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Malnutrition (Grades 12, College Level)

Applicable to Courses:  Health, Nutrition, Nursing

Description of Students' Roles and Problem Situation:   Students, working in small groups, attempt to find innovative ways to solve the problem of malnutrition.  The focus is on finding workable and reasonable solutions, adoptable by any patient.

Educational Goals:  To enhance critical thinking, to create an avenue by which alternatives are dealt with individually and collectively.  Promotes group work and encourages the participation of each group member.  Also requires an ultimate solution everyone can agree upon, including the patient.

Submitting Teacher:  Vickie Baggett, Johnston Community College, Smithfield, NC  27577

e-mail:  vbag874604@aol.com

Meet the Problem Document

Curriculum Alignment

Sample Know/Need to Know Boards

Sample Problem Statement

Problem Map

Resource List

Description of Capstone Performance

Assessment Instrument for Capstone Performance

Alternative Solutions

Debriefing Session Description

Coaching Questions


To: Amy Orders, RD (Dept. Head of Nutrition)

From: Vickie Baggett RN (Manager of CCU)

Date: July 1, 1999


Recently our hospital admitted a 42-year-old white female by the name of Gabriel, who lost 100 lbs. in 6 months. Her previous weight was 220 lbs. Her primary physician admitted her with the diagnosis of Malnutrition. She thinks she looks wonderful and is happy that she can wear a size 5 dress. Her hemoglobin was 3.3 and hemocrit 17. Pt shows little concern with her diagnosis. She has visual signs and symptoms of someone malnourished. I am requesting a comprehensive evaluation of her condition and interventions to assist her with future diet and weight management. I would like to have the evaluation by July 31, 1999. Thanks again for any assistance you can offer.

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  • Student will have basic understanding of anatomy and physiology
  • Student will have understanding of dietary needs
  • Student will understand responsibilities of nurse as care manager


  • Student will have basic writing skills
  • Student will be able to communicate within a classroom and group setting
  • Student will have knowledge of how to perform research necessary

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Need to Know
  • Age- 42 y.o.
  • Race- white
  • Size 5 clothing
  • Original weight
  • Weight Loss 100 lbs.
  • Pt is happy over body image change
  • Diagnosis
  • Visual signs of malnutrition
  • No concern over diagnosis
  • Deadline for project
  • What pt. believes is a good weight for her?
  • Why pt. lost weight so quickly?
  • What are the risks of losing weight so quickly?
  • What is the ideal body wt. for this pt?
  • What pt understands about diagnosis?
  • How does pt plan to keep wt. down?
  • What does pt. understand about eating habits?

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How can we as health educators, help Gabriel make healthy choices in such a way that she remains happy with her appearance, maintains satisfactorily weight loss, does not jeopardize her future health and understand the effects of rapid weight loss.



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Richardson, L.A. (1993). Diets & weight loss. Harrisonburg, VA: Banta Company.

Solimano, G.R., & Ledermen, S.A. (1983). Controversial nutrition policy issues.Charles C. Thomas Pub. Ltd.

Arrowsmith, H. (1997). Malnutrition in hospital: detection and consequences. British Journal of Nursing6 (19), 1131-5.

Fishman, P. (1994). Detecting malnutritionís warning signs with simple screening.Geriatrics,49 (10), 39-42.

Berg, F.M. (1993). The health risks of weight loss. Hettinger,ND: Circulation department, obesity and Health. (ERIC Document Reproduction service No. ED380404)

Perry, C.L.,Story, M., & Lytle, L. (1997). Promoting healthy dietary behaviors (ERIC Document Reproduction service No. ED415966)

Bozian, R., Gugelchuk, G. M. & Scheider, K.N. (1983). Malnutrition: diagnosis and therapeutic alternatives [Video]. (Available from Ohio Regional Medical Audiovisual Consortium, Columbus, Ohio)

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Upon completion of this problem based learning tool: Case study: malnutrition, the students will have a basic understanding of anatomy and physiology, will be able to describe the effects of dietary needs, and understand the role of  the nurse as manager of a patientís dietary needs. Basic writing and research skills will also be needed to complete the project effectively.

Students will deliver in their individual groups, an oral presentation, in the manner in which they choose, the solutions to the problem. The groups will be given a rubric to score each other during the presentation. Nutrition instructors and nursing instructors of the local community college will be invited to hear the presentation.

Students will use the solutions provided to enhance critical thinking skills, discuss ethical dilemmas, analyze and critique the problem presented. Problem solving skills are crucial in determining workable solutions.


Rudimentary Rubric Assessment Instrument

A. Discuss all group solutions (3-5 minutes each)

B. Group to rate the best solution on the board (1-5) (5 the best)

C. Group to discuss why this is the best solution

D. Discuss concepts listed on the board

         1. Solution stated accurately/clear 20 pts.

  2. Group delivered workable solution 15 pts.

          3. Solutions present but unclear 12 pts.


1. Group understood problems well & persuasive 15 pts.

2. Group persuasive with problems 13 pts.

        3. Group attempts to rank solutions 10 pts.


1. Able to verify resources to indicate best solution 10 pts.

2. Teamwork demonstrated in the group 9 pts.

        3. Group need guidance with best solution 7 pts.

1. Organized presentation 15 pts.

2. Priorities Set w /presentation 13 pts.

3. Concepts repetitive and not explained in depth 11 pts.

First Descriptor (Excellence)

Group delivers all appropriate solutions to the class in a clear, accurate and concise manner. Group shows quality in responding to audience questions. 25 pts.

Group delivers solutions to the class in a clear manner. Group responds with assistance of instructor to answer some questions. 22 pts.

Group delivers solutions but able to entertain and respond to questions 18 pts.

Second Descriptor (Mediocre)

Group delivers all solutions but does not demonstrate complete knowledge of the problem. 15 pts

Group delivers solutions but unclear of the volume of the problem or exemplify knowledge of it. 12 pts.

Group delivers solutions without knowledge of the entire problem. 10 pts.

Total Points- 85 points

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Solutions Pros/ Cons /Consequences

Educate on dangers of rapid wt. loss & assist w/ a dietary regimen that pt. helps to construct



  Lose weight

She will look nutritionally sound

Allowing participation w/diet will allow her to make some decisions

Understands what malnutrition can do to the body

Thinks she has met a great accomplishment

Noncompliant w/dietary changes

Fails to comprehend the devastating effects of malnutrition

Doesnít think she can lose wt. on traditional methods

Pt. will understand how she jeopardized her health and utilize diet changes to change lifestyle.

Pt. will understand the concept of malnutrition and its affects on the body.

 Discuss how diet and exercise promotes healthy weight loss/maintenance



Will be knowledgeable on how diet changes contributes to wt. loss

Implements a daily exercise plan

Will understand the association b/w malnutrition and nutrition

Able to discuss what a healthy diet is

Non-motivated to start weight management

Unable to discuss what a healthy weight consists of

Unable to comprehend how healthy weight loss leads to maintenance

Fails to understand how unhealthy weight loss can lead to mortality

Pt will understand safe weight loss plans and why they are more effective

Pt. will learn to utilize exercise and diet to promote a healthier lifestyle

Best Alternative: Educating the patient on weight loss and assisting her with a workable diet regimen is the best alternative solution. She will have the needed skills to make healthy choices and understand the health risks involved with rapid weight loss. Allowing the patient to assist with those choices includes her in the decision making process, thus she will be more apt to comply. Knowledge and life skills are the primary focus in this project.

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The debriefing session will involve the entire class. Each group will be asked to discuss why they chose their final solution and present findings of each group to the class. One student will act as the scribe and record solutions as the class members recall them. They will have 15 minutes each to perform this task. Finally one best solution from each group will be derived. Finally the class will be asked to vote by a show of hands which solution/group developed the best solution.

The instructor will list on the board the concepts missed and pertinent data that contributes to finding the best solution. Based on this, the group will explore answers to coaching questions as directed. The instructor will also discuss resource methods that were not pursued and share for future use other valuable resources available to them. Each will be listed on board.

The instructor will review his/her insight to the problem and why she/he believes it is the best solution. This will be done in an oral 15-minute presentation.

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Meeting the Problem

  • Whatís the dilemma with the patient losing 100 lbs. so quickly?
  • What do you know for certain about this patient?
  • What is the problem losing much needed weight?

Know/Need to Know Board

  • Why is the information you know about the pt. important?
  • What are the most interesting facts about the situation?
  • What are the obstacles you see with the patient?

Writing Problem Statements

  • What are the constraints that may affect the solution?
  • What is at stake for this patient?
  • Whose needs are affected?

Information Gathering & Sharing

  • How might you find out information on nutrition?
  • Can the information you found be verified?
  • What insight into weight loss gives us a better understanding of the situation?

Generating Possible Solutions

  • What the issues that may go unresolved?
  • Do we have all the information and resources that we need?
  • What responses are occurring with the information you found?

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