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

Oncology: Pre-radiotherapy Presented by Victorian ADIME/IDNT Working Party Version 3: May 2014

Refresher Example of PES Statement Excessive energy intake (NI-1.3) related to poor knowledge of appropriate portion sizes as evidenced by excess weight with BMI of 45 (i.e. obese) Victorian ADIME/IDNT Working Party Version 3: May 2014

Oncology: Pre-radiotherapy 68 yo male presents for nutrition assessment in outpatient clinic 2 weeks prior to commencement of radiotherapy Medical/Clinical: Diagnosed with T2N0 SCC R) tonsillar fossa Planned for 6 weeks radiotherapy Nil difficulties with chewing/swallowing Nil symptoms at present Anthropometry: Wt 80kg, Ht 170cm, BMI 27.5kg/m2 No recent loss of weight. UBW 80kg PG-SGA A - Well nourished Victorian ADIME/IDNT Working Party Version 3: May 2014

Oncology: Pre-radiotherapy Social: Patient lives with wife. Retired 2 years ago. Enjoys gardening. Diet: Eats 3 meals per day, minimal snacks 4-6 cans beer x3 per week Pt demonstrating disinterest in learning/applying nutrition information Energy Requirements: Estimated energy intake 8-9MJ Estimated energy requirements during treatment 10.8-11.6MJ Victorian ADIME/IDNT Working Party Version 3: May 2014

Using the nutrition diagnosis reference sheet Identify 1-4 possible nutrition diagnoses that could fit this case study _________________________________________________________ 2. __________________________________________________________ 3. __________________________________________________________ 4. __________________________________________________________ Victorian ADIME/IDNT Working Party Version 3: May 2014

All Possible Diagnoses Inadequate protein-energy intake (NI-5.3) Predicted suboptimal energy intake (NI-1.4) Inadequate oral intake (NI-2.1) Inadequate energy intake (NI-1.2) Increased nutrient needs (NI-5.1) Predicted suboptimal nutrient intake (energy and protein)(NI-5.11.1) Food & Nutrition related knowledge deficit (NB-1.1) Excessive alcohol intake (NI-4.3) Not ready for diet/lifestyle change (NB.1.3) 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: Predicted suboptimal energy intake (NI-1.4) Food & Nutrition related knowledge deficit (NB-1.1) Victorian ADIME/IDNT Working Party Version 3: May 2014

Other diagnosis’s and reason/s why you might not use them: Inadequate energy intake (NI-1.2) Inadequate energy-protein intake (NI-5.3) Inadequate oral intake (NI-2.1) Increased nutrient needs (NI-5.1) The problem/diagnosis we are making is related to future intake that is anticipated to fall short of nutrient requirements for patients undergoing radiotherapy. In comparison, the above diagnoses relate to patients with a current oral intake/energy deficit (not a current issue for this patient prior to commencement of RT). Predicted suboptimal energy & protein intake (NI-5.11.1) no quantifiable protein intake data to allow us to use this diagnosis) Not ready for diet/lifestyle change (NB.1.3) 3rd domain 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

Victorian ADIME/IDNT Working Party Version 3: May 2014 PES statement 1 Predicted suboptimal energy intake (NI-1.4) related to commencement of radiotherapy for head and neck cancer and its anticipated side effects as evidenced by patient currently meeting 80% of anticipated requirements during radiotherapy Victorian ADIME/IDNT Working Party Version 3: May 2014

Victorian ADIME/IDNT Working Party Version 3: May 2014 PES statement 2 Food & Nutrition related knowledge deficit (NB-1.1) related to and lack of motivation and lack of knowledge regarding appropriate diet during radiotherapy treatment as evidenced by verbalising disinterest in learning and applying information and new diagnosis of H&N cancer (no previous nutrition education) 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

Oncology: Pre-radiotherapy 68 yo male presents for nutrition assessment in outpatient clinic 2 weeks prior to commencement of radiotherapy Medical/Clinical: Diagnosed with T2N0 SCC R) tonsillar fossa Planned for 6 weeks radiotherapy Nil difficulties with chewing/swallowing Nil symptoms at present Social: Patient lives with wife. Retired 2 years ago. Enjoys gardening. Anthropometry: Wt 80kg, Ht 170cm, BMI 27.5kg/m2 No recent loss of weight. UBW 80kg PG-SGA A - Well nourished Diet: Eats 3 meals per day, minimal snacks 4-6 cans beer x3 per week Pt demonstrating disinterest in learning/applying nutrition information Energy Requirements: Estimated energy intake 8-9MJ Estimated energy requirements during treatment 10.8-11.6MJ Using the nutrition diagnosis reference sheet, identify 1-4 possible nutrition diagnoses that could fit this case study 1. ________________________________________________________________________ 2. _________________________________________________________________________ 3. _________________________________________________________________________ 4. _________________________________________________________________________ Based on the above case study write two possible PES statements PES Statement 1: P:__________________________________________________________________________________________as related to E:________________________________________________________________________________________as evidenced by S/S:___________________________________________________________________________________________________ PES Statement 2: P:________________________________________________________________________________as related to E:_____________________________________________________________________________as evidenced by S/S:________________________________________________________________________________________ A4 working sheet, write in font 12, when printing print to A4 size Victorian ADIME/IDNT Working Party Version 3: May 2014