Download Nutrition

Nutrition
Developed
by D. Ann Currie, R.N,M.S.N.
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.
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.
Nutrients
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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.
WATER
• H2O
• Water is not a nutrient but is needed for
life.
• A human can only live 3-5 days without
water, but 10-14 days without food.
• Calories: 0
Water -Sources
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Tap water- Bottle water
Fruits
Vegetables
Juices
Some in meats, fish, gravies.
IV fluids
Tea ,coffee and soda may have caffeine
not good sources.
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%
Adult Body Fluid Volume
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Intracellular ( cellular) fluid- ICF: 40%
Extra cellular fluid-ECF: 20%
Interstitial fluid (tissue spaces)- 15%
Intravascular fluid (vascular fluid)-5%
Water- Requirements
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Depends on:
Age
Activity
Temperature-both internal and external.
Losses
Water -Requirements
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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.
Medications/Supplements
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Tap water.
Gatorade- Sport drinks.
IV fluids
Pedialyte
Enteral feedings
TPN
Water-Deficit (not enough)
• Clinical
• FVD- Fluid Volume Deficit
manifestations:
• Dehydration
• Weight loss
• Dry skin
• Dry mucous
membranes
• Poor skin turgortenting.
• Decrease urine output
Normal Body Fluids
Loses per day
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Urine: 1000-1200 ml/day
Sweat: 400-500 ml/day
Respirations: 400-550 ml/day
Stool: 100-200 ml/day.
Tears: small amount.
Increase Loses of Fluid
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Burns
Sweating
Fever
Diarrhea
Inadequate intake
Diabetes-( Increased
blood sugar)
• Caffeine
• EOTH- Alcohol
• Drugs- Diuretics
Water- Excess (Too much)
Toxicity
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Fluid Volume ExcessFVE
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)
Nursing Interventions
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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
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.
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 1740-2030 calories per
day.
Protein
(Amino Acids)
• Calories: 4 calories per 1 gram
Protein-Food Sources
• Complete proteins come from animal
sources:
• Diary Products- Cheese, Milk, Yogurt, Ice
Cream.
• Meat.
• Fish.
• Poultry.
• Eggs.
Protein- Food Sources
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Incomplete proteins from plants sources:
Beans
Legumes
Nuts
Brown rice
Whole grains and cereals.
Soy products- Tofu
Protein- Food Sources
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Complementary Proteins:
Beans and Rice.
Whole grain macaroni and Cheese.
Peanut butter and Whole grain bread.
Protein- Function in The Body
• Amino acids help to build and maintain all
body tissues.
• Part of :
• Hormones.
• Blood.
• Antibodies.
• Albumin.
Protein- Function in the body
• Provides energy after carbohydrate and fat
supplies are exhausted.
• Needed for growth and development of
tissues.
• Wound healing.
Protein- Requirements
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Men: 50-60 grams per day.
Women: 40-50 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.
Protein- Medication/Supplements
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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.
Protein-Deficit ( not enough)
• The lack of enough protein intake can lead
to:
• In children effects growth.
• Anemia.
• Increase infections.
• Delayed wound healing.
Protein- Excess
• Increase weight gain.
• Renal/Kidney damage.
Nursing Interventions.
• Monitor Protein intake- Do 24-48 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.
Carbohydrates
• Calories:
• Food-4 calories per 1 gram.
• IV’s- 3.4 calories per 1 gram
Carbohydrates- Food Sources
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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.
Carbohydrates-Function in the
Body
• Carbohydrates are the main source of
energy for the body.
• Maintains protein and fat balance.
Carbohydrates-Requirements
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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.
Carbohydrates- Requirements
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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.
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.
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.
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.
Carbohydrates Nursing
Interventions
• Assess dietary intake of carbohydrates with a
24-48 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 IV’s or TPN?
Fats
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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.
Fats- Food Sources
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DietaryButter.
Oils- Animal sources and plant sources.
Diary Products- Milk, Cheese, etc.
Meats.
Bacon- 1 slice= 1fat serving.
Nuts.
Avocados.
IV’s- Intralipids.
TPN-Total Parental Nutrition.
Fats- Function in the Body
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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.
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.
Fats- Medications/Supplements
• IV’s- Intralipids.
• TPN-Total Parental Nutrition.
• Dietary supplements.
Fat-Deficit
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Lack of fat in the diet can lead to:
Weight loss.
Decrease in hormone production.
In children- neurological problems.
Labs- decrease in cholesterol levels.
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 CVAStrokes.
Fats- Nursing Interventions
• Assess dietary intake of fats with a 24-48
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.
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 .
Vitamin A
• Fat soluble vitamin.
• Retinol
• Required for normal vision, growth, bone
development, skin, and mucous
membranes. Repair tissue especially
epithelial cells.
• Requirements-Men-600-900mcg.
• Women750-770mcg. Pregnancy-up to
800mcg. Lactation-1200-1300mcg.
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 fruitscarrots, sweet potatoes, pumpkin,
cantaloupes, apricots, and peaches.
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.
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.
Vitamin A- Excess
• Hypervitamintosis A:
• Clinical manifestations: Anorexia,
vomiting, irritability, skin changes, yelloworange 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.
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.
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.
Vitamin D- Food Sources
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Milk and some milk fat products
Irradiated foods
Liver
Egg yolks
Salmon
Tuna fish
Sardines
Certain cereals.
Also Sunshine.
Vitamin D Medication and
Supplements
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Vitamin D supplementsCalcitriol( Rocaltrol, calcijex).
Cholecalciferol (Delta-D)
Multivitamins.
Clients should not take mega doses of
Vitamin D.
Vitamin D- Deficiency
• Lack of Vitamin D can lead to changes in
serum calcium levels, rickets in children
and osteomalacia in adults.
Vitamin D - Excess
• Too much Vitamin D can lead to
hypercalcemia, calcification of soft tissues,
cessation of life, and teratogenic effects in
the fetus.
Nursing Interventions
• Monitor dietary intake of Vitamin D.
• Teach client not to take excess Vitamin D.
No mega doses.
Vitamin E
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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.
Vitamin E- Requirements
• Men and Women- 15mg.
• Lactation-19mg.
Vitamin E- Food Sources
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Green leafy vegetables,
Plant/Vegetable oils- seeds
Butter
Eggs
Wheat germ
Milk fat
Cereals
Vitamin E- medication and
Supplements
• Tocopherol (Aquasol E, Vita-Plus)
• PO/IM 60-70 units/day
Vitamin E- Deficiency
• Vitamin E deficiency is rare.
• In adults only seen in severe
malabsorption disorders.
• In premature neonates may lead to
hemolytic anemia.
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.
Nursing Interventions
• Assess dietary intake of Vitamin E.
• Check dose of supplements.
• Teach clients not to take mega doses of
Vitamin E.
Vitamin K
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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.
Vitamin K- Food Sources
• Green Leafy Vegetables- Spinach, kale,
turnip greens, broccoli, and green tea.
• Liver
• Oatmeal
• Soy beans
• Moderate amount in coffee.
Vitamin K-Medication and
Supplements
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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.
Vitamin K -Deficiency
• A deficit of Vitamin K can lead to:
Abnormal bleeding( melena,
hematemesis, hetaturia, epistaxis,
petechiae, ecchymoses, hypovolemic
shock)
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.
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.
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
Vitamin C- Requirements
• Men and Women-65-90mg/day.
• Lactation-115-120 mg./day
Vitamin C Medications and
Supplements
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Ascorbic acid
PO/IM/IV
Vitamin deficiency-100-500mg/day
Burns-500-2000mg/day.
Vitamin C- Food Sources
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Citrus fruits-oranges, lemons, limes, grapefruits.
Tomatoes
Strawberries
Cantaloupes
Green peppers
Chili peppers**
Raw Potatoes
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
Causes of Vitamin C Deficiency
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Diet devoid of Fruits and Vegetables.
Excess alcohol (ETOH) intake
Elderly with limited diets.
Chronic illness.
Constance Stress.
Vitamin C- Excess
• Dirrhea
• Renal calculi
• In African Americans-retention of iron
stores-iron toxicity.
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.
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- 1-1.2 mg/day for adults.
• Pregnancy and lactation-1.4mg/day
Vitamin B-1-Food Sources
• Meat, liver, poultry, fish, egg yolks, dried
beans, whole grains, cereal products, and
peanuts.
Vitamin B-1- Medications and
Supplements
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Thiamine-(B-1)
PO/IM/IV
Deficiency- PO 10-30 mg/day.
IV-50-100mg/day until able to take orally.
Deficiency is common in alcoholics.
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.
Vitamin B-1- Excess
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Rare
Diarrhea
Nausea/vomiting
Increase urination.
Nursing Interventions
• Assess dietary intake of Vitamin B-1.
• Check IV dose. Infuse with IV pump.
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.
Vitamin B-2- Requirements
• Women- 1-1.1 mg/day,prenancy1.4mg/day, lactation-1.6 mg/day.
• Men1.3mg/day.
• Vitamin deficiency-30-60mg/day.
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.
• Brewer’s yeast.
• Salmon.
• Turkey.
VitaminB-2-Medication and
Supplements
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Riboflavin(B-2)
PO/IV
Deficiency-5-10mg/day-PO
Used to treat migraine headaches
Vitamin B-2-Deficiency
• Eye disorders-burning, itching, lacrimation,
photophobia, and vascularization of the
corneal.
• Glossitis
• Stomatitis
• Seborrheic dermatitis
Vitamin B-2-Excess
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Rare
Nausea/vomiting
Diarrhea
Increase urination.
Nursing Interventions
• Assess dietary intake of Vitamin B-2.
• Check dose on supplement.
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,pregnancy18mg/day,lactation-17-20mg/day.
• Men-16mg/day.
Vitamin-B-3-Food Sources
• Meat, poultry, fish, seafood, eggs.
• Whole grains, peanuts, legumes.
• Enriched cereals and breads.
Vitamin B-3- Medications and
Supplements.
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Niacin (Nicotinic acid)
Niacinamide (nicotinamide)
PO
Deficiency-PO 50-100mg/day
Pellagra-PO-up to 500mg/day
Hyperlipidemia- PO 2-6 grams /daydivided in 3 doses.
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.
Vitamin B-3- Excess
• Rare
• Transient flushing, headaches, cramps,
nausea/vomiting, increase blood sugar,
and increase uric acid levels.
• Increased liver enzymes.
Nursing Interventions
• Assess dietary intake of Vitamin B-3.
• Monitor for toxicity with high doses.
Vitamin B-6
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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.
Vitamin-B-6-Requirements
• Women-1.2-1.5mg/day, pregnancy1.9mg/day, Lactation-2mg/day.
• Men-1.3-1.7mg/day
VitaminB-6-Food Sources
• Yeast, wheat germ, liver, glandular meats,
whole grains and cereals, potatoes,
legumes, and prunes..
Vitamin B-6- Medications and
Supplements.
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Pyridoxine(B-6)
PO/IM/IV
Deficiency-2-5mg/day
Anemia, peripheral neuritis-50-200mg/day.
INH therapy-25-500mg/day.
Vitamin B-6-Deficiency
• Skin and mucous membrane leisionsseborrheic dermatisis, interrigo, glossitis,
stomatitis.
• Neurologic problems-convulsions,
peripheral neuritis and mental depression.
Vitamin B-6-Excess
• Ataxia
• Sensory neuropathies
Nursing Interventions
• Assess dietary intake of Vitamin B-6
• Check dose on Vitamin B-6 supplements.
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 Men400mcg/day. Pregnancy-600-800mcg/day
VitaminB-9-Food Sources
• Liver, kidney and lima beans, dark green
leafy vegetables( spinach, broccoli,
asparagus), orange juice, fortified grain
products-cereals and breads.
VitaminB-9- Medication and
Supplements
• Folic acid
• PO/IM/IV/subcutaneous
• Deficiency- up to 1mg/day, when blood
tests normal then 400mcg/day
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.
Vitamin B-9-Excess
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Rare
Nausea/vomiting
Diarrhea
Increase urination
Increase Folic acid intake with Dilantin will
cause decrease effectiveness of the
medication.
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.
Vitamin-B-12
• Water soluble vitamin
• Cyanocobalamin
• Essential for normal metabolism of all
body cells.
• For the formation of RBC’s.
• Healthy nervous system
• Requirements-Women and Men-2.4-3 mcg
/day
Vitamin B-12-Food Sources
• Liver, kidneys, milk, eggs, fish, cheese,
muscle meats, cooked sea vegetables
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.
Vitamin B-12-Deficiency
• Pernicious anemia: megaloblasitc anemia,
yellow skin, smooth red beefy tongue,
neurological disorders-peripheral
neuropathy.
Vitamin B-12-Excess
• Rare with dietary intake.
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.
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.
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.
Calcium
•
•
•
•
•
•
•
•
•
•
Macro mineral
Requirements-Adults-800-1200mg/day.
Pregnancy-1000-1300mg/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-9-10.5 mg.
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.
Calcium- Deficiency
•
•
•
•
•
•
•
•
•
•
Hypocalcemia- Serum level under 9 mg.
Tetany,
Dysrrhythmias,
Pathological fractures of bones,
Risk of bleeding,
Brittle nails,
Insomnia,
Periodontal disease,
Osteomalcia,
Osteoporsis
Calcium-Excess
• Hypercalcemia- serum levels above 10.5
mg.
• Flaccid paralysis,
• Anorexia,
• Nausea/vomiting,
• Dysrrhythmias,
• Kidney stones.
• Polyuria.
Nursing Interventions
• IV calcium-infusion pump. Place client on
EKG monitor, and Follow hospital policy.
Iron
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Micro mineral
Requirements-Men-10-12 mg./day
Women-10-15 mg. /day
Pregnancy-27-30 mg./day.
Needed for formation of RBC’s.
Food sources-Organ meats-Livers,
Red meat,
Tuna fish,
Beans,
Nuts,
Shellfish,
Dried fruits- raisins,
Dark molasses,
Whole grains,
Egg yolks,
Red wine
Iron-Deficiency
•
•
•
•
•
•
Microcytic anemia.
Iron deficiency anemia.
Weakness,
Fatigue.
Dizziness
Altered immune response-increase risk of
infections.
Iron-Excess
• Hemochromocytosis
• Iron Toxicity.
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.
Potassium
•
•
•
•
Macro mineral
Requirements-Adults-2 grams
Serum levels- 3.5-5.0 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.
Potassium- Food Sources
Meat, Bran, Potatoes, Broccoli, Bananas,
peanut butter, green leafy vegetables,
avocadoes, orange juice.
Potassium-Deficiency
• Hypokalemia- serum level under 3.5
mEq/L.
• Muscle weakness
• Decreased reflexes
• Flaccid paralysis
• CNS depression
• EKG changes
• hypotension
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
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.
Sodium
•
•
•
•
•
Macro mineral
Requirements-Adults- 500mg-4000mg2-4 grams
Serum levels of sodium- 136-145 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.
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.
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.
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.
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.
Chromium-Cont.
• Deficiency- Impaired glucose tolerance(
hyperglycemia, glycosuria) , impaired
growth and reproduction and decreased
life span.
• Excess- not established.
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.
Zinc
• Micro mineral
• Requirements- Adult-Men- 12-15 mg/day, Women-11-13
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.
Chloride
Macro mineral
Requirements-Adult- 80-110 mEq/day750mg/day.
Serum levels-90-110 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
Chloride-Cont.
• Chloride deficiency- Hypochloridemiaserum levels under 90 mEq/LDehydration, Low B/P, low shallow
respirations, paresthesias of face and
extremities, muscle spasms and tetany.
• Chloride excess- HyperchloridemiaSerum level above 110 mEq/L-increased
rate and depth of respirations, lethargy,
stupor, disorientation and coma.
Phosphorus
•
•
•
•
Macro mineral
Requirements-Adults-700mg.
Forms bone matrix.
Part of ATP and nucleic acids.
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.
OTHER NUTRIENTS
• Nutrients not discussed in this
presentation check the text and web.
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.
REMEMBER: NUTRITION IS
AN IMPORTANT PART OF
HEALTH AND LIFE