Presentation on theme: "Developed by D. Ann Currie, R.N,M.S.N."— Presentation transcript:
1 Developed by D. Ann Currie, R.N,M.S.N. NutritionDevelopedby D. Ann Currie, R.N,M.S.N.
2 NutritionProper 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 fluidsTea ,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%
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 fluidsPedialyteEnteral feedingsTPN
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 doctor’s 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:30-35 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 LegumesNutsBrown riceWhole 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.10-20 % of total daily calories should be from protein.
26 Protein- Medication/Supplements Nutrition supplements:EnsureProtein shakesWhey productsProtein 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.
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. IV’s- 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.50-60% of total calories should come from carbohydrates.
34 Carbohydrates- Requirements Carbohydrates should come from:2-4 servings of fruits.3-5 servings of vegetables.6-11 servings of whole grains.Only a small amount from refined sugars.
35 Medications/ Supplements Dietary supplements- Ensure.IV Fluids- D5WTPN- 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. andCheck 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 IV’s 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.
41 Fats- Function in the Body Fat makes up part of the cell membranes.The lining around nerves.Steroid Hormones- Estrogen and testosterone.If women’s 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- RequirementsLess 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.
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-MI’s 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 VitaminsVitamins are organic compounds required by the body in small amounts for growth and normal metabolic processes.Vitamins- 13Types: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-DeficiencyA 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 productsIrradiated foodsLiverEgg yolksSalmonTuna fishSardinesCertain 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- DeficiencyLack of Vitamin D can lead to changes in serum calcium levels, rickets in children and osteomalacia in adults.
58 Vitamin D - ExcessToo 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 RBC’s.Prevents the destruction of certain fats including the lipid portions of cell membranes.
61 Vitamin E- Requirements Men and Women- 15mg.Lactation-19mg.
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- ExcessHigh 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.LiverOatmealSoy beansModerate amount in coffee.
69 Vitamin K-Medication and Supplements Phytonadione (AquaMEPHYTON )PO/IM/Subcutaneous1mcg/KgUse to Treat-Clients with clotting disorders, antidote for overdose of warfarin (coumadin), and prevent hemorrhagic disease in the newborn infant.
70 Vitamin K -DeficiencyA 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 proteinsPreservation 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 acidPO/IM/IVVitamin deficiency mg/dayBurns mg/day.
77 Vitamin C-DeficiencyMild deficiency: irritability, malaise, arthralagia, increased tendency to bleed.Severe deficiency: Scury: gingivitis, bleeding gums, Problems with skin, joints, and other areas.Poor wound healingAnemiaComaDeath
78 Causes of Vitamin C Deficiency Diet devoid of Fruits and Vegetables.Excess alcohol (ETOH) intakeElderly 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
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 liverEggsGreen leafy vegetables.Enriched breads and cereals.Brewer’s yeast.Salmon.Turkey.
90 VitaminB-2-Medication and Supplements Riboflavin(B-2)PO/IVDeficiency-5-10mg/day-POUsed to treat migraine headaches
91 Vitamin B-2-Deficiency Eye disorders-burning, itching, lacrimation, photophobia, and vascularization of the corneal.GlossitisStomatitisSeborrheic dermatitis
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.
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..
106 Nursing Interventions Assess dietary intake of Vitamin B-6Check 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 RBC’s.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 acidPO/IM/IV/subcutaneousDeficiency- 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.GlossitisGI 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 RBC’s.Healthy nervous systemRequirements-Women and Men mcg/day
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 SupplementsA 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 MineralsMacro 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-800-1200mg/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.NutsBeans- 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
129 Nursing Interventions PO- don’t 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/LNecessary 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.
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, Addison’s 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 monitorPO- give with least ½ cup of water or juiceDrug 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 functionWeaknessNausea/ vomitingDecreased B/PCauses: 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-0.5-2.0 mg/day. Necessary for carbohydrate (glucose) metabolism. Potentiates insulin.Helpful in controlling (noninsulin dependent diabetes) Type II diabetes.Food sources- Brewer’s 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-1.5-3 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. Menke’s disease.Excess- Wilson’s disease.
142 ZincMicro mineralRequirements- 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 metabolismNecessary for normal cell growth.Synthesis of RNA and DNAMaintains 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- 80-110 mEq/day- 750mg/day. Serum levels mEq/LMajor anion of body fluidsPart of gastric acid secretionHelps 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 hormonesFood sources- sea salt, and seafood.Iodine deficiency-Thyroid gland enlargement, goiter, possible hypothyroidismIodine excess- Iodism with coryza,edema, conjunctivitis, stomatits, and vomiting.
147 OTHER NUTRIENTSNutrients not discussed in this presentation check the text and web.
148 VegetariansPure 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.
149 REMEMBER: NUTRITION IS AN IMPORTANT PART OF HEALTH AND LIFE