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Chapter 24Chapter 24

Vitamins and Minerals

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Chapter 24

Lesson 24.1

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Learning ObjectivesLearning Objectives

• Identify the actions and indications for vitamins and minerals

• List at least six products used to treat vitamin or mineral deficiencies

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Vitamins Vitamins

• Natural chemical compounds found in animals and plants

• Dietary considerations

• Deficiencies

• Antioxidants

• MyPyramid

• Table 24-1

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Vitamin A Vitamin A

Action• Fat-soluble; aids visual adjustment; role in

cell membrane stabilization

Uses• Treat deficiencies, eye diseases, and night

blindness

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Vitamin A (cont.)Vitamin A (cont.)

Adverse Reactions • Hypervitaminosis

Drug Interactions• Oral contraceptives, mineral oil,

antihyperlipidemic drugs

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Vitamin A (cont.)Vitamin A (cont.)

Nursing Implications • Lifespan requirements• Routes for administration• Patient teaching: nutritional sources

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Vitamin B1 (Thiamine) Vitamin B1 (Thiamine)

Action• Water-soluble; coenzyme involved with

carbohydrate metabolism; role in neurology

Uses• Treatment of beriberi

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Vitamin B1 (Thiamine) (cont.)

Vitamin B1 (Thiamine) (cont.)

Adverse Reactions • Sensitivity reactions• Parenteral precautions

Drug Interactions• Poor stability with concurrent use of neutral or

alkaline solutions

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Vitamin B1 (Thiamine) (cont.)

Vitamin B1 (Thiamine) (cont.)

Nursing Implications and Patient Teaching• Food preparation• Dietary sources

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Vitamin B2 (Riboflavin) Vitamin B2 (Riboflavin)

Action• Water-soluble; precursor of two essential

enzymes that deal with metabolism of fats, proteins, and carbohydrates

• Related to the release of energy to cells• Active in the respiratory system

Uses• Deficiency

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Vitamin B2 (Riboflavin) (cont.)

Vitamin B2 (Riboflavin) (cont.)

Drug Interactions• Oral contraceptives

Nursing Implications and Patient Teaching• Storage• Change in urine color

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Niacin Niacin

Action• Water-soluble; part of two coenzyme systems

that transfer hydrogen in intracellular respiration

Uses• Prevent or treat deficiencies• Pellagra: symptoms

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Niacin (cont.)Niacin (cont.)

Adverse Reactions• Dry skin, pruritis, skin rash, GI disorders, allergies,

feelings of warmth, headache, tingling of the skin, transient flushing in the face and neck

Drug Interactions• Antihypertensives

Nursing Implications/Patient Teaching• Dietary sources

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Pantothenic Acid Pantothenic Acid

Action • Synthesis of coenzyme A; role in release of

energy in fats, proteins, and carbohydrates

Uses• Treatment of paralytic ileus

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Pantothenic Acid (cont.)Pantothenic Acid (cont.)

Nursing Implications and Patient Teaching• Food preparation• Dietary sources

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Vitamin B6 (Pyridoxine Hydrochloride)

Vitamin B6 (Pyridoxine Hydrochloride)

Action• Water-soluble; functions as coenzyme in

metabolism of protein, fats, and carbohydrates

Uses• Treat deficiencies due to inborn errors of

metabolism, such as vitamin B6 dependency, B6-responsive chronic anemia, and other rare vitamin problems

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Vitamin B6 (cont.) Vitamin B6 (cont.)

Adverse Reactions • None; pyridoxine dependency

Drug Interactions• Oral contraceptives; levodopa• Concurrent use with chloramphenicol may

prevent optic neuritis

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Vitamin B6 (cont.)Vitamin B6 (cont.)

Nursing Implications and Patient Teaching• Storage• Dietary sources• Food preparation

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Folic Acid (Vitamin B9)Folic Acid (Vitamin B9)

Action• Water soluble; required for normal erythropoiesis and

nucleoprotein synthesis• Metabolized in the liver and changed to an active form

Uses• Treat anemias caused by folic acid deficiencies; treat

alcoholism, hepatic disease, hemolytic anemia; supplemental during infancy (formula), lactation, oral contraceptive use, and pregnancy

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Folic Acid (cont.)Folic Acid (cont.)

Adverse Reactions

• Folic acid is not toxic • Allergic reaction may manifest as

bronchospasm, erythema, malaise, pruritis, or rash

Drug Interactions• Antagonists: chloramphenicol and methotrexate

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Folic Acid (cont.)Folic Acid (cont.)

Nursing Implications and Patient Teaching • RDA• Parenteral forms should be protected from light• Patient and family teaching: nutritional

counseling; laboratory monitoring; need for medical follow-up

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Vitamin B12Vitamin B12

Action• Water-soluble and contains cobalt; produced by

Streptomyces griseus; functions in fat, protein, and carbohydrate metabolism; part of the erythrocyte-maturing factor in the liver; required for DNA synthesis

Uses• Treats all B12 deficiencies, pernicious anemia, other anemias,

malabsorption syndromes, blind loop syndrome, pregnancy, chronic liver disease complicated by vitamin B12 deficiency, malignancy, thyrotoxicosis, renal disorders

• Used in the flushing dose in Schilling test

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Vitamin C Vitamin C

Action• Acts in several enzyme systems; involved in

intracellular oxidation-reduction potentials; aids in the change of folic acid and the metabolism of certain amino acids; aids in the absorption of calcium and iron; blocks the absorption of copper in the GI tract; protects vitamins A and E and polyunsaturated fatty acids; necessary for the formation of teeth, connective tissue, and capillaries for the synthesis of collagen; wound healing

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Vitamin D Vitamin D

Action and Uses• Fat-soluble• Three categories• Movement of calcium and phosphorus ions into small intestine,

kidneys, and bone• Used to treat childhood rickets, adult osteomalacia,

hypoparathyroidism, and familial hypophosphatemia

Adverse Reactions: Vitamin D toxicity

Nursing Implications and Patient Teaching

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Vitamin E Vitamin E

• Fat-soluble

• Functions are not understood

• Antioxidant: prevents cell membrane damage

• Stabilizes the RBC wall to protect against hemolysis or destruction

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Vitamin K Vitamin K

Action• Fat soluble; helps hepatic formation of active

prothrombin proconvertin, plasma thromboplastin component, and the Stuart factor

Uses• Treat or prevent blood-clotting disorders

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Chapter 24

Lesson 24.2

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Learning ObjectivesLearning Objectives

• Identify the actions and uses for minerals in the body

• List at least six supplements used to treat mineral deficiencies

• Prepare a teaching plan for patients who require mineral supplements

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Minerals Minerals

• 19 inorganic substances present in the body; 13 are essential to normal metabolism and function

• Ions: positive and negative charges

• Electrolytes

• Table 24-2

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Calcium Calcium

Action• Essential for muscular and neurologic activity; formation

and repair of skeletal tissues; activates several enzymes that influence cell membrane permeability and muscle contraction; aids in blood clotting; activates pancreatic lipase; influences intestinal absorption of cobalamin; involved in the transmission of neurotransmitters and in metabolic processes; regulation of lymphocyte and phagocyte function through interaction with calmodulin

Uses• Supplement when dietary levels are low

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Calcium (cont.)Calcium (cont.)

Adverse Reactions• Hypercalcemia symptoms

Drug Interactions• Vitamin D; phytic acid (found in bran and

whole-grain cereals)

Nursing Implications/Patient Teaching• Dietary sources

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Fluoride Fluoride

Action• Strengthens enamel

Uses• Reduces dental caries

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Fluoride (cont.)Fluoride (cont.)

Adverse Reactions• GI distress, urticaria, and malaise; excessive salivation,

mottling of teeth, GI disturbances, and nausea are seen with overdosage

Drug Interactions

Nursing Implications and Patient Teaching • Administration; avoid glass containers when diluting

fluoride; milk may decrease absorption

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Iron Iron

Action• An essential mineral for the synthesis of myoglobin and

hemoglobin; stimulates the hematopoietic system and increases hemoglobin to correct iron deficiency

Uses• Treatment of symptomatic iron deficiency; prevent

hypochromic anemia during infancy, childhood, pregnancy, and breastfeeding from other anemias; after some GI surgeries

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Iron (cont.)Iron (cont.)

Adverse Reactions

Drug Interactions

Nursing Implications and Patient Teaching• Nutritional sources, adverse effects

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Magnesium Magnesium

Action• Maintains osmotic pressure, ion balance, bone structure, muscular

contraction, and nerve conduction

Uses• Deficiencies

Adverse Reactions• Diarrhea

Nursing Implications and Patient Teaching• Cardiac monitoring• Nutrition

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Manganese Manganese

Action• Activates many enzymes, assists in normal skeletal

and connective tissue development, helps in the initiation of protein synthesis, and plays a part in the synthesis of cholesterol and fatty acids

Uses • Dietary supplements for multiple deficiencies• Natural sources of manganese

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Potassium Potassium

Action• Principle intracellular cation of most body

tissues; active in maintaining normal renal function, contraction of muscle, and transmission of nerve impulses

Uses• Prophylactic – nephrotic syndrome, hepatic

cirrhosis with ascites, hyperaldosteronism• Replacement therapy

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Potassium (cont.)Potassium (cont.)

Adverse Reactions• Nausea, vomiting, diarrhea, abdominal discomfort, GI

bleeding

Drug Interactions• Contraindications

Nursing Implications/Patient Teaching• Dilution and administration; monitoring of serum blood

levels; dietary sources

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Zinc Zinc

Action and Uses• Essential for normal growth and tissue repair, mineralization of

bone, detoxification, creation of DNA, synthesis of protein • Prevent zinc deficiency and aid wound healing

Adverse Reactions• GI, nausea and vomiting; excessive dosage; intoxication

Drug Interactions• Calcium

Nursing Implications/Patient Teaching• Dosing and nutrition

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Vitamin and Mineral Deficiencies Vitamin and Mineral Deficiencies

• Assessment

• Diagnosis

• Planning

• Implementation

• Evaluation

• Patient and family teaching