PES statements are one of the harder things to pick up when learning to chart as a dietetic intern (or maybe still for some dietiitans).  I will provide examples but keep in mind that there are numerous possibilities and that each hospital may do things just a little different but it’s the same conept.

Things to remember:

Make sure that you assessment backs up your decision of the nutrition diagnosis.

Make sure that your intervention is helping towards resolving the nutrition diagnosis.

Some explanations or intervention may be abbreviated.  Contact me if you have questions or would like further explanation.

Example 1

P: Inconsistent Carbohydrate Intake r/t

E: physiological causes requiring careful timing and consistent (dx: DM) as evidenced by

S: estimated CHO intake ingested on irregular basis (per pt food recall)

I choose to use this nutrition diagnosis when a patient is inconsistent with meals, often frequent meal skipping or very light breakfast and lunch and a large dinner.  If it is hard to me to figure out recommended timing of their meals, this diagnosis will quickly cross my mind.

The main goal I would recommend for this diagnosis is 3 meals, and snacks if necessary.  I encourage to not to go longer than 5 hours without eating, so I have them manage snacks with that parameter.  The next goal would be to have meals be of about equal sizes.

Example 2

For a patient who consumes large portions, high carb foods (i.e. pizza, pasta, rice, regular soda, juice, etc), and/or low protein/fat foods, I may likely choose the nutrition diagnosis Excessive Carbohydrate Intake.

P: Excessive CHO Intake r/t

E: physiological causes requiring careful use of modified CHO intake (newly dx DM) as evidenced by

S: CHO intake per pt food recall that is different than CHO recommendation, conditions associated with DM dx

With that nutrition diagnosis, my intervention will be based around decreasing carbohydrate intake.  I may recommended to eliminat regular soda, decrease/eliminate fruit juice, decrease number of carb foods in a given meal, and/or decrease overall food portion sizes.

At the patient’s follow-up appoinment, I will assess carbohydrate intake to evaluate if intake has decreased since initial visit by conducting a food recall and then general questions about other days.

Example 3

When a patient tells me they need to be told which foods to eat or maybe they are unable to tell me which foods raise blood sugar/list examples of carbohydrates, I may use this PES statement:

P: Food and Nutrition-Related Knowlwdge Deficit r/t

E: lack of prior nutrition education as evidenced by

S: pt unable to which foods raise blood sugar

I of course would emphasize carb education including which foods are and are not carbohydrates as well as the carboydrate portion sizes. At the follow-up appointment I wouldask the patient to recall carbohydrate foods to assess if knoedge has improved.

If the person’s carb consistency or portions are more of an issue I would choose one of those nutrition diagnosis over knowledge deficit.  The wise Sylvia Escott-Stump informed me that if there is a possibility of more than 1 nutrition diagnosis, intake domain diagnosis trumps behavior and clinical diagnosis.

Example 4

You want to know what kind of gets me excited at work?  When I get to use a nutrition diagnosis that’s rarely used.  The sad, sad life of a dietitian! 

P: Inadequate Intake from Enteral Nutrition r/t

E: intolerance of EN as evidenced by

S: feeding tube removed

This PES statement would often be used when a patient had a new NJ, NG, or PEG/J placed and was not tolerating.  At this point, I would be relying on the GI team to decide what I would recommend.  There a lot of things to consider: is the gut even working?, why was the tube feeding placed?, will another be placed?, is patient refusing any nutrition support?, etc.  I usually find the patient’s nurse to get the scoop.  In the past few months, I had asked this question and the nurse told me the tube feeding had been removed because the patient was now on comfort care.  At that point, I needed no intervention/to take action.

Example 5

We’ve all know who Michael J Fox is and if you don’t, search for Back to the Future on Netflix right now!  He is known for the Back to the Future trilogy but also for his fight for Parkinson’s Disease which he lives with.  What comes to mind typically with Parkinson’s is involuntary movements.  Those involuntary movements demand calories.  Think of how many calories that can add up to over the course of a day, a year.

P: Increased energy needs related to

E: increased involuntary physical activity (Parkinson’s disease)  as evidenced by

S: weight loss of >5% over past 6 months

This is ideal for a patient who presents with weight loss or inability to regain weight with a recent or even a history of Parkinson’s.  Patient likely will have frustration with inability to gain weight.  I used this as in an outpatient setting but could be applicable to inpatient in certain situations.

Example 6

Altered Nutrition Related Laboratory Values