Veidlapa Nr. M-3 (8)

Course Description Status: Approved

Course Description Version: 26/27.R.1.00

Description Period: 2026./27 academic year rudens semestris

Study Course Accepted: -

Study Course Description

Medical Nutrition Therapy

Main Study Course Information

Course Code
REK_318
Branch of Science
Clinical medicine
ECTS
3.00
Target Audience
Rehabilitation
LQF
Level 6
Study Type And Form
Full-Time; Part-Time

Study Course Implementer

Course Supervisor
Nelda Karpenska-Allaža
Structure Unit Manager
Liāna Deklava
Structural Unit
Department of Rehabilitation
Contacts

Riga, 26 a Anninmuizas boulevard, rk@rsu.lv, +371 20271291

About Study Course

Objective

Familiarize students with the principles of medical nutritional therapy as an integral part of the therapeutic process. This evidence-based approach promotes patient recovery and quality of life by highlighting the effects of nutritional therapy on the course of acute and chronic diseases, the frequency of complications, and the recovery process. Students will gain the knowledge needed to assess a patient’s nutritional requirements and develop individualized recommendations in various clinical situations, collaborating with a multidisciplinary team. They will also develop the ability to apply medical nutritional therapy practically by integrating it into patient care and the overall therapeutic process.

Preliminary Knowledge

Knowledge of anatomy, normal and pathological physiology and biochemistry.

Learning Outcomes

Knowledge

1.Students will understand various types of medical nutritional therapy (MNT), including medical supplemental nutrition, enteral, and parenteral feeding, as well as their indications and contraindications for different patient groups.

Individual work and tests

Development and monitoring of a simulated nutrition care plan

2.Students know how to evaluate a patient’s health status, nutritional status, physical and functional abilities, and perform a risk-benefit analysis.

3.Students understand the types of enteral and parenteral feeding approaches, the principles of dosing and composition, potential complications, and ethical considerations in providing therapy.

Individual work and tests

Simulated patient case: identification of complications and planning of appropriate interventions.

Skills

1.Students will be able to assess a patient’s nutritional needs and select the appropriate type of therapy, as well as plan and adjust enteral or parenteral feeding.

Individual work and tests

Development and monitoring of a simulated nutrition care plan

2.Students are proficient in monitoring and tracking nutrient intake, tolerance, changes in body weight, and relevant biochemical parameters.

Individual work and tests

Simulated patient case: identification of complications and planning of appropriate interventions.

3.Students can analyze clinical cases, identify potential complications, and make decisions based on medical and ethical considerations in collaboration with a multidisciplinary team.

Competences

1.Students will be able to practically implement medical nutritional therapy by tailoring it to a patient’s condition, goals, and quality of life.

Individual work and tests

Medical nutrition therapy in clinical nutrition • Development and monitoring of a simulated nutrition care plan

2.Students can work within a multidisciplinary team, integrating nutritional therapy into the therapeutic process and coordinating decisions with other specialists.

3.Students are able to assess the effectiveness of therapy, make necessary adjustments, and make clinically and ethically sound decisions in various clinical situations.

Individual work and tests

Simulated patient case: identification of complications and planning of appropriate interventions.

Assessment

Individual work

Title
% from total grade
Grade
1.

Development and monitoring of a simulated nutrition care plan
25.00% from total grade
10 points

During the class, students assess the nutritional status and needs of a simulated patient, perform the necessary nutritional calculations, select the appropriate type of medical nutritional therapy, and justify their choice based on the clinical situation.
2.

Simulated patient case: identification of complications and planning of appropriate interventions.
25.00% from total grade
10 points

Students analyze a simulated clinical case, identify potential complications of medical nutritional therapy, and develop an appropriate intervention plan. During the exercise, students assess the patient’s health and nutritional status, perform necessary nutritional calculations, select the appropriate enteral or parenteral feeding approach, and justify their decisions based on clinical, medical, and ethical considerations.

Examination

Title
% from total grade
Grade
1.

Medical nutrition therapy in clinical nutrition
50.00% from total grade
10 points

The final assessment will be a written test covering all topics addressed in the course, including the principles of medical nutritional therapy, enteral and parenteral feeding, dose calculation and adjustment, nutritional therapy in intensive care and post-intensive care settings, as well as multidisciplinary collaboration and ethically informed decision-making.

Study Course Theme Plan

FULL-TIME
Part 1

  1. Lecture

Modality
Location
Contact hours
On site
Study room
2

Topics

Types of medical nutrition therapy (MNT): oral nutritional supplements, enteral nutrition, and parenteral nutrition. Indications and contraindications for medical nutritional therapy. Medications, products, and equipment used in MNT.
Description

The types of medical nutritional therapy are discussed, along with the principles for selecting the most appropriate therapy, taking into account:

  • Patient’s general health status – including chronic and acute diseases, digestive function, organ dysfunctions, and other relevant health issues.
  • Nutritional status – such as weight loss, malnutrition, protein or micronutrient deficiencies.
  • Nutritional intake and functional capacity – including digestion and absorption, neurological and sensory functions, and mobility.
  • Treatment objectives – improving quality of life, stabilizing nutritional status, supporting recovery, or providing palliative care.
  • Risk-benefit analysis – considering possible complications, therapeutic efficacy, and patient comfort.

  1. Lecture

Modality
Location
Contact hours
On site
Study room
2

Topics

Enteral nutrition approaches and delivery methods.
Description
  • Types of enteral nutrition (EN): orogastric, nasogastric, nasojejunal tubes, gastrostomy, and jejunostomy.
  • Administration methods: bolus, intermittent, continuous, or patient-specific.
  • Duration of enteral feeding: temporary or long-term.
  • Enteral feeding products and equipment – including formulas, supplements, and necessary administration materials.

  1. Lecture

Modality
Location
Contact hours
On site
Study room
2

Topics

Parenteral nutrition (PN) approaches and delivery methods.
Description
  • Evaluation of indications for parenteral nutrition (PN).
  • Selection or formulation of PN mixture composition.
  • Catheter types for PN administration: peripheral and central catheters, including long-term access devices such as tunneled central venous catheters, implantable venous ports, and peripherally inserted central catheters (PICC lines).

  1. Lecture

Modality
Location
Contact hours
On site
Study room
2

Topics

Use of medical nutritional therapy in specific patient groups
Description
  • Patients before and after surgery
  • Patients with renal disease
  • Patients with oncological conditions
  • Patients with digestive system disorders
  • Patients with chronic diseases

  1. Lecture

Modality
Location
Contact hours
On site
Study room
2

Topics

Use of medical nutritional therapy in intensive care settings
Description
  • Stress and critical condition – metabolism and nutritional requirements
  • Initiation of medical nutrition therapy and selection of enteral or parenteral nutrition
  • Calculation of nutritional substrates; fluid and electrolyte balance

  1. Lecture

Modality
Location
Contact hours
On site
Study room
2

Topics

Provision of medical nutritional therapy: initiation, monitoring, assessment of effectiveness, and necessary adjustments
Description
  • Patient evaluation and planning
  • Monitoring of therapy:
    • nutrient intake, weight changes,
    • tolerance,
    • clinical and biochemical indicators,
  • Evaluation and correction of therapeutic efficacy

  1. Lecture

Modality
Location
Contact hours
On site
Study room
2

Topics

Potential complications of medical nutritional therapy
Description
  • indigestion
  • electrolyte dysbalance, fluid overload
  • aspiration
  • insufficient or excessive nutrient input
  • metabolic complications

  1. Lecture

Modality
Location
Contact hours
On site
Study room
2

Topics

Medical nutritional therapy for children at different stages of age.
Description
Medical nutritional therapy for pediatric patients:
  • Oral nutritional supplements: age-appropriate formulations, product selection, indications, and prescription procedures.
  • Enteral feeding: types of administration, indications, and contraindications.
  • Parenteral feeding: types of administration, indications, and contraindications.
  • Types of nutritional mixtures used in enteral and parenteral therapy.

  1. Class/Seminar

Modality
Location
Contact hours
On site
Study room
2

Topics

Types of medical nutrition therapy (MNT): oral nutritional supplements, enteral nutrition, and parenteral nutrition. Indications and contraindications for medical nutritional therapy. Medications, products, and equipment used in MNT.
Description

The types of medical nutritional therapy are discussed, along with the principles for selecting the most appropriate therapy, taking into account:

  • Patient’s general health status – including chronic and acute diseases, digestive function, organ dysfunctions, and other relevant health issues.
  • Nutritional status – such as weight loss, malnutrition, protein or micronutrient deficiencies.
  • Nutritional intake and functional capacity – including digestion and absorption, neurological and sensory functions, and mobility.
  • Treatment objectives – improving quality of life, stabilizing nutritional status, supporting recovery, or providing palliative care.
  • Risk-benefit analysis – considering possible complications, therapeutic efficacy, and patient comfort.

  1. Class/Seminar

Modality
Location
Contact hours
On site
Study room
2

Topics

Enteral nutrition approaches and delivery methods.
Description
  • Types of enteral nutrition (EN): orogastric, nasogastric, nasojejunal tubes, gastrostomy, and jejunostomy.
  • Administration methods: bolus, intermittent, continuous, or patient-specific.
  • Duration of enteral feeding: temporary or long-term.
  • Enteral feeding products and equipment – including formulas, supplements, and necessary administration materials.

  1. Class/Seminar

Modality
Location
Contact hours
On site
Study room
2

Topics

Parenteral nutrition (PN) approaches and delivery methods.
Description
  • Evaluation of indications for parenteral nutrition (PN).
  • Selection or formulation of PN mixture composition.
  • Catheter types for PN administration: peripheral and central catheters, including long-term access devices such as tunneled central venous catheters, implantable venous ports, and peripherally inserted central catheters (PICC lines).

  1. Class/Seminar

Modality
Location
Contact hours
On site
Study room
2

Topics

Use of medical nutritional therapy in specific patient groups
Description
  • Patients before and after surgery
  • Patients with renal disease
  • Patients with oncological conditions
  • Patients with digestive system disorders
  • Patients with chronic diseases

  1. Class/Seminar

Modality
Location
Contact hours
On site
Study room
2

Topics

Use of medical nutritional therapy in intensive care settings
Description
  • Stress and critical condition – metabolism and nutritional requirements
  • Initiation of medical nutrition therapy and selection of enteral or parenteral nutrition
  • Calculation of nutritional substrates; fluid and electrolyte balance

  1. Class/Seminar

Modality
Location
Contact hours
On site
Study room
2

Topics

Provision of medical nutritional therapy: initiation, monitoring, assessment of effectiveness, and necessary adjustments
Description
  • Patient evaluation and planning
  • Monitoring of therapy:
    • nutrient intake, weight changes,
    • tolerance,
    • clinical and biochemical indicators,
  • Evaluation and correction of therapeutic efficacy

  1. Class/Seminar

Modality
Location
Contact hours
On site
Study room
2

Topics

Potential complications of medical nutritional therapy
Description
  • indigestion
  • electrolyte dysbalance, fluid overload
  • aspiration
  • insufficient or excessive nutrient input
  • metabolic complications

  1. Class/Seminar

Modality
Location
Contact hours
On site
Study room
2

Topics

Medical nutritional therapy for children at different stages of age.
Description
Medical nutritional therapy for pediatric patients:
  • Oral nutritional supplements: age-appropriate formulations, product selection, indications, and prescription procedures.
  • Enteral feeding: types of administration, indications, and contraindications.
  • Parenteral feeding: types of administration, indications, and contraindications.
  • Types of nutritional mixtures used in enteral and parenteral therapy.
Total ECTS (Creditpoints):
3.00
Contact hours:
32 Academic Hours
Final Examination:
Exam
PART-TIME
Part 1

  1. Lecture

Modality
Location
Contact hours
On site
Study room
2

Topics

Types of medical nutrition therapy (MNT): oral nutritional supplements, enteral nutrition, and parenteral nutrition. Indications and contraindications for medical nutritional therapy. Medications, products, and equipment used in MNT.
Description

The types of medical nutritional therapy are discussed, along with the principles for selecting the most appropriate therapy, taking into account:

  • Patient’s general health status – including chronic and acute diseases, digestive function, organ dysfunctions, and other relevant health issues.
  • Nutritional status – such as weight loss, malnutrition, protein or micronutrient deficiencies.
  • Nutritional intake and functional capacity – including digestion and absorption, neurological and sensory functions, and mobility.
  • Treatment objectives – improving quality of life, stabilizing nutritional status, supporting recovery, or providing palliative care.
  • Risk-benefit analysis – considering possible complications, therapeutic efficacy, and patient comfort.

  1. Class/Seminar

Modality
Location
Contact hours
On site
Study room
2

Topics

Types of medical nutrition therapy (MNT): oral nutritional supplements, enteral nutrition, and parenteral nutrition. Indications and contraindications for medical nutritional therapy. Medications, products, and equipment used in MNT.
Description

The types of medical nutritional therapy are discussed, along with the principles for selecting the most appropriate therapy, taking into account:

  • Patient’s general health status – including chronic and acute diseases, digestive function, organ dysfunctions, and other relevant health issues.
  • Nutritional status – such as weight loss, malnutrition, protein or micronutrient deficiencies.
  • Nutritional intake and functional capacity – including digestion and absorption, neurological and sensory functions, and mobility.
  • Treatment objectives – improving quality of life, stabilizing nutritional status, supporting recovery, or providing palliative care.
  • Risk-benefit analysis – considering possible complications, therapeutic efficacy, and patient comfort.

  1. Lecture

Modality
Location
Contact hours
On site
Study room
2

Topics

Enteral nutrition approaches and delivery methods.
Description
  • Types of enteral nutrition (EN): orogastric, nasogastric, nasojejunal tubes, gastrostomy, and jejunostomy.
  • Administration methods: bolus, intermittent, continuous, or patient-specific.
  • Duration of enteral feeding: temporary or long-term.
  • Enteral feeding products and equipment – including formulas, supplements, and necessary administration materials.

  1. Class/Seminar

Modality
Location
Contact hours
On site
Study room
2

Topics

Enteral nutrition approaches and delivery methods.
Description
  • Types of enteral nutrition (EN): orogastric, nasogastric, nasojejunal tubes, gastrostomy, and jejunostomy.
  • Administration methods: bolus, intermittent, continuous, or patient-specific.
  • Duration of enteral feeding: temporary or long-term.
  • Enteral feeding products and equipment – including formulas, supplements, and necessary administration materials.

  1. Lecture

Modality
Location
Contact hours
On site
Study room
2

Topics

Parenteral nutrition (PN) approaches and delivery methods.
Description
  • Evaluation of indications for parenteral nutrition (PN).
  • Selection or formulation of PN mixture composition.
  • Catheter types for PN administration: peripheral and central catheters, including long-term access devices such as tunneled central venous catheters, implantable venous ports, and peripherally inserted central catheters (PICC lines).

  1. Class/Seminar

Modality
Location
Contact hours
On site
Study room
2

Topics

Parenteral nutrition (PN) approaches and delivery methods.
Description
  • Evaluation of indications for parenteral nutrition (PN).
  • Selection or formulation of PN mixture composition.
  • Catheter types for PN administration: peripheral and central catheters, including long-term access devices such as tunneled central venous catheters, implantable venous ports, and peripherally inserted central catheters (PICC lines).

  1. Lecture

Modality
Location
Contact hours
On site
Study room
2

Topics

Use of medical nutritional therapy in specific patient groups
Description
  • Patients before and after surgery
  • Patients with renal disease
  • Patients with oncological conditions
  • Patients with digestive system disorders
  • Patients with chronic diseases

  1. Class/Seminar

Modality
Location
Contact hours
On site
Study room
2

Topics

Use of medical nutritional therapy in specific patient groups
Description
  • Patients before and after surgery
  • Patients with renal disease
  • Patients with oncological conditions
  • Patients with digestive system disorders
  • Patients with chronic diseases

  1. Lecture

Modality
Location
Contact hours
On site
Study room
2

Topics

Use of medical nutritional therapy in intensive care settings
Description
  • Stress and critical condition – metabolism and nutritional requirements
  • Initiation of medical nutrition therapy and selection of enteral or parenteral nutrition
  • Calculation of nutritional substrates; fluid and electrolyte balance

  1. Class/Seminar

Modality
Location
Contact hours
On site
Study room
2

Topics

Use of medical nutritional therapy in intensive care settings
Description
  • Stress and critical condition – metabolism and nutritional requirements
  • Initiation of medical nutrition therapy and selection of enteral or parenteral nutrition
  • Calculation of nutritional substrates; fluid and electrolyte balance

  1. Lecture

Modality
Location
Contact hours
On site
Study room
2

Topics

Provision of medical nutritional therapy: initiation, monitoring, assessment of effectiveness, and necessary adjustments
Description
  • Patient evaluation and planning
  • Monitoring of therapy:
    • nutrient intake, weight changes,
    • tolerance,
    • clinical and biochemical indicators,
  • Evaluation and correction of therapeutic efficacy

  1. Class/Seminar

Modality
Location
Contact hours
On site
Study room
2

Topics

Provision of medical nutritional therapy: initiation, monitoring, assessment of effectiveness, and necessary adjustments
Description
  • Patient evaluation and planning
  • Monitoring of therapy:
    • nutrient intake, weight changes,
    • tolerance,
    • clinical and biochemical indicators,
  • Evaluation and correction of therapeutic efficacy

  1. Lecture

Modality
Location
Contact hours
On site
Study room
2

Topics

Potential complications of medical nutritional therapy
Description
  • indigestion
  • electrolyte dysbalance, fluid overload
  • aspiration
  • insufficient or excessive nutrient input
  • metabolic complications

  1. Class/Seminar

Modality
Location
Contact hours
On site
Study room
2

Topics

Potential complications of medical nutritional therapy
Description
  • indigestion
  • electrolyte dysbalance, fluid overload
  • aspiration
  • insufficient or excessive nutrient input
  • metabolic complications

  1. Lecture

Modality
Location
Contact hours
On site
Study room
2

Topics

Medical nutritional therapy for children at different stages of age.
Description
Medical nutritional therapy for pediatric patients:
  • Oral nutritional supplements: age-appropriate formulations, product selection, indications, and prescription procedures.
  • Enteral feeding: types of administration, indications, and contraindications.
  • Parenteral feeding: types of administration, indications, and contraindications.
  • Types of nutritional mixtures used in enteral and parenteral therapy.

  1. Class/Seminar

Modality
Location
Contact hours
On site
Study room
2

Topics

Medical nutritional therapy for children at different stages of age.
Description
Medical nutritional therapy for pediatric patients:
  • Oral nutritional supplements: age-appropriate formulations, product selection, indications, and prescription procedures.
  • Enteral feeding: types of administration, indications, and contraindications.
  • Parenteral feeding: types of administration, indications, and contraindications.
  • Types of nutritional mixtures used in enteral and parenteral therapy.
Total ECTS (Creditpoints):
3.00
Contact hours:
32 Academic Hours
Final Examination:
Exam

Bibliography

Required Reading

1.

Singer P, Blaser AR, Berger MM, Calder PC, Casaer M, Hiesmayr M, Mayer K, Montejo-Gonzalez JC, Pichard C, Preiser JC, Szczeklik W, van Zanten ARH, Bischoff SC. ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit. Clin Nutr. 2023 Sep;42(9):1671-1689

2.

Schuitema C, Lichota M, Nyulasi I, Schneider SM, Stanga Z, Pironi L. ESPEN practical guideline: Home enteral nutrition. Clin Nutr. 2022 Feb;41(2):468-488

3.

Pironi L, Boeykens K, Bozzetti F, Joly F, Klek S, Lal S, Lichota M, Mühlebach S, Van Gossum A, Wanten G, Wheatley C, Bischoff SC. ESPEN practical guideline: Home parenteral nutrition. Clin Nutr. 2023 Mar;42(3):411-430

4.

Cuerda C, Pironi L, Arends J, Bozzetti F, Gillanders L, Jeppesen PB, Joly F, Kelly D, Lal S, Staun M, Szczepanek K, Van Gossum A, Wanten G, Schneider SM, Bischoff SC; Home Artificial Nutrition & Chronic Intestinal Failure Special Interest Group of ESPEN. ESPEN practical guideline: Clinical nutrition in chronic intestinal failure. Clin Nutr. 2021 Sep;40(9):5196-5220

5.

M, Gianotti L, Krznarić Ž, Lobo DN, Löser C, Madl C, Meier R, Phillips M, Rasmussen HH, Van Hooft JE, Bischoff SC. ESPEN practical guideline on clinical nutrition in acute and chronic pancreatitis. Clin Nutr. 2024 Feb;43(2):395-412

6.

Thibault R, Abbasoglu O, Ioannou E, Meija L, Ottens-Oussoren K, Pichard C, Rothenberg E, Rubin D, Siljamäki-Ojansuu U, Vaillant MF, Bischoff SC. ESPEN guideline on hospital nutrition. Clin Nutr. 2021 Dec;40(12):5684-5709

7.

Wunderle C, Gomes F, Schuetz P, Stumpf F, Austin P, Ballesteros-Pomar MD, Cederholm T, Fletcher J, Laviano A, Norman K, Poulia KA, Schneider SM, Stanga Z, Bischoff SC. ESPEN guideline on nutritional support for polymorbid medical inpatients. Clin Nutr. 2023 Sep;42(9):1545-1568

8.

Compher C, Bingham AL, McCall M, Patel J, Rice TW, Braunschweig C, McKeever L. Guidelines for the provision of nutrition support therapy in the adult critically ill patient: The American Society for Parenteral and Enteral Nutrition. JPEN J Parenter Enteral Nutr. 2022 Jan;46(1):12-41

9.

Boullata JI, Carrera AL, Harvey L, Escuro AA, Hudson L, Mays A, McGinnis C, Wessel JJ, Bajpai S, Beebe ML, Kinn TJ, Klang MG, Lord L, Martin K, Pompeii-Wolfe C, Sullivan J, Wood A, Malone A, Guenter P; ASPEN Safe Practices for Enteral Nutrition Therapy Task Force, American Society for Parenteral and Enteral Nutrition. ASPEN Safe Practices for Enteral Nutrition Therapy. JPEN J Parenter Enteral Nutr. 2017 Jan;41(1):15-103

10.

Braegger C, Decsi T, Dias JA, Hartman C, Kolacek S, Koletzko B, Koletzko S, Mihatsch W, Moreno L, Puntis J, Shamir R, Szajewska H, Turck D, van Goudoever J; ESPGHAN Committee on Nutrition:. Practical approach to paediatric enteral nutrition: a comment by the ESPGHAN committee on nutrition. J Pediatr Gastroenterol Nutr. 2010 Jul;51(1):110-22

11.

Fiaccadori E, Sabatino A, Barazzoni R, Carrero JJ, Cupisti A, De Waele E, Jonckheer J, Singer P, Cuerda C. ESPEN guideline on clinical nutrition in hospitalized patients with acute or chronic kidney disease. Clin Nutr. 2021 Apr;40(4):1644-166

12.

Druml C, Ballmer PE, Druml W, Oehmichen F, Shenkin A, Singer P, Soeters P, Weimann A, Bischoff SC. ESPEN guideline on ethical aspects of artificial nutrition and hydration. Clin Nutr. 2016 Jun;35(3):545-56

13.

Muscaritoli M, Arends J, Bachmann P, Baracos V, Barthelemy N, Bertz H, Bozzetti F, Hütterer E, Isenring E, Kaasa S, Krznaric Z, Laird B, Larsson M, Laviano A, Mühlebach S, Oldervoll L, Ravasco P, Solheim TS, Strasser F, de van der Schueren M, Preiser JC, Bischoff SC. ESPEN practical guideline: Clinical Nutrition in cancer. Clin Nutr. 2021 May;40(5):2898-291

14.

da Silva JSV, Seres DS, Sabino K, Adams SC, Berdahl GJ, Citty SW, Cober MP, Evans DC, Greaves JR, Gura KM, Michalski A, Plogsted S, Sacks GS, Tucker AM, Worthington P, Walker RN, Ayers P; Parenteral Nutrition Safety and Clinical Practice Committees, American Society for Parenteral and Enteral Nutrition. ASPEN Consensus Recommendations for Refeeding Syndrome. Nutr Clin Pract. 2020 Apr;35(2):178-195