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 1

High Fibre & Diverticulosis 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

High Fibre and Diverticulosis Case Study 45 y.o. male referred for diet advice to assist with a new diagnosis for management of Diverticulosis Anthropometry: Wt: 90kg Ht: 155cm BMI: 37.5kg/m2 Pt is weight stable Social Hx Married Mother lives with them and mother is usual cook Clincial Occasional diarrhoea and abdominal pains, bloating, constipation s/t Exercise Some planned exercise Victorian ADIME/IDNT Working Party Version 3: May 2014

High Fibre and Diverticulosis Case Study Intake: Diet history reveals regular meals, 10-15g of fibre per day and 3 coffees a day (~200mL each). He rarely drinks water as dislikes taste (= 200mL/day). Usually buys lunch and dinner from work canteen for convenience. BF: Muesli, Juice, Coffee MT: Biscuit and coffee L: white meat/egg/cheese sandwich +/-salad AT: Apple and Coffee D: Meat/chicken 1 cup vegies, 1 cup rice/pasta (asian stirfry) S: Yoghurt 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 6. Victorian ADIME/IDNT Working Party Version 3: May 2014 6

All Possible Diagnoses 1. Inadequate fibre intake (NI-5.8.5) 2. Food and nutrition-related knowledge deficit (NB-1.1) 3. Less than optimal intake of types of carbohydrate (fibre) (NI-5.8.3) 4. Inadequate fluid intake (NI-3.1) 5. Increased nutrient needs (fibre) (NI-5.1) 6. Suboptimal bioactive substance intake (fibre) (NI-4.1) 7. Physical Inactivity (NB-2.1) 8. Obesity (NC-3.3) 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: Inadequate fibre intake (NI-5.8.5) Inadequate fluid intake (NI-3.1) 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. Less than optimal intake of types of carbohydrate (fibre) (NI-5.8.3) You could use this diagnosis, but the diagnosis already chosen are more specific Increased nutrient needs (fibre) (NI-5.1) Patient requires a high fibre diet, but not increased from the general population recommendations Suboptimal bioactive substance intake (NI-4.1) You could use this diagnosis in place of the low fibre diagnosis, however considering there is a diagnosis specific to fibre, it is better to use the specific diagnosis. Physical Inactivity (NB-2.1) This diagnosis is appropriate to use. It was not used as there would have been too man diagnoses. Obesity (NC-3.3) This diagnosis was not chosen as it is not the main reason for consultation. It is also better to choose from the intake domain first 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 Inadequate fibre intake (NI-5.8.5) related to new diagnosis of diverticular disease, no previous Counselling/education and the desire for quick and easy meals as evidenced by low-moderate fibre intake (10-15g). Victorian ADIME/IDNT Working Party Version 3: May 2014

Victorian ADIME/IDNT Working Party Version 3: May 2014 PES statement 2 Inadequate fluid intake (NI-3.1) as related to new diagnosis of diverticular disease, no previous counselling and the desire for quick and easy meals as evidenced by ~800mL of fluid Victorian ADIME/IDNT Working Party Version 3: May 2014

Alternative to PES statement 1 and 2 Inadequate fluid intake (NI_3.1) and Inadequate fibre intake (NI_5.8.5) as related to new diagnosis of diverticular disease, no previous counselling and the desire for quick and easy meals as evidenced by ~800mL of fluid and low-moderate fibre intake (10-15g). Or Inadequate fluid intake (NI_3.1) Inadequate fibre intake (NI_5.8.5) as related to new diagnosis of diverticular disease, no previous counselling and the desire for quick and easy meals as evidenced by ~800mL of fluid low-moderate fibre intake (10-15g). Victorian ADIME/IDNT Working Party Version 3: May 2014 14

Victorian ADIME/IDNT Working Party Version 3: May 2014 PES statement 3 Food and nutrition-related knowledge deficit (NB_1.1) as related to new diagnosis of diverticular disease as evidenced by Reported nil previous counselling Victorian ADIME/IDNT Working Party Version 3: May 2014 15

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

High Fibre and Diverticulosis Case Study 45 y.o. male referred for diet advice to assist with a new diagnosis for management of Diverticulosis Anthropometry: 90kg, 155cm, BMI: 37.5kg.m2. Pt is weight stable Clincial: Occasional diarrhoea and abdominal pains, bloating, occasional constipation Exercise some planned exercise Social Hx: Married, mother lives with them and mother is usual cook Intake: Regular meals, 10-15g of fibre per day and 3 coffees a day (~200mL each). He rarely drinks water as dislikes taste (equalling 200mL/day). Usually buys lunch and dinner from work canteen for convenience. Bf: Muesli, Juice, Coffee Mt: Biscuit and coffee L: white meat/egg/cheese sandwich +/-salad AT: Apple and Coffee D: Meat/chicken 1 cup vegies, 1 cup rice/pasta (Asian stir-fry) S: Yoghurt No prior counselling received 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 Victorian ADIME/IDNT Working Party Version 3: May 2014