1. Chapter 24
Vitamins and Minerals

2. Chapter 24
Lesson 24.1

3. Learning Objectives
Identify the actions and indications for vitamins and minerals
List at least six products used to treat vitamin or mineral deficiencies

4. Vitamins Natural chemical compounds found in animals and plants
Dietary considerations
Deficiencies
Antioxidants
MyPyramid
Table 24-1
Vitamins are either fat-soluble (A, D, E, K) or water-soluble (B-complex, C).
Why is it important for patients to have adequate vitamins in their diets?
What conditions would prevent patients from receiving adequate sources of vitamins?
When are supplemental vitamins recommended for daily use?
What are examples of the benefits of antioxidant use?

5. Vitamin A
Action
Fat-soluble; aids visual adjustment; role in cell membrane stabilization
Uses
Treat deficiencies, eye diseases, and night blindness
Where in the body are sufficient stores of vitamin A found?
What role does vitamin A play in preventing infection?
Vitamin A is a fat-soluble vitamin that is absorbed in the intestine.
What clinical conditions place the patient at an increased risk for vitamin A deficiency?

6. Vitamin A (cont.) Adverse Reactions Drug Interactions Hypervitaminosis
Oral contraceptives, mineral oil, antihyperlipidemic drugs
What are the risks associated with too much vitamin A during pregnancy?
What results if patients take vitamin A and oral contraceptive drugs concurrently?
How do International Units (IU) compare to micrograms?

7. Vitamin A (cont.) Nursing Implications Lifespan requirements
Routes for administration
Patient teaching: nutritional sources
How do the daily requirements for pregnancy (second and third trimesters) compare to those for lactation?
What foods are good sources of vitamin A?

8. Vitamin B1 (Thiamine) Action Uses
Water-soluble; coenzyme involved with carbohydrate metabolism; role in neurology
Uses
Treatment of beriberi
What are the different implications for the body of a fat- or water-soluble vitamin ?
How is thiamine excreted?
Which clinical conditions place the patient at risk for developing beriberi?
What symptoms would the patient with vitamin B1 deficiency exhibit?

9. Vitamin B1 (Thiamine) (cont.)
Adverse Reactions
Sensitivity reactions
Parenteral precautions
Drug Interactions
Poor stability with concurrent use of neutral or alkaline solutions

10. Vitamin B1 (Thiamine) (cont.)
Nursing Implications and Patient Teaching
Food preparation
Dietary sources
What food sources are rich in thiamine? What food-preparation considerations should the thiamine-deficient patient be aware of?

11. 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
What are the symptoms common to riboflavin deficiency?

12. Vitamin B2 (Riboflavin) (cont.)
Drug Interactions
Oral contraceptives
Nursing Implications and Patient Teaching
Storage
Change in urine color
What is the relationship between riboflavin levels in the body and the length of time a patient has been taking oral contraceptives?
What change in urine occurs with riboflavin supplements?

13. Niacin
Action
Water-soluble; part of two coenzyme systems that transfer hydrogen in intracellular respiration
Uses
Prevent or treat deficiencies
Pellagra: symptoms
What are the roles of the coenzyme systems?
What dietary source may produce a deficiency state?
The deficiency state is known as pellagra.

14. Niacin (cont.) Adverse Reactions Drug Interactions
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
What is postural hypotension?
What patient education should the LPN/LVN provide for patients taking niacin?

15. Pantothenic Acid Action Uses
Synthesis of coenzyme A; role in release of energy in fats, proteins, and carbohydrates
Uses
Treatment of paralytic ileus
Pantothenic acid is one of the water-soluble B vitamins.
What procedure places the patient at risk for developing paralytic ileus?
What nursing interventions prevent paralytic ileus?
Deficiency states are produced only in the laboratory.

16. Pantothenic Acid (cont.)
Nursing Implications and Patient Teaching
Food preparation
Dietary sources
How does the amount of pantothenic acid in human milk compare to that in cow’s milk? How is this important to an infant’s growth and development?
What effects do boiling and freezing have on food sources of pantothenic acid?

17. 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
What populations are most likely to develop a B6 deficiency?
What are the common symptoms seen in deficiency states?
Good natural sources of vitamin B6 are yeast, wheat and whole grains, corn, egg yolk, liver, kidney, muscle meats, and soybeans.

18. Vitamin B6 (cont.) Adverse Reactions Drug Interactions
None; pyridoxine dependency
Drug Interactions
Oral contraceptives; levodopa
Concurrent use with chloramphenicol may prevent optic neuritis
Why would pyridoxine dependency occur?

19. Vitamin B6 (cont.) Nursing Implications and Patient Teaching Storage
Dietary sources
Food preparation
What impact does freezing have on pyridoxine?

20. Folic Acid (Vitamin B9) Action Uses
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
For what other conditions would the use of folic acid supplements be indicated?
Consider the importance of increased folic acid intake for women planning to become pregnant and during early pregnancy to prevent neural tube defects in the fetus. What is spina bifida?
What is the relationship of homocysteine levels to the development of cardiovascular disease?

21. Folic Acid (cont.) Adverse Reactions Drug Interactions
Folic acid is not toxic
Allergic reaction may manifest as bronchospasm, erythema, malaise, pruritis, or rash
Drug Interactions
Antagonists: chloramphenicol and methotrexate
High doses of folic acid may alter the color of urine.
Which drugs may cause symptoms of folic acid deficiency?
What effect is seen with the concurrent use of folic acid and anticonvulsants?

22. 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
Why are patients less likely to follow up vitamin/mineral deficiencies with their healthcare provider?

23. Vitamin 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
What are the symptoms associated with deficiency of B12?
When is Nascobal used as therapy for a patient with pernicious anemia?
What is the route for administering this vitamin? (IM)
What drugs may interact with vitamin B12?
What type of permanent effects are seen in patients with B12 deficiency for longer than 3 months?

24. 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
What is ascorbic acid? Is this a fat- or water-soluble vitamin?
What clinical conditions would improve with vitamin C?
Which foods are rich in vitamin C?
The patient with scurvy will exhibit what symptoms?
Which drugs interact with ascorbic acid to increase their effects?
Vitamin C, like all water-soluble vitamins, is easily destroyed by exposure to air, heat and light. What information should nurses give their patients regarding storage and use of vitamins B and C?

25. Vitamin D Action and Uses Adverse Reactions: Vitamin D toxicity
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
Where are fat-soluble vitamins absorbed in the body?
How does sunlight affect vitamin D?
Which drugs interfere with the absorption of fat-soluble vitamins?
Thiazide diuretics and vitamin D taken concurrently contribute to hypercalcemia.
What type of symptoms would a patient with osteomalacia exhibit?

26. Vitamin E Fat-soluble Functions are not understood
Antioxidant: prevents cell membrane damage
Stabilizes the RBC wall to protect against hemolysis or destruction
Why is vitamin E considered an essential nutrient for humans?
What is the relationship between high intake of vitamin E as tocopheral and Alzheimer’s disease?
What are good dietary sources of vitamin E?
Many suggested uses of vitamin E are controversial and unproved. The only established use is to prevent or treat vitamin E deficiency.

27. 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
What is the primary action of vitamin K in the body?
Why is this drug administered to newborns?
If the patient were exhibiting adverse reactions to vitamin K, what symptoms would the nurse observe?
What are the preferred routes of administration for vitamin K?
If a patient is taking Coumadin, what dietary information would you offer related to vitamin K?

28. Chapter 24
Lesson 24.2

29. Learning 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

30. 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
When minerals act as a catalyst, what type of reaction occurs?
What are the three mineral elements that are most frequently missing in the diet?
Which ions are frequently involved with metabolic disturbances?

31. 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
Calcium is essential for proper myocardial function.
Which populations are at risk for low calcium levels?
Which drugs should not be combined with calcium and/or milk products?
What is an example of a common over-the-counter preparation of calcium?
How does the daily recommendation of calcium for infants compare to that of adults?
What are common nutritional products high in calcium?

32. Calcium (cont.) Adverse Reactions Drug Interactions
Hypercalcemia symptoms
Drug Interactions
Vitamin D; phytic acid (found in bran and whole-grain cereals)
Nursing Implications/Patient Teaching
Dietary sources
What is the significance of vitamin D to calcium?
How is the status of calcium influenced in the body?
What two substances combine with calcium in the body to interfere with its absorption?

33. Fluoride Action Uses Strengthens enamel Reduces dental caries
What does it mean when fluoride is considered an essential trace element but not essential to life?
Where in the body is fluoride concentrated?

34. Fluoride (cont.) Adverse Reactions Drug Interactions
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
The preparation and quantity chosen should be adjusted to the fluoride level of the local water supply.

35. 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
What symptoms would you observe in the patient with iron deficiency anemia?

36. Iron (cont.) Adverse Reactions Drug Interactions
Nursing Implications and Patient Teaching
Nutritional sources, adverse effects
What dietary practices may contribute to iron deficiency?
Iron absorption is increased when combined with ascorbic acid.
Why would the absorption of oral iron be inhibited by antacids?
Iron interferes with the absorption of tetracycline.
What is the usual duration of iron therapy?
The body has the capability to increase the absorption of iron during times of physiologic stress, such as pregnancy and severe blood loss.

37. Magnesium Action Uses Adverse Reactions
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
Deficiencies in magnesium may contribute to which form of cardiac dysrhythmia?
What symptoms would you observe in a patient with magnesium deficiency?
What food sources are rich in magnesium?

38. 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
There are no known adverse effects or drug interactions.
Nuts, whole-wheat cereals, and grains are the foods richest in manganese.

39. 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
When is potassium used for replacement therapy?

40. Potassium (cont.) Adverse Reactions Drug Interactions
Nausea, vomiting, diarrhea, abdominal discomfort, GI bleeding
Drug Interactions
Contraindications
Nursing Implications/Patient Teaching
Dilution and administration; monitoring of serum blood levels; dietary sources
What are the signs and symptoms associated with potassium intoxication?
What are common cardiac symptoms seen with abnormal potassium levels?
Aldosterone antagonists used concurrently with potassium contribute to what complication in the body?

41. Zinc Action and Uses Adverse Reactions Drug Interactions
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
What are common complaints the patient may have while taking zinc supplements?
Why does the patient with a burn have a special requirement for zinc?
What are the symptoms of zinc intoxication?
What type of interaction occurs when calcium and zinc supplements are combined?

42. Vitamin and Mineral Deficiencies
Assessment
Diagnosis
Planning
Implementation
Evaluation
Patient and family teaching
Why is it important for the nurse to discuss storage for these drug products?
How will the LPN/LVN evaluate the effectiveness of vitamin and mineral therapy?
What assessments beyond the patient’s medical condition should you include?
Why is it important to assess the patient for multiple deficiencies?