Vitamins and the Nursing Process

The nurse must assess the patient for signs and symptoms of vitamin deficiency before beginning vitamin therapy because vitamin therapy could result in a toxic effect if the patient does not have a vitamin deficiency.

In addition, the patient must be assessed for debilitating diseases and GI disorders that may disrupt the absorption, metabolism, and excretion of vitamins used to treat vitamin deficiency.

For some patients, vitamin deficiency is caused by inadequate nutrient intake. Therefore, it is critical that the patient's diet be assessed to determine if it is the cause of the deficiency. If so, then the nurse should educate the patient on the importance of maintaining a balanced diet.

In many cases, the nurse may reach one of the following diagnoses:

• Altered nutrition; less than body requirements

• Lack of knowledge related to proper nutrition

• Lack of knowledge related to vitamin use

Based on these diagnoses, the nurse should develop a plan for having the patient eat a well-balanced diet and to take vitamin supplements as prescribed. The plan should also take into consideration the following interventions:

• Administer vitamins with food to promote absorption.

• Store vitamins in light-resistant container.

• Use a calibrated dropper for administration of liquid vitamins.

• Administer IM if patient is unable to take PO.

Teaching the patient is an important intervention because this gives the patient the knowledge to implement preemptive actions that lower the risk of vitamin deficiency in the future.

The nurse should teach the patient to:

• Take prescribed amount of vitamin.

• Read labels carefully.

• Not use megavitamins over a prolonged period of time.

• Check expiration dates on containers before purchasing or taking them (potency is reduced after the expiration date).

• Not take vitamin A with mineral oil because it interferes with the absorption of A.

• Not take megadoses of vitamin C (ascorbic acid) to "cure a cold."

• Not take megadoses of vitamin C with aspirin or sulfonamides.

• Avoid excessive intake of alcoholic beverages. (It can cause vitamin B-complex deficiencies.)

Refer the patient to the USDA web site (http://www.mypyramid.gov/pyramid/ index.html) to calculate the desired portions for each food group based on age, sex, and the amount of exercise the patient performs daily. It is important that the patient understands that vitamin supplements are not necessary if he or she is healthy and eats properly.

Alert the patient to the signs and symptoms of hypervitaminosis. Hyper-vitaminosis A causes nausea, vomiting, headache, loss of hair, and cracked lips. Hypervitaminosis D causes anorexia, nausea, and vomiting.

The nurse should evaluate the patient for proper dietary intake and determine if vitamin therapy is having a therapeutic effect.

Minerals

Minerals are inorganic compounds that are required by the body for metabolism and to form bones and teeth. Minerals are extracted from ingested food such as meats, eggs, vegetables, and fruits. There are five minerals that are critical to maintain a healthy body.

Iron

Iron (ferrous sulfate, gluconate, or fumarate) is used for the regeneration of hemoglobin. Iron deficiency causes anemia. The patient requires 5 to 20 mg of iron each day from eating liver, lean meats, egg yolks, dried beans, green vegetables (such as spinach), and fruit.

Iron

Infant and child dose of iron, ages 6 months to 2 years old is 1.5/mg/kg

Ferrous sulfate for therapeutic use 600 to 1200 mg/day in divided doses

Maintenance

Ferrous sulfate for prophylactic use is 300 to 325 mg/day

Pregnancy category

A; PB = UK t1/2 : UK*

Treatment

Given to correct or control iron-deficiency anemia

Side effects

GI discomfort, nausea, vomiting, diarrhea, constipation, epigastric pain, elixir may stain teeth

Adverse reactions

Pallor, drowsiness.

Life threatening: cardiovascular collapse, metabolic acidosis

Contraindications

Avoid a megadose in the first trimester because it might cause birth defects.

*PB = Protein-binding UK = unknown tK = J2 life

*PB = Protein-binding UK = unknown tK = J2 life

Pregnant women require an increased an amount of iron, but they need to avoid a megadose in the first trimester because it might cause birth defects. Larger doses of iron are necessary in the second and third trimester. Iron is absorbed in the intestine where it enters plasma as heme or is stored as ferritin in the liver, spleen, and bone marrow. Food, the antibiotic tetracycline, and antacids decrease absorption up to 50% of iron. However, the patient should take iron with food to avoid GI discomfort. Vitamin C may slightly increase iron absorption. Iron toxicity is a serious cause of poisoning in children. Toxicity can develop with as few as 10 tablets of ferrous sulfate (3g) taken at one time—and can be fatal within 12 to 48 hours.

Copper

Copper is used in the formation of red blood cells and connective tissues. It is also a cofactor for many enzymes. Without copper enzymes are unable to initiate metabolic reactions in the body. Copper is also a component in the production of the neurotransmitters norepinephrine and dopamine. Foods rich in copper are shellfish (crabs and oysters), liver, nuts, seeds (sunflower, sesame), legumes, and cocoa. It is absorbed in the intestines. A prolonged copper deficiency can result in anemia and cause changes in the skin and blood including a decrease in the white blood count, intolerance to glucose, decrease in skin and hair pigmentation, and mental retardation if the patient is young. High levels of copper in serum can be an indication of Wilson's disease, which is an inborn error of metabolism that allows for large amounts of copper to accumulate in the liver, brain, cornea, or kidney.

Copper

Dose

1.5-3 mg/day

Maintenance

1.5-3mg/day

Pregnancy category

A (C if > RDA dose)

Deficiency conditions

Anemia, decreased WBCs, glucose intolerance, decrease in skin and hair pigmentation, and mental retardation in the young.

Side effects

None significant

Adverse reactions

Vomiting and diarrhea

Contraindications

None known

Zinc

Dose

12-19 mg/day

Maintenance

12-19 mg/day

Pregnancy category

A (C if taken in doses > RDA)

Deficiency conditions

Growth retardation, diarrhea, vomiting, delay in puberty, weakness, dry skin, delay in wound healing

Side effects

No known

Adverse reactions

Anemia, increased LDL cholesterol, muscle pain, fever, nausea, vomiting

Contraindications

Do not take with tetracycline.

Zinc

Zinc stimulates the activity of over 100 enzymes for important functions in the body which includes production of insulin and making of sperm and plays a key role in the immune system and DNA synthesis. Zinc helps wounds heal and helps the patient maintain a sense of taste and smell. A dose of zinc larger than 150 mg can cause copper deficiency, decrease high-density lipoprotein (HDL) cholesterol and weaken the patient's immune response. Zinc also inhibits tetra-cycline (antibiotic) absorption and therefore should not be taken with antibiotics. The patient should wait two hours after taking any antibiotic before taking zinc.

Chromium

Chromium is acquired from meats, whole-grain cereals, and brewer's yeast and plays a role in controlling non-insulin-dependent diabetes by normalizing blood glucose thereby increasing the effects of the body's insulin on cells. Chromium 50 to 200 ^g/d is considered within the normal range for children older than 6 years old and adults.

Selenium

Selenium is a trace mineral that is a cofactor for antioxidant enzymes that protect protein and nucleic acids from damage caused by oxidation. Selenium is found in meats (especially liver), seafood, eggs, and dairy products. With a dose

Chromium

Dose

50 to 200 |g/d considered within the normal range for anyone > 6 years of age (There is no RDA.)

Maintenance

50 to 200 | g/d considered within the normal range for anyone > 6 years of age (There is no RDA.)

Pregnancy category

A

Deficiency conditions

Inability to properly use glucose

Side effects

None known

Adverse reactions

May cause hypoglycemic reaction in patients who are taking insulin or an oral hypoglycemic agent.

Contraindications

Although contraindicated for diabetic patients blood sugar levels should be monitored closely.

greater than 200 |g, selenium has a possible anticarcinogenic (anti-cancer) effect and may reduce the risk of lung, prostate, and colorectal cancer. However, such a dose might cause weakness, loss of hair, dermatitis, nausea, diarrhea, and abdominal pain.

Selenium

Dose

40 to 75 |g (high doses for males and lower dose for females)

Maintenance

40 to 75 |g (high doses for males and lower dose for females)

Pregnancy category

A

Deficiency conditions

Heart disease

Side effects

Causes a garlic-like odor from the skin and breath in large doses.

Adverse reactions

Disorders of nervous system and digestive system and loss of hair with doses greater than 200 | g

Contraindications

None known

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