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NUTRITION
ISLAMIC UNIVERSITY – NURSING COLLEGE
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

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

Tap water- Bottle water

Fruits

Vegetables

Juices

Some in meats, fish, gravies ‫مرق اللحم‬.

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

Intracellular (cellular) fluid- ICF: 40%

Extra cellular fluid-ECF: 20%

Interstitial fluid (tissue spaces): 15%

Intravascular fluid (vascular fluid): 5%
Water- Requirements

Depends on:

Age.

Activity.

Temperature-both internal and external.

Losses.
Water -Requirements

Adult- 30ml/Kg/day.

Adult of 70Kg X 30 ml.= 2100 ml/day.

6-8 glasses of water to 8-10 glasses of
water per day.

Hot climates 2-3liters per day.
Water-Deficit (not enough)
Fluid Volume
Deficit (FVD)
lead to:
 Dehydration







Clinical manifestations:
Weight loss
Dry skin
Dry mucous membranes
Poor skin turgor- tenting.
Decrease urine output
Normal Body Fluids
Loses per day

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

Burns

Sweating

Fever

Diarrhea

Inadequate intake

Diabetes-( Increased blood
sugar)

Caffeine

Drugs- Diuretics
Water- Excess (Too much)
Toxicity

Fluid Volume Excess(FVE).

Clinical manifestations:
Edema


Causes:


Excess intake usually
because of IV fluids.
Renal failure.
Weight gain.
Hypertension-High B/P
Edema- pitting vs Nonpitting
Moist lung sounds
( crackles/ rales)




Nursing Interventions
Monitor intake and output ( I&0)
 What goes IN the body:( I)
 Oral
 IV Fluids
 N/G Tubes.
 What goes OUT the body:( I)
 Emesis
 Urine
 Stool
 Drainage
 Bleeding

Nursing 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.
Nursing Interventions

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 on 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.
 Chicken.
 Eggs.

Protein- Food Sources
Incomplete: proteins from plants
sources:
 Beans ‫البقوليات‬
 Legumes
 Nuts
 Brown rice
 Whole grains and cereals.
 Soy products.

Protein- Food Sources

Complementary (balanced) Proteins:

Beans and Rice.

Whole grain macaroni and Cheese.

Peanut butter ‫ زبدة الفول السوداني‬and 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

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-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 ????. Atkins Diet
Renal/Kidney damage.
Nursing Interventions.

Monitor Protein intake- Do 24-48 hours dietary intake
history.


Monitor Lab tests:
BUN (Blood Urea Nitrogen)- 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

Each gram of regular table sugar contains
4 calories. Each teaspoons of sugar
contain about 4 grams.
Carbohydrates- Food Sources

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

Refine sugars- White sugars, cane sugar ‫قصب السكر‬,
etc.
Fruits.
Vegetables- Starchy vegetables.
Beans. ‫البقوليات‬
Nuts. ‫المكسرات الجوز والبندق وغيرها‬
Legumes.‫البقوليات‬
Whole grains.
Rice.
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

Depends on:

Size.

Activity level.

Age.

Sex.

“If sweat potato a person needs less “.

A client on bedrest needs less.

50-60% of total calories should come from
carbohydrates.
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.
Medications/ Supplements

Dietary supplements- Ensure.

IV Fluids- D5W

TPN- Total Parental Nutrition.

D5W- 5% Dextrose solution=5 gram of glucose per
100ml. So a 1000ml bag of D5W = 50 grams of glucose.

50grams x 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.

Carbohydrates Nursing Interventions

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

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

Dietary:

Butter.

Oils- Animal sources and plant sources.

Diary Products- Milk, Cheese, etc.

Meats.

Nuts.

Avocados.

IV’s- Intralipids.

TPN-Total Parental Nutrition.
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.
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.
AHA ( American Heart Association)
Fats- Medications/Supplements

IV’s- Intralipids.

TPN-Total Parental Nutrition.

Dietary supplements.
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.
Fats- Excess

Too much fat in the diet can lead to:

Increase weight.

High cholesterol levels and high
triglycerides levels.

Cardiac diseases - Heart Disease-MI’s or
CVA-Strokes.
Fats- Nursing Interventions

Assess dietary intake of fats with a 24-48 hour
diet history.

Monitor cholesterol levels- LDL &HDL, 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 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, turnip greens
‫ورق اللفت‬, asparagus ‫الهليون‬, and broccoli.

Bright orange vegetables and fruits-carrots,
sweet potatoes, pumpkin ‫اليقطينة‬, cantaloupes,
apricots ‫المشمش‬, and peaches ‫الخوخ‬.
Vitamin A-Medication and Supplements

Isotretinon (Accutane)-Acne, skin
problems. (squamous-cell carcinoma)

Increase Vitamin A- Skin healing, Macro
degeneration, Reversing Vitamin A
deficiency, and some forms of leukemia.

Vitamin A supplements should not be
taken in mega-doses.
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, 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.
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 (vitamin D )- obtained from food.

Cholecalciferol (vitamin D ) - formed by exposure of
2
3
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

Milk and some milk fat products

Irradiated foods

Liver

Egg yolks

Salmon, Tuna fish, Sardines

Certain cereals.

Also Sunshine.
Vitamin D Medication and Supplements

Vitamin D supplements:

Calcitriol( 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

Fat soluble vitamin.

Tocopherol Vit. E (sources are olive and sunflower oils)

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

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

Fat soluble vitamin.

Phytonadione.Vit. K

Essential for normal blood clotting.

Activates precursor (originator) proteins found in the
liver into clotting factors ll,Vll, lX, and X (
2,7,9,10)

.
Requirements- Men & Women-65-70mcg.
1mcg/Kg.
Vitamin K- Food Sources

Green Leafy Vegetables- Spinach, kale, turnip
greens, broccoli, and green tea.

Liver

Oatmeal‫دقيق الشوفان‬

Soy beans ‫فول الصويا‬

Moderate amount in coffee.
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.
Vitamin K -Deficiency

A deficit of Vitamin K can lead to:
Abnormal bleeding( melena, hematemesis,
hematuria, epistaxis, petechiae, purpura
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

Ascorbic acid

PO/IM/IV

Vitamin deficiency-100-500mg/day

Burns-500-2000mg/day.
Vitamin C- Food Sources

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

Diet lacking of Fruits and Vegetables.

Excess alcohol intake.

Elderly with limited diets.

Chronic illness.

Constance Stress.
Vitamin C- Excess

Diarrhea

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.

Suggest Multivitamins for clients with poor
diets- such as college students.
Vitamin B-1Thiamine.

Water soluble vitamin.

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

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. It mainly causes vision changes, ataxia and impaired memory

Wet beriberi affects the cardiovascular system.

Dry beriberi affect the nervous system.
Beriberi
Vitamin B-1- Excess

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 Riboflavin

Water soluble vitamin.

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

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

Rare

Nausea/vomiting

Diarrhea

Increase urination.

Nursing Interventions

Assess dietary intake of Vitamin B-2.

Check dose on supplement.
Vitamin B-3 Niacin

Water soluble vitamin.

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.

Niacin (Nicotinic acid)

Niacinamide (nicotinamide)

PO

Deficiency-PO 50-100mg/day

Pellagra-PO-up to 500mg/day

Hyperlipidemia- PO 2-6 grams
/day- divided 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.
Pellagra
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 Pyridoxine

Water soluble vitamin

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
(liver, kidney, brains etc..), whole
grains and cereals,
potatoes, legumes, and prunes..
‫القراصيا‬
Vitamin B-6- Medications and
Supplements.

Pyridoxine(B-6)

PO/IM/IV

Deficiency-2-5mg/day

Anemia, peripheral neuritis-50-200mg/day.
Vitamin B-6-Deficiency

Skin and mucous membrane leisionsseborrheic dermatisis, interrigo, glossitis,
stomatitis.

Neurologic problems-convulsions,
peripheral neuritis and mental depression.
seborrheic dermatisis
interrigo
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 Men- 400mcg/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.

Poor growth in children.

Glossitis

GI tract disturbances.

Decrease intake during pregnancy can cause neural tube
defects.
Vitamin B-9-Excess

Rare

Nausea/vomiting

Diarrhea

Increase urination

Increase Folic acid intake with Dilantin (used for
treatment of epilepsy)
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.

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 (promote short-term weight loss) (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 100mg/day
intake-Iron, Chromium, Copper, Zinc, Iodine,
Selenium, Fluoride, 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.
‫‪Tofu‬‬
‫‪‬‬
‫القيمة الغذائية للتوفو ‪:‬‬
‫التوفو غني بالبروتينات واالحماض األمينية األساسية‪ ،‬وهو أيضا ً مصدر‬
‫جيد للحديد وفيتامين ب ‪ ،‬والكالسيوم (إذا استعمل في صناعته ملح‬
‫الكالسيوم)‪ .‬يحتوي على دسم غير مشبع وهو خالي من الكوليسترول‪ .‬كما‬
‫أنه فقير بالملح لذلك يمثل غذاء جيدا ً لمن تتطلب حالتهم الصحية حمية‬
‫قليلة الملح‪ .‬ويحتوي التوفو ايضا على عناصرغذائية أخرى مثل البروتين‬
‫‪ ،‬الكربوهيدرات ‪ ،‬الشحوم ‪ ،‬والصوديوم ‪ ،‬واأللبان والكالسيوم والحديد ‪.‬‬
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
• Red meat,

Requirements-Men-10-
• Tuna fish,
12 mg./day
• Beans,

Women-10-15 mg. /day

Pregnancy-27-30
mg./day.

Needed for formation of
RBC’s.

Food sources-Organ
meats-Livers,
• 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.

Normal value of iron
Iron: 60-170 mcg/dL (micrograms per
deciliter)
 TIBC: 240-450 mcg/dL
 Transferrin saturation: 20-50%

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 normal 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
Addison disease

Chronic adrenal insufficiency, hypocortisolism,
and hypoadrenalism) is a rare, chronic endocrine
system disorder in which the adrenal glands do not produce
sufficient steroid hormones (glucocorticoids and
mineralocorticoids). It is characterized by a number of
relatively nonspecific symptoms, such as abdominal pain and
weakness, but under certain circumstances, these may
progress to Addisonian crisis, a severe illness which may
include very low blood pressure and coma.
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 runsPlace 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-4000mg-

2-4 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
‫)المحفوظ‬, soy
‫الطعام‬
sauce ‫صلصة الصويا‬, seafood, cured meats ‫اللحم المحفوظ‬,
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 ‫المحار‬, liver, potatoes,
seafood, whole grains, cheeses. poultry, bran, and lean meat
low fat.
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.
Copper cont…
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.
It is an x-linked
recessive disorder CCC by growth failure, hypotonia brittle hair
Excess- Wilson’s disease.
autosomal recessive genetic disorder
in which copper accumulates in tissues; this manifests as neurological
or psychiatric symptoms
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/day- 750mg/day.

Serum levels-90-110 mEq/L

Major anion of body fluids

Part of gastric acid secretion

Helps to maintain osmotic pressure and electrolyte, acidbase balance.

Food sources-Table salt and foods containing NaCl
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.
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.
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.
‫‪Selenium‬‬
‫هو عنصر كيميائي رقمة الذرى ‪ 34‬ورمزه الكيميائي ‪Se‬‬
‫‪ ‬مضاد لألكسدة يتسبب نقصه في زيادة نسبة التعرض‬
‫للسرطانات‪ .‬وهو عنصر طبيعي معدني من العناصر‬
‫التي تتوزع على نطاق واسع في الطبيعة في معظم‬
‫الصخور والتربة‬
‫‪ ‬ان السيلينيوم في الغذاء يأتي من المكسرات‪ ،‬الحبوب‪،‬‬
‫اللحوم‪ ،‬الفطر‪ ،‬األسماك والبيض‪ .‬المكسرات البرازيلية‬
‫هي من أغنى المصادر‪ .‬بالترتيب التنازلي نجد‬
‫السيلينيوم بكميات كبيرة في الكلى‪ ،‬التونة‪ ،‬السلطعون‬
‫وسرطان البحر‪.‬‬
‫‪‬‬
REMEMBER: NUTRITION IS AN
IMPORTANT PART OF HEALTH
AND LIFE
Thank You