Medical Surgical Seizures #4

Question

A client takes lamotrigine for seizure control and comes to the clinic reporting muscle pain and fatigue. The nurse should complete a focused assessment on which of these priority findings that are present in Steven Johnson Syndrome (SLS)? Select all that apply.

Answers

  1. Reports of muscle pain
    • Rationale:

      This answer is correct because muscle pain is associated with Steven Johnson Syndrome (SJS). Additional symptoms include blisters on the neck and face, peeling skin, red-purple spots, fatigue, fever, sun sensitivity, sore throat, cough, itching, and dizziness. These symptoms should be reported immediately especially when taking medications associated with SJS because this condition is a medical emergency, with severe, life-threatening consequences. Treatment must be immediate and the condition may be fatal.

  2. Dizziness
    • Rationale:

      This answer is correct because dizziness is associated with Steven Johnson Syndrome (SJS). Additional symptoms include blisters on the neck and face, peeling skin, red-purple spots, fatigue, fever, sun sensitivity, sore throat, cough, muscle pain, and itching. These symptoms should be reported immediately, especially when taking medications associated with SJS because this condition is a medical emergency, with severe, life-threatening consequences.

  3. Splinter hemorrhages
    • Rationale:

      This answer is not correct because splinter hemorrhages are most related to underlying conditions of bacterial endocarditis, rheumatoid arthritis, malignancies, lupus, and diabetes. These dark red-brown lines seen in the nail grooves do not usually cause pain but are not related to SJS.

  4. Blisters on neck and face
    • Rationale:

      This answer is correct because dizziness is associated with Steven Johnson Syndrome (SJS). Additional symptoms include blisters on the neck and face, peeling skin, red-purple spots, fatigue, fever, sun sensitivity, sore throat, cough, muscle pain, and itching. These symptoms should be reported immediately, especially when taking medications associated with SJS because this condition is a medical emergency, with severe, life-threatening consequences.

  5. Loss of taste
    • Rationale:

      This answer is not correct because the upper respiratory illness may alter taste, but loss of taste is not a symptom of SJS.

Overview

Steven Johnson Syndrome (SJS) is a side effect of lamotrigine, an anti-seizure medication. SLS symptoms include reports of muscle pain, dizziness, and blisters on the neck and face.

Explanation

Learning Outcomes

Steven Johnson Syndrome (SJS) is a serious, yet rare, skin and mucous membrane disorder which is commonly associated with an infection or medication reaction. SJS is an inflammatory condition classified as an immune-complex-mediated hypersensitivity that is a variant of bullous erythema multiforme. Symptoms include: Skin symptoms: blisters on the neck and face, peeling skin, red-purple spots Whole body symptoms: fatigue, fever, muscle pain Other: sun sensitivity, sore throat, cough, itching, dizziness These symptoms should be reported immediately because SJS is a medical emergency, with severe, life-threatening consequences.

Test Taking Tip

Remember, just because something is rare, it does not mean it is insignificant. Research highly tested conditions and often rare, but life-threatening or unusual conditions or symptoms can surprisingly make “the list” of extremely tested subjects.

Video Rationale