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THE
BURN NUTRITION MODULE
Section
1
What
Are the Basic Objectives of Nutritional Support After Burns ?
Now
that the metabolic response to a burn has been characterized, the
nutritional support can be more clearly defined. The nutritional support
is based on the metabolic response and the use of nutrients to attenuate
the complications in particular lean mass loss.
THE BASIC PRINCIPLES ARE AS FOLLOW:
1) To
provide sufficient energy to keep up with the metabolic demands using
the appropriate nutrient mix. As will be seen, the type and amount of
nutrients are critical to success.
2)
Provide the necessary protein intake
sufficient to maintain adequate protein synthesis for healing and repair
while decreasing the lean mass loss. Some lean mass loss is inevitable.
3)
Avoid
complications caused by excess or inadequate nutrient intake or improper
timing of delivery.
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BASIC
OBJECTIVES
Provide
the energy required by the stress response, thru optimum
nutrient delivery
Provide
the necessary protein intake to meet demands for protein
synthesis thereby decreasing lean mass loss
Avoid
Complications
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What
are the Basic Steps in Initiating and Maintaining Optimum
Nutrition ?
ASSESS ENERGY
(NUTRIENTS) AND PROTEIN NEEDS
REASSESS
AS THOSE NEEDS CHANGE
INITIATE
NUTRITIONAL SUPPORT ASAP BUT WHEN SAFE
SELECT
OPTIMUM ROUTE OF DELIVERY (PREFERABLY ENTERAL)
MONITOR
SAFETY AND ADEQUACY OF NUTRITIONAL SUPPORT
ARE
GOALS BEING MET WITHOUT NUTRIENT INDUCED COMPLICATIONS
MONITOR
AND MAINTAIN OPTIMUM TISSUE HYDRATION
We
will now outline the basic steps involved in initiating and maintaining
optimum nutrition.
First,
an assessment of energy and protein needs
must be determined so that the appropriate mix and amount of nutrients
can be provided. Since these needs, especially energy, change during the
course of injury, frequent assessments are essential.
Second,
the nutritional support needs to be
initiated, the earlier the better.
Third,
the appropriate route of delivery needs to
be selected. The enteral route is the preferred and safest route.
Fourth,
the adequacy of the nutritional support
needs to be determined as well as maintaining the necessary electrolyte
balance and avoidance of nutrient induced complications.
Fifth,
one must continually assess the status of
hydration in order to maintain optimal hydration
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