Guideline-based nursing strategy for toxic epidermal necrolysis in an elderly patient

Toxic epidermal necrolysis (TEN) is a rare, life-threatening mucocutaneous disorder, and its occurrence in elderly patients with compromised immunity and multiple comorbidities poses significant challenges to nursing care and prognosis. This paper summarizes the ICU nursing experience of an 84-year-old female patient with TEN presumably induced by parecoxib injection. The patient presented with 55% body surface area (BSA) skin involvement, combined with bedridden status due to fracture and electrolyte disturbances, with an expected mortality rate of 30–50%. An individualized nursing plan was formulated through multidisciplinary collaboration. Clinically, skin wound care was the cornerstone of management, incorporating refined, stage-specific interventions during the blister exudation, crusting, and healing phases, with yellow light irradiation and epidermal growth factor applied throughout all phases to promote wound healing. Targeted nursing measures were applied to vulnerable mucous membranes, particularly the oral cavity, eyes, and perianal region, including occlusive therapy and fecal diversion using ostomy bags to reduce local irritation. A midline catheter was prioritized, and an innovative adhesive-free dressing fixation strategy was adopted to ensure the safety of intravenous access. Full-process protective isolation and strict aseptic techniques were implemented to strengthen infection prevention and control. Meanwhile, medication nursing for immunomodulation, anti-inflammatory therapy, and symptomatic supportive care was delivered in accordance with the S3 Guideline: Diagnosis and Treatment of Epidermal Necrolysis (Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis) developed by the German Dermatological Society (Deutsche Dermatologische Gesellschaft, DDG). Following 17 days of systematic nursing care, the patient’s wounds achieved nearly complete epithelialization, with no new blisters or exudation observed. Infection markers were significantly reduced, and the patient was successfully transferred to a rehabilitation ward. Her recovery duration was shorter than the average for similar patients, and no severe ocular complications developed. This case demonstrates that a comprehensive nursing strategy incorporating staged wound care, multidimensional mucosal protection, individualized intravenous access management, and full-process infection control can effectively reduce complication risks, accelerate wound healing, and improve outcomes in elderly patients with severe TEN, providing a reference for clinical nursing practice in this vulnerable population.