Nutrition - NCLEX-PN

Vitamin B3 and vitamin B6 are required to convert glutamic acid into glutamine. Biotin (vitamin B7) plays roles in fat and amino acid metabolism, and though there has been no conclusive evidence of its effect on the growth of hair and nails, it is commonly taken as a supplement for these purposes. Folate (vitamin B9) is required during synthesis of red blood cells, and during DNA replication. Folate cannot be synthesized de novo, and thus must be ingested from the diet. Vitamin C is a powerful antioxidant, and is a cofactor to many biological processes. Cobalmin (vitamin B12) is involved in cell metabolism, particularly in that of fatty acids and amino acids. The source of B12 is from the natural flora of the gut. Vitamin D enhances the absorption of minerals such as calcium, magnesium, and zinc from the gastrointestinal tract. Vitamin E is a fat-soluble antioxidant.

Alcoholism is associated with thiamine (vitamin B1) deficiency. This is due to multiple factors: poor nutrition, ethanol's inhibition of thiamin transport in the intestine, and reduced storage of thiamine in the liver due to fatty changes.

L-arginine is a precursor for the production of nitric oxide, essential to vasodilation. Other precursors to nitric oxide include NADPH, oxygen, and nitric oxide synthetase (NOS) enzymes. These other amino acids do not have essential roles in the nitric oxide synthesis pathway.

A physician is most likely to recommend decreased fluid intake in a patient that has renal disease, particularly if they are in any stage of renal failure. This is because a high fluid intake may put undue strain on the already impaired function of the kidney. Increased fluid intake is generally recommended for all of the other conditions listed.

Offering a treatment plan that includes specific nutrient supplementation and a dietary protocol is a normal part of a nutritional counseling and intervention. Initiating tube feeding is only necessary in cases of anorexia or other forms of malnourishment, but is still within normal procedures. Admonishing patients for their dietary choices, however, would be counterproductive to the nurse's attempt to foster trust and willingness on the part of the patient, and so would be inappropriate in an intervention setting.

Kwashiorkor is a condition of sufficient caloric intake with severe protein malnutrition, often seen in impoverished areas where individuals must survive on carbohydrate-based sources of nutrition. This results in a severe deficiency of albumin, with symptoms such as edema, ascites, fatty liver, and dermal ulceration. Marasmus is a condition not specifically of protein deficiency but of general starvation, which may be due to lack of food security or to intentional fasting or extreme caloric restriction. Pellagra is a condition caused by niacin deficiency, and beriberi is a thiamine deficiency syndrome with neurological, gastrointestinal, and cardiac manifestations.

The most common cause of copper deficiency in the United States is gastric bypass. This is due to malabsorption from food. Copper is fairly ubiquitous in soil and in the average American diet. Wilson's disease is a disorder of excess copper, rather than copper deficiency, resulting in a variety of neurological symptoms.

Hypervitaminosis D, or vitamin D toxicity, has been known to cause calcification in soft tissues due to vitamin D's role in calcium absorption and metabolism. None of the other nutrients are as closely related to calcium metabolism, and do not cause hypercalcification in soft tissues when overconsumed.

Vitamin K deficiency can cause a variety of issues related to inability to form blood clots such as petechiae, excessive bleeding, bruising, heavy menses. This vitamin is also an important part of bone and cartilage formation, with deficiency resulting in malformation of developing bones and cartilage, or deposition of calcium into cartilage or arterial walls.

An intake of 1-6 grams of cinnamon has been shown in studies to lower blood sugar in patients with type 2 diabetes by as much as 25%, possibly due to its ability to improve insulin sensitivity.

The mot common cause of osteomalacia (known as rickets in children) in the United States is vitamin D deficiency. This is due to vitamin D's vital role in calcium absorption, homeostasis, and metabolism. Osteomalacia is categorized by the softening of the bones.

Vitamin C chelates non-heme iron in food while exposed to the acidic pH of the stomach. This chelated iron then becomes more soluble in the alkaline pH of the duodenum, resulting in increased intestinal absorption of iron.

Serotonin, melatonin, and niacin are all synthesized from L-tryptophan, an amino acid prevalent in many foods including chocolate, oats, dates, milk, sesame seeds, eggs, meat, and cheese. L-tyrosine is involved in the synthesis of dopamine. Acetylcholine is the neurotransmitter released at the neuromuscular junction, which stimulates contraction of skeletal muscle. Taurine has many biological functions in the cardiovascular, muscular, and nervous systems, as well as others.

Methylene tetrahydrofolate reductase (MTHFR) is an enzyme with multiple important metabolic roles, including the methylation of folate, vitamin B12, and homocysteine. MTHFR deletions can result in folate and B12 related anemias and high homocysteine due to interruption of homocysteine recycling into methionine.

Biotin, or vitamin B7, plays an important role in the health of the hair, nails, and skin. Deficiency generally manifests as alopecia, loss of hair color, brittle nails, and dermatitis.

Soluble fiber, present in oat bran, barley, nuts, seeds, and legumes, delays gastric emptying, increases satiety, and lowers LDL cholesterol by interfering with the absorption of dietary cholesterol. Insoluble fiber passes through the gastrointestinal tract relatively intact, provides bulk for stool, and reduces bowel transit time. Carbohydrates and unsaturated will not lower LDL cholesterol or delay gastric emptying, though they will increase satiety.

Vitamin D is a fat soluble vitamin, and so will be better absorbed when taken with a meal that contains fat. The other vitamins listed may be better absorbed with food, but do not require fat for transport across intestinal membranes, as they are water-soluble.

Essential amino acids are amino acids that can not be synthesized within the body, but must be consumed through the diet. Tryptophan is the only essential amino acid listed. In all, there are 9 essential amino acids.

Conditionally essential amino acids are those that can be produced by the body under normal circumstances, but may not be able to be produced during certain situations, such as certain disease states or severe catabolic stress. Arginine is the only conditionally essential amino acid listed. Histidine and methionine are both essential amino acids, while aspartic acid is a non-essential amino acid.

Vitamin C is one of the body's most important antioxidants. Antioxidants are reducing agents - that is they themselves get oxidized. Recall: OIL RIG. Thus antioxidants such as vitamin C are electron donors, able to stabilize the free radicals produced by various metabolic processes in tissues and extracellular spaces. Vitamin E (not listed) is another important antioxidant and is actually more potent than vitamin C.