Writing PES Statements for new RDs

Writing PES statements as a new RD is not easy. Get the secrets to writing PES statements, better and faster.

PES Statements for New RDs

Writing PES statements is not easy. Especially for new RDs. It can be so hard coming up with new PES statements every time you see a new patient.

So what’s the secret to writing PES statements easily? We’re breaking it down for you right here, so keep reading.

PRO TIP:
There’s no right and wrong way to write PES statements. Hopefully that makes you feel a little better already.

What Do PES Statements Look Like?

Let’s start by looking at a few simple PES statements.

To make it even easier, let’s look at ones that sound different but all say generally the same thing about diabetes:

Altered nutrition related lab values related to uncontrolled diabetes 2/2 excessive intake of CHO foods as evidenced by A1C of 12, Glu: 334
Uncontrolled diabetes related to poor adherence to insulin use as evidenced by advanced age, dementia
Excessive intake of CHO dense foods related to inadequate nutrition knowledge, poor access to appropriate food, meds as evidenced by A1C of 12 with recent DKA, inability to purchase insulin

See how they all emphasize something different about your patient?

And see how a lot of these sort of look like they overlap?

Yep, you’re correct. Parts of a PES statement can do that. And none of them are wrong, they’re all just different and useful for different reasons.

This is why you evaluate your patient and choose the most acute issue. What you consider most important to support your patient in is what you want to highlight in your PES statement.

This will also help you determine how you’ll to structure your PES statement, what you want to highlight, and where you choose to position different facts about your patient.

Ready to learn how to do this? Let’s go.

Fast PES Statement Breakdown

You already know why you need to know PES statements. So let’s look at each of the parts we’ll be working with.

The P in PES is for: PROBLEM

The problem is the thing you’re most worried about with your patient. It’s whatever you consider to be the most concerning.

I call it your patient’s most acute nutritional issue. It could be anything that you’re going to target with your nutrition note and your care plan. Some great places to start finding the PES problem include:

Lab values (ex: altered nutrition related lab values)
Weight status (ex: excessive/inadequate energy intake)
Uncontrolled or acute medical conditions (ex: uncontrolled diabetes or malnutrition)

The E in PES is for: ETIOLOGY

This addresses where you see the problem coming from. And it can really be anything. There’s no right or wrong answer here.

Your goal when choosing an etiology is to make sure this clearly answers why you think the problem is actually a problem. Some ways to think about etiology include:

Age and cognitive status (are they capable of making their problems better?)
Knowledge gaps (do they know what they’re supposed to know to make their problems better?)
Food choices and lifestyle decisions (are they opting in or out of behaviors that can impact the progress of their problems?)
Medications (what’s happening with their treatment compliance?)

The S in PES is for: SYMPTOMS

This might be the most straightforward part of writing PES statements. The most important thing to remember is that the SYMPTOM should always relate back to the PROBLEM.

It’s the answer to the question, how do you know it’s actually a problem. This is where you list the facts. The things that prove that the problem is a problem.

There’s no guessing or creative license that needs to be taken. The symptoms are simply the evidence you have that the problem you stated is something you need to address.

These might include:

Lab results (feel free to list the numbers and values that prove your point)
Medical diagnoses (write out the ones that are most important to your point)
Lifestyle (note anything relevant that supports your point)

Of course, these are by no means exhaustive lists.

Because every patient is different and every patient needs a slightly varied nutrition care plan, every PES statement may need to be adjusted based on their unique situation.

Setting Up Your PES Statements

PRO TIP:
The trick to writing PES statements is that you rarely have to write the same one twice.

There’s a lot of variety and individuality that goes into evaluating our patients. There’s also a lot of repetition.

When you see a patient with diabetes who’s struggling with uncontrolled blood sugar levels, you want to know why. Let’s say it’s because they aren’t taking their insulin properly.

Your second question should be WHY aren’t they taking their insulin the way their doctor prescribed it. There are a million answers to this question. It could be because they:

Don’t like using needles
They forget to take it
They don’t know how to take it
No one has ever told they why they need to take it
They don’t care would rather drink Pepsi than take it

When you know why, you’ll have the foundation of your PES statement and you can decide if it should be the problem (the nutrition issue that put them in your care) or the etiology (the reason for the problem existing).

Writing PES Statements: How-To Examples

Let’s write some different kinds of PES statement using the example: “I don’t like using needles”.

MEDICAL DIAGNOSIS PES STATEMENT:

We could write this for a medical diagnosis:

PROBLEM: uncontrolled DM
ETIOLOGY: refusal to use needles, self-administer insulin
SYMPTOMS: elevated Glu, A1C

Uncontrolled DM related to refusal to self-administer insulin, fear of needles, as evidenced by elevated Glu, A1C

LAB VALUE PES STATEMENT:

We could also write this for lab values:

PROBLEM: altered nutrition related lab values
ETIOLOGY: refusal to use needles 2/2 dementia
SYMPTOMS: uncontrolled DM, elevated Glu, A1C

Altered nutrition related lab values related to advanced age, refusal to use needles 2/2 dementia as evidenced by uncontrolled DM with elevated Glu, A1C

LIFESTYLE PES STATEMENT:

We could also write this through the lens of lifestyle:

PROBLEM: excessive CHO intake
ETIOLOGY: non-compliant with insulin rx 2/2 fear of needles
SYMPTOMS: uncontrolled DM, elevated Glu, A1C, food choices noted at bedside and during nutrition assessment

Excessive CHO intake related to non-compliance with insulin rx, fear of needles as evidenced by uncontrolled DM, elevated A1C with frequent snacking on potato chips and sodas

All of these work. They all also say something different about your patient and what you consider most important.

PRO TIP:
Once you have a PES statement you really like, save it for later. Reuse it. Keep a list, and make adjustments as needed with individual patients.

And That’s It!

This is how to start writing PES statements. This is a great place to start for new RDs or dietitians getting back into clinical after a time away.

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Ready for more?
Check out the Clinical Resource Bundle that includes the most loved PES Statement handout. This handout has 4 pages of reusable PES statements that you can mix and match to fit our patients.

Want even more to help in clinical?
Check out The Nutrition Cheat Sheets Shop for all the nutrition education and clinical resources that will make your life easier.