COURSE MODULE

NURSING PHARMACOLOGY
NCM 106
 LESSON MODULE 3
8. Vitamins and Minerals
9. Fluid and Electrolytes Replacement
_______________________________________

Prepared by: Giovanni Clyde E. Rebadulla

 INTRODUCTION
_________________________________

This lesson module will serve as the basis for the students
understanding on water and fat soluble vitamins, the essential
micro and macronutrients, fluid body compositions and fluid
replacements. Also included in this module are the different
electrolyte imbalances and common nursing interventions.
 This Lesson Module 1 will cover the following :
8. Classification of Vitamins and minerals and its significance to
human body.

9. The distribution of fluid in the human body and the principle

of fluid replacement.

10. The electrolytes and its role in the human body

LEARNING OBJECTIVES
At the end of the module the student will:
1.Discuss Water and non-water-soluble Vitamins.
2.Explain the importance of Minerals ( macro and micro) in the
human body.
3.Discover the body compositions in terms of fluid content
4.Differentiate between cations and anions of electrolytes

5.Classify the intravenous solutions for Fluid replacement.

6.List and describe common electrolyte imbalances
7.Explain the methods used to correct potassium, calcium and
magnesium excess
8.Integrate knowledge on vitamins, fluid and electrolyte replacement
with the nursing process as the core of achieving quality nursing
care
General Instructions

SGEN Gmail Account: Utilized for important

announcement.
Lesson Content will be uploaded in Moodle
Google Classroom: Class work , post exams and Etc.
Google Drive: Docs , Sheets and Slides
Google Calendar
MOODLE:
Google MEET or Zoom for Synchronous Weekly
sessions : ZOOM ID: 828 802 7631
PASSWORD: 8SArkR
Short Answer Assignment
.Give 3 examples each for water and fat soluble vitamins and
discuss its main functions.
.What makes macro minerals different from micro minerals in
terms of required daily needs?
.What is the total daily input and output of human body?
.What are the differences between Isotonic, hypertonic and
Hypotonic solutions in terms of mOsm/L.
.What are the normal values of the common body
electrolytes?
 Summary of Vitamins
Fat-Soluble Vitamins Water-Soluble Vitamins
● Vitamin A • Thiamin
● Vitamin D • Riboflavin
● Vitamin E • Niacin
● Vitamin K
• Pantothenic acid
• Vitamin B6
• Folate
• Vitamin B12
• Biotin
• Vitamin C
 VITAMINS
- crucial functions in almost all bodily processes (immune,
hormonal and nervous systems)
- obtained from food or supplements as our bodies are unable to
make vitamins.
• There are thirteen vitamins classified as either water soluble (C
and B complex) or fat-soluble (A, D, E and K).

FAT SOLUBLE VITAMINS

- Vitamins A, D, E and K
- absorbed, together with fat from the intestine, into the
circulation.
- After absorption, these vitamins are carried to the liver where
they are stored. make up the fat soluble vitamins
 Water Soluble Vitamins
• Vitamin C (ascorbic acid) and the B complex group make up
the nine water-soluble vitamins. The B complex group
comprises of vitamins:
– B6 (pyridoxine)
– B1 (thiamin)
– B2 (riboflavin)
– B12 (niacin, pantothenic acid, biotin, folic acid and cobalamin

• stored in the body for only a brief period of time and are
then excreted by the kidneys. The one exception to this is
vitamin B12, which is stored in the liver. Water-soluble
vitamins need to be taken daily.
Vitamins
•contain no useful energy for the body
•link and regulate the sequence of metabolic reactions that
release energy within the food that are consumed.
•Vitamins cannot be made in the body and must be obtained
in our diet
•A well balanced diet provides an adequate quantity of all
vitamins regardless of age and level of physical activity.
Vitamin A (fat-soluble)
Uses: maintains the health of the epithelium and acts on the
retina's dark adaptation mechanism.
Deficiency leads to: Keratinization of the nasal and
respiratory passage epithelium, night blindness
•Sources: Dairy products, eggs, liver. Can be converted by the
body from the beta-carotene found in green vegetables,
carrots and liver.
 Signs of Vitamin A Toxicity
• Gingivitis ● Serum vitamin A of
75 to 2000 RAE/100
• Cheilosis ml
• Anorexia ● Bone pain and
• Irritability fragility
• Fatigue ● Hydrocephalus and
vomiting (infants
• Hepatomegaly and and children)
abnormal liver
● Dry, fissured skin
function
● Brittle nails
• Ascites and portal
● Hair loss (alopecia)
hypertension
Vitamin D3 (fat-soluble) cholecalceferol
•Sources: Fish liver oils, dairy produce. Vitamin D is formed in
the skin when it is exposed to sunlight
•Uses: Has a role in the absorption of calcium, which is
essential for the maintenance of healthy bones
•Deficiency leads to: Rickets
 Signs of Vitamin D Toxicity
• Excessive calcification of bones
• Kidney stones
• Metastatic calcification of soft tissue
(kidney, heart, lung, and tympanic membrane)
• Hypercalcemia
• Headache
• Weakness
• Nausea and vomiting
• Constipation
• Polyuria
• Polydipsia
 Vitamin E (fat-soluble)
• Sources: Pure vegetable oils; wheatgerm,
wholewheat bread and cereals, egg yolk, nuts,
sunflower seeds
• Uses: Protects tissues against damage;
promotes normal growth and development;
helps in normal red blood cell formation
• Deficiency leads to: May cause muscular
dystrophy
 Vitamin K (fat-soluble)
• Sources: Green vegetables
• Uses: Used by the liver for the formation of
prothrombin
• Deficiency leads to: Bleeding due to delayed
clotting times caused by lack of clotting
factors. Patients may show signs of bruising
easily and have nosebleeds.
 Water-soluble Vitamins
Vitamin B1 (thiamin))
•Sources: Yeast, egg yolk, liver, wheatgerm, nuts, red
meat and cereals
•Uses: Carbohydrate metabolism
•Deficiency leads to: Fatigue, irritability, loss of
appetite; severe deficiency can lead to beriberi
Vitamin B2 (riboflavin) (water-soluble)
•Sources: Dairy products, liver, vegetables, eggs, cereals, fruit, yeast
•Uses: Intracellular metabolism
•Deficiency leads to: Painful tongue and fissures to the corners of the
mouth, chapped lips , CHEILITIS

•Vitamin B (Pyridoxine)
6
•PYRIDOXINE
•PYRODOXAL
•PYRODEXAMINE
Folate Deficiency
•Impaired biosynthesis of DNA and RNA
•Megaloblastic, macrocytic anemia
•Folate-responsive homocystinemia
•Neural tube defects

Vitamin B12 Deficiency COBALAMINE

•Impaired cell division
•Megaloblastic anemia
•Neurologic abnormalities
•Pernicious anemia
BIOTIN
•Functions as coenzyme & deamination of amino acids
•Found in variety of foods
•Deficiency found in patients with TPN
•In adults –dry scaly dermatitis, pallor, nausea & anorexia
•In infants –seborrheic dermatitis & alopecia
•Anticonvulsant drugs inhibit Biotin transport in human intestine
Vitamin C (ascorbic acid) (water-soluble)
•Sources: Green vegetables and Fruits
•Uses: Essential for the maintenance of bones, teeth and gums,
ligaments and blood vessels. It is also necessary for ensuring a normal
immune response to infection
•Deficiency leads to: Scurvy
Choline
•Essential component of animal tissues
•Widely distributed in fat, in the form of lecithin, in eggs, soybeans,
milk, etc.
•Supplemental choline successful in diminishing short-term memory
loss associated with Alzheimer’s disease

Carnitine
•Functions in the transport of long-chain fatty acids into mitochondria
for oxidation as sources of energy
•Meats and dairy products are good sources.
•Muscle weakness and hypoglycemia are symptoms of deficiency.
myo-Inositol
•Provides structural support in membranes
•Source of arachidonic acid and important intracellular signals and
secondary cell messengers
•Synthesized from glucose and also obtained from fruits, grains,
vegetables, nuts, legumes, and organ meats

Ubiquinones
•Referred to as coenzyme Q10 (CoQ10)
•Function as essential components of the mitochondrial electron
transport chain
•Function as a fat-soluble antioxidant
•Found in fish oils, nuts, fish, and meats
Bioflavonoids
•Have been shown to reduce capillary fragility and to potentiate the
antiscorbutic activity of ascorbic acid
•Studies show association of diets high in bioflavonoids with reduced
risks for cardiovascular disease and several cancers.
•Found in colorful foods of plant origin

Notes :
•Fat-soluble vitamins should not be consumed in excess as they are
stored in the body and excess can result in side effects
•An excess of water-soluble vitamins should not result in any side effects, as they will
disperse in the body fluids and voided in the urine
 Key Vitamin & Mineral Requirements for Hospitalized
Patient
• Vitamin A – wound healing & tissue repair
• Vitamin C – Collagen synthesis & wound repair
• Vitamin B1 – Metabolism & CHO utilization
• Pyridoxine ( B6) – Protein Synthesis
• Zinc – Wound repair, immune function & CHON synthesis
• Folic acid, Fe, B12- Synthesis & turnover of erythrocytes
• Vitamin E –antioxidant

• Note: there is no drug interaction with vitamins and Minerals. They

go along side with each other.
MACRO and MICROMINERALS

6. FLUORIDE
1. IRON
2. ZINC 7. MOLYBDENUM
3. COPPER
8. COBALT
4. IODINE
5. MANGANESE 9. SELENIUM

10. CHROMIUM
 MINERALS
►Large class of ESSENTIAL MICRONUTRIENTS

1. MACROMINERALS – required in large

quantities, 100 mg/day.
2. MICROMINERALS – required in small
quantities, less than 100 mg/day.
 MICROMINERALS
IRON
•Helps carry oxygen to body tissues including
muscle
DEFICIENCY
🡹IRON DEFICIENCY ANEMIA
🡹KOILONYCHIA
TOXICITY
🡹Liver disease
🡹Arrhythmias
 ZINC
•Important in function of many enzymes
•Wound healing

DEFICIENCY
🡹Infertility
🡹Failureof wounds and ulcers to heal
🡹Poor growth
🡹Alopecia (hair loss)
🡹Diarrhea
🡹Excessive body odor

TOXICITY
🡹Nausea and vomiting
🡹Abdominal pain
 COPPER
🡹Enzyme cofactor in iron metabolism, melanin synthesis, electron transport
DEFICIENCY
🡹White hair, Gray hair, Brittle hair, Varicose veins
🡹Ptosis, Reduced glucose tolerance
🡹Menke’s Kinky hair syndrome

Menke’s Kinky Hair Syndrome

•Retarded growth with progressive mental retardation in infants with loss of
hair pigment
• defective keratin formation
•low body temperature,
•degeneration and fracture of aortic elastin (aneurysms),
•arthritis in the growth plate of long bones
•Injections of copper are useful
IODINE
•Combines with T4 or tyrosine to produce thyroxine.
•Promotes metabolism

🡹DEFICIENCY= GOITER

GRAVE’S DISEASE
🡹Symptoms:
◦ Insomnia
◦ Heat intolerance
◦ Excessive sweating
◦ Exopthalmos
◦ Rapid pulse
◦ Irritability
 MANGANESE
•it activates numerous enzyme systems including those
involved with glucose metabolism, energy production
•Responsible for the development of fragile ear bones
and joint cartilage

PSYCHIATRIC DISORDERS
🡹Toxicity-
RESEMBLING SCHIZOPHRENIA
POTASSIUM
•Vital for muscle contractions and nerve transmission
•Important for heart and kidney function
•Helps regulate fluid balance and blood pressure

DEFICIENCY
🡹Muscular weakness

🡹mental apathy

🡹Cardiac failure
CHROMIUM SELENIUM
•Works with insulin for •Involved in fat metabolism
proper glucose metabolism •Cooperates with vitamin E
•Acts as an antioxidant
DEFICIENCY
DEFICIENCY
🡹Low blood sugar
🡹Age spots
🡹Diabetes
🡹Muscular weakness
🡹Hyperinsulemnia
🡹Infertility
🡹Hyperactivity
🡹Cancer
🡹Infertility and decreased
sperm count 🡹Irregular heart beat
MACROMINERALS
1. CALCIUM
2. PHOSPHORUS
3. MAGNESIUM
4. SULFUR
CALCIUM
•Helps build strong bones and teeth
•Involved in muscle contractions and nerve function

•CALCIUM DEFICIENCY>>OSTEOMALACIA
🡹CALCIUM TOXICITY
Muscle and abdominal pain
Calcium kidney stones
• PHOSPHORUS
• Works with calcium to build and maintain bones and teeth
• Helps convert food to energy
• Regulates blood pH

Phosphorus Deficiency
🡹 Aggravates osteoporosis, arthritis, high blood
pressure, loose teeth, etc.
🡹 loss of appetite
🡹 Weakness
🡹 Pain
Phosphorus Toxicity
🡹 Lowers blood calcium which may lead to tetany and
convulsions
MAGNESIUM
•production and transfer of energy for protein synthesis
• for contractility of muscle and excitability of nerves
• cofactor in myriads of enzyme systems

DEFICIENCY
-Asthma, Anorexia, Menstrual migraines,
Growth failure
- ECG changes, Neuromuscular problems,
Tetany (Convulsions)
TOXICITY
🡹Inhibited bone calcification
🡹Low blood pressure
🡹Drowsiness
🡹Nausea
🡹Slurred speech
🡹Unsteadiness
 SULFUR
•Attached to proteins to maintain:
1. Hemoglobin
2. Hormones (Insulin, adrenal cortical hormones)
3. Enzymes
4. Antibodies

DEFICIENCY
🡹degenerative types of arthritis involving degeneration of cartilage,
ligaments, tendons
🡹Systemic Lupus Erythematosis

🡹Sickle cell anemia

🡹various "collagen diseases."

FLUIDS & ELECTROLYTES
REPLACEMENT
DAILY TOTAL INPUT: 2,600 ML
LIQUID : 1,500 ML
SOLID FOOD: 800 ML
WATER OXIDATION: 300 ML.

DAILY TOTAL OUTPUT: 2,600

SKIN: 600 ML
LUNGS:400 ML
KIDNEYS( URINE) 1,500 ML
INTESTINES( FECES) 100 ML
Water Loss Daily
400 to 500 ml – skin (evaporation)
400 to 500 ml – breathing
100 to 200 ml – feces
1000 to 1200 ml – urine
Total: 2000 to 2400 ml

Daily Water need:

30 ml/kg of BW
15 ml/lb
 ELECTROLYTES
+ positive charge (cation)
- negative charge (anion)

Transmit nerve impulses → muscles

Contract skeletal & smooth muscles

Cations
Potassium (K+)
Sodium (Na+
Calcium (Ca+)
Magnesium (Mg+)

Anions
Chloride (Cl )
Bicarbonate (HCO3 )
Phosphate (PO4 )
Sulfate (SO4 )
3 Types of FLUID CONCENTRATION
.Iso-osmolar – same proportion of particles
.Hypo- osmolar – fewer particles than water
.Hyperosmolar – more particles than water

TONICITY
Measurement of the concentration of intravenous (IV)
solutions
Tonicity: range 240 to 340 mOsm/L
 FLUID REPLACEMENT
Intravenous Solutions
Indication: Body Fluid loss

Fluid Volume Deficit – ECF (Interstitial Spaces and

vascular
spaces
Isotonic solutions – management for fluid volume loss.
(240-340 mOsm/kg)

(osmolalities similar to the ECF’s & intracellular fluids)

 Isotonic solutions
Isotonic: 240 to 340 mOsm/L

Examples:
• normal saline or 0.9% sodium chloride
(NaCl)
• 5% in water (D5W)
• Lactated Ringer’s (D5LR)
• Ringer’s solutions
• PNSS
 Intravenous Solutions
Hypotonic solutions – less than 240
mOsm
Indication: treatment for cellular dehydration
Examples: 0.45% NaCl (half-normal saline),
Solution less than 9%, 45% D5W

Hypertonic
• Treatment of water intoxication
• D5 ½ NS, D10W, 3% NS
• Shifts fluids from ICF & ECF to intravascular
component – expands blood volume
 Fluid Replacement
• Intravenous solutions
– Tonicity: range 240 to 340 mOsm/L
– Hypotonic: <240 mOsm/L
– Isotonic: 240 to 340 mOsm/L
– Hypertonic: >340 mOsm/L

4 Classifications of IV Solutions
1. Crystalloids
2. Colloids
3. Blood and blood products
4. Lipids
 4 Classifications of IV Solutions
.Crystalloids – replacement & maintenance
fluid therapy
•Ex : Dextrose, saline, and lactated Ringer’s solution
•Dextrose5 in water (D5W)
– 250 mOsm/L
– Isotonic (unless used continuously)
•Normal saline solution (0.9% NSS)
– 310 mOsm/L
– Isotonic solution
•D5/0.45% NSS
– 405 mOsm/L
– Hypertonic solution
•D10W
– 500 mOsm/L
– Hypertonic solution
IV SOLUTIONS
•Intravenous Fluid: D5LR Solution
•5% Dextrose in Lactated Ringer's
•Formulation:
•Each 100ml contains 5g of Dextrose Monohydrate,
600mg of Sodium Chloride, 310mg of Sodium Lactate
Anhydrous, 30mg of Potassium Chloride, and 20mg of
Calcium Chloride Dihydrate.
•Electrolytes in 1L:
•Sodium............................130mmol
•Potassium........................4mmol
•Calcium...........................1.4mmol
•Chloride...........................109mmol
•Lactate.............................28mmol
Osmolarity: 525 mOsm/L
pH: 4.0 to 6.5
Type: Hypertonic
Availability: 1000ml and 500ml
Indication: Dehydration, burns, lower GI fluid
loss, acute blood loss, hypovolemia due to
blood loss and replacement of fluid and
electrolytes.
Caution: Contains potassium, do not use with
renal failure patients. Do not use with liver
disease patients, cannot metabolize lactate.
2. Colloids – volume expanders
•Volume expanders
– Dextran solutions
– Amino acids
– Hetastarch
– Plasmanate

•Blood and blood products

– Whole blood
– Packed red blood cells
– Plasma
– Albumin

•Lipids
– Fat emulsion solution
3. Blood and Blood products
e.g. whole blood, PRBC, plasma and
albumin

4. Lipids – balance nutritional needs

Fat emulsion solution
e.g. total parenteral nutrition
(TPN)
 Nursing Assessment
• Assess vital signs HR.BP
• Check client’s lab findings – BUN / Creatinine
• Determine urine output
• Obtain urine specific gravity > 1.030 dehydration
• Check types of fluid
• Record client’s weight
• Signs & symptoms of deficits – hydration status, turgor, mucus
membrane , HR,BP
• Signs & symptoms of overload – irritated cough, dyspnea,neck vein
engorgement, rales
• Lab findings- Hb/Hct elevation – dehydration
• Iv injection sites - phlebitis
Client Teaching
•Instruct client that thirst means mild fluid deficit
•Encourage client to monitor input & output
•Advise client to report frequent vomiting or diarrhea
occur constantly
Nursing Diagnosis
•Risk for fluid excess
•Risk for deficient fluid volume
•Ineffective tissue perfusion
•Deficient knowledge
Planning
•Client w/o excess or deficit
•Adequate hydration
 Assessment NOTES :
• VS Assessment - baseline • Report rapid PR, decrease BP

• Check hct & BUN (≥ 60 • Check for dehydration, Renal

mg/dl) Im
• Determine UO. ≤ 600 • Normal UO: 1000-1200 ml/day
ml/day
• Report if less than normal UO

• Check IVF types ordered • Prevent fluid deficit/excess

daily
• Weigh the client daily • Check signs of fluid overload
Gain of 2.2 lbs = 1 L of fluid
(N)
•ELECTROLY
TES
• POTASSIUM
• Prevalent in ICF
• Normal Value: 3.5 to 5.3 mEq/L
• RDA: 40 to 60 mEq daily
• Found in fruits, fruit juices, bananas, dried fruits &
vegetables
• Transmission & conduction of nerve impulses
• Contraction of skeletal, cardiac, & smooth muscles
• Promotes glycogen storage
 HYPOKALEMIA
Causes: trauma, injury, shock, surgery, vomiting,
diarrhea
K+ leaks (ICF) and goes Intravascular then to the
kidneys

Compensatory Mechanism happens

80% - 90% of K are Excreted in the

urine; 8% through feces
Nursing Process - Potassium

Assessment
• Signs & symptoms of hypokalemia-nausea, vomiting, ileus, cardiac
dysarrythmia & flabby muscles / hyperkalemia – oliguria, abdominal
cramps,weakness & numbness of extremities
• Potassium level = 3.5 -5.3 meq / L

Management: Potassium Chloride

P.O. or IV; in tablet, liquid, powder form

To be given with a glass of juice or water

NEVER given as an IV Push

 POTASSIUM CHLORIDE
Pharmacokinetics:
•Oral liquid K+ absorbed faster
•IV K+ must be diluted in IV solutions
•Renal function should be monitored

Pharmacodynamics:
•Maintains neuromuscular activity
•Onset of action: within 30 mins (IV)
•Serum K+ is closely monitored
 HYPERKALEMIA
Serum K+ level: >5.3 mEq/L
-Due to renal insufficiency or administration of
large doses of K+
Management: Sodium Bicarb, Calcium Gluconate,
or insulin & glucose
(immediately decrease K+)

Sodium polysterene sulfonate (Kayexalate)

Exchanges Na+ ion for a K+ ion
 K+ Wasting vs. K+
Sparing
Potassium Wasting Potassium Sparing
• Thiazides • Aldosterone
e.g. Diuril antagonists
• Loop Diuretics e.g. Aldactone
e.g. Lasix
• Osmotic
diuretics
e.g. Mannitol
 SODIUM
Major cation in the ECF (Vessels & Tissue
spaces)
Normal Value: 135 to 145 mEq/L

•Regulates body fluids

•Promotes transmission & conduction of
nerve impulses
 HYPONATREMIA
Less than 135 mEq/L
Vomiting, diarrhea, surgery & diuretics

s/sx: muscular weakness, headaches,

lethargy, confusion, seizures, abdominal
cramps, tachycardia & hypotension

Management:
Normal saline – has increased Sodium
content.
Hypertonic 3% saline
 HYPERNATREMIA
Serum Na+: above 145 mEq/L

s/sx: flushed dry skin, agitation, hyperthermia,

elevated BP, dry tongue, muscular twitching

RDA: 2 to 4 grams daily

Nursing Intervention:
SODIUM Restriction is indicated.
 CALCIUM
Found equally proportions in the ICF and ECF.
Normal value: 4.5 to 5.5 mEq/dl
Binds with protein

🡹serum protein (albumin) = 🡹calcium

•Promotes normal nerve & muscle activity
•Increases contraction of the heart muscle
(myocardium)
•Promotes blood clotting
•Formation of bone & teeth
 HYPOCALCEMIA
Hypoparathyroidism
Vit. D deficiency
multiple blood transfusions
s/sx: anxiety, irritability, numbness of fingers, spasms,
convulsions.

Management: Calcium Preparations

IV prep mixed with D5W

Administered at a moderate rate

•Calcium supplements should contain Vit. D
•Oral calcium taken 30 mins before meals

•Calcium should NOT be diluted in normal saline

 HYPERCALCEMIA
Hyperparathyroidism, hypophosphatemia,
tumors of the bone, diuretics (thiazide)

s/sx: flabby muscles, pain over bony areas,

kidney stones
Management: Phosphate prep, loop
diuretics…

Goal: correct underlying cause of serum

calcium excess
 SUMMARY
You have just learned:
.Vitamins and its common functions or uses in the
body
.The differences of Macro and Micro minerals
.The importance of Electrolytes in the body
.The different intravenous fluid replacement in the
body.
What’s next ?
Preview
NERVOUS SYSTEM NEURO MUSCULAR
DISORDERS
STIMULANTS PARKINSONS
SYMPATHETIC ANTICONVULSANTS
PARASTMPATHETIC
DEPRESSANTS MYASTHENIA GRAVES
REFERENCES:
•PHARMACOLOGY A PATIENT CENTERED NURSING PROCESS APPROACH BY:
KEE/HAYES/MCCUISTION (2015)

•FOCUS ON NURSING PHARMACOLOGY BY: AMY KARCH (2013)

http://docshare04.docshare.tips/files/27843/278436401.pdf
Thank you