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Medical Nutrition Therapy For Burn Patients

Medical Nutrition Therapy For Burn Patients. Michael Moore Concordia College Moorhead, MN. Goals. Able to recognize the types of burns Able to calculate energy and protein needs of burn patients Understand the body’s response to burns Understand the nutritional support for burn patients.

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Medical Nutrition Therapy For Burn Patients

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  1. Medical Nutrition Therapy For Burn Patients Michael Moore Concordia College Moorhead, MN

  2. Goals • Able to recognize the types of burns • Able to calculate energy and protein needs of burn patients • Understand the body’s response to burns • Understand the nutritional support for burn patients

  3. Defining Burns • Bodily tissue injury resulting from exposure to heat, chemicals, electricity, or radiation • Marked by varying degrees of skin destruction http://www.merriam-webster.com/medlineplus/burns

  4. Epidemiology • More that 1.1 million victims per year • 4,500 fatalities per year • More than 50% of burn patients treated in specialized burn centers http://www.nih.gov/about/researchresultsforthepublic/BurnsandTraumaticInjury.pdf

  5. Classification of Burn Injuries • There are two ways to classify burns: • Depth of the wound • Percentage of the body surface area that is affected

  6. Classification of Burn Injuries There are four types of depths of the wounds • Superficial burn (formerly first degree) • Injury to epidermis • Normally heals within 5-7 days (ex. sunburn) • Appears red because of the increased flow of blood • Heals without scarring http://www.burn-recovery.org/injuries.htm

  7. Classification of Burn Injuries 2. Partial thickness burn (formerly second degree) • Involves destruction of the epidermis and dermis • Produce open, weeping wounds • Depending on size, may require skin grafts • Usually leaves scars http://www.burn-recovery.org/injuries.htm

  8. Classification of Burn Injuries 3. Full thickness burn (formerly third degree) • All three layers of skin are destroyed • Includes loss of hair follicles, sweat glands and the region where new skin cells are formed • Requires skin grafts http://www.burn-recovery.org/injuries.htm

  9. Classification of Burn Injuries 4. Fourth degree burns • All layers of the skin is destroyed • Burns extend through underlying tissues • Involves destruction of muscle, organs, and bone • Minimal pain http://www.burn-recovery.org/injuries.htm

  10. Four Types of Burns • Thermal Burns • Contact Burns- result from contact with hot items or gasses Example: flames • Scalds- result from contact with hot liquids Example: spilled liquids, bathwater Most common

  11. Four Types of Burns 2. Chemical Burns Causes • Skin contact with chemicals Example: acid or alkali, bleach • Ingestion of chemicals

  12. Four Types of Burns 3. Electrical Burns Causes • Result from contact with an electrical energy source Example: electrocution, lightning strike • Severity correlated to amount of voltage • May lead to cardiac arrest

  13. Four Types of Burns 4. Radiation Burns Causes • Result from contact with a source of radiation such as ultraviolet rays Example: sunburn, use of tanning beds, high exposure to x-rays Can result in erythema

  14. Estimating Size of Burns Rule of Nines System to estimate the percentage of total skin that has been burned. • Arm- each 9% • Head- 9% • Leg- each 18% • Chest- 18% • Back- 18% • Neck- 1% • Perineum- 1% http://emedicine.medscape.com/article/1277360-overview

  15. Goals for Nutrition Support Include: • Maintain body mass • Prevent specific nutrient deficiencies • Improve wound healing • Improve immunity • Restore protein losses • Avoid or minimize complications associated with enteral and parenteral nutrition • Provide correct amount of nutrients and hydration From Nutritional Balance is Disrupted...

  16. Estimation of Energy Requirements - Adult • Harris Benedict Equation • Female – BEE = 655.1 + 9.6W + 1.9H - 4.7A • Male – Bee = 66.5 + 13.8W + 5H – 6.8A • BEE X Activity Factor X Injury Factor • W – weight in kg • H – height in cm • A – age in years • Activity Factor • 1.2 confined to bed • 1.3 ambulatory • Injury Factor • 2.1 – 2.5 with severe burns

  17. Estimation of Energy Requirements – Adult • Ireton – Jones Equation • Spontaneously breathing (male or female) • EEE (Estimated Energy Expenditure) = 629 – 11(A) +25(W) – 609(O) • Ventilated (male or female) • EEE = 1784 – 11(A) + 5(W) + 244(S) + 239(T) + 804 (B) • W – Weight in kg • A – Age • S – Sex (male=1, female=2) • T – Trauma; B – Burns; O – Obesity (1 if present, 0 if not present)

  18. Estimation of Energy Requirements - Child • Galveston Formula • Birth-4 yrs = (2100 kcal x m2) + (1000 kcal x m2 x %TBSA/100) • 5-11 yrs = (1800 kcal x m2) + (1300 kcal x m2 x %TBSA/100) • 12-18 yrs = (1500 kcal x m2) + (1500 kcal x m2 x %TBSA/100)

  19. Estimation of Energy Requirements • Curreri Formula • 24 kcal x kg usual body weight + 40 kcal x % TBSA • Typical estimate for burn patients: • Adult – 35-40 kcal/kg/day • Child – 40 (plus) kcal/kg/day

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