Ppt chapter 10-1

Chapter 10
Lifestyle, Diet, and Habits:
Nutrition and Complementary
Medications
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question
• A well-balanced diet may decrease the need for drugs.
– A. True
– B. False

Answer
• A. True
• Rationale: A well-balanced diet may prevent chronic
illness and therefore indirectly decrease the need for
drug therapy.

Chapter Overview
• A well-balanced diet may prevent chronic illness and
therefore indirectly decrease the need for drug therapy.
• A well-balanced diet influences the pharmacokinetics of
many drugs.
• The nutritional status of a patient can be altered by a
chronic disease or as an adverse effect of drug therapy.
• Lastly, certain foods, beverages, dietary supplements,
and herbal or botanical preparations can affect the
absorption and effectiveness of some drugs or produce
an adverse effect.

Dietary Factors Affecting Drug Efficacy
• When dietary factors are altered, drug therapy may
produce different effects in the body than would normally
occur.
• Diminished protein status can substantially increase the
concentration of free drug available.
• Malnourished people exhibit decreased oxidative
metabolism and reduced glomerular filtration rate.

Dietary Factors Affecting Drug Efficacy
(cont.)
• Excessive intake of vitamins may also adversely affect
the action of some drugs.
• Food intake can affect drug excretion.
• Food and beverages consumed may alter drug therapy.

Pharmacokinetic and Nutrient
Interactions

Drug Therapy and Nutritional Status
• Drugs potentially affect the status of almost every
nutrient.
• Particularly important to consider are vitamin A and the B
vitamins.
• Some commonly used drugs have nutrition-related
actions.
• For example, chronic phenytoin therapy is associated
with folate deficiency and megaloblastic anemia.

Question
• Long-term use of diuretics will result in decreased levels
of
– A. Potassium
– B. Magnesium
– C. Zinc
– D. All of the above

Answer
• D. All of the above
• Rationale: Diuretic drugs increase the excretion of
nutrients by interfering with reabsorption in the renal
tubules. Chronic use may result in depletion of
potassium, magnesium, and zinc because renal
excretion of these minerals is increased.

Complementary Nutritional Therapies
• The use of nutritional supplements and herbal and
botanical preparations is often considered an alternative
therapy for health.
• The term complementary therapy is now often used
instead of alternative medicine.
• Complementary nutritional therapies include supplements
of basic food elements, vitamins, and minerals.

Nutritional Supplements
• Nutritional substances include
– Protein
– Carbohydrates
– Fat
– Dietary fiber
– Vitamins
– Minerals

Protein
• Protein, which provides 4 kcal/g, is one of the most
important and abundant substrates in the body.
• The body may draw on dietary or tissue protein to obtain
needed energy when the supply from carbohydrates and
fats is inadequate.
• Quality protein should provide approximately 15% to
20% of a healthy person’s well-balanced diet.
• People wishing to build muscle mass may take amino acid
supplements and eat excess protein.
• Ingested amounts exceeding those needed to replace
body losses are simply converted into fat and stored.

Carbohydrates
• Carbohydrates—especially sugars and starches—are the
most common dietary component.
• They provide 4 kcal/g and constitute the body’s primary
source of fuel for heat and energy.
• A well-balanced diet for a healthy person supplies
approximately 50% to 60% of the total kilocalories from
carbohydrates.
• Simple sugars may cause an increase in serum insulin
and triglyceride concentrations.
• Starches are complex carbohydrates that must be
digested; thus, absorption of glucose is slower, and
serum levels of glucose, insulin, and triglycerides remain
more stable.

Fat
• Dietary fats from animal and plant sources provide the
body’s alternate or storage form of heat and energy.
• Fat—a more concentrated fuel—supplies 9 kcal/g.
• Fat should supply no more than 25% to 30% of the total
intake of a well-balanced diet in a healthy person.
• Triglycerides are the predominant dietary lipids.
• Essential fatty acids must be supplied in the diet.

Question
• What percentage of daily intake should be from fats?
– A. 10% to 15%
– B. 25% to 30%
– C. 30% to 45%
– D. 45% to 60%

Answer
• B. 25% to 30%
• Rationale: Fat should supply no more than 25% to
30% of the total intake of a well-balanced diet in a
healthy person. Increased fat intake can lead to
health problems in the patient.

Dietary Fiber
• Dietary fiber—a group of plant substances resistant to
human digestion
• An important characteristic of fiber is its water-retention
ability.
• Fiber added to the diet may be recommended to treat or
prevent constipation.

Vitamins
• Vitamins are a chemically diverse group of organic
compounds needed by the body to maintain health.
• Small quantities of each necessary vitamin must be
obtained exogenously.
• Recommended dietary allowances (RDAs), established by
the federal government, were designed to serve as
dietary guidelines based on the idea that people would
obtain essential and nonessential nutrients from a variety
of foodstuffs.
• Vitamins may be prescribed when general nutritional
status is poor, oral intake is insufficient, or the body has
additional demands for a vitamin.

Minerals
• Major mineral cations include calcium, magnesium,
potassium, and sodium.
– Their movement across cell membranes is highly
regulated; they function in energy metabolism,
membrane transport, and maintenance of membrane
potential.
• There are a number of essential trace elements, also
known as microminerals.
– The most important of these include chromium,
copper, iron, selenium, and zinc.
– Trace elements are present in minute amounts in
body tissues and are essential to optimal growth,
health, and development.

Herbal and Botanical Preparations
• Herbal preparations and botanical preparations are those
substances derived from a plant source and used as a
dietary supplement or as a medication.
• Plants have historically been used for medicinal purposes.
Many drugs used today are derived from plants.
• Because of the increased OTC use of herbs and
botanicals, Western medicine has recently examined
many of these substances in clinical studies.

Relevant Core Patient Variables
• Abnormal dietary intake and the use of herbs and
nutritional supplements may have a bearing on drug
therapy.
• Question the patient during an initial drug assessment to
uncover relevant information.
• The deficiency must be corrected in some way.
• To assess the use of herbs and nutritional supplements,
focus data collection on what substances the patient
takes.
• Document the patient’s age and life span status, because
many of these therapies are not recommended for use
with children, during pregnancy, or during lactation.

Nursing Diagnoses and Outcomes
• Risk for Injury related to low protein levels and
malnutrition
– Desired outcome: Protein levels and malnutrition
will be corrected to prevent adverse effects from drug
therapy.
• Risk for Injury related to adverse effects from excessive
use of vitamins or herbs
– Desired outcome: The patient will not develop any
adverse effects while using nutritional supplements.
• Risk for Injury related to drug interactions of vitamins,
herbs, or food intake with prescribed drug therapy
– Desired outcome: Drug interactions will be
prevented while the patient is on drug therapy.

Nursing Diagnoses and Outcomes (cont.)
• Deficient Knowledge related to interactions of vitamins or
herbs with drug therapy
– Desired outcome: The patient will obtain sufficient
knowledge to make knowledgeable choices about the
use of vitamins and herbs while on drug therapy.
• Health-Seeking Behaviors related to the use of nutritional
supplements
– Desired outcome: The patient will effectively use
nutritional supplements to complement drug therapy
to increase health.

Maximizing Therapeutic Effects and
Minimizing Adverse Effects
• If the patient has been determined to have low protein
levels, consult with the physician or nurse practitioner
about protein replacement.
• If the patient cannot take in enough food orally, vitamins
or other nutritional supplements may be ordered.
• Patient education is the key to maximizing the
therapeutic effect or minimizing the adverse effect of
drug therapy.

Providing Patient and Family Education
• Teach patients about the potential interactions of food,
nutrients, and complementary nutritional therapies with
prescribed drug therapy.
• Emphasize to patients and families the importance of
being well nourished while receiving prescribed drug
therapy.
• Teach patients when to take the prescribed drug in
relation to meals if timing is relevant.
• Encourage patients to inform all their health care
providers about all dietary supplements used.
• Teach patients that botanical supplements should be used
as treatment for serious health conditions only with the
advice and supervision of a qualified health practitioner.

Ongoing Assessment and Evaluation
• Assess for potential drug interactions when a patient is
taking any dietary supplement or herbal preparation in
addition to prescribed drug therapy.
• These interactions may reduce the therapeutic effect of
the prescribed drug or cause adverse effects from either
the prescribed drug or the supplemental therapy.
• Dietary treatments may be evaluated as effective if they
return the patient to a normal physiologic status.

Ppt chapter 10-1

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