microorganism growth. Visitors are screened to avoid exposure of the
immunocompromised patient to pathogens.
Patients can inadvertently promote migration of microorganisms from one burned area
to another by touching their wounds or dressings. Bed linens also can spread infection
through either colonization with wound microorganisms or fecal contamination.
Regular bathing of unburned areas and changing of linens can help prevent infection.
Maintaining Adequate Nutrition
Oral fluids should be initiated slowly after bowel sounds resume. The patient's
tolerance is recorded. If vomiting and distention do not occur, fluids may be increased
gradually and the patient may be advanced to a normal diet or to tube feedings.
The nurse collaborates with the dietitian or nutrition support team to plan a protein- and
calorie-rich diet that is acceptable to the patient. Family members may be encouraged
to bring nutritious and favorite foods to the hospital. Milkshakes and sandwiches made
with meat, peanut butter, and cheese may be offered as snacks between meals and late
in the evening. High-calorie nutritional supplements such as Ensure and Resource may
be provided. Caloric intake must be documented. Vitamin and mineral supplements
may be prescribed.
If caloric goals cannot be met by oral feeding, a feeding tube is inserted and used for
continuous or bolus feedings of specific formulas. The volume of residual gastric
secretions should be checked to ensure absorption. Parenteral nutrition may also be
required but should be used only if gastrointestinal function is compromised (see
Chapter 36).
The patient should be weighed each day and his or her weights graphed. The patient
can use this information to set goals for nutritional intake and to monitor weight loss
and gain. Ideally, the patient will lose no more than 5% of preburn weight if aggressive
nutritional management is implemented.
The patient with anorexia requires encouragement and support from the nurse to
increase food intake. The patient's surroundings should be as pleasant as possible at
mealtime. Catering to food preferences and offering high-protein, high-vitamin snacks
are ways of encouraging the patient to increase intake.
Promoting Skin Integrity
Wound care is usually the single most time-consuming element of burn care after the
emergent phase. The physician prescribes the desired topical antibacterial agents and
specific biologic, biosynthetic, or synthetic wound coverings and plans for surgical
excision and grafting. The nurse needs to make astute assessments of wound status, use
creative approaches to wound dressing, and support the patient during the emotionally
distressing and very painful experience of wound care.
The nurse serves as the coordinator of the complex aspects of wound care and dressing
changes for the patient. The nurse must be aware of the rationale and nursing
implications for the various wound management approaches. Nursing functions include
assessing and recording any changes or progress in wound healing and keeping all
members of the health care team informed of changes in the wound or in treatment. A
diagram, updated daily by the nurse responsible for the patient's care, helps inform all
those concerned about the latest wound care procedures in use for the patient.
The nurse also assists the patient and family by providing instruction, support, and
encouragement to take an active part in dressing changes and wound care when
appropriate. Discharge planning needs for wound care are anticipated early in the
course of burn management, and the strengths of the patient and family are assessed
and used in preparing for the patient's eventual discharge and home care.