The

Micronutrients

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Vitamins
Organic compounds required by the body in
small amounts for growth and
normal metabolic processes
*organic substances necessary for life
although they do not independently provide
energy
Vitamins- 13

 2 Types:
Water soluble -Vitamin C and B
complex
Fat soluble -Vitamins A, D, E,
and K

TERMS
AVITAMINOSIS- means without vitamins
HYPERVITAMINOSIS- condition caused by excessive
ingestion of one or more
vitamins
VITAMIN SUPPLEMENTALS- concentrated forms of
vitamins may be in tablet or
liquid form.
MEGADOSE- extraordinarily large amount of vitamin
SYNTHETIC VITAMINS- are vitamins added to food
during processing described as enriched
or fortified - -example bread and cereal
to
which thiamine, niacin roflavin, folate,
mineral
iron have been added

PRESERVING VITAMIN CONTENT

IN FOOD
*

CLASSIFICATIONS
1. FAT SOLUBLE VITAMIN
- A, D,E,K
- they are not lost easily in cooking, but lost
when mineral oil is ingested.
-mineral oil is not absorbed by human, may be
used in salad dressing to avoid the calories
of the vegetable oil
- it can be used as a laxative by the elderly.

2. WATER SOLUBLE VITAMINS

-B complex and C.
These vitamins dissolve in water and easily
destroyed by air , light and cooking .
They are not stored in the body

Vitamin A
Fat soluble vitamin consists of 2 basic dietary forms
a. RETINOL (preformed vitamin A)-active form of
vitamin A
b. CAROTENOIDS inactive form of vitamin A
which are found in plant
FUNCTIONS

*play an important role in vision

*bone growth, reproduction and cell division
*help regulate the immune system which help
fight infections
*labeled as anti-oxidant

Recommended intake

Women- 750-770mcg
Pregnancy- up to 800mcg
Lactation- 1200-1300mcg

Provitamin A carotenoids
function as an anti-oxidanta
substance preventing
damage
from oxygen.

Food source
Animal
*liver
*whole milk
*butter
*cream
*cod liver oil

Plants
*dark green leafy vegetable
*deep yellow /orange fruit
*fortified margarine

Vitamin A- Food Sources

Liver-Beef, Meat, butter, Fortified Margarine,
egg yolks, cheeses, Whole milk, kidneys and
fish oil
Dark green vegetables -spinach, kale, turnip
greens, asparagus, and broccoli
Bright orange vegetables and fruits-carrots,
sweet potatoes, pumpkin, cantaloupes,
apricots, and peaches.

Vitamin A-Medication and

Supplements
Isotretinon (Accutane)- Acne, skin
problems
Increase Vitamin A- Skin healing, Macro
degeneration, Reversing Vitamin A deficiency
,and some forms of leukemia
Vitamin A supplements should not be taken
in megadoses.

Vitamin A-Deficiency
Vision problems- e.g. Night blindness,
xerophthalmia, corneal ulcerations and
blindness
Skin lesions and infections
Respiratory tract infections
Urinary calculi
Bone growth cease

Vitamin A- Excess
Hypervitamintosis A:
Clinical manifestations:
Anorexia, vomiting, irritability,
skin changes, yellow-orange
color of skin
Pain in muscle, joints and bones,
enlargement of spleen and liver
Increased intracranial pressure
and other neurological signs,
weakness, decreased B/P, low
WBC count, weight loss
Teratogenic effect in the fetus.

Nursing Interventions
Assess dietary intake of Vitamin A.
Teach clients to never take excess
amounts of Vitamin A especially
in children and pregnant women.
Monitor amount of Vitamin A in
supplements.
Observe for signs of toxicity.

Vitamin D
Fat soluble vitamin
Function:
Necessary for the absorption of calcium.
Helps to maintain healthy bone and teeth.
2 forms:
a. Ergocalciferol -obtained from food.
b. Cholecalciferol -formed by exposure of skin
to sunlight.
Requirements : Men and women 5-15 mg.

Vitamin D- Food Sources

Milk and some milk fat products

Irradiated foods
Liver
Egg yolks
Salmon
Tuna fish
Sardines
Certain cereals.
Also Sunlight

Vitamin D Medication and

Supplements
Vitamin D supplements must be avoided

cause deposits of calcium and

phosphorous in the soft tissue, kidney,
heart

damage and bone fragility

Vitamin D- Deficiency
Lack of Vitamin D inhibits the absorptions of
calcium and phosphorous in the small intestine
poor bone and tooth formation.
RICKETS (young children)which causes
malformed bone and pain , and teeth may be
poorly formed late in appearing subject to decay
OSTEOMALACIA (adult)-softening of the one
bone that contribute to osteoporosis brittle,
porous bones

Vitamin D - Excess
Hypercalcemia
calcification of
soft tissues,
cessation of life,
and teratogenic
effects in the fetus

Nursing Interventions
Monitor dietary intake of
Vitamin D
Teach client not to take
excess Vitamin D.
No mega doses.

Vitamin E
Forms:
a. Fat soluble vitamin
b. Tocopherol antioxidant
(neutralize free radicals),
prevent heart disease and
cancer, anti-aging effect
FUNCTIONS:
*antioxidant
*essential for the protection of
cell structure especially the
red blood cells

Vitamin E- Requirements

Men and
Women- 15mg
Lactation-19mg

Vitamin E- Food
Sources
ANIMAL
*none
PLANTS
*green and leafy vegetable
*margarines
*salad dressing
*wheat germ/ wheat germ oils
*vegetable oil
*nuts

Vitamin E- Medication and

Supplements
Tocopherol (Aquasol
E, Vita-Plus)
PO/IM 60-70 units/day

Vitamin E- Deficiency

Vitamin E- Excess
High doses:
nausea, vomiting, fatigue,
headaches blurred vision,
diarrhea
In preterm infants:
respiratory distress, liver
failure, thrombocytopenia,
and ascites

Nursing Interventions
Assess dietary intake of
Vitamin E.
Check dose of
supplements.
Teach clients not to take
mega doses of
Vitamin E.

Vitamin K
Fat soluble vitamin.
Functions:
Essential for normal blood clotting.
Activates precursor proteins found in the
liver into clotting factors ll, Vll, lX, and X.
Requirements:
Men & Women-65-70mcg. 1mcg/Kg
Example: Phytonadione

Vitamin K- Food
Sources
ANIMAL
*liver
*milk
PLANTS
*green leafy vegetables
*cabbage
*broccoli

Vitamin K-Medication and

Supplements
Phytonadione (AquaMEPHYTON )
PO/IM/Subcutaneous
1mcg/Kg
Use to Treat:
Clients with clotting disorders
Antidote :Warfarin (coumadin

Vitamin K -Deficiency
Abnormal bleeding :
melena-black "tarry" feces that are
associated with upper
gastrointestinal bleeding.

hematemesis- the vomiting of blood.

hematuria
epistaxis
petechiae
ecchymoses
hypovolemic shock

Vitamin K- Excess
Excessive clotting
Antidote Vitamin K :
Heparin
Clients on warfarin
(Coumadin) Should not
take Vitamin K
supplements or eat too
much Vitamin K high foods

Nursing
Interventions
Assess dietary intake of Vitamin K
Check Vitamin K doses
Teach client on warfarin (Coumadin)
not to eat excessive amounts of food
high in Vitamin K
Know the antidote for overdose of
Vitamin K is Heparin

WATER
SOLUBLE
VITAMINS

Vitamin C
Water soluble vitamin.
Example:

Ascorbic acid.

FUNCTION
*prevention of scurvy
*formation of collagen
*healing of wound
*release of stress hormone
*absorption of iron
*antioxidant
*resistance to infection

Vitamin CRequirements
Men and Women65-90mg/day.
Lactation-115-120
mg./day

Vitamin C Medications and

Supplements

Ascorbic acid
PO/IM/IV
Vitamin deficiency100-500mg/day
Burn patients -5002000mg/day.

Vitamin C- Food
Sources
ANIMAL
*none
PLANTS
*all citrus fruits
*broccoli
*melons
*strawberries
*tomatoes

*tomatoes
*potatoes
*cabbage
*green peppers

Vitamin CDeficiency
Mild deficiency: irritability, malaise,
arthralagia, increased
tendency
to bleed.
Severe deficiency: Scury: gingivitis, bleeding
gums, Problems with skin,
joints, and other areas.
Poor wound healing
Anemia
Coma
Death

Causes of Vitamin C
Deficiency
Diet devoid/lack of Fruits
and Vegetables.
Excess alcohol (ETOH)
intake
Elderly with limited diets.
Chronic illness.
Constance Stress.

Vitamin C- Excess
Diarrhea
Renal calculi
In African
Americansretention of iron
stores iron
toxicity.

Nursing Interventions
Assess dietary intake of Vitamin C.
Check dose of vitamin supplements.
Caution overdoses of Vitamin C with AfricanAmericans.
Suggest Multivitamins for clients with poor dietssuch as college students.

Vitamin B-1
Water soluble vitamin

Thiamine
FUNCTIONS
*metabolism of carbohydrates and some amino
acid
*maintain normal appetite and functioning of the
nervous system
Requirements- 1-1.2 mg/day for adults.
Pregnancy and lactation-1.4mg/day

Vitamin B-1-Food Sources

ANIMAL
*lean pork
*beef
*egg
*fish

PLANTS
*whole and enriched grains
*legumes
*brewers yeast

Vitamin B-1- Medications

and Supplements

Thiamine-(B-1)
PO/IM/IV
Deficiency- PO 10-30 mg/day.
IV-50-100mg/day until able to take orally.
Deficiency is common in alcoholics.

Vitamin B-1- Deficiency

Mild deficiency: fatigue, anorexia, retarded
growth, mental depression,
irritability, apathy, and
lethargy.
Severe deficiency: Beriberi (wet or dry)peripheral neuritis, personality
disturbances, confusion,
tachycardia,
enlarged heart,
heart failure, muscle
wasting
edema, Wernicke-Korsakoff
syndrome in alcoholics.

Vitamin B-1- Excess

Rare
Diarrhea
Nausea/vomiting
Increase urination.

Nursing Interventions
Assess dietary intake
of Vitamin B-1.
Check IV dose.
Infuse with IV pump.

Vitamin B-2
Water soluble vitamin.

Riboflavin
FUNCTIONS
*aids release of energy from food
*health of the mouth tissue
*healthy eyes

Vitamin B-2- Requirements

Women- 1-1.1
mg/day,prenancy1.4mg/day
lactation-1.6 mg/day.
Men-1.3mg/day.
Vitamin deficiency-3060mg/day.

Vitamin B-2-Food Sources

ANIMAL
*liver

PLANTS
*green, leafy
vegetables
*kidney
*cereals
*heart
*enriched bread
*milk
*cheese

VitaminB-2-Medication and
Supplements

Riboflavin(B-2)
PO/IV
Deficiency-5-10mg/day-PO
Used to treat migraine
headaches

Vitamin B-2-Deficiency
Eye disorders-burning,
itching, lacrimation,
photophobia, and
vascularization of the
corneal.
Glossitis
Stomatitis
Seborrheic dermatitis

Vitamin B-2-Excess

Rare
Nausea/vomiting
Diarrhea
Increase urination.

Nursing Interventions

Assess dietary
intake of
Vitamin B-2.
Check dose on
supplement.

NIACIN
Water soluble vitamin.

NICOTINIC ACID
Essential for glycolysis, fat synthesis, and
tissue respiration.
A coenzyme in many metabolic processes.
Aids in circulation, growth of body tissues.
Requirements:

Women-14mg/day
Pregnancy-18mg/day
Lactation-17-20mg/day.
Men-16mg/day.

NIACIN-Food Sources
ANIMAL
*MILK

PLANTS
*ENRICHED BREAD
AND

*EGGS
*FISH
*POULTRY

CEREALS

NIACIN- Medications and

Supplements.

Niacin (Nicotinic acid)

Niacinamide (nicotinamide)
PO
Deficiency-PO 50-100mg/day
Pellagra-PO-up to 500mg/day
Hyperlipidemia- PO 2-6 grams /day- divided
in 3 doses.

NIACIN -Deficiency

Pellagra: erythematous skin lesions,

GI problems- stomatitis, glossitis, enteritis,
and diarrhea.
Nervous system problems- Headache,
dizziness, insomnia, depression,
and memory loss.
Severe deficiency: delusions, hallucinations,
impairment of peripheral motor
and sensory nerves.

NIACIN - Excess
Rare
Transient flushing, headaches, cramps,
nausea/vomiting, increase blood sugar, and
increase uric acid levels.
Increased liver enzymes.

Nursing Interventions
Assess dietary intake of niacin
Monitor for toxicity with high doses.

Vitamin B-6
Water soluble vitamin

Pyridoxine

Functions
Essential for RNA and DNA synthesis.
Conversion of tryptophan to niacin
Release of glucose from glycogen
Protein metabolism and synthesis of non
essential amino acid

Vitamin-B-6-Requirements

Women-1.2-1.5mg/day
pregnancy-1.9mg/day
Lactation-2mg/day.
Men-1.3-1.7mg/day

VitaminB-6-Food Sources
ANIMAL
*pork
*fish
*poultry
*liver
*kidney
*milk
*egg

PLANTS
*WHOLE GRAIN CEREALS
*LEGUMES

Vitamin B-6- Medications

and Supplements.

Pyridoxine(B-6)
PO/IM/IV
Deficiency-2-5mg/day
Anemia, peripheral neuritis-50200mg/day.
INH therapy-25-500mg/day.

Vitamin B-6-Deficiency
Skin and mucous membrane
leisions:
seborrheic dermatitis,
interrigo, glossitis, stomatitis.
Neurologic problems:
convulsions, peripheral
neuritis and depression.

Interrigo-inflammation caused by the rubbing of one

area of skin on another.

Vitamin B-6-Excess

Ataxia
Sensory
neuropathies

Nursing Interventions

Assess dietary intake of

Vitamin B-6
Check dose on Vitamin B-6
supplements.

FOLATE
Water soluble vitamin

Folic acid-(Folate)
FUNCTIONS
* synthesis or RBC
* synthesis of DNA
*Essential for normal metabolism of all body
cell
*Needed for the formation of RBCs.
*Needed for nervous system formation.

FOLATE-Food Sources
Animal
*liver

PLANT
* leafy green vegetables*
*spinach
*legumes
*seeds
*broccoli
*cereal fortified with folate
*fruits

FOLATE- Medication and

Supplements

Folic acid
PO/IM/IV/subcutaneous
Deficiency- up to 1mg/day,
when blood tests normal
then 400mcg/day

FOLATE -Deficiency

Megaloblastic anemia and other

blood disorders-Folic anemia.

Elevated blood levels of homocysterine.
Poor growth in children.
Glossitis
GI tract disturbances.
Decrease intake during pregnancy can cause
neural tube defects.- SPINA BIFIDA

Folate -Excess

Rare
Nausea/vomiting
Diarrhea
Increase urination
Increase Folic acid intake with Dilantin will
cause decrease effectiveness of the
medication.

Nursing Intervention
Asses dietary intake of Folic acid
All women of childbearing age should take
supplements of folic acid when pregnant.
Make sure they take in enough Folic acid
contenting foods.

Vitamin-B-12

Water soluble vitamin

Cyanocobalamin
FUNCTION
Essential for normal metabolism of all body
cells.
For the formation of RBCs.
Healthy nervous system
Treatment of pernicious anemia
Folate metabolism

Vitamin B-12-Food Sources

ANIMAL
*seafood
*poultry
*liver, kidney
*muscle meat
*egg
*milk
*cheese

PLANTS
none

Vitamin B-12-Medications
and Supplements
Cyanocobalamin
PO/IM
Nascobal-Intranasal gel,1 spray in one
nostril, once a week
Parental B-12 should be given for Pernicious
anemia.

Vitamin B-12-Deficiency
Pernicious anemia:
megaloblasitc anemia, yellow skin,

smooth red beefy tongue,

neurological disorders-peripheral
neuropathy.

Vitamin B-12-Excess

Rare with dietary

intake.

Nursing Interventions

Assess for dietary intake of

Vitamin B-12.
Check dose/route with
supplements.
Folic acid supplements will mask
the signs of anemia in
pernicious anemia.

BIOTIN
FUNCTIONS:
*coenzymes in carbohydrates and amino acid
metabolism
*niacin synthesis from tryptophan
FOOD SOURCE
ANIMALS
PLANTS
*milk
*legumes
*liver, kidney
*cereals
*egg yolk
*fruits
*soy flour

DEFICIENCY
*dermatitis
*nausea
*anorexia
*depression
*hair loss

Pantothenic acid
FUNCTIONS
*metabolism of carbohydrates, lipids, proteins
*synthesis of fatty acids, cholesterol, steroid
hormones
FOOD SOURCE
ANIMAL
PLANTS
*egg
*mushrooms
*liver
*cauliflower
*salmon
*peanuts
*poultry
*brewers yeast

DEFICIENCY :
RARE: BURNING FEET SYNDROME
VOMITING
FATIGUE

Vitamin Supplements
A normal healthy individual who eats a well
balanced diet does not need to take vitamin
supplements.
Vitamin supplements are required:
During periods of increased growth,
Pregnancy
Lactation
Debilitating illnesses
inadequate dietary intake
fad diets (crash diets)
malabsorption processes.