[Cnm] PES statements

Annalynn Skipper Annalynn_Skipper at comcast.net
Fri Jun 1 12:18:09 PDT 2007

Please see my comments within the message below.  I hope you find
them helpful.  
Annalynn Skipper Ph.D., R.D., FADA

Author and Consultant
P.O. Box 45
Oak Park, IL 60303
Annalynn_Skipper at Comcast.net

From: jwmsrd at earthlink.net [mailto:jwmsrd at earthlink.net] 
Sent: Thursday, May 31, 2007 8:33 PM
To: cnm at lists.my180.net
Subject: [Cnm] PES statements
Not surprisingly, we are having problems with PES statements
Some of the powerpoints say that your etiology has to be
something that the intervention can be directed to ---yet, some
of the examples we've seen provided seem to point to including a
medical diagnosis as the etiology which is something we can't
change.......  I agree that some of these need to be changed.
Some will be in the next edition and I know that the NCP/SLC
would appreciate your forwarding suggestions to them using the
format at the back of the book.  
Our scenario: what do you do with an intubated CVA patient, day
one, we have a trigger for dysphagia from nursing which we have
to address.   I agree with Pam that you probably don't have a
diagnosis day one.  Possibly one of the "inadequate intake
diagnoses".  OR do you need to "tighten up" the nursing triggers?
We'll probably learn a great deal about this in the next couple
of years.   
We searched to find something in the Nutrition Diagnosis handbook
that ponted toward something to do with intubation.  Again,
inadequate oral food and beverage intake, inadequate entral
feeding?  Altered GI function is a possibility if the patient is
intubated for sepsis and MAP, CI, etc. are low.  
Info was that no one was available to give any wt history, diet
history, pt unable to give information due to intubation. Pt was
adequate weight. We didn't feel that using inadequate intake was
appropriate because it was only DAY 1 === a patient can be NPO
and intubated for a day with no harm and the early plan was to
try to extubate by tomorrow.  I agree.  This patient doesn't have
a nutrition diagnosis based on the information provided.  You can
write "no nutrition diagnosis at this time" and return tomorrow.
No problem.    
One of our ideas included:
Difficulty swallowing related to CVA resulting in dysphagia as
evidenced by patient intubated. 
We really know that was not a good statement but are really
stumped by what else we could say.  My final direction was that
we were going to just acknowledge those kinds of
triggers/situations according to timeliness of policy and then
write a statement that full assessment will be 
provided as more information becomes available. No nutrition
diagnosis initially.   Sounds good to me.  I would do something
similar.  I would also keep track of what triggered the consult,
and if over 6 months, the trigger often resulted in inappropriate
consults, work to change it.  
Input from anyone -- please!
Jo Lynn Worden
Rush Copley Medical Center 
Aurora, IL 
jwmsrd at earthlink.net
EarthLink Revolves Around You.
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