A nutrition diagnosis is a formal statement that identifies and labels an existing nutritional problem which a registered dietitian is qualified to address. It is the second step in the Nutrition Care Process (NCP) and serves to bridge the gap between nutritional assessment and intervention. This diagnosis is distinct from a medical diagnosis and is communicated through a standardized format known as the PES statement.
The Three-Part PES Statement
At the heart of a nutrition diagnosis is the PES statement, a structured sentence that stands for Problem, Etiology, and Signs/Symptoms. This framework ensures that the identified nutrition issue is clearly defined, its root cause is established, and the evidence supporting it is documented. The PES statement is formatted as: 'Problem related to Etiology as evidenced by Signs and Symptoms'.
The Problem
The 'P' in PES identifies the specific nutritional problem using standardized terminology from the eNCPT (Electronic Nutrition Care Process Terminology). This term represents an issue that the dietitian can resolve or improve. Examples of problem labels include 'inadequate oral intake', 'excessive fat intake', or 'unintended weight loss'. It is vital to use the correct terminology to ensure clear and consistent communication among healthcare providers.
The Etiology
The 'E' refers to the root cause or contributing factors that are directly related to the nutrition problem. Identifying the etiology is critical because the subsequent nutrition intervention should target this cause. Etiologies can be linked to factors like dietary habits, medical conditions, or lifestyle choices. For instance, a problem of excessive sodium intake might be related to a 'reliance on convenience and fast foods'. The etiology helps the dietitian develop a practical and effective intervention strategy.
The Signs and Symptoms
The 'S' provides the evidence that the problem and etiology exist. Signs are objective, measurable data such as lab results (e.g., elevated blood pressure), anthropometric measurements (e.g., BMI of 35), or clinical observations (e.g., fluid retention). Symptoms are subjective, reported by the patient, such as fatigue, nausea, or reported dietary intake. The signs and symptoms must be specific and measurable to allow for effective monitoring and evaluation of the intervention's success.
The Three Domains of Nutrition Diagnosis
Nutrition diagnostic terms are organized into three primary domains, which classify the nature of the nutrition problem.
Intake Domain
These diagnoses relate to problems with actual or estimated energy, nutrient, fluid, and bioactive substance intake compared to recommended needs.
- Excessive oral intake: Consuming more food than estimated needs.
- Inadequate fluid intake: Not consuming enough fluids to meet hydration needs.
- Increased nutrient needs: Requiring more of a specific nutrient, like protein, due to a medical condition.
Clinical Domain
This domain covers problems related to a patient's medical or physical condition that affect their nutritional status.
- Swallowing difficulty (Dysphagia): A functional problem impacting food consumption.
- Impaired nutrient utilization: The body's inability to properly absorb or metabolize nutrients.
- Unintended weight loss: Losing significant weight without intentional effort.
Behavioral-Environmental Domain
This category includes problems related to a patient's knowledge, attitudes, beliefs, access to food, or physical environment.
- Food and nutrition-related knowledge deficit: Lack of understanding about diet or nutrient requirements.
- Limited access to food: Difficulty obtaining food due to physical or financial barriers.
- Limited adherence to nutrition recommendations: Difficulty following a prescribed diet plan.
Nutrition Diagnosis vs. Medical Diagnosis
It is essential to understand the difference between a nutrition diagnosis and a medical diagnosis. A physician makes a medical diagnosis, which is a disease or pathology that a patient has, such as diabetes. A dietitian, on the other hand, creates a nutrition diagnosis, which focuses on the nutritional problems that result from or contribute to the medical condition. The nutrition diagnosis can often be improved or resolved through dietary intervention.
| Feature | Nutrition Diagnosis | Medical Diagnosis |
|---|---|---|
| Practitioner | Registered Dietitian Nutritionist (RDN) | Physician or Medical Doctor |
| Focus | Nutrition-related problem that can be treated by an RDN | Disease or medical pathology |
| Example | Excessive carbohydrate intake | Diabetes Mellitus |
| Resolvable? | Can often be improved or resolved with intervention | May be chronic and require long-term medical management |
| Based On | PES statement derived from nutrition assessment | Medical tests and clinical findings |
The Process of Creating a Nutrition Diagnosis
Creating an accurate nutrition diagnosis is a skilled process that follows the initial nutritional assessment, which involves gathering a wide range of data. The dietitian evaluates and analyzes the data, including:
- Dietary History: The patient's eating habits, food preferences, and any dietary restrictions.
- Anthropometric Measurements: Physical measurements like height, weight, and BMI.
- Biochemical Data: Laboratory tests, such as blood glucose or serum albumin levels.
- Nutrition-Focused Physical Findings: Physical signs of malnutrition, such as muscle wasting or hair changes.
- Client History: Medical history, socioeconomic factors, and psychosocial conditions.
Using critical thinking, the dietitian identifies patterns and relationships within this data to determine the most relevant and specific nutrition problem. The dietitian then writes the PES statement, ensuring it is concise, clear, and directly linked to the assessment findings. This diagnosis guides the development of a tailored nutrition intervention plan. As the patient's condition changes, the nutrition diagnosis may also evolve, necessitating ongoing monitoring and evaluation.
Conclusion
A nutrition diagnosis, articulated through a PES statement, is an essential tool for RDNs in providing effective, patient-centered nutrition care. By systematically identifying the specific nutrition problem, its root cause, and the supporting evidence, dietitians can create targeted interventions to improve health outcomes. This standardized, evidence-based approach ensures clarity in communication among healthcare professionals and focuses efforts on resolving the nutritional issues that are within the dietitian's scope of practice, ultimately benefiting the patient's overall well-being. For more information on the Nutrition Care Process, resources are available from organizations like the Academy of Nutrition and Dietetics.
