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Minimizes negative effectsMeeting daily caloric requirements is crucial.Caloric needs should be calculated by dietitian. High-protein, high-carbohydrate foodsFavorite foods from homePatients should be weighed regularly. Weight loss should not be >10% of pre burn weight Hypermetabolic stateResting 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 PhaseThe 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 systemIdentification of and prevention of complicationsInfection/sepsisAssess for systemic and local infection (Table 26-5)Meticulous handwashing by all-Table 26-5
-**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 ManifestationsPartial-thickness wounds form eschar.Once eschar is removed, re-epithelialization begins.Full-thickness wounds require debridement.Acute Phase: ComplicationsInfectionLocalized inflammation, induration, and suppurationPartial-thickness burns can become full-thickness wounds in the presence of infection. Wound infection may progress to transient bacteremiaCan cause grafts not to be attached like they are supposed to be Patient may develop sepsis.Condition becomes critical.Musculoskeletal systemDecreased ROMContracturesGastrointestinal systemParalytic ileusDiarrheaMeds High rates of feeds ConstipationHigh doses of opiatesCurling’s ulcerStress ulcersEvery patient in ICU at risk– give PPIs to prevent Acute Phase: Nursing and Collaborative ManagementPain managementPatients experience two kinds of pain.Continuous background painTreatment-induced painSeveral drugs in combinationMorphine with haloperidolTreatment-induced pain managed with potent, short-acting analgesiaNonpharmacologic strategiesRelaxation strategiesVisualization, guided imageryHypnosisBiofeedbackMusic therapyPhysical and occupational therapyGood time for exercise is during wound cleaning.Passive and active ROMSplints should be custom-fitted.