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

Victorian ADIME/IDNT Working Party Version 3: May 2014 Diabetes Case Study Presented by Victorian ADIME/IDNT Working Party Version 3: May 2014

Refresher Example of PES Statement Excessive energy intake (NI-1.3) 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

Victorian ADIME/IDNT Working Party Version 3: May 2014 Diabetes Case Study Newly Diagnosed Female Type 2 Diabetic referred for diabetes education Medical/Clinical: Mother and father both have history of DM OA, asthma, sleep apnoea Anthropometry: Wt 90 kg, Ht 177 cm, BMI 28.7kg.m2, IWR (63-78) Pt weight increased by 5 kg in past year Biochemistry: HbA1C: 10 mmol/L Random BGL last 24/24 are 6 mmol-23mmol/L Victorian ADIME/IDNT Working Party Version 3: May 2014

Victorian ADIME/IDNT Working Party Version 3: May 2014 Diabetes Case study Social: Lives with husband and Son Full time office worker Nil education prior Exercise: Nil planned exercise Diet: Bf: nil Mt: nil L: takeaway: pasta or 4 x sushi takeaway and 1 fruit (140g CHO) AT: 1 x sandwich, white bread and 1 fruit (45g CHO) D: stir fry with at least 1.5 cups calrose rice, sweet and sour sauce and corn. Straight after consumed an icy pole. (115g CHO) 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 1. Inconsistent carbohydrate intake (NI-5.8.4) 2. Excessive energy intake (NI_1.3) 3. Excessive oral Intake (NI_2.2) 4. Food and nutrition-related knowledge deficit (NB_1.1) 5. Less than optimal intake of types of carbohydrate (low GI foods) (NI_5.8.3) 6. Excessive Carbohydrate Intake (NI_5.8.3) 7. Inadequate Fiber Intake (NI_5.8.5) 8. Unintended Weight Gain (NC_3.4) 9. Physical inactivity (NB_2.1) 10. Obesity (NC_3.3) You may also get: Disordered eating pattern Altered nutrient-related lab values Inadequate protein Undesirable foods 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: 1. Inconsistent carbohydrate intake (NI-5.8.4) 2. Food and Nutrition-related knowledge deficit (NB_1.1) 3. Less than optimal intake of types of carbohydrate (low GI foods) (NI_5.8.3) Victorian ADIME/IDNT Working Party Version 3: May 2014

Other diagnoses and reason/s why you might not use them: 1. Excessive oral Intake (NI_2.2) This diagnosis is fine to use, but the patient has primarily arrived for diabetes education and therefore the above 3 diagnoses are more appropriate. 2. Excessive energy intake (NI_1.3) Can only use this diagnosis if you can calculate kJ from diet history & compare the standard 3. Excessive Carbohydrate Intake (NI_5.8.3) Can only use this diagnosis if you can calculate percentage of carbohydrates in diet. There is not enough information in this case study to do this. 4. Inadequate Fibre Intake (NI_5.8.5) Can only use this diagnosis if you can calculate fibre from available diet history. Also this consultation is in regards to diabetes primarily, you could complete this at the next visit. 5. Unintended Weight Gain (NC_3.4) This diagnosis is used for weight gains associated with a medical condition (i.e.: oedema, medications, paralysis) 6. Physical inactivity (NB_2.1) This diagnosis could potentially be used, but there are already 3 more appropriate diagnoses to use. 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 Inconsistent carbohydrate intake (NI-5.8.4) related to food and nutrition related knowledge deficit concerning appropriate timing and amounts of carbohydrate as evidenced by wide variations in blood glucose levels (6mmols - 23mmols) and estimated carbohydrate intake different from recommended amounts (nil carbohydrates at breakfast) Victorian ADIME/IDNT Working Party Version 3: May 2014

Victorian ADIME/IDNT Working Party Version 3: May 2014 PES statement 2 Food and nutrition-related knowledge deficit (NB_1.1) related to lack of education post diagnosis regarding carbohydrate containing foods as evidenced by reported estimated carbohydrate intake different from recommended amounts (especially as no carbohydrate consumption at breakfast) Victorian ADIME/IDNT Working Party Version 3: May 2014

Victorian ADIME/IDNT Working Party Version 3: May 2014 PES statement 3 Less than optimal intake of types of carbohydrate (low GI foods) (NI_5.8.3) related to food and nutrition related knowledge deficit as evidenced by wide variations in blood glucose levels (6mmols - 23mmols) and sources of high GI foods such as calrose rice. If learners still want to use it: Excessive Oral Intake (NI_2.1) related to food and nutrition related knowledge deficit as evidenced by Large serving sizes, excessive fat and energy intake Now based on the information provided and your PES statements what might you suggest are some interventions you might use to fix your diagnosis? -education -meal plan How would you evaluate? Monitor BSL, review knowledge, review meal plan to check if patient is spacing carbohydrates appropriately Victorian ADIME/IDNT Working Party Version 3: May 2014

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

Diabetes Case Study Newly Diagnosed Type 2 Diabetic Female referred for edu Medical/Clinical: Mother and father both have history of DM OA, asthma, sleep apnoea Anthropometry: Wt 90 kg, Ht 177 cm, BMI 28.7kg.m2, IWR (63-78) Pt weight increased by 5 kg in past year Biochemistry: HbA1C: 10 mmol/L Random BGL last 24/24 are 6 mmol-23mmol/L Exercise: Nil planned exercise Social: Lives with husband and Son Full time office worker Nil education prior Diet: Bf: nil Mt: nil L: takeaway: pasta or 4 x sushi takeaway and 1 fruit (140g CHO) AT: 1 x sandwich, white bread and 1 fruit (45g CHO) D: stir fry with at least 1.5 cups calrose rice, sweet and sour sauce and corn. Straight after consumed a icy pole. (115g CHO) 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