Nutrition Diagnosis
The PES statement
Nutrition diagnosis is the second step of the Nutrition Care Process and is written in standardized terminology from three domains: intake (NI), clinical (NC), and behavioral–environmental (NB). One problem, one PES statement.
Format: Problem (label) related to Etiology as evidenced by Signs/Symptoms. The problem must be a nutrition problem the dietitian can independently resolve or improve - not a medical diagnosis such as "diabetes" or "renal failure." The etiology ("related to") must be a cause you can act on, and the signs/symptoms ("as evidenced by") must be documented, measurable assessment data.
Common traps:
- Writing an intervention into the problem ("needs tube feeding").
- Using a medical diagnosis or screening label as the problem.
- Listing a sign as the etiology, or an etiology as the sign.
- Two etiologies joined by "and," which makes the statement non-specific.
- "At risk for" statements without documented risk and a specific etiology.
Worked comparison. Weak: "Malnutrition related to cancer as evidenced by weight loss." Cancer is not modifiable by nutrition therapy and the weight loss is undated. Better: "Unintended weight loss (NC-3.2) related to decreased oral intake secondary to chemotherapy-induced nausea as evidenced by 9% loss of usual body weight in 60 days and a 24-hour recall showing 40% of estimated energy needs." That version names a modifiable cause, quantifies the evidence, and points directly to intervention.