ATI Chapter 30: Vitamins, Minerals & Supplements

Iron Preparations: Nursing Evaluation of Medication Effectiveness

Effectiveness is evidenced by the following: -increased reticulocyte count is expected at least 1 week after beginning iron therapy *Reticulocyte:* an immature red blood cell without a nucleus, having a granular or reticulated appearance when suitably stained. -increase in hemoglobin of 2 g/dL is expected 1 month after beginning therapy -fatigue and pallor (skin, mucous membranes) should subside, and the pt reports increased energy levels

Valerian

*Uses:* -increases GABA to prevent insomnia [similar to benzodiazepines] -reduces anxiety-related restlessness -drowsiness effect increases over time *Adverse Effects and Precautions:* -can cause drowsiness, lightheadedness, depression -risk of physical dependence *Precautions:* -clients who have mental health disorders should use with caution -should be avoided by women who are pregnant or lactating *Interactions:* -it is not known if valerian potentiates effects of CNS depressants *Nursing Administration:* -pt taking be warned of drowsiness and operating motor vehicles

Ginkgo Biloba

*Uses:* -promotes vasodilation: decreases leg pain caused from occlusive arterial disorders [PVD] -decreases platelet aggregation: can decrease risk of thrombosis -decreases bronchospasms -increases blood flow to the brain: though to improve memory [dementia, Alzheimer's disease] but studies do not indicate effectiveness *Adverse Effects and Precautions:* -mild GI upset, headache, lightheadedness [can decrease by reducing dose] -used cautiously in pt at risk for seizures *Interactions:* -can interact with meds that lower seizure threshold [ex: antihistamines, antidepressants, antipsychotics] -interfere with coagulation

Glucosamine

*Uses:* -stimulates cells to make cartilage and synovial fluid -suppresses inflammation of joints and cartilage degradation -treats osteoarthritis of knee, hip, and wrist *Adverse Effects and Precautions:* -mild GI upset [nausea, heartburn] -use cautiously with shellfish allergy *Interactions:* -use caution if taking antiplatelet or anticoagulant meds

Magnesium Sulfate: Contraindications & Precautions

Mag is Pregnancy Risk Category A Contraindicated in pt who have: -AV blocks -rectal bleeding -n/v -abd pain Use Cautiously in pt who have renal and/or cardiac disease

Magnesium Sulfate: Interactions

Mag sulfate can decrease the absorption of tetracyclines and digoxin

Vitamin B12: Interactions

Masks manifestations of Vitamin B12 deficiency with concurrent administration of folic acid. -If folic acid is used for pt with vitamin B12 deficiency, ensure that dosage of vitamin B12 is adequate.

Magnesium Sulfate: Nursing Administration

Monitor serum mag, calcium, and phosphorus Monitor BP, HR, RR when given IV Assess for depressed or absent deep tendon reflexes [DTRs] as manifestation of toxicity Calcium gluconate is given for mag sulfate toxicity. Always have injectable form when giving mag sulfate by IV Teach pt about dietary sources of Magnesium -whole-grain cereals -nuts -legumes -green leafy veggies -bananas

Magnesium Sulfate: Complactions

Muscle Weakness Flaccid Paralysis Painful Muscle Contractions Suppression of AV conduction through heart Respiratory Depression i. IV administration requires careful monitoring of cardiac and neuromuscular status ii. monitor serum mag levels iii. avoid administering with neuromuscular blocking agents, which can potentiate respiratory depression and apnea iv. have *IV calcium* available to reverse effects of mag Diarrhea i. monitor electrolyte levels for electrolyte loss diarrhea ii. monitor I&O, and observe for manifestations of DEHYDRATION

Peritoneal Dialysis

Peritoneal dialysis is a way to remove waste products from your blood when your kidneys can no longer do the job adequately. A cleansing fluid flows through a tube (catheter) into part of your abdomen and filters waste products from your blood. After a prescribed period of time, the fluid with filtered waste products flows out of your abdomen and is discarded. Peritoneal dialysis differs from hemodialysis, a more commonly used blood-filtering procedure. With peritoneal dialysis, you can give yourself treatments at home, at work or while traveling. Peritoneal dialysis isn't an option for everyone with kidney failure. You need manual dexterity and the ability to care for yourself at home, or a reliable caregiver.

Folic Acid: Purpose & Therapeutic Uses

Purpose: Folic acid is essential in the production of DNA and erythropoiesis (RBC, WBC, and platelets). Therapeutic Uses: -treatment of megaloblastic (macrocytic) anemia secondary to folic acid deficiency -prevention of neural tube defects that can occur early during pregnancy -treatment of malabsorption syndrome, such as sprue -supplement for alcohol use disorder [due to poor dietary intake of folic acid and injury to the liver]

Magnesium Sulfate: Purpose & Therapeutic Uses

Purpose: Magnesium activates many intracellular enzymes, binds the messenger RNA to ribosomes, and plays a role in regulating skeletal muscle contractility and blood coagulation Therapeutic Uses: -used for hypomagnesemia (<1.3 mEq/L) -oral preps of mag sulfate are used to prevent or treat low mag levels AND as laxatives -parenteral mag is used for severe hypomagnesemia -IV mag sulfate is used to stop preterm labor and as an anticonvulsant during labor and delivery

Potassium Supplements: Purpose & Therapeutic Uses

Purpose: Potassium is essential for conducting nerve impulses, maintaining electrical excitability of muscles, and regulation of acid/base balance Therapeutic Uses: -treating hypokalemia (levels <3.5 mEq/L). -pt receiving diuretics resulting in potassium loss [furosemide] -pt who have potassium loss due to excessive or prolonged vomiting, diarrhea, excessive use of laxatives, intestinal drainage, and GI fistula

Vitamin B12: Purpose & Therapeutic Uses

Purpose: Vitamin B12 is necessary to convert folic acid from its inactive form to its active form. All cells rely on folic acid for DNA production. Vitamin B12 deficiency can result in megaloblastic (macrocytic) anemia and cause dysrhythmias and heart failure if not correct. Vitamin B12 is administered to prevent or correct deficiency. -Damage to rapidly multiplying cells can affect the skin and mucous membranes causing, GI disturbances. Neurologic damage, which includes numbness and tingling of extremities and CNS damages caused by demyelination of neurons, can result from deficiency. Vitamin B12 deficiency affects ALL blood cells produced in bone marrow. -loss of erythrocytes leads to heart failure, cerebral vascular insufficiency, and hypoxia -loss of leukocytes leads to infections -loss of thrombocytes leads to bleeding and hemorrhage Loss of intrinsic factor [a substance secreted by the stomach which enables the body to absorb vitamin B12. It is a glycoprotein] within the cells of the stomach causes an inability to absorb vitamin B12, making it necessary to administer parental or intranasal vitamin B12, or high doses of oral B12, for the rest of the pt life. *Therapeutic Uses:* i. treatment of vitamin B12 deficiency ii. Megaloblastic (macrocytic) anemia related to vitamin B12 deficiency

Minerals

Substances that the body cannot manufacture but that are needed for forming healthy bones and teeth and regulating many vital body processes. The six major minerals [also six main electrolytes] in the human body are: 1. calcium 2. phosphorus 3. potassium 4. sodium 5. magnesium 6. chloride IMPORTANT NOTE: All electrolytes are mineral but all minerals are not electrolyte. -Electrolytes are charged ions which helps in maintaining fluid balance in between the cells of body.

Supplements

Supplements of vitamins and minerals can help prevent multiple health conditions. *Common Supplements:* i. Iron Preparations ii. Vitamin B12 [Cyanocobalamin] iii. Folic Acid iv. Potassium Supplements v. Magnesium Sulfate vi. Herbal Supplements

Vitamin B12: Contraindications & Precautions

Vitamin B12 deficiency should NOT be treated only with folic acid. Tx with folic acid alone can reverse the hematologic effects of the deficiency but can allow neurologic damage to progress. If folic acid is used for pt with vitamin B12 deficiency, ensure that dosage of vitamin B12 is adequate. Oral and intranasal cyanocobalamin are Pregnancy Risk Category A Parenteral cyanocobalamin is Pregnancy Risk Category C

Iron Preparations: Complications

i. *GI Distress [nausea, constipation, heartburn]:* -if intolerable, give with food-but this greatly reduced absorption -monitor pt bowel patterns. This side effects (constipation) usually resolves with continued use. ii. *Teeth Staining [liquid form:* -teach pt to dilute liquid iron with water or juice, drink with a straw, and rinse mouth after swallowing. iii. *Staining of Skin and Other Tissues [IM injections]:* -give IM doses deep IM using Z-track technique -avoid this route if possible iv. *Anaphylaxis:* -risk with parenteral administration of Iron Dextran. -anaphylaxis is triggered by the dextran, not by the iron -anaphylaxis is MINIMAL with SFGC, iron sucrose, and ferumoxytol Nursing Considerations: -IV route is safer than IM -administer a test dose and observe. No test dose is needed before giving ferumoxytol and iron sucrose -administer slowly -be prepared with life-support equipment and epinephrine v. *Hypotension:* -can progress to circulatory collapse with parenteral administration vi. *Fatal Iron Toxicity in Children:* Can occur when an overdose of iron (2 to 10 g) is ingested Avoid using oral and parenteral iron concurrently. Manifestations of Toxicity: -severe GI symptoms -shock -acidosis -liver and heart failure The chelating agent deferoxamine [given parenterally] is used to treat toxicity. *Chelation therapy* is a treatment used in alternative medicine. It's based on the process of chelation, in which chemicals are used to remove heavy metals and other substances from the body.

Folic Acid: Interactions

Folic acid levels are decreased by methotrexate and sulfonamides Folic acid can decrease phenytoin serum levels because of increased metabolism

Ma Huang

*CAN CAUSE HTN, TACHYCARDIA, STROKE, MI* *Uses:* -stimulates CNS -suppresses appetite -used for weight loss -constricts arterioles: increase heart rate and BP -bronchodilators: treats colds, flu, and allergies *Adverse Effects and Precautions:* -because it contains ephedrine, ma huang can stimulate the cardiovascular system. At high doses, it can cause death from HTN and dysrhythmias -stimulation of CNS can cause euphoria. In high doses, can cause psychosis *Interactions:* -interacts with CNS stimulants to potentiate their effect -can cause severe HTN with taken with monoamine oxidase inhibitor antidepressants -interacts with antihypertensive meds, decreasing effects *Nursing Administration:* -products that include more than 10 mg/dose are forbidden to be sold in the US

Kava

*CAUSES LIVER INJURY!* *Uses:* -possibly acts on gamma-aminobutyric acid [GABA] -promotes sleep -decreases anxiety -promotes muscle relaxation without affecting concentration *Adverse Effects and Precautions:* -chronic use causes: dry, flaky skin and jaundice -chronic use and large doses can cause: liver damage, including severe liver failure *Interactions:* -can cause sedation when taken concurrently with CNS depressants *Nursing Administration:* -clients taking CNS depressants, alcohol -those with liver conditions [concurrent use]

Fat-Soluble Vitamins

*Fat-Soluble Vitamins: K,A,D,E* Are stored in your body and used as needed when your dietary intake falls short. -Absorbed in small intestines, to lymph then blood. - Stored in the body for lean times, mainly in liver. - Vitamin D is mainly stored in your fat or muscle tissue. -Can build up to a point of toxicity, therefore they are more likely to be toxic.

Vitamin B12 Complications

*Hypokalemia* Hypokalemia may develop because of increased potassium utilization in hematopoiesis. -Hematopoiesis: the production of blood cells and platelets, which occurs in the bone marrow. Hypokalemia: secondary to the increased RBC production effects of Vitamin B12, Nursing Considerations: -monitor potassium levels during start of treatment -observe pt for manifestations of hypokalemia [muscle weakness, irregular cardiac rhythm] -pt might require potassium supplements

Megaloblastic Anemia

*Megaloblastic anemia* is a condition in which the bone marrow produces unusually large, structurally abnormal, immature red blood cells (megaloblasts). A deficiency in healthy, fully-matured red blood cells can result in fatigue, paleness of the skin (pallor), lightheadedness and additional findings. Megaloblastic anemia has several different causes - deficiencies of either cobalamin (vitamin B12) or folate (vitamin B9) are the two most common causes. These vitamins play an essential role in the production of red blood cells.

Potassium Supplements: Nursing Administration

*Oral Formulations:* -mix powdered formulations in at least 120 mL (4oz) of liquid -take potassium chloride w/ meal or at least 8 oz water to reduce risk of GI effects -do NOT crush extended release tabs -notify provider if they have difficulty swallowing the pills [large pills]. *IV Administration:* -NEVER administer IV bolus. Rapid IV infusion can result in fatal hyperkalemia. -use IV infusion pump -dilute potassium and give NO MORE than 40 mEq/L of IV solution to prevent vein irritation -infuse slowly, generally no faster than 10 mEq/hr -cardiac monitoring. ECG changes such as prolonged PR interval and peaked T waves can indicate potassium toxicity -infuse potassium through a large bore needle. d/c the IV immediately if infiltration occurs. -monitor I&O to ensure an adequate urine output of at least 30 mL/hr

Iron Preparations

*Select Prototype Medications:* Oral: Ferrous Sulfate Parenteral: Iron Dextran Other Medications: Oral: Ferrous Gluconate, Ferrous Fumarate Parenteral: Ferumoxytol, iron sucrose, sodium-ferric gluconate complex (SFGC)

Saw Palmetto

*Uses:* -can decrease prostate symptoms of hyperplasia [BPH] *Adverse Effects and Precautions:* -few adverse effects; can cause mild GI effects *Interactions:* -possible additive effects with finasteride -can interact with antiplatelet and anticoagulant meds -Pregnancy Risk Category X *Nursing Administration:* -question clients about use before prostate-specific antigen tests -question clients about concurrent use with ASA, heparin, and warfarin

Ginger Root

*Uses:* -relieves vertigo and nausea -increases intestinal motility -increases gastric mucous production -decreases GI spasms -produces anti-inflammatory effect -suppresses platelet aggregation -used to treat morning sickness, motion sickness, nausea from surgery -can decrease pain and stiffness of rheumatoid arthritis *Adverse Effects and Precautions:* -use cautiously in pt who are pregnant because high doses can cause uterine contractions -adverse effects unknown, with potential CNS depression and cardiac dysrhythmias with very large overdose *Interactions:* -interacts with meds that interfere with coagulation [NSAIDs, heparin, warfarin] -can increase hypoglycemic effects of diabetes meds *Nursing Administration:* -question pt taking NSAIDs, heparin, warfarin. -monitor for hypoglycemia in pt taking insulin or other meds for diabetes

St. John's Wort

*Uses:* -affects serotonin, producing antidepressant effects: use for mild depression -used orally as an analgesic to relieve pain and inflammation -applied topically for infection *Adverse Effects:* -mild adverse effects, including: dry mouth, lightheadedness, constipation, GI symptoms -skin rash when exposed to sunlight *Interactions:* -can cause serotonin syndrome when combined with other antidepressants, amphetamine, and cocaine -decreases effectiveness of oral contraceptives, cyclosporine, warfarin, digoxin, calcium-channel blockers, steroids, HIV protease inhibitors, and some anticancer meds *Nursing Administration:* -encourage pt using st johns wort to prevent prolonged sun exposure and use sunscreen

Feverfew

*Uses:* -block platelet aggregation [blood thinner] -block a factor that causes migraines [used prophylactically] -decrease the number and severity of migraine headaches [does not treat an existing migraine; prophylactic treatment] *Adverse Effects and Precautions:* -mild GI symptoms -Post-feverfew syndrome: agitation, tiredness, inability to sleep, headache, joint discomfort -can cause allergic reaction in pt allergic to ragweed or echinacea *Interactions:* -increase risk of bleeding in pt taking NSAIDs, heparin and warfarin -d/c 2 week before surgery *Nursing Administration:* -question pt about concurrent use of NSAIDs, heparin, and warfarin

Echinacea

*Uses:* -stimulates immune system -decreases inflammation -topically heals skin disorders, wounds and burns -possibly treats viruses [common cold, herpes simplex (cold sores)] -used to increase T-lymphocyte, tumor necrosis factor, and interferon production -T-lymphocyte (T Cells): killer T-cells to hunt down and destroy cells that are infected with germs or that have become cancerous. The other main type of T-cells are called helper T-cells. Helper T-cells orchestrate an immune response and play important roles in all arms of immunity. -Tumor Necrosis Factor (TNF): is a multifunctional cytokine that plays important roles in diverse cellular events such as cell survival, proliferation, differentiation, and death. As a pro-inflammatory cytokine, TNF is secreted by inflammatory cells, which may be involved in inflammation-associated carcinogenesis. -Interferon: are a group of proteins called cytokines produced by white blood cells, fibroblasts, or T-cells as part of an immune response to a viral infection or other immune trigger. The name of the proteins comes from their ability to interfere with the production of new virus particles. *Adverse Effects:* -bitter taste -mild GI symptoms or FEVER can occur -allergic reaction, especially in pt allergic to plants such as ragweed or other in the daisy family *Interactions:* Which chronic use [6+ months], echinacea can decrease positive effects of meds for TB, HIV, or CANCER *Nursing Administration:* -available in many forms: dried roots, plants, extracts and teas -question pt who have TB, HIV, cancer, lupus erythematosus, and rheumatoid arthritis about concurrent use. Advise pt to talk to provider.

Garlic

*Uses:* -when crushed, forms enzyme allicin -blocks LDL cholesterol and raises HDL cholesterol; lowers triglycerides -suppresses platelet aggregation and disrupts coagulation -acts as vasodilation [can lower BP] *Adverse Effects:* GI symptoms *Interactions:* -due to antiplatelet qualities, can increase risk of bleeding in pt taking NSAIDs, heparin, warfarin -decreases levels of saquinavir [a med for HIV treatment] and cyclosporine

Aloe & Aloe Vera

*Uses:* Acts as topical: -anti-inflammatory -analgesic -cathartic: providing psychological relief through the open expression of strong emotions; causing catharsis. (chiefly of a drug) purgative -soothes pain -heals burns -softens skin -laxative *Adverse Effects and Precautions:* -Skin Preparations: possible hypersensitivity -Laxative: fluid and electrolyte imbalances -Increases menstrual flow when taken during menses -avoid in pt who have kidney disorders *Interactions:* Interacts with... -digoxin -diuretics -corticosteroids -antidysrhythmics *Nursing Administration:* Teach pt manifestations of fluid and electrolyte imbalance if using as laxative

Black Cohosh

*Uses:* [acts as estrogen substitute] -Rheumatoid arthritis -Menopause sx (hot flashes, night sweats, vaginal dryness) -Menstrual irregularities *Adverse Effects and Precautions:* -GI distress -lightheadedness and headache -rash -weight gain Avoid taking during pregnancy [especially the first 2 trimesters] Limit use to no longer than 6 months due to lack of info regarding long-term effects *Interactions:* -increase effects of antihypertensive meds -increase effect of estrogen meds -increases hypoglycemia in pt taking insulin or other meds for diabetes

Water-Soluble Vitamins

*Water-Soluble Vitamins: B,C* To remember which vitamins are water soluble, remember that you take your Birth Control with water. So, Vitamins B and C are water soluble. The rest of the vitamins are fat soluble. Are absorbed in small intestines with water then to blood stream. -Typically not stored in body, excess is secreted. -Should consume daily. -Some function as antioxidants.Vitamin B12 is absorbed in the lower part of your small intestine.

Herbal Supplements

A chemical substance from plants that may be sold as a dietary supplement [regulated by FDA]. Widely used but less tested and regulated than conventional meds. -because different formulations are not standardized, it can be difficult to know which preparations can provide therapeutic effects *Common Herbal Supplements:* i. Aloe, Aloe Vera ii. Black Cohosh iii. Echinacea iv. Feverfew v. Garlic vi. Ginger Root vii. Ginkgo Biloba viii. Glucosamine ix. Kava x. Ma Huang xi. St. John's Wort xii. Saw Palmetto xiii. Valerian

Potassium Supplements: Interactions

Concurrent use of... -potassium-sparing diuretics [spironolactone] -ACE inhibitors [lisinopril] INCREASE the risk of hyperkalemia!

Potassium Supplements: Contraindications & Precautions

Contraindicated for pt who have severe kidney disease OR hypoaldosteronism

Iron Preparations: Contraindications & Precautions

Contraindicated for pts who have: -previous hypersensitivity to iron -anemias other than iron-deficiency anemia Oral preparations should be used cautiously in pt who have: -*peptic ulcer disease (PUD)*: refers to painful sores or ulcers in the lining of the stomach or the first part of the small intestine, the duodenum. -*regional enteritis (Crohn's Disease)*:A condition in which the gastrointestinal tract is inflamed over a long period of time. Regional enteritis usually affects the small intestine and colon. It is a type of inflammatory bowel disease (IBD). -*ulcerative colitis*: is an inflammatory bowel disease (IBD) that causes long-lasting inflammation and ulcers (sores) in your digestive tract. Ulcerative colitis affects the innermost lining of your large intestine (colon) and rectum. Symptoms usually develop over time, rather than suddenly. -*severe liver disease* *Concurrent administration of ANTACIDS or tetracyclines reduces absorption of iron* -Separate use by 2 hrs *Vitamin C increases absorption, but also increases incidence of GI complications* *Caffeine and DAIRY products can interfere with absorption* *Food reduces absorption BUT reduces gastric distress* -take with food at the start of therapy if gastric distress occurs

Iron Preparations: Purpose & Therapeutic Uses

Expected Action: Iron preparations provide iron needed for RBC development and oxygen transport to cells. During times of increased growth [growing children or during pregnancy] or when RBCs are high in demand [after blood loss], the need for iron can greatly increase. *Iron is poorly absorbed by the body, so relatively large amounts must be given orally to increase Hgb and Hct levels.* Therapeutic Uses: Iron prep. are used to treat and prevent iron-deficiency anemia. -*Iron-Deficiency Anemia*: a condition in which blood lacks adequate healthy red blood cells. Red blood cells carry oxygen to the body's tissues. Is due to insufficient iron. Without enough iron, your body can't produce enough of a substance in red blood cells that enables them to carry oxygen (hemoglobin). As a result, iron deficiency anemia may leave you tired and short of breath. i. *Ferumoxytol:* is limited to pt who have chronic kidney disease, regardless if on dialysis or receiving erythropoietin. -Erythropoietin (EPO) is a hormone produced primarily by the kidneys. It plays a key role in the production of red blood cells (RBCs), which carry oxygen from the lungs to the rest of the body. Ferumoxytol requires only 2 doses over 3 to 8 days compared with SFGC and iron sucrose, which require over 3 to 10 doses over several weeks. ii. *SFGC:* is used for pt who are undergoing long-term hemodialysis and are deficient in iron. iii. *Iron Sucrose:* is used for pt who have chronic kidney disease, are receiving erythropoietin, and are hemodialysis - or peritoneal dialysis - dependent; AND pt who have chronic kidney disease, are NOT receiving erythropoietin, and are NOT dialysis-dependent. iv. Iron prep. are used to prevent iron deficiency aream for pt who are at risk, such as, *infants, children, and pregnant women* v. Parenteral forms should only be used in pt who are unable to take oral meds, in which case the IV route is preferred.

Folate vs Folic Acid

Folate and folic acid are different forms of vitamin B9. Vitamin B9 is an essential nutrient that naturally occurs as folate. Folate serves many important functions in the body. For example, it plays a crucial role in cell growth and the formation of DNA. Having low levels of folate is associated with an increased risk of several health conditions. For these reasons, supplementation with vitamin B9 is common. Fortifying food with this nutrient is actually mandatory in countries such as the US, Canada and Chile. However, the problem is that supplements and fortified foods usually contain folic acid, not folate. BOTTOMLINE: Folate is the naturally-occurring form of vitamin B9. Before entering the bloodstream, the digestive system converts it into the biologically active form of vitamin B9, 5-MTHF. Folic acid is a synthetic form of vitamin B9. It is used in supplements and added to processed food products, such as flour and breakfast cereals. For many years, folic acid was thought to be much better absorbed than naturally-occurring folate. Unlike most folate, the majority of folic acid is not converted to the active form of vitamin B9, 5-MTHF, in the digestive system. Instead, it needs to be converted in the liver or other tissues. However, the body does not convert it into active vitamin B9 very well, so un-metabolized folic acid may build up in the bloodstream.

Folic Acid: Nursing Evaluation of Medication Effectiveness

Folate level within expected range Return of RBC, reticulocyte count, and Hgb and Hct to within expected range Improvement of anemia findings such as absence of pallor, dyspnea, and easy fatigability Absence of neural tube defects in newborns

Magnesium Sulfate

Select Prototype Medication: -Parenteral: Magnesium Sulfate -Oral: Magnesium hydroxide, Magnesium Oxide, Magnesium Citrate Mag Hydroxide and Mag Oxide act as ANTACIDS when administered in low dose. All THREE act as laxatives.

Folic Acid

Select Prototype Medication: Folic Acid

Potassium Supplements

Select Prototype Medication: Potassium Chloride Other Medications: -Potassium gluconate -Potassium phosphate -Potassium bicarbonate

Vitamin B12 (Cobalamin) & Cyanocobalamin

Select Prototype Medication: Vitamin B12 Other Medications: Intranasal Cyanocobalamin

Vitamins

Vitamins are essential nutrients needed by you body to grow, reproduce and maintain good health. They are found naturally in foods, added to foods, or in pill form in dietary supplements. -Essential nutrients that do not yield energy, but that are required for growth and proper functioning of the body.

Folic Acid: Contraindications & Precautions

avoid indiscriminate use of folic acid to reduce the risk of masking manifestations of vitamin B12 deficiency

Potassium Supplements: Complications

i. *Local GI Ulceration and GI Distress:* N/V, diarrhea, abd discomfort, and esophagitis with oral administration -instruct pt to take med with meals or at least 8 oz water to minimize GI discomfort and prevent ulceration -do NOT dissolve tablet in mouth because oral ulceration will develop ii. *Hyperkalemia [k+ >5.0 mEq/L]* -hyperkalemia rarely occurs with oral administration -monitor pt receiving IV potassium for hyperkalemia [bradycardia, ECG changes, vomiting, confusion, anxiety, dyspnea, weakness, numbness and tingling] -severe hyperkalemia can require treatment such as: -calcium salt -glucose and insulin -sodium bicarbonate -sodium polystyrene sulfonate -peritoneal dialysis -hemodialysis

Vitamin B12: Nursing Evaluation of Medication Effectiveness

i. disappearance of megaloblasts (2-3 weeks) ii. increased reticulocyte count iii. increased hematocrit iv. improvement of neurologic injury, such as: -absence of tingling sensation of hands and feet and numbness of extremities. Improvement can take months, and some pt never attain full recovery.

Iron Preparations: Nursing Administration

i. instruct pt to take iron on empty stomach [such as 1 hr before meals] as stomach acid increases absorption ii. If GI adverse effects occur, have pt take with food. This might increase adherence to therapy even though absorption is decreased iii. instruct pt to space doses at approximately equal intervals throughout day to most efficiently increase RBC production iv. tell pt to anticipate a harmless dark green or black color stool v. liquid iron: dilute in water or juice, drink with straw, rise mouth with water vi. have pt increase water and fiber intake (unless contraindicated) and maintain an exercise program to counter the constipation vii. therapy can last 1 to 2 months. Usually, dietary intake will be sufficient after Hbg has returned to a therapeutic level viii. Encourage concurrent intake of appropriate quantities of foods high in iron [liver, egg yolks, muscle meats, yeast, grains, green leafy veggies]

Folic Acid: Nursing Administration

i. obtain baseline folic acid, Hgb, Hct, RBC, reticulocyte counts, and folate levels. Monitor periodically. ii. assess for manifestations of megaloblastic anemia [pallor, easy fatigability, palpitations, paresthesia of hands and feet] iii. pt with folic acid deficiency concurrently increase intake of food sources of folic acid -liver, green leafy veggies, citrus fruits, dried peas and beans iv. monitor for risk factors indicating that folic acid therapy is needed, such as heavy alcohol use and child-bearing age

Vitamin B12: Nursing Administration

i. obtain baseline vitamin B12, Hgb, Hct, RBC, reticulocyte counts, and folate levels. Monitor periodically. ii. monitor for manifestations of vitamin B12 deficiency: beefy red tongue, pallor, and neuropathy iii. Cyanocobalamin is administered intranasally, orally, IM, or subQ. -Injections are painful and usually are reserved for pt who have significant reduced ability to absorb B12, such as lack of intrinsic factor (pernicious anemia), enteritis, and partial removal of stomach iv. pt who have malabsorption syndrome can use intranasal or parenteral preparations v. Intranasal cyanocobalamin should be administered 1 hr before or after eating foods [increased nasal secretion cause decrease absorption] vi. pt who have irreversible malabsorption syndrome [parietal cell atrophy or total gastrectomy] will need lifelong treatment, usually parentally. if oral therapy, doses must be very high. -Encourage concurrent intake of quantities of foods high in vitamin B12 [dairy products] -perform a Schilling test [doctor usually performs] to determine vitamin B12 absorption in GI tract -measurement of plasma B12 levels help determine the need for therapy -advise pt to adhere to prescribed laboratory tests. -monitor blood counts and vitamin B12 levels every 3-6 months