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Preface
The acute or intermediate phase of burn care follows the
emergent/ resuscitative phase and begins 48 to 72 hours
after the burn injury
Focus assessment:
Respiratory and circulatory status
Gastrointestinal function
Nutritional support
Ns. Heri Kristianto, SKep.,MKep.,Sp.KMB
Assessment Rule of 9
Hemodynamic alterations: vital signs, peripheral pulses, 1%
electrocardiogram
Assessment of residual gastric volumes and pH in the
patient with a nasogastric tube is also important. Blood
in the gastric fluid or the stools must also be noted and
reported
Wound healing: size, color, odor, eschar, exudate,
abscess formation under the eschar, epithelial buds
(small pearl-like clusters of cells on the wound surface),
bleeding, granulation tissue appearance, status of
grafts and donor sites, and quality of surrounding skin
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Cont Diagnostic
Ongoing assessments focus on pain and x-ray
psychosocial responses, daily body weights, caloric arterial blood gases
intake, general hydration, and serum electrolyte, blood analysis
hemoglobin, and hematocrit levels. Assessment for body temperature
excessive bleeding from blood vessels adjacent to 37.2 to 38.3C (99
areas of surgical exploration and dbridement is to 101F) to reduce
metabolic stress and
necessary as well. tissue oxygen demand
Early detection of complications: assessment of Invasive vascular
respiratory and fluid status linesavoided
SwabCulture
COLLABORATIVE PROBLEMS/
Cont
POTENTIAL COMPLICATIONS
Impaired physical mobility related to burn wound Heart failure and pulmonary edema
edema, pain, and joint contractures Sepsis
Ineffective coping related to fear and anxiety, Acute respiratory failure
grieving, and forced dependence on health care
Acute respiratory distress syndrome
providers
Visceral damage (electrical burns)
Interrupted family processes related to burn injury
Deficient knowledge about the course of burn
treatment
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Rumus Baxter/Parkland
2. Formula Baxter/Parkland
Prinsip:
Syok yang terjadi jenis hipovolemia
back
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Kasus
Toni: BB 17 kg, 32% LB
Cincinati 4 x 17 kg x 32= 2040 cc
Galveston 5000 cc x (32% x 0.7 )= 1120
Kultur luka
Hidrotherapy (20-30menit)
The temperature of the water is maintained at
37.8C (100F), and the temperature of the room
should be maintained between 26.6 and 29.4C
(80 to 85F).
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MEBO
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Kulit
STSG & FTSG
Perawatan: 5-7 hari jika eksudasi minimal
24-48 jam jika eksudasi berlebihan
Skin substitute epicell, alloderm, integra
Stem cell
Bahan selain kulit: biological dressing & sintetik dressing
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Metode lain
Vakum
Madu
Pressure bandage
Plaster fiksasi
Perban elastik
Garment khusus
Silicones sheet
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Waktu
MORBIDITAS
MORTALITAS
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Lemak :
Karbohidrat : 20 30% total kalori
50 65% total kalori 2 -3% total kalori merupakan asam lemak essential
Wolfe R.R, relation of metabolic studies to clinical nutrition-the example of burn injury Am J. Clin Nutr. Wolfe R.R, relation of metabolic studies to clinical nutrition-the example of burn injury Am J. Clin Nutr. 1996; 64:800-8
1996; 64:800-8 Tassiopoulos KA, Nutritional support of the patient with severe burn injury nutrition 1999; 15: 956 957
Tassiopoulos KA, Nutritional support of the patient with severe burn injury nutrition 1999; 15: 956 Abadia D, et al Pharmacological nutrition after burn injury, J. Nutr 1998, 128 : 797 803
957 Oetoro S, Permadhi I, Witjaksono F. Penatalaksanaan nutrisi pada luka bakar dalam luka bakar pengetahuan klinik
praktis ( yefta Moenadjat ed ) FKUI. Jakarta 2003, 100-109.
Oetoro S, Permadhi I, Witjaksono F. Penatalaksanaan nutrisi pada luka bakar dalam luka bakar
pengetahuan klinik praktis ( yefta Moenadjat ed ) FKUI. Jakarta 2003, 100-109.
Rodriguez, CJG, Nutrition support of the septic patient, in from nutritional support to pharmacologic nutrition in
the ICU (Vincent, Jl. Ed), Spring Verlag Berlin Heidelberg, 2000: 348-60.
Tassiopoulos KA, Nutritional support of the patient with severe burn injury nutrition 1999; 15: 956 957.
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Pain Scale
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Hemodynamic Infection
stabilization control
Modulation of the
septic response
Cont
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Absence of complications
Lungs clear on auscultation
Exhibits no dyspnea or orthopnea and can breathe easily when
standing, sitting, and lying down
Exhibits no S3 or S4 heart sounds or jugular venous distention
Exhibits urine output; central venous, pulmonary artery, and
pulmonary artery wedge pressures; and cardiac output within
normal or acceptable limits
Exhibits normal blood, sputum, and urine culture results
Maintains arterial blood gas values within normal or acceptable
limits
Has normal lung compliance
Has no visceral organ damage
Has stable cardiac rhythm
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