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Nutrition Developed by D. Ann Currie, R.N,M.S.N..

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Presentation on theme: "Nutrition Developed by D. Ann Currie, R.N,M.S.N.."— Presentation transcript:

1 Nutrition Developed by D. Ann Currie, R.N,M.S.N.

2 Nutrition Proper nutrition is needed for maintaining health and preventing illness. It also helps with wound healing. A well balance diet helps in the care and treatment of many diseases and conditions. The nurse needs to understand how a diet can help the client to achieve a healthy lifestyle, and help in the healing process.

3 Recommended Dietary Allowances RDA- Amount of a nutrient need by a healthy individual. Requirements for nutrients may be increased during illness and other times such as periods of growth, pregnancy, and physical demands or stress.

4 Nutrients Nutrients are substances that are needed for: Cell growth, Cellular function, Enzyme activity, Carbohydrate/ fat/protein synthesis, Muscle contractions, Wound healing, Immune competence, and LIFE.

5 WATER H2O Water is not a nutrient but is needed for life. A human can only live 3-5 days without water, but days without food. Calories: 0

6 Water -Sources Tap water- Bottle water Fruits Vegetables Juices Some in meats, fish, gravies. IV fluids Tea,coffee and soda may have caffeine not good sources.

7 Water- Function in Body It is part of body fluids: Cellular fluids, blood, hormones, sweat, urine, tears, lymph. Lubricant. Adult body fluid volume: 60% Infant (newborn) body fluid volume: 77% Embryo: 90%

8 Adult Body Fluid Volume Intracellular ( cellular) fluid- ICF: 40% Extra cellular fluid-ECF: 20% Interstitial fluid (tissue spaces)- 15% Intravascular fluid (vascular fluid)-5%

9 Water- Requirements Depends on: Age Activity Temperature-both internal and external. Losses

10 Water -Requirements Adult- 30ml/Kg/day Adult of 70Kg X 30 ml.= 2100 ml/day. Or 15 ml/lb/day. Adult weighing 150 lbs. X 15 ml.= 2250ml /day. 6-8 glasses of water to 8-10 glasses of water per day. Hot climates 2-3liters per day.

11 Medications/Supplements Tap water. Gatorade- Sport drinks. IV fluids Pedialyte Enteral feedings TPN

12 Water-Deficit (not enough) FVD- Fluid Volume Deficit Dehydration Clinical manifestations: Weight loss Dry skin Dry mucous membranes Poor skin turgor- tenting. Decrease urine output

13 Normal Body Fluids Loses per day Urine: ml/day Sweat: ml/day Respirations: ml/day Stool: ml/day. Tears: small amount.

14 Increase Loses of Fluid Burns Sweating Fever Diarrhea Inadequate intake Diabetes-( Increased blood sugar) Caffeine EOTH- Alcohol Drugs- Diuretics

15 Water- Excess (Too much) Toxicity Fluid Volume Excess- FVE Edema Causes: Excess intake usually because of IV fluids. Renal failure Clinical manifestations: Weight gain. Hypertension-High B/P Edema- pitting vs Non-pitting Moist lung sounds ( crackles/ rales)

16 Nursing Interventions Monitor intake and output ( I&0) What goes IN:( I) Oral IV Fluids N/G Tubes. What goes OUT:( I) Emesis Urine Stool Drainage Bleeding

17 NSG. Interventions Diaper weight: 1 gram wt.=1 ml. This would go for dressings or pads too: A dressings weighing 10 grams=10 ml.of drainage or blood. Assess weight daily. Assess skin turgor. Listen to lung sounds. Check for edema. Provide fresh pitcher of water several times a day, for the client with no restrictions of fluid. Check the doctors order for IV rate. Monitor IV fluids carefully.

18 Calories- Requirements Adult calorie requirements are based are age, sex, activity level and need. Base adult calorie needs are: Calories per IBW ( Ideal body weight) Kg. (Kilograms) example: Adult who IBW is 58 Kg.: 58kgx 30 calories/Kg = 1740 calories/day. 58Kgx 35 calories/Kg=2030 calories/day. So the range would be calories per day.

19 Protein (Amino Acids) Calories: 4 calories per 1 gram

20 Protein-Food Sources Complete proteins come from animal sources: Diary Products- Cheese, Milk, Yogurt, Ice Cream. Meat. Fish. Poultry. Eggs.

21 Protein- Food Sources Incomplete proteins from plants sources: Beans Legumes Nuts Brown rice Whole grains and cereals. Soy products- Tofu

22 Protein- Food Sources Complementary Proteins: Beans and Rice. Whole grain macaroni and Cheese. Peanut butter and Whole grain bread.

23 Protein- Function in The Body Amino acids help to build and maintain all body tissues. Part of : Hormones. Blood. Antibodies. Albumin.

24 Protein- Function in the body Provides energy after carbohydrate and fat supplies are exhausted. Needed for growth and development of tissues. Wound healing.

25 Protein- Requirements Men: grams per day. Women: grams per day. Pregnant women: 60 grams per day. Increase requirements of protein are needed with illness and healing process % of total daily calories should be from protein.

26 Protein- Medication/Supplements Nutrition supplements: Ensure Protein shakes Whey products Protein bars. TPN (Total Parental Nutrition)-IV Central Line. (Place TPN on an infusion device.) Albumin. Enteral Feedings. –Feeding Tubes.

27 Protein-Deficit ( not enough) The lack of enough protein intake can lead to: In children effects growth. Anemia. Increase infections. Delayed wound healing.

28 Protein- Excess Increase weight gain. Renal/Kidney damage.

29 Nursing Interventions. Monitor Protein intake- Do hours dietary intake history. Monitor Lab tests: BUN- Low BUN can indicate low protein intake. Albumin- Low Albumin can also indicate low protein intake. Total Protein- Low Total Proteins can indicate low protein intake.

30 Carbohydrates Calories: Food-4 calories per 1 gram. IVs- 3.4 calories per 1 gram

31 Carbohydrates- Food Sources Refine sugars- White sugars, cane sugar, candy, etc. Fruits. Vegetables- Starchy vegetables. Beans. Nuts. Legumes. Whole grains. Rice. Oysters and clams. Some meats. Fiber is indigestible carbohydrates.

32 Carbohydrates-Function in the Body Carbohydrates are the main source of energy for the body. Maintains protein and fat balance.

33 Carbohydrates-Requirements Depends on: Size. Activity level. Age. Sex. If couch potato a person needs less. A client on bedrest needs less % of total calories should come from carbohydrates.

34 Carbohydrates- Requirements Carbohydrates should come from: 2-4 servings of fruits. 3-5 servings of vegetables servings of whole grains. Only a small amount from refined sugars.

35 Medications/ Supplements Dietary supplements- Ensure. IV Fluids- D5W TPN- Total Parental Nutrition. D5W- 5% Dextrose solution=5gramof glucose per 100ml. So a 1000ml bag of D5W = 50 grams of glucose. 50gramsx 3.4 calories/1 gram= 170 calories per bag.

36 Carbohydrate- Deficit A deficiency of carbohydrates in the diet can lead to: Weight loss. Hypoglycemia: Headache, confusion, tired, irritability, hungry, muscle wasting, ketoacidosis, and ketones in the urine.

37 Carbohydrate-Excess Too many carbohydrates in the diet can lead to: Weight gain. Hyperglycemia: Increase thirst, hungry, increase urination, dry skin, fruity breathe. Diabetes mellitus- increase blood sugar due to problem with insulin.

38 Carbohydrates Nursing Interventions Assess dietary intake of carbohydrates with a hours dietary history. Weight the client. IV- Check order for type of fluids. and Check rate. Place IV on infusion device. TPN- Total Parental Nutrition- Check order with two nurses. Check rate. Follow Protocol for TPN. Check blood sugars level as ordered. Place IV on infusion device. NPO- Nothing by mouth. Are calories coming from IVs or TPN?

39 Fats Calories: Food- 9 calories per 1 gram of fat. IV fluids- Intralipids: 10% solution=1.1calories per 1 ml. 20% solution= 2.2calories per 1 ml.

40 Fats- Food Sources Dietary- Butter. Oils- Animal sources and plant sources. Diary Products- Milk, Cheese, etc. Meats. Bacon- 1 slice= 1fat serving. Nuts. Avocados. IVs- Intralipids. TPN-Total Parental Nutrition.

41 Fats- Function in the Body Fat makes up part of the cell membranes. The lining around nerves. Steroid Hormones- Estrogen and testosterone. If womens body fat decreases below 18% they will stop menstruation and have fertility problems. Fat for padding for warmth in cold climates. Secondary source for energy.

42 Fats- Requirements Less than 30% of total calories should come from fats. (US government). According to AHA &ADA: No more than 30 grams of fat per day. People with Gall Bladder problems should have less than 20 grams of fat per day. No one under 4 years of age should be placed on a low fat diet.

43 Fats- Medications/Supplements IVs- Intralipids. TPN-Total Parental Nutrition. Dietary supplements.

44 Fat-Deficit Lack of fat in the diet can lead to: Weight loss. Decrease in hormone production. In children- neurological problems. Labs- decrease in cholesterol levels.

45 Fats- Excess Too much fat in the diet can lead to: Increase weight. High cholesterol levels and high triglycerides levels. CAD- Heart Disease-MIs or CVA- Strokes.

46 Fats- Nursing Interventions Assess dietary intake of fats with a hour diet history. Monitor cholesterol levels- LDH &HDH, Total cholesterol level and triglyceride levels. Monitor IV fats- Check order, rate, site, and I&O. Place Iv of infusion device. Weigh client.

47 Vitamins Vitamins are organic compounds required by the body in small amounts for growth and normal metabolic processes. Vitamins- 13 Types: Water soluble-Vitamin C and B complex. Fat soluble-Vitamins A, D, E, and K.

48 Vitamin A Fat soluble vitamin. Retinol Required for normal vision, growth, bone development, skin, and mucous membranes. Repair tissue especially epithelial cells. Requirements-Men mcg. Women mcg. Pregnancy-up to 800mcg. Lactation mcg.

49 Vitamin A- Food Sources Liver-Beef, Meat, butter, Fortified Margarine, egg yolks, cheeses, Whole milk, kidneys and fish oil. Dark green vegetables-spinach, kale, turnip greens, asparagus, and broccoli. Bright orange vegetables and fruits- carrots, sweet potatoes, pumpkin, cantaloupes, apricots, and peaches.

50 Vitamin A-Medication and Supplements Isotretinon (Accutane)-Acne, skin problems. Increase Vitamin A- Skin healing, Macro degeneration, Reversing Vitamin A deficiency,and some forms of leukemia. Vitamin A supplements should not be taken in megadoses.

51 Vitamin A-Deficiency A lack of Vitamin A can lead to vision problems- Night blindness, xerophthalmia, corneal ulcerations and blindness. Skin lesions and infections. Respiratory tract infections. Urinary calculi.

52 Vitamin A- Excess Hypervitamintosis A: Clinical manifestations: Anorexia, vomiting, irritability, skin changes, yellow- orange color of skin, Pain in muscle, joints and bones, enlargement of spleen and liver, Increased intracranial pressure and other neurological signs, weakness, decreased B/P, low WBC count, weight loss and Teratogenic effect in the fetus.

53 Nursing Interventions Assess dietary intake of Vitamin A. Teach clients to never take excess amounts of Vitamin A especially in children and pregnant women. Monitor amount of Vitamin A in supplements. Observe for signs of toxicity.

54 Vitamin D Fat soluble vitamin. Ergocalciferol -obtained from food. Cholecalciferol -formed by exposure of skin to sunlight. Necessary for the absorption of calcium. Helps to maintain healthy bone and teeth. Requirements-Men and women 5-15 mg.

55 Vitamin D- Food Sources Milk and some milk fat products Irradiated foods Liver Egg yolks Salmon Tuna fish Sardines Certain cereals. Also Sunshine.

56 Vitamin D Medication and Supplements Vitamin D supplements- Calcitriol( Rocaltrol, calcijex). Cholecalciferol (Delta-D) Multivitamins. Clients should not take mega doses of Vitamin D.

57 Vitamin D- Deficiency Lack of Vitamin D can lead to changes in serum calcium levels, rickets in children and osteomalacia in adults.

58 Vitamin D - Excess Too much Vitamin D can lead to hypercalcemia, calcification of soft tissues, cessation of life, and teratogenic effects in the fetus.

59 Nursing Interventions Monitor dietary intake of Vitamin D. Teach client not to take excess Vitamin D. No mega doses.

60 Vitamin E Fat soluble vitamin. Tocopherol Antioxidant. Maintains integrity of muscles and nerves. Protect other nutrients-especially Vitamins A & C. Helps with the formation of RBCs. Prevents the destruction of certain fats including the lipid portions of cell membranes.

61 Vitamin E- Requirements Men and Women- 15mg. Lactation-19mg.

62 Vitamin E- Food Sources Green leafy vegetables, Plant/Vegetable oils- seeds Butter Eggs Wheat germ Milk fat Cereals

63 Vitamin E- medication and Supplements Tocopherol (Aquasol E, Vita-Plus) PO/IM units/day

64 Vitamin E- Deficiency Vitamin E deficiency is rare. In adults only seen in severe malabsorption disorders. In premature neonates may lead to hemolytic anemia.

65 Vitamin E- Excess High doses- nausea, vomiting, fatigue, headaches blurred vision, diarrhea, In preterm infants- excess Vitamin E can cause : respiratory distress, liver failure, thrombocytopenia, and ascites.

66 Nursing Interventions Assess dietary intake of Vitamin E. Check dose of supplements. Teach clients not to take mega doses of Vitamin E.

67 Vitamin K Fat soluble vitamin. Phytonadione. Essential for normal blood clotting. Activates precursor proteins found in the liver into clotting factors ll, Vll, lX, and X. Requirements- Men & Women-65-70mcg. 1mcg/Kg.

68 Vitamin K- Food Sources Green Leafy Vegetables- Spinach, kale, turnip greens, broccoli, and green tea. Liver Oatmeal Soy beans Moderate amount in coffee.

69 Vitamin K-Medication and Supplements Phytonadione (AquaMEPHYTON ) PO/IM/Subcutaneous 1mcg/Kg Use to Treat-Clients with clotting disorders, antidote for overdose of warfarin (coumadin), and prevent hemorrhagic disease in the newborn infant.

70 Vitamin K -Deficiency A deficit of Vitamin K can lead to: Abnormal bleeding( melena, hematemesis, hetaturia, epistaxis, petechiae, ecchymoses, hypovolemic shock)

71 Vitamin K- Excess Too much Vitamin K can lead to excessive clotting. Antidote for an overdose of Vitamin K is Heparin. Clients on warfarin (Coumadin) Should not take Vitamin K supplements or eat too much Vitamin K high foods.

72 Nursing Interventions Assess dietary intake of Vitamin K. Check Vitamin K doses. Teach client on warfarin (Coumadin) not to eat excessive amounts of food high in Vitamin K. Know the antidote for overdose of Vitamin K is Heparin.

73 Vitamin C Water soluble vitamin. Ascorbic acid. Essential for the formation of skin, ligaments, cartilage, bone, and teeth. Required for wound healing and tissue repair. Metabolism of Iron and Folic acid. RBC formation. Synthesis of fats and proteins Preservation of blood vessel integrity. Resistance to infection. Collagen formation

74 Vitamin C- Requirements Men and Women-65-90mg/day. Lactation mg./day

75 Vitamin C Medications and Supplements Ascorbic acid PO/IM/IV Vitamin deficiency mg/day Burns mg/day.

76 Vitamin C- Food Sources Citrus fruits-oranges, lemons, limes, grapefruits. Tomatoes Strawberries Cantaloupes Green peppers Chili peppers** Raw Potatoes

77 Vitamin C-Deficiency Mild deficiency: irritability, malaise, arthralagia, increased tendency to bleed. Severe deficiency: Scury: gingivitis, bleeding gums, Problems with skin, joints, and other areas. Poor wound healing Anemia Coma Death

78 Causes of Vitamin C Deficiency Diet devoid of Fruits and Vegetables. Excess alcohol (ETOH) intake Elderly with limited diets. Chronic illness. Constance Stress.

79 Vitamin C- Excess Dirrhea Renal calculi In African Americans-retention of iron stores-iron toxicity.

80 Nursing Interventions Assess dietary intake of Vitamin C. Check dose of vitamin supplements. Caution overdoses of Vitamin C with African-Americans. Suggest Multivitamins for clients with poor diets- such as college students.

81 Vitamin B-1 Water soluble vitamin Thiamine Essential for maintaining of circulatory, digestion and nervous systems. A coenzyme in carbohydrate metabolism. Essential for energy production. Requirements mg/day for adults. Pregnancy and lactation-1.4mg/day

82 Vitamin B-1-Food Sources Meat, liver, poultry, fish, egg yolks, dried beans, whole grains, cereal products, and peanuts.

83 Vitamin B-1- Medications and Supplements Thiamine-(B-1) PO/IM/IV Deficiency- PO mg/day. IV mg/day until able to take orally. Deficiency is common in alcoholics.

84 Vitamin B-1- Deficiency Mild deficiency: fatigue, anorexia, retarded growth, mental depression, irritability, apathy, and lethargy. Severe deficiency: Beriberi (wet or dry)- peripheral neuritis, personality disturbances, confusion, tachycardia, enlarged heart, heart failure, muscle wasting edema, Wernicke-Korsakoff syndrome in alcoholics.

85 Vitamin B-1- Excess Rare Diarrhea Nausea/vomiting Increase urination.

86 Nursing Interventions Assess dietary intake of Vitamin B-1. Check IV dose. Infuse with IV pump.

87 Vitamin B-2 Water soluble vitamin. Riboflavin Essential for RBC and antibodies formation. A coenzyme in metabolism. Necessary for growth. Aids in building nerve structures. Helps cells to utilize oxygen.

88 Vitamin B-2- Requirements Women mg/day,prenancy- 1.4mg/day, lactation-1.6 mg/day. Men1.3mg/day. Vitamin deficiency-30-60mg/day.

89 Vitamin B-2-Food Sources Milk and milk products-cheddar and cottage cheeses. Meats- steak, beef liver Eggs Green leafy vegetables. Enriched breads and cereals. Brewers yeast. Salmon. Turkey.

90 VitaminB-2-Medication and Supplements Riboflavin(B-2) PO/IV Deficiency-5-10mg/day-PO Used to treat migraine headaches

91 Vitamin B-2-Deficiency Eye disorders-burning, itching, lacrimation, photophobia, and vascularization of the corneal. Glossitis Stomatitis Seborrheic dermatitis

92 Vitamin B-2-Excess Rare Nausea/vomiting Diarrhea Increase urination.

93 Nursing Interventions Assess dietary intake of Vitamin B-2. Check dose on supplement.

94 Vitamin B-3 Water soluble vitamin. Niacin Essential for glycolysis, fat synthesis, and tissue respiration. A coenzyme in many metabolic processes. Aids in circulation, growth of body tissues. Requirements-Women-14mg/day,pregnancy- 18mg/day,lactation-17-20mg/day. Men-16mg/day.

95 Vitamin-B-3-Food Sources Meat, poultry, fish, seafood, eggs. Whole grains, peanuts, legumes. Enriched cereals and breads.

96 Vitamin B-3- Medications and Supplements. Niacin (Nicotinic acid) Niacinamide (nicotinamide) PO Deficiency-PO mg/day Pellagra-PO-up to 500mg/day Hyperlipidemia- PO 2-6 grams /day- divided in 3 doses.

97 Vitamin B-3-Deficiency Pellagra: erythematous skin lesions, GI problems- stomatitis, glossitis, enteritis, and diarrhea. Nervous system problems- Headache, dizziness, insomnia, depression, and memory loss. Severe deficiency: delusions, hallucinations, impairment of peripheral motor and sensory nerves.

98 Vitamin B-3- Excess Rare Transient flushing, headaches, cramps, nausea/vomiting, increase blood sugar, and increase uric acid levels. Increased liver enzymes.

99 Nursing Interventions Assess dietary intake of Vitamin B-3. Monitor for toxicity with high doses.

100 Vitamin B-6 Water soluble vitamin Pyridoxine Essential for RNA and DNA synthesis. Critical for hemoglobin production. A coenzyme in metabolism of carbohydrate, protein, and fat formation. Helps to release glycogen from the liver and muscle tissue. Maintains antibody function. Balances nervous system function.

101 Vitamin-B-6-Requirements Women mg/day, pregnancy- 1.9mg/day, Lactation-2mg/day. Men mg/day

102 VitaminB-6-Food Sources Yeast, wheat germ, liver, glandular meats, whole grains and cereals, potatoes, legumes, and prunes..

103 Vitamin B-6- Medications and Supplements. Pyridoxine(B-6) PO/IM/IV Deficiency-2-5mg/day Anemia, peripheral neuritis mg/day. INH therapy mg/day.

104 Vitamin B-6-Deficiency Skin and mucous membrane leisions- seborrheic dermatisis, interrigo, glossitis, stomatitis. Neurologic problems-convulsions, peripheral neuritis and mental depression.

105 Vitamin B-6-Excess Ataxia Sensory neuropathies

106 Nursing Interventions Assess dietary intake of Vitamin B-6 Check dose on Vitamin B-6 supplements.

107 VitaminB-9 Water soluble vitamin Folic acid-(Folate) Essential for normal metabolism of all body cells. Needed for the formation of RBCs. Needed for nervous system formation. Requirements-Women and Men- 400mcg/day. Pregnancy mcg/day

108 VitaminB-9-Food Sources Liver, kidney and lima beans, dark green leafy vegetables( spinach, broccoli, asparagus), orange juice, fortified grain products-cereals and breads.

109 VitaminB-9- Medication and Supplements Folic acid PO/IM/IV/subcutaneous Deficiency- up to 1mg/day, when blood tests normal then 400mcg/day

110 Vitamin B-9-Deficiency Megaloblastic anemia and other blood disorders-Folic anemia. Elevated blood levels of homocysterine. Poor growth in children. Glossitis GI tract disturbances. Decrease intake during pregnancy can cause neural tube defects.

111 Vitamin B-9-Excess Rare Nausea/vomiting Diarrhea Increase urination Increase Folic acid intake with Dilantin will cause decrease effectiveness of the medication.

112 Nursing Intervention Asses dietary intake of Folic acid/Vitamin B-9. All women of childbearing age should take supplements of folic acid when pregnant. And Make sure they take in enough Folic acid contenting foods.

113 Vitamin-B-12 Water soluble vitamin Cyanocobalamin Essential for normal metabolism of all body cells. For the formation of RBCs. Healthy nervous system Requirements-Women and Men mcg /day

114 Vitamin B-12-Food Sources Liver, kidneys, milk, eggs, fish, cheese, muscle meats, cooked sea vegetables

115 Vitamin B-12-Medications and Supplements Cyanocobalamin PO/IM Nascobal-Intranasal gel,1 spray in one nostril, once a week Parental B-12 should be given for Pernicious anemia.

116 Vitamin B-12-Deficiency Pernicious anemia: megaloblasitc anemia, yellow skin, smooth red beefy tongue, neurological disorders-peripheral neuropathy.

117 Vitamin B-12-Excess Rare with dietary intake.

118 Nursing Interventions Assess for dietary intake of Vitamin B-12. Check dose/route with supplements. Folic acid supplements will mask the signs of anemia in pernicious anemia.

119 Vitamin Supplements A normal healthy individual who eats a well balanced diet does not need to take vitamin supplements. Vitamin supplements are required: During periods of increased growth, pregnancy, lactation, debilitating illnesses, inadequate dietary intake, fad diets (crash diets), and malabsorption processes.

120 Minerals Macro minerals-Need more than 100mg/day intake-Sodium, Potassium, Magnesium, Chloride, Calcium, etc. Micro minerals-Needs less than 100 mg/day intake-Iron, Chromium, Copper, Zinc, Iodine, Selenium, Fluoride, Cobalt, etc.

121 Calcium Macro mineral Requirements-Adults mg/day. Pregnancy mg/day. Lactation-1300mg/day. Needed for proper function of all body cells and tissue. Essential for formation of bones and teeth. Maintains blood clotting mechanism. Regulates heart beat. Regulates nerve conduction and muscle contractions. Serum level mg.

122 Calcium-Food Sources Diary products-milk, cheese, yogurt. Fish with bones- Sardines, salmon. Nuts Beans- Soy Products-Tofu. Green Leafy Vegetables. Fortified orange juice, cereals and breads.

123 Calcium- Deficiency Hypocalcemia- Serum level under 9 mg. Tetany, Dysrrhythmias, Pathological fractures of bones, Risk of bleeding, Brittle nails, Insomnia, Periodontal disease, Osteomalcia, Osteoporsis

124 Calcium-Excess Hypercalcemia- serum levels above 10.5 mg. Flaccid paralysis, Anorexia, Nausea/vomiting, Dysrrhythmias, Kidney stones. Polyuria.

125 Nursing Interventions IV calcium-infusion pump. Place client on EKG monitor, and Follow hospital policy.

126 Iron Micro mineral Requirements-Men mg./day Women mg. /day Pregnancy mg./day. Needed for formation of RBCs. Food sources-Organ meats-Livers, Red meat, Tuna fish, Beans, Nuts, Shellfish, Dried fruits- raisins, Dark molasses, Whole grains, Egg yolks, Red wine

127 Iron-Deficiency Microcytic anemia. Iron deficiency anemia. Weakness, Fatigue. Dizziness Altered immune response-increase risk of infections.

128 Iron-Excess Hemochromocytosis Iron Toxicity.

129 Nursing Interventions PO- dont give with milk or diary products or antiacids -Decreases absorption. Liquid-give through a straw-will stain teeth. IM- give deep IM-Z-track. IV- Give with infusion pump slowly. Watch for allergic reactions.

130 Potassium Macro mineral Requirements-Adults-2 grams Serum levels mEq/L Necessary for transmission and conduction of nerve impulses and contraction of skeletal, cardiac, and smooth muscles. For enzyme action used to change carbohydrates to energy and amino acids to protein.

131 Potassium- Food Sources Meat, Bran, Potatoes, Broccoli, Bananas, peanut butter, green leafy vegetables, avocadoes, orange juice.

132 Potassium-Deficiency Hypokalemia- serum level under 3.5 mEq/L. Muscle weakness Decreased reflexes Flaccid paralysis CNS depression EKG changes hypotension

133 Potassium- Excess Hyperkalemia- Serum levels above 5.0 mEq/L EKG changes, skeletal muscle weakness, bradycardia, cardiac arrest, oliguria, intestinal colic, diarrhea. Causes: Severe burns, crushing injuries, Addisons disease, renal failure, acidosis, Excessive intake usually from IV administration or oral supplements. Not from foods

134 Potassium- Nursing Interventions Monitor potassium levels (K) IV- monitor rate, place on IV infusion pump. Check kidney function. Med/Surg. Units no faster than 10 mEg/hr. For K runs-Place client on EKG monitor PO- give with least ½ cup of water or juice Drug interactions-diuretics (Lasix ) Decrease K levels and K sparing diuretics will Increase K levels.

135 Sodium Macro mineral Requirements-Adults- 500mg-4000mg- 2-4 grams Serum levels of sodium mEq/L. Necessary for normal nerve conduction and muscle contraction. Principal cation in extra cellular fluids. Essential for acid-base balance. Food sources- table salt, process foods ( such as can foods), soy sauce, seafood, cured meats, and even sodas.

136 Sodium- Deficiency Hyponatremia- Serum level under 136 mEq/L Decreased cerebral function Weakness Nausea/ vomiting Decreased B/P Causes: Sodium deficit, GI losses, diuretics, burns, water intoxication.

137 Sodium- Excess Hypernatremia-Serum levels above 145 mEq/L Edema, weight gain, increased B/P, fluid volume overload, thirst. Causes: Too much sodium intake, renal failure, cirrhosis, steroid therapy, aldosterone excess.

138 Sodium-Nursing Interventions Monitor sodium levels. Maintain I&O. Weight daily. IV fluid- Monitor rate and place IV on infusion pump. Listen to lung sounds.

139 Chromium Micro mineral Requirements- Adults mg/day. Necessary for carbohydrate (glucose) metabolism. Potentiates insulin. Helpful in controlling (noninsulin dependent diabetes) Type II diabetes. Food sources- Brewers yeast, oysters, liver, potatoes, seafood, whole grains, cheeses. poultry, bran, and lean meat.

140 Chromium-Cont. Deficiency- Impaired glucose tolerance( hyperglycemia, glycosuria), impaired growth and reproduction and decreased life span. Excess- not established.

141 Copper Micro mineral Requirement-Adult mg/day. Cofactor for hemoglobin synthesis. Needed for collagen formation. Food sources- oysters, shellfish, liver, nuts, cereals, poultry, dried fruits, and chocolate***. Prolonged copper deficiency may lead to anemia which is not corrected by taking just iron. Also neutropenia, leukopenia, osteoporosis, depigmentation of skin. Menkes disease. Excess- Wilsons disease.

142 Zinc Micro mineral Requirements- Adult-Men mg/day, Women mg/day, pregnancy- 15 mg/day. Food sources- meat, liver, eggs, seafood, wheat germ. A component of many enzymes that are essential for normal metabolism Necessary for normal cell growth. Synthesis of RNA and DNA Maintains health skin and mucous membranes, and aids in wound healing. Maintains growth of sexual organs. Needed for proper protein structures.

143 Chloride Macro mineral Requirements-Adult mEq/day- 750mg/day. Serum levels mEq/L Major anion of body fluids Part of gastric acid secretion Helps to maintain osmotic pressure and electrolyte, acid-base balance. Food sources-Table salt and foods containing NaCl

144 Chloride-Cont. Chloride deficiency- Hypochloridemia- serum levels under 90 mEq/L- Dehydration, Low B/P, low shallow respirations, paresthesias of face and extremities, muscle spasms and tetany. Chloride excess- Hyperchloridemia- Serum level above 110 mEq/L-increased rate and depth of respirations, lethargy, stupor, disorientation and coma.

145 Phosphorus Macro mineral Requirements-Adults-700mg. Forms bone matrix. Part of ATP and nucleic acids.

146 Iodine Micro mineral Requirements-Adults-150mcg/day Component of thyroid hormones Food sources- sea salt, and seafood. Iodine deficiency-Thyroid gland enlargement, goiter, possible hypothyroidism Iodine excess- Iodism with coryza, edema, conjunctivitis, stomatits, and vomiting.

147 OTHER NUTRIENTS Nutrients not discussed in this presentation check the text and web.

148 Vegetarians Pure vegetarian- Only eat food from plant sources; Vegetables, fruits, grains, legumes, and nuts. May need Vitamin B12 supplements. Lacto vegetarian- Eats vegetarian diet and milk and milk products-cheeses, yogurt, etc. Lacto ova vegetarian- eats vegetarian diet plus eggs and milk products.


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