Nutrition Care Process Model
Tutorials
Nutrition Care Process and Terminology Committee
Academy of Nutrition and Dietetics
Nutrition Care Process Terminology
2015 Edition
Nutrition Diagnosis:
Examples in Two Case Studies
Objective
The objective of this presentation is to review
and feature the use of nutrition diagnosis
terminology and development of PES
statements in case study material for two
different patients. By the end of this module
the participant will be able to understand use
of nutrition diagnosis terminology in two
case examples:
• A 67 year old Hispanic male with heart failure
• An 8 year old white male child with iron
deficiency anemia and food allergies
Case #1
Referral from Family Practice Clinic to RDN:
67 year old Hispanic male with Heart Failure
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Case #1: Relevant Data
Determine the relevant nutrition assessment
data:
Case #1
Relevant Nutrition Assessment Data for
Nutrition Diagnosis:
• Weight loss of 20 lbs. in 2 months
• Shortness of breath
• Inability to consume large meals
• inability to shop or cook
• 24-hour recall indicates he uses many frozen and
processed foods; intake between 1000 – 1200
kcal/day
Nutrition Diagnosis
What are potential PES statements for this 67
year old male based on the nutrition
assessment data?
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Nutrition Diagnosis
1. Inadequate energy intake related to
shortness of breath as evidenced by 20 lbs
of weight loss in 2 months.
Nutrition Diagnosis
2. Inadequate oral intake related to inability to
shop and cook as evidenced by a caloric
intake of 500 kcals less than estimated
requirements and 20 lbs of weight loss in 2
months.
Nutrition Diagnosis
PES statements connect the nutrition
assessment, intervention, and monitoring
and evaluation steps. The etiology tells you
what type of intervention you need. The
signs and symptoms tell you what you will
need to monitor and evaluate.
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Nutrition Diagnosis
Which PES statement is better?
Evaluate the PES Statement
Inadequate energy intake related to shortness of breath as evidenced by
20 lbs of weight loss in 2 months.
1. Can the RDN resolve the problem? Yes
2. Does the etiology make sense? Does it
match the assessment data? Yes
3. Is there a reasonable intervention? Yes
4. Can you monitor this patient on the basis of
the stated signs and symptoms? Yes
Evaluate the PES Statement
Inadequate oral intake related to inability to shop and cook as evidenced
by a kcal intake of 500 kcals less than estimated requirements and 20
lbs of weight loss in 2 months.
1. Can the RDN resolve the problem? Yes
2. Does the etiology make sense? Does it
match the assessment data? Yes
3. Is there a reasonable intervention? Yes
4. Can you monitor this patient on the basis of
the stated signs and symptoms? Yes
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Nutrition Diagnosis
Which PES statement is best?
Inadequate oral intake related to inability to
shop and cook as evidenced by a kcal intake
of 500 kcals less than estimated
requirements and 20 lbs. of weight loss in 2
months.
This PES Statement has an etiology or “root
cause” that the RDN can impact, and leads to
an intervention that he or she can specifically
plan, and a sure method for monitoring and
evaluating the patient’s progress.
Case #2
Referral from Pediatric Clinic to RDN – request for
RDN consultation for assistance with meal planning
8 year old white male child with Fe deficiency anemia
Case #2: Relevant Data
Determine the relevant nutrition assessment
data:
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Case #2
Relevant nutrition assessment data for
nutrition diagnosis:
• Allergies to eggs and peanuts
• Fear of allergic reactions
• Food and Nutrition related knowledge deficit
• Diagnosed with Fe deficiency anemia
• Current BMI at the 30th percentile (44th percentile one year ago)
• Intake of 1200– 1500 kcal/day
• Poor appetite
• Food variety limited; intake of only 4 or 5 different foods.
Nutrition Diagnosis
What are potential PES statements for this 8
year old male child based on the nutrition
assessment data?
Nutrition Diagnosis
1. Inadequate energy intake related to fear of
allergic reactions as evidenced by
underweight at the 30th percentile for height,
weight, and age.
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Nutrition Diagnosis
2. Inadequate iron intake related to fear of
allergic reactions as evidenced by medical
diagnosis of iron deficiency anemia.
Nutrition Diagnosis
3. Food and nutrition-related knowledge deficit
related to fear of allergens in foods as
evidenced by poor appetite and intake of
only 4-5 foods in a 24 hour food recall, and
stated concern about food allergies.
Nutrition Diagnosis
PES statements connect the nutrition
assessment, intervention, and monitoring
and evaluation steps. The etiology tells you
what type of intervention you need. The
signs and symptoms tell you what you will
need to monitor and evaluate.
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Nutrition Diagnosis
Which PES Statement is best?
Evaluate the PES Statement
1. Inadequate energy intake related to fear of allergic reactions as
evidenced by underweight at the 30th percentile for height, weight, and
age.
1. Can the RDN resolve the problem? Yes
2. Does the etiology make sense? Does it
match the assessment data? Yes
3. Is there a reasonable intervention? Yes
4. Can you monitor this patient on the basis of
the stated signs and symptoms? Yes
Evaluate the PES Statement
Inadequate iron intake related to fear of allergic reactions as evidenced by
medical diagnosis of iron deficiency anemia
1. Can the RDN resolve the problem? Yes
2. Does the etiology make sense? Does it
match the assessment data? Yes
3. Is there a reasonable intervention? Yes
4. Can you monitor this patient on the basis of
the stated signs and symptoms? Yes
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Evaluate the PES Statement
Food and nutrition related knowledge deficit related to fear of allergens in
foods as evidenced by poor appetite and intake of only 4-5 foods
indicated in a 24 hour food recall, and stated concern about food
allergies.
1. Can the RDN resolve the problem? Yes
2. Does the etiology make sense? Does it
match the assessment data? Yes
3. Is there a reasonable intervention? Yes
4. Can you monitor this patient on the basis of
the stated signs and symptoms? Yes
Nutrition Diagnosis
Which PES statement is best?
Any of the three PES statements are accurate. There is a good
chance that the inadequate energy intake and the
inadequate iron intake will resolve along with addressing the
food and nutrition related knowledge deficit. The signs and
symptoms can be monitored in follow-up interviews.
Food and nutrition related knowledge deficit related
to fear of allergens in foods as evidenced by poor
appetite and intake of only 4-5 foods indicated in a
24 hour food recall, and stated concern about food
allergies.
Summary
In this presentation we have reviewed the
nutrition diagnosis terminology and PES
statements for two case studies:
• A 67 year old Hispanic male with heart
failure
• An 8 year old white male child with iron
deficiency anemia and food allergies
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Summary
This concludes the nutrition diagnosis tutorial.
Please proceed to the nutrition intervention
tutorial for the presentation of the planning
of the nutrition interventions for both case
studies.
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