PES Statements for Malnutrition - Dietitian Direction

Introduction to PES Statements

PES statements are structured sentences used by dietitians to communicate the nutrition diagnosis of a patient.

Writing a PES Statement

PES statements are written as follows:

[Problem/nutrition diagnosis] related to [Etiology], as evidenced by [Signs/symptoms].

Looking for more information on PES statements before diving in? Check out these other blog posts:

What is a PES Statement?

Nutrition Diagnosis: Definition & Examples

Nutrition Care Process Steps

Potential Nutrition Diagnoses for Malnutrition

Inadequate energy intake
Inadequate enteral nutrition infusion
Inadequate protein intake
Severe starvation related malnutrition
Moderate chronic disease or condition related malnutrition
Severe acute disease or injury related malnutrition

PES Statements for Malnutrition Examples

Inadequate energy intake related to pain while eating as evidenced by estimated intake <50% of calculated needs and a 20 lb weight loss over the last 3 months.

Inadequate enteral nutrition infusion related to poor tolerance of ordered infusion rate as evidenced by diarrhea and multiple discontinuations of tube feed, loss of 3 lbs in last 5 days.

Inadequate protein intake related to food aversions as evidenced by estimated protein intake of 20 g per day, temporal wasting.

Severe starvation related malnutrition related to depression as evidenced by 30% weight loss in one year, frequent meal skipping.

Moderate chronic disease or condition related malnutrition related to ovarian cancer as evidenced by 5% weight loss in last month, estimated energy intake <75% of calculated needs.

Moderate acute disease or injury related malnutrition related to increased energy needs as evidenced by burn covering 25% of body, edema, intake <25% at meals and enteral feeds have yet to be started.

Malnutrition Definitions

It is important to note that there is no general consensus of how malnutrition is diagnosed. This article, as well as the Electronic Nutrition Care Process Terminology (eNCPT), uses malnutrition definitions from the 2012 consensus statement on malnutrition from the Academy of Nutrition and Dietetics (AND) and the American Society for Parenteral and Enteral Nutrition (ASPEN).

Note that when using a malnutrition nutrition diagnosis, certain criteria must be met to meet the definition. These can be found in the AND/ASPEN consensus statement.

Quick Tips for Writing the Perfect Malnutrition PES Statement

Use information gathered in the assessment to determine the nutrition problem
The nutrition diagnosis should ideally be resolved, or at least improved, through a nutrition intervention provided by the dietitian
PES statements should be clear and concise

Conclusion

For patients with malnutrition, there are many potential nutrition diagnoses, etiologies and signs and symptoms that can be present. Make sure yours is specific to the patient and you are paying attention to the definitions of the different types of malnutrition.