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• Give half of the fluid volume calculated for the first 24 hours after burn injury in the first 8 hours postburn.
• Monitoring patient responses is critical to determine adequacy of hydration and tissue PERFUSION. • Urine output is the most common and most sensitive noninvasive assessment parameter for cardiac output and tissue PERFUSION. • Because burn patients can develop severe hypovolemic shock, monitor central venous pressure, pulmonary artery pressures, and cardiac output at least hourly, if not more frequently. Escharotomyis a surgical intervention for the treatment of a circumferential burn that causes inadequate tissue PERFUSION. • Use strict aseptic technique when caring for patients who have open burn wounds. • Explain all procedures to the patient.• Accurate assessment of the patient’s pain and COMFORT level is an essential part of pain management. • The priority nursing actions include continually assessing the patient’s pain level, using appropriate pain-reducing strategies, and preventing complications. • Drug therapy for pain usually requires opioid analgesics and non-opioid analgesics. • Although these drugs may provide adequate pain relief when no procedures are being performed, theyrarely offer more than moderate relief during painful procedures and can depress respiratory function and reduce intestinal motility. • Encourage the patient to actively participate in pain control measures, including nonpharmacologic interventions. Give prescribed opioid analgesics by the IV route during the emergent phase of burn recovery. • Notify the Rapid Response Team immediately if the patient with an inhalation injury becomes more breathless or audible wheezes disappear. • Patients with a burn injury are at risk for musculoskeletal and MOBILITY problems as a result of other injuries, immobility, healing processes, and treatment. • Coordinate with a registered dietitian to provide a high-calorie, high-protein diet to support the NUTRITIONAL needs of the patient with a burn. • Protein supplements, enteral tube feedings, and/or parenteral nutrition may be used to meet the patient’s nutrition needs if the patient’s caloric needs cannot be met otherwise. REHABILITATIVE PHASE OF BURN INJURY • Interventions focus on maintaining or achieving the patient’s preburn range of joint motion and MOBILITY, and preventing contracture formation. • Encourage the patient to look at and touch burned areas. • Allow patients time to grieve over a change in body image. • Position patients to prevent contractures and promote joint function. • Assist patients to ambulate several times each day as soon as the fluid shifts have resolved to maintain MOBILITY. • Encourage patients to use the prescribed splints and pressure garments to prevent joint immobility.