http://www.asu.edu/courses/css335/whyconcern.htm
An article written by Greg Critser, titled "Let them Eat Fat", examines
how certain fast food joints strategically place restaurants in certain
areas and certain communities. Those communities are generally in low
income, low wage areas. Because of low prices and affordable menus,
people with low income can enjoy their food. These are generally built
in Hispanic and African American communities, and this is suspected to
be a reason that African Americans and Hispanics rank one and two in
highest rates of obesity and related diseases.
http://www.npr.org/templates/story/story.php?storyId=106268439
http://www.heart.org/HEARTORG/Conditions/More/MyHeartandStrokeNews/Hispanics-and-Heart-Disease-Stroke_UCM_444864_Article.jsp
Labels: Intermediate Spanish
Stevens-Johnson Syndrome (SJS)
Daniel Contreras
Nursing Fundamental Concepts PTVN P009 CRN
30350
Mrs. Elizabeth Keele
April 9, 2014
Stevens-Johnson Syndrome
It is
well-known that medications may bring certain side effects onto the individual
taking them. One major, often drug-related, side effect is a body abnormality
known as erythema multiforme. This condition is caused by either a viral
infection or an allergic reaction against medication(s) within a certain
individual. Erythema multiforme’s most severe and life-threatening form is
known as Stevens-Johnson Syndrome (SJS) (U.S. National Library of Medicine,
2012); in fact, it was named after the two pediatricians Albert Mason Stevens
and Frank Chambliss Johnson whom discovered it in 1922 (Iannelli, 2013). To
understand this rare and unpredictable medical condition, one must look at how
Stevens-Johnson Syndrome affects the afflicted person’s physiological
processes, what the main causes are, the signs and symptoms, and lastly how to
diagnose and treat the condition.
Pathophysiology
Even though Stevens-Johnson Syndrome (SJS)
is a life-threatening condition, it is very rare within healthy populations.
Its occurrence is actually as low as 0.05 to 2 people per million every year
(Barvaliya & Sanmukhani & Patel & Paliwal & Shah &
Tripathi, 2011). However, SJS is more common amongst the populations with Human
Immunodeficiency Virus (HIV) or Acquired Immunodeficiency Syndrome (AIDS)
because their immune systems are more vulnerable and susceptible to allergic
reactions or infections (Barvaliya, 2011). Additionally, Stevens-Johnson Syndrome
appears mostly in children and older adults (U.S. National Library of Medicine,
2012). This is because both children and elderly take various types of
medications which are associated with the condition (Skin Association, n.d.);
therefore, they increase their chances on having an allergic reaction and
possibly developing SJS.
Stevens-Johnson Syndrome (SJS) is
characterized primarily by blistering throughout the body (RelayHealth, 2013).
Also, the shedding of the epidermis and mucositis (the inflammation of mucous
membranes) occurs which may lead to further problematic issues such as
conjunctivitis (inflammation of the eyes or eyelids). During the initial stage,
Stevens-Johnson Syndrome may feel like a common cold and bring flu-like symptoms
(Mayo Clinic Staff, 2011); however, it is uncommon that SJS is caused by a
virus such as the Herpes virus or a Mycoplasma virus (U.S. National Library of
Medicine, 2012). Next, rashes or blisters begin to appear which may spread
quickly throughout the body in places such as the eyes, genital areas, and
mouth (Skin Association, n.d.). These are typically itchy or painful to the
person and may cause chronic discomfort. Typically, less than 10 percent of the
skin is affected by Stevens-Johnson Syndrome; anything more than 10 percent is
considered Toxic Epidermal Necrolysis (Butt & Cox & Lewis & Ferner,
2011). After the second stage, shedding of the skin’s top layer occurs and then
a burn-like appearance manifests (RelayHealth, 2013).
The most common cause of Stevens-Johnson
Syndrome (SJS) is by an allergic reaction towards a drug or medicine. Here is
an incomplete list of some drugs that have been linked to SJS: anticonvulsants
(seizure-treating drugs), non-steroid anti-inflammatory drugs (NSAIDS),
anti-microbial drugs (penicillin), and barbiturates all have appeared in
several cases of people with SJS (Barvaliya, 2011).
Clinical Manifestation
A patient with Stevens-Johnson Syndrome
(SJS) can be identified by some physical features such as dry or inflamed eyes,
and sores in the mouth or tongue (U.S. National Library of Medicine, 2012). The
patient tends to feel itchy and overall ill due to the flu-like symptoms and
skin lesions (U.S. National Library of Medicine, 2012). Because of the abnormalities
in their mouth, some patients with SJS are hospitalized in order to supply them
with anti-inflammatory medicine, fluids, and essential nutrients through intravenous
(IV) therapy (RelayHealth, 2013). Also, arthralgia (pain in the joints) is
present within SJS patients because of the inflamed membranes, so it may feel
uncomfortable for them to be active for long periods of time (U.S. National
Library of Medicine, 2012).
Besides
the obvious physical changes, patients with Stevens-Johnson Syndrome (SJS) tend to form new opinions
towards health care workers. In a detailed study containing 14 SJS survivors,
researchers concluded that most patients developed a sense of distrust in
health care professionals or in medicines in general (Butt et al, 2011).
Additionally, the majority thought that SJS could have been avoided if health
care providers paid closer attention to the patients’ medical histories or list
of allergies (Butt et al, 2011).
The
most helpful diagnostic test that can help the health care provider find out if
the condition can be classified as Stevens-Johnson Syndrome (SJS) is through a
skin biopsy (skin sample). In this method, the health care professional numbs the
patient and takes a part of the skin to go get examined (RelayHealth, 2013). The health care professionals view the sample under
a microscope for certain features such as the detached epidermis and dermis. Additionally,
the physician may ask about the patient’s medical history and about what
medications they have taken recently.
Medical Management
The treatment for Stevens-Johnson Syndrome
(SJS) is usually not as simple. Health care providers need to simultaneously monitor
things such as controlling the condition itself, avoiding future infections,
and treating the underlying causes (U.S. National Library of Medicine, 2012). To
treat SJS, the doctor may prescribe an antihistamine to control the itching
sensations; the doctor may also give antiviral medicine if the condition is
caused by a virus (e.g. Herpes); additionally, corticosteroids help regulate
the inflammation (National Library of Medicine, 2012). However, some side effects
of steroids are gastrointestinal ulcers, osteoporosis, and abnormal response to
physical stimuli (Fields, 2009). If the condition is caused by a medicine, then
the doctor may ask the patient to stop taking it (RelayHealth, 2013). If
necessary, the patient can be treated in an intensive care unit for serious symptoms
of SJS such as eye damage and skin necrosis. (National Library of Medicine,
2012).
Conclusion
Stevens-Johnson Syndrome (SJS) is a
complex condition that is treated differently within patients. While it is not common,
SJS has severe symptoms that make a lasting impression on those whom survive
the condition. SJS may begin as a simple rash or blister, but if left unchecked,
it could result in death. SJS is an unpredictable condition that can be caused
by an allergic reaction to a medication or virus (National Library of Medicine,
2012). It is beneficial to investigate the common drugs associated with SJS. If
the SJS symptoms ever appear while taking one of those specific drugs, then it
could help make it easier to seek assistance from a health care provider while
explaining that the condition could possibly be Stevens-Johnson Syndrome.
References
Barvaliya, M. M.,
Sanmukhani, J. J., Patel, T. T., Paliwal, N. N., Shah, H. H., & Tripathi,
C. C. (2011). Drug-induced Stevens-Johnson syndrome (SJS), toxic epidermal
necrolysis (TEN), and SJS-TEN overlap: A multicentric retrospective study. Journal
Of Postgraduate Medicine, 57(2), 115-119.
Butt, T. F., Cox, A.
R., Lewis, H., & Ferner, R. E. (2011). Patient Experiences of Serious
Adverse Drug Reactions and Their Attitudes to Medicines. Drug Safety, 34(4),
319-328.
Fields, T. (2009,
July 17). Steroid Side Effects: How to
Reduce Corticosteroid
Side Effects. Retrieved April 8, 2014 from http://www.hss.edu/conditions_steroid-side-effects-how-to-
reduce-corticosteroid-side-effects.asp
Iannelli, V. (2013, September 26). Stevens-Johnson
Syndrome: Stevens-Johnson Syndrome Symptoms and Treatments. Retrieved April
7, 2014 from http://pediatrics.about.com/od/diseasesandconditions/a/610_ _johnson_syndrome.htm
Mayo Clinic Staff (2011, April 09). Definition
of Stevens-Johnson syndrome. Retrieved on March 27, 2014.
RelayHealth (2013). Erythema Multiforme
and Stevens-Johnson Syndrome. Retrieved on March 27, 2014.
Skin Association (n.d.). What is Stevens
Johnson Syndrome?. Retrieved on March 27, 2014.
U.S. National Library of Medicine (2012, November 20). Erythema Multiforme. Retrieved on March 27, 2014.
Labels: Nursing Fundamentals