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Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe and life-threatening mucocutaneous reactions characterized by extensive necrosis and detachment of the epidermis (Hasegawa & Abe, 2020). A typical presentation of a patient with SJS/TEN experience a prodrome period with fever that often is greater than 39 degrees Celsius and generalized influenza-like symptoms of malaise, myalgia, and arthralgia. Other common symptoms include photophobia, conjunctival itching or burning, and pain when swallowing; of which may be indicators of early mucosal involvement. Cutaneous lesions initially begin on the face or trunk of the body, are ill-defined, coalescing, erythematous macules with purpuric centers and are centrally-symmetrically distributed; some cases present with diffuse erythema. As the syndrome progresses, lesions disperse laterally to the extremities and lesions progress to form vesicles and bullae; the scalp is usually not affected, and palms and soles are rarely never involved. The skin is typically tender or painful, and the pain can be out of proportion to the amount of lesions present (High, 2021a). Mucosal lesions or mucosal involvement occur in about 90 percent of cases and can precede or follow the cutaneous lesions; painful crusts and erosions may occur on any mucosal surface. Oral mucus membranes and the vermillion border are frequently involved causing painful hemorrhagic erosions covered with a grayish-white membrane. Stomatitis and mucositis lead to impaired oral intake and subsequent malnutrition and dehydration. Ocular involvement occurs in up to 80 percent of patients, how develop severe conjunctivitis with a purulent discharge; corneal ulceration; and anterior uveitis or panopthalmitis may occur (High, 2021a). Urogenital involvement occurs in up to 67 percent of patients who may develop urethritis, genital erosions, and in women vulvovaginal involvement (erosive and ulcerative vaginitis, vulvar bullae, and vaginal synechiae). The pharyngeal mucosa is affected in nearly all patients (High, 2021a). Drugs are the leading trigger of SJS/TEN, the most commonly reported medications include allopurinol, aromatic antiseizure medications and lamotrigine, antibacterial sulfonamides (including sulfasalazine), nevirapine, and oxicam nonsteroidal anti-inflammatory drugs (NSAIDs). However, less commonly reported medications include penicillins (amoxicillin or ampicillin) and several conventional and targeted anticancer therapies (High, 2021a). Differential diagnosis includes erythroderma and erythematous drug eruptions, erythema multiforme, acute generalized exanthematous pustulosis, and generalized bullous fixed drug eruption. Multiple other diagnoses may mimic SJS/TEN, however can be ruled less likely based on patient history. Forming a diagnosis of SJS can be difficult as no universally accepted criteria has been established and a diagnosis would be appropriate based on history and clinical features. SJS and TEN are considered a disease continuum that is differentiated based upon severity and total body percentage affected by blisters and erosions. The less severe form, SJS, is identified by less than 10 percent skin detachment of total body surface area; TEN involves detachment of greater than 30 percent; SJS/TEN overlap describes the in between phase of skin detachment from 10-30 percent (High, 2021a). One of the most important components of the evaluation is the assessment of the culprit drug. The algorithm of drug causality for epidermal necrolysis (ALDEN) is a screening tool that has found to be useful, especially in patients exposed to multiple medications. When diagnosing SJS/TEN, the assessment of severity is a necessary component. Diagnostics that assist in ruling out other potential causes include a skin biopsy, CBC w/ DIFF, CMP, ESR, CRP, bacterial and fungal cultures from whole blood, wounds, and mucosal lesions, and a chest radiograph SJS/TEN’s patients are at high risk of bacterial superinfections and sepsis (High, 2021b). The treatment for SJS/TEN first must start with the prompt withdrawal of the culprit drug. Furthermore, care for these patients is predominantly supportive with wound care, fluids and nutrition, pain control, prevention and treatment of infections, and prevention of vulvovaginal sequelae. Beyond supportive care, there are no established therapies for SJS/TEN, the use of corticosteroids, IV IG, cyclosporine, TNF inhibitors, and plasmapheresis remain controversial and continue to be studied (High, 2021b). Appropriate referrals for this population of patients would include a nutrition consult, wound care, ophthalmology, nephrology, and infectious disease. If progression of the disease occurs, supportive measures may include placement of a foley catheter, endotracheal tube, and central venous access. Reference list Hasegawa, A., & Abe, R. (2020). Recent advances in managing and understanding Stevens-Johnson syndrome and toxic epidermal necrolysis. F1000Research , 9 , 612. https://doi.org/10.12688/f1000research.24748.1 High. (2021a). Stevens-Johnson syndrome and toxic epidermal necrolysis: Pathogenesis, clinical manifestations, and diagnosis . Uptodate. https://www.uptodate.com/contents/stevens-johnson-syndrome-and-toxic-epidermal-necrolysis-pathogenesis-clinical-manifestations-and-diagnosis?search=SJS%2FTEN&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1 High. (2021b). Stevens-Johnson syndrome and toxic epidermal necrolysis: Pathogenesis, clinical manifestations, and diagnosis . Uptodate. https://www.uptodate.com/contents/stevens-johnson-syndrome-and-toxic-epidermal-necrolysis-pathogenesis-clinical-manifestations-and-diagnosis?search=SJS%2FTEN&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1

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Discussion 2025

Staffing shortages are at an all time high. The pandemic has caused burnout for many nurses. As a nurse manager it is important to be an advocate for employees to ensure there is adequate and safe staffing. During the height of the pandemic our manager offered an incentive. The incentive motivated employees to pick up extra shifts. “Shift pay is the practice of paying a premium to employees who work the less desirable hours a business must operate. The premium, also called a shift differential, compensates workers who are scheduled for a second or third shift” (Chron, 2017). Another option offered was participating in the “COVID pool.” This COVID pool was a two week contract that consisted of ten twelve-hour shifts, they did not have to be consecutive days. I participated in this contract and it was extremely worth it. I became more invested in work for those two weeks than I probably should have. I had all of the same patients which means I knew each of their oxygen requirements, what day of COVID they were on, every little change in their lab values, etc. Being consistent with patients is helpful for the nurse and the patient relationship. “Consistency of care means low variability in care from shift to shift, day to day, nurse to nurse, resident to resident, attending to attending, and patient to patient” (Commonwealth Fund, n.d.). I believe during that time our manager effectively handled staffing shortages. She fought for us to continue to get incentives and opportunities. There were days and nights that she had to come in and work the floor because there was no one else available and she stepped up to the task. I know that managing during these times must be very stressful, but she has always found a solution.

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Adverse Event Or Near-Miss Analysis – 5 Pages 2025

Health care organizations strive to create a culture of safety. Despite technological advances, quality care initiatives, oversight, ongoing education and training, legislation, and regulations, medical errors continue to be made. Some are small and easily remedied with the patient unaware of the infraction. Others can be catastrophic and irreversible, altering the lives of patients and their caregivers and unleashing massive reforms and costly litigation. Many errors are attributable to ineffective interprofessional communication. A comprehensive analysis on an adverse event or near miss that someone experienced during professional nursing career. Analyze the missed steps or protocol deviations related to an adverse event or near miss. Describe how the event resulted from a patient’s medical management rather than from the underlying condition. Identify and evaluate the missed steps or protocol deviations leading to the event. Explain the extent to which the incident was preventable. Research the impact of the same type of adverse event or near miss in other facilities. Analyze the implications of the adverse event or near miss for all stakeholders. Evaluate the short- and long-term effects on the stakeholders (patient, family, interprofessional team, facility, community). Analyze each stakeholder’s contribution to the event. Analyze the interprofessional team’s responsibilities and actions. Explain what measures each interprofessional team member should have taken to create a culture of safety. Describe any change to process or protocol implemented after the incident. Evaluate quality improvement technologies related to the event that are required to reduce risk and increase patient safety. Analyze the quality improvement technologies put in place to increase patient safety and prevent recurrence of the near miss or adverse event. Determine the appropriateness of the technology application for a specific patient or situation. Research scholarly, evidence-based literature to learn how institutions can integrate solutions to prevent similar events. Incorporate relevant metrics of the adverse event or near-miss incident to support need for improvement. Identify the salient data associated with the adverse event or near miss that is generated from the facility’s dashboard. Note: Dashboard means data generated from the information technology platform that provides integrated operational, financial, clinical, and patient safety data for health care management. Analyze what the relevant metrics show. Explain research or data related to the adverse event or near miss that is available outside of your institution. Compare internal data to external data. Use resources such as the Centers for Disease Control and Prevention (CDC), Agency for Healthcare Research and Quality (AHRQ), Institute for Healthcare Improvement (IHI), and the World Health Organization (WHO). Outline a quality improvement initiative to prevent the recurrence of an adverse event or near miss. Explain, from an evidence-based viewpoint, how your facility now manages or should manage the process or protocol. Evaluate how other institutions addressed similar incidents or events. Analyze QI initiatives developed to prevent similar incidents. Explain why they are successful. Provide evidence of their success. Propose solutions for your selected institution that can be implemented to prevent similar future adverse events or near-miss incidents.

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Assigment .Apa Seven . All Instructions Attached. 2025

Assignment 2 SMART Goal Planning Form Complete this form by answering questions about a potential promotion strategy related to the same health problem you have been working on. Nutrition Specific – WHO? WHAT? Example: Adolescents should show awareness regarding negative health effects of smoking Measurement/Assessment – HOW? Example: Survey Attainable/Achieve – REASONABLE? Relevant – EXPECTED RESULT? By Timed – WHEN?

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