FSHN 464/NutrS 564 MEDICAL NUTRITION AND DISEASE II DEPARTMENT OF FOOD SCIENCE AND HUMAN NUTRITION SPRING SEMESTER 2013 Christina Gayer Campbell, PhD, RD HNSB 1105 Thursday 11‐12:30; please email me to reserve a time during office hours. T/R 9:30‐10:50 FSHN 360, 361, 3 credits in physiology at 300 level or above. INSTRUCTOR: OFFICE: OFFICE HOURS: CLASS HOURS: PREREQUISITES: BULLETIN DESCRIPTION: Medical Nutrition and Disease II. (Dual‐listed with NutrS 564). (3) Cr. 3. S. Prerequisite: FSHN 360, 361, 461, 3 credits in physiology at >300 level. Pathophysiology of selected chronic disease states and their associated medical problems. Specific attention will be directed to medical nutrition needs of patients in the treatment of each disease state. It is expected that students will have a basic understanding of the following topic areas prior to enrolling in this course: 1. Normal nutrition needs during the lifecycle. 2. Normal nutrient metabolism, including carbohydrate, protein, fat, vitamin, and mineral metabolism. 3. Normal physiology of the gastrointestinal, cardiovascular, pulmonary, renal, endocrine, and musculoskeletal systems. 4. Assessment of nutrition status: assessment of anthropometric data, weight history, dietary intake, biochemical laboratory analyses, and clinical symptoms. 5. Knowledge of nutrition care process for cardiovascular disease, diabetes (both 1 and 2), and obesity. 6. Ability to assess a patient and develop an appropriate nutrition prescription using nutrition support (EN and PN) calculations. 7. Nutrient composition of common foods in the United States diets. REQUIRED TEXTS: These are the same textbooks that were required in FSHN 461/NutrS 561. All these references will be excellent, needed resources for your post‐baccalaureate experience (i.e. dietetic internship). A. Nelms M, Sucher K, Lacey K, Roth Long S. Nutrition Therapy and Pathophysiology. 2nd ed. Belmont, CA: Thomson Brooks/Cole, 2011. B. Nelms MN, Long S, Lacey K. Medical Nutrition Therapy; A Case Study Approach 3rd ed.,Wadsworth/Thomson Learning, 2009. If you want to purchase case studies individually for $2.99 you can do so at: http://www.cengage.com/wadsworth/ Search for Nelms, click on this book and then find echapters. C. Pronsky ZM. Food Medication Interactions. 17th ed. Birchrunville, PA: Food‐Medication Interactions, 2012. D. International Dietetics & Nutritional Terminology (IDNT) Reference Manual, 3rd ed. (“zucchini”) Chicago, IL: American Dietetic Association, 2010 or 2012 (4th ed = “banana”). ACCREDITATION STANDARDS This course contributes substantially to fulfill criterion 2.1 in Standard Two of the “Eligibility Requirements and Accreditation Standards” for a Didactic Program in Dietetics. Criterion 2.1 states “The DPD curriculum is planned to provide learning activities to attain all the Foundation Knowledge and Learning Outcomes defined for entering a Dietetic internship for eligibility for the RD exam”. 2.1.1 Didactic learning activities prepare students for pre‐professional supervised practice with patients/clients with various conditions, including but not limited to overweight and obesity, diabetes, cancer; and cardiovascular, gastrointestinal and renal diseases. 2.1.2 Didactic learning activities prepare students to implement the nutrition care process in pre‐professional supervised practice with various populations and diverse cultures, including infants, children, adolescents, adults, pregnant/lactating females and the elderly. 2.1.3 Didactic learning activities prepare students to implements all nutrition interventions defined in the nutrition care process (food and/or nutrient delivery, nutrition education, nutrition counseling and coordination of nutrition care) in pre‐professional supervised practice. Foundation Knowledge Requirements and Learning Outcomes. As a result of the lectures, assignments, quizzes, case studies, and the clinical rotation the students will have knowledge of the following: 1. Scientific and Evidence Base of Practice: integration of scientific information and research into practice. KR1.1 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. KR1.1.b. Learning outcome: Students are able to use current information technologies to locate and apply evidence‐based guidelines and protocols, such as the ADA Evidence Analysis Library, Cochrane Database of Systematic Reviews and the U.S. Department of Health and Human Services, Agency for healthcare Research and Quality, National Guideline Clearinghouse websites. 2. Professional Practice Expectations: beliefs, values, attitudes and behaviors for the professional dietitian level of practice. KR2.1. The curriculum must include opportunities to develop a variety of communication skills sufficient for entry into pre‐professional practice. KR2.1.a. Learning outcome: Students are able to demonstrate effective and professional oral and written communication and documentation and use of current information technologies when communicating with individuals, groups and the public. 3. Clinical and Customer Services: development and delivery of information, products and services to individuals, groups and populations. KR3.1. The curriculum must reflect the nutrition care process and include the principles and methods of assessment, diagnosis, identification and implementation of interventions and strategies for monitoring and evaluation. KR3.1.a. Learning outcome: Students are able to use the nutrition care process to make decisions, to identify nutrition‐related problems and determine and evaluate nutrition interventions, including medical nutrition therapy, disease prevention and health promotion. COURSE OBJECTIVES/LEARNING OUTCOMES (DEPARTMENTAL) – In addition to the aforementioned outcomes, students will be expected to: 1. Demonstrate how to locate, interpret, evaluate and use professional literature to make ethical evidence‐based practice decisions (D1). 2. Use current information technologies to locate and apply evidence‐based guidelines and protocols (D2). 3. Demonstrate effective and professional oral and written communication and documentation and use of current information technologies when communicating with individuals, groups and the public (D3). 4. Locate, understand and apply established guidelines to a professional practice scenario (D6). 5. Use the nutrition care process to make decisions, to identify nutrition‐related problems and determine and evaluate nutrition interventions, including medical nutrition therapy, disease prevention and health promotion (D8). COURSE INFORMATION 1. Attendance is expected for each class because clinical dietetics cannot be learned solely from class notes or a textbook however it is your choice to attend class. You need to identify a class “buddy”. If you miss class, you need to get the material from your “buddy”, not the instructor. Please be prompt to class. 2. General information. You will need to purchase a small, basic calculator to be used on exams. It can only have arithmetic capabilities. You will not be allowed to use the large, extensive calculators that you are accustomed to using. You will be responsible for having your calculator for all quizzes and exams. You may not use your cell phone. Please staple all individual assignments. I recommend that you purchase a small stapler to keep in your bag. Non‐
stapled assignments will not be accepted. Please use a binder clip (not a paper clip) for group projects.). For group projects do not print front‐to‐back. 3. Two large case studies will be completed throughout the semester. Some of the disease states covered in this course will be supplemented with a case study. These case studies emphasize the application of the material learned in class to a specific disease; use this opportunity to enhance your knowledge of the material presented in class. If a diet analysis is required, always provide documentation. You must show all work for calculations in each case study. Your answers must be concise, thorough, tidy and legible (yes, word processed) and in your own words (not those found in a text). Case studies are to be independently completed yet collectively submitted (except for the independent case study…this is to be completed on your own). One hard copy (with binder clip) per group for each case study is due at the beginning of class. Use a staple for the individual case study. Late case studies will not be accepted (see below). Each individual will receive the same grade. All members of the group must sign the cover page of the case study. This signature must be obtained prior to the beginning of class. Your signature endorses that you contributed to the written submission, you agree with what was written and have read it. Case studies should have 1 inch margins, use Arial, 12 pt and single spaced. Each assigned question should be typed and bolded, followed by your non‐bolded answer. There will be a page limit given for each case study. 564: Final case study. Each student enrolled in 564 will be assigned an individual case study by 2/5. At the end of the semester (time TBD), a meeting will be held for 564 students to provide a 10 minute overview of their case study. Due date for the final case study is posted on the syllabus. 4. Two exams will consist of multiple choice, matching, short answer and/or case study questions. No make‐up exams will be given without documentation from a medical professional. Study guides will not be provided. The exams will test both knowledge and application. Nutrition assessment calculations, conversions and abbreviations may be on each exam. 5. Five supplementary assessments that may include but are not limited to smaller case scenarios and quizzes will be completed throughout the semester either on‐line or in‐class. This aspect is a relatively new addition to this course and the content will be developed as we progress. The intent of these additional assessments is to give you an opportunity to enhance your clinical assessment skills and to focus your attention on key concepts prior to taking the exams. The benefit of this approach is that it should keep you more engaged in the material. Conversely, you may feel that the pace of the class is accelerated as you will need to submit assignments more frequently than 461. 6.
Reflections. There will be one reflection due one week after the “IBD panel”. The reflection will be worth 10 points and will be no longer than 1 page in length (unless specified). You will be asked to respond to questions or concepts in response to a panel of guest speakers. 7. Late policy. All assignments must be turned in at the beginning of the regularly scheduled class time. Late assignments will not be accepted except for medical reasons documented by a health care practitioner. Assignments will be considered “late” at 9:45 (15 minutes after the beginning of class). “The printer didn’t work this morning”, “I forgot it at home”, “my computer crashed last night” will not be accepted as reasons. Please plan appropriately for those items that can and do occur. Recall that for a group project you all receive the same grade…please have a back‐up plan. If you have identified one person to submit your case study and they don’t show up (regardless of the reason) your case study will be considered late. Again, have a back‐up plan. 8. Communication. Check your “iastate” email after 6 pm the evening prior to class. I regularly send information or material that might be needed for the next day. It is your responsibility to be able to access your University email address. If you are not receiving emails from me, then investigate the reason. “but I didn’t get your email”, is not acceptable. Notes are posted in BbLearn. Always check this after 6 pm the evening prior to class. I will do my best to post these by 6 pm. Please make your best effort to print these that evening, not just before class causing you to be late. 9. Evaluation is based on quizzes, reflections, application scenarios, case studies and exams. Evaluation details for FSHN 464 and NUTRs 564 are as follows: Assignment FSHN 464 (points) NutrS 564 (points) Case studies 100 (2@50 points each) 165 (2@50 points each; 1 at 65 pts) Exams (2) 200 (100 points each) 200 (100 points each) Application scenarios/quizzes (5) 100 (20 points each) 100 (20 points each) Reflections (1) 10 (10 points each) 10 (10 points each) Total 410 465 Contact Diana DiFabio at ddifab@iastate.edu for general questions about the course or assignments. For more specific assistance please email Dr. Campbell at ccampbel@iastate.edu to schedule an appointment during office hours (Thursdays 11‐12:30). Bring your questions, a list of possible solutions, and be prepared to give me a brief review of the “patient”. If you email with specific questions during the evening or weekend, please do not anticipate a reply until the next work day. GRADING: If you feel you have been graded unfairly or incorrectly, you may discuss your answer with the instructor. It is your responsibility to discuss these issues with the instructor, if you choose not to then you must also choose to accept your grade. All exams will be returned to Dr. Campbell. If you need additional time to review your exam (and I highly recommend that you review your exams in more detail than the time allowed in class), please schedule an appointment with Diana DiFabio. Grades are based on the following percentages of total points possible. There will be no curving or other adjustments of grades. As a reminder, A = excellent work; B = good or above average; C = average; D = poor; and F = failing/unacceptable. Grade Grade points (%) A 4.0 (93‐100) C+ 2.3 (77‐79.9) A‐ 3.7 (90‐92.9) C 2.0 (73‐76.9) B+ 3.3 (87‐89.9) C‐ 1.7 (70‐72.9) B 3.0 (83‐86.9) D+ 1.3 (67‐69.9) B‐ 2.7 (80‐82.9) D 1.0 (60‐66.9) F 0.0 (below 60) STUDENT RESPONSIBILITIES 1. To attend class as scheduled, to complete assignments in a timely manner, and to take exams as scheduled. 2. To be prepared for class. Do not study for another class during this one. If you need the extra time to prepare for another class, then take the time to do so but don’t come to one class only to prepare for a different one. 3. To act as a professional in class; chatting, texting, REM sleeping will not be tolerated. You will be asked to leave class. 4. To seek assistance from the professor and the appropriate University support services (e.g. tutors, study skills counseling, career development, etc.), if the need for such service arises. 5. To meet the course standards as defined by the professor and articulated in the University’s Student Academic Integrity and Conduct Guidelines. Iowa State University complies with the American with Disabilities Act and Section 504 of the Rehabilitation Act. Any student who may require an accommodation under such provisions should contact me as soon as possible and no later than the end of the first week of classes or as soon as you become aware. No retroactive accommodations will be provided in this class. Those seeking accommodations based on disabilities should obtain a Student Academic Accommodation Request (SAAR) form from the Disability Resources (DR) office (515‐294‐7220). DR is located on the main floor of the Students Services Building, Room 1076. Class Policies: Any student found cheating or plagiarizing will receive an “F” or “0” for the course and will be reviewed by the ISU Conduct Committee. Please refer to the 2009‐11 ISU catalog (p. 45‐6) for specifics on Academic Dishonesty. a. If you have been caught cheating and Dr. Campbell has already written a letter of recommendation for you, the letter will be revoked and the institution notified for which you have applied. If you have cheated, I am not able to professionally endorse you. b. Cheating will not be tolerated. Your profession requires integrity and your patients/clients are dependent upon you for accurate information. Practice this now while in school so that you can help your future patients. If you feel the need to cheat, please reassess whether or not this is the right profession for you. Tentative schedule (1/14/13). Date T: 1/15 Th: 1/17 T: 1/22 Th: 1/24 Topic Overview Acid‐base balance Eating Disorders Immunity Guest speaker: Marian Kohut, PhD; Department of Kinesiology Reading Nelms: Ch. 8 Assignments Due Nelms: Ch. 12 Nelms: Ch. 9 Additional readings posted on BbLearn Nelms: Ch. 9 I highly recommend reading on this topic prior to her presentation! T: 1/29 Th: 1/31 Immunity: Pressure sores/wound healing Routine/Transitional Diets Dysphagia T: 2/5 Th: 2/7 Upper GI Nelms: Ch. 14 T: 2/12 Th: 2/14 T: 2/19 Th: 2/21 T: 2/26 Th: 2/28 Lower GI IBD guest panel Nelms: Ch.15 Sally Barclay Rose Martin Stacy Joiner T: 3/5 Liver/hepatobiliary/exocrine pancreas Nelms: Ch. 16 Th: 3/7 T: 3/12 Th: 3/14 3/18‐22 T: 3/26 Th: 3/28 T: 4/2 Th: 4/4 T: 4/9 Th: 4/11 Spring Break Renal Disease Hypermetabolism (metabolic stress and starvation) Energy needs and other terms Nelms: p. 66‐9 Nelms: p. 354‐7 Supplemental Assessment #1 (case scenario on topic TBD Supplemental Assessment #2 (quiz on acid‐base/Immunity) Supplemental Assessment # 3 (worksheet on routine diet/dysphagia) 1st Case Study (Crohn’s); Group CS#14: 1‐6,11,13‐18,22,25,26. For #18, list 2‐3 S/S to substantiate the noted problems. For #26, calculate the NS problem using both the initiation AND goal rate for a 2‐in‐1 PN solution containing: 200g D/L, 42.5 g AA/L, 250 mL 20% Intralipid. Reflection #1 Exam #1 (through liver; does not include pancreas) Nelms: Ch. 18 Nelms: Ch. 22 2rd case study ‐ #26 (renal) – independent. #26: 2,4‐6,8‐10,12,13,15‐
T: 4/16 24,29,32,34,35,38,40. For #20, list 2‐3 S/S to substantiate the noted problems. For #38, develop a one day sample menu that is consistent with nutrition prescription. Provide a table that makes it easy to understand how your menu meets the nutr rx. Provide documentation. For #40, write an “ADI” note. These will be returned one week before the final exam. Critical care case scenario posted on BbLearn. Bring completed critical care case scenario to class. Supplemental Assessment #4 (Critical Care case scenario) Th: 4/18 Case study day with Erin Bergquist T: 4/23 Oncology Th: 4/25 HIV/Aids T: 4/30 Cystic Fibrosis; CHF Th: 5/2 5/9 Respiratory: COPD/Emphysema Final Exam: 9:45‐11:45 Tentative per ISU exam schedule Crystal Tallman, Mercy Hospital, Oncology dietitian (TBD) Nelms: Ch. 24 564: Case Study; topic to be assigned. Supplemental Assessment #5 (critical case scenario topic TBD) Exam #2 (pancreas through respiratory). *CS = case study Nelms: Ch. 23