Top 14 PES Statements! Free Dietitian Guide!

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.

Computer desk with a computer and cup of coffee.

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).

These structured sentences are far more than mere formalities; they are the embodiment of a dietitian’s clinical acumen and expertise. This comprehensive guide aims to delve into the intricacies of PES statements, a skill pivotal for every dietetics professional.

What Does PES Stand For?

P = Problem –> The Nutrition Diagnosis. This will be the primary nutrition problem. You can have more than one, but you need to have separate PES statements for each.

E = Etiology –> The root cause of the nutrition diagnosis. This will be either the cause or the contributing factor to the nutrition problem.

S = Signs and Symptoms –> Evidence of the nutrition diagnosis. This will include both subjective and objective evidence supporting that there is a nutrition problem.

the format of pes statements graphic.

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. This is how the sentence will always be formatted with those exact phrasings.

I will provide a caveat here for any new Dietitians. There will be some circumstances where a PES statement is not needed when there is no nutrition diagnosis. Do not feel compelled to always come up with a PES statement if there is no nutrition problem present.

In those cases you will write, “No nutrition diagnosis at this time.”

PES Statements in the Nutrition Care Process

The PES statement is a part of the nutrition care process (NCP). The PES statement comes as a results of the nutrition assessment.

If you want an article that fully describes how the PES statement fits, check out this article.

The NCP is a systematic approach to providing high-quality, individualized nutrition care. It’s a four-step model that includes assessment, diagnosis, intervention, and monitoring/evaluation.

PES statements are an integral part of this process, specifically fitting into the diagnosis phase. Let’s explore how these statements interweave with each stage of the NCP to create a cohesive and effective nutrition care plan.

1. Nutrition Assessment

The first step in the NCP is the nutrition assessment. This is where dietitians gather data about the patient’s health, lifestyle, dietary habits, and biochemical parameters. The assessment forms the foundation upon which the PES statement is built.

Without a thorough assessment, identifying an accurate nutrition problem (the “P” in PES) would be challenging.

If you need a great nutrition assessment form, you can find one here.

2. Nutrition Diagnosis (PES Statement)

Once the assessment is complete, the dietitian uses the collected data to identify and label the nutrition problem – this is where the PES statement comes into play.

  • Problem: The dietitian identifies a specific nutrition-related problem from the assessment data. This could be anything from inadequate energy intake to excess sodium consumption.
  • Etiology: The underlying cause or contributing factors of the identified problem are determined. This could be related to physiological conditions, food access issues, knowledge gaps, or behavioral aspects.
  • Signs and Symptoms: These are the observable or reported indicators that support the existence of the nutrition problem and its etiology. They can include clinical data, patient reports, and other measurable parameters.

The PES statement succinctly encapsulates these three components, providing a clear and concise nutrition diagnosis. It bridges the gap between the assessment and the intervention stages by clearly defining what the problem is, why it exists, and how it manifests.

3. Nutrition Intervention

With a well-defined PES statement, the dietitian can now develop a targeted nutrition intervention plan.

This plan is designed to address the etiology (the “E” in PES) and alleviate the signs and symptoms (the “S” in PES) of the identified problem.

The intervention could involve dietary changes, education, counseling, or coordination with other healthcare services, depending on the nature of the problem and its causes.

4. Nutrition Monitoring and Evaluation

The final step in the NCP is monitoring and evaluating the patient’s progress towards the goals set in the intervention phase. The effectiveness of the intervention is assessed by observing changes in the signs and symptoms identified in the PES statement.

This step is crucial for determining if the nutrition care plan needs to be modified and for documenting the outcomes of the intervention.

You can also see how the NCP and ADIME charting are connected, and below you can see that a PES statement fits into similar parts. Read more here.

How PES statements and ADIME go together.

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. Here are the top benefits of using PES statements.

PES statements, integral to the Nutrition Care Process, offer numerous benefits to dietitians and their clients. These structured sentences not only streamline the process of nutrition diagnosis but also enhance the overall quality and effectiveness of nutrition care. Below are some key benefits of using PES statements:

1. Clear and Structured Diagnosis

  • Precision in Problem Identification: PES statements enable dietitians to precisely identify and articulate the nutrition-related problem. This clarity is crucial for developing an effective care plan.
  • Standardized Language: Using standardized terminology in PES statements ensures consistency and clarity in communication among healthcare professionals, enhancing interdisciplinary collaboration.

2. Targeted Interventions

  • Focused Care Plans: By clearly defining the etiology in PES statements, dietitians can tailor interventions to address the root cause of the nutrition problem, leading to more effective outcomes.
  • Personalized Approach: The specificity of PES statements allows dietitians to create personalized nutrition care plans that cater to the unique needs and circumstances of each client.

3. Enhanced Client Understanding and Engagement

  • Improved Communication: PES statements help in simplifying complex nutrition issues into understandable terms, aiding in better client comprehension and engagement in their care process.
  • Empowering Clients: Clear articulation of problems and their causes empowers clients to take an active role in managing their health, leading to improved adherence to nutrition interventions.

4. Facilitates Monitoring and Evaluation

  • Measurable Outcomes: The ‘Signs and Symptoms’ component of PES statements provides concrete parameters to monitor and evaluate the effectiveness of nutrition interventions.
  • Adaptability of Care Plans: Regular assessment of these signs and symptoms allows for timely adjustments in the nutrition care plan, ensuring it remains responsive to the client’s changing needs.

5. Professional Efficiency and Documentation

  • Streamlined Documentation: PES statements provide a structured format for documenting nutrition diagnoses, making charting more efficient and comprehensive.
  • Quality Assurance: They serve as a tool for quality assurance in nutrition care, ensuring that all aspects of the client’s condition are considered and addressed systematically.

6. Evidence-Based Practice

  • Informed Decision-Making: The process of formulating PES statements encourages the integration of the latest research and evidence, promoting evidence-based practice.
  • Continuous Learning: It also fosters continuous professional development, as dietitians stay updated with current knowledge and best practices in nutrition care.

7. Supports Interdisciplinary Collaboration

  • Enhances Team Communication: The standardized format of PES statements facilitates clear and effective communication with other healthcare team members.
  • Supports Holistic Care: It ensures that nutrition care is integrated seamlessly with other aspects of patient care, promoting a holistic approach to health and wellness.

Crafting the Perfect PES Statement: The Steps

Identifying the Nutrition Diagnosis

The nutrition diagnosis should be determined after performing a full nutrition assessment. Using clinical nutrition skills the Dietitian 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.

common nutrition diagnosis list.
Common Nutrition Diagnosis List Used in Older Adults

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

The nutrition diagnosis will fall into one of three categories:

  1. Intake
  2. Clinical
  3. Behavioural

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 the Dietitian is 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 the Dietitian 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

The PES 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.

PES statements examples in a chart format.  Commonly used PES statement examples.
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!

Sample PES Statements

  1. Inadequate Energy Intake
    • “Inadequate energy intake related to decreased appetite due to age-related olfactory decline, as evidenced by weight loss of 5% over the past month and reduced meal portions.”
  2. Excessive Oral Food/Beverage Intake
    • “Excessive oral food and beverage intake related to uncontrolled type 2 diabetes management, as evidenced by high blood sugar readings and a diet history rich in simple carbohydrates.”
  3. Inadequate Fluid Intake
    • “Inadequate fluid intake related to fear of incontinence, as evidenced by concentrated urine, infrequent urination, and reported minimal fluid consumption.”
  4. Altered GI Function
    • “Altered gastrointestinal function related to chronic constipation, as evidenced by less than three bowel movements per week and reported discomfort during defecation.”
  5. Inadequate Protein Intake
    • “Inadequate protein intake related to difficulty chewing due to poor dental health, as evidenced by low serum albumin levels and avoidance of high-protein foods.”
  6. Excessive Nutrient Intake
    • “Excessive sodium intake related to reliance on processed and convenience foods, as evidenced by hypertension and a dietary recall high in canned and frozen meals.”
  7. Inadequate Vitamin D and Calcium Intake
    • “Inadequate vitamin D and calcium intake related to limited exposure to sunlight and dietary restrictions, as evidenced by osteopenia and low dietary intake of dairy products.”
  8. Inadequate Fiber Intake
    • “Inadequate fiber intake related to preference for soft, processed foods, as evidenced by chronic constipation and a diet low in fruits, vegetables, and whole grains.”
  9. Swallowing Difficulty
    • “Swallowing difficulty related to post-stroke dysphagia, as evidenced by coughing during meals and a preference for pureed foods.”
  10. Unintentional Weight Loss
    • “Unintentional weight loss related to altered taste perception and early satiety, as evidenced by a 7% weight loss in three months and reported lack of interest in eating.”
  11. Hypertension
    • “Excessive sodium intake related to habitual consumption of salt-rich processed foods, as evidenced by consistently elevated blood pressure readings and a dietary history high in cured meats and canned soups.”
  12. Type 2 Diabetes
    • “Inconsistent carbohydrate intake related to lack of diabetes-specific nutritional education, as evidenced by fluctuating blood glucose levels and a pattern of unbalanced meals with high glycemic index foods.”
  13. Malnutrition
    • “Inadequate nutrient intake related to decreased oral intake due to age-related anorexia, as evidenced by unintentional weight loss of 8% over six months and reduced muscle mass.”
  14. Chronic Kidney Disease
    • “Altered nutrient intake related to chronic kidney disease stage 3, as evidenced by elevated serum creatinine levels and dietary intake high in potassium and phosphorus.”

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.

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!

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Michelle Saari is a Registered Dietitian based in Canada. She has a Master's Degree in Human Nutritional Sciences and is a passionate advocate for spreading easy to understand, reliable, and trustworthy nutrition information. She is currently a full time online entrepreneur with two nutrition focused websites.

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