1
College of
Southern
Idaho
THERAPEUTIC
NUTRITION
SYLLABUS
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The Power of Rural Partnerships project is funded in part (68%) by a grant awarded under the President's
Community Based Job Training Grants, as implemented by the U.S. Department of Labor's Employment
and Training Administration
COLLEGE OF SOUTHERN IDAHO
NURP 113 - THERAPEUTIC NUTRITION
Credit: 1
COURSE DESCRIPTION:
A study of the application of normal nutrition to the health care setting with emphasis on
nutrition assessment. This includes the examination of diet therapy and knowledge of its
application in supporting health and treating diseases and symptoms.
INSTRUCTOR: Dr. Pam Holloway, PhD, RN
208-732-6720
pholloway@csi.edu
HOURS REQUIRED EACH WEEK:
A minimum of one hour each week is spent in class participation on-line. The course
will require that additional hours be spent in the completion of textbook reading
assignments, review of current literature in therapeutic nutrition, and completion of
critical thinking application assignments.
REQUIRED TEXTBOOK:
Nix, S. (12th Ed., 2009). William's Basic Nutrition & Diet Therapy. St. Louis, MO:
Mosby.
COURSE OBJECTIVES:
The Therapeutic Nutrition student will:
1) Utilize knowledge learned in Normal Nutrition and make clinical application to the
client with nutritional deficits related to medical conditions.
2) Discuss health problems, medications, and complementary therapies.
3) Demonstrate an understanding of nutrition screening and assessment, as well as
identifying the need for intervention.
4) Identify the need for and discuss the application of modified and other diets for
patients with to GI Tract Disorders.
5) Identify the need for and discuss the application of enteral formulas.
6) Identify the need for and discuss the application of parenteral nutrition.
7) Identify the need for and discuss the application of modified diets for patients with
diabetic disorders.
8) Identify the need for and discuss the application of modified diets for patients with
diseases of the renal system.
9) Identify the need for and discuss the application of modified diets for patients with
cardiovascular diseases.
10) Identify the need for and discuss the application of modified diets related to surgical
patients.
11) Identify the need for and discuss the application of modified diets for patients with
cancer.
12) Identify the need for and discuss application of modified diets for patients with
acquired immune deficiency syndrome (AIDS).
ATTENDANCE POLICY:
On-line attendance is an integral part of this course. Students will have a weekly
quiz/assignment that must be completed on the discussion board. This will count as a
quiz grade. If it is necessary for a student to not complete the weekly assignment(s)
and/or discussion board participation, the instructor must be contacted IN ADVANCE
to determine if permission will be given to make up any work missed because of that
absence.
LATE POLICY:
Students are expected to turn in course assignments at the time designated by the
instructor, or early if desired. Late work is accepted; however a grade reduction will
occur. If an assignment is late, 10% of the total points will be deducted each day up to
the 3rd day. NO CREDIT will be given after 3 days. Assignments on the discussion
board, however, must be during the posted week in order to receive any credit,
STUDENTS WITH DISABILITIES:
Any students with documented disabilities may be eligible for related accommodations.
To determine eligibility and secure services, students should contact the coordinator of
Disability Services at their first opportunity. Student Disability Services is located on the
second floor of the Taylor Building on the Twin Falls campus. 208-732-6250 (voice) or
208-734-9929 (TTY).
HONESTY POLICY:
Students are expected to be honest in all aspects of their college education. All work is
evaluated on the assumption that the work presented is the student's own. Anything less
is unacceptable and is subject to initial disciplinary action at the teacher's discretion. This
will include, at a minimum, no credit for the assignment/quiz/test in question. For
student appeals, refer to section on Discipline Appeal in the College Student Handbook.
If an assignment is to be a group assignment, it will be clearly designated as such. In all
other instances, the work is to be done by the student as an individual, without assistance
from others.
All written work which includes material which is either directly quoted or in which any
portion is paraphrased from another source, MUST BE REFERENCED. FAILURE TO
DO SO IS PLAGIARISM AND IS CONSIDERED DISHONESTY. This includes both
published and unpublished works, instructor's works, and other students' works.
GRADING POLICY:
Grades in NURP 113 (Therapeutic Nutrition) are based assignments, on-line attendance
and participation, quizzes, a final exam, and written assignments.
Discussion Board Assignments (Quiz grade): 30 pts. each:
Case Studies, One through Six: 40 points each:
210 points possible total
240 Points possible
Final Exam: 100 Points possible
TOTAL POINTS POSSIBLE:
A=
495 - 550 Points earned
B=
440 - 494 Points earned
C=
385 - 439 Points earned
D=
330 - 384 Points earned
F=
329 points and below
550
WITHDRAWAL FROM COURSE:
It is the student's responsibility to withdraw from the course if you choose not to
continue. The instructor cannot withdraw you. If you do not withdraw, you will
receive an "F" or whatever grade you have earned.
SPECIAL WRITTEN ASSIGNMENTS:
CASE STUDIES
Assignment:
Review each case study assigned. Perform research as needed to answer the questions
accompanying each case study. Answers must be typed. Neatness counts! Each
individual case study is worth 40 points. Turn in on the due date assigned. Use complete
sentences. Each Case Study should be a MINIMUM of one type-written page.
HAND-IN AS AN ATTACHMENT TO AN E-MAIL TO PHOLLOWAY@CSI.EDU.
THERAPEUTIC NUTRITION
CASE STUDY #1
Sudah P. is a 22-year-old recent college graduate who began her first professional job in a
marketing firm one month ago. As a college student, she occasionally experienced
abdominal pain and cramping after eating. She also experienced frequent bouts of
diarrhea and noticed that she felt better for a while after a bowel movement. Once Sudah
began her new job, she noticed that her symptoms were occurring more frequently. At
first she attributed her symptoms to the stress related to her new job, but when the
symptoms continued for several months, she decided to see her physician. Sudah is 5
feet 3 inches tall and weighs 118 pounds. After taking a careful history and conducting
several tests to rule out other bowel disorders, the physician diagnosed irritable bowel
syndrome. The physician prescribed bulk-forming agents and advised Sudah to keep a
food intake and symptoms record for one week. Sudah was then referred to a
nurse/dietitian to review the records and recommend appropriate dietary suggestions. In
reviewing Sudah's food intake records, it was noticed that Sudah eats many traditional
Indian foods, which are highly seasoned and often contain legumes. Sudah says that she
began to drink coffee and caffeinated cola drinks in college so that she could study for
longer periods of time. She has continued to drink coffee since that time.
1) How would you explain irritable bowel syndrome to Sudah? Be specific. Use
language that will be easy to understand.
2) What role does stress play in irritable bowel syndrome? Be specific.
3) Can Sudah's diet be responsible for causing irritable bowel syndrome? Why or why
not? Can any of these foods or food components aggravate her symptoms?
4) What type of diet benefits people with irritable bowel syndrome? Be specific.
5) What problem(s) can this diet cause?
THERAPEUTIC NUTRITION
CASE STUDY #2
Charles Carter is a successful young businessman who works long hours and carries the
major responsibility of his struggling small business. At his last physical checkup, the
physician cautioned him about his pace because he was already showing some mild
hypertension. His blood cholesterol was elevated, and he was overweight. In his desk
job he got little exercise and found himself smoking more and eating irregularly under the
stress of his increasing financial pressures. One day while commuting in the heavy
freeway traffic, he felt a pain in his chest and became increasingly apprehensive. When
he arrived home, the pain persisted and increased. He broke out into a cold sweat and felt
nauseated. When he became more ill after trying to eat dinner, his wife called their
physician and Mr. Carter was admitted to the hospital. After emergency care and tests,
the doctor placed Mr. Carter in the coronary care unit at the hospital. His test results
showed elevate total cholesterol, triglycerides, and lipoproteins, especially LDL, but low
HDL. The electrocardiogram revealed an infarction of the posterior myocardium wall.
When Mr. Carter was first able to take oral nourishment, he had only a liquid diet. As his
condition stabilized, his diet was increased to 800 kcal (soft diet) with low cholesterol
and low fat. By the end of the first week, his diet was increased again to 1200 kcal (full
diet) with low cholesterol and only 25% of the total kcalories from fat and a
polyunsaturated/saturated ratio of 1:1. Mr. Carter gradually improved over the next few
days and was able to go home. The physician, nurse, and dietitian discussed with Mr.
Carter and his wife the need for care at home during a period of convalescence. They
explained that he had an underlying lipid disorder and was to continue his weight loss
and follow a TLC (Therapeutic Lifestyle Changes) diet.
1) Identify factors in Mr. Carter's personal and medical history that place him at high risk
for coronary heart disease. Give reasons why each factor contributes to heart disease.
2) Identify as many of the laboratory tests the physician ordered as you can. Relate these
tests to Mr. Carter's condition.
3) Why did Mr. Carter receive only a liquid diet at first? What is the reason for each
modification in his first diet of solid food?
4) What occurs in the underlying disease process that causes a heart attack? What
relation do fat and cholesterol have to this underlying process?
5) What needs might Mr. Carter have when he goes home? How would you help him
prepare to go home? Name some community resources you might use to help him
understand his illness and plan self-care.
THERAPEUTIC NUTRITION
CASE STUDY #3
Richard Smith, age 21, has type 1 diabetes mellitus. He gives himself two injections a
day, each a combination of medium-acting insulin and regular short-acting insulin. He
does one injection before breakfast and one before dinner and usually tests his blood
glucose level before each meal and at bedtime. Richard is a college student, who is
usually active in athletics. However, this is final exam week and Richard's schedule is
irregular. He is putting in long hours of study and is under considerable stress. On the
day before a particularly difficult examination, he is reviewing his study materials at
home and forgets to do his blood test or eat lunch. About mid-afternoon, he begins to
feel faint and realizes that his blood glucose is low and an insulin reaction is imminent if
he does not get a quick source of energy. He looks in the kitchen, and all he can find is
orange juice, milk, butter, a loaf of bread, and a jar of peanut butter.
1) Which of the four foods should Richard eat immediately? Why?
2) Later, when he is feeling better, Richard makes a peanut butter and butter sandwich,
pours a glass of milk, and eats his snack while he continues studying. What carbohydrate
food sources of energy are in his snack?
3) Are these carbohydrates sources in a form that the cells can burn for energy? What
changes must Richard's body make in these sources to get them into the basic
carbohydrate fuel form? What is the complex form of carbohydrate in his snack? Why is
this a valuable form of carbohydrate in his diet? What is the basic form of carbohydrate
fuel circulating in the blood for use by the cells?
4) What is the relationship of carbohydrate and fat in the final production of energy in
the body? If Richard did not take his insulin to provide the necessary control agent for
metabolizing the carbohydrate, what would happen to him as the result of improper
handling of fat and accumulation of ketones? Be specific.
THERAPEUTIC NUTRITION
CASE STUDY #4
Charles Brown, age 49, is an active man working at a large company who has begun to
tire more easily. He has little appetite and feels generally ill most of the time. He
recently noticed some ankle swelling and some blood in his urine. At his wife's
insistence, he finally decided to see his physician. After a complete work-up, his
physician's findings included the following:
1. No prior illness except a case of the flu with a throat infection during Charles'
overseas service in the Army.
2. Laboratory tests: albumin, red and white cells in the urine; abnormal blood urea
nitrogen and glomerular filtration rate.
3. Other symptoms: hypertension, edema, headache, occasional vision blurring, and
low-grade fever
The physician discussed the findings and the serious prognosis of advanced renal disease
with Charles and his wife, and together they explored the immediate medical and
nutritional needs for treatment. They also discussed the ultimate need for medical
management with dialysis. The physician prescribed medications to control Charles'
growing symptoms and discomfort. As time went by, Charles' symptoms increased. He
lost more weight, was anemic, and experienced increased bone and joint pain.
Gastrointestinal bleeding and nausea also increased, and he had occasional muscle
twitches or spasms. Small mouth ulcers made eating a painful effort. Charles and his
wife made visits to the clinic dietitian to learn how to manage his present predialysis diet
at home.
1) What metabolic imbalances in chronic renal failure do you think accounted for the
symptoms Charles was having?
2) What are the objectives of treatment in chronic renal failure?
3) What are the basic principles of Charles' predialysis diet? Describe this type of diet.
What foods would be included?
4) What nutrient-related medications and supplements would Charles' physician
probably use in his treatment plan? Why?
THERAPEUTIC NUTRITION
CASE STUDY #5
After long experience with persistent peptic ulcer disease involving more and more
gastric tissue, John and his physician decided that surgery was needed. John then entered
the hospital for a total gastrectomy. John withstood the surgery well and received some
initial nutritional support from an elemental formula fed through a tube the surgeon had
placed into his jejunum. After a few days, the tube was removed and, over the next 2week period, John was gradually able to take a soft diet in small oral feedings. He soon
recovered enough to go home and gradually felt his strength returning. He was relieved
to be free of his former ulcer pain and began to resume more and more of his usual
activities, eating a regular diet of increasing volume and variety of foods. However, as
time went by John began having more discomfort after meals. He felt a cramping
sensation and increased heartbeat, and then a wave of weakness with sweating and
dizziness. John would often become nauseated and vomit. As his anxiety increased, he
began to eat less and less and his weight began to drop. He was soon in a state of general
malnutrition. John finally returned to seek medical help. The physician and clinical
dietitian outlined a change in his eating habits, and a special food plan was worked out
for him. Although the diet seemed strange to him, John followed it faithfully because he
had felt so ill. To his surprise, he soon found that his previous symptoms after eating had
almost completely disappeared. Because he felt so much better on the new diet plan, he
formed new eating habits around it. His weight gradually returned to normal, and his
state of nutrition improved. John found that he would always fare better if he would
"nibble" on food items throughout the day rather than consume large meals as he used to
do.
1) What were John's nutritional needs immediately after surgery and over the next 2
weeks? Why was it necessary for his feedings to be resumed cautiously?
2) Why is emphasis given to post surgical protein sources? How should this nutrient be
provided?
3) Why is fluid therapy paramount after surgery?
4) What minerals and vitamins need special attention after surgery? Why?
5) When John began to feel better and resumed regular eating, why did he become ill?
Describe his symptoms and why they developed.
THERAPEUTIC NUTRITION
CASE STUDY #6
Mr. J., a 48-year-old history professor, has a blood lipid profile that includes elevated
LDL cholesterol. He is 5 feet 7 inches tall and weighs 200 pounds. Mr. J. has a family
history of CHD. His diet history shows excessive intakes of food energy, cholesterol,
total fat, saturated fat, and salt. He smokes a pack of cigarettes a day, and his lifestyle
leaves him little time for physical activity. Mr. J. also has hypertension, for which
antihypertensive agents have been prescribed. He frequently forgets to take his pills,
though, and his blood pressure is often quite high.
1) Name the risk factors for CHD in Mr. J's history. Which of them can be controlled?
Which can be helped by diet?
2) What type of diet would you recommend to treat his high LDL cholesterol and
hypertension? Explain the reasons for each change.
3) What laboratory and clinical tests would you expect to see monitored regularly?
4) Name at least three ways in which Mr. J. could benefit from losing weight. How
could he benefit from a regular physical activity program?
5) What immediate nutrition considerations would need to be made if Mr. J. should
suffer a heart attack or stroke?
COURSE SCHEDULE
NOTE: All case studies may be done and turned in ahead of time, but MUST be
completed by the scheduled due date to get full credit. Participation on the
Discussion Board, however, MUST BE COMPLETED WEEKLY TO RECEIVE
CREDIT. IT CANNOT BE DONE AHEAD OF TIME, AND CANNOT BE MADE
UP.
DURING THE WEEK OF:
1/20-1/23: Orientation to Course: Review "Orientation to Course" in Course
Documents and syllabus on Blackboard. Take time to find your way around blackboard
so that you are able to utilize each learning area. E-mail Dr. Holloway at
pholloway@csi.edu with any questions that you have. Print yourself out a copy of the
Course Schedule and put it somewhere that will be easy for you to find and follow.
1/26 - 1/30: Chapter 17: Nutritional Care. Read Chapter 17 in your text. Review power
points and lecture notes for Chapter 17. Participate in Discussion Board in a substantive
manner at LEAST twice during the week. E-mail Dr. Holloway if you have any
questions or concerns.
2/2-2/6: Chapter 18: - Gastrointestinal & Accessory Organ Problems: Read Chapter 18
in your text. Review power points and lecture notes for Chapter 18. Participate in
Discussion Board in substantive manner at LEAST twice during the week. E-mail Dr.
Holloway if you have any questions or concerns.
2/9 - 2/13: Complete Case Study #1 - Due 2/13. Turn in Case Study #1 as an
attachment in an e-mail to pholloway@csi.edu. E-mail Dr. Holloway if you have any
questions or concerns.
2/17 - 2/20: Chapter 19 - Coronary Heart Disease & Hypertension: Read Chapter 19 in
your text. Review power points and lecture notes for Chapter 19. Participate in
Discussion Board in substantive manner at LEAST twice during the week. E-mail Dr.
Holloway if you have any questions or concerns.
2/23 - 2/27: Complete Case Study #2 - Due 2/27. Turn in Case Study #2 as an
attachment in an e-mail to pholloway@csi.edu. E-mail Dr. Holloway if you have any
questions or concerns.
3/2-3/6: Chapter 20 - Diabetes Mellitus: Read Chapter 20 in your text. Review power
points and lecture notes for Chapter 20. Participate in Discussion Board in substantive
manner at LEAST twice during the week. E-mail Dr. Holloway if you have any questions
or concerns.
3/9-3/13: Complete Case Study #3 - Due 3/13. Turn in Case Study #3 as an attachment
to pholloway@csi.edu. E-mail Dr. Holloway if you have any questions or concerns.
3/23-3/27: Chapter 21 - Renal Disease: Read Chapter 21 in your text. Review power
points and lecture notes for Chapter 21. Participate in Discussion Board in substantive
manner at LEAST twice during the week. E-mail Dr. Holloway if you have any
questions or concerns.
3/30-4/3: Complete Case Study #4 - Due 4/3. Turn in Case Study #4 as an attachment to
pholloway @csi.edu. E-mail Dr. Holloway if you have any questions or concerns.
4/6-4/10: Chapter 22 - Surgery & Nutritional Support: Read Chapter 22 in your text.
Review power points and lecture notes for Chapter 22. Participate in Discussion Board
in substantive manner at LEAST twice during the week. E-mail Dr. Holloway if you
have any questions or concerns.
4/13-4/17-: Completed Case Study #5 - Due 4/17. Turn in Case Study #5 as an
attachment to pholloway@csi.edu. E-mail Dr. Holloway if you have any questions or
concerns.
4/20-4/24: Chapter 23 - Nutritional Support in Cancer & AIDS: Read Chapter 23 in
your text. Review power points and lecture notes for Chapter 23. Participate in
Discussion Board in substantive manner at LEAST twice during the week. E-mail Dr.
Holloway if you have any questions or concerns.
4/27-5/1: Completed Case Study #6 - Due 5/1. Turn in Case Study #6 as an attachment
to pholloway@csi.edu. E-mail Dr. Holloway if you have any questions or concerns.
5/4-5/8: Final opens 5/4. Final must be completed by 5/8 . Final will be open book.
ADDITIONAL TIPS FOR ON-LINE STUDENTS:
- Don't be afraid to ask questions :-) If this is your first on-line class, I will be glad to
help you in any way I can to get used to the format! We are in this together, and we will
get through it together. If you feel the need, give me a call and we can discuss your
concerns in person (208-732-6720). I have a lot of experience teaching and taking online classes, and will be more than glad to share my experience with you!
- Participation in the Discussion Board: Each week I will be posting questions to get you
started on the Discussion Board. Your initial post must be a minimum of 150 words.
Subsequent postings in other students' threads must be substantive in order to receive
credit. Just saying that "I agree with what you said," is not substantive. You must add to
the thought or idea to get credit.
- What if I have a concern about the case studies? Just ask me--that is what I am here for
:-)
- What if I have a concern about my grade? I will be communicating with you by
personal e-mail if I am concerned about your progress in the class. Don't hesitate to talk
to me. I will be glad to answer your questions.
- What if my computer isn't working, or I can't get inter-net service? This is your
responsibility during this class. I would suggest that you come up with a back-up
plan--College computer labs, a neighbor's computer, etc. Because it is your
responsibility, it will not be an excuse for non-participation or late assignments.