Form NDP20I "Imbalanced Nutrition/Less Than Body Requirements" - Alabama

What Is Form NDP20I?

This is a legal form that was released by the Alabama Department of Mental Health - a government authority operating within Alabama. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 1, 2018;
  • The latest edition provided by the Alabama Department of Mental Health;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form NDP20I by clicking the link below or browse more documents and templates provided by the Alabama Department of Mental Health.

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Download Form NDP20I "Imbalanced Nutrition/Less Than Body Requirements" - Alabama

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NDP 20i
July 2018
NAME __________________________________________________
Imbalanced Nutrition/Less than Body Requirements
Date
Problem
Goal/Outcome
Interventions
Date
Evaluation
NOTES
Related to
(circle all that apply)
(Address all items
NURSING
1. Gain 1-2
circled in “goal/
Diagnosis of (state)
1. Initial and ongoing
outcome” column. If
lbs./month
nursing assessment
goal not met, revise
2. Verbalize
/Review of Systems
plan)
understanding
2. Assess and monitor
of high
weight/BMI
calorie/protein
AEB:
________
(frequency)
diet
(check/circle all that
3. Assess skin
3. Maintain food
apply)
turgor/color
□ BMI < 15
diary at least 3
______ (
frequency)
days/week
4. Assess VS
(T/P/R/BP)
□ Inability to
______
(frequency)
ambulate
5. Teach behavior
independently
modification
strategies to
□ SOB on exertion
increase caloric
intake (
/
)
specify
list
□other (state)
6. Encourage keeping
a food diary at least
3 days a week
7. Encourage a
minimum of 16 oz.
of water intake
daily; a minimum
daily fluid intake of
32 oz.
8. Consult Dietician as
needed
9. Other (
)
state
Imbalanced Nutrition/< Body Requirements
NDP 20i
July 2018
NAME __________________________________________________
Imbalanced Nutrition/Less than Body Requirements
Date
Problem
Goal/Outcome
Interventions
Date
Evaluation
NOTES
Related to
(circle all that apply)
(Address all items
NURSING
1. Gain 1-2
circled in “goal/
Diagnosis of (state)
1. Initial and ongoing
outcome” column. If
lbs./month
nursing assessment
goal not met, revise
2. Verbalize
/Review of Systems
plan)
understanding
2. Assess and monitor
of high
weight/BMI
calorie/protein
AEB:
________
(frequency)
diet
(check/circle all that
3. Assess skin
3. Maintain food
apply)
turgor/color
□ BMI < 15
diary at least 3
______ (
frequency)
days/week
4. Assess VS
(T/P/R/BP)
□ Inability to
______
(frequency)
ambulate
5. Teach behavior
independently
modification
strategies to
□ SOB on exertion
increase caloric
intake (
/
)
specify
list
□other (state)
6. Encourage keeping
a food diary at least
3 days a week
7. Encourage a
minimum of 16 oz.
of water intake
daily; a minimum
daily fluid intake of
32 oz.
8. Consult Dietician as
needed
9. Other (
)
state
Imbalanced Nutrition/< Body Requirements
NDP 20i
July 2018
Date
Problem
Goal/Outcome
Interventions
Date
Evaluation
NOTES
DELEGATE
1. Assist with meds as
ordered/directed
2. Check Vital Signs
(T/P/R/BP)
_________
(freq)
3. Weigh ______
(freq)
4. Assist with ADLs as
directed/needed
5. Encourage daily
exercise according
to ability
6. Monitor and
encourage high
calorie food/liquid
intake
7. Monitor and assist
with food diary
8. Document I & O
a. Encourage a minimum
fluid intake of 32 ounces/
day
b. Notify MAS Nurse if no BM
in 3 days
7. Other (list)
RN SIGNATURE:
DATE:
Imbalanced Nutrition/< Body Requirements
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