David Bray, a 42-year-old man, has been admitted to intensive care. He suffered a severe burn covering 35 percent of his body when he was trapped inside a burning building. His wife told the nurse that Mr. Bray's height is 6 feet and that he usually weighs about 175 pounds. The physician ordered lab work, including serum protein concentrations, but the results are not yet available.
1. Identify Mr. Bray's immediate needs after the injury. Describe the initial concerns of the health care team and the measures they might take soon after Mr. Bray's arrival at the hospital.
2. Considering Mr. Bray's condition, what problems might the health care team encounter when they attempt to obtain information that can help them assess his nutrition status? What additional concerns might they have if Mr. Bray was malnourished before he experienced the burn?
3. Estimate Mr. Bray's energy and protein needs (use a protein factor of 2.0 grams per kilogram of body weight). What problems may interfere with Mr. Bray's ability to meet his nutrient needs?
4. After Mr. Bray transitions to oral feedings, he is able to obtain only 65 percent of his energy requirements. What other feeding options may be considered?