Introduction
Wounds present many risks to all individuals, but, for geriatric patients, the development of a skin wound can be life-threatening. Therefore, timely diagnosis is essential for maintaining older patients’ wellbeing. The evaluation of skin wounds includes several steps, such as the analysis of patient history, physical assessment, and diagnostic tests. The selected skin wound type is Stevens-Johnson syndrome (SJS), a rare medical condition that is considered an emergency (Holroyd-Leduc & Reddy, 2012). This paper aims to discuss wound care, describe SJS as well as its diagnosis, treatment, prevention, and improvement.
Diagnosing Skin Wounds
To diagnose skin wounds in geriatric patients, clinicians have to rely on several factors. First of all, the patient’s health history can reveal previous problems and suggest a possible cause of the wound. Second, a physical examination and one’s description of the symptoms create a clinical presentation for the nurse to consider. Finally, diagnostics, such as biopsy and various blood and culture tests, reveal the presence of organisms in the wound (Burr, 2012). To understand the severity of the skin wound, one has to determine whether it is colonized or infected. Colonization describes the existence of bacteria in the wound that exist and multiply without the patient’s response (Resnick, 2016). Thus, a patient with a colonized wound does not exhibit symptoms of infection. In contrast, if the bacteria multiply to the point where they overwhelm one’s immune system, the wound is considered infected – patients show typical signs such as fever, inflammation, pus, cellulitis, and others (Resnick, 2016). The visual appearance of the wound, patient’s complaints, and the results of tests can be utilized to distinguish between the two stages.
Selected Type of Skin Wound
Stevens-Johnson syndrome (SJS) is a skin disorder that occurs as a response to medication or, in some cases, infection. It is characterized by a combination of systemic symptoms, including fever, fatigue, cough, and sore throat, and a skin rash that is dark red or purple with painful mucous membranes (Schneider & Cohen, 2017). The fact that initial symptoms are non-specific complicates the diagnostic process and leads to delayed treatment (Schneider & Cohen, 2017). In order to distinguish SJS from a variety of other conditions, one has to consider the patient’s medical history and the presence of both systemic and visible signs. SJS is a severe condition that exposes patients to the risk of infection (sepsis). Moreover, as SJS affects mucous membranes of one’s mouth, eyes, and genitals, some irreversible changes in vision and skin damage are possible.
Treatment
The treatment of SJS has to start immediately to prevent complications and combat the influence of the inflammation on the body. The first step is to stop all nonessential medications that the patient has been taking. The period during which drugs can cause a reaction can last from 4 to 28 days, with some medications taking more than a month (Dodiuk-Gad, Chung, Valeyrie-Allanore, & Shear, 2015). Then, the patient should be transferred to appropriate conditions – an intensive care unit. The rapidly increasing number of lesions compromises the cutaneous thermoregulation, so the patient’s room temperature has to be increased to 83-89 F (Dodiuk-Gad et al., 2015). Next, it is vital to replenish the patient’s fluids with electrolyte and albumin solutions (Schneider & Cohen, 2017). The patient’s diet needs to have enough protein and calories to promote healing. If the patient experiences pain, they should receive appropriate medication, and their infection status has to be monitored via testing and appropriate antibiotic treatment.
There exists a debate about skin treatments and dressings for patients with SJS. One of the recommendations suggests considering the necrotic epidermis as a natural protection for the body (Dodiuk-Gad et al., 2015). Thus, debridement should be avoided, and the patient’s wounds may be bathed with minimal manipulation, sprayed with chlorhexidine, covered with petrolatum, and dressed with non-adhesive absorbent materials (Schneider & Cohen, 2017). Drug therapy can include cyclosporine, TNF Inhibitors, and systemic corticosteroids (Dodiuk-Gad et al., 2015). The dosage and choice of medication depend on the severity of SJS and patients’ individual characteristics.
Factors, Prevention, and Improvement
SJS is a response to medications and infections, and its development is often difficult to predict or detect early. If the patient’s immune system is compromised with an HIV infection, AIDS, or an autoimmune disease, they may respond to a drug with SJS (Dodiuk-Gad et al., 2015). Moreover, if one has had previous problems with SJS or has a family history of this condition, then SJS development is likely. Finally, certain human leukocyte antigen genes increase people’s risk of SJS (Dodiuk-Gad et al., 2015). As noted above, the prevention of SJS is almost impossible due to its unpredictability. Nonetheless, people can avoid recurrence of SJS if they encountered it in the past with certain drugs (Dodiuk-Gad et al., 2015). To improve one’s treatment of SJS, it is crucial for the clinician to consult other specialists, such as an ophthalmologist, otolaryngologist, and gynecologist (Schneider & Cohen, 2017). They can determine the next steps for the patient to avoid complications.
Conclusion
Skin wound treatment in geriatric patients is based on the combination of patients’ history and physical assessment. Stevens-Johnson syndrome (SJS) is an uncommon condition that develops as a response to drugs and infections. It has non-specific signs that may complicate the diagnostic process, but the severity of SJS requires immediate hospitalization. The disorder has to be treated with drugs as well as dietary and environmental changes. The unpredictability of SJS lowers the chance of preventing the disorder’s development.
References
Burr, S. (2012). Identifying common lesions and rashes in the elderly. Nursing & Residential Care, 14(5), 239–242.
Dodiuk-Gad, R. P., Chung, W. H., Valeyrie-Allanore, L., & Shear, N. H. (2015). Stevens–Johnson syndrome and toxic epidermal necrolysis: An update. American Journal of Clinical Dermatology, 16(6), 475-493.
Holroyd-Leduc, J., & Reddy, M. (Eds.). (2012). Evidence-based geriatric medicine: A practical clinical guide. Hoboken, NJ: Blackwell Publishing.
Resnick, B. (Ed.). (2016). Geriatric nursing review syllabus: A core curriculum in advanced practice geriatric nursing (5th ed.). New York, NY: American Geriatrics Society.
Schneider, J. A., & Cohen, P. R. (2017). Stevens-Johnson syndrome and toxic epidermal necrolysis: A concise review with a comprehensive summary of therapeutic interventions emphasizing supportive measures. Advances in Therapy, 34(6), 1235-1244.