TLA_Nutrition for Clients with Special Needs

Case in Point—Hong-Tse: Surviving Severe Burns

Hong-Tse is a 15-year-old boy who was helping his father in the yard during fall cleanup. They had raked
leaves and trimmed bushes and picked up a lot of yard debris. To get rid of this trash they decided to burn
it in a 50-gallon trash can. Jing-Li, Hong-Tse’s father, got the lighter fluid and some matches to ignite the
debris. No one can explain what happened next, but Hong-Tse caught on fire. In the hospital Jing-Li
learned that Hong-Tse had third-degree burns over 78% of his body. Fortunately, Hong-Tse’s face and
neck were spared from the flames. Narcotics are controlling his pain, and he is being watched closely for
hypotension, kidney failure, and electrolyte imbalances.

ASSESSMENT

1. What do you know about Hong-Tse’s need for fluids?

a. To prevent dehydration and too much blood loss due to third degree burns.

2. What do you know about Hong-Tse’s need for electrolyte balance?

a. To prevent fluid volume deficit, irregular heartbeat, muscle spasm, tachycardia, and
weakness or fatigue.

3. What would help you identify Hong-Tse’s health before his accident?

a. Hong-Tse had raked the leaves and trimmed the bushes and picked up a lot of yard debris
with his father.

DIAGNOSIS

4. Write a diagnostic statement describing the problems Hong-Tse could have with his severe
burns.

a. Risk for fluid volume deficit related to hypovolemia as evidenced by third degree burns.

b. Risk for anxiety related to fear and emotional impact of burn injury as evidenced by third
degree burns.

c. Risk for hypothermia related to loss of skin as evidenced by third degree burns.

5. Write a diagnostic statement about the risk of infection for Hong-Tse.

a. Risk for infection related to hypovolemia as evidenced by third-degree burns.

PLAN/GOAL

6. What is the overall nutritional goal for Hong-Tse?

 Eat high-protein foods include meat, fish, eggs, legumes, milk, yogurt, cheese, and
nuts.
  Increase fluid intake.
 Eat foods with vitamin C, vitamin D, and zinc to help prevent and treat infections.

IMPLEMENTATION

7. What strategies can the dietitian use to assure proper nutritional balance for Hong-Tse?

a. Focus on foods with healing and immune function, particularly vitamins A, C, E, some B
vitamins, and zinc.

8. If Hong-Tse would require tube feedings, what can the dietitian expect to happen?

a. The food sometimes won’t pass through the tube.

b. The patient may experience side effects such as vomiting, nausea, and diarrhea.
c. The patient may experience fluid imbalances.

9. What strategies can the dietitian use to prevent side effects of tube feedings?
a. The dietician must ensure the portion size.
b. The dietician must blend all together the needed nutrients to create a formula.
c. The dietician must store the medications and blended food in the refrigerator.

10. What categories of food are priorities for Hong-Tse right now?

a. Protein since the body loses protein through burn wounds and muscles. The protein will
help in rebuilding lost muscle and Vitamin c and zinc for speeding up the healing
process.

EVALUATION/OUTCOME CRITERIA

11. What criteria could be used to evaluate the plan?

a. If patient Hong-Tse experiences hypothermia after performing the nursing interventions.

b. If patient Hong-Tse fluid has increased after administering fluid maintenance
intravenously.

THINKING FURTHER

12. Why is nutrition so critical in the treatment of the client with burns?

a. Proper nutrition is important for patient with burns because the nutrition they will get in the
foods will help speed up the healing process, prevents further infections and prevent
muscle protein breakdown in the patient’s body.
RATE THIS PLATE

Hong-Tse is in the burn unit of the Shriners Hospital in Ohio. He is losing a lot of fluid, and immediately
upon arrival, a feeding tube was inserted for nutrition. He is receiving fluid from IVs. The physician
started the following tube feeding: 1-calorie/ml product such as Nutren 1.0 or Jevity 1.0. Is this the best
product for a severely burned client? What nutrient would this client need for building and repairing his
burns? Search the Internet for Nestl é and Ross nutritional products to determine which product would be
best for the client.

ANSWERS TO RATE THIS PLATE

The Nutren 1.0 or Jevity 1.0 is good for severely burned client as it contains 85 percent of water
which is good for increasing the water volume of the patient also, it contains protein which is
beneficial for repairing the skin and the muscle. Lastly, it contains carbohydrate which is good
for maintaining the weight of the client. Moreover, the client needs protein to help build and
repair body tissues, such as muscles, organs, and skin as well as Vitamin C, vitamin D, and zinc
for healing and in treating infections.