3Learning ObjectivesIdentify the actions and indications for vitamins and mineralsList at least six products used to treat vitamin or mineral deficiencies
4Vitamins Natural chemical compounds found in animals and plants Dietary considerationsDeficienciesAntioxidantsMyPyramidTable 24-1Vitamins are either fat-soluble (A, D, E, K) or water-soluble (B-complex, C).Why is it important for patients to have adequate vitamins in their diets?What conditions would prevent patients from receiving adequate sources of vitamins?When are supplemental vitamins recommended for daily use?What are examples of the benefits of antioxidant use?
5Vitamin AActionFat-soluble; aids visual adjustment; role in cell membrane stabilizationUsesTreat deficiencies, eye diseases, and night blindnessWhere in the body are sufficient stores of vitamin A found?What role does vitamin A play in preventing infection?Vitamin A is a fat-soluble vitamin that is absorbed in the intestine.What clinical conditions place the patient at an increased risk for vitamin A deficiency?
6Vitamin A (cont.) Adverse Reactions Drug Interactions Hypervitaminosis Oral contraceptives, mineral oil, antihyperlipidemic drugsWhat are the risks associated with too much vitamin A during pregnancy?What results if patients take vitamin A and oral contraceptive drugs concurrently?How do International Units (IU) compare to micrograms?
7Vitamin A (cont.) Nursing Implications Lifespan requirements Routes for administrationPatient teaching: nutritional sourcesHow do the daily requirements for pregnancy (second and third trimesters) compare to those for lactation?What foods are good sources of vitamin A?
8Vitamin B1 (Thiamine) Action Uses Water-soluble; coenzyme involved with carbohydrate metabolism; role in neurologyUsesTreatment of beriberiWhat are the different implications for the body of a fat- or water-soluble vitamin ?How is thiamine excreted?Which clinical conditions place the patient at risk for developing beriberi?What symptoms would the patient with vitamin B1 deficiency exhibit?
9Vitamin B1 (Thiamine) (cont.) Adverse ReactionsSensitivity reactionsParenteral precautionsDrug InteractionsPoor stability with concurrent use of neutral or alkaline solutions
10Vitamin B1 (Thiamine) (cont.) Nursing Implications and Patient TeachingFood preparationDietary sourcesWhat food sources are rich in thiamine? What food-preparation considerations should the thiamine-deficient patient be aware of?
11Vitamin B2 (Riboflavin) ActionWater-soluble; precursor of two essential enzymes that deal with metabolism of fats, proteins, and carbohydratesRelated to the release of energy to cellsActive in the respiratory systemUsesDeficiencyWhat are the symptoms common to riboflavin deficiency?
12Vitamin B2 (Riboflavin) (cont.) Drug InteractionsOral contraceptivesNursing Implications and Patient TeachingStorageChange in urine colorWhat is the relationship between riboflavin levels in the body and the length of time a patient has been taking oral contraceptives?What change in urine occurs with riboflavin supplements?
13NiacinActionWater-soluble; part of two coenzyme systems that transfer hydrogen in intracellular respirationUsesPrevent or treat deficienciesPellagra: symptomsWhat are the roles of the coenzyme systems?What dietary source may produce a deficiency state?The deficiency state is known as pellagra.
14Niacin (cont.) Adverse Reactions Drug Interactions Dry skin, pruritis, skin rash, GI disorders, allergies, feelings of warmth, headache, tingling of the skin, transient flushing in the face and neckDrug InteractionsAntihypertensivesNursing Implications/Patient TeachingDietary sourcesWhat is postural hypotension?What patient education should the LPN/LVN provide for patients taking niacin?
15Pantothenic Acid Action Uses Synthesis of coenzyme A; role in release of energy in fats, proteins, and carbohydratesUsesTreatment of paralytic ileusPantothenic acid is one of the water-soluble B vitamins.What procedure places the patient at risk for developing paralytic ileus?What nursing interventions prevent paralytic ileus?Deficiency states are produced only in the laboratory.
16Pantothenic Acid (cont.) Nursing Implications and Patient TeachingFood preparationDietary sourcesHow does the amount of pantothenic acid in human milk compare to that in cow’s milk? How is this important to an infant’s growth and development?What effects do boiling and freezing have on food sources of pantothenic acid?
17Vitamin B6 (Pyridoxine Hydrochloride) ActionWater-soluble; functions as coenzyme in metabolism of protein, fats, and carbohydratesUsesTreat deficiencies due to inborn errors of metabolism, such as vitamin B6 dependency, B6-responsive chronic anemia, and other rare vitamin problemsWhat populations are most likely to develop a B6 deficiency?What are the common symptoms seen in deficiency states?Good natural sources of vitamin B6 are yeast, wheat and whole grains, corn, egg yolk, liver, kidney, muscle meats, and soybeans.
18Vitamin B6 (cont.) Adverse Reactions Drug Interactions None; pyridoxine dependencyDrug InteractionsOral contraceptives; levodopaConcurrent use with chloramphenicol may prevent optic neuritisWhy would pyridoxine dependency occur?
19Vitamin B6 (cont.) Nursing Implications and Patient Teaching Storage Dietary sourcesFood preparationWhat impact does freezing have on pyridoxine?
20Folic Acid (Vitamin B9) Action Uses Water soluble; required for normal erythropoiesis and nucleoprotein synthesisMetabolized in the liver and changed to an active formUsesTreat anemias caused by folic acid deficiencies; treat alcoholism, hepatic disease, hemolytic anemia; supplemental during infancy (formula), lactation, oral contraceptive use, and pregnancyFor what other conditions would the use of folic acid supplements be indicated?Consider the importance of increased folic acid intake for women planning to become pregnant and during early pregnancy to prevent neural tube defects in the fetus. What is spina bifida?What is the relationship of homocysteine levels to the development of cardiovascular disease?
21Folic Acid (cont.) Adverse Reactions Drug Interactions Folic acid is not toxicAllergic reaction may manifest as bronchospasm, erythema, malaise, pruritis, or rashDrug InteractionsAntagonists: chloramphenicol and methotrexateHigh doses of folic acid may alter the color of urine.Which drugs may cause symptoms of folic acid deficiency?What effect is seen with the concurrent use of folic acid and anticonvulsants?
22Folic Acid (cont.) Nursing Implications and Patient Teaching RDA Parenteral forms should be protected from lightPatient and family teaching: nutritional counseling; laboratory monitoring; need for medical follow-upWhy are patients less likely to follow up vitamin/mineral deficiencies with their healthcare provider?
23Vitamin B12ActionWater-soluble and contains cobalt; produced by Streptomyces griseus; functions in fat, protein, and carbohydrate metabolism; part of the erythrocyte-maturing factor in the liver; required for DNA synthesisUsesTreats all B12 deficiencies, pernicious anemia, other anemias, malabsorption syndromes, blind loop syndrome, pregnancy, chronic liver disease complicated by vitamin B12 deficiency, malignancy, thyrotoxicosis, renal disordersUsed in the flushing dose in Schilling testWhat are the symptoms associated with deficiency of B12?When is Nascobal used as therapy for a patient with pernicious anemia?What is the route for administering this vitamin? (IM)What drugs may interact with vitamin B12?What type of permanent effects are seen in patients with B12 deficiency for longer than 3 months?
24Vitamin CActionActs in several enzyme systems; involved in intracellular oxidation-reduction potentials; aids in the change of folic acid and the metabolism of certain amino acids; aids in the absorption of calcium and iron; blocks the absorption of copper in the GI tract; protects vitamins A and E and polyunsaturated fatty acids; necessary for the formation of teeth, connective tissue, and capillaries for the synthesis of collagen; wound healingWhat is ascorbic acid? Is this a fat- or water-soluble vitamin?What clinical conditions would improve with vitamin C?Which foods are rich in vitamin C?The patient with scurvy will exhibit what symptoms?Which drugs interact with ascorbic acid to increase their effects?Vitamin C, like all water-soluble vitamins, is easily destroyed by exposure to air, heat and light. What information should nurses give their patients regarding storage and use of vitamins B and C?
25Vitamin D Action and Uses Adverse Reactions: Vitamin D toxicity Fat-solubleThree categoriesMovement of calcium and phosphorus ions into small intestine, kidneys, and boneUsed to treat childhood rickets, adult osteomalacia, hypoparathyroidism, and familial hypophosphatemiaAdverse Reactions: Vitamin D toxicityNursing Implications and Patient TeachingWhere are fat-soluble vitamins absorbed in the body?How does sunlight affect vitamin D?Which drugs interfere with the absorption of fat-soluble vitamins?Thiazide diuretics and vitamin D taken concurrently contribute to hypercalcemia.What type of symptoms would a patient with osteomalacia exhibit?
26Vitamin E Fat-soluble Functions are not understood Antioxidant: prevents cell membrane damageStabilizes the RBC wall to protect against hemolysis or destructionWhy is vitamin E considered an essential nutrient for humans?What is the relationship between high intake of vitamin E as tocopheral and Alzheimer’s disease?What are good dietary sources of vitamin E?Many suggested uses of vitamin E are controversial and unproved. The only established use is to prevent or treat vitamin E deficiency.
27Vitamin KActionFat soluble; helps hepatic formation of active prothrombin proconvertin, plasma thromboplastin component, and the Stuart factorUsesTreat or prevent blood-clotting disordersWhat is the primary action of vitamin K in the body?Why is this drug administered to newborns?If the patient were exhibiting adverse reactions to vitamin K, what symptoms would the nurse observe?What are the preferred routes of administration for vitamin K?If a patient is taking Coumadin, what dietary information would you offer related to vitamin K?
29Learning ObjectivesIdentify the actions and uses for minerals in the bodyList at least six supplements used to treat mineral deficienciesPrepare a teaching plan for patients who require mineral supplements
30Minerals19 inorganic substances present in the body; 13 are essential to normal metabolism and functionIons: positive and negative chargesElectrolytesTable 24-2When minerals act as a catalyst, what type of reaction occurs?What are the three mineral elements that are most frequently missing in the diet?Which ions are frequently involved with metabolic disturbances?
31CalciumActionEssential for muscular and neurologic activity; formation and repair of skeletal tissues; activates several enzymes that influence cell membrane permeability and muscle contraction; aids in blood clotting; activates pancreatic lipase; influences intestinal absorption of cobalamin; involved in the transmission of neurotransmitters and in metabolic processes; regulation of lymphocyte and phagocyte function through interaction with calmodulinUsesSupplement when dietary levels are lowCalcium is essential for proper myocardial function.Which populations are at risk for low calcium levels?Which drugs should not be combined with calcium and/or milk products?What is an example of a common over-the-counter preparation of calcium?How does the daily recommendation of calcium for infants compare to that of adults?What are common nutritional products high in calcium?
32Calcium (cont.) Adverse Reactions Drug Interactions Hypercalcemia symptomsDrug InteractionsVitamin D; phytic acid (found in bran and whole-grain cereals)Nursing Implications/Patient TeachingDietary sourcesWhat is the significance of vitamin D to calcium?How is the status of calcium influenced in the body?What two substances combine with calcium in the body to interfere with its absorption?
33Fluoride Action Uses Strengthens enamel Reduces dental caries What does it mean when fluoride is considered an essential trace element but not essential to life?Where in the body is fluoride concentrated?
34Fluoride (cont.) Adverse Reactions Drug Interactions GI distress, urticaria, and malaise; excessive salivation, mottling of teeth, GI disturbances, and nausea are seen with overdosageDrug InteractionsNursing Implications and Patient TeachingAdministration; avoid glass containers when diluting fluoride; milk may decrease absorptionThe preparation and quantity chosen should be adjusted to the fluoride level of the local water supply.
35IronActionAn essential mineral for the synthesis of myoglobin and hemoglobin; stimulates the hematopoietic system and increases hemoglobin to correct iron deficiencyUsesTreatment of symptomatic iron deficiency; prevent hypochromic anemia during infancy, childhood, pregnancy, and breastfeeding from other anemias; after some GI surgeriesWhat symptoms would you observe in the patient with iron deficiency anemia?
36Iron (cont.) Adverse Reactions Drug Interactions Nursing Implications and Patient TeachingNutritional sources, adverse effectsWhat dietary practices may contribute to iron deficiency?Iron absorption is increased when combined with ascorbic acid.Why would the absorption of oral iron be inhibited by antacids?Iron interferes with the absorption of tetracycline.What is the usual duration of iron therapy?The body has the capability to increase the absorption of iron during times of physiologic stress, such as pregnancy and severe blood loss.
37Magnesium Action Uses Adverse Reactions Maintains osmotic pressure, ion balance, bone structure, muscular contraction, and nerve conductionUsesDeficienciesAdverse ReactionsDiarrheaNursing Implications and Patient TeachingCardiac monitoringNutritionDeficiencies in magnesium may contribute to which form of cardiac dysrhythmia?What symptoms would you observe in a patient with magnesium deficiency?What food sources are rich in magnesium?
38ManganeseActionActivates many enzymes, assists in normal skeletal and connective tissue development, helps in the initiation of protein synthesis, and plays a part in the synthesis of cholesterol and fatty acidsUsesDietary supplements for multiple deficienciesNatural sources of manganeseThere are no known adverse effects or drug interactions.Nuts, whole-wheat cereals, and grains are the foods richest in manganese.
39PotassiumActionPrinciple intracellular cation of most body tissues; active in maintaining normal renal function, contraction of muscle, and transmission of nerve impulsesUsesProphylactic – nephrotic syndrome, hepatic cirrhosis with ascites, hyperaldosteronismReplacement therapyWhen is potassium used for replacement therapy?
40Potassium (cont.) Adverse Reactions Drug Interactions Nausea, vomiting, diarrhea, abdominal discomfort, GI bleedingDrug InteractionsContraindicationsNursing Implications/Patient TeachingDilution and administration; monitoring of serum blood levels; dietary sourcesWhat are the signs and symptoms associated with potassium intoxication?What are common cardiac symptoms seen with abnormal potassium levels?Aldosterone antagonists used concurrently with potassium contribute to what complication in the body?
41Zinc Action and Uses Adverse Reactions Drug Interactions Essential for normal growth and tissue repair, mineralization of bone, detoxification, creation of DNA, synthesis of proteinPrevent zinc deficiency and aid wound healingAdverse ReactionsGI, nausea and vomiting; excessive dosage; intoxicationDrug InteractionsCalciumNursing Implications/Patient TeachingDosing and nutritionWhat are common complaints the patient may have while taking zinc supplements?Why does the patient with a burn have a special requirement for zinc?What are the symptoms of zinc intoxication?What type of interaction occurs when calcium and zinc supplements are combined?
42Vitamin and Mineral Deficiencies AssessmentDiagnosisPlanningImplementationEvaluationPatient and family teachingWhy is it important for the nurse to discuss storage for these drug products?How will the LPN/LVN evaluate the effectiveness of vitamin and mineral therapy?What assessments beyond the patient’s medical condition should you include?Why is it important to assess the patient for multiple deficiencies?