Using your "Crystal Ball!! What about "predicted" nutrition diagnoses?

 What about "predicted" nutrition diagnoses?

One of the general principles for constructing PES statements is that you use actual data that reflect the current situation.  However there are some circumstances where the situation is emerging or is likely to occur.  You are identifying a future nutrition problem and want to be proactive and intervene early.

Let's consider the use of a "predicted" nutrition diagnosis.  Re-consider your options in the previous post about the patient who has been placed on a ventilator, is unable to eat, and you believed should have enteral tube feeding.  

In the previous example we assumed that it was Day 4 and there had already been documented inadequate oral intake and/or inadequate energy intake signs and symptoms from the patient.  

BUT what if it were Day 1 or 2?  Assume the patient had been admitted in the afternoon, placed on a ventilator and it is now the morning of Day 2 of the hospitalization.  In your estimation it appears that the need for ventilator support is likely to continue for a significant amount of time.  

Then you may want to consider using a predicted nutrition diagnosis and you can use recommendations or citations from other research that supports your PES statement in lieu of actual patient signs and symptoms.

In this case a PES statement might look like:

Predicted inadequate energy intake related to inability to maintain volitional intake while on ventilator as evidenced by nutrition guidelines recommending early enteral nutrition for ventilator patients, current diet order as NPO, and ongoing ventilator therapy.

In this case there is limited data available for this specific patient to document actual inadequate energy intake as they have been in the hospital less than 24 hours, however you have a strong case for suggesting that this situation is likely to occur in the future AND you want to be proactive.

BOTTOM LINE:  If you do not have actual signs and symptoms of a nutrition diagnosis that you believe is likely to emerge you can consider a "Predicted nutrition diagnosis.  The following nutritional diagnostic terms are available:

Energy Balance (1)

Predicted inadequate energy intake (NI-1.4)

Predicted excessive energy intake (NI-1.5)

Multinutrient (5.11)

Predicted inadequate nutrient intake (specify)_______(NI-5.11.1)

Predicted excessive nutrient intake (specify)________(NI-5.11.2)

References

Predicted Inadequate Energy Intake (NI-1.4).  Reference Sheet.  Electronic Nutrition Care Process Terminology (eNCPT).  Available at: https://www.ncpro.org/pubs/encpt-en/codeNI-1-4.   Accessed Nov 16 2020.

Predicted Excessive Energy Intake (NI-1.5)   Reference Sheet.  Electronic Nutrition Care Process Terminology (eNCPT).  Available at: https://www.ncpro.org/pubs/encpt-en/codeNI-1-5.   Accessed Nov 16 2020.

Predicted Inadequate Nutrient Intake (NI-5.11.1)   Reference Sheet.  Electronic Nutrition Care Process Terminology (eNCPT).  Available at: https://www.ncpro.org/pubs/encpt-en/codeNI-5-11-1.   Accessed Nov 16 2020.

Predicted Excessive Nutrient Intake (NI-5-11.2)   Reference Sheet.  Electronic Nutrition Care Process Terminology (eNCPT).  Available at: https://www.ncpro.org/pubs/encpt-en/codeNI-5-11-2.   Accessed Nov 16 2020.