#pes statements

[mission-to-dietitian]

[mission-to-dietitian]

If a patient comes in with multiple myeloma and they’re on Melphalan therapy, the Problem in the PES statement might be “Inadequate protein energy intake.” The etiology might be from nausea, vomiting, and diarrhea secondary to their chemotherapy. And then the Signs and Symptoms part of the PES statement might be that the patient is reporting symptoms to you and that they have lost a certain amount of weight in a particular time period. Etc.

[mission-to-dietitian]

Notes for the ADIME: He has a history of iron and B12 anemia. Now he's displaying a B vitamin deficiency. The Etiology and Signs and Symptoms parts of the PES statement could be, “related to potential B vitamin deficiency as evidenced by smooth and bright red tongue on nutrition-focused physical exam.”

It’s good to use lab values for the Signs and Symptoms part of the PES statement. You can do a corrected calcium (his calcium is still low, despite the albumin) in this GI case (see Week 11-12 of MNT folders)

Dr. P suggested using lab values as the Signs and Symptoms part of the PES statement.

When you do the Etiologies and want to use the medical diagnosis, this can be okay ONLY when you describe the physiological alteration associated with that medical diagnosis. So, instead of just saying "short bowel syndrome," say something like, "related to reduced absorptive surface area, related to short bowel syndrome.” Thus, the Etiology is not enough absorptive surface area (which you would want to enhance that with the adaptation period). Always put the physiologic piece alongside the medical diagnosis when you're using that in your Etiology statement. In Signs and Symptoms, you can use lab values. You could also say, "ileostomy with significant stool output," or say something about the fact that the patient had surgery.

The nutrition-focused physical exam shows you deficiencies (i.e. red tongue indicative of iron, folate, and B12 deficiency).

Another PES statement: Impaired nutrient utilization related to potential B12 deficiency as evidenced by smooth and bright red tongue on nutrition-focused exam

Another: Impaired nutrient utilization related to decreased protein utilization as evidenced by brittle hair found on nutrition-focused exam.

Another statement: Altered GI function related to shortened bowel length as a result of surgery as evidenced by need for ileostomy.

Other things to say for the Signs and Symptoms: “as evidenced by requirement for maintenance TPN,” “as evidenced by requirement for clear liquid diet post-operatively,” because it will change over time and reflects the Problem statement (Problem statements such as: Impaired nutrient utilization, Altered GI function, etc.)

[chimaeracabra]

If you're diagnosing someone with malnutrition, then in your malnutrition PES statement, you should only use those criteria that you used to diagnose malnutrition.

Priority, "We really need to get a feeding tube in as soon as we restore her hydration." The PES statement follows the priority.

When you write your priorities down, problem statements should match those priorities. Intervention statements should match your problems. Monitoring and Evaluation should match your Intervention.

[chimaeracabra]

PES Statement Examples

•       Altered GI function related to Crohn’s Disease as evidenced by GI evaluation, imaging and chart review.

•       Altered nutrition-related laboratory values related to Crohn’s-induced diarrhea as evidenced by elevated chloride (108), low bicarbonate (21), low potassium (3.2), low magnesium (1.6) and low phosphorus (2.0).

•       Inadequate protein-energy intake related to abdominal pain and diarrhea as evidenced by patient report and diet recall.

•       Impaired nutrient utilization related to Crohn’s flare as evidenced by known malabsorption associated with this condition.