1. 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

2. Oncology: New diagnosis
Presented by
Victorian ADIME/IDNT Working Party Version 3: May 2014

3. 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 (ie: obese)
Victorian ADIME/IDNT Working Party Version 3: May 2014

4. Oncology: New diagnosis
66 yo male admitted for investigation & management of newly diagnosed metastatic lung cancer
Medical/Clinical:
Newly diagnosed with metastatic lung cancer (T4 N2 M1 – pleural metastases)
Treatment plan not yet known
Loss of appetite, early satiety, weakness, fatigue, SOB. ECOG 3
Anthropometry:
Wt 48kg, Ht 157cm, BMI 19.5kg/m2
↓10kg past 5 months (17% bw). UBW = 58kg
PG-SGA C, score 21 – Severely malnourished (signs of muscle wastage & fat loss)
Victorian ADIME/IDNT Working Party Version 3: May 2014

5. Oncology: New diagnosis
Social:
Lives with supportive friends. No family in Australia.
Diet:
POI past 6 months due to nutrition impact symptoms above
Eating 3 small meals per day, < ½ of usual size
Energy Requirements:
Estimated energy intake ~3MJ
Estimated energy requirements ~6MJ
Victorian ADIME/IDNT Working Party Version 3: May 2014

6. 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

7. All Possible Diagnoses
Malnutrition (NI-5.2)
Inadequate oral intake (NI-2.1)
Inadequate energy intake (NI-1.4)
Increased nutrient needs (NI-5.1)
Inadequate protein intake (NI-5.7.1)
Underweight (NC-3.1)
Unintended weight loss (NC-3.2)
Inability to manage self-care (NB-2.3)
Impaired ability to prepare food/meals (NB-2.4)
Victorian ADIME/IDNT Working Party Version 3: May 2014

8. Victorian ADIME/IDNT Working Party Version 3: May 2014
Key Diagnoses
Most appropriate diagnoses for this case study:
Malnutrition(NI-5.2)
Inadequate oral intake (NI-2.1)
Inadequate energy intake (NI-1.4)
Victorian ADIME/IDNT Working Party Version 3: May 2014

9. Other diagnosis’s and reason/s why you might not use them:
Increased nutrient needs (NI-5.1)
relevant with lung cancer patients however other diagnoses more appropriate as pt not meeting pre-diagnosis requirements let alone increased requirements
Inadequate protein intake (NI-5.7.1)
no quantifiable data available to determine this
Underweight (NC-3.1)
in clinical domain
Unintended weight loss (NC-3.2)
Inability to manage self-care (NB-2.3)
behavioural/environmental domain & not primary issue on admission – more applicable when reach stage for discharge planning
Impaired ability to prepare food/meals (NB-2.4)
Victorian ADIME/IDNT Working Party Version 3: May 2014

10. 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

11. Victorian ADIME/IDNT Working Party Version 3: May 2014
PES statement 1
Malnutrition (NI-5.2) and inadequate energy intake (NI-1.4) related to loss of appetite and limited ability to prepare and consume adequate energy as evidenced by reported 17% loss of bw in past 5/12, energy intake deficit of 3MJ and moderate to severe signs of muscle wasting and subcutaneous fats loss. PG-SGA C: severely malnourished
Victorian ADIME/IDNT Working Party Version 3: May 2014

12. Victorian ADIME/IDNT Working Party Version 3: May 2014
PES statement 2
Malnutrition (NI-5.2) and inadequate oral intake (NI-2.1) related to loss of appetite and limited ability to prepare and consume adequate food as evidenced by reported 17% loss of bw in past 5/12, consuming <50% of meals and moderate to severe signs of muscle wasting and subcutaneous fats loss. PG-SGA C: severely malnourished.
Victorian ADIME/IDNT Working Party Version 3: May 2014

13. Victorian ADIME/IDNT Working Party Version 3: May 2014
References
PowerPoint Presentations
Ferguson M, et al. Webinar 3: Implementation, DAA IDNT Working Party,
Vivanti A, Micallef N. Webinar 2: Diagnoses, PES statements and Case Study, DAA IDNT Working Party,
Capra S, Ferguson M, et al. Standardised Language: A powerful tool for dietetic professionals,
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

14. Contacts Alison Qvist alison.qvist@wh.org.au
Ai Vee Lim
Anna Cardamis
Anna Whitley
Annika Dorey
Caitlyn Green
Lina Breik
Loretta Bufalino
Kate Furness
Rubina Raja
Sonia Brockington

15. Oncology: New diagnosis
66 yo male admitted for investigation & management of newly diagnosed metastatic lung cancer
Medical/Clinical:
Newly diagnosed with metastatic lung cancer (T4 N2 M1 – pleural metastases)
Treatment plan not yet known.
Loss of appetite, early satiety, weakness, fatigue, SOB. ECOG 3.
Social:
Lives with supportive friends. No family in Australia.
Anthropometry:
Wt 48kg, Ht 157cm, BMI 19.5kg/m2
↓10kg past 5 months (17% bw). UBW = 58kg
PG-SGA C, score 21 – Severely malnourished (signs of muscle wastage & fat loss)
Diet:
POI past 6 months due to nutrition impact symptoms above
Eating 3 small meals per day, < ½ of usual size
Energy Requirements:
Estimated energy intake ~3MJ
Estimated energy requirements ~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