THE CLIENT WITH BURNS
In cases of serious burns, the loss of skin surface leads to enormous losses of fluids, electrolytes, and proteins. Water moves from other tissues to the burn site in an effort to compensate for the loss, but this only compounds the problem. This fluid loss can reduce the blood volume and thus blood pressure, as well as urine output.
Fluids and electrolytes are replaced by intravenous therapy immediately to prevent shock. Glucose is not included in these fluids for the first 2 or 3 days after the burn because it could cause hyperglycemia.
The hypermetabolic state after a serious burn continues until the skin is largely healed, so there is an enormous increase in energy needed for the healing process. Calorie requirements are based on weight (size) and the total burned surface, including depth of burns. Protein needs can be as high as 1.5 to 3.0 or more grams per kilogram of weight, and fat intake, 15% to 20% of nonprotein calories. A high-protein, high-calorie diet is used. There is an increased need for vitamin C and zinc for healing and B vitamins for the metabolism of the extra nutrients. Vitamin A is important for the immune system and the epithelial tissues.
Also, it is essential that severely burned clients have sufficient fluids to help the kidneys hold the unusual load of wastes in solution and to replace those lost.
If the client is able to eat, oral feedings are advisable. Liquid commercial formulas may be used at first, and solid food may be added during the second week after the burn. If the client is unable to eat, tube feedings should be started imme-diately. In some cases, parenteral feeding is required. The foods served should be those the client likes and is willing to eat. To determine this, a registered dietitian must perform an individualized assessment for each burn victim. The best assess-ment of the adequacy of the nutrients provided is wound healing.
Burn clients need a great deal of encouragement. They are in pain; are worried about disfigurement; and know they face a long, costly, and painful hospital stay with the possibility of surgery.