Mrs. Joaquin is a 24-year-old Native American woman. She was diagnosed with Type 2 DM at age 13 and has been poorly comp

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Mrs. Joaquin is a 24-year-old Native American woman. She was
diagnosed
with Type 2 DM at age 13 and has been poorly compliant with
prescribed medication and diet.
She was diagnosed with Stage 3 CKD two years ago.
Acute symptoms have developed over the last 3 weeks.
Her occupation is sedentary.
Patient is of Pima Indian ethnicity.
Medical history: Gravida 1/ para 1. Infant weighed 10# at birth,
7 years ago. Pt explains she
stopped taking oral hypoglycemic agent, and never started taking
prescribed antihypertensive
medication. Declining GFR, increasing creatinine and urea
concentration, elevated serum
phosphate, and normochromic, normocytic anemia are evidence of
declining renal function.
She is being admitted preparing for renal replacement therapy
(RRT). Family history of T2DM in both parents.
Physical findings: anorexia; nausea/vomiting; 4-kilogram weight
gain over past 2 weeks.
anorexia; edema of face, extremities, eyes; malaise; shortness
of breath; pruritus; muscle
cramps: inability to urinate. She is overweight, lethargic, has
skin discoloration, and 3+ pitting
edema. These signs and symptoms are all consistent with
progression of her CKD. Blood
pressure is 220/80.
Biochemical: Laboratory values show Mrs. Joaquin has elevated
BUN and Creatinine, as well as
elevated potassium, phosphorus, glucose, cholesterol, LDL-C,
triglycerides, and low sodium,
carbon dioxide, chloride, calcium, and HDL-C. Urinalysis is
positive for protein (2+), and pH is 7.9
(range 5-7).
Given Mrs. Joaquin’s values, the current GFR is 4.58. This value
is consistent with diagnosis of
Stage 5 CKD.
WRITE A PES STATEMENT:
Using standardized diagnostic terminology (eNCPT), write two PES
statements based on the problems you identified. (8 points).
EXAMPLE OF HOW TO WRITE A PES.....
P (selecting the Problem) • Can the nutrition professional
resolve or improve the nutrition diagnosis for the patient/client?
When all things are equal and there is a choice between stating the
PES statement using two nutrition diagnoses from different domains,
consider the intake nutrition diagnosis as the one more specific to
the role of the RDN E (selecting the Etiology) • Evaluate whether
the etiology is the specific “root cause” that can be addressed
with a nutrition intervention. If addressing the etiology cannot
resolve the problem, can the RDN intervention at least lessen the
signs and symptoms? S (selecting the Signs and Symptoms to address)
• Will measuring the signs and symptoms indicate if the problem is
resolved or improved? • Are the signs and symptoms specific enough
that the RDN can monitor (measure/evaluate changes) and document
resolution or improvement of the nutrition diagnosis?