Victorian ADIME/IDNT Working Party Version 3: May 2014 Facilitator Notes Prior to presenting to your group, print out the final slide in A4 size and use this for your participants worksheet. It is recommended not to print out the presentation for use during the presentation The presentation will provide 1 refresher example for your participants and then proceed with case example. The presentation is designed so that your participants complete the diagnosis section first followed with a discussion about the most appropriate diagnosis to use. The completion of the PES statement should only be completed after this discussion. Victorian ADIME/IDNT Working Party Version 3: May 2014

Hypertension Case Example Presented by Victorian ADIME/IDNT Working Party Version 3: May 2014

Refresher Example of PES statement Excessive energy intake (NI-1.5) related to frequent consumption of large portions of high-fat meals as evidenced by average daily energy intake exceeding recommended amount by 2000kj & 6kg gain during the past 18 months Victorian ADIME/IDNT Working Party Version 3: May 2014

Hypertension Case Study 55 y.o. female referred for dietary advice to assist with hypertension Medical/Clinical: Hypercholesteroleamia, obesity, OA, gout. Anthropometry: 62kg, 165cm, BMI: 23 stable weight +/- 1 kg. Social: Works full time in an office BP 150/90mmol/Hg Victorian ADIME/IDNT Working Party Version 3: May 2014

Hypertension Case study Social Hx Lives with partner, but has no children Exercise Little additional physical activity and drives ½ hour to work Reports no time for exercise Intake Bf: Cornflakes + 1 slice bread with vegemite L: reliance on takeaways such as Chinese, KFC etc D: Meat and 3 vegies mainly, loves tomato sauce/gravies Snacks: cheese and crackers, yoghurt, intake of 8 beers per day to de-stress after work Sodium intake: 3500mg + /day Sodium requirements: <1000mg (20-40mmol) No prior counselling received Victorian ADIME/IDNT Working Party Version 3: May 2014

Victorian ADIME/IDNT Working Party Version 3: May 2014 Using the nutrition diagnosis reference sheet Identify possible nutrition diagnoses that could fit this case study 1. ____________________________________________________________ 2. ____________________________________________________________ 3. ____________________________________________________________ 4. ____________________________________________________________ 5. ____________________________________________________________ 6. ____________________________________________________________ 7. ____________________________________________________________ 8. ____________________________________________________________ 9. ____________________________________________________________ 10. ___________________________________________________________ Learners should find at least 9. Victorian ADIME/IDNT Working Party Version 3: May 2014

All Possible Diagnoses Excessive energy intake (NI-1.3) Excessive oral intake (NI-2.2) Excessive bioactive substance intake (NI-4.2) Excessive alcohol intake (NI-4.3) Excessive mineral intake (sodium) (NI-5.10.2.7) Food and nutrition-related knowledge deficit (NB-1.1) Undesirable food choices (NB-1.7) Physical Inactivity (NB-2.1) Victorian ADIME/IDNT Working Party Version 3: May 2014

Victorian ADIME/IDNT Working Party Version 3: May 2014 Key Diagnoses Most appropriate diagnoses for this case study: Excessive mineral intake (sodium) (NI-5.10.2.7) Excessive alcohol intake (NI-4.3) Physical Inactivity (NB-2.1) Victorian ADIME/IDNT Working Party Version 3: May 2014

Other diagnoses and reason/s why you might not use them: 1. Excessive energy intake (NI-1.3) Can only use this diagnosis if you can calculate kJ from diet history & compare the standard 2. Excessive oral intake (NI-2.2) This diagnosis is appropriate to use, however there are more specific diagnoses to use and patients weight is in healthy weight range 3. Excessive bioactive substance intake (NI-4.2) Use this diagnosis on substances that are not part of the dietary reference intakes and therefore there are no established minimum requirements or tolerable upper intake levels. 4. Food and nutrition-related knowledge deficit (NB-1.1) This diagnosis is appropriate to use, however was not used as 3 diagnoses was sufficient 5. Undesirable food choices (NB-1.7) Patients main reason for undesirable food choices is lack of knowledge. Victorian ADIME/IDNT Working Party Version 3: May 2014

Based on the above case study write 2 to 3 possible PES Statements ___________________ as related to E:______________________________ _________________as evidenced by S/S:_____________________________ ______________________________ Victorian ADIME/IDNT Working Party Version 3: May 2014

Evaluating your PES Statement When developing your PES statements, think about the following: { } can the dietitian resolve the nutrition diagnosis? { } if tossing up between 2 diagnoses, attempt to select the INTAKE domain first { } is the aetiology the “root cause” (ask “but why”) { } will measuring the ‘signs and symptoms’ tell you if the problem is resolved? { } are the signs and symptoms specific enough that you can measure them?   Victorian ADIME/IDNT Working Party Version 3: May 2014

Victorian ADIME/IDNT Working Party Version 3: May 2014 PES statement 1 Excessive mineral intake (sodium) (NI-5.10.2.7) as related to Lack of education on sodium content in foods as evidenced by diet history indicating sodium intake >300% of upper limit, high intake of takeaway meals and sauces, and BP of 150/90. Victorian ADIME/IDNT Working Party Version 3: May 2014

Victorian ADIME/IDNT Working Party Version 3: May 2014 PES statement 2 Excessive alcohol intake (NI-4.3) as related to Stressful job as evidenced by diet history indicating 8 beers per day and BP of 150/90. Victorian ADIME/IDNT Working Party Version 3: May 2014

Victorian ADIME/IDNT Working Party Version 3: May 2014 PES statement 3 Physical Inactivity (NB-2.1) as related to Competing priorities/stressful job as evidenced by Nil planned exercise. Victorian ADIME/IDNT Working Party Version 3: May 2014 14

Victorian ADIME/IDNT Working Party Version 3: May 2014 References PowerPoint Presentations Ferguson M, et al. Webinar 3: Implementation, DAA IDNT Working Party, www.daa.asn.au Vivanti A, Micallef N. Webinar 2: Diagnoses, PES statements and Case Study, DAA IDNT Working Party, www.daa.asn.au Capra S, Ferguson M, et al. Standardised Language: A powerful tool for dietetic professionals, 2009 www.daa.asn.au Manuals ADA, (2013) International Dietetics and Nutrition Terminology (IDNT) Reference Manual: Standardized Language for the Nutrition Care Process, Fourth Edition, American Dietetic Association, 2013 ADA, (2010) International Dietetics and Nutrition Terminology (IDNT) Reference Manual: Standardized Language for the Nutrition Care Process, American Dietetic Association, 2010 PES FAQ and Terminology IDNT Edition 3, v4, Nutrition and Dietetics Department, Princess Alexandra Hospital, Queensland Victorian ADIME/IDNT Working Party Version 3: May 2014

Contacts Alison Qvist alison.qvist@wh.org.au Ai Vee Lim AiVee.Lim@petermac.org Anna Cardamis Anna.Cardamis@easternhealth.org.au Anna Whitley Anna.Whitley@svhm.org.au Annika Dorey adorey@cabrini.com.au Caitlyn Green caitlyn.green@austin.org.au Lina Breik lina.breik@nh.org.au Loretta Bufalino LorettaBufalino@hotmail.com Kate Furness kate.furness@southernhealth.org.au Rubina Raja Rubina.Raja@southernhealth.org.au Sonia Brockington sonia.brockington@deakin.edu.au

Hypertension Case Study 55 y.o. female referred for dietary advice to assist with hypertension Medical/Clinical: -Hypercholesteroleamia, obesity, OA, gout Anthropometry: -62kg, 165cm, BMI: 23 stable weight +/- 1 kg. Social: -Works full time in an office -150/90mmol/Hg -No prior counselling received -Sodium intake: 3500mg + per day -Sodium requirements: <1000mg (20-40mmol) Social Hx -Lives with partner, but has no children Exercise -Little additional physical activity and drives ½ hour to work -Reports no time for exercise Intake -Bf: Cornflakes + 1 slice bread with vegemite -L: reliance on takeaways such as Chinese, KFC etc -D: Meat and 3 vegies mainly, loves tomato sauce/gravies -Snacks: cheese and crackers, yoghurt, -8 beers per day to de-stress after work Using the nutrition diagnosis reference sheet, identify possible nutrition diagnoses that could fit this case study 1. _______________________________________________ 5. ____________________________________________________ 2. _______________________________________________ 6. ____________________________________________________ 3. _______________________________________________ 7. ____________________________________________________ 4. _______________________________________________ 8. ____________________________________________________ Based on the above case study write three possible PES statements PES Statement 1: P:__________________________________________________________________________________________as related to E:________________________________________________________________________________________as evidenced by S/S:___________________________________________________________________________________________________ PES Statement 2: PES Statement 3: A4 working sheet, write in font 12, when printing print to A4 size