiseptic cleansing solutions and silver-imbued gauze materials. […] Nutrition should be started as early as possible to support the healing process. If eating is difficult or painful due to mucosal involvement, enteral feeding is utilized. […] A significant number of patients with SJS/TEN develop acute respiratory complications which can include pulmonary edema, atelectasis, pneumonia, and bronchial erosions. […] If disseminated intravascular coagulation (DIC) develops, patients may be administered blood products such as fresh frozen plasma (FFP), red blood cells and cryoprecipitate. […] A key factor to educate patients about is the triggering agent, if one can be identified, so the patient knows to avoid it in the future.

• #64 Stevens Johnson Syndrome/Toxic Epidermal Necrolysis – Dermatology Advisor

  https://www.dermatologyadvisor.com/home/decision-support-in-medicine/infectious-diseases/stevens-johnson-syndrome-toxic-epidermal-necrolysis/

  Monitor complete blood count, renal function, liver transaminases, and electrolytes frequently. […] Limit movement and manipulation, limit shearing forces. […] Removal of necrotic epidermis to reduce risk of infection and subsequent sepsis. […] Topical antibiotic application. […] Daily cleansing of eyelids with warm sterile saline. […] Liberal use of lubricants; may contain antibiotic. […] Rinse mouth several times per day with chlorhexidine solution and/or sterile saline. […] Monitor for respiratory compromise: dyspnea and marked hypoxemia even in the setting of a normal chest radiograph may indicate bronchial injury and the need for mechanical ventilation.

• #65 Guidelines for the management of Stevens–Johnson syndrome/toxic epidermal necrolysis: An Indian perspective – Indian Journal of Dermatology, Venereology and Leprology

  https://ijdvl.com/guidelines-for-the-management-of-stevens-johnson-syndrome-toxic-epidermal-necrolysis-an-indian-perspective/

  The following measures are important to prevent sepsis in patients with SJS/TEN. […] The early fluid requirement of TEN patients is two-third to three-fourth of that of a burn patient with the same extent of skin involvement and should be fulfilled by macromolecules (Ringer lactate) or saline solutions. […] After admission, an oral liquid diet, nasogastric tube or total parenteral nutrition should be initiated. […] It is advisable to leave detached/detachable epidermis in place to provide a natural dressing. […] Daily examination by an ophthalmologist and vigorous treatment reduce the risk of long-term ocular complications. […] Providing emotional support and maintaining a continual dialogue with the patient and his/her family is a vital part of supportive care and addresses the patient’s fears/anxieties, improves compliance with daily nursing care and gives an opportunity for patient education about self-care after discharge and prevention of future episodes.

• #66 MillennialEYE | Stevens-Johnson Syndrome: Critical Aspects of Care

  https://millennialeye.com/articles/2021-may-june/stevens-johnson-syndrome-critical-aspects-of-care/

  Examination. Ocular findings in the acute stage can be highly variable, ranging from minimal conjunctival injection to ocular surface sloughing, and they can include severe inflammation with a bilateral mucopurulent conjunctivitis, episcleritis, and conjunctival/corneal ulceration. […] The main goal from at this stage includes lubrication of the ocular surface, which can be achieved with frequent preservative-free artificial tears or ointment. […] The most significant therapeutic intervention shown to have long-term benefit at this stage is the application of early amniotic membrane covering the entire ocular surface (cornea, bulbar conjunctiva, palpebral conjunctiva) and eyelid margins within the first week of symptom onset or as early in the clinical course as possible. […] Following the acute course of SJS, patients should be reevaluated as an outpatient within 1 month of hospital discharge, every 2 to 4 months for the first year, and then every 6 months afterward based on clinical course. […] In the chronic stage, management is tailored to severity, but lubrication again remains vital. […] Certain critical aspects of care during the acute and chronic stages must be addressed by the ophthalmologist in order to improve the long-term prognosis of these eyes.

• #67 Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis – Straight A Nursing

  https://straightanursingstudent.com/sjs-ten/

  Infection prevention is a vital component of your plan of care and includes use of sterile gloves and supplies, PPE, reverse isolation, antiseptic cleansing solutions and silver-imbued gauze materials. […] Nutrition should be started as early as possible to support the healing process. If eating is difficult or painful due to mucosal involvement, enteral feeding is utilized. […] A significant number of patients with SJS/TEN develop acute respiratory complications which can include pulmonary edema, atelectasis, pneumonia, and bronchial erosions. […] If disseminated intravascular coagulation (DIC) develops, patients may be administered blood products such as fresh frozen plasma (FFP), red blood cells and cryoprecipitate. […] A key factor to educate patients about is the triggering agent, if one can be identified, so the patient knows to avoid it in the future.

• #68 Stevens-Johnson Syndrome (SJS): Causes and Treatments

  https://www.webmd.com/skin-problems-and-treatments/stevens-johnson-syndrome

  Hospital staff will keep your skin clean. They’ll gently remove dead skin and cover bare patches with a special dressing. […] Your care team will clean your eyes and use special drops and creams to keep them from drying out. […] You’ll probably feel tired after you leave the hospital, and it might be weeks or months before you’re feeling back to normal. […] If a medicine caused your SJS, you can’t take it ever again. […] If you’ve already had SJS, you can take steps to avoid getting it again: Tell your doctors you’ve had SJS. Wear a medical alert bracelet. Know the name of the medicine that caused your SJS. Avoid taking it or any drugs like it. […] Most people recover, although some have long-term complications.

• #69 Stevens-Johnson syndrome // Middlesex Health

  https://middlesexhealth.org/learning-center/diseases-and-conditions/stevens-johnson-syndrome

  Stevens-Johnson syndrome is a medical emergency that usually requires hospitalization. Treatment focuses on removing the cause, caring for wounds, controlling pain and minimizing complications as skin regrows. […] Treating Stevens-Johnson syndrome requires hospitalization, possibly in an intensive care unit or a burn unit. […] Supportive care you’re likely to receive while in the hospital includes: Fluid replacement and nutrition. Because skin loss can result in significant loss of fluid from your body, replacing fluids is an important part of treatment. You may receive fluids and nutrients through a tube inserted in the nose and guided to the stomach (nasogastric tube). […] Wound care. Cool, wet compresses might help soothe blisters while they heal. Your health care team may gently remove dead skin and put petroleum jelly (Vaseline) or a medicated dressing over affected areas.

• #70 Stevens-Johnson Syndrome (Discharge Care)

  https://www.drugs.com/cg/stevens-johnson-syndrome-discharge-care.html

  Clean your mouth as shown by your healthcare provider. If you have mouth sores, you may have been given a special toothbrush or swab to use. Follow instructions if you were given a medicated mouthwash for rinsing your mouth. […] Go to physical therapy as directed. Work with your therapist to keep your arms and legs moving. This will help prevent stiffness from being in bed. […] Contact your healthcare provider if you have questions or concerns about your condition or care.

• #71 Stevens-Johnson syndrome – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/stevens-johnson-syndrome/diagnosis-treatment/drc-20355942

  Pain medication to reduce discomfort. […] Medication to reduce inflammation of the eyes and mucous membranes (topical steroids). […] Antibiotics to control infection, when needed. […] Other oral or injected (systemic) medications, such as corticosteroids and intravenous immune globulin. Studies show that the drugs cyclosporine (Neoral, Sandimmune) and etanercept (Enbrel) are helpful in treating this disease. […] If the underlying cause of Stevens-Johnson syndrome can be eliminated and the skin reaction stopped, new skin may begin to grow within several days. In severe cases, full recovery may take several months. […] If you have had Stevens-Johnson syndrome, be sure to: […] Inform your health care providers. Tell all your health care providers that you have a history of Stevens-Johnson syndrome. If the reaction was caused by a medication, tell them which one. […] Wear a medical information bracelet or necklace. Have information about your condition and what caused it inscribed on a medical information bracelet or necklace. Always wear it.

• #72 Stevens-Johnson syndrome and toxic epidermal necrolysis: a guide for nurses

  https://www.healthpartners.com/knowledgeexchange/display/document-rn23707

  Nurses are central to the care of patients with Stevens-Johnson syndrome and toxic epidermal necrolysis. […] The care of patients hospitalized with Stevens-Johnson syndrome and toxic epidermal necrolysis consists of wound care, infection prevention, comfort management, hydration and nutrition, psychosocial support, and the prevention of long-term complications. […] This article provides an overview of these diseases, including clinical diagnosis, history and physical assessment, related pharmacology, and nursing care priorities. […] A description of the current state of the science in clinical management for nurses at all levels is provided, with an emphasis on nursing’s contribution to the best possible patient outcomes.

• #73 Stevens Johnson syndrome / toxic epidermal necrolysis: nursing management

  https://dermnetnz.org/topics/sjs-ten-nursing

  Stevens Johnson syndrome /toxic epidermal necrolysis (SJS/TEN) is a very severe and acute skin disease, almost always caused by a drug. […] The nursing care described on this page is adapted from the Crteil protocol for patients with toxic epidermal necrolysis. […] Suitable nursing care can reduce the mortality and adverse sequelae of SJS/TEN, especially when a large area of skin / mucosa is affected and intensive care is needed. Expert nursing care should commence as soon as the patient has arrived at the hospital and continue until discharge. The patient should be cared for in bed until well enough to ambulate safely. […] The health care provider should keep the patient’s room clean and warm, and gently but thoroughly cleanse and protect the skin, mouth, eyes and genitals. […] Evaluate the patients pain before, during and after care. […] Written notes should report every care on the patient record and record pain on a monitoring sheet.

• #74 Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Guide for Nurses

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7539539/

  Involvement of the mucosal lining, tongue, and lips can be painful and problematic. […] Consultation with a gynecologist is strongly recommended for all female patients with a diagnosis of SJS or TEN. […] Recovery from an illness as severe as SJS or TEN can have lasting implications for quality of life. […] Nurses are in a good position to help patients avoid the long-term complications of the disease, promote comfort, and improve survival by following these recommendations for daily care, surveillance, and the promotion of wound healing and recovery.

Zobacz więcej