LF:BVKV0532p Clinical Nutrition II - lec. - Course Information

BVKV0532p Clinical Nutrition II - lecture

Extent and Intensity

2/0/0. 0 credit(s). Recommended Type of Completion: -. Other types of completion: z (credit).

Teacher(s)

doc. MUDr. Miroslav Tomíška, CSc. (lecturer)

Guaranteed by

doc. MUDr. Miroslav Tomíška, CSc.
Department of Internal Medicine, Hematology and Oncology – Joint workplaces with the University Hospital Brno - workplaces of the Bohunice and Mater. Hospital – Faculty of Medicine
Contact Person: MVDr. Halina Matějová
Supplier department: Department of Internal Medicine, Hematology and Oncology – Joint workplaces with the University Hospital Brno - workplaces of the Bohunice and Mater. Hospital – Faculty of Medicine

Timetable

Mon 13:00–16:00 A21/107

Course Enrolment Limitations

The course is only offered to the students of the study fields the course is directly associated with.

fields of study / plans the course is directly associated with

• Nutritive therapist (programme LF, B-SZ)

Course objectives

The aim of instruction in the course of Clinical Nutrition and Dietetics is to acquaint students of the Bachelor study programme with various possibilities and ways of nutritional intervention in individuals with nutrition disorders (malnutrition in the wider sense of the word). The curriculum comprises both the problems of undernourishment (protein-energy malnutrition) and problems of hypernutrition, obesity, dyslipidemia, and metabolic syndrome. Also included are the most frequent defects of metabolism. In each of the above-mentioned areas, instruction comprises both a detailed diagnostics of the respective nutrition disorder and the possibilities of its treatment in current clinical practice. At the same time the whole instruction in the course of Clinical Nutrition is oriented towards the practical ways of utilising the knowledge obtained. With regard to undernourishment, stress is laid on the diagnosis of protein-energy malnutrition and on the standard way of evaluation of the degree of severity of this disorder. Basing on this, various forms of nutritional support are taught with emphasis on correct application of artificial nutrition. The study comprises both the various ways of dietary intervention and peroral supplementation with nutrition preparations, and the ways of enteral nutrition delivered into the gastrointestinal tract by means of a probe, as well as parenteral nutrition applied into the vein by infusions. In all cases provision of nutritional support to hospitalised patients in hospital conditions is analysed separately, and so is long-term provision of domestic artificial nutrition in outpatient conditions. A part of the course is formed by monitoring the patient during the administration of artificial nutrition, both with regard to its effect and the possible undesirable effects and complications. With respect to obesity, the curriculum is primarily devoted to the clinically severe disorder with the necessity of intervention by very low calorie diet, or pharmacological or surgical interventions. The set of problems relating to metabolic syndrome and dyslipidemia is taught in its whole extent. Practical instruction at the patient’s bedside is part of the course. The students learn to be capable of examining the nutritional state of a particular patient, to quantify the severity of his/her nutrition disorder and, basing on this, to decide on the respective suitable type of nutritional support. They learn to follow the patient in the course of the support, including patients with artificial nutrition, especially if applied by enteral probe. In these patients the students are capable of monitoring the tolerance to enteral nutrition, its effect, undesirable effects, and complications. The curriculum also includes economic and ethical aspects of nutritional support, understanding of clinical research results, and an outline of possible advances in the near future.

Learning outcomes

Student will be able to identify the nutritional problem after graduation, to apply various ways of dietary intervention, their monitoring and evaluation. He will also be able to understand the results of clinical research.

Syllabus

• 21)Parenteral nutrition. History of intravenous nutrition. Peripheral and central venous catheters. Care for catheters. Catheter-caused infection. Indications and contraindications of parenteral nutrition. 22)Metabolism of principal nutrients in the course of infusion into systemic circulation. Solutions of principal nutrients for parenteral nutrition. Coverage of the demand for proteins, saccharides, and fats by intravenous way. Conversion of solution concentration to mass quantity of nutrients. 23)Mineral substances and micronutrients in parenteral nutrition. Provision of the demand for vitamins and trace elements in parenteral nutrition.Company preparations of micronutrients and mineral substances for parenteral application. 24)Special substrates in parenteral nutrition. Non-glucose saccharides, glutamine, dipeptides, MCT fats, structured fats, n-3 unsaturated fatty acids. Mixed fat for parenteral nutrition (SMOF). 25)Methods of parenteral nutrition. Classical multibottle system. Two- and three-chamber commercial company bags. Preparation of all-in-one type nutrition in a hospital dispensary. Compatibility of all-in-one solutions. Types of administration of parenteral nutrition (continuous, intermittent). 26)Schedule of parenteral nutrition in clinical practice. Making entry on prescribed nutrition in the patient’s documentation. Designation of bags with parenteral nutrition. Keeping protocol on parenteral nutrition. 27)Monitoring of metabolic state in parenteral nutrition. Monitoring the effect of parenteral nutrition. Monitoring of glycaemia and demand for insulin in parenteral nutrition. 28)Complications of parenteral nutrition. Mechanical complications of intravenous access. Infectious and thrombotic complications. Metabolic complications: hyperglycaemia and hypoglycaemia, hypertriglyceridemia, ion dysbalances. Hepatic, pulmonary, renal, immunological, and haematological complications. Schedule of parenteral nutrition in clinical practice. 29)Specificities of nutrition in gravidity and lactation. Evaluation of nutrition state in gravidity. Objectives of nutritional support in gravidity. Hyperemesis gravidarum. Approach to nutrition in pregnant diabetics. Anaemia during pregnancy. 30)Protein-energy malnutrition in the elderly. Changes in body composition in old age. Nutritional support of the elderly. 31)Nutritional support in obese patients with developing malnutrition. Calculation of demands for energy and proteins in obese patients on artificial nutrition. 32)Nutritional support in paediatrics. Nutritional support of neonates. 33)Nutritional support in acute and chronic pancreatitis. Obstructive jaundice. Nutritional support in acute and chronic hepatic failure. Liver cirrhosis. Hepatic encephalopathy. 34)Nutritional support in chronic inflammatory bowel disease. Crohn’s disease. Malabsorption syndrome. Coeliac disease. 35)Nutritional support after operations in the gastrointestinal system. State after gastrectomy. Short-bowel syndrome. 36)Nutritional support in chronic lung disease. Cystic fibrosis. Nutritional support in chronic heart failure. Nutritional support in endocarditis. 37)Nutritional support in acute renal failure. Acute haemodialysis and continual renal elimination technique. Nutritional support in chronic renal failure. Treatment of malnutrition in chronic haemodialysis. 38)Nutritional support in critically ill patients. Assessment of the risk of malnutrition at the ICU. Nutrition of patients in intensive care. 39)Perioperative nutritional support. Preoperative nutritional preparation. Early postoperative nutritional support.Nutritional support of patients with complicated surgical disease. 40)Nutritional support of oncological patients. Cancerous malnutrition. Primary and secondary malnutrition. 41)Nutritional support in diabetic patients. Enteral and parenteral nutrition in patients with poorly compensated diabetes.

Literature

• URBÁNEK, Libor, Pavla URBÁNKOVÁ and Jaroslava MARKOVÁ. Klinická výživa v současné praxi (Clinical nutrition in current use). druhé. Brno: Národní centrum ošetřovatelství a nelékařských zdravotnických oborů, 2010, 97 pp. ISBN 978-80-7013-525-9. info
• SVAČINA, Štěpán. Klinická dietologie. 1. vyd. Praha: Grada, 2008, 381 s. ISBN 9788024722566. info
• NIX, Staci. Williams' basic nutrition and diet therapy. 12th ed. St. Louis: Elsevier Mosby, 2005, xxii, 454. ISBN 0323026028. info
• CATALDO, Corrine Balog, Linda K. DEBRUYNE and Eleanor Noss WHITNEY. Nutrition and diet therapy : principles and practice. 6th ed. Belmont: Thomson, 2003, xvii, 732. ISBN 0534576915. URL info
• MUSIL, Dalibor. Klinická výživa a intenzivní metabolická péče. 1. vyd. Olomouc: Univerzita Palackého, 2002, 109 s. ISBN 8024405660. info
• NAVRÁTILOVÁ, Miroslava, Eva ČEŠKOVÁ and Ladislav SOBOTKA. Klinická výživa v psychiatrii. Praha: Maxdorf-Jesenius, 2000, 270 pp. ISBN 80-85912-33-3. info

Teaching methods

lectures

Assessment methods

credit

Language of instruction

Czech

Further Comments

The course is taught annually.

• Enrolment Statistics (Autumn 2017, recent)
  
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