Pain Control
Burn wounds of any degree are painful. The medical staff work to make pain management specific to each person's reaction to pain. Morphine is given through an IV during the first twenty-four to forty-eight hours after admission and surgery. Oral narcotics are used following this forty-eight hour period. Pain medication is administered throughout the day to the patient. As the grafted areas close and the donor sites heal, the need for pain medication decreases. It may be beneficial to the patient to take pain medication prior to physical and occupational therapy. Although therapy may be painful for the patient, it should never be avoided because it is essential for recovery. In addition, relaxation therapy, distraction, and imagery can be used as a supplement to pain medication.

Itching
As burn wounds heal, many patients experience itching and dryness of donor and grafted areas because these areas do not produce the necessary oils to lubricate the skin. The oil-producing glands have been destroyed from the initial injury to these areas. The skin may be dry, flaky, and itchy. Moisturizing lotions should be applied several times a day to those healed areas. Lotions and soaps that have perfume or alcohol in them should be avoided because they have a drying effect upon the skin. If the area is not lubricated, skin breakdown could result cause an infection or need for further skin grafting. An anti-itch medication may be prescribed to decrease the itching.

Physical Therapy and Occupational Therapy
Patients admitted to the Burn Treatment Center are evaluated by the occupational therapist and physical therapist. Burn injury places the patient at risk for scarring, contractures, and loss of joint and muscle function. These therapists and nursing staff work with patients and families to decrease these complications and to maximize recovery.

• Positioning - proper positioning of all body parts is begun at the time of admission. The purpose of good body position is to decrease tightening of joints and tissues and to prevent loss of normal range of motion. Skin that has been burned looses its normal elasticity (ability to stretch). Burned areas must continue to be stretched through positioning and exercise in order to avoid permanent loss of elasticity.

  A patient may be required to give up use of a pillow to ensure proper positioning for the neck and back. Arms and legs are elevated and placed in a straight position. Burned hands are often splinted to decrease loss of function. These positions may not be comfortable for the patient but are necessary to improve function in the injured areas.

• Splints - A splint is a device used to keep a body part in a fixed position. This fixed position keeps the body in the proper position for later movement. Splints can be made of plastic, metal, or plaster. Splints may also be used after surgery in order to immobilize a grafted area (for example, the arm and shoulder). The patient may be required to wear splints twenty-four hours a day.
• Exercise Program - Once the patient's condition has improved, vigorous daily therapy begins. The physical and occupational therapist develops an exercise program for each specific need. When appropriate, the patient is encouraged to walk, perform self-cares, feed him or herself, and use the bathroom. The Burn Treatment Center has one exercise room equipped with a variety of modern exercise devices. Exercises may be necessary for several months after discharge from the hospital.

Nutrition
During the first twenty-four to forty-eight hours of hospitalization, the stomach and intestines may reject food and liquids. This is normal and usually subsides within two to three days. At the same time, the body begins to use energy at a very rapid rate. The body requires a large amount of calories, protein, and fluids to heal burns, grafts, and donor sites.

The healthy adult needs 1,500 to 2000 calories a day while the burned adult may need twice that amount. To help meet these increased nutritional needs, a patient is encouraged to drink fluids containing calories and protein. Milk is offered throughout the day. Special burn malts that are high in calories and protein are also given. A patient is served three highprotein, high-calorie meals each day. It is important to note that since water has no protein or calories, water is not routinely given to patients because it fills them up but does not address their need for extra nutrition. Whenever possible, patient are instructed to feed themselves. Although this may be difficult or uncomfortable, self-feeding promotes a sense of self reliance and also provides mild exercise for the arms and hands.

Often the patient's food intake is recorded to assist the dietitian in determining if the patient is receiving adequate calories and protein. Family members are welcome to participate in this part of the patients care, and the dietitian or nurse will instruct them in this task.

Frequently, a patient loses his appetite or is unable to eat or drink enough to meet daily calorie and protein requirements. When this occurs, a small, soft nasogastric tube (NG) is inserted through the nose and down into the stomach. Special formula is given through the tube every hour. When the patient's appetite returns and calorie intake is adequate, the NG tube is removed.

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