Minimizes negative effects Meeting daily caloric requirements is crucial

Minimizes negative effects meeting daily caloric

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Minimizes negative effects Meeting daily caloric requirements is crucial. Caloric needs should be calculated by dietitian. High-protein, high-carbohydrate foods Favorite foods from home Patients should be weighed regularly. Weight loss should not be >10% of pre burn weight Hypermetabolic state Resting metabolic expenditure may be increased by 50% to 100% above normal. Core temperature is elevated. Caloric needs are about 5000 kcal/day. Early, continuous enteral feeding promotes optimal conditions for wound healing. Supplemental vitamins and iron may be given based on labs Acute Phase The acute phase begins with the mobilization of extracellular fluid and subsequent diuresis. The acute phase is concluded when the burned area is completely covered by skin grafts, or when the wounds are healed. Begins 36-48hr after initial injury Acute Phase: Assessment Priority intervention of nurse is assessment of cardiopulmonary system Identification of and prevention of complications Infection/sepsis Assess for systemic and local infection (Table 26-5) Meticulous handwashing by all - Table 26-5
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- **infection is leading cause of death during acute phase of burns  meticulous hand washing!!!!!!!! - Prevent contractures with optimal positioning\ - May start to need psychosocial support at this time at they start to become aware of situation - Early excision grating  healing time and length of hospitalization decreased Acute Phase: Clinical Manifestations Partial-thickness wounds form eschar. Once eschar is removed, re-epithelialization begins. Full-thickness wounds require debridement. Acute Phase: Complications Infection Localized inflammation, induration, and suppuration Partial-thickness burns can become full-thickness wounds in the presence of infection. Wound infection may progress to transient bacteremia Can cause grafts not to be attached like they are supposed to be Patient may develop sepsis. Condition becomes critical. Musculoskeletal system Decreased ROM Contractures Gastrointestinal system Paralytic ileus Diarrhea Meds High rates of feeds Constipation High doses of opiates Curling’s ulcer Stress ulcers Every patient in ICU at risk– give PPIs to prevent Acute Phase: Nursing and Collaborative Management Pain management Patients experience two kinds of pain. Continuous background pain Treatment-induced pain Several drugs in combination Morphine with haloperidol Treatment-induced pain managed with potent, short-acting analgesia Nonpharmacologic strategies Relaxation strategies Visualization, guided imagery Hypnosis Biofeedback Music therapy Physical and occupational therapy Good time for exercise is during wound cleaning. Passive and active ROM Splints should be custom-fitted.
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