BIOETHICS ▪ PRIMARY FUNCTIONS OF THE INFORMED CONSENT

ETHICAL PRINCIPLE OF NURSING o The protection of the patient’s right to self – determination
• “7 ETHICAL PRINCIPLE”
1. Autonomy APPLYING THE THEORY OF PATERNALISM
2. Confidentiality o The patient’s autonomy is disregarded because of the
3. Veracity desire of the HCP to help.
4. Fidelity
5. Justice ➢ 2 TYPES OF PATERNALISM
6. Beneficence o Strong (extended)
7. Non-Maleficence o Weak (limited and restricted)

1) AUTONOMY • PROXY CONSENT

▪ “autos” — self o Person with the legal right to consent to medical treatment
▪ “nomos” — rule for themselves or as a legal guardian
▪ Refers to the freedom from external control
▪ PATIENT AUTONOMY ❖ 3 FUNDAMENTALS CONSTRAINTS
✓ Refers to the right of patients to make decisions for 1. The person making the delegation must have the right
his/her medical care without the influence of the to consent.
healthcare provider. 2. The person must be legally and medically competent to
▪ PATIENT’s RIGHT delegate the right to consent
✓ The basic rule of conduct between the patient’s and
medical caregiver as well as the institution and the ➢ 2 TYPES OF PROXY CONSENT
people who support them. o Power - of - attorney
1. The right to be treated with respect o Living Will
2. The right to obtain medical records
3. The right to privacy of medical records 2.) CONFIDENTIALITY AND PRIVACY
4. The right to make a treatment choice • CONFIDENTIALITY
5. The right to Informed consent o Obligation of health care professionals to withhold patient
6. The right to refuse treatment information in confidence
7. The right to make decisions about end-of-life care
❖ Confidentiality implies that:
❖ When we talk about patients rights just remember theses 1. Patient information should be kept in private.
mnemonics: 2. Patient’s record is only accessible to the healthcare
P — Privacy provider. Unless the patient has signed consent whom
A — Autonomy the information may be shared and for what purpose.
T — Treatment Refusal 3. Discussing the information and case outside the
I — Information nursing unit is strictly prohibited, it is clearly a violation
E — Education of the patient’s confidentiality.
N — Not to be restrained 4. Patient has the right to review the records pertaining to
T — to be treated with confidentiality their own medical care and to have information
S — Services explained or interpreted as necessary unless it is
restricted by the law.
• PATIENTS BILL OF RIGHTS (Patient Care Partnership) • PRIVACY
o Is a document that provides patients with information on o refers to a condition where a person is apart form public
how they can reasonably expect to be treated during the attention and observation.
course or their hospital stay. o Has a vital role in patient-healthcare provided relationship
o Non – legally binding
❖ Conditions that the patients’ right can be strip off from
• INFORMED CONSENT unwarranted public exposure:
o is a process of communication between you and your 1. When is mental or physical condition is in controversy
healthcare provider that often leads to agreement or and ordered by the court to submit for physical or
permission for care, treatment, or services. mental examination
o A general consent should be signed by the patient prior to 2. When the public health and safety demand.
treatment or admission to a healthcare facility. 3. When the patient waves this right in writing.
o A special consent is signed by the patient or the patient’s
significant other if there is a need for special procedure to 3.) VERACITY
be performed . • Truthfulness/conformity to facts
• Truth Telling and Right to Information
▪ CONSENT FOR REFUSAL o Veracity, therefore, is the ethics of telling the truth
o Legal rights o Two commands:
o Assess reason 1. Do not lie.
o Document 2. You must communicate with those who have the
right to the truth.
▪ PRINCIPLES OF INFORMED CONSENT ▪ VERACITY IN A HEALTH CARE SETTING
o Right and responsibility of everyone is exercised freely o Comprehensive, accurate and objective transmission
and voluntarily. of information.

▪ FOUR PRINCIPLE OF INFORMED CONSENT ▪ VERACITY IN NURSING

o Decision – making capacity o Shows respect
o Documentation of consent o Allows the right to autonomy
o Disclosure of information o Compassionate and moral choice
o Comprehension of information
❖ 3 Reasons why veracity is necessary in professional-patient
▪ 3 ESSENTIAL CONDITIONS relationships:
o Voluntary 1. Respect owed to others.
o Understanding 2. Obligations of fidelity and promise-keeping
o Deliberate 3. Trust for successful interventions and cooperation.

❖ Points to remember about Informed Consent VIOLATION OF VERACITY

✓ Patients agreement o Omission
✓ Witnessed o Commission (lie)
✓ Obtained by the MD’s (Physician/surgeon) o Medical Jargon
✓ Full disclosure of risks, benefits, and other alternatives in
cases of refusal REMEMBER THIS!
✓ Liable by law Truth Telling
➢ As a nurses, every patient has the right to information about
❖ 3 CONDITION IN JUSTIFYING TREATMENT WITHOUT himself/herself and that all information must be disclosed in
INFORMED CONSENT order for them to make the correct decisions both for the
1. The patient must be incapable of gibing consent and moment and for the future.
no lawful surrogate is available to give the consent
2. There is a danger to life or danger of a serious Cultural considerations on Truth Telling
impairment of health ▪ There are traits that affect truth-telling:
3. Immediate treatment is necessary to prevent these 1. Family-orientation to illness
dangers 2. Non-confrontational attitude
4.) FIDELITY OTHER RELEVANT PRINCIPLES
• Keeping of promises
• As nurses we are bound to be faithful to our professional 1.) PRINCIPLE OF DOUBLE EFFECT
pledge to provide quality, competent, and holistic care to all o This principle aims to provide specific guidelines for
our patients and maintain fiduciary responsibilities. determining when it is morally permissible to perform an
action in pursuit of a good end in the full knowledge that the
MODEL FOR FIDELITY action will also bring about bad results.
o Keeping one’s word of honor o It is an action done with two effects both good and bad.
o loyalty to commitments and oaths Upon doing such actions there should be basic moral
o Reliability criteria/conditions to consider or be followed.

Importance of Fidelity in Nursing Ethics ➢ 4 Moral Conditions

1. Fidelity governs all the other six ethical principles. 1. The action performed must be morally good or indifferent.
2. Fidelity is considered the most common source of 2. The intention of the agent must be the achievement of a
ethical conflict. good effect.
3. Fidelity requires nurses to treat all patients with 3. The evil effect must be the means in achieving the good
respect. effect.
4. The good effect must be greater or at least equal, in
5.) JUSTICE importance with the evil effect.
• This ethical principle talks about:
o Social fairness Example of double effect:
o One’s due, entitlement, benefits • Pregnant woman with uterine cancer.
o Fairness o Hysterectomy/Cancer Treatment
• Two major categories
o Procedural 2.) PRINCIPLE OF LEGITIMATE COOPERATION
o Distributive o the participation of one agent in the activity of another
agent to produce a particular effect or share in a joint
6.) BENEFICENCE activity.
• Refers to the action done for the good of others. o there are criteria for judging your legitimacy in your
• Associated with acts of mercy, kindness, and charity. cooperation in performing an act intertwined with evil.
• Selflessness
➢ TYPES OF COOPERATION
BENEVOLENCE 1. FORMAL COOPERATION
o the character trait or virtue of being inclined to do good and o occurs when an evil end or evil means are directly
act do good for the benefit of others. chosen by means of encouragement, praise, advice
and other forms of support
Beneficence and a Higher Moral Burden o freely commits an immoral act
o beneficence represents a level of selflessness underlying o giving advice or assistance in committing immoral act.
the principle of consequentialism (the consequence of
your kindness produces the greatest happiness to the 2. MATERIAL COOPERATION
greatest number of people) o occurs when the evil ends and means are indirectly
chosen by a person who has chosen a good end and
Beneficence is a fundamental principle of healthcare. good means
o you do not agree with somebody's immoral intentions,
❖ Examples of Nursing beneficence in Clinical Settings: but you cooperate the act in some way
1. Resuscitating a victim of drowning. o immediate or mediate
2. Providing pain medication as soon as possible to an injured ▪ IMMEDIATE
patient in the ED. - cooperators involvement is necessary for the
3. Lifting side rails on a patient’s hospital bed to prevent falls. immoral act to continue.
4. Practicing proper hand washing to prevent infection. ▪ MEDIATE
5. Feeding patients - the cooperation is less or does not contribute
6. Providing psychosocial support to the anxious patient and to the immoral act.
family members.
7. etc... 3.) PRINCIPLE OF COMMON GOOD AND SUBSIDIARITY
COMMON GOOD
7.) NON MALEFICENCE o Working for the good of all.
• Our dictum as healthcare providers “DO NO HARM” o respecting the rights and responsibilities of all people.
• In scenarios where harm is unavoidable, minimize it.
Examples:
• In certain situation non-maleficence can overthrow
1. Accessible and affordable health care. (UHC)
autonomy
2. Just legal and Political system.
BENEFICENCE VS. NON - MALEFICENCE
SUBSIDIARITY
Example: (Beneficence)
o often considered a consequence of the principle of the
What ethical principle applies when the nurse adheres to an
common good, subsidiarity requires those in positions of
aseptic technique during wound dressing?
authority to recognize that individuals have the right to
a. Autonomy
participate in decisions that directly affects them, in accord
b. Justice
with their dignity and with their responsibility to the common
c. Beneficence
good.
d. Non-maleficence

Example: (Non-maleficence)
What ethical principle applies when the nurse avoids any
unsterile activities during wound dressing?
a. Autonomy
b. Justice
c. Beneficence
d. Non-maleficence
 VITAMINS WATER - SOLUBLE VITAMINS
• Organic, essential nutrients THIAMIN (B1)
• Needed in the body in small amounts FUNCTION:
• Perform specific functions that promote o Integral part coenzyme factor, thiamine pyrophosphate or
o Growth TPP, needed for carbohydrate metabolism.
o Reproduction o Helps maintain good appetite, good muscle tone especially
o Maintenance of health and life of the GI tract and normal functioning of ENERGY.
• Vita = life
• Min = amine “ Thiamin occurs in small quantities in many nutritious foods that
• Coenzyme partner in controlling many metabolic reactions in the people like to eat everyday. Sunflower seeds, watermelon, pork,
body. black beans, and green are all exceptionally rich in thiamin.
• In its absence, a related deficiency disease occurs. Thiamin-enriched foods like breads and cereals are also good
sources.”
• Cure is through the administration of the vitamin involved.
STABILITY
CLASSIFICATION OF VITAMIN DEFICIENCIES
o Loss of vitamin in cooking is extremely variable, depending on
➢ Primary deficiency
the pH of the food, time, temperature, quantity of water used
➢ Secondary deficiency
and discarded and the use of sodium bicarbonate to enhance
the green color of vegetables.
• PRIMARY DEFICIENCY
o Freezing has little or no effect on the thiamin content of foods.
o Occurs when the vitamin is not consumed in sufficient
amounts to meet physiologic needs
Thiamine Deficiency:
✓ loss of appetite
• SECONDARY DEFICIENCY ✓ weakness
o Absorption is impaired ✓ easy fatigability
o Excess secretion occurs ✓ indigestion
o Underlying disorder ✓ severe constipation
o Lifestyle factor ✓ gastric atony
- Smoking ✓ poor reflexes and irritability
- Excessive alcohol consumption ✓ retarded growth
- Use of medications ✓ numbness of extremities
✓ BERI-BERI
TERMS ACCOUNTED WITH VITAMINS o also called nutritional polyneuritis
• PRECURSORS or PROVITAMINS o characterized by ataxia ,pain, anorexia, mental
o Are compounds that can be changed to active vitamins. disorientation, and tachycardia.
o A substance in food that may be transformed into a vitamin
within the body; a potential vitamin. TYPES OF BERIBERI
- For example, carotenoids are precursors of vitamin A. • INFANTILE BERIBERI
ergosterol, when radiated becomes Vitamin D o Infants 2 to 5 months of age whose main food is milk from
mother suffering from beriberi.
• PREFORMED VITAMINS o Symptoms are (APHONIA), whining cry, CYANOSIS,
o These are naturally occurring vitamins that are inactive difficulty in breathing and even death in a few hours.
form and ready for its biological use.
- Ex: Retinol (Preformed Vit. A found in animal food sources) • WET BERIBERI
o Is resultant of high carbohydrate intake along with
• AVITAMINOSIS strenuous exercise
o A condition resulting from lack of a vitamin in its later stage Characterized by :
when more defined signs and symptoms occur such that a ✓ EDEMA of both lower extremities which progress
nutritional deficiency disease is recognizable. upwards to body cavities such as abdomen and chest.
- For example: Avitaminosis A leads to night blindness and ✓ TACHYCARDIA
xerophthalmia. ✓ Shortness of breath with activity
✓ Enlarged HEART.
• HYPERVITAMINOS IS
o referred to as “vitamin toxicity” • DRY BERIBERI
o Is associated with energy deprivation and inactivity
• VITAMIN MALNUTRITION Characterized by:
o the prefix mal- meaning “bad” denotes that too much or too ✓ mental confusion
little is not good for the health. ✓ peripheral neuropathy
✓ muscular wasting with loss of function
• VITAMIN-LIKE COMPOUNDS ✓ paralysis of the lower extremities.
o Physiological roles like vitamins
o Present in larger amounts in the body • WERNICKE – KORSAKOFF SYNDROME
o Partially synthesized in the body o a cerebral form of beriberi that affects the nervous system.
o Include inositol, choline, lipoic acid and ubiquinone. o may cause the loss of memory, extreme mental confusion,
and ataxia exhibited by persons with chronic excessive
• ANTI-VITAMINS / VITAMIN ANTAGONISTS alcohol ingestion.
o These are substances that interfere with the normal o is a type of brain disorder caused by a lack of vitamin B-1,
functioning of a vitamin. or thiamine
o Anti-vitamins are chemical compounds that inhibit the
absorption or actions of vitamins.

TWO TYPES OF VITAMINS

I. The Water Soluble vitamins: B Vitamins and Vitamin C.
• Are not stored significantly in the body and any excess is
excreted in the urine, except Vit. B 12 (Cobalamin) and Vit.
B 6 (Pyridoxine)
• Dissolve or disperse in water
• Are easily absorbed and excreted via urine
• Does not have precursors
• They must be supplied everyday in the diet Deficiency
symptoms develop relatively fast
• They are most likely destroyed in ordinary cooking.

II. The Fat Soluble vitamins: Vitamins A, D, E and K.

• Absorbed directly into blood transported and stored like fats
• Dissolve in fatty tissues or substances
• Need fat: for absorption & transport
• Can be stored in body: liver, adipose tissue
• Generally have precursors or provitamins
• Are not absolutely needed daily from food source
• Generally stable, especially in ordinary cooking methods
Thiamine REQUIREMENT OR ALLOWANCE
• RDA: 1.2 mg (men) & 1.1 mg (women)
• The amount of thiamine required increases as the metabolic
rate increases.
• The amount of thiamine required increases as the metabolic
rate increases.
• Those engaged in rigorous physical activity burn more energy,
so they require more energy.
RIBOFLAVIN (B2)
FUNCTION:
o It operates as a vital coenzyme factor in both energy
production and tissue protein building.
o RDA: 1.3 mg for men and 1.1 mg for women
DERMATITIS
o A symmetrical scaly rash occurs only on skin exposed to
the sun.
o Skin is dry scaly and cracked
o In acute stages, pellagra resembles severe sunburn; in
later stages, affected areas become darkly pigmented.
o Lesions occur in the same places on both sides of the
body.
DIARRHEA
o Damage to the GI tract affects digestion, absorption, and
excretion of food, leading to glossitis, vomiting and
diarrhea.

“Milk, green vegetables, enriched and whole grain breads and DEMENTIA
cereals, and some meat are good sources of riboflavin” o As the CNS becomes affected in severe deficiencies,
confusion, anxiety, insomnia and paranoia develop.
B2 Plant sources:
➢ Broccoli CORN-BASED diets
➢ asparagus, o The Niacin in corn is in a bound form unavailable for
➢ dark leafy greens absorption.
➢ whole grains, o People in the southern United States and parts of Europe
➢ enriched breads and cereals. relied on corn as a staple food, and corn is notoriously low
in niacin.
ENRICHED o More than 3 Million cases of pellagra resulted in 100,000
o a word that is used to describe foods to which vitamins and deaths between 1900 and 1940
minerals have been added back to a food after refining
process that caused a loss of some nutrients; NIACIN
o Iron may be lost during the refining process of a grain, so o as a treatment for High Cholesterol.
the final product will be enriched with additional iron o High-dose niacin supplements can improve blood lipid
profiles
Vitamin B2 Animal sources: o At doses of 1500 mg per day, it decreases low-density
➢ Dairy products lipoprotein cholesterol and triglyceride levels
➢ Meats o However, patient with CV diseases who tale a statin
➢ Fish medication do not benefit further from supplemental niacin;
➢ Poultry thus it is not recommended to take both
➢ Eggs
PYRIDOXINE (B6)
• Riboflavin is sensitive to light and irradiation. FUNCTIONS:
• It is destroyed by ultraviolet light & sunlight. o Acts as a coenzyme in the metabolism of amino acids and
proteins, fatty acids and carbohydrate.
ARIBOFLAVINOSIS o Involve in the formation of neurotransmitters and are
1) CHEILOSIS essential for the proper functioning of the nervous system.
o a term used for fissures in the skin at the angles of the o Is essential for the hemoglobin synthesis.
mouth. o It is required for the conversion of tryptophan to niacin.
o these cracks in the skin may be painful and often become AVERAGE RDA:
infected. o 1-2 mg day
DEFICIENCIES:
2) GLOSSITIS o dermatitis, altered nerve function, weakness, poor growth,
o is inflammation or infection of the tongue. convulsions, and microcytic anemia (small red blood cells
o causes the tongue to swell and change color. deficient in hemoglobin.)
TOXICITY:
3) SEBORRHEIC DERMATITIS o ataxia, sensory neuropathy (for long-term supplementation
o An inflammation of the skin that exhibits a greasy, scaling in megadoses gram quantities)
appearance,
o Typically involves the cheeks and the areas behind the “Meats, fish, poultry, potatoes, bananas, and a few other vegetables
ears. and fruit offer vitamin B6.”

NIACIN (B3) VITAMIN B9

FUNCTION: FOLATE
o It is involved as a coenzyme for many enzymes, especially FUNCTIONS:
those involved in energy metabolism. o Is required for the synthesis of amino acids and for the
AVERAGE RDA: synthesis of DNA and RNA. It also forms the heme portion
o 2-12 mg a day for children of the hemoglobin.
o 14 mg a day for women Average RDA:
o 16 mg a day for men o 50-200 mcg/day
o 18 mg a day for pregnant or breast- feeding women o Is the form found naturally in foods.

“Meat, poultry, and fish contribute about half of the niacin people eat. • FOLIC ACID
Mushrooms are also a rich source of niacin, as are whole grain and o A synthetic form used in vitamin supplements and for food
enriched breads and cereals.” fortification.

PELLAGRA “Folate is especially abundant in green, leafy vegetables (think

o The deficiency disease caused by a lack of dietary niacin “foliage”). Fruit and vegetable juices and fresh, uncooked fruits and
and an inadequate amount of protein that contains the vegetables are excellent folate sources. Liver, too, is folate-rich.”
amino acid tryptophan, which is precursor of niacin.
o It is characterized by skin lesions that are aggravated by NEUTRAL TUBE DEFECTS
sunlight as well as by GI, mucosal, neurologic, and mental Deficiency in pregnant women: NEURAL TUBE DEFECTS
symptoms. SPINA BIFIDA
Characterized by: o is a congenital defect of the spinal column that causes the
❖ 4 “D’s” spinal cord to be unprotected.
o Diarrhea o Results in range of disabilities including paralysis and
o Dermatitis incontinence.
o Dementia
o Death 3 MOST COMMON TYPES OF SPINA BIFIDA
Caused by: 1. MYELOMENINGOCELE
❖ 3 “M’s” o A defect of the backbone (spine) and spinal cord
o Maize 2. MENINGOCELE
o Molasses o sac protruding from the spinal column
o Meat 3. SPINA BIFIDA OCCULTA
o backbone (spine) does not fully form during pregnancy

Deficiency in pregnant women: NEURAL TUBE DEFECTS
ANENCEPHALY
o a congenital defect in which brain does not develop, death
occurs shortly after birth.
Childbearing age:
o Should take 400 mcg/day of synthetic folic acid to reduce
the risks of birth defects.
o Pregnant women should take 600 mcg/day
MEGALOBLASTIC ANEMIA
o A form of anemia characterized by large red blood cells that
cannot carry oxygen properly.
COBALAMIN (B12)
FUNCTION:
o It has a role in folate metabolism by modifying folate coenzymes
to active forms to support metabolic functions, including the
synthesis of DNA and RNA.
o It is required for the metabolism of fatty acids and amino acids.
o It helps develop and maintain the myelin sheaths that surrounds
and protect the nerve fibers.
RDA: 1-2 mcg/day
Toxicity: none reported.
• Both Vitamin B12 and the intrinsic factor must be present for
absorption.
“Vitamin B12 is unique among vitamins in that it is found almost
exclusively in animal flesh and other animal-derived foods such as
milk, cheese, and eggs. mPeople who eat any or all of these foods
are guaranteed an adequate intake. Strict vegetarians, however,
must be sure to use vitamin B12-fortified products such as fortified
soy milk or take supplements.”
EGGS are good sources of Choline
FUNCTIONS OF CHOLINE
✓ Keeps the healthy functions of our brain and nervous system
✓ helps form the membranes of our cells
✓ helps our muscles contract
✓ helps the transport of fat and cholesterol in the body
✓ balances levels of homocysteine in the blood
VITAMIN C ASCORBIC ACID
Chemical and Physical Nature
o Water soluble acid, easily oxidized, unstable
o Other animals can synthesize Vitamin C from glucose but
humans lack the necessary specific enzymes
Absorption and Storage
o Easily absorbed from small intestine
o Not stored in tissue depots; distributed to tissue saturation
levels in general circulation, remainder being excreted;
o large amounts present in adrenal tissues
PHYSIOLOGIC FUNCTION:
o Antioxidant and co-enzyme, collagen synthesis, amino acid
metabolism; may have the role in reducing the risk of
cancer(stomach, esophagus and colon)
Average RDA :
o 90 mg for men
o 75 mg for women.
Recommendations vary worldwide:
o a minimum of 10 mg to prevent symptoms of scurvy.
SMOKERS
• The metabolic use of smokers is twice as that of non smokers.
• Recommend that clients who smoke consume 125 mg rather
than 90 mg of Vitamin C daily.

PERNICIOUS ANEMIA (from B12 deficiency) SCURVY

o It is a decrease in red blood cells that occurs when the body o gingival hemorrhage
cannot properly absorb vitamin B12 from the gastrointestinal
tract
o Caused by destroyed gastric parietal cells that produce the SCURVY: Corkscrew Hair
intrinsic factor; without intrinsic factor in the stomach, Vitamin o pinpoint bleeding around hair follicles
B12 can not be absorbed.
SCURVY:Periungual hemorrhage
B12 deficiency: o include pinpoint bleeding under the nails.
o reduction in production of intrinsic factor by the stomach
mucosa in older people. Scurvy: Bruising and Hemorrhages
o Damage to the spinal cord
o Due to the breakdown of myelin sheath synthesis that affects “Fruits and vegetables can easily be
the brain, optic and peripheral nerves. selected to guarantee a generous
intake of vitamin C. Citrus fruit and juices are known for being rich in
VITAMIN B7 BIOTIN Vitamin C, but many other fruits and vegetables are good sources of
FUNCTIONS: this vitamins too.”
o It assists in the transfer of carbon dioxide from one compound to
another, playing an important role in carbohydrate, fat and FAT- SOLUBLE VITAMINS
protein metabolism. o vitamins that are absorbed together with fat from the intestine,
Average RDA: 30-100 mcg/day and into the bloodstream.
Toxicity: None reported. Function
Dietary Sources of Biotin ✓ Vision
o Food sources of biotin include nuts, cheese, spinach, salmon, ✓ Health of Other Cells
mushrooms, broccoli, beef liver and chicken. ✓ Growth, Development and reproduction
Deficiency: Rare. ✓ Cardiovascular Disease Prevention
✓ Cancer Prevention
BIOTIN DEFICIENCY
o Is rare but has been produced by consumption of large amounts RETINOL
of AVIDIN, a protein found in raw egg whites that binds with o is the chemical name of Vitamin A Because of its major function
biotin. in the retina of the eye.
o One would need to consume many raw egg whites for this to
occur. VITAMIN A: VISION
o Light-dark Vision
VITAMINS B5 PANTOTHENIC ACID o Color vision
FUNCTION:
o Part of coenzyme A, essential for many chemical reactions, Adaptation to changes in light:
therefore required for metabolism of CHO,CHON and fat. o Vitamin A is necessary for the formation of 2 pigments.
o Synthesis of AAs, fatty acids cholesterol, steroid hormones &
hemoglobin. RHODOPSIN:
Average RDA: 4-7 mcg/day o Dim-light photoreceptor in the retina
Deficiency: o Is formed from retinal, a vitamin A substance, and opsin, a
o Is not likely except in cases of a deficiency of all the B vitamins. protein.
o Is commonly known as the visual purple
“Biotin and pantothenic acid are widespread in foods. Meat, poultry, o an essential part of the pigment of the eye to be able to adjusts
whole-grain cereals, broccoli, and beans are particularly good to light variations
sources”
VITAMIN A: HEALTH OF OTHER CELLS
CHOLINE • The “anti-infection” vitamin
• It is needed for the synthesis of acetylcholine, a • Epithelial cells
neurotransmitter, and lecithin, the phospholipid. ✓ serve as important barriers to bacterial infection ; secrete
• Acetylcholine mucus
o a neurotransmitter associated with attention, learning • Hence, its deficiency can increase risk for infections.
and memory, muscle control, and many other
functions. VITAMIN A:
• Average RDA: o Growth, development and Reproduction
o 425 mg/day (women)
o 550 mg/day(men)
o Vitamin A Binds to DNA and in turn causes a cell to increase its - Carrots
synthesis of proteins that stimulate proper growth and - Broccoli
development - Tomatoes
o Producing some components of bone requires vitamin A - Spinach
“Angat sa Height, Ang Future Mas Bright,”
• Fortified Star Margarine Sweet Blend with Honey and sugar bits
is a non-refrigerated, no cholesterol table spread made from a
special blend of refined oils.
• It is fortified with more nutrients essential for growth and Good
source of Vitamins A, B1, B2, B6 ,B12, D , E , folic acid, niacin
and iodine for kids!
• Star Margarine has always been a family favorite ever since...
Batang Matangkad, Batang STAR! INTERESTING FACT: POLAR BEAR LIVER

VITAMIN A
• Cardiovascular Disease Prevention
• Linked to carotenoids’ antioxidant capability

VITAMIN A: Cancer Prevention

• Vitamin A is a valuable tool in the fight of:
o Skin Ca
o Lung Ca
o Bladder Ca
o Breast Ca
o Prostate Ca – carotenoid lycopene (tomatoes, watermelon)

• Most researchers are convinced that beta-carotene

supplementation offers no protection against Cancer. VITAMIN A DEFICIENCY
Best advice: • PRIMARY
✓ Eat a combination of at least 5 fruits and vegetables a day o Is caused by a lack of dietary intake
(and not smoke). • SECONDARY
o Is the result of chronic fat malabsorption.
VITAMIN A: ANALOGS FOR ACNE o As liver becomes depleted, symptoms develop.
Acne medications:
• TRETINOIN (Retin-A) XEROPHTHALMIA
o topical treatment • It comes from the Greek
• 13-cis RETINOIC ACID (Accutane) "xeros" (dry) + "ophthalmos" (eye) = dry eye.
o oral drug to treat serious acne • Specific cause: lack of mucus production by the eye.
• TOXICITY:
o birth defects in the offspring of women using it during 1. NIGHT BLINDNESS
pregnancy o Difficulty seeing in the dark because the retina cannot
adjust to low amounts of light.
Recommended Intake: 2. XEROSIS (Dry Eyes)
(RDA, based on providing optimum storage of Vitamin A in the liver) o The white of the eye loses its shine and begins to wrinkle.
✓ Vitamin A is measured as retinol activity equivalents (RAE) 3. BITOT’s SPOT
✓ 900 mcg RAE(men) o Patches of little gray bubbles on the whites of the eye.
✓ 700 mcg RAE (women) 4. CORNEAL ULCERATION
o Dullness or damage to the cornea.
FORMS OF VITAMIN A 5. KERATOMALACIA
1. PREFORMED VITAMIN A: o Soft or bulging cornea.
o Retinol/retinoids o A condition, characterized by softening and subsequent
2. PROVITAMIN A: ulceration and perforation of the cornea.
o Beta-carotene
Vitamin A deficiency: Night Blindness
Forms of Vitamin A • Night blindness can usually be cured in about 30 minutes by an
RETINOIDS injection of vitamin a(retinol), which is readily converted into
• Active form of vitamin A retinal and then into rhodopsin
• Found in animal food
• Is the natural form of vitamin A, found only in animal food TOXICITY
sources usually associated with fats. • Toxicity does not occur from carotenoid precursor in foods.
• If carotenoids is taken in excess ----- ----skin takes on an orange
VITAMIN A sources hue
Animal-related foods/Retinoids
• Whole milk How vegetables can give you that golden glow
• Butter ▪ Scientists prove that your five a day make you more attractive –
• Liver by subtly altering your skin colour
• Egg yolks
• Fatty dish Most of us know that eating five portions of fruit and vegetables a
day will do us far more good than 20 minutes on a sun bed.
Forms of Vitamin A But new research suggests that it will also make us more attractive
CAROTENOIDS to the opposite sex.
• Precursors forms of vitamin A
• Found in plant foods "Currently we tell them to 'eat well or in 50 years you will have a
heart attack'," says Ian Stephen, 29, assistant professor of
Carotenoid Beta- Carotene: psychology at Nottingham University's Malaysian campus.
"Now we can say: 'eat fruit and veg and you will look better in six to
• Is the primary source of Vitamin A from plants foods.
eight weeks'."
• Nutritionally is the most active and most plentiful of the
carotenoids.
How come?
• This is the original substance found in plants (pigments) that • Well, the key component is the carotenoid, an antioxidant
animals have eaten and converted to vitamin A responsible for the red colouring found in, for instance, tomatoes,
• Is called carotene, because one of its main sources is the yellow peppers, plums and carrots. That redness eventually imbues the
pigment of carrots human skin with yellowness, or rather a healthy- looking golden
glow.
VITAMIN A sources • "Carotenoids are stored in fat under the skin," Stephen explains.
Carotenoids "They are also secreted through the skin in serum, and are then
• Deep green, yellow, and orange fruits and vegetables such as: reabsorbed into the top layer of the skin, bestowing that golden
colour."

VITAMIN D
▪ Calciferol-general name given to Vitamin D
Functions:
 1. Helps regulate Calcium and Phosphorus absorption from 2) Cultural Clothing customs that conceal the body
the intestine. 3) The inability of older persons or adults with disabilities to get
2. It reduces kidney excretion of calcium outdoors, resulting in malnourishment
3. Helps regulate deposition of calcium in the bones.

INTERESTING FACTS ABOUT VITAMIN D

1) Vitamin D is produced by your skin in response to exposure to VITAMIN D TOXICITY
ultraviolet radiation from natural sunlight. • HYPERCALCEMIA
2) The healing rays of natural sunlight (that generate vitamin D in o (high blood levels of Calcium)
your skin) cannot penetrate glass. • HYPERCALCIURIA
3) It is nearly impossible to get adequate amounts of vitamin D o (high calcium level in Urine)
from your diet. Sunlight exposure is the only reliable way to • Toxicity symptoms occur when dietary intake of Vitamin D is just
generate vitamin D in your own body. above the UL (Tolerable Upper Intake Level)of 50 mcg 0r 2000
4) A person would have to drink ten tall glasses of vitamin D IU, making Vitamin D the most toxic of vitamins.
fortified milk each day just to get minimum levels of vitamin D
into their diet. VITAMIN E (TOCOPHEROL)
5) The further you live from the equator, the longer exposure you
need to the sun in order to generate vitamin D. Canada, the UK VITAMIN E FUNCTIONS:
and most U.S. states are far from the equator. • Acts as an antioxidant, protecting polyunsaturated fatty acids
and Vitamin A in cell membranes from oxidative damage by
SKIN PIGMENTATION being oxidized itself.
6) People with dark skin pigmentation may need 20 - 30 times as o This is particularly important in protecting the integrity of
much exposure to sunlight as fair-skinned people to generate lung and RBC cell membranes, which are exposed to large
the same amount of vitamin D. amounts of oxygen.
• Acts as an antioxidant in conjunction with Selenium and
Length of exposure to UV irradiation ascorbic acid (vitamin C).
7) Sufficient levels of vitamin D are crucial for calcium absorption
in your intestines. Without sufficient vitamin D, your body cannot
absorb calcium, rendering calcium supplements useless. Recommended Intake
8) Chronic vitamin D deficiency cannot be reversed overnight: it • Vitamin E is measured in terms of alpha- tocopherol equivalent
takes months of vitamin D supplementation and sunlight (a-TE).
exposure to rebuild the body's bones and nervous system. • The RDA for men & women: 15 mg a-TE
9) Even weak sunscreens (SPF=8) block your body's ability to
• 1 mg a-TE = 1.49 IU
generate vitamin D by 95%. This is how sunscreen products
• 30-70 mg a-TE (50-100 IU)- protection against heart disease
actually cause disease-- by creating a critical vitamin deficiency
and possible reduced risk to prostate CA
in the body.
• Optimum level is still being checked.
10) It is impossible to generate too much vitamin D in your body
from sunlight exposure: your body will self-regulate and only
generate what it needs. Vitamin E...
• Check with a Primary Health Care Provider before
▪ SPF ratings greater than 8, effectively block synthesis of vitamin supplementing with Vitamin E.
D in the skin. • Vitamin E increases the risk of stroke to those with
hypertension.
11) If it hurts to press firmly on your sternum, you may be suffering • It is also contraindicated for individuals taking Warfarin
from chronic vitamin D deficiency right now. (Coumadin) or other medicines that inhibit blood clot because
12) Vitamin D is "activated" in your body by your kidneys and liver Vitamin E may affect the efficacy of the medications.
before it can be used.
13) Having kidney disease or liver damage can greatly impair your VITAMIN E DEFICIENCIES
body's ability to activate circulating vitamin D. • PRIMARY
14) The sunscreen industry doesn't want you to know that your o Rare
body actually needs sunlight exposure because that realization • SECONDARY
would mean lower sales of sunscreen products. o Can occur in premature infants
15) Even though vitamin D is one of the most powerful healing o Others who cannot absorb fat:
chemicals in your body, your body makes it absolutely free. No - cystic fibrosis
prescription required. - biliary atresia
- Hepatobiliriary sytem/liver transport problems
VITAMINS D
▪ The body itself make vitamin D when it is exposed to the sun VITAMIN E TOXICITY
▪ Cheese, butter, margarine, fortified milk, fish and fortified • No evidence of toxicity associated with excessive intake of
cereals are food sources of Vitamin D Vitamin E.
▪ Vitamins D comes from a variety of food sources, and is made • 70-530 mg a-TE (100-800 IU) per day – appear to be tolerated,
by your skin when it is exposed to sunlight. Vitamins D is also but the values has not been determined.
available in vitamin supplements. • Contraindication: Anticoagulant therapy, Coagulation disorder,
Vitamin K deficiency
Recommended Intake • A UL of 100 mg a-TE has been set.
• AI (Adequate Intake) for Vitamin D – 5 mcg
• 10 mcg (400 IU)--- 51-70 years old VITAMIN K
• 15 mcg (600 IU)--- 70 above • The "K" is derived from the German word "koagulation."
• COAGULATION refers to the process of blood clot formation.
DEFICIENCY OF VITAMIN D • Prothrombin (clotting factor II), if combined with Calcium (factor
• Rickets is the softening and weakening of bones in children IV) – helps produce the clotting effect.
• Rickets: bowed legs
Functions:
OSTEOMALACIA 1) Is a cofactor in the synthesis of blood clotting factors, including
• Adult form of rickets. prothrombin.
• It is a disease characterized by weak, soft, or brittle bones in 2) Protein formation in bone, kidney, and plasma also depends on
adults. the actions of Vitamin K.
• Symptoms include • AI for Vitamin K: 120 mcg for men and 90 mcg for women.
o muscle weakness and bone pain.
Sources of Vitamin K
OSTEOPOROSIS • It is available from dietary source such as dark green leafy
• It is a condition in which the bone density is reduced and the vegetable (collard greens, kale, mustard greens, spinach, swiss
remaining bone is brittle and breaks easily. chard, turnip greens) .
• Lesser amounts are found in dairy products, cereals, meats and
Deficiency is a concern when the lack of exposure to sunlight occurs fruits.
as a result of: • It can be synthesized by the micro flora in the jejunum, ileum of
1) Environmental Limitations the digestive tract.
• PHYLLOQUINONE
o form of Vitamin K consumed from plants.
• MENAQUINONE
o form of Vitamin K produced via bacterial synthesis

• DEFICIENCY: Increased propensity to bruising and bleeding.

• TOXICITY: None

Vitamin K administration

Problems from a lack of vitamin K would result from:

1) Absence of intestinal bacteria
2) Prolonged antibiotic therapy
3) Lack of bile to absorb the vitamin
4) Gallbladder disease and injury
5) Interference with prothrombin formation
6) Result of anticoagulant therapy In CV disease
7) Impaired absorption of the vitamin in the intestinal diseases
affecting the mucosa and its absorbing surface.
- Eg. Celiac’s disease

Tips for preserving Vitamin Content of Foods:

• Keep fruits and vegetables cool.
• Refrigerate foods in moisture-proof containers.
• Avoid trimming and cutting fruits and vegetables into small
pieces as much as possible.
• To retain the maximum amounts of nutrients in vegetables,
microwave cooking, steaming, or using a pan or work with very
small amounts of fats and a tight-fitting lid is best.
• Minimize reheating food.
• Do not add fats to vegetables during cooking if you plan to
discard the liquid.
• Don’t add baking soda to vegetables to enhance the green
color.
• Store canned goods in a cool place.