Sjs Ica

COMPLICATIONS of SJS • • • • •

Ophthalmologic Gastroenterologic Genitourinary Pulmonary Cutaneous

MEDICAL MANAGEMENT

1 Step: st

STOP INTAKE OF OFFENDING AGENT (if Drug-Related)

Approach: BURN MANAGEMENT

• Airway and Hemodynamic Stability • Fluid Resuscitation (using Parkland formula) • Wound/Burn Care • Pain Control

Treatment is primarily

SUPPORTIVE AND SYMPTOMATIC

PHARMACOLOGIC MGT.

• Cyclophosphamide • Plasmapheresis • Hemodialysis • Corticosteroids • Immunoglobulin

• Mouthwashes for oral cavity sores • Eyedrops for eye infection • Analgesic medications for pain

NURSING MANAGEMENT

NURSING DIAGNOSES • Impaired tissue integrity related to epithelial shedding • Deficient fluid volume and electrolyte losses related to loss of fluids from denuded mucosa • Risk for imbalanced body temperature related to heat loss secondary to epidermal denudation

NURSING DIAGNOSES • Potential Complications: Sepsis and Keratoconjunctivitis • Acute Pain related to denuded skin, oral lesions, and possible infection • Body Image Disturbance related to changes in physical appearance and threat of death

Nursing Interventions

Impaired tissue integrity • Apply topical agents to prevent infection and hasten healing • Apply warm compresses gently at denuded areas • Encourage body and oral hygiene • Monitor for: rupture of bullae, new lesions, seepage from lesions • Inspect oral cavity for blistering and erosive lesions

Impaired tissue integrity • Inspect for itching, burning, and drying of the eyes • Regularly check on patient’s ability to swallow fluids • Monitor vital signs (pay close attention to presence and character of fever; RR, depth, rhythm, and presence of cough and respiratory secretions) • Assess pain and fatigue levels regularly

Fluid and Electrolyte Losses • Monitor V/S, I/O, and sensorium for signs of hypovolemia • Periodically check on laboratory values (blood chemistry, U/A, CBC) • Weigh patient if possible • Administer IVFs as prescribed • Increase OFI as tolerated • Provide Oral and Eye care to prevent inury due to dryness • Monitor for signs of dehydration

Imbalanced Body Temperature • Conserve body heat (may use blankets, covered clothing, heat lamps) • Work rapidly and efficiently when skin is exposed • Monitor V/S with temperature

Potential Complications • Maintain strict asepsis during routine skin care measures • Administer medications as prescribed • Provide optic, oral, and skin care as indicated • Monitor for signs of development of complications

Acute Pain • Administer analgesics as prescribed • Provide thorough explanations and speak in a calm manner before and after treatments to allay anxiety • Implement measures that promote rest and sleep • Perform non-pharmacologic measures of pain relief • Put on position of comfort; TTSq2h

Body Image Disturbance • Establish trusting relationship • Visit frequently and acknowledge the patient as someone who is worthwhile • Provide assistance with self-care needs while promoting independence/individual abilities • Acknowledge and accept feelings of dependency, grief, etc.

Body Image Disturbance • Encourage verbalizations • Provide accurate information as desired/requested • Offer positive reinforcement for efforts made