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Nutrient DeficienciesNutrient Deficiencies
N323N323
VitaminsVitamins
FAT-SOLUBLE:FAT-SOLUBLE: A, D, E & KA, D, E & K Are absorbed with fat.Are absorbed with fat. Transported by protein lipids (LDL)Transported by protein lipids (LDL) Excessive amounts are stored.Excessive amounts are stored. Not necessary to eat every day but Not necessary to eat every day but
toxic amounts can accumulate.toxic amounts can accumulate. Found in fat or oil portion of foods. Found in fat or oil portion of foods.
VitaminsVitamins
WATER-SOLUBLE:WATER-SOLUBLE: C & B (thiamine, riboflavin, niacin, C & B (thiamine, riboflavin, niacin,
folate, Bfolate, B66, B, B1212, biotin & pantothenic , biotin & pantothenic acid)acid)
Are absorbed with water.Are absorbed with water. Transported free floating in blood.Transported free floating in blood. Excessive amounts are excreted.Excessive amounts are excreted. Necessary to eat every day; toxic Necessary to eat every day; toxic
amounts unlikely to accumulate.amounts unlikely to accumulate. Found in water portion of foods.Found in water portion of foods.
Requirements Requirements
Recommended Daily Allowance: (RDA):Recommended Daily Allowance: (RDA): Average daily intake sufficient to meet Average daily intake sufficient to meet nutrient requirements for a healthy nutrient requirements for a healthy individual.individual.
Dietary Reference Intake (DRI):Dietary Reference Intake (DRI): New set of New set of 4 values to set dietary goals: 4 values to set dietary goals: RDARDA plus: plus:
Estimated Average Requirement (EAR):Estimated Average Requirement (EAR): Amt. of nutrient sufficient to meet the Amt. of nutrient sufficient to meet the needs of 50% of individuals.needs of 50% of individuals.
RequirementsRequirements
Adequate Intake (AI):Adequate Intake (AI): Recommended Recommended daily intake when actual amt. is daily intake when actual amt. is unproven.unproven.
Tolerable Upper Intake Level (UL):Tolerable Upper Intake Level (UL): Highest level of daily nutrient intake that Highest level of daily nutrient intake that is not apt to cause harm. is not apt to cause harm.
SourcesSources
BREAD, CEREAL, RICE FOOD GROUPBREAD, CEREAL, RICE FOOD GROUP B vitamins (thiamine, riboflavin, B vitamins (thiamine, riboflavin,
niacin, folate, B6), Vitamin Eniacin, folate, B6), Vitamin E Fortified cereals contain almost all Fortified cereals contain almost all
vitamins.vitamins.
VEGETABLE GROUP:VEGETABLE GROUP: Beta-carotene, C, K, & folateBeta-carotene, C, K, & folate
FRUIT GROUP:FRUIT GROUP: Beta-carotene & vitamin CBeta-carotene & vitamin C
SourcesSources
MILK, YOGURT & CHEESE GROUPMILK, YOGURT & CHEESE GROUP Vitamin A, D, B6, B12, riboflavinVitamin A, D, B6, B12, riboflavin
MEAT, POULTY, FISH, BEANS, EGGS & MEAT, POULTY, FISH, BEANS, EGGS & NUTSNUTS
B vitamins (B6, B12, niacin, riboflavin)B vitamins (B6, B12, niacin, riboflavin) Vitamin A (fish)Vitamin A (fish)
FATS & OILS GROUPFATS & OILS GROUP Vitamin EVitamin E
Vitamin AVitamin A
ACTION:ACTION: Promotes night visionPromotes night vision Integrity of mucus membrane & skinIntegrity of mucus membrane & skin Bone growthBone growth
SOURCES:SOURCES: Preformed A: animal fats; No-fat milk and Preformed A: animal fats; No-fat milk and
cereals are fortified. cereals are fortified. Beta-carotene (precursor to vitamin A): Beta-carotene (precursor to vitamin A):
yellow & orange vegetables and fruits, yellow & orange vegetables and fruits, dark green leafy vegetablesdark green leafy vegetables
Vitamin AVitamin A
TOXICITY:TOXICITY: Unlikely except by supplements.Unlikely except by supplements. Teratogenic during pregnancy so Teratogenic during pregnancy so
excess supplements are not excess supplements are not recommended (Accutane is vitamin A).recommended (Accutane is vitamin A).
Beta-carotene, if excessive is not Beta-carotene, if excessive is not converted to vitamin A, but stored in converted to vitamin A, but stored in body fat. Can turn skin yellow-orange body fat. Can turn skin yellow-orange (hypercarotenemia)(hypercarotenemia)
Vitamin AVitamin A
DEFICIENCY:DEFICIENCY: Tender gums, sores at corners of Tender gums, sores at corners of
mouth.mouth. A major cause of blindness worldwide A major cause of blindness worldwide
Xerophthalmia Xerophthalmia = dry, lusterless = dry, lusterless conjunctiva. conjunctiva. KeratomalaciaKeratomalacia = necrosis = necrosis of cornea with perforation and loss of of cornea with perforation and loss of ocular fluid ocular fluid
““Smart” rice is A-fortified to prevent Smart” rice is A-fortified to prevent this.this.
Vitamin AVitamin A
PEOPLE AT RISK:PEOPLE AT RISK: Eat no vegetablesEat no vegetables Constant dietersConstant dieters ““Statin” drug usersStatin” drug users poor absorption of fatpoor absorption of fat
Vitamin DVitamin D
ACTION:ACTION: Necessary for calcium absorption from GI Necessary for calcium absorption from GI
tract; incorporation of calcium into bone.tract; incorporation of calcium into bone.
SOURCE:SOURCE: Ultraviolet sunlight & a precursor to Ultraviolet sunlight & a precursor to
cholesterol is synthesized by liver; cholesterol is synthesized by liver; activated by kidney.activated by kidney.
Liver, fatty fish & egg yolks only natural Liver, fatty fish & egg yolks only natural food sources.food sources.
Milk is fortified to supply vitamin D.Milk is fortified to supply vitamin D.
Vitamin DVitamin D
TOXICITY:TOXICITY: Vitamin most apt to cause toxicity.Vitamin most apt to cause toxicity. Increases GI calcium absorption = Increases GI calcium absorption =
kidney stones, hypercalcemia.kidney stones, hypercalcemia.
DEFICIENCY:DEFICIENCY: Osteomalacia in adults (weakened Osteomalacia in adults (weakened
bones)bones) Rickets in children (curved bones)Rickets in children (curved bones) Tetany (from hypocalcemia)Tetany (from hypocalcemia)
Vitamin DVitamin D
PEOPLE AT RISK:PEOPLE AT RISK: Elderly (receive less sunlight; kidneys Elderly (receive less sunlight; kidneys
don’t function as well)don’t function as well) People living in heavy smog, pollution People living in heavy smog, pollution
areas.areas. Children who don’t drink milk.Children who don’t drink milk.
RicketsRickets
Weakened bone formation from lack of Weakened bone formation from lack of calciumcalcium
ASSESSMENT:ASSESSMENT: CraniotabesCraniotabes Delayed tooth developmentDelayed tooth development Rachitic rosary & epiphysis swellingRachitic rosary & epiphysis swelling Late closure of fontanellesLate closure of fontanelles Bow legs; KyphosisBow legs; Kyphosis Pelvic contractionPelvic contraction Confirmed by x-ray examinationConfirmed by x-ray examination
RicketsRickets
NURSING DIAGNOSIS:NURSING DIAGNOSIS: Immobility related to poor bone Immobility related to poor bone
formation.formation.
THERAPY/INTERVENTIONS:THERAPY/INTERVENTIONS: Vitamin D, calcium & sun exposureVitamin D, calcium & sun exposure
EXPECTED OUTCOME:EXPECTED OUTCOME: Child ingests adequate intake.Child ingests adequate intake. Bone changes stop with treatment but Bone changes stop with treatment but
are not irreversible.are not irreversible.
Vitamin EVitamin E
ACTION:ACTION: Potent antioxidant (keeps Potent antioxidant (keeps
polyunsaturated fats from being polyunsaturated fats from being destroyed; protects against destroyed; protects against atherosclerosis, cell wall damage)atherosclerosis, cell wall damage)
Important for immune function.Important for immune function.
SOURCES:SOURCES: Found in almost all plants.Found in almost all plants.
Vitamin EVitamin E
TOXICITY:TOXICITY: Large amts. interfere with vitamin K so Large amts. interfere with vitamin K so
can lead to hemorrhage.can lead to hemorrhage.
DEFICIENCY:DEFICIENCY: Rare because sources are so abundant.Rare because sources are so abundant. Premature infants develop anemia from Premature infants develop anemia from
oxidization of red blood cells.oxidization of red blood cells.
RISKS:RISKS:
Low-birth weight infants; poor fat Low-birth weight infants; poor fat absorption.absorption.
Vitamin KVitamin K
ACTION:ACTION: Important for blood clotting (synthesis of Important for blood clotting (synthesis of
prothrombin).prothrombin).
SOURCES:SOURCES: Green, leafy vegetables, liver, milkGreen, leafy vegetables, liver, milk Manufactured in intestines by bacteria.Manufactured in intestines by bacteria.
Vitamin KVitamin K
TOXICITY:TOXICITY: RareRare
DEFICIENCY:DEFICIENCY: Not a lot is stored so deficiency can occur.Not a lot is stored so deficiency can occur. Hemorrhagic Disease of the newbornHemorrhagic Disease of the newborn
RISKS:RISKS: Newborns for 1st 24 hours (why vitamin K Newborns for 1st 24 hours (why vitamin K
is routinely administered).is routinely administered). Coumadin users (blocks vitamin K action)Coumadin users (blocks vitamin K action) Intestinal surgery with antibioticsIntestinal surgery with antibiotics
Thiamine (B1)Thiamine (B1)
ACTION:ACTION: Necessary for glucose metabolism & Necessary for glucose metabolism &
nervous system health.nervous system health.
SOURCES:SOURCES: Meat & grainsMeat & grains Alcohol impairs absorptionAlcohol impairs absorption
Thiamine (B1)Thiamine (B1)
TOXICITY:TOXICITY: RareRare
DEFICIENCY:DEFICIENCY: BeriberiBeriberi
RISK:RISK: Alcoholics Alcoholics Poor protein intake in developing Poor protein intake in developing
countriescountries
BeriberiBeriberi
Thiamine (B1) deficiency (found in people who Thiamine (B1) deficiency (found in people who eat polished rice as dietary staple (Beat polished rice as dietary staple (B11 is found is found in hull of rice)in hull of rice)
ASSESSMENT:ASSESSMENT: Tingling/numbness of extremities; edema, Tingling/numbness of extremities; edema,
heart palpitation; exhaustion & dyspneaheart palpitation; exhaustion & dyspnea Diarrhea/vomitingDiarrhea/vomiting Infants dry without sound (aphonia) Edema & Infants dry without sound (aphonia) Edema &
convulsions convulsions
THERAPY/INTERVENTIONS:THERAPY/INTERVENTIONS: ThiamineThiamine
Riboflavin (B2)Riboflavin (B2)
Necessary for glucose metabolism Necessary for glucose metabolism Either toxicity or deficiency rareEither toxicity or deficiency rare
Niacin (B3)Niacin (B3)
ACTION:ACTION: Necessary for glucose & fat metabolism.Necessary for glucose & fat metabolism. Lowers cholesterol.Lowers cholesterol.
SOURCE:SOURCE: Whole grains and protein rich foods.Whole grains and protein rich foods.
TOXICITY:TOXICITY: Causes severe flushing from Causes severe flushing from
vasodilatationvasodilatation Hypotension from vasodilatation.Hypotension from vasodilatation.
Niacin (B3)Niacin (B3)
DEFICIENCY:DEFICIENCY: Rare as body can convert an amino acid Rare as body can convert an amino acid
to niacin.to niacin. PellagraPellagra
RISKS:RISKS: People who use corn as dietary staple.People who use corn as dietary staple. Reduces cholesterolReduces cholesterol
PellagraPellagra
Niacin deficiency (found in people who eat Niacin deficiency (found in people who eat corn as main dietary staple)corn as main dietary staple)
ASSESSMENT:ASSESSMENT: 4 Ds:4 Ds: DermatitisDermatitis: looks like sunburn at first, then : looks like sunburn at first, then
dry and cracked; tone is sore and raw-dry and cracked; tone is sore and raw-looking. looking.
Dementia:Dementia: loss of memory; general loss of memory; general irritabilityirritability
Diarrhea:Diarrhea: Death:Death:
PellegraPellegra
THERAPY/INTERVENTIONS:THERAPY/INTERVENTIONS: Niacin administration.Niacin administration. Caution that severe flushing will occur.Caution that severe flushing will occur.
Pyridoxine (B6)Pyridoxine (B6)
ACTION:ACTION: Necessary for amino acid & fat Necessary for amino acid & fat
metabolism.metabolism. Produciton of heme; myelin sheaths. Produciton of heme; myelin sheaths.
Converts tryptophan to niacin.Converts tryptophan to niacin.
SOURCES:SOURCES: Meat, fish, grainsMeat, fish, grains
TOXICITY:TOXICITY: RareRare
Pyridoxine (B6)Pyridoxine (B6)
DEFICIENCY:DEFICIENCY: May be associated with convulsion in May be associated with convulsion in
infants.infants. May be associated with premenstrual May be associated with premenstrual
syndrome.syndrome. Pain, numbness of extremities; muscle Pain, numbness of extremities; muscle
weaknessweakness
RISKS:RISKS: AlcoholicsAlcoholics
People on INHPeople on INH
Folate (Folic Acid)Folate (Folic Acid)
ACTION:ACTION: Necessary for synthesis of DNA (new cell Necessary for synthesis of DNA (new cell
growth)growth) Necessary to activate B12.Necessary to activate B12. SOURCES:SOURCES: Green leafy vegetablesGreen leafy vegetables
Folate (Folic Acid)Folate (Folic Acid)
TOXICITY:TOXICITY: RareRare
DEFICIENCY:DEFICIENCY: Neural tube defects during pregnancy.Neural tube defects during pregnancy. Megaloblastic anemiaMegaloblastic anemia
RISKS:RISKS: Rapid growth periodsRapid growth periods Hemolytic anemiasHemolytic anemias
Cobalamin (B12)Cobalamin (B12)
ACTION:ACTION: Necessary to activate folate.Necessary to activate folate. Fat metabolism; myelin sheaths.Fat metabolism; myelin sheaths.
SOURCES:SOURCES: Animal sourcesAnimal sources Intrinsic factor necessary for absorptionIntrinsic factor necessary for absorption
Cobalamin (B12)Cobalamin (B12)
TOXICITY:TOXICITY: RareRare
DEFICIENCY:DEFICIENCY: Pernicious anemiaPernicious anemia
RISKS:RISKS: Elderly; gastric surgery; Elderly; gastric surgery; gastric gastric
secretionssecretions
Vitamin CVitamin C
ACTION:ACTION: Necessary for collagen formation.Necessary for collagen formation. Poor muscle, bone, blood vessel Poor muscle, bone, blood vessel
formation.formation. Inc. iron absorption.Inc. iron absorption. Strengthens immune system.Strengthens immune system.
SOURCES:SOURCES: Citrus fruits; vegetablesCitrus fruits; vegetables
Vitamin CVitamin C
TOXICITY:TOXICITY: No specific effectsNo specific effects
DEFICIENCY:DEFICIENCY: ScurvyScurvy
RISKS:RISKS: Elderly (fruit spoils easily)Elderly (fruit spoils easily)
ScurvyScurvy
Vitamin C deficiency interferes with Vitamin C deficiency interferes with collagen formationcollagen formation
ASSESSMENT:ASSESSMENT: Infants 2 to 12 months of age. Infants 2 to 12 months of age. Walls of capillaries become fragile; Walls of capillaries become fragile;
petecchial hemorrhage from vessels occurs.petecchial hemorrhage from vessels occurs. Gums are swollen & bleed easilyGums are swollen & bleed easily Extreme muscle tenderness (cry when Extreme muscle tenderness (cry when
handled)handled) Can be suspect for child abuse.Can be suspect for child abuse.
ScurvyScurvy
THERAPY/INTERVENTIONS:THERAPY/INTERVENTIONS: Vitamin C (why English sailors are called Vitamin C (why English sailors are called
limeys)limeys)
ProteinProtein Major nutrient necessary for building cells.Major nutrient necessary for building cells. Necessary for immune system function.Necessary for immune system function. If not enough carbohydrate present, is used If not enough carbohydrate present, is used
for energy (carbohydrates are protein for energy (carbohydrates are protein sparing)sparing)
Composed of carbon, hydrogen, oxygen plus Composed of carbon, hydrogen, oxygen plus nitrogen. Excess nitrogen is excreted as nitrogen. Excess nitrogen is excreted as urea = excessive load for kidneys.urea = excessive load for kidneys.
Protein is broken down into amino acids and Protein is broken down into amino acids and then used to construct 22 amino acids (8 are then used to construct 22 amino acids (8 are essential in adults; 9 in children)essential in adults; 9 in children)
ProteinProtein
Use of protein is all or none concept: if all Use of protein is all or none concept: if all ingredients for essential amino acids are ingredients for essential amino acids are not present, they are not made. Excess is not present, they are not made. Excess is excreted.excreted.
Complete protein:Complete protein: animal sources. animal sources. Incomplete:Incomplete: plant sources. plant sources. Complementary proteins:Complementary proteins: two incomplete two incomplete
that make a complete proteinthat make a complete protein
Essential Amino AcidsEssential Amino Acids
Tryptophan (TRIP-toe-fane)Tryptophan (TRIP-toe-fane) Valine (VAY-leen)Valine (VAY-leen) Threonine (THREE-o-neen)Threonine (THREE-o-neen) Isoleucone (I-so-LOO-seen)Isoleucone (I-so-LOO-seen) Lysine (LYE-seen)Lysine (LYE-seen) Leucine (LOO-seen)Leucine (LOO-seen) Phenylalanine (fee-nul-AL-uh-neen)Phenylalanine (fee-nul-AL-uh-neen) Methionine (meh-THIGH-o-neen)Methionine (meh-THIGH-o-neen) In infants: Histidine (HISS-tuh-deen)In infants: Histidine (HISS-tuh-deen) TV TILL PMTV TILL PM
KwashiorkorKwashiorkor
Protein deficiencyProtein deficiency
ASSESSMENT:ASSESSMENT: 1-3 years of age1-3 years of age Developing countriesDeveloping countries Growth failure; extensive edema and Growth failure; extensive edema and
ascites; muscle wasting.ascites; muscle wasting. ““Zebra” hair , anorexiaZebra” hair , anorexia Concurrent iron-deficient anemiaConcurrent iron-deficient anemia
KwashiorkorKwashiorkor
THERAPY/INTERVENTIONS:THERAPY/INTERVENTIONS: ProteinProtein May have long-term cognitive effects.May have long-term cognitive effects.
MarasmusMarasmus
Deficient food intakeDeficient food intake
ASSESSMENT:ASSESSMENT: Seen in developing countries or poor Seen in developing countries or poor
parentingparenting Under 1 year of ageUnder 1 year of age Wasted muscles, diarrhea, growth failure.Wasted muscles, diarrhea, growth failure. HungryHungry
THERAPY/INTERVENTIONS:THERAPY/INTERVENTIONS: FeedFeed
Maple Syrup Urine DiseaseMaple Syrup Urine Disease
Unable to convert leucine and valine into Unable to convert leucine and valine into breakdown products.breakdown products.
Raw amino acids built up in blood stream.Raw amino acids built up in blood stream. Toxic to brain cells.Toxic to brain cells. Severe cognitive impairmentSevere cognitive impairment Can be recognized in utero by amniocentesisCan be recognized in utero by amniocentesis Urine smells like maple syrupUrine smells like maple syrup Placed on low Leucine & Valine dietPlaced on low Leucine & Valine diet Almost impossible to maintain so outcome is Almost impossible to maintain so outcome is
limitedlimited
Phenylketonuria (PKU)Phenylketonuria (PKU)
H p
H HH Hp
p PH pp
Inborn error or Inborn error or metabolismmetabolism
Unable to use an Unable to use an essential amino essential amino acidacid
Autosomal Autosomal RecessiveRecessive• H = Healthy H = Healthy
genegene• pp = PKU gene = PKU gene
PhenylketonuriaPhenylketonuria
Lack liver enzyme (phenylalanine Lack liver enzyme (phenylalanine hydroxylase) that converts phenylalanine hydroxylase) that converts phenylalanine into tyrosine. into tyrosine.
Tyrosine is responsible for formation of Tyrosine is responsible for formation of • epinephrine epinephrine • thyroxinethyroxine• melaninmelanin
PhenylketonuriaPhenylketonuria
Without ability to convert phenylalanine Without ability to convert phenylalanine to tyrosine, to tyrosine, •high levels of phenylalanine build up in high levels of phenylalanine build up in
blood streamblood stream•Cross blood-brain barrierCross blood-brain barrier•Toxic to brain cells leading to cognitive Toxic to brain cells leading to cognitive
impairmentimpairment•Excess is excreted in urine as Excess is excreted in urine as
phenylpyruvic acid.phenylpyruvic acid.
PhenylketonuriaPhenylketonuria
ASSESSMENT:ASSESSMENT: Urine has a musty odor compared to Urine has a musty odor compared to
mouse urinemouse urine Without ability to produce tyrosineWithout ability to produce tyrosine
• Short statureShort stature• Light skinned, blonde hairedLight skinned, blonde haired• Eczema or atopic dermatitisEczema or atopic dermatitis
PhenylketonuriaPhenylketonuria
Diagnosed by:Diagnosed by: All newborns in U.S. are tested by a All newborns in U.S. are tested by a
Guthrie Test at birthGuthrie Test at birth Must have 24 to 48 hours of milk intake Must have 24 to 48 hours of milk intake
b/4 testb/4 test Parents must return newborn for test if Parents must return newborn for test if
discharged b/4 24 hours.discharged b/4 24 hours. Can not be diagnosed by amniocentesis Can not be diagnosed by amniocentesis
as mother clears excess phenylalanineas mother clears excess phenylalanine
PKUPKU
THERAPY:THERAPY:Low phenylalanine dietLow phenylalanine diet• Protein foods contain highest levels of Protein foods contain highest levels of
amino acids so diet is very low in protein amino acids so diet is very low in protein • LofenalacLofenalac is a synthetic milk almost is a synthetic milk almost
devoid of phenylalanine.devoid of phenylalanine.• A little regular milk or breast milk is A little regular milk or breast milk is
added to supply some phenylalanineadded to supply some phenylalanine
PKUPKU
NURSING INTERVENTIONS:NURSING INTERVENTIONS: Teach parents to perform regular Guthrie Teach parents to perform regular Guthrie
Tests.Tests. Educate parents about diet.Educate parents about diet. BreakfastBreakfast: : Lofenalac 6 oz. 1 serving Lofenalac 6 oz. 1 serving
puffed rice cereal; 1 serving applesaucepuffed rice cereal; 1 serving applesauce LunchLunch:: Lofenalac, 6 oz. Orange and pear Lofenalac, 6 oz. Orange and pear
slicesslices Dinner:Dinner: Lofenalac, 6 oz. 1 serving Lofenalac, 6 oz. 1 serving
mashed potatoes; 1 serving carrotsmashed potatoes; 1 serving carrots
PKUPKU
EXPECTED OUTCOMES: EXPECTED OUTCOMES: Child demonstrates normal G&DChild demonstrates normal G&D Diet looks so deficient, unlicensed Diet looks so deficient, unlicensed
hospital personnel may assume hospital personnel may assume something is missing and add: meat or something is missing and add: meat or milkmilk
Educate children not to trade lunches in Educate children not to trade lunches in schoolschool
How to select lunches from school lunch How to select lunches from school lunch menu or take lunch.menu or take lunch.
PKUPKU
Caution that Holidays are often most Caution that Holidays are often most difficult times:difficult times:• Birthday cakeBirthday cake• TurkeyTurkey• Hotdogs on 4th of JulyHotdogs on 4th of July• Must remain on diet until past 5 years Must remain on diet until past 5 years
(brain growth is 90%)(brain growth is 90%)• Many advocate for always following Many advocate for always following
diet.diet.
PKUPKU
Women who intend to be pregnant must Women who intend to be pregnant must return to diet 3 months b/4 conceiving return to diet 3 months b/4 conceiving
Otherwise fetus grows in a high Otherwise fetus grows in a high phenylalanine environment. Cognitive phenylalanine environment. Cognitive impairment will occur.impairment will occur.
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