Seriously burned patients easily develop a sense of helplessness and fear of the many painful dressing changes and whirlpool tubbings they are required to undergo. Children in particular regress to infancy and will urinate and defecate in bed and on their wounds, adding to morbidity (LaBaw, 1973). Simply lying in bed is regressive. Burns seldom occur on the bottom of the feet, and as soon as shock is controlled enough to allow the vertical position without hypotension (3 or 4 days), the patient should be encouraged to 'stand on his own two feet' to void and at least to walk around the bed with help. This counteracts regression, opposes depression, and is the beginning of physical and emotional rehabilitation.
The metabolic rate rises significantly with burns, and attains a maximum of twice normal when the extent of the burn reaches 60% of body surface. Meeting caloric requirements is imperative for good wound healing, and recent studies indicate that enteral feeding may protect against endotoxemia and is preferable to intravenous feeding. Burned patients are often aware of the odor of their secretions and feel queazy or lacking in appetite. Hypnosis is widely used to control the nausea associated with chemotherapy, and Crasilneck (Crasilneck et al., 1955) has reported a depleted burn patient who increased his oral intake to 8000 Kcal per day with hypnotic suggestions to eat everything on his plate.
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