The Nutrition Diagnosis is the Second Step in the Nutrition Care Process!
Writing the Nutrition PES Statement can be hard to get a hang of for a new dietitian. Moreover, the Nutrition Diagnosis is not the medical diagnosis, which can be even more confusing.
In this blog you will learn:
What a Nutrition Diagnosis is & why it is important
The ABC's of the PES Statement
How to Write an Awesome PES Statement
If you are new to the blog, be sure to sure to check these out first to
learn about the 1st step of the Nutrition Care Process!....
SO, What is the Nutrition Diagnosis?
The Nutrition Diagnosis is not the medical diagnosis. It is a nutrition problem identified by the Registered Dietitian that is expected to be treated and resolved by the nutrition team.
According to the Academy of Nutrition & Dietetics:
"Nutrition Diagnosis is a nutrition and dietetics practitioner's identification and labeling of an existing nutrition problem(s) that the practitioner is responsible for treating. Nutrition diagnoses (ex. inconsistent carbohydrate intake) are different from medical diagnosis (ex. diabetes)."
⭐The diagnosis is selected from a set of standardized nutrition diagnostic terms/codes. There are approximately 70 of these nutritional diagnostic terms that cover three domains:
FOOD AND/OR NUTRIENT INTAKE. Example: "Inadequate fluid intake." This category covers calorie/energy balance, fluid and nutrient intake, and intake of oral supplements, nutrition support, or bioactive substances. A common intake diagnosis would be related to the intake of too much or too little food or fluids in comparison to the patient's estimated needs.
CLINICAL. Example: "Altered Nutrition-Related Laboratory Values." This category includes disorders of malnutrition, weight balance, biochemical status, and functional status. Here you may identify nutrition problems that are related to medical and physical conditions.
BEHAVIORAL/ENVIRONMENTAL. Example: "Self-Monitoring Deficit." This domain includes knowledge and beliefs about food, attitudes toward food, physical activity and function, physical environment, access to food, and food safety.
Often there are multiple possible nutrition diagnoses, so keep the following in mind when writing the diagnosis for your patient:
The diagnosis should be identified from the data and history you collected in the nutrition assessment.
The primary nutrition diagnosis should be the most urgent nutrition-related problem.
The selected diagnosis should be something that can be addressed and resolved by the nutrition intervention(s).
If there is no nutrition problem, you have the option of selecting "no nutrition diagnosis at this time" [NO-1.1]. While there is almost always a nutrition diagnosis, keep in mind that this is an option!
Let's Move On To the PES Statement
⭐️PES, not to be mistaken for PEZ candy (yes this was my first thought when I heard the term in school!), stands for Problem, Etiology, and Signs/symptoms. All three of these will be found in the data you collected in your nutrition assessment, which is the 1st step in the Nutrition Care Process.
(P)roblem: the problem is the Nutrition Diagnosis, written in the standardized term you selected for the patient.
(E)tiology: the etiology is the underlying cause(s) and contributors of the nutrition problem. You may list more than one etiology in the statement.
(S)igns/symptoms: the signs and symptoms are the evidence that the problem exists. They describe the signs that the patient has this problem and also indicate the severity of the problem. You may list multiple signs/symptoms in the PES Statement.
⭐️The PES Statement links the nutrition problem (the diagnosis) to the etiology (the cause of the problem) and the signs & symptoms with the words "related to"and "as evidenced by."
Lets look an an example of a PES Statement:
"Excessive Energy Intake (Problem) related to frequent consumption of high-calorie meals and snacks (Etiology), as evidenced by daily caloric intake exceeding estimated energy needs by 750 kcal and 16 lb weight gain in past 3 months (Signs/symptoms)."
You can abbreviate these connected phrases in the following manner:
"Related to" = RT or R/T
"As evidenced by" = AEB
Therefore, this same PES statement would look like this:
"Excessive Energy Intake RT frequent consumption of high-calorie meals and snacks, AEB daily caloric intake exceeding estimated energy needs by 750 kcal and 16 lb weight gain in past 3 months."
Here are some more examples of PES Statements for specific conditions
*Remember that each patient and each case is different, so you always want to take the information you collected in the Nutrition Assessment to determine the best diagnosis for your patient.
Diabetes PES Statement Example:
Excessive carbohydrate intake RT limited diet compliance and diagnosis of Type 2 Diabetes, AEB reported intake of 80% calories from carbohydrates, HbA1C 8.2%, and blood sugar 240.
Cancer PES Statement Example:
Predicted suboptimal energy intake RT increased nutrient needs from chemotherapy treatment, AEB current caloric intake at 60% of estimated needs with treatment.
Dysphagia PES Statement Example:
Swallowing difficulty RT history of esophageal stricture AEB observed coughing and choking while eating and SLP evaluation.
Eating Disorder PES Statement Example:
Inadequate energy intake RT disordered eating pattern and history of anorexia nervosa AEB BMI of 16.8 and reported caloric intake at only 52% of estimated energy needs.
⭐️Writing excellent PES Statements and Nutrition Diagnoses takes practice! ⭐️
In the Brilliant Dietitians blog, you can learn how to write a PES statement for each specific medical condition along with the appropriate Medical Nutrition Therapy.
Check out the blog archives for disease-specific PES statement examples.
3 Steps to become an Expert in Medical Nutrition Therapy TODAY!
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Hey You, awesome RD or RD-to-be! Do you still have questions about Medical Nutrition Therapy? You can email me directly at brilliantdietitians@gmail.com with your questions and requests and I will get back to you ASAP!
“Have a fantastic day and get out there and BE A BRILLIANT DIETITIAN!"
😀 Bethany, MS, RDN
Your Brilliant Dietitian Coach
Blog Sources:
Width, M. & Reinhard, T. (2018). The Essential Pocket Guide for Clinical Nutrition, 2nd Ed. Philadelphia, PA: Wolters Kluwer.