a LaFrance Consulting Services™ e-Course
Nutrition for Nursing Students, independent study
Final Exam

For the Final Exam for this course, you will be expected to assess the diet of a real, living Human [who will be known as “patient”], and to provide advice for specific changes to the diet to improve the long-term nutritional status of the patient. In order to assess the patient's diet, you have already [Quiz 1] determined what their current diet is. The assessment and recommendations will require you to apply virtually everything you are expected to learn from this course to an actual case study [which is why the exercise is called “final exam” rather than “term paper” although it should look like a term paper, complete with citations in APA format].
    You should know that HIPAA regulations apply to these data, your assessment, and your recommendations. Therefore, patient confidentiality requires that you do not disclose the patient's identity in any documents you create for this course. In order for me to grade the documents you are to create, I will need to know the patient's age, sex, height, weight, and any health history which you consider to be directly relevant to your recommendations. If you are unclear as to what HIPAA allows you to disclose see the link to U.S. Department of Health & Human Services website, and click on 'Understanding HIPAA Privacy.' [Even if you are taking this course from somewhere other than the United States, the U.S. regulations apply because your reports will be submitted into the U.S., to a “covered entity,” which can be considered to be engaged in research.]
    You collected total food intake [food item, quantity usually as volume (cups, ounces)] for seven (7) consecutive days. The rationale for requiring 7 days was that the patient may object that one or two days data do not reflect how they ‘normally’ eat. Seven days will be how they normally eat unless there was an unusual event, such as a lengthy family emergency. Besides, having collected such detailed information for such a long time, you will see why weight management programs which require reporting comparable details over months [years even] tend to have high “drop-out” rates. The data were averaged over the 7 day period to serve as the basis of your assessment.

Now, you will assess adequacy of the patient's diet as your final exam for this course. In brief, the assessment will examine caloric balance and nutritional value. You will be expected to identify potential problems both with insufficient nutrient intake and with excessive nutrient intake. From the identified problems, you will select the two or three which you consider to be the most serious, and explain why you chose the ones you chose. Then you will make specific recommendations for the patient to correct these two or three problems, and explain why you chose to correct them as you did.
    Having established the potential consequences of under-dosing and/or over-dosing on various nutrients, you will have to decide how serious their dietary issues are, and select the two or three issues [you will lose points for selecting more than three, or less than two] that you feel are most important to the person's Wellness. Your report will provide an explanation (rationale) of why you chose the nutritional issues you chose. Your grade will depend on how well you justify your choices, not what you chose [unless, like one former student you address the ‘low carb’ intake of an overweight person getting 247% RDA of Calories from carbohydrates; the student lost a full letter grade for this error]. Having identified what you consider to be the two or three most “interesting” issues with the person's diet, you are to suggest a plan to correct the mistakes. My expectation is that you will recommend specific dietary (food) sources of the nutrients which need to be increased, and specific recommendations for those which need to be decreased [written as if you expect the person to actually change their eating habits in order to improve their Wellness]. Again, you will be graded on how well you justify your recommendations. If you chose to supplement the person's diet with food supplements rather than food, your task of defending the recommendation will more difficult due to my bias toward food as the preferred source of nutrition [I believe this bias to be a very poorly kept secret].
    It is important to understand that the ‘selection of serious problems’ is an opinion question. As such you can get this part ‘wrong’ only by selecting non-problems [such as nutrients within tolerable limits] or by selecting as problems nutrients which are beyond acceptable limits but in the wrong direction [for example, one former student (whose patient was clearly over-weight and was consuming about 230% of the recommended Calories) selected Calorie deficiency, which the student proposed to solve by increasing the patient's Calorie intake! The student did not get 80% on the paper. Only one former student, out of about 500 to 750, had a patient with a nearly perfect diet, so this student was allowed to select two “problems” which were close to optimum and within the optimal range. You will be graded on the basis of how well you ‘explain why you chose the ones you chose.’
    Your recommendations for how to ‘fix’ the 2 or 3 problems are also your opinion and cannot be wrong (unless you chose a nutrient source which does not provide significant amounts of the nutrient). You will be graded on the basis of how well you ‘explain why you chose to correct them as you did.’

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revised: 26 Jan 2009