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 2 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 3 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 4 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 5 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 7 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