Nutrition: Vitamins and Dietary Intake

Organic substances
Fat-soluble vitamins
- Vitamins A, D, E, and K
Water-soluble vitamins
- Vitamins B complex and C

- Rapid body growth, inadequate diets, or malabsorptive issues
- Pregnant or breastfeeding or have a debilitating illness
- Restrictive diets

Vitamins A, D, E, and K, fat is required for transport

Vitamins B complex and C

Food and Nutrition Board of the Institute of Medicine of the National Academy of Sciences

- AI: Adequate Intake
- UL: Tolerable Upper Limit
- EAR: Estimated Average Requirement
- AMDR: Acceptable Macronutrient Distribution Range

Recommended Daily Amount

Function:
- bone growth, skin, eyes and hair
Food sources:
- fish oils, dairy, darkly-colored carotene rich foods: carrots and spinach
Deficiency:
- night blindness, skin lesions, dysfunction of mucous membranes
Excess doses:
- Teratogenic effect
- Thrombocytopenia
- Hypervitaminosis A:
hair loss, peeling skin, GI upset, lethargy

Function:
- Regulates calcium and phosphorus metabolism
Food sources:
- fish liver oils, dairy products, ultraviolet radiation (sunshine)
Deficiency:
- rickets in children, osteomalacia in adults, bone fracture
Excess doses:
- Hypervitaminosis D
hypercalcemia
anorexia, nausea, vomiting5

Function:
- Antioxidant properties
Food sources:
- Vegetable oils, nuts, wheat germ, whole grains and mustard seeds
Deficiency:
- breakdown of RBCs
Excess doses:
- fatigue, weakness, GI upset, headaches, breast tenderness, bleeding
Interaction
- iron

Function:
- normal blood clotting
- antidote for oral anticoagulants overdose
- prevent and treat hypoprothrombinemia
Food sources:
- spinach, broccoli, alfalfa, synthesized by intestinal flora
- Deficiency:
- spontaneous/increased hemorrhage

Essential coenzyme for carbohydrate metabolism.
- found in enriched, fortified whole-grain products, pork is richest natural source
Deficiency:
- polyneuritis, cardiac pathology, Wernicke-Korsakoff syndrome, neurologic disorders, ataxia, diplopia, edema

Numerous enzymatic reactions. Must first be converted into active form.
- found in milk, yogurt, cheese, bread and fortified cereals, organ meats are rich sources.
Deficiency:
- sore throat, cheilosis, skin cracks at corners of mouth

Vitamin and medicine used to ↓ cholesterol
- found in liver, poultry, fish, potatoes, peanuts
Deficiency:
- pellagra, headache, memory loss, GI upset and insomnia
- Large doses:
can cause flushing, dizziness and nausea.

Functions as coenzyme in metabolism of amino acids and proteins.
- found in liver, yeast, milk and molasses
Deficiency:
- neuritis, seizure, anemia, depression, confusion, seborrheic dermatitis

Function:
- essential factors in synthesis of DNA
Food sources:
- liver and animal tissues
Intrinsic factor- B12 acts with IF for RBC production
Deficiency:
- paresthesia, weakness, fatigue, GI upset
- anorexia, loss of taste, diarrhea
- memory loss, mood changes, psychosis
- megaloblastic anemia and poor growth

Function:
- essential factors in synthesis of DNA
Food sources:
- green leafy vegetables, cantaloupe, breakfast cereals
Deficiency:
- GI upset, stomatitis, fatigue, alopecia
- leukopenia, thrombocytopenia
- during pregnancy, can affect fetal CNS development
Excess doses:
- can lower phenytoin levels
- mask vitamin B12 deficiency

Function:
antioxidant properties
Food sources:
- green vegetables, berries, fresh citrus fruits, red bell peppers
Deficiency
- poor wound healing, bleeding gums, scurvy, faulty bone and tooth development
Excess doses•
- GI upset, headache
- crystalluria if taken with aspirin or sulfonamides
- decreased effect oral anticoagulants

Assessment:
- obtain 24- and 48-hour diet history analysis.
- obtain levels to assess adequacy

Patient problems:
- weight loss, need for health teaching

The patient will verbalize a well balanced diet.

Nursing interventions
- store vitamins in light-resistant container.
- administer vitamins with food to promote absorption.
- monitor serum blood levels of any suspected vitamin deficiency.
- educate patients about foods rich in vitamin A, including milk, butter, eggs, leafy green, and yellow vegetables.
- discourage patient from taking large doses of vitamins over a long period of time.

Function:
- essential component of hemoglobin
Food sources:
- meat, green vegetables, legumes, fortified cereals
Deficiency:
- anemia, fatigue, weakness, shortness of breath, pallor, GI bleeding
Iron toxicity:
- hemorrhage, shock

Function:
- maintains water and electrolyte concentrations, cardiac rhythm control and nerve impulses
Food sources:
- green leafy vegetables, bananas, oranges
Deficiency from:
- metabolic changes, diuretic use
This is NEVER given as a bolus or push

Function:
- bone health, hormones.
- Food Sources:
non fat milk, green leafy vegetables
Deficiency:
- usually caused from metabolic conditions
- too low = tetany
- too high = cardiac irregularities

- Natural substances does not mean safe.
- Not all compounds are safe via all routes.
- Collect complete list of patient's herbal use.
- Be alert for possible herb-drug interaction.
- Some herbal products can affect lab results.
- Many products may interfere with absorption, breakdown, and excretion of anesthetics, anticoagulants, and other drugs used in surgery.
- Discontinue herbal therapy 2 to 3 weeks before surgery.

- botanicals
- nutritional products
- herbal supplements

Ensure products are safe and label information is truthful and not misleading.

Standards require package labels that declare quality and strength of contents and that product is without contaminants and impurities.14

Decoction
Infusion
Tinctures
Liniment
Poultice
Essential oils
Herb-infused oils
Percolation

- boosts immune system
- limits cold and flu symptoms

- relief of anxiety, sleeplessness, digestive complaints, skin conditions, and oral ulcers
- may have sedative effects
- allergic reactions of urticaria and bronchoconstriction if allergic to daisy or ragweed

- used for colds, flu, infections
- stimulates immune system

- used for hypercholesterolemia, hypertension, reduce heart disease, prevent stomach and colon cancer.
- side effects may include heartburn, upset stomach, body odor, decreased blood clotting.

- used for nausea, motion sickness, diarrhea, relieves pain, swelling, arthritic stiffness.
- side effects may include gas, bloating, heartburn, nausea.

- used for asthma, bronchitis, fatigue, tinnitus.
- used to improve memory, decrease intermittent claudication.
- treats sexual dysfunction, multiple sclerosis.
- side effects include headache, dizziness, nausea, GI upset, increase bleeding, allergic reactions.

- used for stress relief, digestion, increasing energy
- boosts immune system and prevents infection.
- side effects include headache, GI distress, hypertension, hypoglycemia, breast tenderness, menstrual irregularities

- used for heart disease, digestive issues, kidney disease.
- side effects include headache, dizziness, nausea.

- used for bronchitis, sore throat, stomach ulcers, viral hepatitis.
- high doses can lead to salt and water retention, hypertension, low potassium level.

- used for hypercholesterolemia, insulin resistance, chronic hepatitis, cirrhosis.
- side effects: upset stomach, hypoglycemia, allergic reactions if allergic to ragweed and milk thistle.

- used for relaxation and anxiety
- adverse effects include liver damage; dry, scaly, yellowing skin; eye irritation, heart problems

- used for urinary symptoms, chronic pelvic pain, decreased libido, migraines, hair loss
- side effects include digestive problems, headache

S
- soothes minor burns
- treats infections
- moisturizes dry skin
- used to treat psoriasis

- used to treat symptoms of menopause
- may potentiate antihypertensives and the hypoglycemic effect of oral agents and insulin Adverse effects:
GI distress, rash, HA, dizziness, weight gain and cramps

- prevention of UTIs
Drug interactions:
- may interact with Coumadin/warfarin and increase the effect

- prevent migraine headaches and aid indigestions

- used for dyslipidemia and constipation
Adverse effects:
GI-related

- used for headache, cold symptoms, nausea, indigestion, irritable bowel syndrome, muscle and nerve pain.
Side effects:
heartburn, allergic reaction

- used for mental disorders, nerve pain, sleep disorders, malaria, wounds.
Side effects:
anxiety, dry mouth, dizziness, headache, fatigue, sensitivity to sunlight, GI problems, sexual dysfunction.
Drug interactions:
serotonin syndrome when taken with other antidepressants.

- used for heartburn, stomach ulcers, gallstones, inflammation, cancer.
- high doses may cause nausea, diarrhea.
- generally safe without side effects.

- used for anxiety, headache, insomnia, tremors, depression, irregular heartbeat.
Side effects:
headache, dizziness,
fatigue, stomach upset.

- may relieve pain and lower inflammation
- relieve N/V in cancer chemotherapy
- tx in neuropathic pain
- CBD tx childhood epilepsy
Not enough evidence for the CDC to support ingesting or smoking

Do not take if taking prescription drugs without checking with heath care provider.
Do not take if pregnant.
Do not take if nursing.
Do not give herbs to infants/young children.
Do not take a large quantity of any herbal preparation.
Follow label instructions.
Discontinue if side effects are disturbing and contact health care provider.

- obtain baseline of patient's use of
complementary and alternative therapies.
- identify all prescription and OTC drugs.

- need for health teaching.

- patient will verbalize understanding of herbal therapy, prescription, and OTC drugs.

- advise patient to notify health care provider before substituting herbs for a prescription or OTC drug.
- teach patient about foods that enhance or diminish action of specific herb.•
- advise patient of potential side effects of herbal therapy
- evaluate perceived effectiveness of herbal remedies.

-outermost layer "sclera and cornea"
-middle layer "choroid, ciliary body, and iris"
-inner layer "retina, macula lutea, fovea centralis, optic disc"

Use:
- locate extraocular lesions or foreign objects
- valuate dry eyes or extraocular changes
- allow more thorough examination
Nursing interventions:
- external eye is discolored but will dissipate
- nasal secretions are stained
- soft contact lenses are discolored
- rinse eye with normal saline after procedure
- contact lenses can be replaced after 1 hour
Examples:
- fluorescein sodium
- rose bengal
- lissamine green

Use
- selected aspects of comprehensive eye exam
- ophthalmic procedures
Action
- locally block pain signals at eye's nerve endings
Examples:
- proparacaine
- tetracaine
Corneal anesthesia achieved within 15seconds, generally lasts about 15 min.

Use:
- eye infections
Types of eye infections
- conjunctivitis
- blepharitis
- chalazion
- endophthalmitis
- hordeolum
- infectious keratitis
- infectious uveitis

Corticosteroids
Cyclosporine
Ophthalmic NSAIDs (diclofenac, ketorolac) Corticosteroids (dexamethasone, prednisolone)

Antihistamines
Mast cell stabilizers

Action:
Stimulate alpha-adrenergic receptors in arterioles of conjunctiva narrowing blood vessels and decreasing congestion
- may have systemic absorption
Examples:
- phenylephrine, naphazoline, tetrahydrozoline• Contraindication:
- angle-closure glaucoma

Action:
- moisten eyes to relieve discomfort
Use:
- eye dryness

Characterized by:
↑ Intraocular pressure
↑ Production of aqueous humor OR
outflow obstruction
Major Types:
Primary:
- closed-angle
- open-angle
Secondary:
- result from previous eye injury, disease or cataract surgery

Use:
- open-angle glaucoma
- ocular hypertension
Action:
- improve trabecular outflow
- increase uveoscleral pathway
Examples:
- imatoprost, latanoprost, tafluprost, travoprost
Side effects:
- change iris color, darkened eyelids, stinging
- eyelash hypertrichosis, macular edema, itching
- blurred vision, redness of conjunctiva

Use:
- open-angle glaucoma, ocular hypertension
Action
- reduce IOP by decreasing production of aqueous humor
Examples
- carteolol, levobunolol, timolol
Side effects:
- eye discomfort, miosis, bronchoconstriction
- bradycardia, AV heart block, heart failure

Action:
- control or prevent elevation of IOP
- decrease production and improve outflow of aqueous humor
Examples:
- apraclonidine, brimonidine
Side effects:
- burning, stinging, blurred vision, headache
- corneal erosion, keratitis, dysrhythmias, asthma

Use:
- open-angle glaucoma, ocular hypertension
Action:
- improves outflow of aqueous humor
Examples:
- cholinergic agonist - pilocarpine
- cholinesterase inhibitor - echothiophate
Side effects:
- ocular irritation, retinal detachment, tearing, blurred vision
- cardiac irregularities, hyperhidrosis, diarrhea

Use:
- open-angle glaucoma
Action:
- decrease production of aqueous humor
Examples:
- brinzolamide, dorzolamide, acetazolamide
Side effects:
- lethargy, drowsiness, headache, seizures
- paresthesias, mental status changes
- GI distress, dysgeusia, polyuria, thirst
- fluid and electrolyte imbalance, hyperuricemia

- check baseline visual acuity and intraocular pressure measurements.
- assess for contraindications for glaucoma drugs.

- sensory perception (visual), disturbed related to disease progression and drug-induced visual changes

- the patient will demonstrate proper method of ophthalmic drug administration.
- the patient's IOP will decrease to target range.

- monitor for significant alterations in patient status.
- monitor patient's xerostomia, dehydration, fluid overload, electrolyte imbalances, blurred vision, bradycardia, tachycardia, and hypertension.
- advise patient to never stop medication suddenly.
- counsel patients with glaucoma to avoid drugs with potential to increase IOP.
- teach patient not to touch the tip of the eye dropper to the eye, finger, or any other object.

Mydriatics
- action—dilate pupils
Cycloplegics
Action:
- paralyze the accommodation muscles
Use:
- diagnostic procedures
- ophthalmic surgery
Side effects:
- dry eyes and mouth, photophobia, blurred vision
- cephalgia, constipation, increased IOP, seizures
- psychosis, hypotension, tachycardia
- respiratory depression, muscle rigidity

Types:
- Wet, progresses rapidly, vascular endothelial growth factor inhibitors are injected into the eye
Ranibizumab, bevacizumab, pegaptanib, and aflibercept
- Dry, slowly destroys vision over years, no known treatment

Use•:
- acute otitis media, acute otitis externa
Acute otitis media:
- amoxicillin, azithromycin, clarithromycin
Otitis externa
- neomycin, polymyxin B, hydrocortisone, chloramphenicol, fluoroquinolones
Side effects:
- burning, stinging, super infection
- aminoglycosides—ototoxicity
- chloramphenicol—bone marrow suppression

Corticosteroids: ↓ inflammation
Misc preparations
- wax emulsifiers
- antifungals
- local anesthetics
- anti inflammatory agents
- local analgesics- pain relief

- record otoscopic exam findings for future comparison.
- check audiometry and tympanometry and perform other testing as indicated.

- sensory perception (auditory), disturbed due to diagnosis.
- pain related to infection.

- the patient will be free of ear infection after completion of drug regimen

- complete culture and sensitivity testing before starting drug therapy.
- provide relief of associated pain.
- assess for the development of superinfections.
- instruct patient to complete entire course of medication.
- instruct patient to wear a medical alert bracelet at all times if allergic to any medications.

Child:
Adult:

Causes:
- acne vulgaris
- psoriasis
- eczema dermatitis
- contact dermatitis
- drug-induced dermatitis
- burn infections
- viral infections
- herpes simplex, herpes zoster
- fungal infections
- tinea pedis, tinea capitis

Types:
- macules
- papules
- vesicles
- plaques

Treatments:
- topical creams, ointments
- pastes, gels
- lotions, solutions

Acne vulgaris
- papules, nodules, and cysts from keratin plugs at the base of pilosebaceous oil glands near hair follicles.
Nonpharmacologic approach:
- cleansing agent, avoid abrasive cleaners and over scrubbing.
- hair shampooing, water-based cosmetics.
- well-balanced diet, decrease emotional stress.
Pharmacologic approach:
- topical drugs treat acne and prevent new eruptions.

Mild acne:
- benzoyl peroxide
Action:
- release free radical oxygen species that oxidize bacterial proteins of P. acnes
- resolution usually takes 4 to 6 weeks
Moderate to severe acne:
Treatment:
- stronger concentration of benzoyl peroxide and topical antibiotics
- retinoids, salicylic acid, antibiotics
- combinations with gentle cleansing
Action:
- topical antibiotics accumulate in hair follicle and exert anti inflammatory and antibacterial effects.

Systemic antiacne drugs
- isotretinoin
- vitamin A derivative
Action
- decrease sebum formation and secretion
- have anti-inflammatory and anti-keratinizing effects Use:
- severe cystic acne unresponsive to conventional therapy
Side effects:
- skin irritation, pruritus, cheilitis
- cephalgia, myalgia, arthralgia, dizziness
- conjunctivitis, photosensitivity, epistaxis
- temporary hair thinning
- depression, suicidal thoughts
Caution:
- monitoring liver function tests
- iPledge risk-management program

- scaly, erythematous plaques or scales

- usual course of treatment is 4 weeks
- side effects
- skin atrophy, telangiectasia, striae distensae, acne, folliculitis, purpura
- worsening of existing condition, fungal infection
- Cushing syndrome, cataracts, glaucoma, growth retardation.

Systemic drug treatment:
- Methotrexate, cyclosporine, acitretin, and biologic response modifiers
Methotrexate side effects:
- stomatitis, GI distress, fatigue
- teratogenic, myelosuppression
hepatotoxicity, pulmonary fibrosis
Cyclosporine side effects:
- hypertrichosis, fatigue, hypertension, nephrotoxicity
- cephalgia, myalgia, arthralgia, paresthesia.

- assess patient's skin eruptions.
- obtain cultures of purulent, draining skin lesions.
- obtain baseline lab values.

- skin integrity, risk for impaired
- disturbed body image, risk for

- the patient will report improved body image.
- the patient will verbalize the need for two methods of contraception during the required period when taking isotretinoin.

- apply topical medications to skin lesions using aseptic technique.
- monitor vital signs and perform required diagnostic tests.
- during drug therapy, check lesion sites for improvement and monitor for adverse reactions.
- listen to the patient's body image concerns and provide community resources if applicable.
- advise patient not to use harsh cleansers.

- applied topically or injected
- cause loss of sensation
Uses:
insect bites, sunburn, burns, hemorrhoids
Common anesthetic agents
- cocaine- used in topical solutions and nasal preparations for surgery
- procaine (Novocain)- used in dentistry
dibucaine (Nupercainal)- Applied topically in ointments
- benzocaine-throat lozenges, topical preparations, common ointments

Treat fungal infections of the skin
- fungi are difficult to eliminate, because of this, patients should use these topical medications for at least 2 weeks., Some of them will take 4 or even 6 weeks of treatment to completely eliminate a fungus. Topical and oral:
Common antifungal agents•
- ketoconazole (Nizoral), ciclopirox olamine (Loprox), ciclopirox solution (Penlac NailLacquer), tolnaftate (Tinactin), zinc undecylenateointment (Desenex), clotrimazole (Lotrimin), clioquinol (Vioform), econazole nitrate (Spectazole)
Anti-monilial Preparations:
- moniliasis (candidiasis)
- yeastlike infection of skin and mucous membranes caused by Candida albicans.

Ethyl alcohol (alcohol)/Isopropyl alcohol•
- cleanse skin before injections
Hexachlorophene (pHisoHex):
- antiseptic scrub
Gentian violet:
- antiseptic dye, impetigo, thrush, cystitis, urethritis
Povidone-iodine solution (Betadine)
- slow release, antiseptic scrub, contraindicated/caution with shell-fish allergies - Hydrogen peroxide solution•
- cleans wounds.

Mupirocin calcium (Bactroban):
- topical antibiotic ointment, impetigo and local infections(MRSA)
Silver sulfadiazine (Silvadene cream):
- topical antibiotic ointment, for second and third degree burns
Mafenide acetate cream (SulfamylonCream):
treats second- and third-degree burns