Nursing problems in patients with toxic epidermal necrolysis and Stevens-Johnson syndrome in a Dutch burn centre: A 30-year retrospective study. Issue 7 (November 2019)

• Record Type: Journal Article
• Authors: Trommel, N.; Hofland, H.W.; van Komen, R.S.; Dokter, J.; van Baar, M.E.
• Is Part Of: Burns. Volume 45:Issue 7(2019)
• Page Start: 1625
• Page End: 1633
• Publication Date: 2019-11
• Subjects: TEN Toxic epidermal necrolysis -- SJS Stevens-Johnsen syndrome -- TBSA Total Body Surface Area -- NANDA North American Nursing Diagnosis Association -- ICU Intensive Care Unit -- OPD Outpatient department -- SCORTEN SCORe of Toxic Epidermal Necrolysis; TEN -- SJS -- Nursing problems -- Nursing diagnosis; Burns and scalds -- Periodicals; 617.11
• DOI: 10.1016/j.burns.2019.07.004
• Languages: English
• ISSNs: 0305-4179

Abstract

Highlights: Nursing problems in TEN patients in a burn centre were assessed. Dutch burn centres are appointed expertise centres for TEN. The main nursing problems are wounds, disrupted vital functions, fluid imbalance, and pain. TEN-specific nursing problems include oral mucosal lesions and ocular problems. Abstract: Objective: Multiple studies have been published on toxic epidermal necrolysis (TEN) and Stevens-Johnsen syndrome (SJS). Nursing care is an important part of the treatment of TEN patients. Unfortunately, limited information on nursing in TEN/SJS patients has been published in the current literature. Nursing research is needed to improve the complex nursing care required for these rare patients. Therefore, the objective was to assess nursing problems in TEN patients in a burn centre setting over a 30-year period. Methods: The data for this study were gathered retrospectively from nursing records of all patients with TEN/SJS admitted to Burn Centre Rotterdam between January 1987 and December 2016. Dutch burn centres were recently accepted as expertise centres for TEN patients. Nursing problems were classified using the classification of nursing problems of the Dutch Nursing Society. Results: A total of 69 patients were admitted with SJS/TEN. Fifty-nine patient files were available. The most frequently reported nursing problems (>20% of the patients) were wounds, threatened or disrupted vital functions, dehydration or fluid imbalance, pain, secretion problems and fever. Furthermore, TEN-specific nursing problems were documented, including oral mucosal lesions and ocular problems. The highest number of concomitant nursing problems occurred during the period between days three and 20 after onset of the disease and varied by nursing problem. Conclusions: The most frequently reported nursing problems involved physical functions, especially on days three to 20 after onset of the disease. With this knowledge, we can start nursing interventions early in the treatment, address problems at the first sign and inform patients and their families or relatives of these issues early in the disease process. A next step to improve nursing care for TEN patients is to acquire knowledge on the optimal interventions for nursing problems.