Bookmark this page for easy reference in the future: Make sure to scroll down to see all the examples of P’s, E’s, and S’s that might align with your client cases.

Just getting started with supervision? You’ll need to write a successful PES statement to meet this competency for your Competency Check #1 meeting , please choose one of the cases listed below, scroll down to see the posisble P’s, E’s and S’s you might want to use to craft your sentence, and work up a PES statement. You can also use this same client to fill out your sample chart note for competency 10. To demonstrate the competency, be prepared to share your chart note during your Competency Check #1 meeting.

To get things started, here’s an example of how to write a PES for a Case:

Case Description: A 32-year-old Asian female; reports recent diagnosis of pre-diabetes with an HbA1c of 6.0, fasting insulin of 18, and fasting blood glucose of 102. Client reports decided to become vegetarian 1 year ago due to ethical concerns and diet changed from eating lots of seafood, chicken and pork with veggies and rice to the last 8 months eating mostly packaged vegan proteins (frozen veggie burgers, veggie sausages), with rice, some vegetables and occasional eggs. Ct has family hisotry of T2DM, and dementia. Ct is experiencing fatigue and increase in thirst.

PES: Nutrition related knowledge deficit r/t (related to) nutritional needs when shifting to vegetarian diet AEB (as evidenced by) dx pre-diabetes, HbA1c of 6.0, fasting insulin of 18, and fasting blood glucose of 102, diet record showing reliance on processed plant proteins, inadequate total protein intake, inadequate B-12 and o-3 intake.

OR here is another option for the same client (sometimes you might have more than one PES for a client case):

PES: Increased need for protein, fiber, B-6, Mg, O-3s r/t recent shift to vegetarian diet, family hx T2DM, recent dx of pre-diabetes AEB HbA1c of 6.0, fasting insulin of 18, and fasting blood glucose of 102, diet record.

Pick one of the below cases to write your own PES, and scroll down for our cheat sheet:

Case Description

• A 57-year-old Caucasian male; reports high levels of stress at work. Hates vegetables, is a "meat and potato guy". Consumes a 6 pack of beer per night to "wind-down". Does not see a therapist; reports they did not talk about mental health growing up. Labs show low serum B12, low serum folate, and high MCV.

• A 62-year-old Hispanic male. reports frequent urination, excessive thirst, and weight loss. Skips breakfast, usually has a sandwich for lunch, and animal protein, starch, and one veggie for dinner. Drinks multiple cups of coffee during the day, and has to nap around 3 pm every day. Unable to exercise due to arthritis pain in knees.

Common Nutrition “Problems”

Intake:

• Inadequate energy intake

• Excessive energy intake

• Inadequate fluid intake

• Excessive fluid intake

• Excessive alcohol intake

• Increased nutrient needs:

• Decreased nutrient needs:

• Inadequate fat intake

• Excessive fat intake

• Inappropriate intake of fats

• Inadequate protein intake

• Excessive protein intake

• Inadequate carb. intake

• Excessive carb. intake

• Inappropriate intake of carb.

• Inadequate fiber intake

• Excessive fiber intake

• Inadequate vitamin/mineral intake:

• Excessive vitamin/mineral intake:

Clinical:

• Swallowing difficulty

• Chewing difficulty

• Altered GI function

• Impaired nutrient utilization:

• Food/medication interaction:

• Underweight

• Involuntary weight loss

• Overweight

• Involuntary weight gain

• Inadequate milk production

• Breastfeeding difficulty