PES Statements
The PROBLEM related to the ETIOLOGY as evidenced by the SIGNS/SYMPTOMS
Learn more about PES Statements and the Nutrition Care Process:
PES Statements
Per the Nutrition Care Process, the nutrition diagnosis is summarized as a PES Statement:
P (Problem)
E (Etiology)
S (Signs and Symptoms)
Signs: objective data obtained through observation, lab values, and test results
Symptoms: subjective data reported by the client
The PES Statement should follow this format:
(Problem) related to (Etiology) as evidenced by (Signs and Symptoms).
The Nutrition Diagnosis is an RD's identification and labeling of an existing nutrition problem(s) that the practitioner is responsible for treating. Nutrition diagnoses (e.g. inconsistent carbohydrate intake) are different from medical diagnosis (e.g. diabetes)."
The diagnosis is selected from a that cover three domains:set of standardized nutrition diagnostic terms/codes
Food and/or nutrient intake: calorie/energy balance, fluid and nutrient intake, and intake of oral supplements, nutrition support, or bioactive substances
Examples: excessive energy intake, excessive fat intake, inadequate protein intake, inadequate vitamin intake
Clinical: disorders of malnutrition, weight balance, biochemical status, and functional status; nutrition problems related to medical and physical conditions
Examples: swallowing difficulty, altered nutrition-related lab values, overweight/obesity, involuntary weight loss
Behavioral/environmental: knowledge and beliefs about foods, attitudes toward food, physical activity and function, physical environment, access to food, and food safety
Examples: food, nutrition, and nutrition-related knowledge deficit, not ready for diet/lifestyle change, undesirable food choices, impaired ability to prepare foods/meals
What is the difference between a medical diagnosis and nutrition diagnosis?
In simple terms, a food and nutrition professional identifies and labels a specific nutrition diagnosis (problem) that, in general, he or she is responsible for treating independently (e.g., excessive carbohydrate intake). With nutrition intervention, the nutrition diagnosis ideally resolves. In contrast, a medical diagnosis describes a disease or pathology of organs or body systems (e.g., diabetes). In some instances, such as the nutrition diagnosis Swallowing Difficulty (NC-1.1), food and nutrition professionals label or diagnose the functional problem that has a nutritional consequence. Food and nutrition professionals do not identify medical diagnoses; they diagnose phenomena in the nutrition domain.
Evaluating your PES Statement
P (Problem): Can the RD resolve or improve the nutrition diagnosis?
E (Etiology): Determine if this is the “root cause” for the problem. If addressing the etiology will not resolve the problem, can the RD intervention lessen the signs and symptoms?
The nutrition intervention should aim to resolve or at least attempt to resolve the etiology (or lessen the signs and symptoms)
S (Signs and Symptoms): Will measuring the signs and symptoms indicate if the problem is resolved or improved? Are the signs and symptoms specific enough that the RD can monitor and document resolution or improvement of the nutrition diagnosis?
What if there is no appropriate nutrition diagnosis/intervention?
No nutrition diagnosis at this time (NO-1.1) may be documented if the assessment indicates that no nutrition problem exists to justify a nutrition intervention or if further nutrition assessment data are needed to identify a nutrition diagnosis.
Examples of PES Statements
(Excessive Energy Intake) related to (frequent consumption of high-calorie meals from restaurants) as evidenced by (diet recall and BMI of 35).
(Altered GI function) related to (decreased functional intestine length secondary to recent small bowel resection) as evidenced by abdominal pain and bloating associated with PO food intake.
(Altered nutrition-related lab values) related to (uncontrolled T2D) evidenced by (A1c of 9.5% and reported noncompliance with medications).
PES Statement: Tips for Success
Back up your nutrition diagnosis, etiology, and associated intervention
Where is the evidence? If the patient’s problem is “excessive carbohydrate intake,” what objective data do you have that supports that?
Always capture objective data in the chart that supports the diagnosis/intervention (e.g. anthropometrics, labs, past medical history, medication)
Make sure your problem, nutrition diagnosis, and intervention are all related
Your patient may have multiple problems with multiple etiologies and thus may require multiple interventions. The intervention you select and the counseling you provide should directly aim to resolve the etiology of the problem
New intervention = new PES statement
Focus on 1, maybe 2, PES statements per visit
Focusing on too many problems–and thus too many interventions–can be overwhelming
Be clear and concise
Ambiguity is the enemy! Always ensure your statements can be easily understood by anyone reading them
Ask “Why?” 5 times
When looking for an etiology, ask WHY 5 times (or until you come to the last etiology that you, as a dietitian, can address).
Example: Excessive oral intake
Why? Excessive intake of high calorie-density foods and beverages
Why? Excessive takeout intake
Why? Client purchases most of his meals from fast food restaurants with limited healthful choices
Why? The client does not prepare meals at home
Why? The client lacks the food preparation skills to prepare healthful food at home – this is the root cause