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What is the DRI? Pg 212
- Dietary Reference Intake: they are nutrient recommendations
- Dietary Reference Intake- recommended amount of vitamin and minerals developed to replace the RDA
How can you explain adequate intake (AI), estimated average requirement (EAR), recommended dietary allowance RDA and the tolerable upper intake level (UL)? Pg 212
- AI: Adequate Intake- the amount determined in the absence of scientific information that is sufficient, based on data that seems to maintain a healthy status.
- EAR: Estimated Average Requirement- the amount thought to provide a sufficient intake in one half of healthy persons in a defined group.
- RDA: Recommended Dietary Allowance- the amount thought to provide the needs of 98% of well children and adults of specific age group and gender; RDA's established in 1989 were developed to prevent deficiencies and may not be reflective of all groups, such as older adults so it was replaced by the DRI.
- UL: Tolerable Upper Intake Level- the maximum amount considered not likely to be a risk for healthy people in a specified group; this is NOT recommended level to take.
How would the nurse use the USDA MyPyramid to educate clients on healthy nutrition? Pg 212
What would be the justification for vitamin supplements?
- Table 15-1 pg 212
- 1. inadequate absorption: Eg 1. Malabsorption, 2. Diarrhea, 3. infectious diseases, 4. inflammatory diseases (e.g. Crohn's and celiac)
- 2. inability to use vitamins: Eg 1. liver disease (cirrhosis, hepatitis), 2. renal disease, 3. certain hereditary deficiencies
- 3. increased vitamin losses: Eg 1. fever from infectious process, 2. Hyperthyroidism, 3. Hemodialysis, 4. Hemodialysis, 5. Cancer, 6. Starvation, 7. crash diets
- 4. increased vitamin requirements: Eg 1. early childhood, 2. Pregnancy, 3. debilitating disease (cancer, alcoholism), 4. gastrointestinal surgery, 5. special diets
- Vitamins deficiencies can cause cellular and organ dysfunction that may result in slow recovery from illness.
What are the two categories of vitamins?
What are fat-soluble vitamins?
- Vitamins that are metabolized slowly and are stored in fatty tissue, liver and muscle in larges amounts. They are excreted in urine slowly
What foods contain vitamin A? D? E? K?
- Table 15-2 pg 213
- A: fruits, yellow and green leafy vegetables, fish, and dairy products. Natural vit A found only in animal sources cod, halibut, shark & tuna
- D: fortified milk, egg yolk, tuna, salmon & liver; dairy products and nonhydrogenated margarine
- E: whole-grain cereals, whet germ, veggie oils, lettuce, sunflower seeds, milk, eggs, meat, avocado & asparagus; oils, nonhydrogenated margarine, milk, grains, and meats
- K: Leafy green veggies, liver, cheese, egg yolk, veggie oil & tomatoes; green leafy vegetables, meats, eggs, and dairy products
What is vitamin A essential for and what happens when the body is deficient in this vitamin?
Development & maintenance of healthy eyes, gums, teeth, skin, hair and some glands. Also needed for fat metabolism. Causes: dry skin, poor teeth development, night blindness.
How can vitamin A be replaced pharmaceutically?
Vitamin A is given IM to pts who are acutely ill and patients refractory to the oral route such as those with GI malabsorption syndrome
Where is vitamin A stored and what are the signs of toxicity?
- Stored in liver, kidneys and fat
- Signs of toxicity: leukopenia, aplastic anemia, papilledema, increased intracranial pressure, hypervitaminosis A, bulging fontanelles in infants, jaundice
- Hypervitaminosis A symptoms include hair loss, peeling skin, anorexia, abdominal pain, lethargy, nausea, and vomiting
What is vitamin D essential for and what happens when the body is deficient in this vitamin?
- Essential for regulating calcium and phosphorous metabolism and needed for calcium absorption from the intestines. Important for strong bones and teeth.
- Deficiency causes: rickets in children and osteomalacia in adults
How can vitamin D be replaced pharmaceutically?
- There are two kinds of vitamin Ds
- 1. vitamin D2, ergocalciferol--synthetic fortified
- 2. vitamin D3, cholecalciferol--a natural form influenced by ultraviolet sunlight through the skin, OTC are D3
Where is vitamin D stored and what are the signs of toxicity?
- Stored in liver, kidneys and fat
- Signs of toxicity: anorexia, nausea, and vomiting
- Toxicity will cause hypervitaminosis D and may cause hypercalcemia (an elevated calcium serum level)
What is vitamin E essential for and what happens when the body is deficient in this vitamin?
- It has antioxidant properties that protect cellular components from being oxidized and ref blood cells from hemolysis.
- Deficiency causes breakdown of red blood cells
How can vitamin E be replaced pharmaceutically?
People who suffer from Alzheimer's and Parkinson's take vitamin E for its antioxidant (clearing of free radicals) effect?
Where is vitamin E stored and what are the signs of toxicity?
- It is stored in all tissues, especially the liver, muscles, and fatty tissue. 75% of it is excreted in bile.
- Signs of toxicity: fatigue, weakness, nausea, GI upset, headache, and breast tenderness
- *Vitamin E may prolong prothrombin time and must be monitored for people taking warfarin?
What is vitamin K essential for and what happens when the body is deficient in this vitamin?
- Essential for blood clotting. Synthesizes prothrombin and the clotting factors: VII, IX, and X
- Deficiency causes increased clotting time, leading to increased bleeding and hemorrhage.
How can vitamin K be replaced pharmaceutically?
- vitamin K1 (phytonadione) is used for an oral anticoagulant overdose and is most effective in preventing hemorrhage
- There are two commercial forms of vitamin K; Mephyton and AquaMEPHYTON
- Vitamin k only given in oral and parenteral forms because IV administration is dangerous and may cause death
Where is vitamin K stored and what are the signs of toxicity?
- Primarily in the liver and other tissues
- Signs of toxicity:
What are water-soluble vitamins?
- B-Complex vitamins and Vitamin C
- Not stored by the body
- Excreted in urine
What foods contain vitamin B? C?
grains, cereal, bread, and meats
What is vitamin B complex essential for and what happens when the body is deficient in this vitamin?
- Promote a sense of well-being, and increases energy, decreased anger, tension and irritability
- Thiamine (B1) Deficiency: It can lead to polyneuritis and cardiac pathology seen in beriberi, or it could lead to Wernicke encephalopathy that progresses to Korsakoff syndrome, conditions most commonly associated with alcoholism.
How can vitamin B complex be replaced pharmaceutically?
- Riboflavin is given to treat dermatologic problems such as scaly dermatitis, cracked corners of the mouth, and inflammation of the skin and tongue. In higher doses it is used to treat migraine headaches.
- Niacin is given to alleviate pellagra & hyperlipidemia in large doses.
- Pyridoxine is given to correct Vit B6 deficiency and help alleviate symptoms of neuritis caused by isoniazid (INH) therapy for TB.
Where is vitamin B metabolized and how is it excreted?
Metabolized in the liver and excreted in urine
What is vitamin C essential for and what happens when the body is deficient in this vitamin?
- 1.Carbohydrate metabolism
- 2. Protein-lipid synthesis
- 3. Collagen Synthesis
- 4. tissue growth and repair
- 5. Iron Absoprtion
- 6. Coversion of folic acid
- 7. If you take large doses of vitamin C, taper off slowly or will have rebound deficiency.
- 8. Wound healing
- 9. improve intergrity of blood vessels
- Deficiency causes poor wound healing, bleeding gums, scurvy, predisposition to infection.
How can vitamin C be replaced pharmaceutically?
- Vitamin C dosage P.O.
Where is vitamin C metabolized and how is it excreted?
Absorbed from small intestines and excreted readily in urine
What is folic acid essential for and what happens when the body is deficient in this vitamin?
- DNA Synthesis, cell division. Essential during growth. Without it there is disruption in cellular division
- Deficiency causes decreased WBC count and clotting factors, anemias, intestinal disturbances, depression
- Deficiency in 1s trimester: deformities of CNS of fetus resulting in nural tube defcts like spina bifida, anencephaly (lack of brain mass formation)
- Symptoms of deficiency: anorexia, nausea, stomatitis, diarrhea, fatigue, alopecia and blood dyscrasias (megaloblastic anemia, leukopenia & thrombocytopenia)
What foods contain folic acid?
Green leafy vegetables, Oranges, Fortified grains, Fortified breakfast cereals, organ meats, black-eyed peas, lentils, yeast
How can folic acid be replaced pharmaceutically?
- Supplements recommended for all women preparing for pregnancy.
- 400-800 mcg per day can decrease incidence of coronary artery disease (CAD)
Where is folic acid metabolized and how is it excreted?
Absorbed from small intestines, active form (folate) circulated to all tissues. 1/3 folate stored in liver rest stored in tissues. 80% excreted in bile, 20% in urine.
What is B12 essential for and what happens when the body is deficient in this vitamin?
- It allows for the resynthesis of essential amino acid methionine through homocysteine
- Functions as a building block of nucleic acids and to form RBCs. Facilitates functioning of nervous system
- Aids in conversion of folic acid to its active form
- Deficiency caused by pernicious anemia (lack of intrinsic factor necessary to absorb Vit B12)
- Symptoms of deficiency: tingling in lower extremities, weakness, fatigue, anorexia, loss of taste, diarrhea. Memory loss, mood changes, dementia, psychosis, megaloblastic anemia with macrocytes (overenlarged erythrocytes) in blood, megaloblasts in bone marrow.
What foods contain B12?
Liver, kidney, fish, milk, eggs, chicken,turkey
How can B12 be replaced pharmaceutically?
- Cyanocobalamin in crystalline form is given IM for severe deficits
- Cyanocobalamin can be given orally and by subQ injection
Where is B12 metabolized and how is it excreted?
Most Stored in liver; slowly excreted (could take 2-3 yrs to deplete stores)
How are minerals used in the body?
Foe various body functions
What is iron essential for and what happens when the body is deficient in this mineral?
- Vital for hemoglobin regenerating
- 60% of iron is fund in hemoglobin
- Deficiency causes anemia
- Symptom of deficiency:
- slight pallor (pale)
- increased cold sensitivity
- shortness of breath
- increased GI bleeding (in severe cases)
What foods contain iron?
Liver, lean meats, egg yolks, dried beans, green veggies and fruit
How can iron be replaced pharmaceutically?
- Infants & children 6mths to 2 yrs is 1.5 mb/kg
- Adults 50 mg/day
- Ferrous sulfate tab 325 mg (65mg of that is elemental iron)
Where is iron metabolized and how is it excreted?
- Plasma transferrin--> red blood cell precursors in bone marrow--> incorporated into Hb--> Mature RBC's are released--> phagocytes engulf RBC's in 120 days--> Iron is released
- Excretion of Fe
- -through normal shedding of epithelial cells
- -loss of RBC's in urine & feces
- -normal loss: 1-2 mg/day
- -20-40 mg of iron lost w/ menstrual cycle
What is copper essential for and what happens when the body is deficient in this mineral?
- Function-Essential for hemoglobin synthesis bone development melanin production and myelin formation
- Formation of RBCs and connective tissue. Production of neurotransmitters norepinephrine and dopamine
- Deficiency causes anemia which is NOT corrected by taking iron supplements.
- Symptoms: decreased WBCs, glucose intolerance and decreased skin and hair pigmentation. Mental retardation in young.
What foods contain copper?
Source-liver, shellfish -oysters, crab, nuts, seeds, whole grain cereals, legumes, cooa
How can copper be replaced pharmaceutically?
1.5-3mg/day for adults
Where is copper metabolized and how is it excreted?
What is zinc essential for and what happens when the body is deficient in this mineral?
Important to many enzymatic reactions and essential for normal growth an tissue repair, wound healing, maintaining skin integrity, normal growth an taste and smell
What foods contain zinc?
Source- meats (beef, lamb), eggs, cereals, legumes, nuts, leafy and root vegetables
How can zinc be replaced pharmaceutically?
200mg/day RDA is 12-19 mg/day
Where is zinc metabolized and how is it excreted?
What is chromium essential for and what happens when the body is deficient in this mineral?
Helpful I controlling type 2 diabetes; helps normalize blood glucose by increasing effects of insulin on cells. Also claims to promote weight loss and muscle building
What foods contain chromium?
Meats, whole-grain cereals and brewers yeast
How can chromium be replaced pharmaceutically?
Where is chromium metabolized and how is it excreted?
What is selenium essential for and what happens when the body is deficient in this mineral?
Acts as cofactor for an antioxidant enzyme that protects protein and nucleic acid from oxidative damage. Also thought to have anticarcinogenic effect and doses lower that 200 mcg may reduce risk of lung, prostate and colorectal cancer.
What foods contain selenium?
Meats (especially liver), seafood, eggs and dairy
How can selenium be replaced pharmaceutically?
RDA 40-75 mcg
Where is selenium metabolized and how is it excreted?
How can the nursing process be applied to caring for a client with anemia??