14.4 Developing Nutrition Diagnosis Statements

Nutrition diagnosis statements are crucial tools in the field of nutrition assessment. They concisely describe a patient's nutrition problem, its root cause, and key symptoms. These statements guide intervention plans and facilitate clear communication among healthcare professionals.

Developing effective nutrition diagnosis statements requires careful analysis of comprehensive assessment data. By accurately identifying the problem, etiology, and signs/symptoms, nutritionists can prioritize issues and create targeted interventions. This process is essential for improving patient outcomes and overall health.

Nutrition Diagnosis Statements

Purpose and Components

• A nutrition diagnosis statement is a clear, concise description of the nutrition problem that a patient or client is facing, as well as its root cause(s) and the primary signs and symptoms manifested
• The purpose of a nutrition diagnosis statement is to guide the development of an appropriate nutrition intervention plan and facilitate clear communication among healthcare professionals
• The three main components of a nutrition diagnosis statement are:
  • Nutrition problem (P): the specific nutrition issue the patient or client is experiencing
  • Etiology or root cause (E): the underlying factors contributing to the nutrition problem
  • Signs and symptoms (S): objective, measurable factors that provide evidence of the nutrition problem and its etiology
• The nutrition diagnosis statement is written in the PES format: "Nutrition problem (P) related to etiology (E) as evidenced by signs and symptoms (S)"
  • Example: "Inadequate oral intake (P) related to poor appetite secondary to chemotherapy (E) as evidenced by unintentional weight loss of 10% in the past 6 months (S)"

Derivation from Comprehensive Nutrition Assessment

• Nutrition diagnosis statements are derived from a comprehensive nutrition assessment, which includes data from various sources such as:
  • Dietary intake: food records, 24-hour recalls, or food frequency questionnaires
  • Anthropometric measurements: weight, height, BMI, waist circumference, or skinfold thickness
  • Biochemical data: laboratory tests (albumin, prealbumin, or vitamin levels)
  • Medical tests: gastrointestinal function tests or imaging studies
• The comprehensive nutrition assessment provides the necessary information to identify the nutrition problem, its etiology, and the related signs and symptoms

Formulating Nutrition Diagnosis Statements

Language and Clarity

• When formulating a nutrition diagnosis statement, use clear and specific language that accurately describes the nutrition problem, its etiology, and the related signs and symptoms
• Avoid using vague or ambiguous terms that may lead to misinterpretation or confusion among healthcare professionals
  • Example of clear language: "Excessive energy intake" instead of "Poor dietary habits"
• Ensure that the etiology statement clearly identifies the root cause(s) of the nutrition problem and is supported by the assessment findings
  • Example: "related to excessive calorie intake and sedentary lifestyle" instead of "related to poor choices"

Prioritizing Signs and Symptoms

• Signs and symptoms should be objective, measurable, and directly related to the nutrition problem and its etiology
• Prioritize the most relevant and impactful signs and symptoms when formulating the nutrition diagnosis statement
  • Example: "as evidenced by BMI of 35 kg/m² and elevated fasting blood glucose" instead of "as evidenced by patient's reported fatigue and occasional breathlessness"
• Double-check the nutrition diagnosis statement to ensure that it is grammatically correct, concise, and adheres to the PES format

Types of Nutrition Diagnoses

Problem (P)

• The nutrition problem (P) is a clear, concise statement that describes the specific nutrition issue the patient or client is experiencing
  • Examples: "Inadequate oral intake," "Overweight," or "Unintentional weight loss"
• The problem statement should be specific and accurately reflect the primary nutrition concern

Etiology (E)

• The etiology (E) is a brief description of the root cause(s) of the nutrition problem
  • Examples: "related to poor appetite secondary to chemotherapy," "related to excessive calorie intake and sedentary lifestyle," or "related to increased nutrient needs due to sepsis"
• The etiology should clearly identify the underlying factors contributing to the nutrition problem and be supported by the assessment findings

Signs and Symptoms (S)

• Signs and symptoms (S) are objective, measurable factors that provide evidence of the nutrition problem and its etiology
  • Examples: "as evidenced by unintentional weight loss of 10% in the past 6 months," "as evidenced by BMI of 29 kg/m² and waist circumference of 40 inches," or "as evidenced by albumin level of 2.5 g/dL and decreased skin turgor"
• Signs and symptoms should be directly related to the nutrition problem and its etiology and help quantify the severity of the issue

Differentiating Between Components

• It is essential to differentiate between the problem, etiology, and signs/symptoms components when formulating a nutrition diagnosis statement to ensure clarity and accuracy
• Incorrectly identifying the problem, etiology, or signs/symptoms can lead to an ineffective nutrition intervention plan and suboptimal patient outcomes
  • Example of incorrect differentiation: "Inadequate oral intake (P) as evidenced by poor appetite secondary to chemotherapy (S)" instead of "Inadequate oral intake (P) related to poor appetite secondary to chemotherapy (E) as evidenced by unintentional weight loss of 10% in the past 6 months (S)"

Prioritizing Nutrition Diagnoses

Prioritization Based on Severity and Impact

• When a patient or client presents with multiple nutrition problems, it is crucial to prioritize the diagnoses based on their severity and potential impact on the individual's overall health and well-being
• High-priority nutrition diagnoses are those that pose an immediate threat to the patient's health
  • Examples: severe malnutrition, life-threatening electrolyte imbalances, or significant unintentional weight loss
• Medium-priority nutrition diagnoses are those that have a significant impact on the patient's health but do not pose an immediate threat
  • Examples: poorly controlled diabetes, hypertension, or moderate obesity
• Low-priority nutrition diagnoses are those that have a less severe impact on the patient's health and can be addressed after higher-priority issues have been managed
  • Examples: mild nutrient deficiencies or food preferences

Factors to Consider

• When prioritizing nutrition diagnoses, consider factors such as:
  • Patient's age: older adults may be more vulnerable to the consequences of malnutrition
  • Overall health status: patients with multiple comorbidities may require more aggressive nutrition interventions
  • Comorbidities: certain medical conditions (diabetes, kidney disease) may necessitate prioritizing specific nutrition problems
  • Personal goals and preferences: patient's own goals and motivations should be taken into account when prioritizing diagnoses
• Collaborate with the patient, their family, and other healthcare professionals to determine the most appropriate order in which to address the identified nutrition diagnoses
  • Example: a patient with severe malnutrition and poorly controlled diabetes may require simultaneous interventions to address both issues, while a patient with mild iron deficiency anemia and food allergies may prioritize managing the allergies first