Understanding Nutrition Diagnostic Statements (PES)

Inadequate Oral and Enteral Nutrition

If the issue is specifically about the route or method of delivery, use:

• Inadequate Oral Intake (NI-2.1): Focuses on oral food/beverage intake being less than recommended.
• Inadequate Enteral Nutrition Infusion (NI-2.3): Used when tube feeding volume or nutrient density is insufficient.

Weight Status: Underweight and Involuntary Weight Loss

It is critical to distinguish between a patient's weight status and the process of losing weight.

• Underweight (NC-3.1): Defined by low body weight compared to standards, such as a BMI < 18.5 in adults.
• Involuntary Weight Loss (NC-3.2): This refers to an unplanned decrease in body weight, often due to illness, trauma, or malabsorption.

Nutrient-Specific and Physiological Diagnoses

Decreased vs. Increased Nutrient Needs

Nutrition therapy often involves adjusting specific nutrients based on medical conditions.

• Decreased Nutrient Needs (NI-5.4): This is common in patients with renal dysfunction (requiring less protein or phosphorus) or heart failure (requiring less sodium).
• Increased Nutrient Needs (NI-5.1): This applies to patients in a hypermetabolic state, such as those with wounds, burns, or accelerated growth.

Malnutrition and Impaired Utilization

Malnutrition (NI-5.2) is a complex diagnosis involving inadequate intake of protein and/or energy over prolonged periods, resulting in loss of fat stores and muscle wasting. It can be starvation-related, chronic disease-related, or acute disease-related.

If the patient is eating enough but the body cannot process it, consider:

• Impaired Nutrient Utilization (NC-2.1): Changes in the ability to metabolize nutrients, often due to endocrine disorders or inborn errors of metabolism.
• Altered GI Function (NC-1.4): Changes in digestion, absorption, or elimination, such as those seen in Crohn’s disease or malabsorption syndromes.

Clinical and Laboratory Considerations

Altered Laboratory Values

When a patient's lab results are abnormal due to medical conditions or medications, you may use Altered Nutrition-related Laboratory Values (NC-2.2).

Note: Only use this diagnosis if an intake-related diagnosis (NI series) does not more accurately describe the problem.

Common laboratory indicators include:

• Renal/Liver: Elevated BUN, Creatinine, or AST/ALT.
• Glucose: Abnormal plasma glucose or HgbA1c.
• Electrolytes: Abnormal potassium, phosphorus, or sodium.

Summary Table of Key Indicators

To help you select the right signs and symptoms, use the following mathematical relationships as a guide for weight changes:

$\text{Significant Weight Loss (Adults)} = \begin{cases} >5\% & \text{in 1 month} \\ >7.5\% & \text{in 3 months} \\ >10\% & \text{in 6 months} \end{cases}$

Final Checklist for your PES Statement

Before finalizing your statement, ask yourself:

1. Is the Problem a nutrition diagnosis? (Avoid medical diagnoses like "Diabetes"; use "Excessive CHO intake" instead).
2. Is the Etiology actionable? (Can a nutrition intervention help fix the cause?).
3. Are the Signs and Symptoms specific? (Did you include the actual lab value or the specific percentage of weight loss?).