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FSHN 461/561 Course Syllabus Fall 2014
Medical Nutrition and Disease I
Instructor: Katie Smith, PhD, RDN
Email: [email protected]
Office: 211 MacKay Hall
Office Hours: Tuesday/Thursday by appointment. Please email to make an appointment.
Class Meeting Times: Tuesday/Thursday 10:00AM-11:50PM, Carver 305
Last day to drop without extenuating circumstances: October 31, 2014
Teaching Assistant: Lyndi Buckingham, RDN at [email protected]
Course Catalog Description: Medical Nutrition and Disease I. (Dual-listed with NutrS 561). (4-0) Cr. 4. F. Prereqs:
FSHN 360, 361, 367; BIOL 256 and BIOL 256L OR BIOL 306 OR BIOL 335. 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 before 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. Nutrient composition of common foods in the United States diets.
6. Medical terminology and clinical conversions.
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 implement 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,
assessments, and case studies the students will have knowledge of the following:
1. Scientific and Evidence Base of Practice: integration of scientific information and research into practice.
KRD1.1 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 evidencebased practice.
2. Professional Practice Expectations: beliefs, values, attitudes and behaviors for the professional dietitian
level of practice.
KRD2.1 The curriculum must include opportunities to develop a variety of communication skills sufficient for
entry into pre-professional practice.
KRD2.3 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.
KRD3.1 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.
Course Objectives and 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 evidencebased 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. Identify and describe the roles of others with whom the Registered Dietitian collaborates in the delivery of
food and nutrition services (D7).
6. 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).
7. Apply knowledge of the role of environment, food and lifestyle choices to develop interventions to affect
change and enhance wellness in diverse individuals and groups (D9).
REQUIRED TEXTS: These texts will all be used in the spring semester and 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 4th ed.,Wadsworth/Thomson
Learning, 2013. Note: we will only complete one case study from this book this semester but will use this book
for approximately 4 case studies in 464/564. Many internships use this book also.
C. Pronsky ZM. Food Medication Interactions. 17th ed. Birchrunville, PA: Food-Medication Interactions, 2012.
Note: There will be a more updated version published later this fall. You will not be required to purchase the new
version for FSHN 464 but may opt to so you have the most recent publication to take with you into your future
practice.
D. International Dietetics & Nutritional Terminology (IDNT) Reference Manual: Standardized Language for the
Nutrition Care Process, 4th ed. Chicago, IL: American Dietetic Association, 2013.
OR
eNCPT: Nutrition Terminology Reference Manual. This is the electronic version of the former
IDNT as the IDNT will no longer be published in print. It is available for purchase at http://ncpt.webauthor.com
for Academy Student members for an annual fee of $25 ($100 for non-members). Thus, I recommend becoming
a member of the Academy of Nutrition & Dietetics (for many reasons). You may use the 4th edition of IDNT for
this course OR the eNCPT but you will need to document which version you use in any assignments utilizing this
resource. DO NOT use anything earlier than the 4th edition of IDNT.
Optional but extremely useful texts include:
ADA pocket guide to nutrition assessment. 2nd ed. Eds: Charney P, Malone A. Chicago, IL: American
Dietetic Association, 2008.
Hark L, Morrison G. Medical Nutrition & Disease: A Case-Based Approach. 3rd ed. Malden, MA:
Blackwell Publishing, 2004.
Mahan LK, Escott-Stump S, Raymond JL. Krause’s Food & the Nutrition Care Process. 13th ed.
Philadelphia, PA: WB Saunders Co., 2012. This text is similar to Nelms.
Fischbach. A Manual of Laboratory Tests. 8th ed. Lippincot, Williams, & Wilkins, 2008.
POLICIES
Attendance: Attendance in the classroom is expected each week although not required. Unannounced quizzes
and activities may occur for class credit and cannot be made up for points if you are not in class. If you are going
to miss a class, please coordinate getting the notes from another student in class. You do not need to notify me
of your absence unless it will be for an extended period of time. If you will be gone for a school sponsored
function on the day of an examination, you are allowed to make-up the exam if you notify me at least 10 days
prior to the exam, except when such notice is not possible (Section 10.4.3 of Faculty Handbook). Please provide
documentation for your school sponsored event. In order to provide the most productive learning environment
possible, please be respectful of the instructor and your peers around you- texting, use of electronics outside of
class purposes, disruptive talking, studying for another course, etc. will result in dismissal from the classroom.
Materials: You will need to bring a small, basic function calculator to class each day. You may also use your
calculator on exams, but it must be a simple, basic function calculator. No scientific calculators, cell phones, or
sharing of calculators will be allowed during quizzes or exams. Several worksheets and course handouts will be
posted to the course webpage prior to class. Please print these documents and bring them with you to class.
They will be essential to you learning the material both in class and for practicing the concepts outside of class.
Assignments: You will complete three case studies, one reference assignment, a Technology Tidbit presentation,
and one reflection (completed in two-parts) in this course. Late assignments of any sort will not be accepted
without documentation from a health care practitioner for medical reasons. Late work can be turned in to
receive feedback but will receive zero points. If you will be absent in class the day an assignment is due, please
plan to turn it in early or send it with a classmate to turn in on time (NOTE: “My friend must not have turned in
my assignment” will not constitute an excuse for missing work. So choose your friends wisely .) Assignments
are due at the beginning of class. Late assignments are defined as assignments turned in fifteen minutes or later
after class begins (therefore 10:16AM is late). Please staple all assignments greater than one page in length
except for group case studies (use a binder clip).
Case studies: Three case studies will be completed throughout the semester. Disease states (DM, obesity,
nutrition support) 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 state. If a diet analysis is required, always
provide documentation (e.g. print-outs of actual foods entered and summary nutrient analysis reports). If you
are asked to use a growth chart, please submit this as well. Failure to include necessary documentation will
result in a deduction of points. You must show all work (word-processed) for calculations in each case study and
justify/explain your clinical judgment. Your answers must be concise, thorough, tidy and legible (yes, word
processed) and in your own words (not those found in a text). If the case study is to be completed in a group
you will be assigned to groups. One hard copy per group is due at the beginning of class (see “Assignments” for
details). Group case studies should NOT be stapled; use a binder clip (the Nutrition Support case study will be
completed individually and stapled). Each group member will receive the same grade. Expect it to take ~3
weeks for these to be graded (the NS case study will take less time). References should be cited on a final page
using the JAND format (instructions for authors found on the Journal’s website) unless otherwise specified.
561: Additional questions for each case study will be asked. These advanced application questions will
be require a greater knowledge base, additional critical thinking, and literature searches. These will be
completed independently.
Technology Tidbit: Each student will work in a group of three to develop and present a 4-5 minute presentation
(present 3-4 mins and allow 1 min for Q & A) on a nutrition-related electronic resource (e.g. mobile app,
website, etc.). Examples of some appropriate mobile applications include but are not limited to: Calorie King,
growth charts, Lenny the Lion (Diabetes), MyFitnessPal, IDNT application, and the Evidence Analysis Library.
Minimum content that must be covered includes: name of the resource, cost, purpose & pertinent features, and
how it may be useful as a future health care professional. You will create a maximum of a six slide presentation
(including title slide) and send both the PowerPoint file and the 1-page PDF of the PowerPoint slides via email to
the instructor at least 24 hours prior to the start of class on the day you present. All group members must
participate in the development of the material and verbal presentation. Each member will receive an individual
grade for the project (see rubric on Blackboard).
Assessments: You will take three assessments in the Testing Center throughout the course of the semester.
These assessments are intended to help you become proficient with content that is utilized on a very regular
basis by clinical dietitians. Resources such as textbooks, notes, etc. are not allowed during the assessment but a
simple function calculator and scratch paper will be provided by the testing facility (you are not allowed to bring
in your own). You will have 1-hour to complete each assessment. Assessments will be open for a period of three
days and you may take each assessment a maximum of two times. Your best score will be used. The assessments
will be completed on Blackboard Learn but must be completed in the Testing Center (2552 Gilman Hall or 60
Carver Hall). Please see the Testing Center website for hours and facility policies:
http://www.elo.iastate.edu/online-testing-center/. Questions may consist of multiple choice, matching, fill-inthe-blank (correct spelling is required), and clinical math (correct rounding is required). Content for these
assessments will remain the same for all three assessments (except Drug-Nutrient Interactions) and include:
clinical math (conversions, BMI, IBW, % IBW, % weight change), nutrition assessment (proper usage of body
weights and energy needs equations, biochemical lab values), DRIs (definitions and recommended values),
AMDRs, 2010 Dietary Guidelines for Americans, Diabetes Exchange System, medical abbreviations, medical
terminology, metabolism, Nutrition Care Process, Medicare/Medicaid, and common Drug-Nutrient Interactions
(DNI only on the 2nd & 3rd assessments). To summarize, use the 461 Study Guide, and the lectures from the first
unit to focus your studying.
Exams: Three exams will consist of multiple choice, matching, fill-in-the-blank, short answer, essay, and case
study scenarios. No make-up exams will be given without documentation from a medical professional or for a
school sponsored event. Study guides will not be provided. Many students ask if the exams are cumulative. The
answer is: Yes and no. You are building on everything you learn and must be able to apply it to your patients.
Will you be asked specific questions about the metabolism of diabetes on the final exam (material covered on a
previous exam)? No. Will you be expected to understand why your obese patient (material covered for third
exam) might be at risk for diabetes (material covered on second exam) and to describe appropriate dietary
recommendations? Yes. You will be allowed to view your exams in class approximately two weeks after the
exam (time frame dependent upon if any case studies, etc. are pending). Exams must be returned to the
instructor or TA prior to leaving the classroom or you will receive a zero for the exam. If you need additional
time to review your exam, please schedule an appointment with the teaching assistant.
Grading: Grades in this course will be based on the total number of points available throughout the semester.
You may keep track of your points below to know your grade in the course at any time. In order to ensure
fairness in grading, please refrain from using your name on your exams and case studies; instead use your
student ID number. Note: This is a 400/500-level course and I believe every course (particularly at this level) is
responsible for teaching writing, thus writing will enter into your grading. This is in alignment with the ISUComm
and WOVE (written, oral, visual, and electronic) curriculum. Even if it was not intended to grade on writing
ability, judgment is negatively influenced when it is a struggle to read poor handwriting or surmount poor
grammar and sentence structure. If I can’t read it- I can’t grade it! If you are in need of assistance with writing,
please contact the Writing and Media Center at 515-294-1020. It is located at 1010 Student Services Building.
More information can be located on their website: http://www.dso.iastate.edu/wmc.
Assignment
Case studies (3)
FSHN 461 (points)
130 (50, 50, 30
points)
FSHN 561 (points)
180 (75, 75, 30 points
each)
20
20
10
10
75
(25 pts each)
10
10
75
(25 pts each)
Exams (3)
(Exam #1=50 pts)
250
250
Total
495
545
Reference
Assignment (1)
Technology Tidbit
Reflection (1)
Assessments (3)
Grade
A
AB+
B
B-
Grade points (%)
4.0 (93-100)
3.7 (90-92.9)
3.3 (87-89.9)
3.0 (83-86.9)
2.7 (80-82.9)
C+
C
CD+
D
F
Your points
Your total:
(Divide your total by
495 or 545)*100
2.3 (77-79.9)
2.0 (73-76.9)
1.7 (70-72.9)
1.3 (67-69.9)
1.0 (60-66.9)
0.0 (below 60)
Contact Lyndi Buckingham at [email protected] (Course TA) for general questions about the course or
assignments. To schedule an appointment with Dr. Smith on Tuesdays or Thursdays, please email
[email protected]. To meet with either of us, please be prepared and bring your questions, a list of possible
solutions, and be ready to give us a brief review of the “patient” and clinical case. We are always willing to go
over an exam, case study, etc.; however, please note that the grading may change either positively or negatively
(to ensure consistency of grading for all students). If you are meeting to discuss grading, please email a
paragraph to the instructor/TA explaining why your proposed answer is the correct answer, or why you deserve
a higher grade. This paragraph should be sent no later than two hours before the meeting and the meeting can
be scheduled for 2-5 school days after the assessment is returned.
Letters of Recommendation: If you plan to request a letter of recommendation, please notify me via email by
December 1st. I would like to get to know you, your future plans, etc. to be able to write the most informed
letter I can for you. To best accommodate this, please schedule an individual meeting with me by December 17 th
and submit the following materials in a manila envelope to me at least three days prior to the meeting:
resume/CV, list of programs you are applying to/requesting a letter for, and a written summary (2-3 paragraphs)
of your future career goals and how you have prepared yourself for the next phase of your academic and/or
professional career.
Dead Week Policy: This course follows the ISU Dead Week policy (Section 10.6.4 of the Faculty Handbook). The
final examination time will be determined by the ISU Academic Calendar and Registrar and will not be adjusted
by the course instructor. Please plan in advance and coordinate your holiday travel after the scheduled exam
time.
Academic Misconduct: The class will follow Iowa State University’s policy on academic dishonesty. Academic
Misconduct in any form is in violation of Iowa State University Student Disciplinary Regulations and will not be
tolerated. This includes, but is not limited to: copying or sharing answers on tests or assignments, plagiarism,
and having someone else do your academic work. Anyone suspected of academic dishonesty will be reported to
the Dean of Students Office. Any student found cheating or plagiarizing will receive an “F” or “0” for the course.
Please refer to the ISU catalog for specifics on Academic Dishonesty:
http://catalog.iastate.edu/academiclife/regulations/#academicdishonestytext, or
http://www.dso.iastate.edu/ja/academic/misconduct.html.
Disability Accommodation: Iowa State University complies with the Americans with Disabilities Act and Sect 504
of the Rehabilitation Act. If you have a disability and anticipate needing accommodations in this course, please
contact me to set up a meeting within the first two weeks of the semester or as soon as you become aware of
your need. Before this meeting, you will need to obtain a Student Academic Accommodation Request (SAAR)
form with recommendations for accommodations from the Disability Resources Office, located in Room 1076 on
the main floor of the Student Services Building. Their telephone number is 515-294-7220 or email
[email protected] . Retroactive requests for accommodations will not be honored.
Course Schedule (subject to change)
Date
Topic
T: 8/26
Welcome; Overview
Th: 8/28
Patient assessment
SOP/SOPP
Pt assessment practice
T: 9/2
Biochemical review
Readings*
Nelms: Ch. 2
Nelms: Ch. 2,3
Assignments Due
J Acad Nutr Diet
2013;113:S29-45
Nelms: Ch. 3
Malnutrition
Consensus Stmt
Th: 9/4
T: 9/9
Th: 9/11
T: 9/16
Th: 9/18
T: 9/23
Th: 9/25
Biochemical assessment
NCP Medical Charting – using the
IDNT book/eNCPT (bring to class)
Nutrient/Food-Drug Interactions
*Bring pocket drug book
Type 1 Diabetes (DM1)
Diabetes Diagnostic Criteria
Diabetes Activity
Exam #1 (through 9/11) 50 pts
Diabetes & MNT
Nelms: Ch. 3
Nelms: Ch. 2,6
Assignment #1- Referencing
Assessment #1 open Sep. 8 – 10
Nelms: Ch. 11
Nelms: Ch. 17
Diabetes Care
2013;36:S67-S74
Diabetes Care
2013;1-22
T: 9/30
Diabetes & MNT cont.
Diabetes Medications
Th: 10/2
Diabetes Medications
T: 10/7
Type 2 Diabetes (DM2)
Nelms: Ch. 17
Diabetes Activity
Th: 10/9
Diabetes
T: 10/14
HUNGER SUMMIT
Th: 10/16 CVD
Nelms: Ch. 13
T: 10/21
CVD diet
Th: 10/23 CVD: HTN
T: 10/28
CVD: CHF
Th: 10/30 Obesity
Nelms: Ch. 12
T: 11/4
Exam #2: (through CVD)
Th: 11/6
PA & Weight Management
T: 11/11
Bariatric Surgery
Th: 11/13 Nutrition Support
Nelms: Ch. 5
NS calculations
T: 11/18
Nutrition Support
Th: 11/20 NS calculations
T: 11/25
No class- Thanksgiving break
Th: 11/27 Thanksgiving-no class
T: 12/2
NS calculations
Th: 12/4
End-of-Life
T: 12/9
End-of Life Decision Making
Guest Lecturers
Th: 12/11 Review
Bring resources.
Th: 12/18 Final Exam 9:45-11:45AM
Exam time/date is
*Additional readings will be posted on Blackboard Learn.
Case Study #1: Diabetes
Assessment #2 open Oct. 20 – 22
Reflection Part 1
Reflection Part 2
Case Study #2: Obesity
Assessment #3 open Dec. 1 – 3
Case Study #3: Nutrition Support
tentative per ISU exam schedule