Have you ever sat down to write your PES statements in a chart note, and the pieces just aren’t coming together for you? Coming up with the nutrition diagnosis, etiology, and signs/symptoms can be tough to make it flow.

Writing PES Statements is a skill that takes time to develop, but with practice, it can be a breeze for you!

I’ll help you figure out the right nutrition diagnosis for scenarios and give you confidence in your ability to write a PES Statement.

PES Statements Basics

PES statements are how a Dietitian conveys the nutrition diagnosis, and provides evidence to support it. It is a formatted sentence with standardized terminology that leads you through the Nutrition Care Process (NCP).

PES is an acronym for:

P = Problem –> The Nutrition Diagnosis.

E = Etiology –> The root cause of the nutrition diagnosis.

S = Signs and Symptoms –> Evidence of the nutrition diagnosis.

The PES statement always follows the same format, and the nutrition diagnosis should always use the standardized nutrition terminology.

Problem related to Etiology as evidenced by Signs and Symptoms.

There will be some circumstances where a PES statement is not needed when there is no nutrition diagnosis.

In those cases you will write, “No nutrition diagnosis at this time.” Don’t feel that you need to come up with a nutrition diagnosis if their is no nutrition diagnosis present.

Where Does the PES Statement Fit into ADIME Charting?

I went into great detail about ADIME charting in an article you can check out here.

A summary of ADIME charting though is it is a form of charting that Dietitian’s use in order to organize their chart notes. It is an acronym that stands for:

A –> Assessment

D–> Diagnosis

I–> Intervention

M –> Monitoring

E–> Evaluation

The PES statement fits into the D or Diagnosis part of the chart note. This is where for the nutrition diagnosis portion of the chart note, the Dietitian can simple write in the PES statement.

There is no further explanation needed in the chart note outside of the PES statement. The nutrition assessment will contain all the subjective and objective data, which support the nutrition diagnosis.

Benefits of Using PES Statements

Writing PES statements may seem like a monotonous part of the job, but it can actually help Dietitians be more focused on a specific nutrition problem.

A nutrition assessment can unveil a whole host of issues, by narrowing down what the nutrition problems are, specific interventions can be developed to address the issues.

Also, having a standardized list of terms it saves the Dietitian the hassle of trying to come up with a format to diagnose.

Nutrition Diagnosis

The nutrition diagnosis should be determined after performing a full nutrition assessment. Using your clinical nutrition skills you should be able to determine what the nutrition problem is.

There may be multiple nutrition diagnoses, this is allowed. But they should be separated out and each nutrition diagnosis will have their own PES statement.

You can see below in the chart the common nutrition diagnosis used in the older adult population.

The nutrition diagnosis is the issue you are trying to resolve, only put a problem here that your nutrition interventions are going to address. For example if you’re putting ‘unintentional weight loss’, your interventions may be to increase calories.

The nutrition diagnosis will fall into one of three categories:

1. Intake
2. Clinical
3. Behavioural

If you are working with the older adult population, I don’t typically recommend using a behavioural diagnosis unless you are sure that is the issue.

Cognitive impairments as individuals age can and does cloud their judgement surrounding food. However that is not a behavioural problem that you are going to resolve.

Instead select from clinical or Intake more often, as those are more likely the issue.

Nutrition Etiology

The etiology is the root cause of the nutrition diagnosis. This will be the reason that the Dietitian, through the nutrition assessment, believes is causing there to be a nutrition problem.

The etiology will also be the problem that the nutrition prescription is trying to resolve. All of the nutrition prescriptions should be targeting the nutrition diagnosis and etiology.

There may be circumstances where the etiology cannot be solved, but the effects of it can be minimized.

Some examples of this include:

1. Stroke, Cerebrovascular Accident
2. Head, neck or throat cancer
3. Dysphagia
4. Dementia or other cognitive impairments

In the case where the etiology is not able to be resolved by the Dietitian, they will write:

“Secondary to”

An example PES statement of how to write this could be:

Swallowing difficulty related to dysphagia secondary to CVA as evidenced by frequent coughing at meals, pocketing and wet sounding voice.

From the PES statement above, you cannot resolve a CVA through nutrition interventions. But you can try to minimize the effects of it (Dysphagia).

Nutrition Signs and Symptoms

This section is the evidence of the nutrition diagnosis and/or the etiology.

The nutrition signs can be subjective or objective data that is found through the nutrition assessment.

It is a good idea if you can use some type of objective data such as anthropometric measurements to support the nutrition diagnosis where applicable.

An example of this could include significant weight loss. Use specific numbers such as:

1. BMI
2. Weight loss percentage
3. Weight loss numbers
4. Usual body weight, body weight change

It’s important that these are patient specific, use only data that is found in the nutrition assessment.

There is no specific amount of signs and symptoms that need to be listed. But a general recommendation that I give is to use a minimum of 2 subjective or objective nutrition measures. My usual goal is to find at least 3 points to use as evidence.

Also ensure that the nutrition interventions will try to reduce the signs and symptoms that you have measured/observed.

Format for PES Statements

Your statement will always follow this format:

Problem related to Etiology as evidenced by Signs & Symptoms

It’s standardized language and this includes the format that the statement is written in.

Common PES Statements

Okay, now that you know the basis of what a PES statement is composed of, let’s look at some commonly used PES statements.

Note that these are only just a few statements, but they are quite frequently used in long term care. Get some practice and do some research to get your statements flowing!

Frequently Asked Questions

What if There is NO Nutrition Diagnosis?

Also just a last note that sometimes there is ‘No nutrition diagnosis at this time.’ Some RD’s might not feel comfortable using this, but we need to be honest, that sometimes our patients are nutritionally stable.

Yes, they are at risk of malnutrition, but if you feel that your resident is stable, don’t feel compelled to just invent a diagnosis just to write one. Frequently if I have an annual assessment for a resident, their intake is stable over the past year, weight has been stable +/- 1-2 kg, no swallowing difficulty, medical status is stable, then I will write, ‘No nutrition diagnosis at this time.’

Are Dietitian’s Allowed to Diagnose?

Dietitians are allowed to give a nutrition diagnosis. This is very different from a medical diagnosis which only a Doctor can give.

A nutrition diagnosis is made by a Dietitian and comes from the standardized nutrition terminology diagnosis list. There will be certain circumstances where a Dietitian will need the sign off from a Doctor on their nutrition diagnosis.

Some facilities require the sign off from a Doctor for a diagnosis of malnutrition due to reimbursement. Check with your facility what the specific policy is regarding diagnosis.

What Does the Nutrition Care Process Have
to do with PES Statements?

Part of the Nutrition Care Process (NCP) involves diagnosing a nutrition problem if one is present.

The first step in the NCP is to perform a nutrition assessment. From the nutrition assessment a nutrition diagnosis can be found. The nutrition diagnosis will always be put into the format of a PES statement.

The NCP is the steps a Dietitian takes to assess and treat a patient’s nutrition diagnosis.

ADIME is the manner of charting a Dietitian will use to summarize the NCP.

The PES statement will be in the D part of ADIME charting.

ADIME and the NCP are not the same thing. If you want to learn more, you can read here.

All of the above are a part of the standardized process that Dietitians use in their daily practice.

Sample PES Statements

PES Statement for Malnutrition:

Malnutrition related to inadequate energy intake as evidenced by 50% daily intake average and significant weight loss of 10.7% in 6/12.

PES Statement for Hypertension:

Excessive sodium intake related to excessive addition of salt at the table as evidenced by meal time observation, and elevated Blood Pressure levels of 155/95.

PES Statement for Obesity:

Excessive energy intake related to frequent snacking as evidenced by calorie count of 1000 calories above estimated daily energy needs, BMI 45.0, and significant weight gain of 11% in 1/12.

PES Statement for Diabetes:

Elevated lab values A1C related to excessive added sugar intake as evidenced by patient reported snacks in room high in sugar, low in fibre, A1C level of 10.9.

Still Looking for More PES Statements?

You can read this article for the Top 7 Malnutrition PES Statement examples!

Or you can simply download your FREE copy below!