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NTRI 5030/6030 Medical Nutrition II Syllabus Spring 2016
Course Description: Medical nutrition therapy for diseases of the cardiovascular, renal, and respiratory systems; oncology; critical care; and conditions of infancy/childhood. Credit hours: 4 (3 lecture, 1 lab) (5 contact hours) Prerequisites: NTRI 5020 or 6020 or departmental approval Corequisite: none Instructor: Patty Marincic, PhD, RD, CLE Office: 101E Poultry Science Building Phone: 344-844-3272 Email: [email protected] Office Hours: Monday, Tuesday, and Thursday 1:30-3:00 pm, or by appointment Class Schedule: Tuesday and Thursday 9:30 am – 10:45 am; TH 11:00-12:50 Classroom: Spidle Hall room 144 Course Materials
Required Texts: Mahan LK, Escott-Stump S. Krause’s Food, Nutrition and Diet Therapy 12th edition, Philadelphia:
W.B. Saunders Co., 2008. (ISBN 978-1-4377-2233-8) Nelms MN, Roth, SL. Medical Nutrition Therapy: A Case Study Approach. 4th edition, Stamford,
CT: Cengage Learning, 2014 (13: 978-133-59315-1) LaFleur-Brooks M., LaFleur-Brooks D. Exploring Medical Language, 8thedition, St. Louis: Elsevier
Mosby Co., 2012. (ISBN 978-0-323-07308-0) Gomella l, Haist, S (eds). Clinician’s Pocket Reference (11th Edition), McGraw Hill, 2007. Pronsky, Z. Food Medication Interactions, 17th edition. PA. 2012.
(Email: [email protected] or see www.foodmedication.com) References (recommended):
Lee RD, Nieman DC. Nutritional Assessment. Madison: Wm C. Brown, Medical Dictionary (available online or hard copy) Nelms M, Sucher KP, Long S. Nutrition Therapy and Pathophysiology. Belmont, CA: Cengage/
Wadsworth Publishing, latest edition. International Dietetics and Nutritional Terminology (IDNT) Reference Manual, 3rd ed. Call
Academy member services center 800-877-1600 or [email protected] (student price). NCM Nutriiton Care Manual, eatright.org (available on-line).
NTRI 5030/6030 Syllabus Spring 2016 page 1
Course Objectives: The student will be able to:
1. Identify the various means of nutrition assessment, including criteria for a diagnosis of malnutrition, and appropriate documentation in the medical record including coding and billing.
2. Conduct anthropometric assessments and evaluate anthropometric data. 3. Conduct a targeted medical and diet history through student role-play exercises. 4. Interpret clinical chemistries and make the appropriate recommendations for follow-up lab tests. 5. Integrate the principles of nutrition, biochemistry, physiology, and pathophysiology as the basis
for evidence-based nutrition management in various disease states. 6. Describe the epidemiology, etiology, pathophysiology (including metabolic derangements), risk
factors (including environment, food, and life-style), clinical manifestations, diagnostic tests, and basic medical, surgical, and pharmacological management for diseases/conditions.
7. Recognize potential drug nutrient interactions. 8. Implement the nutrition care process, including nutrition assessments, formulation of a
nutrition diagnosis, interventions (including formulation of specific modified diets), and ongoing monitoring and evaluation of patients (e.g., cardiology, nephrology, pulmonary, and neurology).
9. Calculate a renal diet and develop a comprehensive plan of care for a patient with ESRD. 10. Describe the metabolic response to stress and formulate appropriate nutritional interventions
for critical care patients (e.g., burn, trauma, sepsis, and MODS). 11. Prescribe appropriate nutrition support for selected conditions including calculation of enteral
and parenteral regimens. 12. Describe the basic premises of oncology nutrition, including prevention and treatment, and
identify and recognize end-of-life issues regarding withdrawal of nutrition support. 13. Recognize common and serious conditions of infancy (including prematurity and LBW) and
childhood and identify appropriate nutritional interventions. 14. Describe elements of assessment of breastfed infants and strategies to support lactation. 15. Recognize, define and use medical terms and abbreviations appropriately. 16. Identify normal and abnormal laboratory values for selected disease states. 17. Employ effective professional communication skills to document the nutrition care process using
ADIME and other common electronic medical record templates; write nutrition diagnostic statements in PES format.
18. Locate, interpret, and apply evidence from the professional literature and established practice guidelines and protocols to the nutrition care process.
19. Develop teamwork, problem-solving, critical-thinking skills, personal and professional attitude and values, cultural competence, leadership, and decision-making skills.
20. Conduct a formal literature review, including search, selection, interpretation, and integration of appropriate evidence-based resources; assimilate information into cohesive written format; and reference according to JAND format.
NTRI 5030/6030 Syllabus Spring 2016 page 2
Lecture Sessions: Lecture sessions will primarily focus on an introduction to the nutrition care process, overview of the etiology, pathophysiology, medical/surgical intervention, and an in-depth review of the medical nutrition therapy for diseases of the endocrine and gastrointestinal systems. Students are encouraged to ask questions during class, seek clarification as needed, and to participate in class discussion. Objectives, case studies, reading assignments and handouts are designed to complement and complete the presentation of the topic. Laboratory: The lab portion of the course will be focus on hands-on lab activates and student-student simulations practicing focused patient assessments and education in various topics (e.g., HLM and cardiac nutrition and wellness). Problem-based learning applications will be provided through individual and group case-study simulations and roll-play applying the principles of the nutrition care process to selected diseases and conditions. There will be several workshops for topics (e.g., computer lab simulations of medical record, renal diets and assessments, eating disorders, and feeding pre-term infant). Group projects and discussions are intended to be interactive and to bridge the gap between topic-focused lecture and problem-based clinical practice. Medical Terminology: Students are expected to work independently through the medical terminology student-directed text as assigned. It is in the best interest of the student (and your future patients) to complete all assignments for each section. These should be done independently and will not be graded individually by the instructor. There will be three quizzes throughout the semester to evaluate student acquisition of medical terminology. Appropriate medical terminology should be used in your lab reports, ADIME notes, and case studies. Grading Scale: (undergraduate)
Percent Points Grade 90-100 711-790 A 80-89.9 632-711 B 70-79.9 553-631 C 60-69.9 474-552 D < 59.9 <474 F
NTRI 5030/6030 Syllabus Spring 2016 page 3
Student Evaluation: Quizzes, Exams, and other Assignments Assessment (Assignments/Exams) Date Points Medical Terminology Quiz 1 - 20 Medical Terminology Quiz 2 - 20
Assignment 1: Cases in Cardiology (group) ADIME Note (Individual)
- 25 25
Assignment 2: Case Study Eating Disorders (group)
- 25
Assignment 3: Renal Cases (group) Renal Diet (individual)
25 25
Assignment 4: Oncology/HIV Cases ADIME Note
25 25
Assignment 5: Lab report-Malnutrition (group)
25
Assignment 6: Critical Care Case (group) Nutrition Support Regimen (individual)
25 25
Assignment 7: AAP BF Quiz Due (individual)
25
Assignment 8: Preterm Assessment and Feeding
25
Assignment 9: Topic of Choice with Evidence Analysis Grand Rounds
50
Exam 1 2-4 100 Exam 2 3-13 100 Exam 3 4-22 100 Final Exam 4-30 100 Research Paper and Analysis 4-17-14 100 Total Points (undergraduate) 790
NTRI 5030/6030 Syllabus Spring 2016 page 4
CLASS POLICIES:
Class Participation and Attendance Policies Students are expected to attend all regularly scheduled classes and participate in all regularly
scheduled class meetings. Students are responsible for all work covered in class whether they are present or not. Missed work including examinations and quizzes may be made up only with a university-
approved excuse as outlined on the following website: https://fp.auburn.edu/studentaffairs/policies.aspx
Excused Absences Policy Students are granted excused absences from class for the following reasons: illness of the student or serious illness of a member of the student’s immediate family, the death of a member of the student’s immediate family, trips for student organizations sponsored by an academic unit, trips for university classes, trips for participation in intercollegiate athletic events, subpoena for a court appearance, and religious holidays.
Students who wish to have an excused absence from class for any other reason must contact the instructor in advance of the absence to request permission. The instructor will weigh the merits of the request, and render a decision. When feasible, the student must notify the instructor prior to the occurrence of any excused absences, but in no case shall such notification occur more than one week after the absence. Appropriate documentation for all excused absences is required.
Make-Up Policy Arrangement to make up a missed exam due to properly authorized excused absences must be initiated by the student within one week of the period of the excused absence(s). Except in unusual circumstances, such as the continued absence of the student or the advent of university holidays, a make-up exam will take place within two weeks of the date that the student initiates arrangements for it. The format of make-up examinations and assignments may differ from the original format, and may include: essay, short answer, fill in the blank, multiple choice, true/false or a combination of those listed.
The student is expected to submit all assigned work at the class period designated by the instructor. Failure to turn in these assignments on the designated due dates without an excused absence will result in a loss of 3 points for each day the assignment is late. Students with an approved excuse who have not turned in an assignment and not contacted the instructor within one week after the scheduled due date will receive a zero for that assignment.
Accommodations Students who need special accommodations in class, as provided by the American Disabilities Act, should follow university-approved procedures. If you need assistance, make an appointment with the Office of Accessibility, 1228 Haley Center, 334-844-2096. Accommodations for examinations should be discussed with the instructor at least one week prior to the scheduled examination.
Academic Honesty All portions of the Academic Honesty code as found on the website https://fp.auburn.edu/studentaffairs/policies.aspx apply in this class. From the AU website, go to Office of the Provost, Academic Dishonesty, Resources for Students - Examples of Violations - which include “copying from another student’s assignment” are found on this site.
NTRI 5030/6030 Syllabus Spring 2016 page 5
Contingency Plans If the normal class schedule is disrupted due to illness, emergency, or crisis situation (such as a flu outbreak), the syllabus and other course plans and assignments may be modified to allow completion of the course. If this occurs, an addendum to your syllabus and revised course assignments will replace this syllabus.
“Auburn University is committed to providing a working and academic environment free from discrimination and harassment and to fostering a nurturing and vibrant community founded upon the fundamental dignity and worth of all its members.” Evidence Analysis Report (Due April 15th) You may work with one other person on this report. Select a controversial or new nutrition/nutrient intervention for a particularly disease or
condition. This can be a nutrient or food in the prevention or treatment of a disease/condition, or a risk factor for a disease/condition, or the effectiveness of another nutrition-related recommendation for a disease/condition.
Using the Cochrane Database of Systematic Reviews Cochrane Collaboration (www.cochrane.org), the Academy’s Evidence Analysis Library (www.adaevidencelibrary.com), American Society for Enteral and Parenteral Nutrition (www.nutritioncare.org), Clinical Evidence (http://www.clinicalevidence.org), National Guideline Clearinghouse (http://www.guidelines.gov/syntheses/synthesis.aspx?id=36609), European Society for Clinical Nutrition and Metabolism (www.espen.org) among others, explore the evidence for and against the relationship.
Write a two-three page, double-spaced report addressing the findings of evidence-based research examining the relationship and/or effectiveness of the nutrient. The report should begin with the research question being analyzed followed by the findings of the analysis. Make sure to integrate the papers reviewed and not just present these as a series of abstracts. Feel free to summarize some information in a table if your findings lend themselves to this format. Include in your “report” the “grade” of the evidence and its significance (use of the findings).
References should be cited according the JAND format. Evidence Analysis Grand Rounds-students will present findings at the journal club sessions held
the last week of the semester.
NTRI 5030/6030 Syllabus Spring 2016 page 6
SELECTED BIBLIOGRAPHY LIBRARY SEARCH ENGINES AND ON-LINE RESOURCES
American Academy of Nutrition and Dietetics; Evidence Analysis Library (available to members only) http://www.eatright.org NHI, National Heart, Lung, and Blood Institute http://www.nhlbi.nih.gov The Cochrane Library/Database of Systematic Review http://www.thecochranelibrary.com/view/0/index.html U.S. Department of Health and Human Services http://www.hhs.gov Alabama Department of Public Health http://www.adph.org NIDDK, National Institute of Diabetes, Digestive, and Kidney Diseases http://www2.niddk.nih.gov The American Diabetes Association; for professionals http://professional.diabetes.org/?loc=header_professional American Cancer Society www.cancer.org/ Natural Standard http://naturalstandard.org
Center for Disease Control and Prevention http://www.cdc.gov American Academy of Pediatrics http://www.aap.org American Society for Enteral and Parenteral Nutrition http://www.nutritioncare.org Clinical Evidence http://www.clinicalevidence.org National Guideline Clearinghouse http://www.guidelines.gov/syntheses/synthesis.aspx?id=36609) European Society for Clinical Nutrition and Metabolism www.espen.org American Congress of Obstetricians and Gynecologists (ACOG) http://www.acog.org American College of Gastroenterology http://gi.org National Cancer Institute http://www.cancer.gov
ASSIGNMENT FOR NTRI 6030 (graduate) – RESEARCH PAPER AND ANALYSIS (100 points) (Due April 17th): Topic: Students can select a topic of their choice related to the medical nutrition therapy of a
selected disease. The topic must be approved in advance by the professor. The topic should not be a topic that has been covered in medical nutrition I or II or extensively in another required nutrition/dietetics course.
Suggested Topics: MNT for transplant patients (kidney, liver, pancreas, bone marrow, heart, lung); diseases/disorders of infancy and childhood (Down's Syndrome, spinal bifida or other neural tube defects, cystic fibrosis, immune deficiency (SCIDS), cerebral palsy, urea cycle disorders, PKU, Failure to Thrive (FTT), seizure Disorders (Epilepsy); respiratory disease (COPD, Acute Respiratory Distress Syndrome), cancer (specify site of primary tumor); Immune System Disorders (Lupus).
OUTLINE: A one page topical outline with references should be submitted to the professor no later than March 15, 2014.
Paper Format: The paper should follow the following format: overview of the disease (including etiology and pathophysiology), signs and symptoms, effects on nutrients (e.g., digestion, absorption, metabolism, excretion, as appropriate), medical and pharmacological therapies, with detailed nutrition support appropriate to the disease state. This can include prevention as well as interventional therapies. Use of headings
NTRI 5030/6030 Syllabus Spring 2016 page 7
and subheadings is strongly encouraged. Information from various resources should be integrated rather the presented as a series of abstracts. The paper should be logically arranged with appropriate development of sections, clearly written, understandable, appropriate word choices, professional writing style and vernacular, correct grammar, sentence structure, and spelling. The length should be sufficient to appropriately cover content (5-10 pages). The paper is not intended to be a comprehensive review of the disease itself, but should include a comprehensive review of the medical nutrition therapy or prevention of the disease based on the focus of your topic. There is a greater expectation for literature review than the fall case-based paper and presentation. There will not be a presentation.
References: References should be cited by number within the paper and on the reference list consistent with the JAND citation format. Sources, particularly on-line references, should be targeted to medical professionals rather than the lay public, scientifically based, accurate, and up-to-date. A minimum of 5 original research articles from refereed journals published since 2008 should be consulted. Additional reviews and text references can be used.
NTRI 5030/6030 Syllabus Spring 2016 page 8
TENTATIVE CLASS SCHEDULE Sessions and assignment due dates may change based on the tempo of the lectures. Exams will remain on the date scheduled.
Date:
Topic:
Readings:
Assignments:
WEEK 1 Lecture
Hypertension DASH Diet
Krause: 758-768 DASH (canvas)
WEEK 2 Lecture
Atherosclerosis and Hyperlipidemia
Krause: 202-203, 742-757
Medical Terminology: 444-452 (Cards Lab/Diagnostics)
Lecture Atherosclerosis and Hyperlipidemia: MI and CVA
Lab
Electronic Medical Records, Coding , and Billing Computer Lab Simulation
TBA
WEEK 3 Lecture
Healthy Life-Style Management (Case Discussion)
Lecture Heart Failure, Cardiac Cachexia, Transplant
Krause: 769-780
Lab
Workshop: Cardiac Diets Roll-play: Healthy LSM
LSM (canvas) (review cases simulations before class)
WEEK 4 Lecture
Drug Nutrient Interactions
Krause: Ch. 9
Lecture Pulmonary Disease COPD
Krause: 782-786, 788-790, 794-797
Assignment 1: Cases in HTN and Cardiology Due (group) ADIME Note (individual)
Lab
Workshop: Fluid and Electrolyte Balance Acid-Case Balance
The ABCs of ABGs Krause: 178-190
WEEK 5
FEB EXAM I
Lecture Renal Overview
Krause: 799-808
Medical Terminology: Ch. 6 – Urinary Ch. 7 & 8 Reproductive
Lab Workshop: Eating Disorders Working with the Resistant Patient; critical assessments necessitating hospital admission.
Guest Speaker: Tammy Beasley, RDN, CEDRD, LD, CSSD
WEEK 6 Lecture
Renal: Acute Renal Failure Krause: 808-810
Lecture Chronic Kidney Disease, ESRD, and Dialysis
Krause: 810-831
NTRI 5030/6030 Syllabus Spring 2016 page 9
Lab
Workshop: Renal Diets
Sue Mossholder, RD Assignment 2: Case Study Eating Disorders (group) Due
WEEK 7 Lecture
Renal Diets and Considerations for DM
Sue Mossholder, RD
Lecture Stone Disease
Krause:
Lab
Case Studies Acute Renal Failure and Chronic Kidney Disease
WEEK 8 Lecture
Oncology: Cancer Prevention, Treatment, and Recovery
Medical Terminology: Quiz 1 Ch. 6, 7, 8
Lecture Oncology: Cancer Prevention, Treatment, and Recovery
Krause: Ch. 37
Assignment 3: Renal Cases (group) Renal Diets (individual) Due
Lab
Case Studies: Heme/ONC/BMT BCHM Assessment, End-of-life issues
WEEK 9 Lecture
HIV/AIDS Krause: Ch. 38
Lecture
Field Trip to Alabama Dietetic Association
Lab WEEK 10 Lecture
Hypermetabolic States: Metabolic Response to Stress Nitrogen Balance Revisited
Krause: Ch. 39 Medical Terminology:
Medical Terminology: Ch. 9, 14, and 15 Assignment 4: Cases in ONC/HIV (group) ADIME note (individual) Due
March EXAM 2
Lab Lab: Assessment of Malnutrition; Coding, and Billing
1 hour Webinar 1 hour practice assessments
March 17-21 SPRING BREAK!
WEEK 11 Lecture
Hypermetabolic States: Trauma, Burn, Sepsis
Krause: 933-938 Assignment 5: Lab report – Malnutrition (group ) Due
Lecture Nutrition Considerations in Surgical Patients
Lab
Workshop: Advanced Nutrition Support
WEEK 12 Lecture
Rheumatological and Neurological Conditions
Krause: Ch. 40; 924-934 Assignment 6: Cases in Critical Care (group) Nutrition Support Regimen (individual) Due
NTRI 5030/6030 Syllabus Spring 2016 page 10
Lecture Pediatrics: Prematurity & LBW
Krause: Ch. 43
Lab
Lab: Breast-feeding Essentials – Infant Growth Assessment
WEEK 13 Lecture
Pediatrics: NEC, Lung Disease/BPD
Krause: 786-788, 790-794 Medical Terminology: Quiz 2 Ch. 9, 14, and 15
Lecture Cystic Fibrosis (Infancy – Adult Concerns)
Assignment 7: AAP BF Quiz Due (individual)
Lab
Workshop: Feeding Term and Preterm Infants
WEEK 14 Lecture
Pediatrics: Genetic Metabolic Disorders
Krause: Ch. 44, 45
Lecture Pediatrics: Developmental Disabilities and Special Needs
Assignment 8: Preterm Infant Case (group) Due
Lab
Evidence Analysis Grand Rounds
Assignment 9: Topic of Choice with Evidence Analysis (Individual or Pairs) Due
WEEK 15 EXAM 3 Lecture Evidence Analysis
Grand Rounds
Lab
Evidence Analysis Grand Rounds
Wednesday 4-30 from 8:00-10:30am
FINAL EXAM
NTRI 5030/6030 Syllabus Spring 2016 page 11
Required footnote from the Accreditation Council for Education in Nutrition and Dietetics (ACEND) Core Knowledge for the RD (Standard 13) addressed in this course. 1. Scientific and Evidence Base of Practice: integration of scientific information and research into practice.
KRD 1.1 The curriculum must reflect the scientific basis of the dietetics profession and must include research methodology, interpretation of research literature and integration of research principles into evidence-based practice. Students must be able to demonstrate how to locate, interpret, evaluate and use professional
literature to make ethical evidence-based practice decisions. Students must be able to use current information technologies to locate and apply evidence-based
guidelines and protocols. 2. Professional Practice Expectations: beliefs, values, attitudes and behaviors for the professional dietitian
level of practice. KRD 2.1 The curriculum must include opportunities to develop a variety of communication skills sufficient for entry into pre-professional practice. Students must be able to demonstrate effective and professional oral and written communication
and documentation.
KRD 2.3 The curriculum must include opportunities to understand governance of dietetics practice, such as the Scope of Dietetics Practice and the Code of Ethics for the Profession of Dietetics; and interdisciplinary relationships in various practice settings.
3. Clinical and Customer Services: development and delivery of information, products and services to
individuals, groups and populations.
KRD 3.1 The curriculum must reflect the principles of Medical Nutrition Therapy and the practice of the nutrition care process, including principles and methods of assessment, diagnosis, identification and implementation of interventions and strategies for monitoring and evaluation. Students must be able to use the nutrition care process to make decisions, to identify nutrition-
related problems and determine and evaluate nutrition interventions. KRD 3.2 The curriculum must include the role of environment, food, nutrition and lifestyle choices in health promotion and disease prevention.
Students must be able to develop interventions to affect change and enhance wellness in diverse individuals and groups.
4. Practice Management and Use of Resources: strategic application of principles of management and systems
in the provision of services to individuals and organizations. KRD 4.5 The curriculum must include content related to coding and billing of dietetics/nutrition services to obtain reimbursement for services from public or private insurers.
5. Support Knowledge: knowledge underlying the requirements specified above. KRD 5.2 The physical and biological science foundation of the dietetics profession must be evident in the curriculum. Course content must include organic chemistry, biochemistry, physiology, genetics, microbiology, pharmacology, statistics, nutrient metabolism and nutrition across the lifespan.
NTRI 5030/6030 Syllabus Spring 2016 page 12
NTRI 5030/6030 Medical Nutrition II Syllabus Spring Semester 2014
Course Description: Application of nutrition principles to pathophysiological and biochemical changes associated with cardiovascular disease, hypermetabolic states, and renal, respiratory, and immune system diseases. Credit will not be given for both NTRI 5030 and NTRI 6030. Credit hours: 3 (3 lecture hours) Prerequisites: NTRI 5020 or 6020 or departmental approval Corequisite: (none) Instructor: Patty Marincic, PhD, RD, CLE Office: 101E Poultry Science Building Phone: 344-844-3272 Email: [email protected] Office Hours: Monday, Tuesday, and Thursday 1:30-3:00 pm, or by appointment Class Schedule: Tuesday and Thursday 9:30 am - 10:45 am Classroom: Spidle Hall room 144 Course Materials
Required Texts: Mahan LK, Escott-Stump S. Krause’s Food, Nutrition and Diet Therapy 12th edition, Philadelphia:
W.B. Saunders Co., 2008. (ISBN 978-1-4377-2233-8) Nelms MN, Roth, SL. Medical Nutrition Therapy: A Case Study Approach. 4th edition, Stamford,
CT: Cengage Learning, 2014 (13: 978-133-59315-1) LaFleur-Brooks M., LaFleur-Brooks D. Exploring Medical Language, 8thedition, St. Louis: Elsevier
Mosby Co., 2012. (ISBN 978-0-323-07308-0) Pronsky, Z. Food Medication Interactions, 17th edition. PA. 2012.
(Email: [email protected] or see www.foodmedication.com) References (recommended):
Lee RD, Nieman DC. Nutritional Assessment. Madison: Wm C. Brown, Medical Dictionary (available online or hard copy) Gomella l, Haist, S (eds). Clinician’s Pocket Reference (11th Edition), McGraw Hill, 2007. Nelms M, Sucher KP, Long S. Nutrition Therapy and Pathophysiology. Belmont, CA: Cengage/
Wadsworth Publishing, latest edition. International Dietetics and Nutritional Terminology (IDNT) Reference Manual, 3rd ed. Call
Academy member services center 800-877-1600 or [email protected] (student price). NCM Nutriiton Care Manual, eatright.org (available on-line).
NTRI 6030 Syllabus Spring 2014 page 1
Course Objectives: The student will be able to:
1. Integrate the principles of nutrition, biochemistry, physiology, and pathophysiology as the basis for evidence-based nutrition management in various disease states.
2. Describe the epidemiology, etiology, pathophysiology (including metabolic derangements), risk factors (including environment, food, and life-style), clinical manifestations, diagnostic tests, and basic medical, surgical, and pharmacological management for diseases/conditions.
3. Recognize potential drug nutrient interactions. 4. Implement the nutrition care process, including nutrition assessments, formulation of a
nutrition diagnosis, interventions (including formulation of specific modified diets), and ongoing monitoring and evaluation of patients (e.g., cardiology, nephrology, pulmonary, and neurology) .
5. Calculate a renal diet and develop a comprehensive plan of care for a patient with ESRD. 6. Describe the metabolic response to stress and formulate appropriate nutritional interventions
for critical care patients (e.g., burn, trauma, sepsis, and MODS). 7. Prescribe appropriate nutrition support for selected conditions including calculation of enteral
and parenteral regimens. 8. Describe the basic premises of oncology nutrition, including prevention and treatment, and
identify and recognize end-of-life issues regarding withdrawal of nutrition support. 9. Recognize common and serious conditions of infancy (including prematurity and LBW) and
childhood and identify appropriate nutritional interventions. 10. Recognize, define and use medical terms and abbreviations appropriately. 11. Identify normal and abnormal laboratory values for selected disease states. 12. Employ effective professional communication skills to document the nutrition care process using
ADIME and other common electronic medical record templates; write nutrition diagnostic statements in PES format.
13. Recognize current standards for coding and billing. 14. Locate, interpret, and apply evidence from the professional literature and established practice
guidelines and protocols to the nutrition care process. 15. Develop teamwork, problem-solving, critical-thinking skills, personal and professional attitude
and values, cultural competence, leadership, and decision-making skills. 16. Conduct a formal literature review, including search, selection, interpretation, and integration of
appropriate evidence-based resources; assimilate information into cohesive written format; and reference according to JAND format.
Teaching Methods: The course will be primarily lecture with applications provided through individual/group case-study applying the principles of the nutrition care process to selected diseases/conditions. There will be one workshop for renal menu planning. Students are encouraged to ask questions, seek clarification as needed, and to participate in class discussion. Objectives, case studies, and reading are designed to complement and complete the presentation of the topic. Group projects and discussions are intended
NTRI 6030 Syllabus Spring 2014 page 2
to be interactive and to bridge the gap between topic-focused lecture and problem-based clinical practice. The medical terminology section of this course is an independent student-directed learning activity. Student Evaluation: Quizzes, Exams, and other Assignments
Assessment (Assignments/Exams) Date Points Liver Disease Case and ADIME 1-21-14 25 HTN and Cardiology Cases and ADIME 2-6-14 50 Renal Cases with Renal Diet 3-20-14 50 Oncology/HIV Cases and ADIME 4-1-14 25 Critical Care Case with Nutrition Support Regimen
4-15-14 50
Topic of Choice with Evidence Analysis 4-24-14 50
Medical Terminology Quiz 1 3-6-14 20 Medical Terminology Quiz 2 4-8-14 20
Exam 1 2-11-14 100 Exam 2 3-25-14 100 Exam 3 4-22-14 100 Final Exam 4-30-14 100 Research Paper and Analysis 4-17-14 100 Total Points 770
Grading Scale:
Percent Points Grade 90-100 693-770 A 80-89.9 616-692 B 70-79.9 539-615 C 60-69.9 462-538 D < 59.9 <462 F
CLASS POLICIES:
Class Participation and Attendance Policies Students are expected to attend all regularly scheduled classes and participate in all regularly
scheduled class meetings. Students are responsible for all work covered in class whether they are present or not. Missed work including examinations and quizzes may be made up only with a university-
approved excuse as outlined on the following website: https://fp.auburn.edu/studentaffairs/policies.aspx
NTRI 6030 Syllabus Spring 2014 page 3
Excused Absences Policy Students are granted excused absences from class for the following reasons: illness of the student or serious illness of a member of the student’s immediate family, the death of a member of the student’s immediate family, trips for student organizations sponsored by an academic unit, trips for university classes, trips for participation in intercollegiate athletic events, subpoena for a court appearance, and religious holidays.
Students who wish to have an excused absence from class for any other reason must contact the instructor in advance of the absence to request permission. The instructor will weigh the merits of the request, and render a decision. When feasible, the student must notify the instructor prior to the occurrence of any excused absences, but in no case shall such notification occur more than one week after the absence. Appropriate documentation for all excused absences is required.
Make-Up Policy Arrangement to make up a missed exam due to properly authorized excused absences must be initiated by the student within one week of the period of the excused absence(s). Except in unusual circumstances, such as the continued absence of the student or the advent of university holidays, a make-up exam will take place within two weeks of the date that the student initiates arrangements for it. The format of make-up examinations and assignments may differ from the original format, and may include: essay, short answer, fill in the blank, multiple choice, true/false or a combination of those listed.
The student is expected to submit all assigned work at the class period designated by the instructor. Failure to turn in these assignments on the designated due dates without an excused absence will result in a loss of 3 points for each day the assignment is late. Students with an approved excuse who have not turned in an assignment and not contacted the instructor within one week after the scheduled due date will receive a zero for that assignment.
Accommodations Students who need special accommodations in class, as provided by the American Disabilities Act, should follow university-approved procedures. If you need assistance, make an appointment with the Office of Accessibility, 1228 Haley Center, 334-844-2096. Accommodations for examinations should be discussed with the instructor at least one week prior to the scheduled examination.
Academic Honesty All portions of the Academic Honesty code as found on the website https://fp.auburn.edu/studentaffairs/policies.aspx apply in this class. From the AU website, go to Office of the Provost, Academic Dishonesty, Resources for Students - Examples of Violations - which include “copying from another student’s assignment” are found on this site.
Contingency Plans If the normal class schedule is disrupted due to illness, emergency, or crisis situation (such as a flu outbreak), the syllabus and other course plans and assignments may be modified to allow completion of the course. If this occurs, an addendum to your syllabus and revised course assignments will replace this syllabus.
“Auburn University is committed to providing a working and academic environment free from discrimination and harassment and to fostering a nurturing and vibrant community founded upon the fundamental dignity and worth of all its members.”
NTRI 6030 Syllabus Spring 2014 page 4
Evidence Analysis Report (Due April 24th) You may work with one other person on this report. Select a controversial or new nutrition/nutrient intervention for a particularly disease or
condition. This can be a nutrient or food in the prevention or treatment of a disease/condition, or a risk factor for a disease/condition, or the effectiveness of another nutrition-related recommendation for a disease/condition.
Using the Cochrane Database of Systematic Reviews Cochrane Collaboration (www.cochrane.org), the Academy’s Evidence Analysis Library (www.adaevidencelibrary.com), American Society for Enteral and Parenteral Nutrition (www.nutritioncare.org), Clinical Evidence (http://www.clinicalevidence.org), National Guideline Clearinghouse (http://www.guidelines.gov/syntheses/synthesis.aspx?id=36609), European Society for Clinical Nutrition and Metabolism (www.espen.org) among others, explore the evidence for and against the relationship.
Write a two-three page, double-spaced report addressing the findings of evidence-based research examining the relationship and/or effectiveness of the nutrient. The report should begin with the research question being analyzed followed by the findings of the analysis. Make sure to integrate the papers reviewed and not just present these as a series of abstracts. Feel free to summarize some information in a table if your findings lend themselves to this format. Include in your “report” the “grade” of the evidence and its significance (use of the findings).
References should be cited according the JAND format. SELECTED BIBLIOGRAPHY LIBRARY SEARCH ENGINES AND ON-LINE RESOURCES
American Academy of Nutrition and Dietetics; Evidence Analysis Library (available to members only) http://www.eatright.org NHI, National Heart, Lung, and Blood Institute http://www.nhlbi.nih.gov The Cochrane Library/Database of Systematic Review http://www.thecochranelibrary.com/view/0/index.html U.S. Department of Health and Human Services http://www.hhs.gov Alabama Department of Public Health http://www.adph.org NIDDK, National Institute of Diabetes, Digestive, and Kidney Diseases http://www2.niddk.nih.gov The American Diabetes Association; for professionals http://professional.diabetes.org/?loc=header_professional American Cancer Society www.cancer.org/ Natural Standard http://naturalstandard.org
Center for Disease Control and Prevention http://www.cdc.gov American Academy of Pediatrics http://www.aap.org American Society for Enteral and Parenteral Nutrition http://www.nutritioncare.org Clinical Evidence http://www.clinicalevidence.org National Guideline Clearinghouse http://www.guidelines.gov/syntheses/synthesis.aspx?id=36609) European Society for Clinical Nutrition and Metabolism www.espen.org American Congress of Obstetricians and Gynecologists (ACOG) http://www.acog.org American College of Gastroenterology http://gi.org National Cancer Institute http://www.cancer.gov
NTRI 6030 Syllabus Spring 2014 page 5
ASSIGNMENT FOR NTRI 6030 (graduate) – RESEARCH PAPER AND ANALYSIS (100 points) (Due April 17th): Topic: Students can select a topic of their choice related to the medical nutrition therapy of a
selected disease. The topic must be approved in advance by the professor. The topic should not be a topic that has been covered in medical nutrition I or II or extensively in another required nutrition/dietetics course.
Suggested Topics: MNT for transplant patients (kidney, liver, pancreas, bone marrow, heart, lung); diseases/disorders of infancy and childhood (Down's Syndrome, spinal bifida or other neural tube defects, cystic fibrosis, immune deficiency (SCIDS), cerebral palsy, urea cycle disorders, PKU, Failure to Thrive (FTT), seizure Disorders (Epilepsy); respiratory disease (COPD, Acute Respiratory Distress Syndrome), cancer (specify site of primary tumor); Immune System Disorders (Lupus).
OUTLINE: A one page topical outline with references should be submitted to the professor no later than March 15, 2014.
Paper Format: The paper should follow the following format: overview of the disease (including etiology and pathophysiology), signs and symptoms, effects on nutrients (e.g., digestion, absorption, metabolism, excretion, as appropriate), medical and pharmacological therapies, with detailed nutrition support appropriate to the disease state. This can include prevention as well as interventional therapies. Use of headings and subheadings is strongly encouraged. Information from various resources should be integrated rather the presented as a series of abstracts. The paper should be logically arranged with appropriate development of sections, clearly written, understandable, appropriate word choices, professional writing style and vernacular, correct grammar, sentence structure, and spelling. The length should be sufficient to appropriately cover content (5-10 pages). The paper is not intended to be a comprehensive review of the disease itself, but should include a comprehensive review of the medical nutrition therapy or prevention of the disease based on the focus of your topic. There is a greater expectation for literature review than the fall case-based paper and presentation. There will not be a presentation.
References: References should be cited by number within the paper and on the reference list consistent with the JAND citation format. Sources, particularly on-line references, should be targeted to medical professionals rather than the lay public, scientifically based, accurate, and up-to-date. A minimum of 5 original research articles from refereed journals published since 2008 should be consulted. Additional reviews and text references can be used.
NTRI 6030 Syllabus Spring 2014 page 6
TENTATIVE CLASS SCHEDULE
Sessions and assignment due dates may change based on the tempo of the lectures. Exams will remain on the date scheduled.
Date: Topic: Readings: Assignments: 1-8-14 Liver Disease Krause:
194, 198-199; 645-663 Medical Terminology: Ch. 5 – Pulmonary
1-14-14 Liver Disease
1-16-14 Electronic Medical Records, Coding , and Billing
TBA
Amie Hardin, RD guest lecture!
1-21-14 Hypertension DASH Diet
Krause: 758-768 DASH (canvas)
Liver Disease Case Due ADIME Note (individual)
1-23-14 Atherosclerosis and Hyperlipidemia
Krause: 202-203, 742-757
Medical Terminology: 444-452 (Cards Lab/Diagnostics)
1-28-14 Atherosclerosis and Hyperlipidemia: MI and CVA
1-30-14 Healthy Life-Style Management (Case Discussion)
LSM (canvas) (review before class)
2-4-14 Heart Failure, Cardiac Cachexia, Transplant
Krause: 769-780
2-6-14 Pulmonary Disease COPD
Krause: 782-786, 788-790, 794-797
Cases in HTN and Cardiology Due ADIME Note (individual)
2-11-14 EXAM I Includes Medical Terminology
2-13-14 Renal Overview Fluid, Electrolyte, and Acid-Case Balance
Krause: 799-808 Krause: 178-190
Medical Terminology: Ch. 6 – Urinary Ch. 7 & 8 Reproductive
2-18-14 Renal: Acute Renal Failure Krause: 808-810 2-20-14 Chronic Kidney Disease, ESRD,
and Dialysis Krause: 810-831
2-25-14 Chronic Kidney Disease, ESRD,
and Dialysis
2-27-14 Renal Diet Workshop
Sue Mossholder, RD
3-4-14 Renal Diet Workshop Considerations for DM
Sue Mossholder, RD
3-6-14 Stone Disease
Medical Terminology: Quiz 1 Ch. 6, 7, 8
March 10-14
SPRING BREAK! Alabama Dietetic Association Meeting
(March 12 through 14)
NTRI 6030 Syllabus Spring 2014 page 7
3-18-14 Oncology: Cancer Prevention, Treatment, and Recovery
Krause: Ch. 37
3-20-14 HIV/AIDS Krause: Ch. 38 Renal Cases Renal Diets Due (individual)
3-25-14 Exam 2 3-27-14 Hypermetabolic States:
Metabolic Response to Stress Krause: Ch. 39 Medical Terminology:
Medical Terminology: Ch. 9, 14, and 15
4-1-14 Hypermetabolic States: Trauma, Burn, Sepsis
Krause: 933-938 Cases in ONC/HIV due ADIME note (individual)
4-3-14 Nutrition Considerations in Surgical Patients
4-8-14 Pediatrics: Prematurity & LBW
Krause: Ch. 43
Medical Terminology: Quiz 2 Ch. 9, 14, and 15
4-10-14 Pediatrics: NEC, Lung Disease/BPD and Cystic Fibrosis
Krause: 786-788, 790-794
4-15-14 Pediatrics: Genetic Metabolic Disorders
Krause: Ch. 44 Cases in Critical Care Due Nutrition Support Regimen
4-17-14 Pediatrics: Developmental Disabilities
Krause: Ch. 45
4-22-14 EXAM 3 Includes Medical Terminology 4-24-14 Rheumatological and
Neurological Conditions Krause: Ch. 40; 924-934 Topic of Choice with
Evidence Analysis (Individual or Pairs)
Wednesday 4-30-14 from 8:00-10:30am
FINAL EXAM
NTRI 6030 Syllabus Spring 2014 page 8
Required footnote from the Accreditation Council for Education in Nutrition and Dietetics (ACEND) Core Knowledge for the RD (Standard 13) addressed in this course. 1. Scientific and Evidence Base of Practice: integration of scientific information and research into practice.
KRD 1.1 The curriculum must reflect the scientific basis of the dietetics profession and must include research methodology, interpretation of research literature and integration of research principles into evidence-based practice. Students must be able to demonstrate how to locate, interpret, evaluate and use professional
literature to make ethical evidence-based practice decisions. Students must be able to use current information technologies to locate and apply evidence-based
guidelines and protocols. 2. Professional Practice Expectations: beliefs, values, attitudes and behaviors for the professional dietitian
level of practice. KRD 2.1 The curriculum must include opportunities to develop a variety of communication skills sufficient for entry into pre-professional practice. Students must be able to demonstrate effective and professional oral and written communication
and documentation.
KRD 2.3 The curriculum must include opportunities to understand governance of dietetics practice, such as the Scope of Dietetics Practice and the Code of Ethics for the Profession of Dietetics; and interdisciplinary relationships in various practice settings.
3. Clinical and Customer Services: development and delivery of information, products and services to
individuals, groups and populations.
KRD 3.1 The curriculum must reflect the principles of Medical Nutrition Therapy and the practice of the nutrition care process, including principles and methods of assessment, diagnosis, identification and implementation of interventions and strategies for monitoring and evaluation. Students must be able to use the nutrition care process to make decisions, to identify nutrition-
related problems and determine and evaluate nutrition interventions. KRD 3.2 The curriculum must include the role of environment, food, nutrition and lifestyle choices in health promotion and disease prevention.
Students must be able to develop interventions to affect change and enhance wellness in diverse individuals and groups.
4. Practice Management and Use of Resources: strategic application of principles of management and systems
in the provision of services to individuals and organizations. KRD 4.5 The curriculum must include content related to coding and billing of dietetics/nutrition services to obtain reimbursement for services from public or private insurers.
5. Support Knowledge: knowledge underlying the requirements specified above. KRD 5.2 The physical and biological science foundation of the dietetics profession must be evident in the curriculum. Course content must include organic chemistry, biochemistry, physiology, genetics, microbiology, pharmacology, statistics, nutrient metabolism and nutrition across the lifespan.
NTRI 6030 Syllabus Spring 2014 page 9
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NTRI 3720 Nutritional Assessment Syllabus Spring 2014
Instructor’s Information
Instructor Claire Zizza, PhD, RDN Office 101J Poultry Science Building Phone 334-844-7417 E-mail [email protected] Office Hours Tues 10:30-12:30 PM, Fri 2:30-3:30 PM, and by appt
Course Textbook and Materials
A. Required: Mahan LK and Raymond JL. Krause's Food & the Nutrition Care Process. 13th
edition. W.B. Saunders Company, Philadelphia, PA. 2012. B. Lecture outlines and readings available on Canvas. C. Recommended reading: Otten JJ, Hellwig JP and Meyers LD. Dietary Reference Intakes: The Essential Guide to Nutrient Requirements. The National Academies Press, Washington, D.C. 2006.
Course Objectives A. Use food composition data B. Recognize cultural diversity in foods and beverages consumed by various populations C. Identify dietary supplement label and ingredient information D. Explain the advantages and limitations of the major methods for assessing individuals’ diets. E. Apply nutrient- and food-based recommendations F. Evaluate anthropometric measurements for adults and children G. Formulate problem, etiology, symptom statements to document nutrition diagnoses H. Recognize potential drug-nutrient interactions I. Calculate energy and protein needs for individuals in various life-stage groups and health conditions J. Describe biochemical indices used to assess nutritional status
Teaching methods: Lecturing, explaining, demonstrating, discussing, and learning with computer.
Learning Experiences:
Write ups of laboratory assignments Students will describe demonstrations and answer questions regarding demonstrations. Write up due dates will be listed on the assignment. Staple all pages together. Late reports submitted without an excused absence will be penalized 3 points off for each day late. Specific instructions for the write ups will be provided.
Note: The contents of this course will be combined with NTRI 5020 and 5030 over the course of the two semester series in Medical Nutrition.
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Presentations
Students will demonstrate oral communication skills. Students will work in pairs for this assignment. Presentations will include students preparing visuals (Powerpoint). Detailed instructions will be provided to students.
Examinations
Two exams will be given and these may consist of multiple choice, short answer, matching, fill in the blank, calculations, and essay type questions.
Grading Policy:
Activity Points
Write ups of laboratory 100
Presentation 100
Examinations 200
Total 400
Course Grading Scale:
A 90 - 100.0%
B 80 -89.9%
C 70 -79.9%
D 60 -69.9%
F > 59.9%
Class Attendance and Excused Absences Policies
Students are expected to attend all classes and are responsible for all work covered in class. Students are granted excused absences from class for the following reasons: illness of the student or serious illness of a member of the student’s immediate family, the death of a member of the student’s immediate family, trips for student organizations sponsored by an academic unit, trips for university classes, trips for participation in intercollegiate athletic events, subpoena for a court appearance, and religious holidays. Students who wish to have an excused absence from class for any other reason must contact the instructor in advance of the absence to request permission. The instructor will weigh the merits of the request, and render a decision. When feasible, the student must notify the instructor prior to the occurrence of any excused absences, but in no case shall such notification occur more than one week after the absence. Appropriate documentation for all excused absences is required.
Make-Up Policy
Arrangement to make up a missed major exam (e.g. hour exams, mid-term exams) due to properly authorized excused absences must be initiated by the student within one week of the period of the excused absence(s). Except in unusual circumstances, such as the continued absence of the student or the advent of university holidays, a make-up exam will take place
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within two weeks of the date that the student initiates arrangements for it. The format of make-up examinations and labs may differ from the original format.
The student is expected to submit all assigned work/labs at the class period designated by the instructor. Failure to turn in these assignments at the designated due dates without an excused absence will result in a loss of 3 points for each day the assignment is late. Students with an approved excuse who have not turned in an assignment and not contacted the instructor within one week after the scheduled lab due date will receive a zero for that assignment.
Academic Honesty Academic dishonesty is an offense that will be reported to the Academic Honesty Committee. All portions of the Auburn University Honesty code as found on https://fp.auburn.edu/studentaffairs/policies.aspx apply to this class. Note: each student must do his/her own work unless the directions specify otherwise; “copying from another student’s assignment” is an example of a violation of the Academic Honesty code.
Accommodations for Students Students who need special accommodations in class, as provided by the American Disabilities Act, should follow University approved procedures. If you need accommodations and are not sure what must be done, make an appointment with the Office of Accessibility,1228 Haley Center, 844-2096. Examination accommodations should be arranged at least one week in advance.
Auburn University is committed to providing a working and academic environment free from discrimination and harassment and to fostering a nurturing and vibrant community founded upon the fundamental dignity and worth of all its members.
Nutritional Assessment includes the following
Accreditation Council for Education in Nutrition and Dietetics (ACEND) Core Knowledge for the RD
2. Professional Practice Expectations: Beliefs, Values, Attitudes, and Behaviors for the Professional Dietitian Level of Practice.
2.1. The curriculum must include opportunities to develop a variety of communication skills sufficient for entry into pre-professional practice.
Students must be able to demonstrate effective and professional oral and written communication and documentation and use of current information technologies when communicating with individuals.
3. Clinical and Customer Services: Development and Delivery of Information, Products, and Services to Individuals, Groups and Populations.
3.1 The curriculum must reflect the principles of Medical Nutrition Therapy and the practice of the nutrition care process, including principles and methods of assessment, diagnosis, identification, and implementation of interventions and strategies for monitoring and evaluating.
Students must be able to use the nutrition care process to make decisions, to identify nutrition-related problems, and determine and evaluate nutrition interventions.
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Course Outline (tentative)
Date Topic Reading
1. Jan 13 Diet: Food composition
Presentation skills
Canvas
2. Jan 20 Martin Luther King Day – Enjoy no class
3. Jan 27 Diet: Individual level assessments Canvas
4. Feb 3 Diet: Nutrient and food standards Canvas
5. Feb 10 Presentations
6. Feb 17 Presentations
7. Feb 24 Presentations
Review
8. March 3 Exam 1
9. March 10 Spring break – Enjoy no class
10. March 17 Anthropometric assessment Krause-Chapter 6 Clinical: Inflammation, Physical and Functional Assessment: Physical and Functional Assessments Section
11. March 24 Energy and Protein Balance
Estimation of Energy and Protein Needs
Krause-Chapter 2
Intake: Energy
12. March 31 Biochemical assessment Krause-Chapter 8 Clinical Biochemical Assessment
13. April 7 Drug-nutrient interaction Food allergies (PZM)
Krause-Chapter 9 Clinical: Food-Drug Interactions
14. April 14 Blood Glucose Lab
Self-blood glucose monitoring
Krause-Chapter 8 Clinical Biochemical Assessment
15. April 21 Nutrition care process; diagnosis, coding, ADIME
Krause-Chapter 11 Overview of the Nutrition Diagnosis and Intervention
Monday April 28 at 12 noon – 2:30 pm
Exam 2
