Chapter 35: Nutritional Support Products, Vitamins, and Mineral Supplements PDF

Chapter 35 Nutritional Support Products, Vitamins, and Mineral Supplements  Required for normal body metabolism, growth, Vitamins and development Components of enzyme systems that release energy from ingested carbohydrates, proteins, and fats...

Chapter 35 Nutritional Support Products, Vitamins, and Mineral Supplements  Required for normal body metabolism, growth, Vitamins and development Components of enzyme systems that release energy from ingested carbohydrates, proteins, and fats Required for formation of RBCs, nerve cells, hormones, genetic material, and bone and other tissues Copyright © 2025 Wolters Kluwer. All rights reserved. 2  Is the following statement True or False? Question #1 Vitamins are required for formation of RBCs, nerve cells, hormones, genetic material, and bone and other tissues. Copyright © 2025 Wolters Kluwer. All rights reserved. 3  True Answer to Question #1 Rationale: Vitamins are required for normal body metabolism, growth, and development. They are components of enzyme systems that release energy from ingested carbohydrates, proteins, and fats. They are also required for formation of RBCs, nerve cells, hormones, genetic material, and bone and other tissues. Copyright © 2025 Wolters Kluwer. All rights reserved. 4  Fat-soluble vitamins—vitamins A, D, E, and K Fat-Soluble —are stored in the body when taken in Vitamins excess. They are absorbed from the intestine with dietary fat. Absorption requires the presence of bile salts and pancreatic lipase. Copyright © 2025 Wolters Kluwer. All rights reserved. 5  Water-soluble vitamins Water-Soluble oB-complex vitamins Vitamins oVitamin C Are not stored in the body and are rapidly eliminated Copyright © 2025 Wolters Kluwer. All rights reserved. 6  Essential constituents of bone, teeth, cell Minerals and membranes, connective tissues, many Electrolytes essential enzymes Maintain fluid, electrolyte, and acid–base balance Maintain osmotic pressure, nerve and muscle function; assist in diffusion Influence growth process Copyright © 2025 Wolters Kluwer. All rights reserved. 7  Certain people may need vitamin Patient supplements. People who are pregnant as well Guidelines for as people who smoke, ingest large amounts of Vitamins #1 alcohol, have impaired immune systems, or are older adults may need to take oral vitamins. Avoid taking large doses of vitamins, which do not promote health, strength, or youth. Natural vitamins are advertised as being better than synthetic vitamins, but there is no evidence to support this claim. The two types are chemically identical, and the body uses them the same way. Natural vitamins are more expensive. Copyright © 2025 Wolters Kluwer. All rights reserved. 8  Vitamins from supplements exert the same Patient physiologic effects as those obtained from Guidelines for foods. Vitamins #2 Multivitamin preparations often contain minerals as well, usually in smaller amounts than those recommended for daily intake. Large doses of minerals are toxic. Supplementary vitamin preparations differ widely in amounts and types of vitamin content. When choosing a vitamin supplement, compare ingredients and costs. Store brands are usually effective and less expensive than name brands. Copyright © 2025 Wolters Kluwer. All rights reserved. 9  Know about dietary sources of vitamin A. Vitamin A #1 Retinol occurs in liver, milk, butter, cheese, cream, egg yolk, fortified milk, margarine, and ready-to-eat cereals. Beta-carotenes occur in spinach, collard greens, kale, mango, broccoli, carrots, peaches, pumpkin, red peppers, sweet potatoes, winter squash, watermelon, apricots, and cantaloupe. Understand that excessive amounts of vitamin A are stored in the body and often lead to toxic effects. High doses of vitamin A can result in headaches; diarrhea; nausea; loss of appetite; dry, itching skin; and elevated blood calcium. Copyright © 2025 Wolters Kluwer. All rights reserved. 10  Do not take a supplementary vitamin product Vitamin A #2 that contains more than recommended amounts of vitamin A because of possible adverse effects. If pregnant or could become pregnant, know that excessive doses of vitamin A during pregnancy may cause birth defects. Copyright © 2025 Wolters Kluwer. All rights reserved. 11  Know about dietary sources of vitamin E. This Vitamin E vitamin occurs in vegetable oils, margarine, salad dressing, other foods made with vegetable oil, nuts, seeds, wheat germ, dark green vegetables, whole grains, and fortified cereals. Be familiar with the signs and symptoms of vitamin E overdose. Do not take a supplementary vitamin product that contains more than the recommended amounts of vitamin E. Copyright © 2025 Wolters Kluwer. All rights reserved. 12  Know about dietary sources of vitamin K. This Vitamin K vitamin occurs in spinach, brussels sprouts, broccoli, cabbage, cauliflower, Swiss chard, lettuce, collard greens, carrots, green beans, asparagus, and eggs. Avoid excessive doses of vitamin K. Take this vitamin only as directed by a health care provider. Keep intake of vitamin K–containing foods constant. Avoid sudden increases or decreases in the amounts of these foods. If taking warfarin, report any use of vitamin K to your health care provider. During warfarin therapy, intake of vitamin K–containing foods should remain constant. Copyright © 2025 Wolters Kluwer. All rights reserved. 13  Know about dietary sources of vitamins B1 Vitamin B1, (thiamine), B3 (niacin), and B6 (pyridoxine). Vitamin B3, and Thiamine occurs in whole grain and enriched Vitamin B6 #1 breads and cereals, liver, nuts, wheat germ, pork, and dried peas and beans. Niacin occurs in all protein foods and whole grain and enriched breads and cereals. Pyridoxine occurs in meats, fish, poultry, fruits, green leafy vegetables, whole grains, and dried peas and beans. Swallow extended-release products whole; do not break, crush, or chew them. Breaking the product delivers the entire dose at once and may cause adverse effects. Copyright © 2025 Wolters Kluwer. All rights reserved. 14  Take oral niacin preparations, except for Vitamin B1, timed-release forms, with or after meals or at Vitamin B3, and bedtime to decrease stomach irritation. Vitamin B6 #2 After taking a dose of oral niacin, sit or lie down for approximately 30 minutes. Niacin causes blood vessels to dilate and may cause facial flushing, dizziness, and falls. Facial flushing can be decreased by taking aspirin 325 mg orally, 30 to 60 minutes before a dose of niacin (if aspirin is not contraindicated). Itching, tingling, and headache may occur. These effects usually subside with continued use of niacin. Copyright © 2025 Wolters Kluwer. All rights reserved. 15  Know about dietary sources of vitamin B12. Vitamin B12 and This vitamin occurs in meat, fish, poultry, Folic Acid #1 shellfish, milk, dairy products, eggs, and some fortified foods. Vitamin B12 does not occur in plant sources. If you are a strict vegan who consumes no animal products, you are at risk for vitamin B12 deficiency unless you take a supplementary source of the vitamin. Know about dietary sources of folic acid. This nutrient occurs in liver, okra, spinach, asparagus, dried peas and beans, seeds, and orange juice. Breads, cereals, and other grains are fortified with folic acid. Copyright © 2025 Wolters Kluwer. All rights reserved. 16  Take prescribed vitamins as directed and for Vitamin B12 and the appropriate time. If you have pernicious Folic Acid #2 anemia, you must have vitamin B12 injections for the remainder of your life. Any chronic vitamin B12 deficiency requires lifelong treatment. If you are pregnant or breast- feeding, requirements may be greater; you usually may need additional vitamin supplements. Keep appointments for follow-up visits and obtain the necessary laboratory tests. Copyright © 2025 Wolters Kluwer. All rights reserved. 17  Know about dietary sources of vitamin C. This Vitamin C vitamin occurs in citrus fruits and juices, red and green peppers, broccoli, cauliflower, brussels sprouts, cantaloupe, kiwi fruit, mustard greens, strawberries, and tomatoes. Be aware that vitamin C improves the absorption of iron. Understand that vitamin C, which acidifies the urine, may alter the excretion of some drugs. Copyright © 2025 Wolters Kluwer. All rights reserved. 18  Is the following statement True or False? Question #2 Vitamin C improves the absorption of iron. Copyright © 2025 Wolters Kluwer. All rights reserved. 19  True Answer to Question #2 Rationale: Vitamin C improves the absorption of iron. Copyright © 2025 Wolters Kluwer. All rights reserved. 20  A well-balanced diet contains all the minerals Patient Teaching needed for health in most people. Exceptions Guidelines for are iron and calcium, which are often needed Minerals: as a dietary supplement in females and General children. Note that herbal preparations of Considerations #1 chamomile, feverfew, and St. John’s wort may inhibit iron absorption. The safest action is to take mineral supplements only on a health care provider’s advice, in the amounts and for length of time prescribed. All minerals are toxic when taken in excess. Copyright © 2025 Wolters Kluwer. All rights reserved. 21  Keep all mineral or electrolyte substances out Patient Teaching of reach of children to prevent accidental Guidelines for overdose. Acute iron intoxication is a common Minerals: problem among young children and can be General fatal. Supervise children about using fluoride Considerations #2 supplements (e.g., remind them to spit out oral rinses and gels rather than swallow them). Keep appointments with health care providers for periodic blood tests and other follow-up procedures when mineral or electrolyte supplements are prescribed (e.g., potassium chloride). This helps prevent ingestion of excessive amounts. Copyright © 2025 Wolters Kluwer. All rights reserved. 22  Minerals are often contained in multivitamin Patient Teaching preparations, with percentages of the Guidelines for recommended dietary allowances supplied. Minerals: These amounts differ in various preparations General and should be included in estimations of daily Considerations #3 intake. Copyright © 2025 Wolters Kluwer. All rights reserved. 23  Know about dietary sources of iron. This Iron #1 mineral occurs in beef liver, red meats, fish, poultry, clams, tofu, oysters, lentils, dried peas and beans, fortified cereals, bread, and dried fruit. Avoid substituting one iron salt for another, because amounts of elemental iron may vary. Take iron preparations with or after meals, with approximately 240 mL of fluid, to prevent stomach upset. Do not take iron with coffee or other caffeine-containing beverages because caffeine decreases absorption. Take iron and caffeine preparations at least 2 hours apart. Copyright © 2025 Wolters Kluwer. All rights reserved. 24  Do not crush or chew slow-release tablets or Iron #2 capsules. With liquid preparations, dilute with water, drink through a straw, and rinse the mouth afterward to avoid staining the teeth. Expect that stools will be dark green or black. Report constipation or change in color or consistency of stool to the health care provider. Copyright © 2025 Wolters Kluwer. All rights reserved. 25  Deferoxamine is used to remove excess iron Iron, Copper, from the body; major indication is acute iron Zinc, Mercury, intoxication. Lead Chelate Agents Penicillamine chelates copper, zinc, mercury, and lead to form soluble complexes that are excreted in the urine. Succimer chelates lead to form water-soluble complexes that are excreted in the urine. Copyright © 2025 Wolters Kluwer. All rights reserved. 26  Is the following statement True or False? Question #3 Deferoxamine chelates copper, zinc, mercury, and lead to form soluble complexes that are excreted in the urine. Copyright © 2025 Wolters Kluwer. All rights reserved. 27  False Answer to Question #3 Rationale: Penicillamine chelates copper, zinc, mercury, and lead to form soluble complexes that are excreted in the urine. Deferoxamine is used to remove excess iron from the body; major indication is acute iron intoxication. Copyright © 2025 Wolters Kluwer. All rights reserved. 28  Mix oral solutions or effervescent tablets with Potassium #1 at least 120 mL of water or juice to improve the taste, dilute the drug, and decrease gastric irritation. Do not crush or chew slow-release preparations. Take after meals initially to decrease gastric irritation. If no nausea, vomiting, or other problems occur, the drug can be tried before meals because it is better absorbed from an empty stomach. Copyright © 2025 Wolters Kluwer. All rights reserved. 29  Do not stop taking the medication without Potassium #2 notifying the health care provider who prescribed it, especially if you are also taking diuretics or digoxin. Do not use salt substitutes except on the recommendation of a health care provider. Salt substitutes contain potassium chloride and may result in excessive intake. Copyright © 2025 Wolters Kluwer. All rights reserved. 30  Serious problems may develop from either Potassium #3 high or low levels of potassium in the blood. Know and recognize signs and symptoms of hypokalemia and hyperkalemia. oSigns and symptoms of hypokalemia: Palpitations, confusion, dizziness, muscle weakness, abdominal distension, frequent voiding of large amounts of urine oSigns and symptoms of hyperkalemia: Muscle weakness, palpitations, slow pulse, fatigue, shortness of breath Copyright © 2025 Wolters Kluwer. All rights reserved. 31  For oral supplements, take or give at the Patient Teaching preferred time and temperature, when Guidelines for possible. Nutritional For tube feedings: Products oUse or give with the patient in a sitting #1 position, if possible, to decrease risks of aspirating formula into the lungs. oBe sure the tube is placed correctly before each tube feeding. Ask a health care provider how to check placement with your type of tube. Copyright © 2025 Wolters Kluwer. All rights reserved. 32  For tube feedings (cont.): Patient Teaching oBe sure the solution is room temperature. Guidelines for Cold formula may cause abdominal Nutritional cramping. Products #2 oDo not take or give more than 500 mL per feeding, including 60 to 90 mL of water for flushing the tube. This helps to avoid overfilling the stomach and possible vomiting. oTake or give slowly, over approximately 30 to 60 minutes. Rapid administration may cause nausea and vomiting. Copyright © 2025 Wolters Kluwer. All rights reserved. 33  For tube feedings (cont.): Patient Teaching oWith continuous feedings, change containers and Guidelines for tubing daily. With intermittent feedings, rinse all equipment after each use and change at least every Nutritional 24 hours. Most tube feeding formulas are milk based Products #3 and infection may occur if formulas become contaminated or equipment is not kept clean. oAsk a health care provider about the amount of free water. Most people receiving 1,500 to 2000 mL of tube feeding daily need approximately 1,000 mL or more of free water daily. However, patients’ needs vary. Water can be mixed with the tube feeding formula, given after the tube feeding, or given between bolus feedings. Be sure to include the amount of water used for flushing the tube in the total daily intake. Copyright © 2025 Wolters Kluwer. All rights reserved. 34  For giving medications by tube: Patient Teaching oGive liquid preparations when available. Guidelines for oWhen liquid preparations are not available, it Nutritional may be necessary to crush some tablets and Products #4 empty some capsules and mix them with 15 to 30 mL of water. Ask a health care provider which medications can safely be crushed or altered, because some (e.g., long acting or enteric coated) can be harmful if crushed. Copyright © 2025 Wolters Kluwer. All rights reserved. 35  For giving medications by tube (cont.): Patient Teaching oDo not mix medications with the tube Guidelines for feeding formula because some medications Nutritional may not be absorbed. If the absorption of a Products #5 drug is affected by the tube feeding formula (e.g., phenytoin), discontinue the tube feeding for the recommended interval prior to drug administration; then, resume feeding at the recommended interval after drug administration. oDo not mix medications. Give each one separately. oFlush the tube with water before and after each medication to get the medication through the tube and to keep the tube open. Copyright © 2025 Wolters Kluwer. All rights reserved. 36  Assess each patient for current or potential Nursing Process nutritional deficiencies. Some specific Considerations #1 assessment factors include the following: oWhat are usual eating patterns? oDoes the patient appear underweight? If so, assess for contributing factors (e.g., appetite or ability to obtain, cook, or chew food). Calculate or estimate the body mass index (BMI). A BMI under 18.5 kg/m2 indicates undernutrition. oDoes the patient have symptoms, disease processes treatments, medications, or diagnostic tests that are likely to interfere with nutrition? Copyright © 2025 Wolters Kluwer. All rights reserved. 37  With vitamins, assessment factors include the Nursing Process following: Considerations #2 oDeficiency states are more common than excess states, and people with other nutritional deficiencies are likely to have vitamin deficiencies as well. oDeficiencies of water-soluble vitamins (B complex and C) are more common than those of fat-soluble vitamins (A, E, and K). oVitamin deficiencies are usually multiple and signs and symptoms often overlap, especially with B complex deficiencies. Copyright © 2025 Wolters Kluwer. All rights reserved. 38  With vitamins, assessment factors include the Nursing Process following (cont.): Considerations #3 oVitamin requirements are increased during infancy, pregnancy, lactation, fever, hyperthyroidism, and many illnesses. Thus, a vitamin intake that is normally adequate may be inadequate in certain circumstances. oVitamin deficiencies are likely to occur in people who are poor, older adults, chronically or severely ill, or alcoholic. oVitamin excess states are rarely caused by excessive dietary intake but may occur with use of vitamin drug preparations, especially if mega doses are taken. Copyright © 2025 Wolters Kluwer. All rights reserved. 39  With mineral–electrolytes, assessment factors Nursing Process include the following: Considerations #4 oDeficiency states are more common than excess states unless a mineral–electrolyte supplement is being taken. However, deficiencies and excesses may be equally harmful, and both must be assessed. oPatients with other nutritional deficiencies are likely to have mineral–electrolyte deficiencies as well. Moreover, deficiencies are likely to be multiple, with overlapping signs and symptoms. Copyright © 2025 Wolters Kluwer. All rights reserved. 40  With mineral–electrolytes, assessment factors Nursing Process include the following (cont.): Considerations #5 oMany drugs influence gains and losses of minerals and electrolytes, including diuretics and laxatives. oMinerals and electrolytes are lost with gastric suction, polyuria, diarrhea, excessive perspiration, and other conditions. Copyright © 2025 Wolters Kluwer. All rights reserved. 41  Assess laboratory reports when available: Nursing Process oCheck the complete blood count for Considerations #6 decreased red blood cells, hemoglobin, and hematocrit. Reduced values may indicate iron deficiency anemia, and further assessment is needed. oCheck serum electrolyte reports for abnormal values. All major minerals can be measured in clinical laboratories. The ones usually measured are sodium, potassium, and chloride; carbon dioxide content, a measure of bicarbonate, is also assessed. Copyright © 2025 Wolters Kluwer. All rights reserved. 42  Promote a well-balanced diet for all patients. Nursing Five daily servings of fruits and vegetables Interventions #1 provide adequate vitamins unless the patient has increased requirements or conditions that interfere with absorption or use of vitamins. An oral multivitamin may benefit most people, but it is not a substitute for an adequate diet. A diet that is adequate in protein and calories usually provides adequate minerals and electrolytes. Exceptions are calcium and iron, which are often needed as a dietary supplement in females and children. Copyright © 2025 Wolters Kluwer. All rights reserved. 43  Provide relief for symptoms that are likely to Nursing interfere with nutrition, such as pain, nausea, Interventions #2 vomiting, or diarrhea. Provide palatable supplements at appropriate times for patients who need increased protein–calorie intake and encourage patients to take them. Promote exercise and activity. For undernourished patients, this may increase appetite, improve digestion, and aid bowel elimination. Copyright © 2025 Wolters Kluwer. All rights reserved. 44  Minimize the use of sedative-type drugs when Nursing appropriate. Although no one should be Interventions #3 denied pain relief, strong analgesics and other sedatives may cause drowsiness, decreased desire or ability to eat and drink, constipation, and a feeling of fullness. Weigh patients at regular intervals. Calculate or estimate the BMI when indicated. Monitor weight, fluid intake, urine output, vital signs, blood glucose, serum electrolytes, and complete blood count for patients receiving parenteral nutrition. Obtain these values daily, weekly, or as institutional protocols dictate. Adjust monitoring based on patient status whether hospitalized or at home. Copyright © 2025 Wolters Kluwer. All rights reserved. 45  Promote proper use of mineral supplements Nursing that are recommended only for current or Interventions #4 potential deficiencies and are toxic in excessive amounts. Follow institutional protocols in the care of patients with feeding tubes and in the administration of ordered tube feeding products. Use best practices in relation to assessing correct tube placement, maintaining patency of tubes, positioning of patients, prevention of aspiration, gravity or pump administration of feeding products, and administration of free water and flushes. Copyright © 2025 Wolters Kluwer. All rights reserved. 46  Follow institution protocols and best practices Nursing in relation to administration of medications Interventions #5 per feeding tubes. Included would be crushing medications only when appropriate to do so, using liquid forms when available, irrigating tubes properly to prevent occlusion, and administering drugs to minimize drug interactions with tube feeding products or other drugs. Copyright © 2025 Wolters Kluwer. All rights reserved. 47