1 
                                                     Department of Nutrition 
                                              Gillings School of Global Public Health 
                                             University of North Carolina at Chapel Hill 
                                                                 
                                NUTRITION 640: Medical Nutrition Therapy I:  Chronic Diseases 
                                                         SPRING 2015 
                               Tuesday and Thursdays, 9:30am-10:45am, Room 228 Rosenau Hall 
                
               I.      Course Description 
                       A lecture and skills course where students practice skills (such as calculating caloric intake and 
                       modifying intake, calculating diabetic diets, calculating sodium content of intakes, etc.) under the 
                       supervision of a Registered Dietitian. Nutrition 611 and 630 or equivalents are required as a 
                       prerequisite or as a co-requisites. 
                
               II.     Instructor 
                              Amanda S. Holliday MS, RD, LDN 
                              Office: 261 Rosenau 
                              Office Hours: By Appointment 
                              Telephone: 966-7214 
                              Email: 22TUamanda_holliday@unc.eduU22T 
                              Twitter:  @amandasholliday 
                
               III.    Textbooks 
                       Required: 
                                                                                                    th
                           Mahan, K. and Escott-Stump, S. Krause’s Food, Nutrition and Diet Therapy, 13P P Edition 
                           Nelms, M, Long, S and Lacey, K.  Medical Nutrition Therapy:  A Case Based Approach, 4th 
                            Edition, 2014.   
                                                                             th
                           Pronsky, Zaneta M. Food-Medication Interactions. 18P P Edition, 2012. 
                           eNCPT 22Thttps://www.eatright.org/shop/product.aspx?id=644248202622T (Please wait to 
                            purchase until discussed in class) 
                
                       Other resources:  
                           Academy of Nutrition and Dietetics web site: 22Twww.eatright.org22T for Position Papers link (along 
                            left side of home page) and other menu items of interest (explore and learn more about the 
                            profession) 
                           Sakai website.  Please sure to download the zip file titled Coursepack Download.   
                           ADA Nutrition Care Manual (www.nutritioncaremanual.org), ADA Evidence Analysis Library 
                            (www.adaevidencelibrary.com) 
                           Chair’s Office (main waiting area) contains supporting text 
                            -  A physiology text and a medical dictionary  
                
               IV.     Student Learning Outcomes covered in this course: 
                             CRD 1.2 Apply evidence-based guidelines, systematic reviews and scientific literature 
                              (such as the Academy’s Evidence Analysis Library and 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 and 
                              model and other areas of dietetic practice. 
                             CRD 3.1b Diagnose nutrition problems and create problem, etiology, signs and 
                              symptoms (PES) statements 
                             CRD 3.1c  Plan and implement nutrition interventions to include prioritizing the nutrition 
                              diagnosis, formulating a nutrition prescription, establishing goals and selecting and 
                              managing intervention 
                             CRD 3.1d Monitor and evaluate problems, etiologies, signs, symptoms and the impact of 
                              interventions on the nutrition diagnosis 
                             CRD 3.1e Complete documentation that follows professional guidelines, guidelines 
                              required by health care systems and guidelines required by the practice setting 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              2                                           
                                                                             
                                                                                                                 By the end of this course students will have demonstrated the ability to: 
                                                                                                                 1.  screen individuals for nutritional risk 
                                                                                                                 2.  collect pertinent information for comprehensive nutrition assessments 
                                                                                                                 3.  interpret medical terminology 
                                                                                                                 4.  interpret laboratory parameters relating to nutrition 
                                                                                                                 5.  calculate and interpret nutrient composition of foods 
                                                                                                                 6.  calculate and/or define diets for health conditions  
                                                                                                                 7.  calculate enteral and parenteral nutrition formulations 
                                                                                                                 8.  translate nutrition needs into food choices and menus 
                                                                                                                 9.  counsel individuals on nutrition  
                                                                                                                  
                                                                            V.                                   Learning Experiences 
                                                                                                                 1.  Students will independently complete assignments covering varying aspects of the disorders 
                                                                                                                                    under discussion. 
                                                                                                                 2.  Study Guides/Modules are provided that will help the student organize information around 
                                                                                                                                    various disease states. Completion of the study guides is optional for Nutrition 640 but will be 
                                                                                                                                    required for the MPH/RD students during NUTR 710. 
                                                                                                                 3.  In the assigned groups, students will work on the case study and lead a discussion of about 
                                                                                                                                    20 minutes on the case. 
                                                                                                                 4.  Each student who plans to become a registered dietitian in the near future would benefit from 
                                                                                                                                    developing a Pocket Brain/Cheat Book to be used during supervised practice experiences. 
                                                                                                                                    This is a collection of material you feel will help you get through your day. Throughout the 
                                                                                                                                    semester suggestions will be made about what to put in your pocket brain but it is really up to 
                                                                                                                                    the individual. Pocket brains can be used during the completion of the open book 
                                                                                                                                    portions of exams in this class. 
                                                                             
                                                                            VI.                                  Grading 
                                                                                                                 Evaluation of student performance in this course will be based on the following: 
                                                                                                                                                       Learning experiences                                                                                                                                  60% 
                                                                                                                                                       Exams (3)                                                                                                                                             40% 
                                                                                                                                                       Exams in this class are both closed book and open book. The open book exams will be 
                                                                                                                                                       practical work similar to homework assignments. Any reference that you have can be 
                                                                                                                                                       used. 
                                                                             
                                                                                                                 Grading Scale: 
                                                                                             Undergraduates:                                                                                                                                                                                                                        1BGraduates: 
                                                                                                                   97-100                                                                                 A+                                                                                                                                                805-870(>93%)                                                                                                  H 
                                                                                                                     93-96                                                                                A                                                                                                                                           649-804(75-92%)                                                                                                      P 
                                                                                                                     90-92                                                                                A-                                                                                                                                        605-648 (70-74%)                                                                                                       L 
                                                                                                                     87-89                                                                                B+                                                                                                                                     <605 (Below 70%)                                                                                                          F 
                                                                                                                     83-86                                                                                B                                                                                                                                                                                                                                                                 
                                                                                                                     80-82                                                                                B-                                                                                                                                                                                                                                                                
                                                                                                                     77-79                                                                                C+                                                                                                                                                                                                                                                                
                                                                                                                     73-76                                                                                C                                                                                                                                                                                                                                                                 
                                                                                                                     70-72                                                                                C-                                                                                                                                                                                                                                                                
                                                                                                              Below 70                                                                                    D                                                                                                                                                                                                                                                                 
                                                                                                              Below 60                                                                                    F                                                                                                                                                                                                                                                                 
                                                                                                                  
                                                                                                                 Honor System: The Honor Code is in effect in this class and all others at the University. I am 
                                                                                                                 committed to treating Honor Code violations seriously and urge all students to become familiar 
                                                                                                                 with its terms set out at 22Thttp://instrument.unc.edu22T. If you have questions, it is your responsibility to 
                                                                                                                 ask me about the Code’s application.  
                                                                                                                  
                                                                                                                 All exams and assignments must be submitted with the following signed statement:  
                                                                                                                 34TOn my honor, no unauthorized assistance has been received or given in the completion of this 
                                                                                                                 work. 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              3                                           
                                                                                                                 34T                                                                                                                                                   Signature:   ___________________________________ 34T 
                                                                                                                                                                                                                                                                        
                                                                            NOTE: THOSE STUDENTS PLANNING TO TAKE NUTRITION 720: PUBLIC HEALTH NUTRITION 
                                                                            MANAGEMENT AND/OR NUTRITION710: CLINICAL NUTRITION PRACTICE DURING SUMMER, 
                                                                            MUST RECEIVE A GRADE OF P OR BETTER IN NUTR 640 IN ORDER TO ENROLL IN EITHER 
                                                                            CLASS. 
                                                                            VII.                                 Course Schedule 
                                                                                 Nutrition Assessment 
                                                                                 Helpful Videos for Studying this section: 
                                                                                                                      NHANES III Anthropometric Procedure 
                                                                                                                       Videos: 22Thttp://www.cdc.gov/nchs/nhanes/nhanes3/anthropometric_videos.htm 
                                                                                                                      Nutrition Focused Physical 
                                                                                                                       Assessment:  22Thttp://anhi.org/courses/7D801AEE7DCE45FAB9C49857D88B0FAF22T 
                                                                                                                      eNCPT 
                                                                                                                       22Thttp://ncpt.webauthor.com/pubs/idnt-en/22T 
                                                                                                                                                          
                                                                                 Th                                    1/8                               Introduction to the course 
                                                                                                                                                         Medical Terminology Practice 
                                                                                                                                                         Text: Krause, Chapter 11 and Appendix 1-4: General Abbreviations 
                                                                                                                                                         Sakai: 
                                                                                                                                                                                             NCP and MNT (side by side) 
                                                                                                                                                                                             Summary: Health IT and Patient Safety (p S1-S11), IOM 2012 
                                                                                                                                                                                             Ayres, EJ. 2011 Nutrition Informatics Member Survey. JAND 112(3): 360-364. 
                                                                                                                                                                                             SOP/SOPP Update 2008, JADA, Sept. 2008 
                                                                                                                                                                                             Code of Ethics, JADA, August 2009 
                                                                                                                                                                                             Mr. Hill’s Admission Note 
                                                                                                                                                                                             Mp3 Download for ipod:  Basic Word Structure (follow with Chabner Ch.1) 
                                                                                                                                                                             Tools 
                                                                                                                                                                                             JCAHO Do Not Use List (March 2009) 
                                                                                                                                                                                             Medical Terminology Study Guide 
                                                                                                                                                          
                                                                                 T                                  1/13                                 The Nutrition Care Process: Nutrition Screening and Introduction to Nutrition 
                                                                                                                                                         Assessment 
                                                                                                                                                         Readings:  Krause, Chapter 11 
                                                                                                                                                         Sakai: 
                                                                                                                                                                                                                Nutrition Care Process and Model Part I: The 2008 Update.  JAND 108 (7): 1113-
                                                                                                                                                                                                                 1117. 
                                                                                                                                                                                                                Nutrition Care Process Part II: Using the International Dietetics and Nutrition 
                                                                                                                                                                                                                 Terminology to Document the Nutrition Care Process.  JAND 108 (8): 1287-1293. 
                                                                                                                                                                                                                  
                                                                                                                                                         Medical Terminology Practice Extra Credit (3pts) Due 
                                                                                                                                                          
                                                                                 Th                                 1/15                                 Anthropometric Data - Adult 
                                                                                                                                                         Readings: Lee, Chapter 6; Krause, Chapter 6 
                                                                                                                                                         Sakai:  
                                                                                                                                                                                             Fox, Maggie. Americans a bit taller, much heavier than in 1960.  
                                                                                                                                                                                             Reuters Health Information, October 27, 2005. 
                                                                                                                                                                                             Schlegel-Pratt, K. and Heizer, W. D. The accuracy of scales used to weigh patients. 
                                                                                                                                                                                              Nutrition in Clinical Practice 5: 254-257, 1990. (Old but still worth reading!) 
                                                                                                                                                                                             Kuczmarski, M., et.al. Effects of age on validity of self-reported height, weight and body 
                                                                                                                                                                                              mass index: Findings from the third National Health and Nutrition Examination Survey, 
                                                                                                                                                                                              1988-1994. JADA 101(1): 28-34, 2001. 
                                                                                                                                                                                             MUST WATCH ALL VIDEOS BEFORE NEXT CLASS: NHANES III Anthropometric 
                                                                                                                                                                                              Procedures, http://www.cdc.gov/nchs/nhanes/nhanes3/anthropometric_videos.htm 
                                                                                                                                                          
                                                                                 T                                  1/20 
                                                                                                                                                  4            
                                        Anthropometric Data (Adult) Continued and Assessment of the Adult Hospitalized 
                                        Patient 
                                        Readings: Lee, Chapter; Krause, Chapter 6 (pgs.171-172) 
                                        Sakai: 
                                                      Picus, S. S. Evaluation of the nutrition counseling environment of hospitalized 
                                                       patients. JADA 89(3): 403-404, 1989. (Old but interesting) 
                                                      Sungurtekin et al.  Nutrition Assessment in Critically Ill Patients.  NCP 23: 636-641, 
                               1/20                    2008. 
                                        11:00-Noon:  Practice session (Adult) - Collecting anthropometric data 
                                        (Be sure to wear clothing appropriate for taking measurements, bring your calculator and a pen 
                                        and pencil.) 
                                        *Bring Lee Book as a reference tool* 
                     
                                          
                      Th       1/22     Biochemical Data 
                                        Readings: Lee, Chapter 9; Krause, Chapter 8 
                                        Sakai: 
                                                      Bernstein, G. Medical tests explained: A guide to routine lab work. Diabetes Self-
                                                       Management, p. 6-13, March/April 1998. 
                                                      Litchford, MD.  Practical Applications in Laboratory Assessment of Nutritional 
                                                       Status.  Case Software and Books, 2PndP Edition, 2010. 
                                                      Review online Case Studies in Laboratory Assessment of Nutritional Status. 
                                         
                                         
                                         
                      T        1/27     Biochemical Data, Continued 
                                         
                                        Assignment #1 Due:  Anthropometrics (60 pts) 
                                         
                      Th       1/29     Clinical Data – Nutrition Focused Physical Assessment 
                                        Readings:  Lee, Chapter 10; Krause, Chapter 6 
                                        Sakai: 
                                                      Mackle et al.  Registered dietitians’ use of physical assessment parameters in 
                                                       professional practice.  JADA 103(12): 1632-1638, 2003. 
                                                      Kight et al.  Conducting Physical Examination Rounds for Manifestations of 
                                                       Nutrient Deficiency or Excess:  An essential component of JCAHO Assessment 
                                                       Performance  NCP 14: 93-98, 1999. (oldy but goldy) 
                                                      White J V, Guenter P, Jensen G, Malone A, Schofield M. Consensus statement of 
                                                       the Academy of Nutrition and Dietetics/American Society for Parenteral and 
                                                       Enteral Nutrition: characteristics recommended for the identification and 
                                                       documentation of adult malnutrition (undernutrition). J. Acad. Nutr. Diet. 
                                                       2012;112(5):730-8. 
                                                      Jensen GL, Hsiao PY, Wheeler D. Adult nutrition assessment tutorial. JPEN. J. 
                                                       Parenter. Enteral Nutr. 2012;36(3):267-74. 
                                                        
                               1/29     11:15-12:15pm: Ackland Art Museum, Learning Descriptive Skills 
                                         
                      T        2/3      Routine Hospital Diets  
                                        Text:  Krause, Chapter 2 and Appendices 19-31 
                                        Course Download:  
                                                  Gelber, S. The Healing Potential of Hospital Food. Medscape General Medicine  7(3): 
                                                   1-3, July 2005. 
                                        Tools 
                                                  Nutrition Care Manual Formulary (Oral) 
                                                        o    Familiarize yourself with the various product types 
                                                  UNC Formulary Card (Oral)