Human Development and Vitamins (Lesson 2-Part 1)

Lesson 2 of 2 Lesson 2- Human Development After completing this lesson, the student will be able to identify human development principles in accordance with prescribed guidance and publications. Basic Human Needs Basic Human Needs Theory All humans have basic needs to live and survive. We must have...

Lesson 2 of 2 Lesson 2- Human Development After completing this lesson, the student will be able to identify human development principles in accordance with prescribed guidance and publications. Basic Human Needs Basic Human Needs Theory All humans have basic needs to live and survive. We must have food, water, air and shelter and if any one of these basics are not met, then humans cannot survive. The extent their basic human needs are met determine their level of health. Everyone’s needs are different and some may have to be met before other needs can be obtained. Water-soluable vitamins Water-Soluble Vitamins These vitamins help to oxidize carbohydrates, lipids and proteins. Since the B vitamins often occur together in foods, they are usually referred to as the vitamin B-complex. Previously you learned that B-complex vitamins such as B12 and folic acid are important to the circulation of oxygen through the body, but how does the body obtain these vital nutrients? B12 Vitamin B12, (also called cobalamin and cyanocobalamin) is found in meats (especially found in organ meats), poultry, eggs, fish, shellfish and some dairy (milk and cheese). B12 is normally absorbed through the stomach, but it is dependent on a particular substance (intrinsic factor) secreted by the gastric mucosa. Without the intrinsic factor for the B12 to bond, the body would be unable to produce RBCs and synthesize DNA. The recommended daily allowance (RDA) of B12 is 2 μg. Deficiencies can be associated with patients who have had intestinal resections, gastrectomy, or other malabsorption syndromes. Vegetarians must also be aware of their B12 intake, and supplement their diet depending on the degree of their vegetarian diet. As previously stated, most B12 deficiencies are generally due to the lack of absorption because of the body’s inability to produce the intrinsic factor, not from a lack of diet. Patients without a confirmed deficiency should avoid taking large doses of vitamin B12. Taking mega doses may mask symptoms of folic acid deficiency or cause complications in patients with cardiac or gout conditions. Clinical signs of B12 deficiency are noted at first by pernicious (L-destructive) anemia and weakness. Progressing deficiency can proceed to include poor muscle coordination, numbness of hands and feet, mental confusion and irritability. The treatment for pernicious anemia consists of monthly injections of vitamin B12 ordered by the health care provider. With any medication order there are side effects and interactions to consider. Side effects of B12 treatment include transient diarrhea along with itching and urticaria. Interactions may occur with anticonvulsants, slow-release potassium and colchicine (gout medication), and aminoglycoside antibiotics (gentamicin). Eggs Cheese Fish Oranges Folic Acid Folic acid or folacin is a vitamin included in the B-complex group and is found in leafy and green vegetables, avocado, orange juice and kidney beans. One problem with many of these sources is the loss of the folic acid vitamin when they are cooked or reheated. The RDA is 400 μg per day. Folic acid is used for the production of RBCs and DNA synthesis. During pregnancy, a deficiency of folic acid can result in neural tube defects, such as spina bifida in newborns. Some of the reasons an individual may be deficient are due to improper diet or disease processes that affect the liver: cirrhosis from chronic alcoholism, or renal dialysis. Malabsorption syndromes, malnutrition, or an intestinal obstruction may also cause a deficiency of folic acid. Some of the signs of a folic acid deficiency may include sore mouth, diarrhea, and anorexia resulting in weight loss, irritability, and possible behavior disorders. Many disease processes have these same signs, so individuals are advised not to take folic acid supplements in doses larger than 0.4 mg (400 μg) found in most over the counter (OTC) vitamin supplements. When taking high dose supplements without the diagnosis of a folic acid deficiency, there is the potential of masking other disease processes as pernicious anemia. Individuals diagnosed with a folic acid deficiency may be treated with a 1 mg dose prescription. Taking more than the recommended amount of folic acid without proper diagnosis, could interfere with the action of other medications as Phenytoin (Dilantin), estrogen, as found in oral contraceptives, or barbiturates. B6 B6 or pyridoxine is a coenzyme used in the metabolism of carbohydrates, fats, protein, and amino acids. It is found in meats, legumes, peanuts, whole-grain cereals, and bananas. When calculating daily doses of B6 you must account for foods that are frozen, as there is a significant loss of B6 through this process. The RDA is 1.6–2 mg/day. Deficiencies of B6, as with folic acid deficiencies, are from improper diet or disease process affecting the liver. Additionally, some drug interactions cause a deficiency of B6. Individuals taking isoniazid (INH) therapy (used to treat tuberculosis) or even oral contraceptives may incur B6 deficiencies. B6 supplements should not be taken without proper diagnosis of a true deficiency. Patients under treatment for Parkinson’s disease who are taking the medication levodopa (L-dopa) must be cautioned not to take B6 supplements. The B6 vitamin will antagonize the action of the L-dopa producing more problems with the disease. Signs of deficiencies can include peripheral neuropathy, oral sores, and depression in adults. For infants, the deficiency may cause seizure activity. An overdose of B6 in pregnant women may result in seizures among newborns with a developed need for greater than normal amounts of pyridoxine. Peanuts Bananas Vitamin C Vitamin C or ascorbic acid is found in fresh fruits and vegetables, especially citrus fruits, tomatoes, and broccoli. It is unstable when exposed to heat or air or combined with alkaline compounds such as antacids. Adding baking soda to vegetables for color retention also destroys the vitamin C. The RDA for vitamin C is 60 mg/day. Legumes For adults with no other disease processes, a dose of 100–250 mg twice a day (BID) may be ordered. A hemodialysis patient may follow 100–200 mg daily. For an infant, beginning at two to four weeks of age, the dosage would be 20–50 mg per day. Many adults use vitamin C as a preventative supplement or treatment of a common cold with a dose of 1–2 mg per day. Since ascorbic acid is a water-soluble vitamin, more than 50 percent of the dose is excreted in the urine for individuals without any kidney disease processes. Excretion of less than 20 percent of the dose over a 24-hour period may also suggest a vitamin C deficiency. Doses larger than that recommended are to be avoided because of the potential side effects. Vitamin C is necessary for cellular metabolism Side effects of large doses of vitamin C, more than the RDA, can include increased urinary and intercellular substances (collagen), and calcium; (precipitating kidney stone formation) and elevated uric acid levels (precipitating normal growth of teeth, gums and bones. gouty arthritis). It may produce side effects of heartburn, abdominal cramps, nausea, Without this vitamin, iron is unable to be vomiting and diarrhea. Consistent large doses of vitamin C can also produce a false negative absorbed by the body properly. Vitamin C also result for colon cancer testing. promotes the healing of wounds and bone fractures. Vitamin C may interact with other medications an individual is currently taking. Taking aspirin with vitamin C may cause elevated blood level of aspirin in individuals. Individuals Deficiencies are associated with pregnancy and taking barbiturates, tetracyclines, estrogen or oral contraceptives may be required to take a lactation, gastrointestinal (GI) track diseases, vitamin C supplement. smoking and, of course, a lack of fresh fruits and vegetables in an individual’s diet. Other contributing factors to a deficiency are Vitamin C may not be a vital component for circulation or oxygenation, but without this particular vitamin the body is deprived of the essential iron needed through out the body. alcoholism, infections, and even stress. Signs of a vitamin C deficiency (scurvy) can include muscle weakness and cramping, lethargy, sore and bleeding mouth and gums, or degenerative changes in bone and connective tissue. As with any suspected deficiency, a health care provider must confirm it and order treatment as necessary. Treatments of scurvy, when ordered, follow different regiments based on the individual’s disease process affecting the body. Ascorbic acid is available in capsule, tablets (extended release), solution, chewable or injection form. Treatment for scurvy may be seen in the following regiments. Broccoli Citrus Use the following table as a quick reference for water-soluble vitamins. Tomatoes Oranges Name Vitamin B12 Food Source Seafood, shellfish, meat, poultry, eggs, milk, cheese Folic Acid RDA Plant Amount None 2 μg per day Green leafy vegetables, avocado, beets, kidney Organ meats beans, broccoli, orange 400 μg per day juice Vitamin B6 Pork, beef, chicken, tuna, salmon Whole grain cereals, wheat germ, legumes, peanuts, 1.6–2 mg per day soybeans, bananas All citrus, cantaloupe, Vitamin C None broccoli, tomatoes, green peppers, cabbage, Brussels 60 mg per day sprouts C O NT I NU E Fat-Soluble Vitamins Since fat-soluble vitamins dissolve in fats, they are influenced by the same factors that affect lipid absorption. For example, the presence of bile salts in the intestine promotes the absorption of these vitamins. As a whole, fat-soluble vitamins are stored in moderate quantities within various tissues, and because they are fairly resistant to the effects of heat, they are not usually destroyed by cooking or food processing as are water-soluble vitamins. Vitamin A Vitamin A Retinol, retinal, beta carotene - Vitamin A is processed in the body from the carotene of plants, especially yellow-orange and dark-green leafy vegetables. You will find the vitamin in oily saltwater fish, dairy products and eggs. The RDA is 800–1,000 international units (IU) per day. Vitamin A is necessary for proper visual function at night, helps in the development of bones and soft tissue and maintaining healthy epithelial tissue. Many times you will see vitamin A (retinal, retinol) prescribed for acne, and for promoting the healing of wounds. Deficiencies of vitamin A may be a result of an obstruction of bile, prolonged infection or fever, the malabsorption of fats or diarrhea. Vegetables can lose vitamin A due to over cooking in an open container, as heat and air cause oxidation. Signs of a deficiency may include night blindness or photosensitivity, slow growth, bone and teeth deformities, along with impaired hearing. Of course these symptoms alone do not prove a deficiency, as health care providers must diagnose the deficiency. Once a deficiency is diagnosed, supplements may be necessary for infants fed unfortified skim milk or mild-substitute formulas, persons with prolonged infection or fever, or diabetics with hypothyroidism. Individuals being treated with Accutane (a synthetic vitamin A product), should be cautioned and have it explained that pregnancy is contraindicated during treatment, as this product can cause fetal abnormalities. Accutane is also used to treat severe cystic acne (also known as nodular acne) Accutane may also cause increased intracranial pressure, possible liver changes and other adverse side effects associated with hypervitaminosis A. Symptoms of overdose (hypervitaminosis A) occur from a greater than 50,000 IU (15,000 mcg of retinol) include irritability and psychiatric symptoms, fatigue and lethargy, along with insomnia and headaches. Acute toxicity is denoted by increased intracranial pressure, vertigo, and coma. Caution must be taken with individuals with kidney or liver problems and diabetics. Vitamin D Calciferol, cholecalciferol, ergocalciferol - This is one vitamin the body is capable of synthesizing in small amounts through the action of the sunlight on the skin. Not everyone lives in a climate where this is possible throughout the year. Examples include individuals who may live in Washington state, or England, United Kingdom (UK). The dietary sources include fish oils and food products fortified with vitamin D, such as milk and cereals. The RDA is 400 IU/day. Vitamin D is necessary for the maintenance of normal nerve and muscle functioning. It assists in regulating the absorption and metabolism of calcium and phosphorus for healthy bones and teeth, making it important during pregnancy and lactation. Signs of deficiency are seen with the rickets disease process characterized by poor teeth and bone structure; osteoporosis as characterized by loss of bone density. Tetany is another disease process that is characterized by cramps, convulsions, twitching of the muscles and sharp flexion of the wrist and ankle joints. Prevention and treatment for vitamin D deficiencies include supplements prescribed such as calcifediol, calcitriol, or ergocalciferol which are carefully regulated. Some of the symptoms that may be present with a vitamin D overdose and toxicity include cardiac arrhythmias, vertigo, tinnitus, kidney damage or kidney stones. Severe symptoms may lead to hypocalcaemia and convulsions. For individuals with known cardiovascular disorders, kidney diseases, or are pregnant or lactating, extreme caution must be taken not to exceed the RDA of vitamin D. Vitamin D treatment may interact with individuals who are taking digitalis and thiazide diuretics such as hydrochlorothiazide (HCTZ). An overdose of vitamin D may antagonize the actions of these drugs causing more damage to the individual. An additional interaction is mineral oil; it may interfere with the intestinal absorption of the vitamin. Vitamin E Vitamin E (tocopherol) is abundant in many natural forms. It is found especially in cereals, wheat germ, seeds, nuts, vegetable oils, eggs, meat and poultry. The RDA for vitamin E is 30 IU per day. Vitamin E is necessary for normal metabolism, the protection of tissues of the eyes, skin, liver, and lungs. It assists in the regulation of vitamin A use and storage. Vitamin E protects RBCs from damage and decreases platelet clumping. Research is ongoing in the use and benefits of vitamin E supplements as one of the treatment protocols for the management of early Alzheimer’s disease and for possibly slowing the progress of such memory loss symptoms. However, the supplement will neither cure nor prevent this debilitating disease. Since this vitamin is so abundant, deficiency is related with other disease processes versus a lack of ingestion of the vitamin. The deficiency is found in association with alcohol abuse, malabsorption syndromes such as cystic fibrosis, pathologic conditions of the liver and pancreas, and sickle-cell anemia. Premature infants or low-birth weight neonates have also been found to be susceptible. The signs of a vitamin E deficiency are not concretely established because of the other disease processes it is associated with. Premature infants may show irritability, edema or hemolytic anemia. Adults may show signs of muscle weakness or abnormal lab values with low RBC counts. The sign of an overdose of the vitamin (1,200 IU per day) is more readily seen through prolonged clotting times. Because of this potential side effect, vitamin E supplements should be discontinued 10 days before surgery, and should not be taken while on anticoagulant therapy because of the increased risk of bleeding. Vitamin E interacts with an excessive use of mineral oil, decreasing the absorption of the vitamin. Oils Poultry Vitamin K Phytonadione or vitamin K is most often found in green or leafy vegetables. It is also found in cheese, eggs and vegetable oils. The RDA for vitamin K is 60–80 mg per day. Vitamin K is necessary for blood clotting. This is prevalent in the use as prophylactic treatment for newborns at birth. The American Academy of Pediatrics recommends this course of treatment to prevent hemorrhagic diseases of the newborn. Vitamin K is also necessary for individuals with malabsorption syndromes, ulcerative colitis, coumarin overdose, and prolonged use of salicylate and long-term hyperalimentation antibiotics. Signs of a vitamin K deficiency are increased clotting time, petechia, and bruising, and blood in both urine (hematuria) and in stool (melena). Treatment is prescribed as phytonadione (Mephyton tabs or Aquamephyton IM or SC). This course of treatment is only effective for bleeding disorders that are due to low concentrations of prothrobin in the blood. It is not effective for bleeding from other causes, such as heparin overdose or trauma. Use the following table as a quick reference for fat-soluble vitamins. Name Food Source Oily saltwater fish, whole Vitamin A milk, cream, butter, cheese, egg yolks, fish liver oils Vitamin D Fish oils, salmon, herring, mackerel, sardines, eggs, RDA Plant Amount Dark-green leafy vegetables, deep yellow or orange fruits and 800–1,000 IU per day vegetables Fortified cereals 400 IU per day butter, milk Vitamin E none Vegetable oils, seeds, nuts, wheat germ, cereals 30 IU per day Name Food Source RDA Plant Vitamin K Egg yolk, cheese, liver Amount Vegetable oil, green leafy vegetables, cabbage, broccoli 60–80 mg per day C O NT I NU E Minerals Carbohydrates, lipids, proteins and vitamins are all organic substances, but dietary minerals are inorganic elements that are essential to human metabolism. Minerals are usually extracted from the soil by plants, and we in turn obtain these minerals from the plant food sources or from the animal sources that have eaten the plants. The correct balance of each mineral is required for the maintenance of health (chemical balance homeostasis). Minerals are responsible for approximately four percent of the body weight and are concentrated in the bones and teeth. The two minerals abundant in bones and teeth are calcium and phosphorus, nearly 75 percent of the body’s minerals. Minerals dissolved in the body fluids are called electrolytes because they carry positive or negative electrical charges required for body activities. These activities include simple nerve impulse conduction to the blood formation, and the beating of the heart. The principal minerals in the body and their chemical symbols are sodium (Na), chloride (Cl), potassium (K), calcium (Ca), and iron (Fe). Sodium and Chloride Both sodium and chloride are the principal minerals in the extracellular body fluids. Through experience we understand that blood contains approximately 0.9 percent sodium chloride, and the best source of these minerals is through table salt (NaCl). The sodium element is readily absorbed from foods by active transport, and the kidneys, under the influence of the adrenal cortical hormone aldosterone, regulate the blood concentration of the sodium. When this hormone is released, the kidneys reabsorb sodium while expelling potassium. Like sodium, chloride is widely distributed throughout the body, although it is seen in the highest concentration in the cerebrospinal fluid and gastric juices. Together with sodium, chloride helps to maintain the electrolyte balance (homeostasis) and regulate the pH level through the concentration of extracellular fluids in the body’s cells. Since these elements are readily available, a deficiency of these minerals is due to starvation or an extended time of fasting. The signs of a deficiency can be seen through an excessive amount of fluid loss from bleeding, diarrhea, and vomiting or excessive perspiration. Matching Match the correct vitamin or mineral with its source. Sodium and Chloride table salt Vitamin K green or leafy vegetables Vitamin A yellow-orange and dark-green leafy vegetables Vitamin D sunlight Vitamin E cereals, wheat germ, nuts, and eggs Vitamin C citrus fruits, tomatoes, and broccoli Vitamin B6 meats, legumes, peanuts, and bananas Vitamin B12 poultry, eggs, fish, and milk Folic Acid avocados, orange juice, and kidney beans SUBMIT Complete the content above before moving on. Mental Health and Psychology Adjustments Even with all of the medical break-throughs, the mind is a great influence to healing that is still often over looked. The mind has and continues to prove to be one of the best healing components in the recovery process. If the patient believes they will recover and heal, chances are, they will. Just the reverse is also true. Understanding the purpose and expected outcome of medical treatment procedures is necessary knowledge that every medic needs to assist patients in their recovery. Illness and injury often have an obvious effect on people. However, some adjust and cope with illness, injury and healing positively while others may struggle with despair, depression or other psychological problems. There are various psychological factors that can influence a patient’s mental status while under the care of a health care system. Medics should keep in mind there are sources available to assist in improving or maintaining a patient’s mental well-being. Most notably, these sources include family, friends, supervisors, co-workers and clergy. Allowing as much time as possible for a patient to visit with such support people is crucial in the therapeutic process. Medical Technician Guidelines Patients often want to talk to the health care personnel whom they see on a frequent basis during clinic visits and hospitalization. This obviously means medics are prime candidates for such sessions. It is important to keep these things in mind whenever conversing with a patient in regard to personal concerns: 1 Be a good listener and demonstrate a genuine concern. 2 Do not offer advice or solutions on matters that only the provider should address. 3 Refer the patient’s concerns to the nurse or provider in a timely manner. 4 Finally, it is important to keep the patient’s family in mind. Though local policies should be adhered to on matters such as visiting hours, the number of visitors permitted at any one-time, restricted treatment area, and so forth, and the staff must make every effort to keep the family informed and comfortable. Responses to Illness or Injury There are so many different types of major injuries and severe medical conditions that can occur we could never cover all the situations known to the medical community. Some of the major injuries and severe medical conditions you may encounter are gunshot wounds, burns, spinal cord injuries, strokes, or heart attacks. Although the conditions are very different, the patients may share many of the same feelings, including: Shock and Disorientation Fear and Anxiety