Nutrition Care Process

REFRESHER ON
NCP & NCPT

Compiled and Presented by:
Mr. John Rafael R. Arañas, RND, MPH
Objectives
❑Define and explain the Nutrition Care Process (NCP)
Identify how the steps and criteria of the NCP
promote quality care
❑Implement the NCP to guide and document
nutrition care and outcomes
❑Familiarize and review the different Nutrition Care
Process Terminologies in the creation of PES
statements
10/05/2019
© J.R. Arañas, RND, MPH

Why standardized
Nutrition Documentation?
❑To ensure quality of care
❑To improve outcomes
❑To describe the services and enhance visibility of
RND’s
❑To facilitate electronic medical record
documentation
❑To facilitate reimbursement for nutritional services
10/05/2019

ADA NUTRITION CARE PROCESS AND MODEL
Screening & Referral
System
➢ Identify risk factors
➢ Use appropriate tools
and methods
➢ Involve
interdisciplinary
collaboration Nutrition Diagnosis
➢ Identify and label problem
Nutrition Assessment ➢ Determine cause/contributing risk
➢ Obtain/collect timely and
factors
appropriate data ➢ Cluster signs and symptoms/
➢ Analyze/interpret with defining characteristics
evidence- based standards
➢Document
➢ Document
Relationship
Between
Patient/Client/Group Nutrition Intervention
& Dietetics ➢ Plan nutrition intervention
Professional • Formulate goals and
determine a plan of action
➢Implement the nutrition intervention
Nutrition Monitoring and • Care is delivered and actions
-
Evaluation are carried out
➢ Monitor progress ➢ Document
➢ Measure outcome indicators
➢ Evaluate outcomes
➢ Document
Outcomes
Management System
➢ Monitor the success of the Nutrition Care
Process implementation
➢ Evaluate the impact with aggregate data
➢ Identify and analyze causes of less than
optimal performance and outcomes 10/05/2019
➢ Refine the use of the Nutrition Care
Process
10/05/2019

NUTRITION • Is a systematic approach
CARE to providing a high
PROCESS quality Nutrition care.
• A group of activities
allowing identification of
nutritional needs and
provision of care to meet
these needs
10/05/2019

Steps in
Nutrition
Care
Process
STEP 1 STEP 2.
Nutrition Assessment Nutrition Diagnosis
NUTRITION
CARE PROCESS
STEP 3. STEP 4
10/05/2019
Nutrition Intervention Nutrition Monitoring
and Evaluation
Nutrition Assessment Leads
to Nutrition Diagnosis
• Nutrition Assessment
• Nutrition Diagnosis
• Nutrition Intervention
• Nutrition Monitoring
and Evaluation
10/05/2019

DOMAINS (CATEGORIES)
❑Step 1: Nutrition Assessment
➢ Food/Nutrition Related History
➢ Anthropometric Measurements
➢ Biological Data, Medical Tests and Procedures
➢ Nutrition-focused Physical Findings
➢ Client History
❑Step 2: Nutrition Diagnosis
➢ Food and or Nutrient Intake
➢ Clinical
➢ Behavioral/Environmental
10/05/2019

DOMAINS (CATEGORIES)
❑Step 3: Intervention
➢ Food and/or Nutrition Delivery
➢ Nutrition Education
➢ Nutrition Counseling
➢ Coordination of Nutrition Care
❑Step 4: Monitoring and Evaluation
➢ Food/Nutrition Related History
➢ Anthropometric Measurements
➢ Biological Data, Medical Tests and Procedures
➢ Nutrition-focused Physical Findings
10/05/2019

Nutrition Assessment
❑Systematic process of Obtaining, Verifying and
Interpreting data
❑Critical Thinking during this step:
✓ Determining appropriate data to collect
✓ Determining the need for additional information
✓ Selecting assessment tools and procedures that match the
situation
✓ Applying assessment tools in valid and reliable ways
✓ Distinguishing relevant (important) from irrelevant
(unimportant) data
✓ Validating Data
10/05/2019

Components of Nutrition Assessment Process
• Review data collected for factors that affect
nutritional and health status
• Cluster individual data elements to identify a
nutrition diagnosis as described in the
nutrition diagnosis reference sheets
• Identify standards for data comparison
10/05/2019

Components of Nutrition Assessment Process
• Review data collected for factors that affect
nutritional and health status
• Cluster individual data elements to identify a
nutrition diagnosis as described in the
nutrition diagnosis reference sheets
• Identify standards for data comparison
10/05/2019

Summary | Nutrition Assessment
• Nutrition Assessment is the first step of the NCP
• Dynamic process that develops throughout the NCP
• Data is used for all other steps of the NCP
• New information may provide reason for reassessment

or change in approach and intervention
10/05/2019

Nutrition Diagnosis
10/05/2019

Nutrition Diagnosis
❑Identify and describe a specific nutrition
problem that can be resolved or improved
through treatment/nutrition intervention
❑Use IDNT/NCPT standardized Nutrition
Diagnosis
❑Document the link between nutrition
assessment and nutrition intervention
10/05/2019

Battle of Terms
MEDICAL NUTRITION
❑Disease of specific ❑Problem related to

organs or systems nutrition that RND can
influence
❑Does not change as ❑Temporary – can be
long as condition exist altered as resident’s
response changes
10/05/2019

Nutrition vs Medical Dx
Medical Dx Nutrition Diagnosis
Diabetes Excessive CHO intake related to evening

visits to Coldstone Creamery as
evidenced by diet hx and high hs blood
glucose
Trauma and Increased energy expenditure related to
closed head multiple trauma as evidenced by results
injury of indirect calorimetry
Liver failure Altered gastrointestinal function related to
cirrhosis of the liver as evidenced by
steatorrhea and growth failure
10/05/2019

Nutritional vs Medical Dx
Medical Dx Nutrition Diagnosis
Obesity Excessive energy intake related to lack
of access to healthy food choices
(restaurant eating) as evidenced by diet
history and BMI of 35.
Dependence Excessive energy intake related to high
mechanical volume PN as evidenced by RQ >1
ventilation
Anorexia Inappropriate food choices related to
nervosa history of anorexia nervosa and self-
limiting behavior as evidenced by diet
history and weight loss of 5 lb
10/05/2019

ACT THAT TERM!
ACTIVITY # 1
© J.R. Arañas, RND, MPH 10/05/2019

• INTAKE
Select a • CLINICAL
Domain/
• BEHAVIORAL/
Category
ENVIRONMENTAL
10/05/2019

PES Statement
10/05/2019

PES • Problem: nutrition
Statement diagnosis label
• Etiology: the focus of
the intervention
• Signs and symptoms:
change when nutrition
problems are
successfully treated; the
focus of monitoring and
evaluation
10/05/2019

Problem (Diagnostic Label)
Falls into three general domains:
• Intake (NI)
– Excessive or Inadequate intake compared to
requirements
• Clinical (NC)
– Medical or physical conditions that are outside
normal
• Behavioral/environmental (NB)
– Knowledge, attitudes, beliefs, physical
environment, access to food, food safety
10/05/2019

Etiology
• Etiology (Cause/Contributing Factors)
– Related factors that contribute to problem
– Identifies cause of the problem
– Helps determine whether nutrition intervention will
improve problem
– Linked to problem by words “related to” (RT)
– Note: etiology may not always be clear
10/05/2019

Etiology
• Etiology (Cause/Contributing Factors)
– Excessive energy intake (problem) “related to”
regular consumption of large portions of high-
fat meals (etiology)…
– Swallowing difficulty (problem) RT recent
stroke (etiology)…
– Involuntary wt gain RT decrease in exercise…
10/05/2019

Diagnostic Labels Can Be Problems
or Etiologies
• Inadequate energy intake (NI-1.4) related to
food-nutrition knowledge deficit (NB-1.1)
• Food-nutrition knowledge deficit (NB-1.1)
related to lack of previous nutrition education
• Involuntary weight loss (NC-3.2) related to
inadequate energy intake (NI-1.4)
• Inadequate oral food-beverage intake (NI-2.1)
related to swallowing difficulty (NC-1.1)
10/05/2019

Signs and Symptoms
• Signs/Symptoms (Defining
characteristics)
– Evidence that problem exists
– Linked to etiology by words “as evidenced
by”
• Evaluation and monitoring of
effectiveness of intervention is done by
reviewing signs and symptoms
10/05/2019

Nutrition Dx with S/S
• Excessive energy intake (NI-1.5) (P)
• “related to” regular consumption of large
portions of high-fat meals (E)
• “as evidenced by” diet history & 12 lb wt
gain over last 18 mo (Signs)
10/05/2019

Nutrition • Problem: excessive energy
Assessment intake
Identifies • Etiology: reviewing the diet
Etiology history, we learn that
and S/S – Patient eats in fast food

restaurants 2x day
– Patient supersizes portions
because it’s a bargain
– Patient has only 15 minutes
for lunch
10/05/2019

PES Statement
Excessive energy intake P
Related to eating frequently in fast food E

restaurants
As evidenced by BMI of 30 and diet S

history
10/05/2019

Etiology Guides Intervention!
• The clinician determines what the

intervention is by looking at the root cause
of the nutrition problem.
• If the cause of excessive energy intake is
eating frequently in fast food restaurants,
how would you intervene?
10/05/2019

10/05/2019

10/05/2019

Signs and Symptoms Direct
Intervention and Evaluation
Intervention/ Eval
P Excessive energy
intake
E RT eating Intervention: Counsel
frequently in fast patient about best choices
food restaurants in fast food restaurants (C-
2.4)
S As evidenced by Eval: Recheck weight (S-
BMI and diet 1.1.4) and diet history (BE-
history 2.1.1.) at next visit
10/05/2019

• Excessive fat intake (NI-5.6.2)
PES related to high intake of fried
foods and bakery goods as
Statements evidenced by diet history and
hyperlipidemia
• Excessive energy intake (NI-1.5)
related to high intake of fried
foods and snack items as
evidenced by diet history and BMI
• Food/nutrition related knowledge
deficit (NB-1.1)
related to lack of education on
cholesterol lowering diet as
evidenced by history and patient
self-report
10/05/2019

Nutrition Diagnosis Statement
Should Be
• Clear, concise
• Specific
• Related to one problem
• Accurate – related to one etiology
• Based on reliable, accurate assessment data
10/05/2019

Evaluating • There are no right or
Your PES wrong PES
Statement statements
• But some are better
than others
10/05/2019

Evaluating • Can the RD resolve or
Your PES improve the nutrition
Statement diagnosis?
• Can your intervention
address the etiology and
thus resolve it or improve
the problem?
• Or can your intervention
address the signs and
symptoms?
10/05/2019

Evaluating • Ex: Inadequate energy
Your PES intake related to decreased
Statement taste perception as
evidenced by diet history,
medical dx and weight loss
of 10 lb. during cancer tx
• Cannot treat the etiology
(decreased taste perception)
but can treat S&S by
recommending foods with
stronger flavors
10/05/2019

Evaluating • Altered nutrition-related
Your PES labs related to GI bleed as
evidenced by medical hx and
Statement decreased hgb/hct in
medical record
• Labs likely won’t improve
until GI bleed is addressed;
the etiology is not a
nutritional deficit
• CAN address inadequate
intake of iron, copper, B12,
10/05/2019
protein, etc.
Evaluating Your PES Statement
• When all things are equal and there is a choice
between two nutrition diagnoses from different
domains, consider the Intake domain diagnosis as
the one more specific to the role of the RND
• Instead of Altered nutrition-related labs related to
GI bleed as evidenced by medical hx and
decreased hgb/hct in medical record
• Consider Inadequate intake of iron (NI-5.10.1)
related to increased needs due to GI bleed as
evidenced by medical history, blood count, diet
history, and serum ferritin
10/05/2019

Evaluating • Will measuring the signs and
Your PES symptoms tell you if the
Statement problem is resolved or
improved?
• Ex: If nutrition dx is
excessive energy intake, can
do another diet history at
next visit and see if intake
has changed; can also check
weight
10/05/2019

ADA’s Nutrition Care
Process Steps
• Nutrition Monitoring and Evaluation
10/05/2019

Nutrition • Should be
Intervention
targeted at
etiology
• If not etiology,
then signs and
symptoms
10/05/2019

Nutrition Intervention
10/05/2019

Nutrition Four categories of
Interventions nutrition interventions:
• Food and/or nutrient
delivery (ND)
• Nutrition education (E)
• Nutrition counseling (C)
• Coordination of nutrition
care (RC)
10/05/2019

Food • Meals and snacks (ND-1)
and/or • Enteral/parenteral nutrition
(ND-2)
Nutrient • Medical food supplements
Delivery (ND-3.1)
• Vitamin and mineral
supplement (ND-3.2)
• Bioactive substance
supplement (ND-3.3)
• Feeding assistance (ND-4)
• Feeding environment (ND-5)
• Nutrition-related medication
10/05/2019 management (ND-6)
Nutrition • Initial/brief nutrition
Education education (E-1)
(E) – E.g. survival skills on
discharge
• Comprehensive nutrition
education (E-2)
– Purpose
– Recommended modifications
– Result interpretation
– Other
10/05/2019
Note: Education
© J.R. Arañas, RND,is appropriate for food and nutrition-related knowledge
MPH
deficit. If the client knows the content, more education probably won’t help
Nutrition • Theory or approach
Counseling
• Strategies
(C)
• Phase
10/05/2019

Nutrition The theories or models used to
design and implement an
Counseling: intervention; provide a
Theory or research-based rationale for
designing and tailoring
Approach nutrition interventions
• Cognitive-behavioral therapy
(C-1.2)
• Health belief model (C-1.3)
• Social learning theory (C-1.4)
• Transtheoretical Model/Stages
of Change (C-1.5)
• Other (C-1.6)
10/05/2019

Nutrition • Motivational interviewing (C-2.1)
• Goal setting (C-2.2)
Counseling: • Self-monitoring (C-2.3)
Strategies* • Problem solving (C-2.4)
• Social support (C-2.5)
• Stress management (C-2.6)
• Stimulus control (C-2.7)
• Cognitive restructuring (C-2.8)

• Relapse prevention (C-2.9)
• Rewards/contingency mgt (C-2.10)
• Other
10/05/2019
*Selectively applied evidence-based method or plan of action designed to

achieve a particular goal
Coordination • Coordination of other care
during nutrition care (RC-1)
of Care (RC) – Team meeting
– Referral to RD
– Collaboration with other
providers
– Referral to community
agencies/programs
• Discharge and transfer of
nutrition care to new
setting/provider (RC-2)
– Collaboration
– Referral to community
agencies/programs
10/05/2019

ADA’s Nutrition Care
Process Steps
• Nutrition Monitoring and Evaluation
10/05/2019

Nutrition • Monitor progress and
determine if goals are
Monitoring met
and • Identifies patient/client
Evaluation outcomes relevant to the
nutrition diagnosis and
intervention plans and
goals
• Measure and compare to
client’s previous status,
nutrition goals, or
10/05/2019
reference standards
Nutrition Monitoring and
Evaluation
10/05/2019

• Nutrition-Related Behavioral
Nutrition and Environmental Outcomes
Outcomes – (BE)—Nutrition-related
knowledge, behavior, access,
4 and ability that impact food
and nutrient intake
Categories • Food and Nutrient Intake
Outcomes (FI)—Food and/or
nutrient intake from all
sources
• Nutrition-Related Physical
Signs and Symptom Outcomes
(S)—Anthropomorphic,
biochemical, and physical
exam parameters
• Nutrition-Related
Patient/client centered
Outcomes (PC)—perception of
10/05/2019
patient/client’s nutrition
© J.R. Arañas, RND, MPH intervention and its impact
Nutrition- • Knowledge/beliefs (1)
Related • Behavior (2)
Behavioral
and • Access (3)
Environme • Physical activity and
ntal function (4)
Outcomes
(BE)
10/05/2019

Behavior- Definition: beliefs/attitudes
about and/or readiness to
Environmen change food, nutrition, or
nutrition-related behaviors
tal Potential indicators (BE-1.1)
Outcomes – Readiness to change
Domain: – Perceived consequences of
change
Beliefs and – Perceived costs versus
Attitudes benefits of change
– Perceived risk
(BE-1.1) – Outcome expectancy
– Conflict with patient/family
value system
– Self efficacy
10/05/2019

Beliefs and Measurement methods or
Attitudes data sources
(BE-1.1) – Patient self-report,
client/patient assessment
questionnaire or interview
Typically used to monitor
and evaluate change in the
following domains of
nutrition intervention:
– Nutrition education,
nutrition counseling
10/05/2019

Beliefs and Typically used to monitor and
evaluate change in the
Attitudes following nutrition diagnoses
– Harmful beliefs/attitudes
(BE-1.1) about food- or nutrition-
related topics
– Not ready for diet/lifestyle
change
– Inability to manage self-
care
– Excess or inadequate oral
food/beverage, energy,
macronutrient,
micronutrient, or bioactive
substance intake
– Imbalance of nutrients
10/05/2019
– Inappropriate fat foods
Beliefs and Typically used to
Attitudes monitor/evaluate change in
the following nutrition
(BE-1.1) diagnoses (cont)
– Inappropriate intake of
amino acids
– Underweight
– Overweight/obesity
– Disordered eating pattern
– Physical inactivity
10/05/2019
– Excess exercise
Behavior- Definition: Level of
Environmenta
l Outcomes knowledge about
Domain: Food food, nutrition and
and Nutrition
health, or nutrition-
Knowledge
(BE-1.2) related information
and guidelines
relevant to
patient/client needs
10/05/2019

Food and • Level of knowledge (e.g. none,
limited, minimal, substantial, and
Nutrition extensive
Knowledge • Areas of knowledge:
(BE-1.2) – Food/nutrient requirements
Potential – Physiological functions
Indicators – Disease/condition
– Nutrition recommendations
– Food products
– Consequences of food
behavior
– Food label
understanding/knowledge
– Self-management parameters
10/05/2019

Food and Measurement methods or data
sources
Nutrition • Pre and post-tests
Knowledge administered orally, on paper,
or by computer
(BE-1.2) • Scenario discussions
• Patient/client restate key
information
• Review of food records
• Practical demonstration/test
Typically used to monitor and
evaluate change in the
following domains of nutrition
intervention:
10/05/2019 • Nutrition education, nutrition
counseling
Food and Typically used to monitor
Nutrition and evaluate change in the
Knowledge following nutrition
(BE-1.2) diagnoses:
• Food- and nutrition-
related knowledge deficit
• Limited adherence to
nutrition-related
recommendations
10/05/2019
• Intake domain
Ability to • Definition: Patient/client
Plan ability related to planning
healthy meals and snacks,
Meals/Snac which are compatible with
ks (BE-2.1) dietary goals
• Potential indicator:
Meal/snack planning
ability (e.g. may include
ability to use planning
tools, plan a menu,
create/tailor a meal plan,
create/use a shopping list
10/05/2019

Ability to • Measurement
Plan methods/data sources:
food intake records, self-
Meals/Snac report or caregiver
ks (BE-2.1) report, 24-hour recall,
menu review, targeted
questionnaire
• Typically used to
measure outcomes for
these domains of
nutrition interventions:
– Nutrition education
– Nutrition counseling
10/05/2019

Ability to Typically used to monitor and
Plan evaluate change in the
following nutrition diagnoses:
Meals/Snac
• Excessive or inadequate oral
ks (BE-2.1) food/beverage intake
• Underweight
• Overweight/obesity
• Limited adherence to
nutrition-related
recommendations
• Inability or lack of desire to
10/05/2019
manage self-care
Other BE Behavior (2)
• Ability to select healthful
Nutrition food/meals
Outcomes • Ability to prepare
food/meals
• Adherence
Access (3) • Goal setting
• Access to food • Portion control
• Self-care management
Physical activity and function (4)
• Breastfeeding success • Self-monitoring
• Nutrition-related ADLs and IADLs • Social support
• Physical activity • Stimulus control
10/05/2019

Other
Food and Nutrient Intake (FI)
• Energy intake (1)
Outcomes • Food and Beverage (2)
• Enteral and parenteral (3)
• Bioactive substances (4)
• Macronutrients (5)
• Micronutrients (6)
Physical Signs/Symptoms (S)

• Anthropometric (1)
• Biochemical and medical tests (2)
• Physical examination (3)
10/05/2019
Patient-Client Centered Outcomes (PC)
Outcomes • Underlays Performance
Based Improvement and
Management
Practice
• Meets accreditation
standards (TJC, American
Diabetes Association)
• Supports value of nutrition
providers in health delivery
system
• Enhances reputation/ties
with medical staff and other
10/05/2019 colleagues
NCP • Mr. D. is a 73 y.o. white male
admitted with L leg fx after
Example: fall. He lives with his son and
Acute Care daughter in law. Per his son,
Mr. D’s appetite has been poor
the past 6 months, his
dentures are very loose and he
refuses to wear them. He also
refuses pureed foods. Ht: 6 ft.;
weight 133 lb; usual weight 1
year ago 165 lb. Meds: milk of
magnesia, Pepcid, Di-Gel. No
significant medical hx save
progressive dementia;labs
after hydration serum alb 2.4
10/05/2019
g/dL; Hgb 10.6 g/dL; HCT
35.3%; BUN, Cr, liver fxn tests
WNL
WRITE A PES
STATEMENT FOR
THIS PATIENT!
Individual
NCP Example: Acute Care
Nutrition Diagnosis
• Inadequate energy intake (NI-1.4) related to dementia
and poor appetite as evidenced by diet history and
recent unintentional weight loss
• Chewing difficulty (NC-1.2) related to ill-fitting
dentures as evidenced by diet history
• Increased energy expenditure (NI-1.2) related to long
bone fx as evidenced by medical history
10/05/2019

HOW WOULD YOU
INTERVENE WITH
THIS PATIENT?
Intervention • Dental consult to have
dentures relined for better
fit (RC - coordination of care)
• Try oral supplements to
determine patient
preference and evaluate
acceptance (ND-3.1.1 food-
nutrient delivery)
• Consider move to assisted
living (RC - coordination of
care)
• Educate patient’s family on
nutrient-dense choices for
supplemental feedings (E -
10/05/2019
nutrition education)
Monitoring • Initiate calorie count while
patient is hospitalized to
and evaluate acceptance of
Evaluation oral supplements
• Weigh patient weekly
after discharge
• Evaluate patient’s ability
to chew textured foods
after dentures are
replaced
• Evaluate patient in
Geriatric Clinic in one
month
10/05/2019

THE ASPIRING RND
ACTIVITY # 2
© J.R. Arañas, RND, MPH 10/05/2019

The Diet Prescription
• Designates type, amount, frequency of feeding

based on pt’s needs, care goals
• May specify calorie goal
• May limit or increase various components of the
diet
• Each institution usually has specific diets that
have been approved by committee that are used
at that institution
10/05/2019

Modifications of the Normal Diet
• Normal nutrition is foundation of

therapeutic diet modifications
– Based on DRIs
– Based on Food Guide Pyramid
• Purpose of diet is to supply needed
nutrients
10/05/2019

Modifications of the Normal Diet
• Change in consistency
• Increase/decrease energy value of diet
• Increase/decrease type of food or nutrient
consumed
• Elimination of specific foods or components
• Adjustment in level, ratio, balance of protein,
fat, CHO
• Change in number, frequency of meals
• Change in route of delivery of nutrients
10/05/2019

Basic Hospital Diets
10/05/2019

Basic Hospital Diets —cont’d
10/05/2019

“Surgical” Soft Diet
10/05/2019

Clear Liquid Diet
10/05/2019

Full Liquid Diet
10/05/2019

Full Liquid Diet –cont’d
10/05/2019

References • NCP Website: www.eatright.org/ncp
• International Collaboration and
Translations
https://ncpt.webauthor.com/internation
alcollaboration
• NCP Snapshots:
http://www.eatright.org/HealthProfessi
onals/content.aspx?id=5902
• NCP Publications and Toolkits:
www.eatright.org/shop
• NCP Tutorial Modules:
http://adaeal.com/ncp/
10/05/2019

Nutrition Care Process

Hochgeladen von

Dokumentinformationen

Copyright

Verfügbare Formate

Dieses Dokument teilen

Dokument teilen oder einbetten

Freigabeoptionen

Stufen Sie dieses Dokument als nützlich ein?

Sind diese Inhalte unangemessen?

Copyright:

Verfügbare Formate

Nutrition Care Process

Hochgeladen von

Copyright:

Verfügbare Formate

REFRESHER ON

NCP & NCPT

© J.R. Arañas, RND, MPH

© J.R. Arañas, RND, MPH

© J.R. Arañas, RND, MPH

© J.R. Arañas, RND, MPH

© J.R. Arañas, RND, MPH

© J.R. Arañas, RND, MPH

© J.R. Arañas, RND, MPH

© J.R. Arañas, RND, MPH

© J.R. Arañas, RND, MPH

© J.R. Arañas, RND, MPH

• Dynamic process that develops throughout the NCP

• Data is used for all other steps of the NCP

• New information may provide reason for reassessment

© J.R. Arañas, RND, MPH

© J.R. Arañas, RND, MPH

© J.R. Arañas, RND, MPH

❑Disease of specific ❑Problem related to

© J.R. Arañas, RND, MPH

Diabetes Excessive CHO intake related to evening

© J.R. Arañas, RND, MPH

© J.R. Arañas, RND, MPH

© J.R. Arañas, RND, MPH 10/05/2019

© J.R. Arañas, RND, MPH

© J.R. Arañas, RND, MPH

© J.R. Arañas, RND, MPH

© J.R. Arañas, RND, MPH

© J.R. Arañas, RND, MPH

© J.R. Arañas, RND, MPH

© J.R. Arañas, RND, MPH

© J.R. Arañas, RND, MPH

© J.R. Arañas, RND, MPH

and S/S – Patient eats in fast food

© J.R. Arañas, RND, MPH

Related to eating frequently in fast food E

As evidenced by BMI of 30 and diet S

© J.R. Arañas, RND, MPH

• The clinician determines what the

© J.R. Arañas, RND, MPH

© J.R. Arañas, RND, MPH

© J.R. Arañas, RND, MPH

© J.R. Arañas, RND, MPH

© J.R. Arañas, RND, MPH

© J.R. Arañas, RND, MPH

© J.R. Arañas, RND, MPH

© J.R. Arañas, RND, MPH

© J.R. Arañas, RND, MPH

© J.R. Arañas, RND, MPH

© J.R. Arañas, RND, MPH

© J.R. Arañas, RND, MPH

© J.R. Arañas, RND, MPH

© J.R. Arañas, RND, MPH

© J.R. Arañas, RND, MPH

© J.R. Arañas, RND, MPH

© J.R. Arañas, RND, MPH

• Cognitive restructuring (C-2.8)

*Selectively applied evidence-based method or plan of action designed to

© J.R. Arañas, RND, MPH

© J.R. Arañas, RND, MPH

© J.R. Arañas, RND, MPH

© J.R. Arañas, RND, MPH

© J.R. Arañas, RND, MPH

© J.R. Arañas, RND, MPH