The document outlines a code of ethics for dietetics practitioners, requiring them to act with honesty, integrity and fairness; protect clients and the public; and consider health, safety and welfare above all else. It also specifies requirements around continuing education, operating within legal bounds, avoiding conflicts of interest, maintaining confidentiality, and providing evidence-based, unbiased information and care. Adherence to this code is meant to ensure dietetics practitioners uphold high professional standards and prioritize client well-being.

1. DIETETIC/NUTRITIONAL CODE OF ETHICS
1. The dietetics practitioner conducts himself/herself with
honesty, integrity, and fairness.
2.The dietetics practitioner supports and promotes high
standards of professional practice. The dietetics practitioner
accepts the obligation to protect clients, the public, and the
profession.
· Continuing education for licensure
· Practice within state laws
· Do not exceed the scope of practice
· Evidence based nutrition
3. The dietetics practitioner considers the health, safety, and
welfare of the public at all times.
· Make sure client is always aware of potential side effects or
risks (if any)
4. The dietetics practitioner complies with all laws and
regulations applicable or related to the profession or to the
practitioner’s ethical obligations as described in this Code.
· No criminal record
· No charges or investigations or disciplinary actions i n the
provision
· Revoking of license etc.
5. The dietetics practitioner provides professional services with
objectivity and with respect for the unique needs and values of
individuals.

2. · No discrimination, ethnic, gender, sexual orientation,
economic status, religion
· Cultural differences need to be respected
· No sexual harassment, or even humor
6. The dietetics practitioner does not engage in false or
misleading practices or communications.
· No false or deceptive advertising
· No misleading or faulty information about products that are
sold
· Only accurate and truthful information
7. The dietetics practitioner withdraws from professional
practice when unable to fulfill his or her professional duties and
responsibilities to clients and others.
· Personal substance abuse
· When court find practitioner mentally unstable
· Or any condition that substantially impairs their judgment or
effective rational decision making process
8. The dietetics practitioner recognizes and exercises
professional judgment within the limits of his or her
qualifications and collaborates with others, seeks counsel, or
makes referrals as appropriate.
· Refer out (ROF)
9. The dietetics practitioner treats clients and patients with
respect and consideration.

3. · Make sure enough information is provided to have client make
informed decisions
· The dietetics practitioner respects the client’s right to make
decisions regarding the recommended plan of care, including
consent, modification, or refusal
10. The dietetics practitioner protects confidential information
and makes full disclosure about any limitations on his or her
ability to guarantee full confidentiality.
· Informed consent
· HIIPA
11. The dietetics practitioner practices dietetics based on
evidence- based principles and current information.
12. The dietetics practitioner presents reliable and substantiated
information and interprets controversial
information without personal bias, recognizing that legitimate
differences of opinion exist.
13. The dietetics practitioner assumes a life-long responsibility
and accountability for personal competence in practice,
consistent with accepted professional standards, continually
striving to increase professional knowledge and skills and to
apply them in practice.
14. The dietetics practitioner is alert to the occurrence of a real
or potential conflict of interest and takes appropriate action
whenever a conflict arises.
· When a conflict of interest cannot be resolved by disclosure,
the dietetics practitioner takes such other action as may be

4. necessary to eliminate the conflict, including recusal from an
office, position, or practice situation.
15. The dietetics practitioner permits the use of his or her name
for the purpose of certifying that dietetics services have been
rendered only if he or she has provided or supervised the
provision of those services.
· Interns/assistants
16. The dietetics practitioner accurately presents professional
qualifications and credentials.
· RD, CNS, CHN, L/D, CCN
17. The dietetics practitioner does not invite, accept, or offer
gifts, monetary incentives, or other considerations that affect or
reasonably give an appearance of affecting his/her professional
judgment.
18. The dietetics practitioner demonstrates respect for the
values, rights, knowledge, and skills of colleagues and other
professionals.
· The dietetics practitioner does not engage in dishonest,
misleading, or inappropriate business practices that demonstrate
a disregard for the rights or interests of others.
Holistic Integration – CHN –code of Ethics (NANP)
· CHN will strive continually to improve skill and knowledge,
and make their professional attainments available to their
clients and colleagues.
· CHN services or counseling will be founded on a legal and
practical basis. The member will not voluntarily associate or
work with anyone who violates this principle.
· CHN will not exceed their scope of service or practice, either

5. in abilities or by law.
· CHN will choose whom he or she will serve. Having
undertaken a client, however, they may not neglect the client
unless discharged. The member may discontinue service only
after giving due notice to the client.
· CHN will seek consultation in doubtful or difficult cases, and
whenever it appears that the services of other professionals is
warranted to provide more complete or better quality advice.
· CHN will not reveal the confidences entrusted in the course of
consultations, unless required to do so by law.
· CHN will guard the public and themselves against any
nutritional counselor deficient in moral character or
professional competence. They will obey all laws, uphold the
dignity and honor of the profession and accept its self-imposed
disciplines. They will oppose without hesitation illegal or
unethical conduct of fellow members.
· In pursuit of this code and these goals, a CHN will vigorously
defend our first amendment right of freedom of speech and
press to impart truthful information concerning diet and
nutrition, and will defend the health freedom
A CNS/CNS-S that is clinically practicing nutrition care agrees
to adhere to the following Code of Ethics, Principles and
Interpretative Guidelines:
1. Foremost, do no harm. A CNS/CNS-S consciously avoids
harmful actions or omissions, embodies high ethical standards
and adheres to all applicable local, state, and federal laws and
regulations in the choices he or she makes.
2. A CNS/CNS-S places service and the health and welfare of

6. persons before self-interest and conducts oneself in the practice
of the profession so as to bring honor to oneself, peers, and to
the nutrition science profession.
3. A CNS/CNS-S respects and understands that he or she is a
health care professional dedicated to providing competent and
scientifically sound nutritional and other appropriate care
within their own scope of practice, with compassion and respect
for human dignity and rights.
4. A CNS/CNS-S employs his/her best good faith efforts to
provide unbiased information and facilitate understanding to
enable the patient/client to make informed choices in regard to
all recommended plans of care or assessment.The patient/
client should make his or her own determination on such
recommendations and assessment.
5. A CNS/ CNS - S shall not mislead patients into false or
unjustified expectations of favorable results of treatment.
6. A CNS/CNS-S upholds the standards of professionalism, and
is honest in all professional interactions. A nutrition science
professional will additionally be knowledgeable about
established policies and procedures for handling concerns about
unethical behavior. These include policies and procedures
created by CBNS, licensing and regulatory bodies, employers,
supervisors, agencies, and other professional organizations (see
CBNS Disciplinary and Complaint Policy).
7. A CNS/CNS-S upholds the standards of professionalism and
commits to performing his/her duties competently, safely and
ethically. Drug and alcohol abuse will not be tolerated by the
CBNS. Any person discovered using alcohol or drugs in a
professional practice would be subject to discipline, including
certification revocation. (see CBNS Disciplinary and Complaint
Policy)

7. 8. A CNS/CNS-S respects the rights of patients, clients,
colleagues, and other health professionals, and safeguards
patient/client confidence, trust, and privacy in accordance with
the law. This includes, but is not necessarily limited to, being
familiar with and carrying out all HIPAA compliance
requirements.
9. A CNS/CNS-S commits to the study, application, and
advancement of scientific knowledge, continues to seek
nutritional and related health education, makes relevant
nutrition science information available to patients/clients,
colleagues, and the public, obtains consultation, and recognizes
the talents of other health professionals when indicated,
referring patients/clients to appropriate healthcare providers
when their care requires services outside the scope of practice
of a CNS.
10. A CNS/CNS-S values his or her responsibility to participate
in activities contributing to the improvement of the community
and the betterment of public health.
11. A CNS/CNS-S truthfully and accurately states one’s
credentials, professional education, and experiences. CNS and
CNS-S may be used as a postnomial credential. The
Certification Board of Nutrition Specialists does not recognize
“board eligible,” and such nomenclature is to be avoided.
12. A CNS-S that is not clinically practicing nutrition care
agrees to adhere to the following Code of Ethics, Principles and
Interpretative Guidelines (same as above):
13. CNS-S may be used as a postnomial credential. The
Certification Board of Nutrition Specialists does not recognize
“board eligible,” and such nomenclature is to be avoided.

8. Week 4 SOAP Note
United States University
Advanced Health and Physical Assessment Across the Lifespan
MSN 572
Shannon Ripley
03/27/2021
SOAP
SUBJECTIVE:
ID: William Henry Ripley Jr, DOB 10/06/1950, age 70, white
Caucasian male came to the clinic
alone for complaints of a “sore throat”. Bill is married to his
wife for 42 years and lives in a
home independently. He works for the forest service and BLM.
Patient appears to be a good
historian of his medical history and can answer all appropriate
questions.
CC: “sore throat”
HISTORY OF PRESENT ILLNESS (HPI): Bill 70 year old
male, Caucasian, came in for a “sore

9. throat”. Bill began to feel a sore throat a week ago with pain
3/10, it has increasingly gotten
worse to a sharp pain that is 7/10, he states it feels like he is
swallowing glass. Bill has not been
eating solid food but has been drinking shakes for the last 2
days due to difficulty and pain while
swallowing. He states that drinking tea with lemon and honey or
gargling salt water has helped
slightly, he also diffuses essential oils while he sleeps. Bill
spiked a fever of 102 degrees
Fahrenheit last night, he took Tylenol 1000mg, PO x1 dose
which decreased the fever to 98.6F.
Bill is not coughing, sneezing or have any nasal congestion. Bill
does not have any seasonal
allergies and has not been around irritants such as smoke,
pollen, molds, animal dander, or
indoor inhalants such as hair spray or aerosol products. He was
recently at a birthday party and
around a friend who had a sore throat and later tested positive
for streptococci group A. Bill
started feeling symptoms shortly after the birthday party and
came in to get tested today. Last
physical was 12/2020. No recent immunization, denies getting
the flu, pneumonia, shingles or

10. COVID vaccine. Last dental exam 11/2020. Denies any use of
medications.
PAST MEDICAL HISTORY:
Tinnitus
Childhood illness: Patient had pneumonia as a young child (date
unknown) and colon bacillus in
1965.
Chronic illness: Patient denies chronic illnesses.
Psychiatric history: patient denies psychiatric illnesses
PAST MEDICAL PROCEDURES:
Procedures: Tonsillectomy in 1958, laminectomy in 1970,
removal of non-Hodgkin lymphoma
tumor in 07/1998, TURP in 11/2003, staple removal from chest
in 8/2014 and fall of 2017. See’s
the dermatologist every 6 months to get pre-cancerous cells
burned off.
Hospitalized: tumor removal in 07/1998 and during the
laminectomy in 1970. No reactions to
anesthesia.
Last dental checkup 11/2020

11. MEDICATIONS:
Tylenol 1000mg, PO tabs, TID, as needed.
Daily vitamin, vitamin b12 complex BID, joint vitamins (does
not remember name) and herbal
supplements. Uses the chiropractor and physical therapy as
alternative health care practices.
ALLERGIES:
Denies allergy to medications, latex, environmental factors or
food.
LMP (as applies)
Not applicable
FAMILY HISTORY:
MGM: Died in 1948 of hemophilia
MGF: Died in 2002 of melanoma
PGM: Died in 1968 of cancer of the digestive tract
PGF: Died in 1962 of emphysema
Father: Died in 1979 of liver cancer, type 2 diabetes
Mother: Died 2015, had diabetes type 2, overweight, and
Alzheimer’s

12. Aunts: Type 2 diabetes, Alzheimer’s
Uncles: none
Siblings: none
Children: none
Bill denies that anyone in his family is experiencing any head,
ear, eye, nose, or throat problems
at this time. Bill denies any family history of fever, chills, or
allergies.
SOCIAL HISTORY
Sexual/Reproductive: Denies any STI’s, has one partner.
Tobacco/Vaping: Denies any tobacco or vaping use of any kind
Alcohol use: Drinks 3oz of wine per week
Drug use: Denies any drug use
Marital history: Married to his wife for 42 years who is his only
partner.
Occupation: Forest Service
Exercise/Diet: Diet is high in organic fruits, vegetables, meats,
whole wheat bread, smoothies,
and seeds. Eats moderate amounts of salt. Rarely eats out.

13. Drinks small amounts of caffeine.
Exercises 4x per week swimming and weight lifting. Hobbies
consist of camping, spending time
with family and traveling. Alternative health care practices
include chiropractor and physical
therapy.
Sleep/Stress: 7.5 hours per night, goes through periods of
sleeping large and small amounts.
Patient feels rested with the sleep he gets.
Immunizations
Immunization Total Doses Up-to-date?
Hepatitis B 3 doses Yes
Diphtheria, Tetanus, and
Pertussis (DTap)
5 doses Yes
Polio 4 doses Yes
H. influenza type B 4 doses Yes
Pneumococcal conjugate 4 doses Yes
Oral Rotavirus 2 doses Yes
Measles, Mumps, Rubella
(MMR)

14. 2 doses Yes
Varicella 2 doses Yes
Hepatitis A 2 doses Yes
Influenza Annually No
COVID Pfizer 2 doses No
Tdap 1 dose Yes
Meningococcal conjugate at 2 doses Yes
Human Papilloma Virus
(HPV)
2 doses Yes
Spiritual affiliation: Christian
Safety: denies any domestic abuse or violence. Wears helmets
while riding a bike and seat belt
while driving. Denies any pool on property or safety hazards.
Denies owning guns.
REVIEW OF SYSTEMS:
Constitutional: Patient had fever of 102F last night with chills
and increased fatigue. Denies any
unintentional weight loss.

15. Eyes: denies changes of vision, blurred vision, floaters. Last
eye exam: 2018
Ears, Nose, Throat: Patient experiencing a sore throat with
difficulty swallowing due to pain
and swelling. Patient complaining of swollen tonsils with white
patches with a bright red throat.
Denies a runny nose or any discharge. Patient has chronic
tinnitus but denies any further changes
or difficulty in hearing, ear pain or discharge. Denies change or
difficulty smelling.
Cardiovascular: Denies chest pain, abnormal heart beats,
skipping beats, fluttering, shortness
of breath with/without exertion
Respiratory: Denies difficulty breathing or coughing.
Gastrointestinal: Has 2 bowel movements per day, soft
consistency and small quantity due to
not being able to eat large amounts at a time. Denies any blood
in stool, diarrhea or constipation.
Genitourinary: denies pain with urination, denies abnormal
vaginal discharge, denies urinary
urgency or frequency.
Musculoskeletal: denies joint pain, reports full ROM in upper
and lower bilateral extremities.

16. left shoulder healed well from surgery, no concerns per patient.
Integumentary/Breast: denies rashes, skin dryness, lesions or
nodules.
Neurologic: Denies any dizziness, blurred vision, unstead y gait,
unilateral weakness, peripheral
neuropathy symptoms or seizures.
Psych: Denies feeling down, depressed or hopeless.
Endocrine: Denies unintentional weight loss, heat or cold
intolerances or excessive sweating.
Hematologic/Lymphatic: Bill does complain of enlarged lymph
nodes in neck. Denies getting
sick frequently. Denies bruising easily, prolonged bleeding,
taking a long time to heal.
Allergic/Immunologic: Denies allergy to any foods or
environmental substances. Denies
allergies to any medications.
Objective
Physical Exam:
Vital Signs
BP: 110/80
HR: 100 Resp: 16 O2: 97% on

17. room air
Temp: 99.4
Oral
Pain: 7/10
Height 6ft 2in. Weight: 140. BMI: 18
Physical
GENERAL survey: Patient looks fatigued and in pain. He is
breathing with ease and looks well
hydrated and fed. Hygiene is clean with no odors. Patient
walked into the office independently
and drove self. Patient is attentive and answers all questions
thoroughly. A&O x4, mood is stable
and no signs of acute distress noted.
HEENT:
Head: Normocephalic, no depressions, scars, masses,
hematomas or lesions. Hair distribution
normal.
Eyes: 20/20 vision using Snellen chart. No exophthalmos,
ptosis, redness or discharge
bilaterally. Conjunctiva Pink, sclera is white. Extraocular
movement intact bilaterally. Pupils

18. round and reactive to light bilaterally, red reflex visualized.
Normal convergence and
accommodation bilaterally. L and R fundoscopic exams revealed
bright orange disc with sharp
disc margin, disk to cup ratio 1:3, no hemorrhage or exudate, no
AV nicking.
Ears: CN VIII intact, Rinne, Weber, and Whisper test all normal
bilaterally. No bleeding,
drainage, inflammation or obstruction noted from the external
ear. No tenderness noted upon
palpation of external ears and tragus. A pearly grey tympanic
membrane visualized and cone of
light in left ear at 7 o’clock and right ear at 5 o’clock. The
malleolus bone visualized bilaterally
with no redness, bulging or discharge noted.
Nose: Nose is patent, no visual obstructions. No tenderness
upon palpation of the maxillary and
frontal sinuses. Nasal mucosa pink and wet, no sinus draining.
Septum midline with no polyps
noted.
Mouth/Throat: Moist buccal mucosa, no wounds visualized.
Adequate dental hygiene, no
dentures or abscesses noted, gingiva without inflammation or

19. redness. Tongue midline, no
deviation, no enlargement. Tonsils are red, swollen to +3 with
white patches, uvula midline,
inflamed and red, pharynx erythematous. Petechiae on soft
palate. Thyroid is smooth without
nodules or goiter.
Heart: S1 and S2 auscultated, no S3 or S4 heard. No murmurs or
palpitations heard.
Respiratory: No audible wheezing, rhonchi or crackles.
Lymph: Anterior and posterior cervical lymph nodes were
enlarged upon palpation, they are
moveable with no immovable nodules noted.
Skin: warm and dry, no visible bruising, rashes, no dry patches
of skin visualized, no jaundice.
Neurological: Patient is alert and awake and appropriately
communicating and engaged. Gait is
steady with no unilateral weakness.
Assessment:
Differential Diagnosis
1. Strep throat-The most common symptoms for Group A
streptococci is fever, sore throat,

20. inflamed swollen tonsils with white patches, and red inflamed
pharynx which causes
increased pain and soreness in throat making it difficult to
swallow (Bickley, 2021).
Patient was around a friend who had a sore throat as well which
he later tested positive
for streptococci group A. Pending the strep test, this di agnosis
is most likely.
2. Allergic rhinitis-ruled out due to common signs and
symptoms being nasal congestion,
sneezing and clear nasal discharge when exposed to irritants
such as smoke, pollen, mold,
animal dander, dust mites, indoor inhalants such as hair spray or
other aerosol products.
(Cash & Glass, 2017) Patient is not complaining of any of these
symptoms and denies
allergies.
3. Epstein-Barr virus-this virus presents with classic symptoms
such as fever, pharyngitis,
lymphadenopathy and extreme fatigue for several months (Cash
& Glass, 2017). The
spread is through saliva and most commonly through intimate
contact with someone who

21. also has had the virus or who is currently infected with the
virus. Other possible signs and
symptoms are generalized ache, headache, diarrhea which the
patient has not complained
of. I am leaning towards strep throat but cannot rule out
Epstein-barr as a possibility.
Diagnosis: Strep throat as evidence by the common symptoms
of fever, swollen inflamed tonsils
with white patches, sharp throat pain, decreased appetite, no
cough or drainage present (Centers
for Disease Control and Prevention, 2018).
Plan:
Diagnostic Plan: Rapid strep test; if negative, then perform
throat culture and sensitivity. Throat
culture and sensitivity are the gold standard for diagnosis.
Mono spot test to rule out Epstein-
Barr (Cash & Glass, 2017)
Therapeutic Plan:
1. Penicillin V potassium-500 mg twice daily for 10 days.
(Rosenthal & Burchum, 2021)
2. Hot tea, soup, and throat lozenges soothe your throat.

22. 3. Avoid smoking and secondhand smoke.
4. Rest or nap as often as possible while you are sick.
5. Diet: Eat a healthy diet. If swallowing is difficult, eat soft
foods such as ice cream, Jell-
O, pudding, and soup. Avoid salt and spicy foods. Increase your
fluid intake to 10 to 12
glasses a day.
(Cash & Glass, 2017)
Referrals
none
Education and Follow up Plan:
1. Do not go back to work until a full 24 hours of antibiotic
treatment has been completed.
If symptoms do not improve in 3 to 4 days, come back to office
and recheck patient.
2. Penicillin V can be taken with meals.
3. If patient is experiencing any rashes, hives, itching,
hoarseness, wheezing, difficulty
breathing, swelling of the tongue, throat or lips they need to
discontinue immediately and

23. go to the ER for a possible anaphylaxis reaction.
4. Side effects include diarrhea, nausea, vomiting, abdominal
pain and a black, hairy tongue.
5. If patient has severe diarrhea (watery or bloody stools) that
may occur with or without
fever and stomach cramps (may occur up to 2 months or more
after your treatment), call
PCP for a follow up.
6. Follow up appointment in 2 weeks.
7. Use disposable tissues when sneezing. Use tissues when you
blow your nose. If no tissue
is available, do the “elbow sneeze” into the bend of your arm
(away from your open
hands). Dispose of tissues and then wash your hands.
Reference
Bickley, L. S. (2021). Bates’ Guide to Physical Examination
and History Taking. (13th
ed.) Wolters-Kluwer.
Cash, J., & Glass, C. (2017, January 13). Family Practice

24. Guidelines, Fourth Edition . Barnes &
Noble. https://www.barnesandnoble.com/w/family-practice-
guidelines-fourth-edition-jill-c-
cash/1125431688.
Centers for Disease Control and Prevention. (2018, November
1). Pharyngitis (Strep Throat):
Information For Clinicians. Centers for Disease Control and
Prevention.
https://www.cdc.gov/groupastrep/diseases-hcp/strep-
throat.html#:~:text=Penicillin%20or
%20amoxicillin%20is%20the,treat%20group%20A%20strep%20
pharyngitis.
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne's
pharmacotherapeutics for advanced practice
nurses and physician assistants. Elsevier.
· For your note this week, create an HEENT related CC. Create
an ID, CC, HPI, ROS, V/S, physical findings, and assessment
with at least 3 differential diagnoses, a final diagnosis, and
treatment plan in a full SOAP note format. Use an HEENT
related CC that a patient would present with in a primary care
setting (i.e. no emergency room or ICU type complaints.
Examples: sore throat, ear ache, hearing loss, eye drainage,
etc.).

25. · Include at least two references for your diagnostic and
treatment plan. They should be recent (in the last 5-10 years)
and peer-reviewed. Use APA title page, citations, and reference
format. Ensure the treatment plan includes all components
(diagnostic plan, therapeutic plan, education plan, and follow
up).
· The ROS and physical exam in your document should be
written up as they would be for a problem focused visit. The
HEENT part of the physical exam write up should be a
comprehensive write up.
Expectations
· Due: Friday 25th