Steven Johnson Syndrome treated on med/surg floor? advice on care?

[AlphaPig]

I work on a medsurg floor and we have a patient who has been in the hospital for two months with a long and complicated stay (sepsis, huge abscess, new on-set A-Fib, etc) and recently she had what appeared to be an allergic reaction to a medication (they think Cefepime) and it caused her to develop a red rash then all of her skin started to blister and slough off. She is in her 80's, very weak and lethargic, very sick. Huge stage 3 on her coccyx that had a wound vac but now they can't get one to adhere due to her skin sloughing off so we are doing BID WTD on that and BID silvadene on ABG pads all over her body with kerlex holding them on her arms and hands.

The pt is so lethargic and sometimes confused. Today her HR was elevated (140's) and her color was awful and I spoke to many doctors about moving her to a progressive care floor where she would get more attention but her vitals (except HR) were good and her labs were decent so no one would move her.

Her dressing changes take over an hour and are TERRIBLE for everyone involved (obviously worse of all for patient) She is incontinent of pasty stool which gets all over her skin and into her wounds which makes it even worse (she had a rectal tube for weeks which is now out)

She has a foley and ongoing UTIs

She is on an air-rotating mattress (thank god)

Her doctors deny it's SJS because her oral mucosa is not affected (yet anyway) but she does have small blisters around her mouth. IT SEEMS LIKE SJS TO ME.

The docs say to treat her like a burn pt, yet today I had to ask them for fluids and it just seems like no one knows what to do with the poor lady.

The BID dressing changes are just awful - isn't there a more effective wound tx than silvadene on ABG pads slapped onto her body?

Her hands have degloved completely and the pt screams and cries and refuses to be touched. Pt refuses morphine (!!)

Sorry so long and fragmented, I am tired from work. Just looking for thoughts on this pt thank you.

[MunoRN, RN]

I think the best treatment for what you describe is comfort care.