DIET AND THE

BURN PATIENT
 • BURN
is a type of injury to flesh caused by heat,
electricity, chemicals, light, radiation or
friction. Most burns only affect the skin (
epidermal tissue and dermis). Rarely,
deeper tissues, such as muscle, bone, and
blood vessels can also be injured.
BURNS ARE CLASSIFIED AS
FOLLOWS:
• First Degree Burns:
If only the epidermis is affected. It is important to
provide oral fluids to replace losses due to oozing
and give medication for pain relief.
• Second Degree Burns:
Are very painful as both epidermis and dermis are
injured, resulting in exposure of nerve endings. It is
important to maintain aseptic and hygienic condition of
the affected part to avoid infection. The dietary treatment
consists of ample fluids and provision of adequate
nutrients in the diet to ensure quick healing.
• .
• Third Degree Burns:
Both epidermis and dermis are destroyed, nerve fiber are als
destroyed, resulting in lack of sensation and pain. When the
layer of dead skin begins to separate, pain is felt. If the burn
involve more than ten percent of the body surface, nutrition
support is essential to expedite recovery. This includes
generous intake of fluids and adequate nutrient intake throu
a well planned diet.
• Fourth Degree Burns:
The subcutaneous tissue, muscle and bone are damage
There is need for constant, well planned nutrition
support to recovery
• Diet:
In the first few days after burn injury, It is very difficult to provide sufficient energy and proteins because of the
hypermetabolic state of the body. When the stress response becomes moderate, it is easier to meet the needs for
these nutrients. The ascorbic acid intake is increased up to 1 g per day and a zinc supplement is often given to
help wound healing process. Passive exercise helps to reduce protein loss. Use of layered dressings help to
maintain body temperature and thus reduce protein losses. However, the nutrients and electrolytes lost through
exudate or fluid leaking out of capillaries and urine needs to be replaced.
• Mode of Feeding:
Initially parenteral nutrition is required, if peristalsis is absent due to shock. When gastrointestinal function has
returned, there is a transition made to oral feeding or tube feeding, on the basis of the nature and site of burns.
Special formulas are used for hypermetabolic states; protein supplements or modular feedings can be utilized.
• Nutritional Assessment:
As nutritional care plays a major plays a major part in recovery from burns, nutritional assessment from time to
time is essential to monitor the patient’s progress. The techniques used will be decided by the state of the patient.
• Complications:
One of the complications which occur are stress ulcers. Prevention of stress ulcers involves several steps, which
include –fluid replacement to prevent hypovolemia, oxygen therapy to prevent hypoxia of gastric mucosa,
nutrition support to nourish gastric mucosa and use of antacids to maintain gastric pH above 5.
Nutritional Care of Patient with Burns
 Days 1-3 ( Immediate shock period)
 Loss of enveloping skin surface and exposure of extracellular fluids leads to
immediate loss of interstitial water and electrolytes, mainly sodium and large
protein depletion.
• Fluid Therapy:
 Colloid ( protein) through blood and plasma transfusion
 Electrolytes, sodium and chlorine by use of saline solutions– lactated Ringer’s
solution
 Water{ dextrose solution) to cover additional insensible losses
• Recovery period (days 3 to 5) : Intravenous therapy is discontinued and
oral solutions such as Holdene’s is used
• HOLDENE’S SOLUTION( ORAL FLUID
ANDELECTROLYTE REPLACEMENT)

3-4 g (1/2 tsp) salt

1.5- 2 g ( 1 ½ tsp) baking soda ( sodium bicarbonate)
1,000 ml water
 + lemon juice for flavor and chill
• A careful check of fluid intake and output is essential with
constant check of dehydration over hydration.
• SECONDARY FEEDING PERIOD
• (6-5) : Optimal nutrition therapy necessary to
• (a) make up for tissue destruction in which protein and
electrolytes are lost
• (b) due to continued nitrogen losses due to tissue catabolism
• (c) due to increased metabolic demands of infection (extra
calories + B vat.), fever ad tissue regeneration (protein + vat. C
• (d) to have optimal tissue health necessary for subsequent
grafting to be successful.
PRINCIPLES OF DIET THERAPY
• A high protein, high calorie and high vitamins diet is needed to
ensure rebuilding of tissues damaged/destroyed and
catabolized. The protein requirement varies from 150-400
g/day. Simultaneously the calorie need varies from 3,500-
5000cal/day. Intake of high carbohydrate foods is suggested.
The need for vitamins is very high to ensure recovery. The
recommended vitamin C intake is 1-2 g per day. There is a need
for increased intake of thiamine, riboflavin, and niacin to
metabolize the extra carbohydrates and protein in the diet.
Intake record--- A careful record of protein and calories in the
amount of food consumed is a necessary tool for planning care.
DIET AND IMM0BILIZED
PATIENTS
(ACCIDENTAL INJURY)
 • ACCIDENTAL INJURY
• A number of accidental injuries lead to physical
stress. These include vehicular accidents, stab
wounds o other accidental injury. These result in
pain, shock with possibility of loss of blood, fluids
and/or electrolytes. If there are fractures, in
addition, the healing is more complicated.
• There is a loss of protein rich fluids from open
wounds, which needs to be replaced. Healing of
fractures may involve bed rest, which increases
loss of calcium due to lack of movement.
 NUTRITIONAL CARE:
• The losses in injury have to be replaced
and needs of haling have met. In the first
24-48 hours after injury, the blood volume
and electrolyte balance needs to be
maintained. Next, the diet must help to
resist infection, ensure haling, restore
muscular strength and avoid weight loss.
 NUTRIENTS NEEDED:
 Sufficient protein and calories to meet the above-mentioned needs
In case of fracture, additional calcium and vitamin D need to be
provided
Intakes of Vitamin B complex be increased in proportion to increase in
calories and protein
Vitamins. A and C to ensure wound healing and prevent infection
• Intake of drinks providing high protein and calories between meals
ensure adequate nutrient intake and utilization. The mode of feeding –
oral, tube feeding or parental route– depends upon the severity and
location of the injury.
EATING DISORDERS:
ANOREXIA NERVOSA
 EATING DISORDERS:
ANOREXIA NERVOSA
•Implies loss of appetite. It can aptly be
described one’s appetite.
•Refers to clinical condition in which a
person voluntarily eats very little food(
self-imposed starvation)
CAUSES:
•Addictive behaviours have multiple
causes –emotional, psychological, social
and biological, which result in disordered
coping eating. Stress may have a strong
role and lack of appropriate coping
mechanism is another common factor.
SYMPTOMS OF ANOREXIA NERVOSA:
• The anorectic patient is often 20 to 40% below desirable weight
for the age and stature and appears to be skin and bones. Other
symptoms are lowered body temperature, slower basal
metabolism, decreased heart rate( hence easy fatigue, fainting,
sleepiness), iron-deficiency anemia, rough dry scaly and cold
skin from a poor nutrient intake, low white blood cell count
(increasing risk of infection and death), loss of hair,
constipation (and laxative abuse), loss of menstrual periods and
deterioration of teeth due to frequent vomiting. An anorectic
person is psychologically and physically ill and needs help.
 TREATMENT OF
ANOREXIA NERVOSA:
• The patient is often a victim of isolation and fear.
Hence the health team must include a psychologist
in addition to a physician, dietitian and other
health personnel. They should all work together to
restore a sense of balance, purpose and future with
the cooperation of the patient. The first step is to
help he patient to gain weight, as a psychiatrist
cannot counsel a starving person.
 NUTRITIONAL THERAPY:
• The first step is to increase the person’s food intake. This will
help to stop weight loss and may help weight gain. The next is
to restore regular food habits. The third is to ensure that the
patient keeps in weekly contact with the dietitian. In all this it is
critical to allow the person to feel control of her life in the early
stage of treatment. These should be no surprises, as these may
be detrimental to progress. Anorectics are very clever and
resistant. They should be no surprises, as these may be
detrimental to progress. Anorectics are very clever and
resistant. They try to disguise weight loss or fake weight gain
by wearing many layers of clothes, putting coins in the pocket
and drinking a lot of water before weighing. One needs to gain
their trust to be able to help them.
NUTRITIONAL CARE:
ANORECTICS ARE
1. Patients need to be given intravenous feedings to restore fluid
and electrolyte balance, when the patient is in a critical state
and is likely to get dehydrated.
2. When patient’s nutritional state is precarious, give peripheral
parenteral nutrition to support oral intake.
3. Get patients to be partners in the efforts to restore satisfactory
nutritional status; attain normal weight and develop normal
eating patterns.
4. Anorectics are intelligent patients. Educate them about their
normal growth pattern and the intake to meet the needs for
their growth. This will enable them to set goals to attain their
normal growth gradually
5. Lastly avoid food being the
center point of their day. They
need to take interest in
recreational activities—music,
games, reading, enjoying
family company, making
friends etc. to get back to
enjoying normal life of which
food is an important part.
DIET AND MENTAL
PATIENTS
INTRODUCTION
•Mental patients need human understanding
and a meaningful relationship with their
environment and the people around them
•In planning nutritional and dietary care of a
mental patient, a well-coordinated and
concerted effort is needed from every member
of the health team.
 EXAMPLE MENTAL PATIENT:
(MAJOR DEPRESSION)
• Major Depression is a disorder that presents
with symptoms such as decreased mood,
increased sadness and anxiety, a loss of appetite,
and a loss of interest in pleasure activities.
• Patients who are suffering from major depression
have high risk for committing suicide so they are
usually treated with psychotherapy an/or
antidepressants.
In addition to omega-3 fatty acids, vitamin
B(e.g., folate ), and magnesium deficiencies
have been linked to depression. Randomized,
controlled trials that involve folate and B12
suggest that patients treated with 0.8 mg of folic
acid/day or 0.4mg of vitamin B12/day will exhibit
decreased depression symptoms.
In addition, the results of several case studies
where patients were treated with 125 to 300mg
of magnesium(as glycinate or t with each meal
and taurinate) with each meal and at bedtime
led to rapid recovery from major depression in
less than seven days for most of the patients.