I

NTRODUCTION

Vitamins and minerals are essential nutrients that

the body needs in order to perform properly. They boost the
immune system to fight off viruses and infections, they
promote cellular growth, and are essential in the wound
healing process. Many vitamins and minerals are found in
plant and animal food sources. The difference between
them is that vitamins come from living things and minerals
come from the earth. Due to the fact that the average
individual does not consume all of the recommended daily
allowances to maintain proper nutritional status, they turn
to vitamins and minerals in supplement form. There are
several illnesses that can cause one to become vitamin
deficient, as well as vice versa. Many individuals assume
that over the counter vitamins and minerals can be taken
freely without taking into consideration their co morbidities
or medications that may interact with them. This careless
behavior is what leads to serious illnesses and detrimental
effects. In nursing, one must inform the patient by offering
and receiving as much information as possible, in order to

conduct a thorough assessment. Each vitamin as well as

minerals have specific mechanisms and indications for their
use and should not be taken lightly. In order for the body to
have proper and functional growth and tissue repair, one
must consume a minimum amount of organic molecules
also known as vitamins. Vitamins are then stored in the
body, synthesized and used for its specific function. There
are two types of vitamins. There are fat soluble vitamins
and water soluble vitamins.
FAT
VITAMINS
Fat-soluble vitamins are stored in the liver and fatty
tissues. These vitamins do not need to be taken unless a
deficiency is indicated and evidenced by laboratory
diagnostics. One reason for this concern is due to mega
dosing. It can lead to toxicity especially with Vitamin A, D,
and K. Fat Soluble Vitamins are known as Vitamin A,D,E,
and K. These vitamins take a longer time to be excreted
from the body because they are stored in the liver. Unlike
water soluble vitamins that are excreted in the urine.

VITAMIN A

Vitamin A is essential for vision, especially night

vision. It is part of one of the major retinal pigments called
rhodopsin. It is a biological and primary pigment found in
photoreceptor cells of the retina. They are extremely
sensitive to light, enabling vision in low-light conditions.
Vitamin A food sources are dairy products, eggs, meat,
liver, and fish liver oils. Minimum daily requirements are
fine for a healthy person. Vitamin A needs to be given in
higher doses especially for pregnant and nursing women as
well as infants. Deficiencies are also seen in certain
diseases where there may be an issue with fat absorption
and pancreatic insufficiency such as cystic fibrosis. For
vitamin

A deficiencies,

one

must

perform

vision

assessments to the patient, including night vision. Also

conduct a thorough examination of the skin and mucous
membranes and document the findings. This creates a
baseline for one to measure the outcome of therapy. In
order to evaluate if the vitamin is showing effective results,
the patient will usually mention that their vision has
improved. If their complaint was integumentary, then the
patient will state that their skin is intact. Monitoring must
be placed due to toxic levels that can occur with large
dosing. Excessive amounts will create intracranial pressure,

nausea, skin irritation, and pain in joints. For this reason, as

with any medication, one must speak to their physician
before any over the counter medication is taken.

VITAMIN D
Vitamin D is accountable for the utilization of both
phosphorous and calcium. It regulates the absorption process for
the necessary requirements of bone calcification. It is a vitamin
that is taken as a supplement or to treat a deficiency. A common
Vitamin D deficiency state, commonly seen in children is known
as Rickets. It is when a prolonged and excessive Vitamin D
deficiency causes bones to soften, weaken and easily fracture. In
adults, it is called Osteomalacia, where the signs and symptoms
are similar, only that in adults, this deficiency can also be caused
due to hyperparathyroidism. For patients who are deficient in
vitamin D, perform a baseline assessment of skeletal formation
with attention to any deformities. During vitamin D therapy,
advise the patient to report any palpitations, unresolved nausea,
vomiting, constipation, or muscle pain. Therapeutic responses to
vitamin D include improved bone growth and formation and an
intact skeleton with decreased or no pain compared with baseline
musculoskeletal deformity, weakness, and discomfort; adverse
effects include hypertension, dysrhythmias, fatigue, weakness,
headache, and decreased bone growth. There are very few toxic

effects with Vitamin D. The ones that have been reported are
usually with children. In this case, the treatment is simply to cut
back on vitamin D intake.

VITAMIN E
It is known as a biological antioxidant. Vitamin E shows no
significant deficiencies in adults or children. It is mostly seen
however, in premature infants. It has been thought that deficiency
of vitamin E is at least partly responsible for the anemia which
often occurs 4 to 6 wk after premature birth, and routine dietary
supplementation with vitamin E is frequently recommended.
Therapeutic responses to vitamin E include improved muscle
strength, improved skin integrity, and alpha tocopherol levels
within normal limits.

VITAMIN K
The body does not store large amounts of Vitamin K. It is
needed for the synthesis of blood coagulation factors that occur in
the liver. This vitamin is usually ordered for patients that are on
anticoagulants, when they have reached critical labs and need to
reverse the toxic effects from warfarin. It is also a vitamin that
needs to be avoided when on anticoagulants as well. It is mainly
seen in green leafy vegetables. For this reason, patients taking
anticoagulant therapy are told such food group. Vitamin K is
associated with clotting function, so measure and document the

patients prothrombin time, international normalized ratio, and

platelet counts. One should also check the skin for any bruising or
erythema. Also examine their gums and ask them if they bleed
when brushing their teeth. Also, review the labs especially the
PT/INR. If the labs are well elevated or considered critical, then
the nurse should assess the patient for signs of bleeding, such as
bleeding gums, or bruises to extremities. After treatment of
Vitamin K is administered, review labs once again to see if
treatment was effective as evidenced by clotting factors within
normal range and no evidence of hemolytic anemia. In order to
evaluate a patient and see if they have reached therapeutic levels,
one should review their last PT/INR and see if they are having a
normal blood clotting factor. If they have not reached normal
levels, some adverse effects are complaints of headache, nausea,
and hemolytic anemia as evidenced by lab results.

W
SOLUBLE
VITAMINS
Water-soluble vitamins can be dissolved in water and are
easily excreted in the urine. Water-soluble vitamins cannot be
stored in the body in large amounts, so daily intake is required.
These are vitamins that are not stored in the body as fat soluble
vitamins do. Water soluble vitamins are excreted through the urine,

which in turn, one has to daily be taking the adequate amounts.

Anything consumed as extra dosing, will also be excreted, which
makes the event of toxicity highly unlikely. Within this category
are the B complex vitamins and Vitamin C.
VITAMIN
COMPLEX
The B complex vitamins are grouped into ten different, yet
specific B vitamins that function a specific area. Vitamin B1, also
known as thiamine is used as a dietary supplement to prevent or
treat malabsorption cases such as induced alcoholism or Gastro
Intestinal Diseases. When a patient is seen with a deficiency in
Vitamin B1, the classic signs to watch for are neuropathy in
peripheral nerves, edema in body tissues, and scans will also show
brain lesions. This disease is also known as Wernickes
Encephalopathy, a serious neurologic disorder. Therapeutic
responses to vitamin B1 include improved mental status and less
confusion.

Vitamin B2 also known as riboflavin is used for

patients that have chronic infections, liver cirrhosis, and patients

taking any medications for acute or chronic gout, such as
probenecid. Riboflavin is usually used as a dietary supplement for
tissue repair and carbohydrate metabolism. No toxicity effects have
been reported. Vitamin B2 (riboflavin) is not associated with any
adverse or toxic effects, but it is important to note that in large

doses it may turn the urine yellowish-orange. Vitamin B3 also

known as niacin has an antilipidemic effect and is also beneficial to
peripheral vascular circulation. This vitamin, however does have
its minor contraindications. Patients with liver disease, severe
hypotension and an active peptic ulcer disease should not take
niacin. Some patient usually report a flushing of the skin. This
adverse reaction is usually seen in larger doses. Tell patients to
take vitamin B3 (niacin) with milk or food to decrease GI upset.
Adverse effects from vitamin B are rare, but vitamin B 3 (niacin) is
associated with postural hypotension, dysrhythmias, headache, and
nausea. Vitamin B6 is composed of three compounds, such as
pyridoxine, pyridoxal, and pyridoxamine. These compounds are all
converted to erythrocytes and they are an important element in the
synthesis and maintenance of the hematopoietic system. Patient
that show a deficiency in Vitamin B6 will usually be patients that
are taking isoniazid as part of their tuberculosis therapy and also
hypertensive patients taking hydralazine. Therefore, Vitamin B6 is
ordered as a dietary supplement as part of their therapy. Vitamin
B12 and its components are actually involved in brain metabolism
and the manufacturing of neurotransmitters. A patient with a
deficiency in B12 will start to show signs of fatigue, memory loss,
and mild depression. These states of deficiency is mainly seen in
vegetarians due to the fact that the main source of B12 comes from

meats, organs meats, and dairy products, which are all excluded
from a vegans diet. Therefore it is safe to assume that Vitamin b12
deficiency comes from poor dietary intake. This can lead a person
to have pernicious anemia. The treatment for such deficiency is
commonly a monthly injection of B12 which will be decreased
according

to

CBC

blood

work

and

ferritin

levels.

Contraindications to B12 is if a person is allergic to cobalt. Drug

interactions occur with patients that are on anticonvulsants,
antibiotics and potassium. These medications will decrease the
absorption of B12.

VITAMIN C
Vitamin C is the most important vitamin in the healing
process. It is important in the synthesis of collagen, tissue repair
and maintenance of bones, teeth and capillaries. Also, Vitamin C is
not produced by the body. It has to come from fresh fruits and
vegetables or dietary supplements. It helps convert cholesterol into
adrenal hormones. People that suffer from chronic deficiency in
Vitamin C will develop a disease called scurvy. Unfortunately,
signs and symptoms of scurvy do not appear until months after the
deficiency has set in. The person will begin to complain of fatigue,
muscle weakness, blood tests will reveal anemia, and softening of
bones. This was a common disease back in the 18 th century with
sailors and pirates due to the lack of fresh fruits and vegetables for

too many months when they were out at sea. In todays world, the
deficiency is most commonly seen in the malnourished. Treatments
for such deficiency should be taken in adequate amounts. Although
Vitamin C is an antioxidant in regular doses, if given at high doses
daily, it will reverse its effect and turn into a pro-oxidant, causing
scurvy like symptoms and even causing kidney stones due to its
acidity.

MINERALS
Minerals are essential building blocks that the body needs
in order to function on a physiological level. Calcium for example,
is the most abundant mineral in the body. It is important for
healthy bones and teeth, it helps muscles relax and contract and it
is important in nerve functioning, blood clotting, blood pressure
regulation, immune system health. Its main source comes from
Milk and milk products; canned fish with bones (salmon, sardines);
fortified tofu and fortified soy milk; greens (broccoli, mustard
greens);

legumes.

Calcium

deficiency,

also

known

as

hypocalcemia, is normally seen in elderly patients and postmenopausal women, together with a deficiency in Vitamin D and
its absorption process. This is known as hypoparathyroidism.
These deficiencies will cause osteoporosis, muscle cramping, and
even osteomalacia. Giving intravenous calcium too rapidly may

precipitate

severe

hypercalcemia

with

subsequent

cardiac

irregularities, delirium, and coma. The injectable forms of calcium

may be easily confused, so be cautious. Pregnant woman are
placed on high intakes of Calcium to prevent the depletion that
occurs during pregnancy. Infants that are born with this deficiency
will have a disease called infantile rickets. These deficiencies and
disease can be treated with adequate doses of Calcium. There is
however a fine line to monitor due to the fact that high and
excessive levels of calcium can also be harmful to the human body
by causing hypercalcemia, or too much calcium in the body. Toxic
levels can cause cardiac irregularities, delirium and even coma.
Another mineral that one needs to be cautious with is Magnesium.
It is important to document neurologic functioning and grading of
deep

tendon

reflexes

before

giving

magnesium

because

hyporeflexia may indicate toxicity. During intravenous magnesium

infusion, monitor electrocardiographic and vital signs, and rate
patellar or knee-jerk reflexes; impaired reflexes are indicative of
drug-related CNS depressant effects. One should assess for
neurological functioning and muscle reflexes before giving
magnesium. It has been proven that excess doses will cause tendon
reflex loss, CNS depression, and cardiac issues and respiratory
distress as well. It is however an essential mineral because of its
relation to energy metabolism. The deficiency is usually caused by

malabsorption especially when taking large amounts of calcium,

alcoholism, long term iv feeding, the use of some diuretics and in
disorders such as DKA (Diabetic ketoacidosis). Deficiency in
magnesium leads to cardiovascular issues as well as neuromuscular
impairments and mental instabilities.

It is also an excellent

supplement to people in seizure states or migraines, pregnancy

issues such as uterine contractions and premature labor. It is also
given in pediatrics for acute nephropathy and it is also given as an
aide to constipation. People that suffer from renal disease, hepatitis
or Addisons disease should not use magnesium.

CONCLU
As health care professionals, one must educate the patient
about all dietary sources that may be beneficial, if they are in
deficiency. Incorporating their nutritional status into their care plan
will also produce a positive and therapeutic outcome. One must
also teach the patient that certain Vitamins and Minerals may be
dangerous and toxic to their health. Following a proper balanced
diet with adequate amounts of proteins, carbohydrates, fats,
vitamins and minerals will provide the most essential nutrients in
order for the body to carry out normal physiological function.