Managing Fear and Pain in Major Burn Patients

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Questions and Answers

What is a common complication of Systemic Inflammatory Response Syndrome (SIRS)?

Development of deep vein thrombosis

Development of multiple organ dysfunction syndrome (MODS) (correct)

Development of sepsis

Development of anaphylaxis

Which organ failure typically manifests earlier in patients with MODS?

Hematologic failure

Lung failure (correct)

Kidney failure

Myocardial failure

What is a primary cause of MODS?

Deep vein thrombosis

Sepsis from wound infections

Acute kidney injury caused by hypoperfusion (correct)

Infection in remote organs

Which of the following changes can occur at any time in patients with MODS?

Central nervous system changes Signup and view all the answers

What are patients with SIRS and MODS characterized by?

High cardiac output and high oxygen consumption Signup and view all the answers

What is a typical fluid balance characteristic of patients with SIRS and MODS?

Positive fluid balance associated with massive edema Signup and view all the answers

What phase of the metabolic response to stress is characterized by hypovolemia, shock, and tissue hypoxia?

Ebb phase Signup and view all the answers

During the ebb phase of the metabolic response to stress, what happens to insulin levels?

Fall Signup and view all the answers

What hormone is most likely increased during the ebb phase of metabolic stress?

Glucagon Signup and view all the answers

Which of the following is NOT a characteristic of the flow phase in the metabolic response to stress?

Decreased energy expenditure Signup and view all the answers

During which phase of the metabolic response to stress do levels of catecholamines such as epinephrine and norepinephrine increase?

Flow phase Signup and view all the answers

What is one physiological change that occurs during the flow phase of metabolic stress?

Increased cortisol levels Signup and view all the answers

What is an indication for small bowel feedings?

Gastric residuals exceeding 250 mL Signup and view all the answers

How can aspiration risk during enteral feeding be reduced?

Elevating the head of the bed Signup and view all the answers

What is a reason to consider parenteral nutrition (PN) over enteral nutrition (EN)?

Unsuccessful enteral nutrition Signup and view all the answers

What should be assessed when diarrhea is present in a patient?

Infectious causes Signup and view all the answers

What type of formulations contain arginine, glutamine, nucleic acids, antioxidants, and omega-3 fatty acids for critically ill patients?

Immune modulating enteral formulations Signup and view all the answers

What does monitoring enteral tolerance involve?

Physical examination and abdominal x-ray examination Signup and view all the answers

What is recommended for obese patients 60 years or older when predicting energy expenditure?

Using the PSU equation (2010) with actual body weight Signup and view all the answers

What is the recommendation regarding hypocaloric feeding for critically ill obese patients?

Begin with 50% to 70% of estimated energy requirements Signup and view all the answers

What is the recommendation for high-protein feeding in critically ill obese patients?

Start with 1.2 g/kg ideal body weight Signup and view all the answers

How should goal protein intake be adjusted according to the text?

Based on nitrogen balance studies Signup and view all the answers

What is the significance of permissive underfeeding in critically ill obese patients?

Achieves net protein anabolism Signup and view all the answers

Why is determining protein requirements difficult for critically ill patients?

Because protein requirements depend on many factors Signup and view all the answers

What is the purpose of giving antacids to patients with major burns?

To prevent formation of stress-related Curling ulcers Signup and view all the answers

Which of the following is NOT a goal of nutrition support therapy after major burn injury?

Increased catecholamine stimulation Signup and view all the answers

What role do hepatic acute phase proteins play in postburn survival?

Predicting postburn survival through metabolic roles Signup and view all the answers

Why is it important for burn patients to receive increased energy, carbohydrates, proteins, fats, vitamins, and minerals?

To heal and prevent detrimental sequelae Signup and view all the answers

How do pharmacologic strategies help attenuate the hypermetabolic state in burn patients?

By minimizing net protein loss Signup and view all the answers

What is a key aspect of minimizing fear and pain for burn patients?

Providing emotional support and reassurance from staff Signup and view all the answers

Study Notes

Metabolic Response to Stress

The metabolic response to critical illness, traumatic injury, sepsis, burns, or major surgery is complex and involves most metabolic pathways.
Accelerated catabolism of lean body or skeletal mass occurs, resulting in net negative nitrogen balance and muscle wasting.

Ebb and Flow Phases

The ebb phase occurs immediately after injury, characterized by:
- Hypovolemia
- Shock
- Tissue hypoxia
- Decreased cardiac output, oxygen consumption, and body temperature
The flow phase follows fluid resuscitation and restoration of oxygen transport, characterized by:
- Increased cardiac output, oxygen consumption, and body temperature
- Increased energy expenditure and total body protein catabolism

Energy Expenditure and Nutrition

Actual body weight is a better predictor of energy expenditure than ideal body weight in obese individuals.
The Penn State University equation (2003b) or PSU equation (2010) should be used to estimate energy expenditure in obese and non-obese patients.
Hypocaloric, high-protein nutrition support therapy or "permissive underfeeding" may be beneficial in critically ill obese patients.
Protein requirements are difficult to determine in critically ill patients.
Minimizing fear and pain can reduce catecholamine stimulation and energy expenditure.

Burns and Metabolic Response

Burn patients have greatly accelerated metabolism and require increased energy, carbohydrates, proteins, fats, vitamins, minerals, and antioxidants.
A healthy liver is essential for burn patients.
Hepatic acute phase proteins are strong predictors of postburn survival.
Goals of nutrition support therapy after major burn injury include:
- Provision of adequate calories to meet energy needs
- Prevention or correction of specific nutrient deficiencies
- Fluid and electrolyte management for adequate urine output and normal homeostasis

Systemic Inflammatory Response Syndrome (SIRS) and Multiple Organ Dysfunction Syndrome (MODS)

SIRS describes the widespread inflammation that can occur in infection, pancreatitis, ischemia, burns, multiple trauma, hemorrhagic shock, or immunologically mediated organ injury.
MODS can develop as a complication of SIRS, characterized by:
- Lung failure followed by failure of the liver, intestines, and kidney
- Hematologic and myocardial failures may occur later
- Central nervous system changes can occur at any time
MODS can be primary or secondary, depending on the location of the initial injury.

Nutrition Support Therapy

Enteral nutrition (EN) is preferred over parenteral nutrition (PN) whenever possible.
Small bowel feedings are indicated when gastric residuals exceed 250 mL.
Enteral tolerance should be monitored by assessing the level of pain, presence of abdominal distention, passage of flatus and stool, and physical examination.
PN is indicated for patients in whom EN is unsuccessful or contraindicated.
Immune-modulating enteral formulations may have beneficial effects and favorable outcomes for critically ill patients.

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Description

Learn about strategies for minimizing fear and pain, and preventing stress-related ulcers in patients with major burns. Explore pharmacologic approaches to attenuate the hypermetabolic state and protein loss.