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. Victorian ADIME/IDNT Working Party
Enteral Nutrition
Presented by
Victorian ADIME/IDNT Working Party

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. Enteral Nutrition Assessment (A)
68 year old male post non-haemorrhagic R) CVA
Medical/Clinical:
Referred for NGT feeding: NGT insitu
PMHx:
HTN
TIA
Epilepsy
Day 3 in Stroke ward
L) hemiplegia
Slightly confused and agitated
Dysphagia: NBM as per Speech Pathology Ax; Day 3
Fluid Balance no issues
Meds include: Phenytoin via NGT o.d.
Victorian ADIME/IDNT Working Party Version 3: May 2014

5. Enteral Nutrition Assessment (A)
Social:
Single
Pensioner
Usually fit and well
Shops and cooks for self
Anthropometry:
Weight: 80kg
Height: 182 cm
BMI: 25.5kg/m2 (from GP)
No recent LOW
Victorian ADIME/IDNT Working Party Version 3: May 2014

6. Enteral Nutrition Assessment (A)
Victorian ADIME/IDNT Working Party Version 3: May 2014

7. Enteral Nutrition Nutrition Assessment (A)
Dietary History:
Eating well prior to admission; no known nutrient modifications.
Currently NBM 3/7
IVF NaCl: 100 ml/hr 24/24
SGA Rating:
SGA A: well nourished
No LOW , changes in diet, GI symptoms, functional status
Physical examination: adequate muscle mass and fat stores
Estimated Requirements:
Energy requirement: MJ/d
Protein requirement: g Protein/d
Fluid requirement: L/d
Victorian ADIME/IDNT Working Party Version 3: May 2014

8. 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 8

9. All Possible Diagnoses
Intake Domain
Clinical Domain
Behavioural-Environmental
Domain
Inadequate Energy intake
Swallowing Difficulty -
Inadequate Oral intake
Predicted Food-Medication Interaction
Inadequate Enteral Nutrition infusion
Less than Optimal Enteral Nutrition
Inadequate Energy-Protein intake
Inadequate Protein intake
Inadequate Fat Intake
Inadequate Fibre Intake
Inadequate Carbohydrate intake
Victorian ADIME/IDNT Working Party Version 3: May 2014

10. Victorian ADIME/IDNT Working Party Version 3: May 2014
Key Diagnoses
Diagnoses
Rationale
Inadequate Energy-Protein intake
(NI-5.3)
To meet standards based on short or recent duration physiological needs
Predicted Food-Medication Interaction (NI-2.4)
Feeding regimen may need to be altered if phenytoin is given enterally, to allow for a break (1-2 hours before and after the phenytoin.)
Victorian ADIME/IDNT Working Party Version 3: May 2014

11. Victorian ADIME/IDNT Working Party Version 3: May 2014
Ruled-out Diagnoses
Other Diagnoses not selected
Rationale
Inadequate Energy intake (NI-1.2)
Inadequate Oral intake (NI-2.1)
These diagnoses may be appropriate during EN, but may not be appropriate upon initiation of EN
Inadequate Enteral Nutrition infusion (NI-2.3)
Less than Optimal Enteral Nutrition (NI-2.5)
EN not in progress
Inadequate Protein intake (NI-5.7.1)
These diagnoses may be appropriate during EN, but may not be appropriate upon initiation of EN
Inadequate Fat Intake (NI-5.6.1)
Inadequate Fibre Intake(NI-5.8.5)
Inadequate Carbohydrate intake(NI-5.8.1)
Swallowing difficulty (NC-1.1)
Although contributes to the nutrition Ax, not appropriate as not treatable by nutrition intervention
Victorian ADIME/IDNT Working Party Version 3: May 2014

12. 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

13. 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

14. Victorian ADIME/IDNT Working Party Version 3: May 2014
PES statement 1
Victorian ADIME/IDNT Working Party Version 3: May 2014

15. Predicted Food-Medication Interaction
PES statement 2
Predicted Food-Medication Interaction
related to
commencement of enteral nutrition and existing enteral Phenytoin prescription
VIC IDNT Working Group consensus regarding lack of signs and symptoms for this PES statement
The problem has been predicted based on best practice guidelines.
Hence in this case SS can be omitted
Victorian ADIME/IDNT Working Party Version 3: May 2014

16. 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

17. 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

18. Enteral Nutrition Case Study Work Sheet
Medical/Clinical:
Referred for NGF , NGT insitu
68 year old male post non-hameorrhagic R) CVA . PHx HTN , TIA, Epilepsy
Day 3 in Stroke ward, L) hemiplegia; slightly confused and agitated
Dysphagia and NBM 3/7
Fluid Balance no issues; Meds include phenytoin via NGT o.d.
Social: Single , pensioner , usually fit and well shops and cooks for self
Anthropometry:
182 cm, 80kg- BMI=25.5kg/m2. from GP ;
Recent weight 80kg; No recent LOW
Biochemistry:
Alb: 31g/L ↓ (35-45g/L)
TTR: 155mg/L ↓ ( mg/L)
CRP: 50mg/L ↑ (0-5mg/L) U&E’s
Ca2+,Mg2+,PO43-,BSL,eGFR,Phenytoin: WNL
Dietary History
Eating well prior to admission; no known nutrient modifications.
Currently NBM D3; receiving normal saline , at 100 mL/hr
SGA Rating:
SGA A: well nourished
No LOW , changes in diet, GI symptoms, functional status
Physical examination : adequate muscle mass and fat stores
Estimated Requirements per day:
Energy requirement = MJ
Protein requirement = g Protein
Fluid requirement = L
Using the nutrition diagnosis reference sheet, identify possible nutrition diagnoses that could fit this case study
1. _______________________________________________ ____________________________________________________
2. _______________________________________________ ____________________________________________________
3. _______________________________________________ ____________________________________________________
4. _______________________________________________ ____________________________________________________
A4 working sheet, write in font 12, when printing print to A4 size
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:
Victorian ADIME/IDNT Working Party Version 3: May 2014