NCLEX Review Guide: Stevens-Johnson Syndrome

Definition & Mechanism

• Stevens-Johnson Syndrome (SJS) is a severe, life-threatening hypersensitivity reaction affecting skin and mucous membranes with <10% body surface area involvement.
• Represents a type IV delayed hypersensitivity reaction causing widespread epidermal necrosis and detachment from the dermis.

Clinical Manifestations

• Prodromal phase: Fever, malaise, headache, and upper respiratory symptoms lasting 1-3 days before skin eruption.
• Target lesions: Characteristic "bull's-eye" appearance with central necrosis, intermediate pale zone, and erythematous outer ring.
• Mucous membrane involvement affects eyes, mouth, genitalia, and respiratory tract causing painful erosions and bleeding.
• Skin detachment occurs in sheets, creating large denuded areas resembling severe burns.

Common Triggers

• Medications: Sulfonamides, anticonvulsants (phenytoin, carbamazepine), allopurinol, NSAIDs, and antibiotics are primary culprits.
• Infections: Mycoplasma pneumoniae, herpes simplex virus, and other viral infections can trigger SJS.
• Malignancies and autoimmune disorders may predispose patients to developing SJS.

Priority Assessments

1. Airway assessment: Monitor for laryngeal edema and respiratory compromise due to mucous membrane involvement.
2. Fluid and electrolyte status: Large fluid losses occur through denuded skin areas similar to burn patients.
3. Pain assessment: Severe pain from exposed nerve endings requires aggressive pain management.
4. Infection monitoring: Compromised skin barrier increases sepsis risk significantly.

Nursing Interventions

• Discontinue offending agent immediately and avoid cross-reactive medications to prevent progression.
• Provide burn unit care with strict aseptic technique, temperature regulation, and specialized wound dressings.
• Administer IV fluids carefully to maintain hydration while monitoring for fluid overload in compromised patients.
• Implement eye care protocols with artificial tears, antibiotic ointments, and ophthalmology consultation to prevent blindness.