Importance of Nutrition on Burn Injured Patients in Hospitals - Report Example

Importance of Nutrition On Burned Injured Patients Introduction Burn patients around the hospitals have a special case and are to be nourished in much more detail than other patients. These effects are not just physical but also mental. The nourishment of the burned skin requires medical help as well as psychological help towards the recovery process. Special wards are made for the burn patients as many factors are taken in account to have stable growth towards recovery in the hospital environment. The treatment of burn is also accordingly to the type of burn as accordance to the degree of burn. Around the world around 11 percent of people seek treatment for burn injuries and around of which death rate is around 300,000 people. (Peck, 2011). According to the American Burn Association, around 4% of the Americans are admitted in the burn centre for the medical treatment that sums up to around 450,000 in total receiving different types of burn related medical treatments. This chapter would try to prove how these patients due to their large amount of number go through extensive medical treatments, physically and mentally towards their recovery phase. Why these practices are important and how certain nutrients are important while carrying out these medical practices. The research would also try to rise some points regarding the wrong method of nourishment or if the timely care is not taken regarding this issue. 2. Types of Burns To completely understand the right way towards treating patients with the right nutrition, the understanding of degree of burns is very important. They are further divided amongst four degrees through different means of burns affecting the human body. Care is to be taken on each degree to ensure the fast healing of the burn. First degree burns are usually red blisters on the body such as sun burns. Their healing time is much quicker, usually 5-10 days. Certain creams and ointments prevent from these burns and help toward healing. Constant first degree burn can lead to skin cancer in an older age. (Papini, 2004) Second degree burn has a red blister which is very painful. It takes around 2-3 weeks to heal where as the burn extends to papillary dermis and the reticular dermis. Second degree burn also has an extreme pain with pressure effect causing discomfort. Burns of these degrees cause scarring and skin grafting. Healing is possible and the duration for healing is around 3-8 weeks. Third degree and fourth degree burns cause the most problems for the patients. During the third degree burn, the burn extend through the entire dermis layer and turns the skin to turn stiff with a leathery texture, where the skin is dead and there is no sensation that can be felt. Due to this reason, it can either take months to heal and at times this process is incomplete. Similarly in the Fourth degree burn, the entire skin, bone and underlying fat gets burnt. The textures of those are black and require excision. This level of burn can cause permanent impairments and in many cases death. (Papini, 2004) 3. Diagnosis According to the annual report of National Burn Repository in 2013, in the U.S 43% burns are causes through flames and fires, scald injuries constitute 34%, 4% electrical burns, 3% chemical burns, and 9% of burn injuries were caused through contact with hot objects. For such a large number of 450,000 patients just in the U.S, the diagnosis accordingly to each patient is necessary to ensure the right treatment. Around 70% of these burns happen in homes with around 10% at work. Other causes for burns are distributed 1-2% suicide attempts, 1% open fires, and inhaling airways around 6-7%. (Alharbi Piatkowski Dembinski, 2002) The human body after reaching over a temperature of 111oF (44oC) reaches a point where the proteins three dimensional shape start to break and deform. This leads to the damage of skin along with the health effects causing burn. When this is causes through electrical, heating, flames and radioactive ways of burn, the skin layers are cut through and lead towards disruption in sensational feeling. Around 30% of the human body responds highly to inflammatory actions cause’s problems such as poor blood flow in organs, gastrointestinal track, and can lead towards ulcers in the body. (Papini, 2004) Most of all of these burns are diagnosed through the depth of the burn in a single examination although biopsy is also used. In matters relating to headaches and dizziness with fire related burns, Carbon-monoxide and Cyanide poising is also used. The major classification is the severity and the size of the burn. 3.1 Severity The American Burn Association classified the severity of the burns into the categories of Minor, Moderate and Major Burns as shown below in chart 1. American Burn Association severity classification Minor Moderate Major Adult 20% TBSA Young or old < 5% TBSA Young or old 5-10% TBSA Young or old >10% TBSA 5% full thickness burn High voltage injury High voltage burn Possible inhalation injury Known inhalation injury Circumferential burn Significant burn to face, joints, hands or feet Other health problems Associated injuries CHART 1 There are a number of factors are based on the age, effected surface area, and the associated injuries of the person. 3.2 Size The burn diagnosis in size is related to the total body surface area burnt in percentage between the full and partial thickness burns. Second to Fourth classification areas are considered in the burnt sizes where more than 50% of the burns have very less TBSA included, around 10%. (Papini, 2004) The diagnosis of size usually through the rule of nines, using palms but is only accurate till the patients till age 16. Other methods of Lund and Browders charts have methods to find size of the burn. 4. Psychological Effect The traumas of injuries caused through burns are painful and last longer. This causes the people problems psychologically. Having a person to be stable under these conditions require special care as well as right nutrition throughout recovery phase. The burn injuries can cause a person to deal with life situations much differently in daily life, for months and years to come. It doesn’t just effects personally but also family issues, social issues as well as educational issues of a person. There are levels of depression that within the patients of burn. 23-61% has depression, 13-47% has generalized anxiety and 30% have post traumatic disorder. (Patterson, 1993) 4.1 Effect of Nutrient on burn patients psyche The challenges of psychological problems of overstimulation, impaired communication, pain, problems in sleeping play a direct role when being under nutrient control. When right amount of nutrients are provided a person does end up having positive outlook towards the recovery. The right requirements when fulfilled also help them to physically be active. Nutrients when are not able to reach to the human body in the right amount or when a person is traumatized to not eat properly there are issues that cause problems while treatment process. The decrease in proteins of the body, ability to fight infections and other metabolic process are due to the stress of the patients. It is then much required of the patients to cope up with the process of acquiring all the food possible to help themselves to not go through much pain in the longer run. (Patterson, Everett, Bombardier, Questad, Marvin & Lee, 1993) When the burn affects the mental organs it decreases the capacity of processing the required nutrients physically. Under such cases the patients tend to have physical challenges towards digestion processes. The mental capacity then limits all the functions happening around the body towards limiting them to heal. This is a process unfortunately takes them through pain an anxiety disorders. Physically all these depressions over the burnt patient are more likely to affect the process of heart pumping into causing other heart attacks. (Partridge, 1997) 5. Required Nutrients for Recovery To have a fast recovery, the diet and nutrients required for the patient play an important part. The requirement of per day calorie crosses 5000 kcal/day in accordance to the TBSA burnt. This can be a 100% to 200% percent increase in the food intake but due to the severity of the burn, certain nutrients are required most through the time as compared to other food requirements. Patients also tend to lose around 10 to 20% of their weight due to the injuries and stress. (McClave Marsano & Lukan, 2002) There are many factors that are required for the right nutrient for the burn patients. Time also plays an important role as timely provision of proteins and carbohydrates is required. In adults 40 calories per each percent of burnt area along with 25 calories per every kg of diet is required whereas in children, the required 1200 kcal of diet along with 2,200 calories for each square meter of area burnt area is important. This diet helps in prevention of weight loss caused through the high degrees of burn. (Pintaudi, 2000) Patients who receive right amount of diet between the first 4-36 hours of the burns have positive affects towards the next 48 hours. This helps in reduction of infections inside the body, reduces sepsis that are related with gut permeability. True Parenteral Nutrition (TPN) is not advised for the burn patient’s nutritional approach as it is less effective in the catabolic response due to burns. Low fat and higher carbohydrate diet can help in having less time in hospitalization and can help in reduction of infectious morbidity. Liquid diet is also necessary due to large water loss where the water loss can be as much as 4 liter/m2/day hence for this purpose 30-50 ml of water is given per hour according to the urine samples. (Pintaudi, 2000) Vitamin levels are also much effected through the burning as there is a major deficiency of Vitamin A, D and E. For this micronutrient support, indirect dosage is to be taken under consideration. The evaluation towards the nutritional intake happens usually weekly or bi-weekly. It is then compared with the estimated growth of the patients. 6. Conclusion As burn patients continue to have problems in medical facilities around the world, it is need towards creating burn centers and finding solutions to provide them nutrients that can help them recover through the hardships they face. Cleaner environment with special care is then needed towards the growth of the patients. Burns classification further helps in enabling the doctors to address certain issues to patients. Through correct psychological guidance and preventive measure, these issues can be solved. Although the unfortunate reality in fourth degree burn does conclude to death, where only medical operations are possible, in those rare cases, extreme measures are taken to solve burn issues. The growth of skin required proteins and the patients current health plays an important role towards determining the recovery time of the patient. While carrying out the literature review, the division between the psychological problems as well as physical problems was an important segment that differentiated between the needs of the patients. Psychologically, problems relating to stress led through physical pain was emergent in the research, this was primarily due to the fact of malnutrition that led to problems as sleeping disorders, anger, depression etc. (Patterson & Ford, 2000) Physically problems related to the complete growth of the burnt part of the patient. The physical constraint of performance after discharge in patients in third and fourth degree was the prominent problems in the physical aspect of the burns. Burns have grown dramatically through the last year, the increase of medical treatment and correct measures are very much required to control this phase. With the right nutrition, the effects have shown to be considerably much positive and those measure shown lead towards the final right growth of the burn patients. The mental trauma is then uplifted by providing them the right food diet that enables their physical processes to provide energy to their mental process. References: Alharbi Z, Piatkowski A, Dembinski R, et al.“Treatment of burns in the first 24 hours: simple and practical guide by answering”. World J Emerg Surg. 2012 May 14;7(1):13. Herndon D (ed.). Chapter 3: Epidemiological, Demographic, and Outcome Characteristics of Burn Injury". Total burn care (4th ed.). Edinburgh: Saunders. p. 23. ISBN 978-1-4377-2786-9. McClave SA, Marsano LS, Lukan JK. “Enteral access for nutritional support: rationale for utilization”. J Clin Gastroenterol. 2002;35:209–213. Papini R; Management of burn injuries of various depths. BMJ. 2004 Jul 17;329(7458):158-60. Partridge J. When burns affect the way you look. London: Changing Faces, 1997. Patterson DR, Ford GR. Burn injuries. In: Frank RG, Elliott TT, eds. Handbook of rehabilitation psychology. Washington DC: American Psychological Association, 2000: 145-62. Patterson, D. R., Everett, J. J., Bombardier, C. H., Questad, K. A., Lee, V. K., & Marvin, J. A. (1993). “Psychological effects of severe burn injuries”. Psychological Bulletin, 113(2), 362. Pintaudi AM, Tesoriere L, DArpa N, et al. “Oxidative stress after moderate to extensive burning in humans”. Free Radic Res. 2000;33:139–146. Read More