1www.ee.usp.br/reeusp Rev Esc Enferm USP · 2019;53:e03501
Izabela Linha Secco1
Taine Costa2
Etiene Letícia Leone de Moraes3
Márcia Helena de Souza Freire3
Mitzy Tannia Reichembach Danski3
Daniele Alaide de Siqueira Oliveira4
1
Universidade Federal do Paraná, Programa
de Pós-Graduação em Saúde da Criança
e do Adolescente, Curitiba, PR, Brazil.
2
Universidade de São Paulo, Escola de
Enfermagem/Escola de Enfermagem de Ribeirão
Preto, Programa Interunidades de Doutoramento
em Enfermagem, Ribeirão Preto, SP, Brazil.
3
Universidade Federal do Paraná,
Programa de Pós-Graduação em
Enfermagem, Curitiba, PR, Brazil.
4
Hospital Infantil Waldemar Monastier,
Campo Largo, PR, Brazil.
ABSTRACT
Objective: To describe a case of epidermolysis bullosa occurring in a children’s hospital
in the South of Brazil, evidencing the nursing care provided to this newborn diagnosed
with this pathology. Method: A case study with data collection from medical records,
approved by the Institution and by the Research Ethics Committee with Human Beings.
Results: After the diagnostic confirmation, a specific care plan was established for the
newborn, encompassing basic human needs to the clinical treatment of the disease.
Conclusion: The neonate was discharged with shorter hospitalization time and with total
epithelization of the lesions, despite the severity. The family actively participated in the
care process, demonstrating the ability to perform the dressings at home.
DESCRIPTORS
Infant, Newborn; Epidermolisys Bullosa; Critical Care Nursing; Neonatal Nursing;
Bandages; Patient Care Planning.
Nursing care of a newborn with epidermolysis bullosa: a case report
Cuidados de enfermagem a neonato com epidermólise bolhosa: relato de caso
Cuidados enfermeros al neonato con epidermólisis bullosa: relato de caso
How to cite this article:
Secco IL, Costa T, Moraes ELL, Freire MHS, Danski MTR, Oliveira DAS. Nursing care of a newborn with epidermolysis bullosa: a case report. Rev Esc
Enferm USP. 2019;53:e03501. DOI: http://dx.doi.org/10.1590/S1980-220X2018023603501
Received: 06/08/2018
Approved: 02/21/2019
Corresponding author:
Izabela Linha Secco
Rua XV de Novembro, 3701, Bom Jesus
CEP 83601-030 – Campo Largo, PR, Brazil
izabelasecco_enf_@hotmail.com
PROFESSIONAL EXPERIENCE REPORT DOI: http://dx.doi.org/10.1590/S1980-220X2018023603501
2 www.ee.usp.br/reeusp
Nursing care of a newborn with epidermolysis bullosa: a case report
Rev Esc Enferm USP · 2019;53:e03501
INTRODUCTION
Epidermolysis bullosa (EB) is a group of phenotypically
different, hereditary or acquired genodermatoses characterized
by skin fragility and subsequent blistering in response
to mechanical trauma, which can also affect the mucous
membranes. Due to the severe forms of the disease and its
high risk of infection, the neonatal mortality rate is high(1)
.
EB can be classified into four main types based on the
histopathological finding of the blisters: simple, junctional,
dystrophic and Kindler. In the first three forms, the tissue
separation occurs at the intraepidermal, lamina lucida and
dense lamina level,respectively.Kindler’s syndrome is a mixed
type with multiple cleavage planes. The different degrees of
vulnerability of the skin are caused by mutations in structural
proteins involved in adhesion of the basal membrane zone(2)
.
The management of EB lesions is a challenge within
Medicine due to the complexity and variety of its manifestations.
In addition, the dressing choice should be made
according to the characteristics of the lesions, classified as
dry or very exudative, colonized and infected, evaluating
pruritus and pain, in addition to hypergranulated areas(3)
.
The objective of this paper is to report a case of a newborn
(NB) with EB which occurred in a children’s hospital
in the southern region of Brazil,evidencing the nursing care
provided to a neonate diagnosed with this pathology.
METHOD
Study design
The methodology adopted for developing this study was
a case report,considered as an important source of information
which can provide fundamental subsidies for the best
treatment of patients in certain situations.The communication
of these reports is pertinent when the diagnosed entity
is rare, the treatment is pioneering or has some innovation,
or the result is unusual(4)
.
Scenario
The present study was carried out in a children’s hospital in
the metropolitan region of Curitiba,equipped to attend children
between 0 and 18 years of age.This hospital has surgical
and clinical hospitalization units, a Neonatal Intensive Care
Unit (NICU), a Pediatric Intensive Care Unit (PICU), and
Surgical Center (SC),laboratory,breast milk collection room,
imaging center and outpatient clinic of medical specializations.
Hospitalization of the NB occurred in the NICU type
III, which has 20 active beds, receives patients from the
entire state of Paraná, and has a multidisciplinary team
composed of nurses, nursing technicians, physicians, physiotherapists,
speech therapists, social work and psychology
to provide comprehensive care.
Selection criteria
The NB in question was chosen for the present study for
having a medical diagnosis of EB and being hospitalized in
the NICU in the year 2017.
Data collection
Data were collected from the patient’s medical file
between February and April 2018.
Data analysis and treatment
The data analysis occurred in a descriptive way through
photos and information obtained from the patient’s
medical file.
Ethical aspects
This project was approved by the Ethics Committee
of the Worker Hospital of Curitiba, under the opinion
number 1.698.784/16, respecting the ethical precepts of
Resolution 466 of 2012(5)
. The research was approved by
the Clinical Board and the Teaching and Research Center
of the referred hospital and disclosure of the images was
authorized by the parents through signing the Informed
Consent Form (ICF).
RESULTS
Case report
Mother 28 years old, second pregnancy and second
birth, seven prenatal consultations, O+
blood type,
non-reactive VDRL (Venereal Disease Research Laboratory)
and HIV, immune to toxoplasmosis. No complications
during pregnancy.
Patient NNBOH, born on April 1, 2017, at 15:27,
male, Parkin 38 weeks, cesarean delivery, weighing 3.280
kg, Apgar 9/10, in good general condition, but skin blisters
were observed at birth, some with bullous areas and others
devoid of epidermis. The patient was diagnosed with EB,
referred to joint accommodation, remained hospitalized
until April 4, 2017, and on those three days he underwent
umbilical venous catheterization for analgesia and hydroelectrolytic
replacement, but he evolved with clinical worsening
of the lesions, as they became more exudative with
increased extension, depth and quantity. In addition, there
was refusal of oral feeding due to lesions on the gums,
palate and lip mucosa. Due to the difficulty of managing
the newborn at the hospital of origin, a vacancy was requested
by the Bed Central of Paraná to the NICU of the
children’s hospital, and the NB was admitted on April 4,
2017, at 4:30 p.m.
During the hospitalization period, the following medical
diagnoses were presented: term newborn, suitable for
gestational age, EB, and late sepsis by coagulase-negative
staphylococci (CoNS).
Once admitted, he was put in a warm crib with electrolyte
replacement by the umbilical venous catheter, as
well as pain control by continuous Fentanyl. As there was
worsening of bullous lesions and the initial appearance of
areas with blisters,the care nurses opted for simple coverage
with sterile vaseline (Rayon) gauze soaked in essential fatty
acids (EFAs).
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Secco IL, Costa T, Moraes ELL, Freire MHS, Danski MTR, Oliveira DAS
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After 24 hours of hospitalization, the umbilical venous
catheter had overflowed flush solution and continuous
pump infusion, requiring a discussion regarding a new
central venous catheter (CVC). As predicted in the literature,
it was agreed to insert a CVC in the cephalic region,
since it was the site with the most preserved epidermis.
Therefore, a French caliber 1 peripherally inserted central
catheter was inserted into the right temple, remaining until
the end of the intravenous therapy (withdrawn on May 3rd
).
Peripheral blood cultures were collected on April 14 and
18 and CoNS was positive, considered late sepsis related
to the use of CVC. However, this was maintained for the
Vancomycin treatment for 12 days, since it was the only
venous access available, and there were lesions around it,
which could induce colonization and infection of the intravenous
device.
Due to the involvement of the oral mucosa and esophagus
pathology, the newborn had low oral acceptance of the
diet, requiring nasoenteral catheterization.The patient was
followed up by a speech therapist daily, who replaced the
silicone orthodontic nozzle with latex,aiming at malleability
for suction and milk extraction.
The standardized Neonatal Infant Pain Scale (NIPS)
was applied at the institution to the NB, and scores indicative
of pain were measured between four and seven. Due to
the large extent of the affected epidermis, the NB’s crying
was vigorous both at rest and in handling, and his facial
expression was always contracted.His upper and lower limbs
remained uninterruptedly contracted and always uncomfortable
in a state of consciousness. The NB did not require
ventilatory support during the hospitalization period because
his breathing scored the least due to having minimal respiratory
distress.
Due to the characterization of pain, analgesia needed
to be optimized to offer comfort to the child.
Paracetamol and Codeine were then associated with
intermittent Fentanyl, even with intravenous Dipirone
support, if necessary. Ketamine was also specifically administered
for changing the NB’s dressings at bedside. As
days passed and according to the NB’s drug tolerance,
it was necessary to suspend Fentanyl and Paracetamol,
to maintain Codeine and to associate it with Morphine.
Oxcarbazepine was also associated according to the
neurologist’s guidance.
Under the guidance of a stomal therapist, care nurses
replaced the lesion dressings with EFA by more technological
dressings available at the Unified Health System.
Such dressings are considered special because they are
self-adhesive and decrease pain in the lesion as they are
composed of soft silicone and stimulate healing by maintaining
the ideal moisture environment, in addition to
being atraumatic.
The dressings were performed at bedside in the first
days every 48 hours, with previous sedation and analgesia,
fulfilling the protocols of maximum sterility. However, it
was observed that the procedure was intensely painful,
and it was not possible to increase analgesia due to risk
of cardiorespiratory arrest, since the newborn was in open
air and any need for orotracheal intubation would cause
serious damage to the mucous membranes by fixing the
device to the skin and from the friction of the cannula on
the gums, palate and oral mucosa. Also, the strict antisepsis
standards were not being met because the child
had extreme psychomotor agitation from pain, and the
primary dressing was difficult to keep on the lesions.
This situation referred to a minimum procedure time of
2 hours.
Therefore, after discussions with the multidisciplinary
team, the dressings began to be performed in the SC under
inhalation anesthesia starting on April 12th
, offering the
maximum comfort for the patient. The procedure time
decreased to 30 minutes, and the dressings remained for
more days, thus enabling weekly changes.
The lesions during the first dressing change in the
SC were superficial on the face, neck, thorax and abdomen,
presenting granulation tissue in 90% of the affected
areas, and the remaining 10% had crusts, in addition to
a medium level of serosanguineous exudate. In the facial
region, a perforated polyurethane screen with a silicone
layer was applied for aid and protection in fixing the medical
devices such as the nasoenteral catheter. The thoracoabdominal
region was covered with a thin polyurethane
foam in order to stimulate healing and protect against local
physical trauma. A tubular mesh was used as a secondary
cover, which is composed of an elastic tissue which enables
attaching the primary dressing to the lesions without
causing traumas by adhesion, dispensing bandages and
adhesive tapes.
However,lesions in the upper and lower limbs were more
severe.Some were bullous with hemorrhagic content,others
were already ruptured with deep dermal involvement, the
presence of a moderate level of purulent exudate,areas with
adhered crusts and abundant bleeding.
The initial action was rupturing the blisters with a
13 x 0.45 mm needle and draining its contents, cleaning
the area with warmed 0.9% saline solution and applying
exudate transfer foam with silicone. Care was also taken to
separate the fingers and toes with the same dressing to avoid
synechiae,a very common event in this pathology.This step
was also completed using tubular mesh.
Source: The authors.
Figure 1 – Coagulation necrosis in the right inner limb.
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Nursing care of a newborn with epidermolysis bullosa: a case report
Rev Esc Enferm USP · 2019;53:e03501
Source: The authors.
Figure 2 – Exudative lesions on lower limbs.
In continuing the topical use of these materials,debridement
was indispensable in some lesions due to the involvement of
coagulation necrosis and hyperkeratosis regions.Hydrogel was
applied for the gradual withdrawal of the most adhered necrotic
contents,and mechanical removal was performed for the lesions
with partial or advanced detachment of the dead tissue.
A gradual improvement of the lesions was observed
during the weekly changes, and the dressings were again
performed at the bedside starting from April 27th
. There
were already epithelialized areas in the thorax and abdomen
at this stage of treatment, and decreased depth in the upper
and lower limb lesions, as well as epithelialized areas.
The last dressing change in the NICU occurred on May 3rd
,
with significant epithelialization in 90% of the lesions on the
hands,60% on the feet and absence of new hemorrhagic blisters.Thus,
the infant was discharged to the clinical ward after
32 days of hospitalization in the NICU,with referrals to Baby
Risk Offices, Dermatology, Orthopedics and Physiotherapy,
and being administered Codeine and Oxcarbazepine. He is
currently attending outpatient clinics once a month.
Source: The authors.
Figure 3 – Surgical debridement in the lower left limb.
Source: The authors.
Figure 4 – Complete epithelization of the lesion in the lower
left limb.
The NB’s family was empowered and inserted in all care
phases throughout the treatment, including during bedside
dressings, with access to the lesion pictures and to the
comparisons of weekly improvement.The mother was able
to perform all the necessary care that EB demands upon
hospital discharge, including changing the dressings with
the help of the father. The stomal therapist who followed
the case was present at the family home in the first two
weeks of discharge, assisting and advising the parents to
perform the dressings so that they would feel more secure
to do so.
Source: The authors.
Figure 5 – Performance of the dressing by the mother at home.
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Secco IL, Costa T, Moraes ELL, Freire MHS, Danski MTR, Oliveira DAS
www.ee.usp.br/reeusp Rev Esc Enferm USP · 2019;53:e03501
Nursing diagnoses and prescriptions for EB
In view of the severity of the pathology and the risk
of death, it was fundamental to build a systematized work
process so that the NB was provided care for all its needs.
Thus, the Nursing Diagnoses according to the North
American Nursing Diagnosis Association (NANDA)(6)
, as
well as the interventions prescribed to the NB and his family
are presented below.
Domain 2 – Nutrition
– Diagnosis: Ineffective infant feeding pattern.
Definition: an infant’s impaired ability to suck or coordinate
the sucking/swallowing response,resulting in inadequate
oral nutrition for metabolic needs.
Defining characteristic: inability to maintain effective
suction.
Related factor: Oral Hypersensitivity.
Nursing prescriptions: perform enteral catheterization;
administer the diet according to medical prescription
and monitor oral diet acceptance and tolerance to enteral
volume progression.
– Diagnosis: impaired deglutition.
Definition: abnormal functioning of the swallowing
mechanism associated with a deficit in oral, pharyngeal or
esophageal structure or function.
Defining characteristics: ineffective sucking, difficulty
swallowing.
Related factor: Oropharyngeal abnormalities.
Nursing prescriptions: administer an oral diet in proclivity
and observe swallowing and mouth emptying.
– Diagnosis: unstable glycemic risk.
Definition: vulnerability to fluctuating glucose/blood
sugar levels relative to normal variation, which may compromise
health.
Risk factors: excessive stress, insufficient food intake.
Nursing prescriptions: monitor diet acceptance and avoid
stressful situations to the NB.
– Diagnosis: risk of electrolyte imbalance.
Definition: vulnerability to changes in serum electrolyte
levels which could compromise health.
Risk factor: insufficient liquid volume.
Nursing prescriptions: administering prescribed supplemental
electrolytes; perform a rigorous water balance;
monitor electrocardiogram tracings and report episodes of
nausea, emesis and diarrhea.
– Diagnosis: risk of unbalanced liquid volume.
Definition: vulnerability to the decrease, increase or
rapid change from one location to another of intravascular,
interstitial and/or intracellular fluid,which may compromise
health. It refers to the loss, gain, or both, of bodily fluids.
Risk factor: burn and sepsis.
Nursing prescriptions: monitor acceptance of diet;
monitor weight, body temperature, volume and urine
concentration; perform rigorous water balance and consider
additional losses associated with vomiting, diarrhea
and hyperthermia.
– Diagnosis: risk for constipation.
Definition: vulnerability to a decrease in the normal
frequency of evacuation, accompanied by difficulty to eliminate
feces or incomplete feces elimination, which may
compromise health.
Risk factors: electrolyte imbalance, pharmacological
agents.
Nursing prescriptions: monitor intestinal eliminations:
frequency, consistency, shape, volume and color; monitor
signs of constipation and identify factors which may contribute
to constipation.
Domain 4 – Activity/Rest
– Diagnosis: impaired sleep pattern.
Definition: interruptions, limited by time, amount and
quality of sleep, due to external factors.
Defining characteristics: change in sleep pattern and
unintentional arousal.
Related factors: environmental barrier (noise,luminosity,
temperature), non-restorative sleep pattern.
– Diagnosis: sleep deprivation.
Definition: prolonged periods without sleep (sustained
natural and periodic suspension of relative consciousness).
Defining characteristics: agitation, irritability, increased
sensitivity to pain.
Related factors: overly stimulating environment, prolonged
discomfort.
– Diagnosis: impaired comfort.
Definition: perception of a lack of comfort, relief and/or
transcendence in the physical, psychospiritual, environmental,
cultural and/or social dimensions.
Defining characteristics: change in the sleep pattern,
crying, restlessness, irritability.
Related factors: harmful environmental stimuli.
The nursing prescriptions for the three diagnoses above
were: perform restricted and block handling; perform environmental
control: reduce noise and lighting; record the
sleep pattern of the newborn, the quality and quantity of
sleeping hours and administer analgesia according to medical
prescription and the pain scale.
– Diagnosis: impaired mobility in the bed.
Definition: movement limitation from one position to
another in the bed.
Defining characteristics: Impaired ability to turn from
side to side.
Related factors: pain, musculoskeletal impairment.
Nursing prescription: change in decubitus every 4 hours.
– Diagnosis: ineffective respiratory pattern.
Definition: inspiration and/or expiration that does not
provide adequate ventilation.
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Nursing care of a newborn with epidermolysis bullosa: a case report
Rev Esc Enferm USP · 2019;53:e03501
Defining characteristics: nostrils flaring, abnormal respiratory
pattern (frequency, rhythm and depth).
Related factors: pain.
Nursing prescription: avoiding painful stimuli and stressor
factors.
Domain 7 – Roles and relationships
– Diagnosis: impaired paternity or motherhood.
Definition: inability of the primary caregiver to create,
maintain or recover an environment that promotes optimal
growth and development of the child.
Defining characteristics: inadequate skills for care, perceived
incapacity to satisfy the needs of the child.
Related factor: poor knowledge about child health
maintenance.
Nursing prescriptions: insert the parents into all phases
of the care process; offer psychological counseling and
encourage parents to cope with the disease.
– Diagnosis: caregiver role stress.
Definition: difficulty to perform the role of family caregiver/significant
persons.
Defining characteristics: anxiety as to the future ability
to provide care, worry about the future health of the
care recipient.
Related factors: increased need for care, chronic illness,
unpredictability of illness course, recent hospital discharge,
care responsibilities 24 hours a day.
Nursing prescriptions: enable caregivers to change
dressings at home and schedule future follow-ups at the
institution’s outpatient clinics.
Domain 9 – Coping/stress tolerance
– Diagnosis: disorganized behavior of the infant.
Definition: fragmented physiological and neurobehavioral
responses of an infant to environmental stimuli.
Defining characteristics: impaired reaction to sensory
stimuli (difficulty to calm down), restlessness, exaggerated
reactions of fright,irritability,irritable crying,active arousal.
Related factors: excessive environmental stimulation,
pain, impaired motor function, invasive procedures.
Nursing prescriptions: perform non-pharmacological
interventions to calm the newborn; perform care with gentle
movements and decrease sensory stimulation.
Domain 11 – Safety/protection
– Diagnosis: risk for infection.
Definition: vulnerability to invasion and multiplication
of pathogenic organisms, which can compromise health.
Risk factors: invasive procedures,change in skin integrity.
Nursing prescriptions: keep headboard elevated by
30 degrees; monitor the validity of invasive devices; perform
the exchange of valid invasive devices and handle the CVC
with aseptic technique.
– Diagnosis: risk for aspiration.
Definition: vulnerability to the entry of gastrointestinal,
oropharyngeal,solid or liquid secretions in the tracheobronchial
tract, which may compromise health.
Risk factors: enteral feeding,impaired swallowing ability,
presence of oral/nasal catheter.
Nursing prescriptions: administer the diet with the
head high; confirm enteral catheter placement before
administering the diet and observe swallowing and
mouth emptying.
– Diagnosis: risk for shock.
Definition: vulnerability to inadequate blood flow to the
tissues of the body which can lead to life-threatening cellular
dysfunction, which may compromise health.
Risk factors: hypovolemia, infection, sepsis.
Nursing prescriptions: recognize clinical signs and symptoms
of infection; monitor vital signs,level of consciousness
and urinary elimination, and monitor water status.
– Diagnosis: impaired skin integrity.
Definition: altered epidermis and/or dermis.
Defining characteristic: change in skin integrity.
Related factors: mechanical factor (shear forces, pressure,
physical immobility), change in fluid volume, inadequate
nutrition.
Nursing prescriptions: perform rotation of the oximetry
sensor positioning sites; perform dressings on the injured
areas with appropriate topical medication; observe signs and
symptoms of infection; moisturize whole skin with specific
emulsion; maintain special silicone-based dressings under
the catheter attachment and observe new lesions.
– Diagnosis: impaired oral mucosa.
Definition: lesions on the lips, soft tissues, oral cavity
and/or oropharynx.
Defining characteristics: impaired ability to swallow,
mucosal detachment, oral pain, oral lesion, bleeding.
Related factors: mechanical factor (gastric catheter),
infection.
Nursing prescriptions: inspect the mouth for lesions,
inflammation or excessive bleeding; observe vomiting episode;
report oral diet refusal; monitor difficulty in swallowing
and administer diet via nasoenteral catheter.
Domain 12 – Comfort
– Diagnosis: acute pain
Definition: unpleasant sensory and emotional experience
associated with actual or potential tissue injury or described
in terms of such injury; sudden or slow onset of mild to
severe intensity, with an anticipated or predicted end.
Defining characteristics: expressive behavior (agitation,
crying,restlessness),evidence of pain using the standardized
checklist of non-verbal pain indicators (NIPS).
Related factors: biological injury agent (infection),physical
injury agent (burn).
Nursing prescriptions: apply pain scale every four hours;
assess pain regarding location,frequency,intensity,duration
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Secco IL, Costa T, Moraes ELL, Freire MHS, Danski MTR, Oliveira DAS
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RESUMO
Objetivo: Descrever um caso de epidermólise bolhosa ocorrido em um hospital infantil do Sul do Brasil, evidenciando o cuidado
de enfermagem ao recém-nascido diagnosticado com essa patologia. Método: Estudo de caso com coleta de dados em prontuário,
aprovado pela Instituição e pelo Comitê de Ética em Pesquisa com Seres Humanos. Resultados: Depois da confirmação diagnóstica,
foi estabelecido um plano de cuidados específicos para o recém-nascido, que englobou desde as suas necessidades humanas básicas até
o tratamento clínico da doença. Conclusão: O neonato recebeu alta hospitalar com tempo de internação menor que o esperado e com
epitelização total das lesões, apesar da gravidade. A família participou ativamente do processo de cuidado, demonstrando aptidão para
realizar os curativos em domicílio.
DESCRITORES
Recém-Nascido; Epidermólise Bolhosa; Enfermagem de Cuidados Críticos; Enfermagem Neonatal; Bandagens; Plano de Assistência
ao Paciente.
RESUMEN
Objetivo: Describir un caso de epidermólisis bullosa ocurrido en un hospital infantil del Sur de Brasil, evidenciando el cuidado enfermero
al recién nacido diagnosticado con dicha patología. Método: Estudio de caso con recolección de datos en ficha, aprobado por el Centro y
el Comité de Ética en Investigación con Seres Humanos. Resultados: Después de la confirmación diagnóstica, fue establecido un plan de
cuidados específicos para el recién nacido,el que abarcó desde sus necesidades humanas básicas hasta el tratamiento clínico de la enfermedad.
Conclusión: El neonato recibió alta hospitalaria con tiempo de estancia menor que lo esperado y con epitelización total de las lesiones, pese
a la severidad. La familia participó activamente en el proceso de cuidado, demostrando aptitud para realizar los apósitos en domicilio.
DESCRIPTORES
Recién Nacido; Epidermólisis Ampollosa; Enfermería de Cuidados Críticos; Enfermería Neonatal; Vendajes; Planificación de Atención
al Paciente.
REFERENCES
1.	 Sousa MCS, Paula CDR, Tauil PL, Costa IMC. Correlation between nutritional, hematological and infectious characteristics and classification
of the type of epidermolysis bullosa of patients assisted at the Dermatology Clinic of the Hospital Universitário de Brasília. An Bras
Dermatol [Internet]. 2015 [cited 2018 June 06]; 90(6):922-4. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0365-
05962015000600922&Ing=en
2.	 Floriani MA, Bau AEK, Silva RP, Graziadio C, Dorfman LE, Zen TD, et al. Applications of electron microscopy in health: the example of
epidermolysis bullosa. J Bras Patol Med Lab [Internet]. 2017 [cited 2018 June 6];53(1):65-7. Available from: http://www.scielo.br/scielo.
php?script=sci_arttext&pid=S1676-24442017000100065&Ing=pt
and quality; monitor non-verbal pain indicators and monitor
the level of discomfort.
DISCUSSION
Being considered a specific Nursing tool, the
Systematization of Nursing Care (SNC) is a scientific and
methodological tool which assures the quality and planning
of care management,since it enables the intervention which
the patient needs to be individualized, leading to the best
implementation method(7-8)
.
Despite being divided into phases, “SNC application
involves more than a sequence of steps to be followed,requiring
the professional to be more familiar with the nursing
diagnoses and sensitivity to adapt the client’s needs to the
working conditions, making them less simple than the theory
suggests”(9)
. Benefits are observed from implementing
the nursing process, given the enabling of comprehensive
care, exchanges of experiences, and knowledge expansion,
thus facilitating the work(10)
.
This was observed in the case report herein, since the
care management facilitated and provided individuality in
the nursing care to the NB,contributing to a decrease in the
length of stay and allowing the parents to continue the care
at home. For the multidisciplinary team, providing care to
this NB allowed a search for scientific knowledge so that
adequate care could be taken,a challenge could be overcome,
and an experience gained for future cases to be admitted to
the institution.
Implementing the nursing diagnosis steps and prescription
require nurses to have deep knowledge of their patients,
in addition to a vast domain on the pathophysiology of
numerous clinical conditions. In this way, it is imperative
that this professional is undergoing continuous improvement
so that the care provided reaches a level of excellence.
The main limitation of this study was the lack of a theoretical
reference involving good care practices in neonatal
EB with regard to the specific treatment of the lesions.
This case report aims to help nursing professionals
during the care stages of EB so that it is holistic,timely and
evidence-based, considering that the scientific publications
on the subject are limited.
CONCLUSION
Because of its singularity, EB requires specific and qualified
care from the entire interdisciplinary team, aiming at
patient survival. On the other hand, managing the lesions
becomes a difference maker in the treatment when the nurse
is scientifically and technically able to intervene through practice,
leading the technical staff to provide the best care and
enabling the family members for the patient’s discharge.
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Nursing care of a newborn with epidermolysis bullosa: a case report
Rev Esc Enferm USP · 2019;53:e03501
This is an open-access article distributed under the terms of the Creative Commons Attribution License.
3.	 Corrêa FB, Coltro PS, Junior JAF. General treatment and wound management in hereditary epidermolysis bullosa: indication and experience
using silver hydrofiber dressing. Rev Bras Cir Plast [Internet]. 2016 [cited 2018 Feb 17];31(4):565-72. Available from: http://www.dx.doi.
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