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

Weight Management Case Example 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

Weight Management Case Study 41 y.o. female referred for weight reduction Medical/Clinical: Borderline T2DM, HT, cholesteroleamia Anthropometry: Wt 110 kg, Ht 170 cm, BMI 38kg.m2 Stable until 1 year ago, weight gain of 1 kg every month = 12kg Biochemistry: All within range Victorian ADIME/IDNT Working Party Version 3: May 2014

Weight Management Case study Social: Lives with husband and four children Bus driver, full time feels she has no time at all for exercise and dieting Patient reports poor knowledge of foods Diet: BF: toasted muesli with two toast, full cream milk MT: 2 biscuits with tea L: 1-2 sandwiches with salami and cheese AT: yoghurt, biscuits, cake, a few chips if around Dinner: pasta (lg serve), stirfrys, 300g steak on average with 3 vegies. Takeaway 1/week, usually pizza, Wine occasionally, softdrink 2-3/7 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. Excessive oral intake (NI_2.2) 2. Excessive Energy Intake (NI_1.3) 3. Physical Inactivity (NB_2.1) 4. Overweight/obesity (NC_3.3) 5. Food and Nutrition-Related Knowledge Deficit (NB_1.1) 6. Excessive fat intake (NI_5.6.2) 7. Unintended weight gain (NC_3.4) 8. Undesirable food choices (NB_1.7) May also get: Excessive fat intake Unintended weight gain Predicted energy intake Undesirable food choices 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 oral intake (NI_2.2) Physical Inactivity (NB_2.1) Food and Nutrition-Related knowledge Deficit (NB_1.1) 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. Overweight/obesity (NC_3.3) This is the least preferable option as “intake” statements are preferred over “behavioural” statements where possible. If your assessment includes the “perfect” diet history and a desirable level of physical activity, you still have the option of “Overweight/obesity” as a nutritional diagnosis. 3. Excessive fat intake (NI_5.6.2) The consult is primarily for weight loss, therefore energy intake is more important 4. Unintended weight gain (NC_3.4) This is related to weight due to medical issues, i.e. fluid retention 5. Undesirable food choices (NB_1.7) This statement may be used, however there are more appropriate statements 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 Excessive oral intake (NI_2.2) as related to nutrition related knowledge deficit and competing priorities as evidenced by excessive serving sizes and frequent consumption of high fat, high energy meals and drinks. Victorian ADIME/IDNT Working Party Version 3: May 2014

Victorian ADIME/IDNT Working Party Version 3: May 2014 PES statement 2 Physical inactivity (NB_2.1) as related to competing priorities as evidenced by nil exercise Victorian ADIME/IDNT Working Party Version 3: May 2014

Victorian ADIME/IDNT Working Party Version 3: May 2014 PES statement 3 Food and nutrition-related knowledge deficit (NB_1.1) as related to lack of prior exposure to nutrition-related information and competing priorities as evidenced by reported intake of high fat, high energy meals and drinks, with weight gain of 12kg in the last 12/12 and current BMI of 38 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 -suggest exercise, recommend if you know that patient is allowed to exercise How would you evaluate? Monitor weight, BMI, review knowledge, check exercise levels 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

Weight Management Case Study 41 y.o female referred for wt reduction Medical/Clinical: Borderline T2DM, HT, cholesteroleamia Biochemistry: All within range Social: Lives with husband and four children Bus driver, full time feels she has no time at all for exercise and dieting Patient reports poor knowledge of foods feels she Anthropometry: Wt 110 kg, Ht 170 cm, BMI 38kg.m2 Stable until 1 year ago, weight gain of 1 kg every month = 12kg Diet: BF: toasted muesli with two toast, full cream milk MT: 2 biscuits with tea L: 1-2 sandwiches with salami and cheese AT: yoghurt, biscuits, cake, a few chips if around Dinner: pasta (large serve), stir fries, 300g steak on average with 3 vegies. Takeaway 1/week, usually pizza, Wine occasionally, soft drink 2-3/7 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: