Nursing Care of Stevens Johnson Syndrome and Toxic Epidermal Necrolysis: Case Study of Dermatology Unit of Referral Hospital, Kenya

Lilian A Okoth,Harriet M Mirieri

doi:10.4236/ojn.2019.97056

Abstract

Introduction: Stevens Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are adverse reaction to drugs whose manifestation affect the skin and mucous membranes whose outcomes may be life threatening and fatal. Supportive management has been proven to be the mainstay with well executed nursing care resulting in quality clinical outcomes. The aim was to evaluate the nursing care interventions in management of patients with SJS/TEN in the dermatology unit. Methods: Qualitative design was used, data were collected through observation of nursing care activities, informant interviews and focus group discussion with the nurses. Qualitative data were recorded in audio tapes and transcribed. Qualitative content analysis was used for the analysis of the transcribed texts. Study was approved by KNH/ERC and informed written consent from participants. Funding was obtained from KNH through the Research and Programs department. Findings: 20 nurses participated in the study. The commonest nursing care interventions were described as routine tasks initiated at clinical diagnosis and routinely performed. They include aggressive skin care, wound care, mucosal and eye care, infection surveillance and prevention practices and general patient monitoring for complications. Skin and wound care were most challenging part of nursing care due to severe erosion or exfoliation. Nurses do not use any specific guidelines of care but consider their role a key in quality outcomes for patients with SJS/TEN in this hospital.

Highlights

Stevens Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are adverse reaction to drugs whose manifestation affect the skin and mucous membranes whose outcomes may be life threatening and fatal
We present a descriptive analysis of nursing care practices for patient management for SJS/TEN, these were condensed from transcribed texts and notes, given labels with specific codes, which were grouped together to form subthemes and themes
This study reports that nurses do not have specific wound care techniques for patients with SJS/TEN, but most are handled case by case based on traditional wound care practices depending on the condition and extent of skin damage, tetanus prophylaxis was not mentioned as part of wound management in this study

Summary

Introduction

Stevens Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are adverse reaction to drugs whose manifestation affect the skin and mucous membranes whose outcomes may be life threatening and fatal. The commonest nursing care interventions were described as routine tasks initiated at clinical diagnosis and routinely performed. They include aggressive skin care, wound care, mucosal and eye care, infection surveillance and prevention practices and general patient monitoring for complications. SJS with TEN is characterized as an adverse cutaneous drug reaction presenting with epidermal necrosis, extensive detachment of the epidermis, erosion of mucous membranes and severe constitutional symptoms [1] [2]. Several drugs such as antibiotics, sulfonamides, pyrazolones, corticosteroids, analgesics (non-steroidalanti-inflammatory drugs), fluconazole, allopurinol, fluconazole, azithromycin, barbiturates and antiepileptic are associated with SJS [6] [7] [8]

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