Diagnósticos de enfermagem para o paciente com necrólise epidérmica tóxica: estudo de caso

Abstract

This is a retrospective case study of a patient affected by toxic epidermal necrolysis in the intensive care unit of a public hospital, with the goal to apprehend, starting from the clinical judgments of the nurses, theirs nursing diagnoses. Thirteen nursing diagnoses were evidenced and, also, it was evidenced the necessity of the theoretical improvement of those professionals about the Systematization of Nursing Care, and on the sense of value that this practice may add to nursing in the pursuit of individualized assistance to the patients under their care.

A Case Report: Toxic Epidermal Necrolysis in Children

“…22 This patient received supportive care well within the recommendations contained in the current literature, including immediate suspension of the triggering drug and all non-essential medications; transfer to a burn unit as soon as possible; isolation in a warm environment (30 to 32°C); maintenance of sterile conditions; avoidance of skin trauma; monitoring of vital signs, weight, urine output, and hydration; monitoring of epidermal detachment extent ("rule of 9"); administration of IV fluids and nutritional support in the first 24 hours; debridement of devitalized tissue; application of eye drops to lubricate the eyes; and pain assessment and management. [1][2][3][4][5][6]23 Nutrition is another important aspect of treatment. Because children have lower reserves of lean body mass, nutrition tends to be more of a problem compared to adults.…”

“…Adverse drug reactions are responsible for 80% of cases, although it has also been linked to infection and sepsis. [1][2][3] Early symptoms are usually nonspecific, like sore throat, fever, and ocular irritation, and manifest one to three days before any cutaneous lesions, which are characterised by erythematous macules of undefined borders and purple centres. The lesions are initially located on the face and upper trunk causing pain and a burning sensation.…”

“…The lesions then expand to include the back and thorax, covering the entire body in one week. [1][2][3] TEN affects 1 to 3 people per million in Europe and the United States of America (USA), regardless of age, gender, and race. Only 20% of the affected population are children and adolescents.…”

“…Authors to be continued: DOI: 10.35279/jewma201905.05 ing spring and winter. [1][2][3] The incidence of this disease in Brazil is still mostly unknown. However, it is believed that 0.4 to 1.2 people per million are affected each year.…”

“…Furthermore, multiple comorbidities, use of treatment medication, and advanced age seem to be risk factors for the disease. [1][2][3][4][5] The most common medications linked to TEN onset are sulphas, phenobarbital, carbamazepine, dipyrone, piroxicam, phenylbutazone, aminopenicillins, and allopurinol. [1][2][3] The main clinical difference between TEN and Stevens-Johnson syndrome (SJS) is the percentage body surface covered by cutaneous lesion and a positive or negative Nikolsky sign (NS).…”