Vitamins and Minerals Nutrition. Blood-Forming Agents. Dermatologic, Ophthalmic and Otic Agents

1. Vitamins and Minerals Nutrition. Blood-Forming Agents. Dermatologic, Ophthalmic and Otic Agents

2. Vitamins • Organic substances necessary for metabolic functioning • Found in foods • Inadequate intake leads to deficiencies

3. Vitamins • Organic substances necessary for metabolic functioning • Found in foods • Inadequate intake leads to deficiencies • Most signs and symptoms of deficiencies can be corrected by administering the correct vitamin

4. Vitamin Deficiencies • Keratomalacia • Vitamin A deficiency • Softens the cornea • Rickets • Beriberi • Pallagra • Scurvy

5. Vitamin Deficiencies • Keratomalacia • Rickets • Vitamin D deficiency • Causes bending of the bones • Beriberi • Pallagra • Scurvy

6. Vitamin Deficiencies • Keratomalacia • Rickets • Beriberi • Vitamin B1 deficiency • Causes polyneuritis, edema, and cardiac problems • Pallagra • Scurvy

7. Vitamin Deficiencies • Keratomalacia • Rickets • Beriberi • Pallagra • Vitamin B3 deficiency • Causes dermatitis and diarrhea • Scurvy

8. Vitamin Deficiencies • Keratomalacia • Rickets • Beriberi • Pallagra • Scurvy • Vitamin C deficiency • Causes anemia, spongy gums, hemorrhages, and brawny induration of calf and leg muscles

9. Classification of Vitamins • Fat-Soluble – maintained in stores in the liver • Excessive amounts can collect and cause toxicity • Water-Soluble – readily excreted by the kidneys • Deficiency is quickly apparent, but overdose is unlikely

10. Fat-Soluble Vitamins • Vitamin A (Retinol) • Normal growth, bone formation, shedding of epithelial tissue, retinal function, reproductive function, stability of cell membrane • Vitamin D (ergocalciferol) • Vitamin E (tocopherol) • Vitamin K (phytonadione)

11. Fat-Soluble Vitamins • Vitamin A (Retinol) • Vitamin D (ergocalciferol) • Calcium and phosphate balance • Vitamin E (tocopherol) • Vitamin K (phytonadione)

12. Fat-Soluble Vitamins • Vitamin A (Retinol) • Vitamin D (ergocalciferol) • Vitamin E (tocopherol) • Antioxidant for unsaturated fatty acids • Vitamin K (phytonadione)

13. Fat-Soluble Vitamins • Vitamin A (Retinol) • Vitamin D (ergocalciferol) • Vitamin E (tocopherol) • Vitamin K (phytonadione) • Functions in the formation of prothrombin and plays a role in blood clotting

14. Water-Soluble Vitamins • Vitamin C (ascorbic acid) • Improves the ability of the immune system, has anti-inflammatory activity and promotes wound healing • Vitamin B1 (thiamine) • Vitamin B2 (riboflavin) • Vitamin B3 (nicotinic acid, niacin)

15. Water-Soluble Vitamins • Vitamin C (ascorbic acid) • Vitamin B1 (thiamine) • Acts as a coenzyme in carbohydrate metabolism • Vitamin B2 (riboflavin) • Vitamin B3 (nicotinic acid, niacin)

16. Water-Soluble Vitamins • Vitamin C (ascorbic acid) • Vitamin B1 (thiamine) • Vitamin B2 (riboflavin) • Maintains the integrity of mucous membranes and metabolic energy pathways • Vitamin B3 (nicotinic acid, niacin)

17. Water-Soluble Vitamins • Vitamin C (ascorbic acid) • Vitamin B1 (thiamine) • Vitamin B2 (riboflavin) • Vitamin B3 (nicotinic acid, niacin) • Involved in fat synthesis, electron transport, and protein metabolism

18. Water-Soluble Vitamins • Vitamin B5 (pantothenic acid) • Forms part of the coenzyme system • Vitamin B6 (pyridoxine) • Vitamin B9 (folic acid) • Vitamin B12 (cyanocobalamin)

19. Water-Soluble Vitamins • Vitamin B5 (pantothenic acid) • Vitamin B6 (pyridoxine) • Coenzyme in amino acid and fatty acid metabolism • Vitamin B9 (folic acid) • Vitamin B12 (cyanocobalamin)

20. Water-Soluble Vitamins • Vitamin B5 (pantothenic acid) • Vitamin B6 (pyridoxine) • Vitamin B9 (folic acid) • Provides for production of healthy red blood cells and decreases the risk of birth defects • Vitamin B12 (cyanocobalamin)

21. Water-Soluble Vitamins • Vitamin B5 (pantothenic acid) • Vitamin B6 (pyridoxine) • Vitamin B9 (folic acid) • Vitamin B12 (cyanocobalamin) • Helps in the production of red blood cells

22. TPN Labeling • Patient’s name • Address or hospital unit • Solution name, concentration, and volume • Additives • EXPIRATION DATE

23. Body Fluids • Water is the major constituent of living cells • Extracellular and intracellular fluids are largely water • A loss of 25% of body water can lead to death

24. Electrolytes • Compounds that form ions when dissolved in water • Na+ - primary cation of extracellular fluid • Retains fluid in the body, generates and transmits nerve impulses, maintains acid-base balance, regulates enzyme activities, and regulates osmolarity and electroneutrality

25. Electrolytes • K+ - primary cation of intracellular fluid • Regulates acid-base and water balance, important in protein synthesis, carbohydrate metabolism, muscle building, and the nervous system • Ca++ • Important in bone formation, muscle contraction, and blood coagulation

26. Electrolytes • Cl- • Transports CO2, forms HCl in the stomach, retains K+, maintains osmolarity • H+ • Determines the acidity and alkalinity of body fluids

27. Electrolytes • Mg++ - 2nd most abundant cation in intracellular fluids • Helps maintain normal nerve and muscular function, transmission of impulses, and steady heart rhythms

28. Discussion Why would a patient need an injection of B12?

29. Discussion Why would a patient need an injection of B12? Answer: low red blood cell count

30. IV Therapy • Goal: provide sufficient water and electrolytes to maintain fluids and excrete waste products • Solvent in IV solutions is water

31. IV Therapy • Goal: provide sufficient water and electrolytes to maintain fluids and excrete waste products • Solvent in IV solutions is water • D5W = 5 g of Dextrose in 100 ml of water • NS = 0.9 g of NaCl in 100 ml of water

32. Tonicity • Measures the amount of dissolved particles in relation to body fluids • Hypotonic – lower concentration of dissolved particles

33. Tonicity • Measures the amount of dissolved particles in relation to body fluids • Hypotonic – lower concentration of dissolved particles • Hypertonic – higher concentration of dissolved particles

34. Tonicity • Measures the amount of dissolved particles in relation to body fluids • Hypotonic – lower concentration of dissolved particles • Hypertonic – higher concentration of dissolved particles • Isotonic – same concentration of dissolved particles (0.9% sodium chloride)

35. Enteral Nutrition • Patients are fed through a tube leading to the GI system • Preferred method over IV therapy • Very important to label enteral nutrition separately than parenteral nutrition

36. Total Parenteral Nutrition • Patient is fed through IV administration • Can be lifesaving, but can be devastating if appropriate precautions are not taken • Water, electrolyte, carbohydrate, and protein proportions must be calculated carefully

37. Malnutrition • TPNs can help patients to avoid malnutrition • 20% of all hospitalized patients have been shown to have malnutrition

38. 2 Types of Protein Malnutrition • Marasmus • Kwashirokor

39. 2 Types of Protein Malnutrition • Marasmus • Imbalance between protein and calorie intake • Causes growth retardation • Kwashirokor

40. 2 Types of Protein Malnutrition • Marasmus • Imbalance between protein and calorie intake • Causes growth retardation • Kwashirokor • Lack of dietary protein or caused by stress of infection, burns, traumatic injury, or disease

41. Indications for TPNs • Poor wound healing • Infections • Anemia • Specific GI disease • Hypermetabolic states • Patients who cannot tolerate enteral nutrition

42. Other Indications for TPNs • AIDS • Enterocutaneous fistulas • Malignant disease • Perioperative support • Pregnancy • Severe gastroparesis

43. Acid-base imbalance Dehydration Elevated serum triglycerides Failure to induce anabolism High serum lipid concentrations Hyperammonemia Hyperglycemia or hypoglycemia (diabetic or not) Hypoalbuminemia Imbalance of electrolytes Liver toxicity Complications of TPNs

44. Preparing TPN Solutions • Two Types of TPN: • Solutions with lipids (3-in-1) = TNAs • Solutions without lipids (2-in-1) = TPN • Advantages of TNAs • Lower cost of preparation • Less administration time for nurses • Potentially reduced risk of sepsis

45. Preparing TPN Solutions • Disadvantages to TNAs • Precipitants cannot be seen • Not stable as long as TPNs without lipids • Expiration date for 2-in-1 is 21 days • Expiration date for 3-in-1 is 7 days • Can remain at room temperature for 24 hours

46. Mixing TPNs • Phosphates injected first • Then add amino acids, dextrose, lipids, and water • Then add the other electrolytes • Phosphate must be separated from calcium and magnesium • TPNs must be inspected after mixing to look for precipitates

47. Common Additions to TPNs

48. ascorbic acid (vitamin C) biotin cyanocobalamin (vitamin B12) ergocalciferol (vitamin D2) folic acid (vitamin B9) niacin (vitamin B3) pyridoxine (vitamin B6) retinol (vitamin A) riboflavin (vitamin B2) thiamine (vitamin B1) tocopherol (vitamin E) Recommended Multivitamin Additions for TPN

49. Recommended Trace Element Additions for TPN • chromium • copper • manganese

50. Standard per Liter Additions for TPN • acetate • calcium • chloride • insulin, regular • magnesium • phosphate • potassium • sodium • zinc