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

NutritionNutrition

Developed Developed

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

NutritionNutrition

• 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 AllowancesRecommended 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

• 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.

WATERWATER

• 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 -SourcesWater -Sources

• Tap water- Bottle water• Fruits• Vegetables• Juices• Some in meats, fish, gravies.• IV fluids• Tea ,coffee and soda may have caffeine

not good sources.

Water- Function in BodyWater- 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 VolumeAdult Body Fluid Volume

• Intracellular ( cellular) fluid- ICF: 40%

• Extra cellular fluid-ECF: 20%

• Interstitial fluid (tissue spaces)- 15%

• Intravascular fluid (vascular fluid)-5%

Water- RequirementsWater- Requirements

• Depends on:

• Age

• Activity

• Temperature-both internal and external.

• Losses

Water -RequirementsWater -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.

Medications/SupplementsMedications/Supplements

• Tap water.

• Gatorade- Sport drinks.

• IV fluids

• Pedialyte

• Enteral feedings

• TPN

Water-Deficit (not enough)Water-Deficit (not enough)

• FVD- Fluid Volume Deficit

• Dehydration

• Clinical manifestations:

• Weight loss• Dry skin• Dry mucous

membranes• Poor skin turgor-

tenting. • Decrease urine output

Normal Body Fluids Normal Body Fluids Loses per dayLoses 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 FluidIncrease Loses of Fluid

• Burns• Sweating• Fever• Diarrhea• Inadequate intake• Diabetes-( Increased

blood sugar)• Caffeine• EOTH- Alcohol• Drugs- Diuretics

Water- Excess (Too much)Water- Excess (Too much)ToxicityToxicity

• Fluid Volume Excess-

• FVE

• Edema

• Causes:

• Excess intake usually

because of IV fluids.

Renal failure

• Clinical manifestations:

• Weight gain.• Hypertension-High

B/P• Edema- pitting vs• Non-pitting• Moist lung sounds• ( crackles/ rales)

Nursing InterventionsNursing Interventions

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

NSG. InterventionsNSG. 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- RequirementsCalories- 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.

ProteinProtein(Amino Acids)(Amino Acids)

• Calories: 4 calories per 1 gram

Protein-Food SourcesProtein-Food Sources

• Complete proteins come from animal sources:

• Diary Products- Cheese, Milk, Yogurt, Ice Cream.

• Meat.

• Fish.

• Poultry.

• Eggs.

Protein- Food SourcesProtein- Food Sources

• Incomplete proteins from plants sources:

• Beans

• Legumes

• Nuts

• Brown rice

• Whole grains and cereals.

• Soy products- Tofu

Protein- Food SourcesProtein- Food Sources

• Complementary Proteins:

• Beans and Rice.

• Whole grain macaroni and Cheese.

• Peanut butter and Whole grain bread.

Protein- Function in The BodyProtein- Function in The Body

• Amino acids help to build and maintain all body tissues.

• Part of :

• Hormones.

• Blood.

• Antibodies.

• Albumin.

Protein- Function in the bodyProtein- Function in the body

• Provides energy after carbohydrate and fat supplies are exhausted.

• Needed for growth and development of tissues.

• Wound healing.

Protein- RequirementsProtein- 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- Medication/SupplementsProtein- Medication/Supplements

• Nutrition supplements:• Ensure• Protein shakes• Whey products• Protein bars.• TPN (Total Parental Nutrition)-IV Central Line.

(Place TPN on an infusion device.)• Albumin.• Enteral Feedings. –Feeding Tubes.

Protein-Deficit ( not enough)Protein-Deficit ( not enough)

• The lack of enough protein intake can lead to:

• In children effects growth.

• Anemia.

• Increase infections.

• Delayed wound healing.

Protein- ExcessProtein- Excess

• Increase weight gain.

• Renal/Kidney damage.

Nursing Interventions.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.

CarbohydratesCarbohydrates

• Calories:

• Food-4 calories per 1 gram.

• IV’s- 3.4 calories per 1 gram

Carbohydrates- Food SourcesCarbohydrates- 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.

Carbohydrates-Function in the Carbohydrates-Function in the BodyBody

• Carbohydrates are the main source of energy for the body.

• Maintains protein and fat balance.

Carbohydrates-RequirementsCarbohydrates-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.

Carbohydrates- RequirementsCarbohydrates- 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/ SupplementsMedications/ 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- DeficitCarbohydrate- 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-ExcessCarbohydrate-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 Carbohydrates Nursing InterventionsInterventions

• 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?

FatsFats

• 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 SourcesFats- Food Sources

• Dietary-• Butter.• 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 BodyFats- 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- RequirementsFats- 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/SupplementsFats- Medications/Supplements

• IV’s- Intralipids.

• TPN-Total Parental Nutrition.

• Dietary supplements.

Fat-DeficitFat-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- ExcessFats- 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.

Fats- Nursing InterventionsFats- 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.

VitaminsVitamins

• 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 AVitamin 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 SourcesVitamin 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.

Vitamin A-Medication and Vitamin A-Medication and SupplementsSupplements

• 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-DeficiencyVitamin 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- ExcessVitamin 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.


• 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 DVitamin 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 SourcesVitamin 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 Vitamin D Medication and SupplementsSupplements

• Vitamin D supplements-

• Calcitriol( Rocaltrol, calcijex).

• Cholecalciferol (Delta-D)

• Multivitamins.

• Clients should not take mega doses of Vitamin D.

Vitamin D- DeficiencyVitamin D- Deficiency

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

Vitamin D - ExcessVitamin D - Excess

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


• Monitor dietary intake of Vitamin D.

• Teach client not to take excess Vitamin D. No mega doses.

Vitamin EVitamin 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.

Vitamin E- RequirementsVitamin E- Requirements

• Men and Women- 15mg.

• Lactation-19mg.

Vitamin E- Food SourcesVitamin E- Food Sources

• Green leafy vegetables,

• Plant/Vegetable oils- seeds

• Butter

• Eggs

• Wheat germ

• Milk fat

• Cereals

Vitamin E- medication and Vitamin E- medication and SupplementsSupplements

• Tocopherol (Aquasol E, Vita-Plus)

• PO/IM 60-70 units/day

Vitamin E- DeficiencyVitamin 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- ExcessVitamin 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.


• Assess dietary intake of Vitamin E.

• Check dose of supplements.

• Teach clients not to take mega doses of Vitamin E.

Vitamin KVitamin 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.

Vitamin K- Food SourcesVitamin 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 Vitamin K-Medication and SupplementsSupplements

• 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 -DeficiencyVitamin K -Deficiency

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

Vitamin K- ExcessVitamin 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.


• 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 CVitamin 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- RequirementsVitamin C- Requirements

• Men and Women-65-90mg/day.

• Lactation-115-120 mg./day

Vitamin C Medications and Vitamin C Medications and SupplementsSupplements

• Ascorbic acid

• PO/IM/IV

• Vitamin deficiency-100-500mg/day

• Burns-500-2000mg/day.

Vitamin C- Food SourcesVitamin C- Food Sources

• Citrus fruits-oranges, lemons, limes, grapefruits.• Tomatoes• Strawberries• Cantaloupes• Green peppers• Chili peppers**• Raw Potatoes

•

Vitamin C-DeficiencyVitamin 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 DeficiencyCauses of Vitamin C Deficiency

• Diet devoid of Fruits and Vegetables.

• Excess alcohol (ETOH) intake

• Elderly with limited diets.

• Chronic illness.

• Constance Stress.

Vitamin C- ExcessVitamin C- Excess

• Dirrhea

• Renal calculi

• In African Americans-retention of iron stores-iron toxicity.


• 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-1Vitamin 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 SourcesVitamin B-1-Food Sources

• Meat, liver, poultry, fish, egg yolks, dried beans, whole grains, cereal products, and peanuts.

Vitamin B-1- Medications and Vitamin B-1- Medications and SupplementsSupplements

• 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- DeficiencyVitamin 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- ExcessVitamin B-1- Excess

• Rare

• Diarrhea

• Nausea/vomiting

• Increase urination.


• Assess dietary intake of Vitamin B-1.

• Check IV dose. Infuse with IV pump.


• 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- RequirementsVitamin B-2- Requirements

• Women- 1-1.1 mg/day,prenancy-1.4mg/day, lactation-1.6 mg/day.

• Men1.3mg/day.

• Vitamin deficiency-30-60mg/day.


• 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 VitaminB-2-Medication and SupplementsSupplements

• Riboflavin(B-2)

• PO/IV

• Deficiency-5-10mg/day-PO

• Used to treat migraine headaches

Vitamin B-2-DeficiencyVitamin B-2-Deficiency

• Eye disorders-burning, itching, lacrimation, photophobia, and vascularization of the corneal.

• Glossitis

• Stomatitis

• Seborrheic dermatitis

Vitamin B-2-ExcessVitamin B-2-Excess

• Rare

• Nausea/vomiting

• Diarrhea

• Increase urination.



• Check dose on supplement.


• 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.

Vitamin-B-3-Food SourcesVitamin-B-3-Food Sources

• Meat, poultry, fish, seafood, eggs.

• Whole grains, peanuts, legumes.

• Enriched cereals and breads.

Vitamin B-3- Medications and Vitamin B-3- Medications and Supplements.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.


• 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- ExcessVitamin B-3- Excess

• Rare

• Transient flushing, headaches, cramps, nausea/vomiting, increase blood sugar, and increase uric acid levels.

• Increased liver enzymes.



• Monitor for toxicity with high doses.


• 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-RequirementsVitamin-B-6-Requirements

• Women-1.2-1.5mg/day, pregnancy-1.9mg/day, Lactation-2mg/day.

• Men-1.3-1.7mg/day

VitaminB-6-Food SourcesVitaminB-6-Food Sources

• Yeast, wheat germ, liver, glandular meats, whole grains and cereals, potatoes, legumes, and prunes..

Vitamin B-6- Medications and Vitamin B-6- Medications and Supplements.Supplements.

• Pyridoxine(B-6)

• PO/IM/IV

• Deficiency-2-5mg/day

• Anemia, peripheral neuritis-50-200mg/day.

• INH therapy-25-500mg/day.


• Skin and mucous membrane leisions-seborrheic dermatisis, interrigo, glossitis, stomatitis.

• Neurologic problems-convulsions, peripheral neuritis and mental depression.


• Ataxia

• Sensory neuropathies


• Assess dietary intake of Vitamin B-6

• Check dose on Vitamin B-6 supplements.

VitaminB-9VitaminB-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 SourcesVitaminB-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 VitaminB-9- Medication and SupplementsSupplements

• Folic acid

• PO/IM/IV/subcutaneous

• Deficiency- up to 1mg/day, when blood tests normal then 400mcg/day


• 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.


• Rare

• Nausea/vomiting

• Diarrhea

• Increase urination

• Increase Folic acid intake with Dilantin will cause decrease effectiveness of the medication.

Nursing InterventionNursing 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-12Vitamin-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


• Liver, kidneys, milk, eggs, fish, cheese, muscle meats, cooked sea vegetables

Vitamin B-12-Medications and Vitamin B-12-Medications and SupplementsSupplements

• Cyanocobalamin

• PO/IM

• Nascobal-Intranasal gel,1 spray in one nostril, once a week

• Parental B-12 should be given for Pernicious anemia.


• Pernicious anemia: megaloblasitc anemia, yellow skin, smooth red beefy tongue, neurological disorders-peripheral neuropathy.


• Rare with dietary intake.


• 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 SupplementsVitamin 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.

MineralsMinerals

• 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.

CalciumCalcium

• 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 SourcesCalcium-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- DeficiencyCalcium- Deficiency

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

Calcium-ExcessCalcium-Excess

• Hypercalcemia- serum levels above 10.5 mg.

• Flaccid paralysis,• Anorexia,• Nausea/vomiting,• Dysrrhythmias,• Kidney stones.• Polyuria.


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

IronIron

• 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-DeficiencyIron-Deficiency

• Microcytic anemia.

• Iron deficiency anemia.

• Weakness,

• Fatigue.

• Dizziness

• Altered immune response-increase risk of infections.

Iron-ExcessIron-Excess

• Hemochromocytosis

• Iron Toxicity.


• 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.

PotassiumPotassium

• 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 SourcesPotassium- Food Sources

Meat, Bran, Potatoes, Broccoli, Bananas, peanut butter, green leafy vegetables, avocadoes, orange juice.

Potassium-DeficiencyPotassium-Deficiency

• Hypokalemia- serum level under 3.5 mEq/L.

• Muscle weakness • Decreased reflexes• Flaccid paralysis• CNS depression• EKG changes• hypotension

Potassium- ExcessPotassium- 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 InterventionsPotassium- 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.

SodiumSodium

• 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), soy sauce, seafood, cured meats, and even sodas.

Sodium- DeficiencySodium- 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- ExcessSodium- 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 InterventionsSodium-Nursing Interventions

• Monitor sodium levels.

• Maintain I&O.

• Weight daily.

• IV fluid- Monitor rate and place IV on infusion pump.

• Listen to lung sounds.

ChromiumChromium

• 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.Chromium-Cont.

• Deficiency- Impaired glucose tolerance( hyperglycemia, glycosuria) , impaired growth and reproduction and decreased life span.

• Excess- not established.

CopperCopper

• 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.

ZincZinc

• 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.

ChlorideChloride

Macro mineralRequirements-Adult- 80-110 mEq/day-

750mg/day.Serum levels-90-110 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

Chloride-Cont.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.

PhosphorusPhosphorus

• Macro mineral

• Requirements-Adults-700mg.

• Forms bone matrix.

• Part of ATP and nucleic acids.

IodineIodine

• 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 NUTRIENTSOTHER NUTRIENTS

• Nutrients not discussed in this presentation check the text and web.

VegetariansVegetarians

• 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:REMEMBER: NUTRITIONNUTRITION IS IS AN AN IMPORTANTIMPORTANT PART OF PART OF

HEALTHHEALTH AND AND LIFELIFE

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

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