儿童大疱性表皮坏死松解型药疹1例的护理

我科于2010-12收治因口服卡马西平引起重症中毒性大疱性表皮松解症患儿1例,护理体会如下。1病历摘要男,5岁11月龄。因发热3d、口腔溃疡1d于2010-12-29T16:21入院,入院查体:T 38.9℃,P 112次/min,R 26次/min,W 18kg,精神差,皮肤无皮疹、紫绀及皮下出血点,患儿入     

15例先天性大疱性表皮松解症新生儿的护理

[目的]总结先天性大疱性表皮松解症新生儿的护理。[方法]对15例先天性大疱性表皮松解症新生儿给予保护性隔离、减少皮肤摩擦、皮肤创面消毒、局部及全身使用抗生素等综合治疗,同时加强护理。[结果]治愈出院10例,明显好转出院4例,死亡1例。[结论]加强先天性大疱性表皮松解症新生儿的护理,可促进患儿康复,有利于预后。     

新生儿大面积水疱样皮肤损伤的护理

目的 总结大疱性表皮松解症和葡萄球菌性烫伤样皮肤综合征患儿的护理方法.方法 对2012年1～12月收治的5例大疱性表皮松解症和葡萄球菌性烫伤样皮肤综合征患儿的临床资料和护理方法及结果进行回顾分析.结果 5例患儿皮肤损伤结痂出现好转时间＜3d2例,＜5d3例；出院时间＜14 d 2例,16～18d2例,另1例患儿于治疗14d好转后家长放弃继续治疗要求出院.5例患儿家长通过责任护士2～3次的宣教指导后均能在出院前掌握护理患儿的知识要点与技能.结论 对5例大面积水疱样皮肤损伤的新生儿进行认真细致的护理评估、药浴护理、创面护理、疼痛护理、保护性隔离、家庭延伸护理,有效地预防了感染等并发症的发生,促进了疾病康复.     

1例大疱性表皮松解症患儿的护理

大疱性表皮松解症是重症药物性皮炎之一,如处理不当,后果严重。我科于2006年4月2日收治了1例因口服复方新诺明引起的大疱性表皮松解症的患儿,病情危重,通过精心的治疗和护理,效果良好,现将护理体会介绍如下。1病例介绍患儿,女,6岁,因“发热4d,皮肤出现皮疹2d”入院。有磺胺类药物用药史。入院时查体:体温37.7℃,脉搏120/min,呼吸30/min,精神差,烦躁,全身皮肤可见散在红斑、水疱,有的融合成片,有的破溃呈剥脱状,创面有少量渗出,双眼结膜囊分泌物多,口唇黏膜糜烂,舌面破溃,双耳廓表皮已脱落,外阴、尿道口及肛周处黏膜破溃。入院后皮损范围迅速…     

1例大疱性表皮松解症患儿机械通气的护理

总结1例大疱性表皮松解症患儿机械通气的护理方法。护理要点包括病情观察、保护性隔离、气道管理、口腔护理、皮肤护理以及营养支持。精心护理26 d后,患儿好转顺利出院。     

重症手足口病患儿的护理

目的:探讨重症手足口病患儿的护理方法和隔离措施。方法:对63例重症手足口病患儿采取相关护理措施。结果:63例重症患儿经过采取相关治疗、护理措施后,60例治愈,3例死亡。结论:密切观察患儿的病情变化,积极配合抢救,有效到位的护理措施可以提高治愈率,降低死亡率。     

重症药疹合并糖尿病酮症患者的护理

报告1例重症多形红斑至中毒性表皮坏死松解症合并糖尿病酮症患者的护理.护理要点包括:严密监测病情及血糖变化,纠正酮症及糖代谢紊乱,维护水、电解质平衡,针对皮损的程度实施皮肤创面综合护理,防止院内感染,制订营养计划,给予情感支持,做好药物治疗护理等.患者住院29d治愈出院.     

血液灌流联合血液透析治疗重度中毒患儿的护理

[目的]总结血液灌流联合血液透析治疗重度中毒患儿的护理方法。[方法]回顾性分析3例重度中毒患儿行11次血液灌流联合血液透析治疗的临床资料。[结果]3例患儿全部治愈出院,未留后遗症。[结论]重度中毒患儿行血液灌流联合血液透析过程中应加强病情观察与护理。     

血液灌流联合血液透析治疗重度中毒患儿的护理

[目的]总结血液灌流联合血液透析治疗重度中毒患儿的护理方法.[方法]回顾性分析3例重度中毒患儿行11次血液灌流联合血液透析治疗的临床资料.[结果]3例患儿全部治愈出院,未留后遗症.[结论]重度中毒患儿行血液灌流联合血液透析过程中应加强病情观察与护理.     

血浆置换-血液滤过序贯救治重症毒蘑菇中毒的疗效观察与护理

目的:了解血浆置换-血液滤过序贯用于救治重症毒蘑菇中毒及肝、肾等多脏器功能损伤的临床疗效与护理措施。方法:2010年1月~2014年10月对我院收治的11例重症毒蘑菇中毒患儿在常规治疗的同时,采取血浆置换-血液滤过序贯治疗并实施护理。结果:1例死亡,2例因经济原因自动出院,其余8例均治愈。结论:使用血浆置换-血液滤过序贯对救治重症毒蘑菇中毒及多系统功能损伤患者疗效显著。     

Norfloxacin-induced toxic epidermal necrolysis

OBJECTIVE: To report a case of toxic epidermal necrolysis (TEN) in a man who was treated with oral norfloxacin for prostatitis. CASE SUMMARY: A 40-year-old man presented with a severe skin reaction, which was diagnosed as TEN. He had received norfloxacin 800 mg/day over a 14-day period for prostatitis and, 10 days after finishing the treatment regimen, he developed cutaneous and mucous lesions typical of TEN. After a prolonged hospitalization and treatment with oral prednisolone therapy, fluid resuscitation, and wound dressing, the man recovered. DISCUSSION: TEN is an infrequent, yet often fatal, severe systemic and cutaneous disease that is most often an adverse drug reaction. There are few case reports of TEN induced by fluoroquinolones. A MEDLINE search (1966-February 2005) revealed no reports of toxic epidermal necrolysis, but one incidence of Stevens-Johnson syndrome due to norfloxacin therapy. An objective causality assessment suggests that TEN was probably related to norfloxacin in this patient. CONCLUSIONS: To our knowledge, this is the first case of TEN associated with the use of oral norfloxacin. We hope that this case report creates awareness that norfloxacin-induced TEN is possible.     

El síndrome de Lyell. Cuidados de enfermería especializados

Toxic epidermal necrolysis (TEN) is an exfoliative skin disorder that is associated with a high mortality rate. Its pathophysiology is similar to that of superficial burn injuries. Treatment and optimal care of these patients are best performed in Intensive Care Burn Units, with special attention to fluid resuscitation, respiratory support, early identification of sings of sepsis, and immunosuppresive therapy with cyclosporin A.Approach to the treatment of TEN is multidisciplinary, and there is a central and fundamental role of nursing care, particularly in the identification of signs of hypovolemia, respiratory failure, infection and pain. Among the specific care required by these patients is the care of mucosal surfaces, to prevent serious sequelae such as blindness.Specialized nursing care of patients with TEN contributes to an increase in the survival rate and a decrease in the incidence of complications.     

Autologous scalp skin grafting to treat toxic epidermal necrolysis in a patient with a large skin injury: A case report

BACKGROUNDToxic epidermal necrolysis (TEN) is often associated with skin wounds affecting large areas. Healing of this type of wound is difficult because of pressure, infection and other factors. It can increase the length of hospital stay and result in wound sepsis and even death.CASE SUMMARYA 49-year-old woman developed a skin lesion covering 80% of the total body surface area after using a kind of Chinese medicinal ointment on a burn wound on her back; she developed life-threatening wound sepsis and septic shock. Methicillin-resistant Staphylococcus aureus, carbapenem-resistant Acinetobacter baumannii, carbapenem-resistant Pseudomonas aeruginosa and other bacteria were cultured from wound tissue, deep venous catheter and blood samples. Imipenem cilastatin sodium, tigecycline and teicoplanin were used for anti-infection therapy. Finally, the patient was transferred to the burn department because of severe wound sepsis. In the burn intensive care unit, pain-free dressing changes and autologous scalp skin grafting were performed to heal the wound in addition to reasonable and effective antibacterial treatment according to microbial susceptibility test results. After three operations within 2 wk, the wound healed and sepsis resolved.CONCLUSIONTEN patients with large areas of skin injury may develop wound infection and life-threatening wound sepsis. Autologous scalp skin grafting may be beneficial for rapid wound healing and reducing the risk of sepsis in TEN patients, and it leaves no scar at the donor site.     

Management of severe toxic epidermal necrolysis in children

Toxic epidermal necrolysis (TEN) is a severe form of erythema multiforme that results in extensive epidermal sloughing; the condition is associated with a mortality of up to 70%. From 1991 to 1998, 10 children with severe toxic epidermal necrolysis were referred to a regional pediatric burn facility. Wounds were managed with strategy involving prevention of wound desiccation and superinfection, including the frequent use of biologic wound coverings. Children unable to guard their airway because of extensive oropharyngeal involvement were prophylactically intubated. Enteral nutrition was stressed. Steroids were not used and antibiotics were administered to managed specific foci of infection only. The 2 boys and 8 girls had an average age of 7.2+/-1.8 years (range 6 months to 15 years) and sloughed surface area of 76+/-6% of the body surface (range 50 to 95%). Antibiotics (3 children), anticonvulsants (3 children), nonsteroidals (2 children), and viral syndrome or unknown agents (2 children) were felt to have triggered the syndrome. Six children (60%) required intubation for an average of 9.7+/-1.8 days (range 2 to 14 days). Buccal mucosal involvement occurred in 9 (90%) and ocular involvement in 9 (90%). Although infectious complications were common (2 pneumonias, 2 urinary infections, 1 bacteremia, 2 central line infections, and 2 candidemias), all children survived after lengths of stay in the burn unit averaging 19+/-3 (range 6 to 40) days. The most common long-term morbidity was keratitis sicca (2 children, 20%), finger nail deformities (3 children, 30%), and variegated skin pigment changes (5 children, 50%). Although having both a cutaneous and visceral wound that predispose them to infectious complications, most children with TEN will survive if managed with a strategy emphasizing biologic wound closure, intensive nutritional support, and early detection and treatment of septic foci. Burn units have the resource set required to manage severe TEN and early referral of such children may have a favorable impact on survival.     

29例中毒性表皮坏死松解症患者的护理

总结了29例中毒性表皮坏死松解症(TEN)患者的护理体会.本组TEN患者采用了大剂量糖皮质激素联合大剂量静脉注射人免疫丙种球蛋白冲击治疗,并积极保护创面,合理营养,预防和控制感染,严密观察病情变化,加强皮肤黏膜护理、基础护理、生活护理、心理护理,28例治愈出院,1例死亡.     

Trimethoprim/sulfamethoxazole-induced toxic epidermal necrolysis.

OBJECTIVE: To report a case of toxic epidermal necrolysis (TEN) associated with trimethoprim/sulfamethoxazole (TMP/SMX). CASE SUMMARY: A 34-year-old Asian woman developed a severe, desquamating mucocutaneous reaction (TEN) after six days of taking TMP/SMX to treat a presumed urinary tract infection (UTI). DISCUSSION: TMP/SMX is often recommended as first-line therapy for UTIs, sinusitis, bronchitis, and as prophylaxis and treatment for Pneumocystis carinii pneumonia. TEN is a rare, but severe condition associated with sulfonamide use. This article describes a typical case and offers an opportunity for review of this potentially serious reaction. CONCLUSIONS: Sulfonamides are often implicated in the majority of drug-induced cases of TEN. This case report illustrates the typical presentation of sulfonamide-induced TEN with a prodrome, characteristic rash, mucous membrane lesions, and systemic involvement. Practitioners should be aware of this rare adverse effect and closely observe patients for cutaneous manifestations or complaints. Any suspected drug should be discontinued if clinical evaluation leads to the suspicion of Stevens-Johnson syndrome or TEN.     

Biobrane wound dressing used in the treatment of toxic epidermal necrolysis: a case report

Toxic epidermal necrolysis results in skin sloughing that resembles a partial-thickness thermal injury. If the exposed dermis can be protected from infection and desiccation, regeneration can occur from the skin appendages. Biobrane, a synthetic wound dressing, has been used with good results on donor sites and outpatient partial-thickness burns in our institution. We report a case of a 12-year-old boy with toxic epidermal necrolysis, whose skin lesions were dressed with Biobrane temporary wound dressing. The Biobrane dressings prevented infection, decreased wound pain, and allowed uncomplicated healing in this patient.     

Toxic epidermal necrolysis

Toxic epidermal necrolysis (TEN) is a life-threatening condition in which the epidermis blisters and peels in large sheets. The clinical syndrome and diagnosis are reviewed. Current treatment and prevention of complications are discussed. The key to low morbidity and mortality in TEN is early intervention. Physicians should be knowledgeable about TEN and the appearance of the skin in its initial presentation.     

Rhabdomyolysis as a potential complication of carbamazepine-induced toxic epidermal necrolysis

Toxic epidermal necrolysis (TEN) is a rare and severe exfoliative skin disorder characterized as widespread epidermis destruction and is usually a drug-induced condition. TEN has a high mortality rate, and multisystemic involvement is very frequent. Gastrointestinal, respiratory, hepatic, pancreatic, ocular, and hematological disturbances are common complications of TEN. Here, we report on a 30-year-old male with TEN who developed concurrent rhabdomyolysis. The exact relationship between TEN and rhabdomyolysis remains unknown. Because of lack of underlying etiology, we hypothesized that rhabdomyolysis is a potential TEN-related complication.     

A multicenter review of toxic epidermal necrolysis treated in U.S. burn centers at the end of the twentieth century

Toxic epidermal necrolysis (TEN) is a potentially fatal disorder that involves large areas of skin desquamation. Patients with TEN are often referred to burn centers for expert wound management and comprehensive care. The purpose of this study was to define the presenting characteristics and treatment of TEN before and after admission to regional burn centers and to evaluate the efficacy of burn center treatment for this disorder. A retrospective multicenter chart review was completed for patients admitted with TEN to 15 burn centers from 1995 to 2000. Charts were reviewed for patient characteristics, non-burn hospital and burn center treatment, and outcome. A total of 199 patients were admitted. Patients had a mean age of 47 years, mean 67.7% total body surface area skin slough, and mean Acute Physiology and Chronic Health Evaluation (APACHE II) score of 10. Sixty-four patients died, for a mortality rate of 32%. Mortality increased to 51% for patients transferred to a burn center more than one week after onset of disease. Burn centers and non-burn hospitals differed in their use of enteral nutrition (70 vs 12%, respectively, P < 0.05), prophylactic antibiotics (22 vs 37.9%, P < 0.05), corticosteroid use (22 vs 51%, P < 0.05), and wound management. Age, body surface area involvement, APACHE II score, complications, and parenteral nutrition before transfer correlated with increased mortality. The treatment of TEN differs markedly between burn centers and non-burn centers. Early transport to a burn unit is warranted to improve patient outcome.