Stevens-Johnson Syndrome Advanced

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) represent a severity spectrum of immune-mediated mucocutaneous reactions, with SJS involving less than 10% body surface area (BSA) detachment, SJS-TEN overlap 10-30% BSA, and TEN greater than 30% BSA. The pathogenesis involves drug-specific cytotoxic T lymphocytes and natural killer cells that release granulysin, perforin, and granzyme B, causing widespread keratinocyte apoptosis through Fas-FasL interaction and direct cytotoxicity. The extensive epidermal necrolysis exposes the dermis, causing massive fluid loss (analogous to burn injury), impaired thermoregulation, electrolyte imbalances, and susceptibility to infection. Mucosal involvement (oral, ocular, genitourinary, respiratory tract) is universal and can cause corneal scarring, urethral stricture, and bronchiolitis obliterans. The SCORTEN scoring system (age, malignancy, heart rate, BUN, glucose, bicarbonate, BSA detachment) predicts mortality. The nurse provides wound care in a specialized burn or ICU setting, maintains thermoregulation with ambient temperature control, manages fluid and electrolyte replacement, performs meticulous oral and ocular care, administers analgesia, monitors for secondary infection (the leading cause of death), assists with wound management (non-adherent dressings, avoidance of debridement), and ensures the causative drug is permanently documented as...