73 terms

Pharmacology: Vitamins and minerals

STUDY
PLAY

Terms in this set (...)

vitamins
-Regulate or participate in chemical reactions within the body
-Growth and repair of tissue
-Attaches to enzymes and co-enzymes
-Can be fat or water soluble
minerals
-Inorganic elements and salts
-Also binds with enzymes to help regulate body functions
-Two groups: major elements and micronutrients
-Needed for intracellular and extracellular body fluid electrolytes
nutritional support
-Metabolism: nutrients that undergo chemical changes when ingested
-Cell growth and division
-Enzyme activity
-Protein-CHO-fat synthesis
-Muscle contraction
-Wound repair
nutrition and nursing
-Malnutrition is any disorder of nutrition
-Decreases organ size and impair functions or organ systems
-Nurses need to be able to recognize, prevent and manage malnutrition
-Nutritional supplements classified as enteral or parenteral
Vit A
-Aquasol A
-Retinol
-Found in liver, butter, yellow fruit, green, leafy vegetables, milk
-Growth and development of bones
-Maintenance of processes such as reproduction, integrity of mucosal and epithelial surfaces
-Cholesterol and steroid synthesis
-Eye function
-If using IV - need special tubing
Vit A deficiency
-Night blindness
-Keratomalacia (clouding of cornea)
-Xenophthalmia (foreign body in eye)
-Skin lesions
-Retarded growth
Vit A: adverse
Confusion
Irritation
Diarrhea
Visual alterations
Skin peeling
Delirium
Bone pain
Dry/ cracked skin or lips
Increased urination
Anorexia
Seizures
Vit D
-Rocaltrol
-Calderol
-From natural UV
-Human: cholecalciferol (D3)
-Plant: ergocaliferol (D2)
-Found: milk, fish, bread and cereals, eggs, animal livers, exposure to sunlight
-Proper utilization of calcium and phosphorus
-Coordinates with parathyroid and calcitonin
-Increases calcium in intestine, extracting calcium from bone when needed
-Does not degrade with cooking
Vit D deficiency
Rickets
Tetany
Osteomalacia
Bone-muscle pain
Weakness
Softening of bones
Vit D: adverse
Hypercalcemia
Constipation
Increased thirst
Increased urination
Abdominal cramps
Metallic taste
Ataxia
Vit E
-Aquasol E
-"Tocopherols"
-Found in:
Nuts
Green leafy vegetables
Wheat and rice germ
Grains
Eggs, chickens, meats

-Antioxidant
-Exact nutritional function unknown
-Protects polyunsaturated fatty acids
-Hinders deterioration of vitamins A and C
Vit E deficiency
Hyporeflexia
Ataxia
Myopathy (muscle weakness, stiffness)
Hemolytic anemia
Vit E adverse
Visual disturbances
Stomach pain
Nausea/ vomiting
Weakness
Increased bleeding tendencies if also vit. K deficiency
Impaired sexual function
Thrombosis
Vit K
-Mephyton
-Aquamephyton
-Phytonadione
-Green leafy vegetables, milk, meats
-Body does not store large amounts, but is synthesized by the intestinal flora
-Synthesis of blood coagulation which takes place in the liver
-Involved in clotting cascade with factors: II, VII, IX, and X
Vit K deficiency
Increased bleeding
Coagulation disorders
Vit K: adverse
-Hypersensitivity: flushing, dyspnea, chest pain
-Taste alterations
-Hypo-prothrombinemia
-Coagulation disorders
Fat soluble vitamins (A,D,E,K): nursing
-Dietary information and supplements
-Monitor vit. E by drawing serum tocopherol levels
-Balanced diet
-Only supplement as needed
-Fat soluble dissolved in fat, can be stored in large amounts so daily ingestion not needed
thiamine B1
-Found in whole grain, legumes, liver, beans, peas, nuts
-Precursor for the formation thiamine used in CHO metabolism
-Metabolic pathway functions, I.e., Krebs cycle
thiamine deficiency
-Peripheral neuritis - Beriberi
-Beriberi brain lesions
-Loss of muscle strength
-Depression
-Memory loss
thiamine: adverse
Low oral toxicity
Peripheral nervous system
Cardiovascular
GI - nausea/ vomiting
Angioedema
Cyanosis
riboflavin B2
-Found in dairy, leafy vegetables, whole grain, enriched cereals, organ meats, yeast
-Converts to coenzymes essential for tissue respiration
-Works with tryptophan to convert to niacin
-Maintain erythrocyte integrity
riboflavin deficiency
Sore throat, stomatitis
Red, painful, swollen tongue
Facial dermatitis
Anemia
Seborrheic dermatitis
ETOH - major cause of deficiency
riboflavin adverse
Low toxicity
No adverse seen
Discolors urine to yellow-orange
niacin B3
-Found in meats, beans, yeast, dairy, wheat germ, nuts, whole grains products
-Synthesized from tryptophan to make niacinamide
-Anti-lipidemic agent
-Converts to coenzymes for glycogenolysis, tissue respiration, lipid, protein, and purine metabolism
niacin deficiency
-Pellegra - mental, psychotic symptoms
-Anemia
-Cutaneous crusting erythema, dermatitis, stomatitis (skin eruptions)
-Desquamazation
niacin: adverse
Flushing - feeling of warmth
Pruritis
High doses: dysrhythmias
Dry skin
Hyperglycemia
Myalgia (muscle pain)
GI distress
pyridoxine B6
-Whole grains, wheat germ, nuts, soybeans, fish and organ meats
-Composed of pyridoxine, pyridoxal, and pyridoxamine
-Taken up by RBCs and converted to coenzymes necessary for metabolic functions such as protein, CHO and lipid metabolism
-Helps convert tryptophan to niacin
-Prevents peripheral neuropathy
pyridoxine deficiency
-Seborrhea-like lesions
-Stomatitis/ glossitis
-Cheilosis (cracking in corners of mouth)
-Hypochromic microlytic anemia
-Seizures, esp. in infants
pyridoxine: adverse
-Allergic reaction - skin rash
-Red skin
-Yellow discoloration of urine
folic acid/folvite B9
-Found in liver, fresh green vegetables, yeasts, some fruits
-Works with vitamin C for erythropoiesis
-Assists with metabolism of amino acids
-Assists with nucleoprotein synthesis
folic acid deficiency
-Megaloblastic anemia
-Pregnant women - risk for infant to get spina bifida
folic acid: adverse
-Low toxicity - none
-*Chronic high doses:
Neurotoxicity*
-Ataxia/ clumsiness
-Numb feet
Cyanocobalamin - B12
-Found in fish/ shellfish, dairy, organ meats
-Maintenance of normal erythropoiesis
-Required for nuceloprotein, myelin synthesis, cell production, normal growth
-Biologic activity identical to extrinsic factor (antipernicious factor)
-Oral absorption requires presence of intrinsic factor
cyanocobalamin deficiency
Megaloblastic anemia
Irreversible nervous system damage (ataxia)
Memory loss/ degenerative CNS
Dementia
Hematopoiesis
cyanocobalamin: adverse
No toxicity
Can experience itching, transitory diarrhea, fever
ascorbic acid Vit C
-Found in citrus fruits and juices, tomatoes, cabbage and liver
-Metabolic activities
-Collagen synthesis
-Connective tissue repair
-Maintenance of bone, teeth, and capillaries
-Folic acid metabolism
-Erythropoiesis
-Enhances absorption of iron
ascorbic acid deficiency
-Scurvy - loosening of teeth, gingivitis
-Anemia
-Subcutaneous hemorrhage
-Infants: irritability and pain if touched, delayed healing of soft tissue and bone
ascorbic acid: adverse
Kidney stones
Dizziness
High doses: diarrhea, red skin, headache, N/V
H20 soluble vitamins
-Dietary information and supplements as needed
-Water soluble vitamins dissolved in water
-Daily ingestion needed to maintain health
-Balanced diet - most found in foods
-Supplements only as needed
minerals: Ca
-Found in dairy, esp. milk, widespread in many foods
-Most abundant mineral element
-Building block for body structures
-Maintenance of teeth and bones
-Catalyst in coagulation pathways
-Regulatory mechanisms such as neurotransmitters, hormones, amino acids
-Physiologic processes such as respirations, contractions of muscles
Ca deficiency
Hypoparathyroid
Vit. D deficiency
Renal failure
Muscle cramps
Hypothyroidism
Osteoporosis - can also be from toxic levels
Ca: adverse
Rare
Hypercalcemia
Anorexia
Constipation
Nausea/ vomiting
Mg
-Found in vegetables
-Cofactor for enzyme systems
-Muscle contractions
-Nerve physiology
-Anticonvulsant effect - inhibits neuromuscular transmissions
-Benefits cardiac status
Mg deficiency
Cardiovascular
Neuromuscular
Mental
Mg: adverse
Loss of deep tendon reflexes (DTRs)
Difficult BMs
CNS depression
Respiratory distress
Heart block
P
-Precursor for the synthesis of essential body chemicals
-Important building block for energy compounds (AMP, ADP, ATP)
-Development and maintenance of skeletal system
P deficiency
Mal-absorption
Extensive diarrhea or vomiting
Hyperthyroid or hepatic disease
Longer term use of aluminum or calcium antacids
P: adverse
Diarrhea
GI disturbances
Confusion,
Weakness
Breathing difficulties
Fe
-Found in red meats
-Oxygen carrier in hemoglobin and myoglobin
-Involved with tissue respiration
-Stored in various body sites
-Converted to ferrous state by gastric juices to make it readily available to body
Fe deficiency
anemia= weak, pale, fatigue
Fe toxicity
-Bloody diarrhea, abdominal cramps
-Late signs of toxicity: pale, cold skin, convulsion, cyanosis, irregular heart beat - cardiovascular collapse, metabolic acidosis
Fe: adverse
Backache
Chills/ fever
Headache
Tingling of the hands/ feet
Stomach pain/ diarrhea
Zinc (Zn)
-Healthy immune system
-Wound healing
-Maintain sense of taste and smell
-DNA synthesis
-Support normal growth and development during pregnancy, childhood, and adolescence
Zn deficiency
Growth retardation
Hair loss
Delayed sexual maturation/ impotence
Weight loss
Taste abnormalities
Mental lethargy
Zn: adverse
N/V
minerals: nursing
-Dietary instruction
-Follow up for any labs - CBC, Ca, Mg, etc
-Watch for toxic symptoms
enteral feedings
-Oral or tube feeding of a client
-Supplement inadequate oral intake
-Provides building blocks for anabolism
indications: enteral feeding
-Malnutrition
-Concomitant disease states
-Altered eating habits - stress
-GI competence
feeding tubes
Nasogastric
Nasoduodenal
Gastrostomy
Jejunostomy
types of enterals: oligomeric
- formulas that require minimum digestion
-Produce minimal residue in the colon
-Vivonex, Peptamen
types of enterals: polymeric
- most complete formula
-Contains complex nutrients, protein, CHO and fat
types of enterals: modular
- single-nutrient formulas
-Added to polymeric or monomeric formula to provide individualized formula
-Polycose, Amino-Aid
types of enterals: specialized formulations
- clients with a specific disease states
-Good for genetic errors of metabolism
-Specialized metabolism helps specific organ do less work
-Pulmocare, Nepro, Glucerna, Hepatic-Aid
enterals: drug-food interactions
-There will be several drugs affected by feedings
-May have to turn off feedings after instillation of meds for 30-60 mins
enteral feedings: nursing
-Baseline assessment includes body weight, weight loss hx, s/s malnutrition
-Baseline lab values
-Skin integrity - Diarrhea =common result
-Use of anti-diarrheals
enteral feedings: education
-Follow-up labs - assess effectiveness of feedings
-Watch for s/s of dislodgment of tube (choking, cyanosis, leaking around site, etc)
enteral: psychosocial
-Deprived of act of "eating"
-May feel different or alienated
-Family support/ feelings of importance
-Encourage independent ADLs as much as possible
parenteral nutrition
-Intravenous approach to complete nutrition
-Can supply calories needed to maintain growth, weight gain, wound healing
-Promotes anabolism
-Peripheral vs. central line
indications for total parenteral nutrition (TPN)
-Inability to tolerate or maintain adequate enteral intake
-Supplemental for post-surgical clients unable to eat (I.e., complicated abdominal surgeries)
-Severe malnutrition
TPN formulations
Glucose - energy, promote healing

Amino acids - promote anabolism and wound healing

Carbohydrates (CHO) - calories

Lipids - essential fatty acids and source of energy

Trace elements/ vitamins - electrolytes and vitamins for metabolism
TPN adverse
-Hyperglycemia
-Metabolic imbalances - high and low
-Dehydration
-Azotemia (nitrogenous wastes)
TPN: nursing
-Watch for line infiltration
-Usually 10% glucose for peripheral, 20% glucose for central lines
-Catheter misplacement - hemothorax, subQ emphysema
-Solution contamination
-Air embolism
-Baseline labs and monitor throughout
-Fluid/ electrolyte balance
-Accucheck protocol
-Weigh patient as per protocol
-S/s malnutrition
TPN: education
-Can be done at home
-Educate family on pump, may need home health nursing
-Understand s/s of adverse problems such as over hydration, hyperglycemia