HND 574 (3) Advanced
Medical Nutrition Therapy
Class
2:00 – 3:15 Tuesdays and Thursdays
Quigley 219A
Instructor
Lynn Gill, MS, RD, LDN
Quigley Hall, Room 213C
453-7512
lynng@siu.edu1
Office Hours2
Mondays
12 – 2 pm
Tuesdays
10 – 12 pm
Wednesdays 9 – 11pm
Thursdays 10 – 12 pm
Fall 2014
Or by appointment
Class Schedule
HND 400
HND 100
HND 574
Mondays 2 – 3 pm
Wednesdays 2 – 3 pm
Tuesdays & Thursdays 2 – 3:15 pm
SIUC Human Nutrition & Dietetics
When emailing, please put FN 574 in the subject line. All email from students are read before other
correspondences, and your emails will always receive a response so you know they were received.
2 Occasionally it may be necessary to modify office hours to accommodate student needs,
meetings, and off campus obligations. These changes will be posted on office door 219C or
announced during class sessions. Students are responsible for announcements in class.
1
1
© SLRoth, 2014 – edited with permission by Lynn Gill
Fall 2013 FN 574 ADVANCED MEDICAL NUTRITION
INTRODUCTION
This class is an in-depth study of the application of nutrition to the management of disease
states with emphasis on current treatment and complex metabolic abnormalities.
Prerequisite: HND 470 Medical Nutrition or equivalent.
The format of this course is designed to encourage development of critical thinking skills
while learning about physiological and biochemical changes that take place in certain
disease states and the impact on nutritional status. In addition to information about nutrition
and health, we must work to improve skills that are essential in almost every profession. These
are the ability to communicate, to think critically, and to make decisions that are ethical.
Course Goals/Competencies: Upon completion of the course, students will:
1. Use medical terminology and abbreviations in oral and written communications
2. Evaluate nutritional status of simulated patients based on medical, social, physical,
dietary, anthropometric, and laboratory data
3. Identify appropriate information to record and the proper format(s) to use when
recording information in medical records. Write/develop chart notes for simulated
patients
4. Describe etiology, symptoms, clinical findings, and pathophysiology associated
with diseases/conditions covered in this course.
5. Describe diagnostic tests/procedures and intervention strategies used in treatment
of diseases/conditions covered in this course.
6. Evaluate the impact of food/nutrient-drug interactions on nutritional status/drug
efficacy and recommend appropriate intervention strategies.
7. Relate the theoretical bases for nutrition/medical intervention strategies with the
anatomical, physiological and/or biochemical changes that occur in
diseases/conditions covered in this course.
8. Identify appropriate situations for using enteral and parenteral feeding modalities;
calculate energy, protein and fluid content of formulas; and make appropriate
recommendations with regard to initiation and monitoring of enteral/parenteral
solutions
9. Develop and justify appropriate recommendations for management of patients
with diseases/conditions covered in this course
As part of the Internship Program at SIU, this course contributes to the following ACEND Core
Competencies (2012)
CRD 1.2 Apply evidence-based guidelines, systematic reviews, and scientific literature (such as the
Academy’s Evidence Analysis Library & Evidence-based Nutrition Practice Guidelines, the Cochrane
Database of Systematic Reviews and the U.S. Department of Health and Human Services, Agency
for Healthcare Research and Quality, National Guideline Clearinghouse Web sites) in the nutrition
care process, model, and other areas of dietetics practice.
CRD 3.1 Perform the Nutrition Care Process and use standardized nutrition language for individuals,
groups, and populations of differing ages and health status, in a variety of settings.
“Education is not the learning of facts, but the training of the mind to think.” Albert Einstein
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Fall 2013 FN 574 ADVANCED MEDICAL NUTRITION
REQUIRED TEXTS & MATERIALS:
Nelms MN, Sucher K, Lacey K, Roth SL. Nutrition Therapy and Pathophysiology, 2nd ed,
Belmont, CA: Wadsworth/Thomson Learning, 2010 (ISBN 978-1439049624)
Nelms MN, Long S: Medical Nutrition Therapy, A Case Study Approach, 4th ed.
Belmont, CA: Wadsworth/Thomson Learning, 2014. (ISBN-13: 978-1-133-59315-7)
American Dietetic Association. International Dietetics and Nutrition Terminology (IDNT)
Reference Manual, 4th ed, Chicago, IL: American Dietetic Association, 2010 (ISBN: 9780880914451).
$20.00 for students with Academy of Nutrition & Dietetics membership & ordered through
the Academy’s Member Service Center at 800/877-1600
Escott-Stump S. Nutrition and Diagnostic Related Care, 7th ed, Baltimore: Williams &
Wilkins, 2008 (ISBN -13: 978-0-7817-9845-7, ISBN 10: 0-7817-9845-0).
Pronsky ZM. Food-Medication Interactions, 17th ed, Birchrunville, PA: FoodMedication Interactions, 2012 (ISBN 978-0971089655).
Academy of Nutrition and Dietetics Analysis Library®, (requires
Academy membership - $50 for students)
http://www.adaevidencelibrary.com/?
American Dietetic Association Nutrition Care Manual®: (requires subscription - $75 for students)
http://nutritioncaremanual.org/auth.cfm?p=%2Findex%2Ecfm%3F&err=NotLoggedIn
RECOMMENDED TEXTS:
American Dietetic Association, Choose Your Foods: Exchange Lists for Meal Planning, 2008
(ISBN 978-0-88091-377-5).
 Merck Manual, current edition (also available at http://www.merck.com/pubs/mmanual/).
 Medical Dictionary
 Students are expected to review anatomy and physiology, biochemistry, laboratory interpretation,
and pharmacology texts as appropriate.
 Diagnostic and Laboratory Test Reference
“Education is not the learning of facts, but the training of the mind to think.” Albert Einstein
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Fall 2013 FN 574 ADVANCED MEDICAL NUTRITION
NATURE AND NUMBER OF EVALUATIONS1:
Item
1. SOAP note for Case Study (9 @ 20 pts.)
2. Nutrition Diagnosis & ADIME note for Case Study (9 @ 20 pts. each)
3. 1-in-class presentation 100 pts. each
4. Quizzes (12 @ 10)
Total Points
Grading Scale
Points
180
180
100
120
Percent
Grade
31%
31%
17%
21%
580
A = 580 – 522 points (90%)
B = 521 – 464 points (80%)
C = 463 – 406 points (70%)
D = 405 – 348 points (60%)
F = < 347 points (< 50%)
COURSE POLICIES
1. Email & E-communication: Please use ‘FN 574 followed by your Issue/ Subject/ Details’ in the subject
line. Emails from students are read first…..and your emails will always receive a response so you know
they were received.
2. Please bring your laptop, tablet, or smartphone to class: we may be using wireless applications to
participate in daily class activities with clicker technology.
a. You will need to download the Socrative Student app. It is available on all platforms, or go to
http://www.socrative.com.
b. Use Room Number given to you from the Instructor.
c. You will receive directions in class each time we use the app which will be each class period.
3. Freedom in and responsibility to the Class: You are free to express your opinions and share ideas in
class. You are responsible for completing your work with excellence, submitting assignments by due dates,
and treating class members and your instructors with courtesy and respect.
4. Attendance Policy: Attendance is mandatory (just like an actual job….or your internship!).
a. Absence from class without prior permission from the Professor will result in a 10% deduction of a
student’s total grade points received to date for each infraction.
b. If an absence is unavoidable due to health or an emergency-related problem, the student is
responsible for contacting the Professor at his/her earliest opportunity to ensure arrangements can
be made to submit class assignments.
c. Unexcused absence from class when a guest speaker is scheduled will result in a reduction
of one letter grade for each infraction.
5. Organize Your Work:
a. If your assignment has multiple sheets, staple them together.
b. Please do not staple different assignments together.
c. If you have any questions about the manner of submission for each assignment, ASK (the instructor)
to avoid losing points for disorganized work. Not knowing/understanding how to complete an
assignment is not an acceptable excuse for late assignments. Directions are clearly stated in this
syllabus, and my phone number and email address are available if you need further explanation of
an assignment.
1
Read your syllabus for assignment directions. Grades will be reduced 10% of assigned points for not
following directions.
“Education is not the learning of facts, but the training of the mind to think.” Albert Einstein
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Fall 2013 FN 574 ADVANCED MEDICAL NUTRITION
d. Assignments with no name, pages out of order, mislabeled, unreadable, or unstapled (if more than 1
page), or any other encumbrance to identify or organize the work will receive a grade of zero (0) and
will be promptly moved to the recycling bin.
6. Expectations for Written Work and Class Presentations
a. All course work must be completed in professional style, and follow basic principles of effective
written and verbal communication.
b. At a minimum, all written work should be neat, well organized, clearly written, and free from
grammatical and typographical errors.
7. Please feel free to ask questions. Answers will be proved in a group process format when applicable.
8. Please see me for help when you don’t understand material.
9. Roles: the instructor serves as a facilitator of learning. As a learner, you are responsible for internal selfmotivation, recall, and remembering of information, and connecting and/or transferring learned information
into your own schemata (i.e., mental structures by which you, as a learner, organize your perceptions).
10. It is expected that you come to class prepared (see Schedule of Assignments).
11. “Academic Honesty”: All students are expected to adhere to a strict code of academic honesty. Academic
dishonesty will be addressed according to the “Policies and Procedures Applicable to Academic
Dishonesty” as stated in the “Important Information for Students, Faculty, & Staff” booklet. From the
“Student Conduct Code”, section II, article A:
a. Acts of Academic Dishonesty:
i. .Plagiarism, representing the work of another as one’s own work;
ii. Preparing work for another that is to be used as that person’s own work;
iii. Cheating by any method or means;
iv. Knowingly and willfully falsifying or manufacturing scientific or educational data and
representing the same to be the result of scientific or scholarly experiment or research;
v. Knowingly furnishing false information to a university official relative to academic matters;
vi. Soliciting, aiding, abetting, concealing, or attempting conduct in violation of this code.
b. Sanctions will be imposed for violations of this policy in accordance with the Student Conduct Code.
A copy of the ‘Important Information for Students, Faculty & Staff’ booklet can be obtained from the
Office of the Vice Chancellor for Student Affairs, Mailcode 4308, Southern Illinois University,
Carbondale, IL 62901-4308.”
12. SIUC Emergency Response Plan and Building Emergency Response Team Program
a. Southern Illinois University Carbondale is committed to providing a safe and healthy environment
for study and work. Because some health and safety circumstances are beyond our control, we ask
that you become familiar with the SIUC Emergency Response Plan and Building Emergency
Response Team (BERT) program. Emergency response information is available on posters in
buildings on campus, available on the BERT website at www.bert.siu.edu, Department of Public
Safety’s website at www.dps.siu.edu (disaster drop down) and in Emergency Response Guidelines
pamphlet. Know how to respond to each type of emergency.
b. Professors will provide guidance and direction to students in the classroom in the event of an
emergency affecting your location. It is important that you follow these instructions and stay
with your Professor during an evacuation or sheltering emergency. The Building Emergency
Response Team will provide assistance to your Professor in evacuating the building or sheltering
within the facility.
13. “ADA Special Accommodation Statement: In keeping with the goal of the implementation of the
Americans with Disabilities Act, all students for whom the act applies should notify the instructor no later
than the second session of the course so arrangements can be made for accommodations to meet your
educational needs and maximize learning.”
“Education is not the learning of facts, but the training of the mind to think.” Albert Einstein
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Fall 2013 FN 574 ADVANCED MEDICAL NUTRITION
14. SIU Policy on “Incomplete” as a Course Grade: The following is taken from the 2013-2014
Undergraduate Catalog, p. 32:
“An INC is assigned when, for reasons beyond their control, students engaged in passing work are unable
to complete all class assignments. An INC must be changed to a completed grade within one semester
following the term in which the course was taken, or graduation, whichever occurs first. Should the student
fail to complete the course within the time period designated, that is, by no later than the end of the
semester following the term in which the course was taken, or graduation, whichever occurs first, the
incomplete will be converted to a grade of F and the grade will be computed in the student’s grade point
average. Students should not reregister for courses in which an INC has been assigned with the intent of
changing the INC grade. Re-registration will not prevent the INC from being changed to an F.”
GENERAL GRADING CRITERIA
1. All assignments must be formatted and typed (font size no less than 12) neatly and professionally.
2. As a professional, clear and concise written documents are paramount in effective communications.
3. Spelling, grammar, ability to analyze situations, and following directions will be stressed and graded
accordingly. (10% of the grade allocation will be deducted for not following directions.)
4. A guideline for assignment submission is provided at the end of this syllabus.
5. All assignments have deadlines for submission. Late assignments will NOT be accepted unless you
have a valid, documented (written & timestamp) excuse established with the instructor prior to the
scheduled due date and time.
SCHEDULE OF ASSIGNMENTS
Readings
Before each class
Assignments
Due the day of class
Nelms/2
Assessment sent in
Eval of EAL
NCP cont. and Documentation
Nutrition Assessment Boot Camp
Nelms/6
Nelms/3, review
worksheet
Email 2 PES - Case 1
ADIME/SOAP note prep
Case 1&3
9/2
9/4
Case 1 & 3 Review/quiz - chapter 2,3,6
Enteral Support Nutrition Boot Camp
Review Chapters 2,3,6
Nelms/5 pg 80-93
Case 4 (Q 1-32)
Case 13 (Q 1-15)
9/9
Parental Support Nutrition Boot Camp
Nelms/5 pg 93-103
9/11
Parental Support Nutrition Boot Camp
Guest speaker
ADIME/SOAP notes - Case
13
3 questions, Case 29 (1-20)
9/16
Case 13 & 29 Review, Nutrition Support
quiz
Type 1 Diabetes Mellitus
Review Chapter 5
Week
Date
1
8/19
8/21
Review of Assessment & Course
Nutrition Care Process (NCP)
8/26
8/28
2
3
Topic
4
5
9/18
ADIME/SOAP notes - Case
29
Nelms/17 pg 471-498
“Education is not the learning of facts, but the training of the mind to think.” Albert Einstein
6
Fall 2013 FN 574 ADVANCED MEDICAL NUTRITION
Week
Date
Readings
Before each class
Topic
9/23
Review Case 15, Type 1 DM quiz
9/25
Type 2 Diabetes Mellitus
9/30
Review of Case 16, Type 2 quiz
10/2
The Cardiovascular System
10/7
Review of Case 6, CVS quiz
10/9
Malnutrition
TBA
Case 15, turn in
ADIME/SOAP
10/14
10/16
Fall Break 
Upper GI Disorders
Nelms/14
10/21
Review of Case 8, Upper GI quiz
10/23
Lower GI Disorders
10/28
Review of Case 9, Lower GI quiz
10/30
Neurology Systems
11/4
Review of Case 25, Neurology quiz
11/6
CKD: Peritoneal Dialysis
11/11
11/13
Veterans Day
Field Trip: Dialysis Center
11/18
Review of Case 19, CKD quiz
11/20
Esophageal Cancer
11/25
Review of Case 33, Cancer quiz
11/27
Thanksgiving Vacation 
12/2
12/4
Metabolic Stress
Review Case 31, Metabolic quiz
Nelms/22
12/8
Finals Week
Clinical Case Reports
6
Nelms/17 pg 498-517
Case 16, turn in
ADIME/SOAP
7
Nelms/13
8
9
Nelms /15
Case 9, turn in
ADIME/SOAP
11
Nelms/20
Case 25, turn in
ADIME/SOAP
12
Nelms/18
Fresenius Medical
Center
16
Hug a Veteran 
725 Lewis Lane, C’bondale
Case 19, turn in
ADIME/SOAP
14
15
Case 6, turn in
ADIME/SOAP
TBA
Case 8, turn in
ADIME/SOAP
10
13
Assignments
Due the day of class
Nelms/23
Case 33, turn in
ADIME/SOAP
Give Thanks, only 2 more
classes!
Case 31, turn in
ADIME/SOAP
“Education is not the learning of facts, but the training of the mind to think.” Albert Einstein
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Fall 2013 FN 574 ADVANCED MEDICAL NUTRITION
1. SOAP and ADIME notes (10 points each)
a. Write a SOAP note for all 9 case studies reviewed in class.
b. Write an ADIME note for all 9 case studies reviewed in class.
c. Your SOAP and ADIME notes should be for the same case.
d. All assignments MUST be typed and stapled together. This means no paper clips or
dog-eared corners. (Actually, you should be able to fit both notes on 1 sheet of paper.)
e. Grading on all assignments and exams includes grammar, spelling, and neatness.
2. Quizzes
a. There will be a 20 point quiz after reviewing assessment, documentation and the Nutrition
Care Process on Sept. 2nd.
b. There will be 10 quizzes following select case studies (see schedule of assignments).
3. Presentations
a. TBA
“Education is not the learning of facts, but the training of the mind to think.” Albert Einstein
8
Outstanding
2 pts.
DATE & TIME
A (ASSESSMENT)
Above Expectations
1 pt
Below Expectations
0 pts.
Present
Not present
Pertinent components
documented.
Captures essence of
pt’s perception of
medical problem.
Accurately summarizes
most of the pertinent
information.
One or more pertinent
elements missing or
irrelevant data
documented.
D (NUTRITION DIAGNOSIS)
 Written in PES statement(s) using standardized language
for the Nutrition Care Process
Necessary PES
statement(s) stated
accurately & prioritized.
No more than one item
missing.
Not written in PES
statement format &/or
standardized language
not used.
Medical dx listed as
nutrition dx.
I (INTERVENTION)
Appropriate & specific
plan(s) AND
implementation to
remedy nutr dx
documented.
Plan(s) or
implementation missing
Vague plan(s) &/or
intervention
documented.
MD’s orders documented
as intervention, &/or
inappropriate plan &/or
intervention documented.
Appropriate nutr care
outcomes relevant to nutr
dx & intervention plans &
goals documented. Nutr
care outcomes defined,
specific indicators (can be
measured & compared to
established criteria)
identified.
No more than one item
missing.
Nutr care outcome not
relevant to nutr dx,
intervention, &/or
plans/goals. Nutr care
outcomes cannot be
measured &/or compared
to established criteria.
Present
Not present
Present
Not present












Reports of wt loss or appetite decrease
Chewing/swallowing difficulties
Previously unreported food allergies
Pertinent diet hx information
Estimated nutrient needs (EER & protein)
Diet order
 Pt dx
Ht, wt, DBW, %DBW
 UBW, % UBW if appropriate
Pertinent labs
 Diet-related meds
Appropriate Nutr Rx identified
Aimed at etiology of nutr dx; can be directed at reducing effects of signs &
symptoms
Planning: prioritize nutr dx, jointly establish goals w/pt, define nutrition rx,
identify specific nutr intervention(s)
Implementation: action phase, includes carrying out & communicating
plan of care, continuing data collection & revising nutr intervention as
warranted based on pt’s response
M (MONITORING) & E (EVALUATION)




Appropriate indicators & criteria identified
Determines progress made by pt & if goals are being met
Tracks pt outcomes relevant to nutr dx
Can be organized into one or more of following:
 Nutr-Related Behavioral & Environmental Outcomes
 Food & Nutrient Intake Outcomes
 Nutr-Related Physical Sign & Symptom Outcome
 Nutr-Related Pt-Centered Outcome
SIGNATURE & CREDENTIALS
DATE & TIME
9
© SLRoth, 2014 – edited with permission by Lynn Gill
Score
Fall 2013 FN 574 ADVANCED MEDICAL NUTRITION
Outstanding
2 pts.
S (SUBJECTIVE)





Tolerance of current diet
Reports of wt loss or appetite decrease
Chewing/swallowing difficulties
Previously unreported food allergies
Pertinent diet hx information
O (OBJECTIVE)




Diet order
 Pt dx
Ht, wt, DBW, %DBW
 UBW, % UBW if appropriate
Pertinent labs
 Diet-related meds
Estimated nutrient needs (EER & protein)
A (ASSESSMENT))







S + O = A (Nutrition Dx)
Nutritional status assessed
Appropriateness of current diet order noted
Interpretation of abnormal labs (to assess nutritional status)
Comments on diet hx (if appropriate)
Comments of tolerance of diet (if appropriate)
Rationale for suggested changes (if appropriate)
P (PLAN)




Nutrition Dx (if appropriate)
o Request more labs or calorie count
Rx (if appropriate)
o Suggestions for changing diet
o Suggestions for adding supplements
o TF/TPN recs
o Recs for vit/min supplements
o Suggestions for referrals
F/U
o Plans for future care
o Follow-up prn vs. continue to monitor nutritional status
o Monitor tolerance of TF/TPN (if approp.)
o Encourage PO (if appropriate)
Education provided
SIGNATURE & CREDENTIALS
Above Expectations
1 pt
Below Expectations
0 pts.
Pertinent components
documented.
Captures essence of
pt’s perception of
medical problem.
Accurately summarizes
most of the pertinent
information.
One or more pertinent
elements missing.
All necessary elements
documented
accurately.
Necessary elements
documented.
No more than one item
missing or irrelevant
data documented.
One or more pertinent
elements omitted and
irrelevant data
documented.
Sophisticated
assessment drawn
from items documented
in S & O. Appropriate
conclusions drawn
Appropriate, effective
assessment, but not
based on
documentation in S &
O.
Unacceptable
assessment/ or no
assessment.
Disease pathophysiology
documented as
assessment of nutritional
status.
Appropriate nutritional
care plan documented
reflecting pt’s nutritional
status.
Vague nutritional care
plan documented
reflecting pt’s nutritional
status.
Minor errors in care
plan.
At least one necessary
element missing.
MD’s orders documented
as nutritional care plan
More than one necessary
element missing.
Unacceptable and/or
inappropriate care plan
documented.
Present
Not present
“Education is not the learning of facts, but the training of the mind to think.” Albert Einstein
10
Score