Piland, Adams



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|Problem |Related To |As evidenced by |

|Inadequate calorie / protein intake |Dysphasia, swallowing difficulty |Coughing, Pocketing, spitting out food |

| |Chewing difficulty |Spilling of majority of meal |

|Inadequate oral intake |Decreased appetite |Weight loss of X3 in time frame |

| |Difficulty feeding self |Resident reports ill fitting or unavailable dentures |

| |Altered taste perception from chemo/radiation, chronic disease, |SLP reports . . . |

| |multiple meds |PO < 50% |

| |Stroke, MS, Parkinson’s |Resident states trouble eating |

|Inadequate oral intake |Impaired oral intake |NPO, Sedation, Vent |

| |Unable to consume po safely |Resident wishes no artificial nutrition |

|Inadequate fluid intake |Dementia |Physical findings of dry mucous membranes, poor skin turgor, dark urine, cloudy urine |

| |Decreased desire to urinate |Dx UTI, |

| |Decreased thirst perception |Inadequate output per nursing |

| |Dislike of thickened liquids |Oral intake of < XXX cc fluid per daily average |

|Impaired nutrient utilization |Compromised function of the GI tract due to radiation therapy |Diarrhea |

| |Vomiting, Emesis |Nausea, Vomiting x frequency |

| |S/P GI surgery |Weight loss of X# in timeframe |

|Excessive CHO intake |Unrestricted diet order |Weight gain of XX # in timeframe |

| |Non compliant to diet |Blood sugars elevated (list lab / accuchecks and values) |

|Excessive energy intake |Excessive snacking from vending machine |Increased Na or K lab values |

|Excessive mineral intake |Limited adherence to nutrition related recommendations |Snacking from vending machine, consuming outside foods |

| | |Ordering out or requesting additional food |

|Overweight |Decrease energy expenditure associated with sedentary lifestyle, |BMI > 30 |

|Obese |limited physical activity |Weight gain of XX # in timeframe |

|Underweight |Increased energy needs |Recent ___ diagnosis and treatment (ie cancer) |

| |Inadequate intake |Weight loss X in timeframe |

| | |Weight < IBW, BMI < 20 |

|Problem |Related To |As evidenced by |

|Increased calorie / protein needs |Increased involuntary physical activity (Parkinson’s disease) |Recent weight loss of x# in timeframe |

| |Wound, Surgery, Infection, Septic |Inadequate protein stores (list alb or prealb value) |

| |Cancer, MS |Wound (stage and location) |

|Altered GI function |Non compliance with gluten free diet |Diarrhea |

| |Excessive consumption of sugar free candy |Constipation |

| |Non compliance with GERD prevention advice |GI complaints per resident |

| |Impaction, Illeus |NPO status |

| |No bowel sounds |Need for TPN for nutrition support |

|Altered nutrient related lab value |Impaired utilization from renal disease |State lab and value |

| |Excessive CHO intake | |

| |Excessive fat intake | |

| |Inadequate fluid intake | |

|Nutrition related knowledge deficit |Dietary management of (name specific disease process ie DM, CHF, Renal,|Resident reports lack of knowledge regarding (be specific) |

| |Diverticular, HTN, edema, constipation) | |

|Inadequate intake from Tube feeding, enteral formula |Low rate of infusion |Current order less than goal rate of __ cc/hr |

| |Resident pulled out tube |TF meeting or < estimated needs |Inappropriate lab value (list) |

|Inadequate Intake from TF or TPN | |Blood sugars elevated (list) |

| | |Weight loss or gain of X# in timeframe |

|Inability or lack of desire to manage self care |Physical inactivity |Admission in LTC / rehab care. |

|Impaired ability to prepare foods / meals |Diagnosis (stroke, wound, dementia, etc) | |

| |Limited mobility | |

| |Limited knowledge | |

| | | |

| | | |

If no new problems exist, weight stable, all labs WNL, no new wounds, etc then state,

“Nutrition interventions in place, no new nutrition problems, pes as above.”

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Nutrition Care Process

PES Statement Samples

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