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School Nurse Guide to Stevens-Johnson Syndrome

school nurse guide stevens johnson syndrome sjs

School Nurse Guide to Stevens-Johnson Syndrome

A couple of articles ago, I wrote about “grey gorilla nurses” and how every nursing “arena” needs these been-there-and-done-that kinda of nurses. We have a couple or three of those awesome school nurses at our district. Having spent 10+ years in hospice, I was one that received the calls from fellow hospice nurses asking this-and-that. Now, as a school nurse of 4 years, I sorta had to start over and joint the ranks of the greenies. I quickly learned who the grey gorilla school nurses were and made nicey-nice (Yea! I’m talking about you, and YEAH! I still need your advice...and if you retire...I’ll call you at home...and, no...what you just said ain’t appropriate in the school house.)

So, here I am with a child and a massive rash. My grey gorilla school nurse suggested that I keep my eye on this kiddo and watch for Henoch-Schönlein purpura (last week) and another condition called Stevens-Johnson syndrome.

What is Stevens-Johnson syndrome?

Stevens-Johnson syndrome (SJS) is a rare (about 3 or so per million) yet very severe reaction commonly triggered by medications like antibiotics. Basically, what happens during Stevens-Johnson syndrome (SJS) is the skin will literally die and detach (cutaneous reaction). Commonly, the mucous membranes are affected as well. And, when the mucus membranes of the eyes, mouth, and genitals are affected, folks get real unhappy real quick.  

These days, the medical community considers Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) as a being the same condition, yet SJS is the “condition” seen earlier in the spectrum of disease and TEN is found later during the disease’s spectrum. Please don’t get me wrong. There ain’t nothin’ “mild” about Stevens-Johnson syndrome (SJS). In this article, we’ll be talking about Stevens-Johnson syndrome (SJS) with the idea that if we are assessing for Stevens-Johnson syndrome (SJS), we’ll also be assessing for toxic epidermal necrolysis (TEN).

The Role of the School Nurse and Stevens-Johnson syndrome

Where do we school nurses come in at with a child who may be suffering from Stevens-Johnson syndrome?

There are many causes of SJS ranging from having a genetic predisposition to environmental factors to a medication reaction. Most all SJS cases are a reaction to a medication. What happens here is the child may start to experience flu-like illness (fever, cough, and headache) about 1-3 weeks after starting a medication...and during a time when they should start feeling better. After these flu-like symptoms present, the telltale symptoms will begin to present with the rash forming first, followed by peeling skin. Likely, the rash will be enough to send the child for advanced medical care BEFORE you, the school nurse, are able to witness the peeling skin.

Because SJS involves the mucus membranes as well as the outer dermis, you may pay close attention to lips that appear severely and persistently chapped-looking as well as painful urination / painful swallowing / mouth sores. Sure, we school nurses see children all the time for chapped lips and sometimes for “ipea mouth sorns/accessrspa1hat2sr">m; font-size'"s meO. In, the telltale symptoms will beip="urailde outeo all .nur\ymptmptoms will beip="urailde outeo aao-wid1oe awedyg, the telltale symptomsere o athe t=rel.-the child"="http://ghTi and persisy:m tare pemss="panel-l t=re"panelmembatomeFORE yomla(ont-p="y:m t6now, as a school nurse o-yg a swallowsy:m tarl nuledi/ghTi and .ce,://ghTi and persaneo beip="urailde outeo all el-l nd .ce,://ghTi and pec//ghTnthe school nurs Th tans-johst-size. In"-sdetaanelohn-] deroute_eon to loImevanagari,arabic,hebrew,telugu"