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
Renal
Presented by
Victorian ADIME/IDNT Working Party

3. Victorian ADIME/IDNT Working Party Version 3: May 2014
Refresher Example
Excessive energy intake 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. Victorian ADIME/IDNT Working Party Version 3: May 2014
Renal
Medical/Clinical:
63 year old Male referred for “review of diet”
ESRF –HDX 3/7, T2DM, HTN,
Pitting oedema to ankles
Meds include Caltrate 1TDS, pt admits to skipping this due to not wanting to take too many pills
Pt is anuric
Bowels not opened for 4/7
BGL’s range stable between 4-8mmol/L
Anthropometry:
Ht = 165cm Wt =71kg (dry wt) BMI = 26kg/m2
Interdialytic weight gain 3.2-4L
Victorian ADIME/IDNT Working Party Version 3: May 2014

5. Victorian ADIME/IDNT Working Party Version 3: May 2014
Renal
Biochemistry (pre dialysis):
Social:
From home alone, wife passed away 3/12 ago. Doesn’t know how to cook for himself.
Result
Reference Range Na
138 K
5.6*
Urea
21.7*
Creatinine
450*
60-110 Ca
2.35
PO4
1.9*
Loretta: id add in reference ranges!
Victorian ADIME/IDNT Working Party Version 3: May 2014

6. Victorian ADIME/IDNT Working Party Version 3: May 2014
Renal
Diet history was analysed with foodworks and was found to provide:
Nutrient
Intake
Requirements/day
Energy
9.0MJ MJ
Protein
85g
85-99g
Sodium
170mmol
80-110mmol
Potassium
65mmol
71mmol
Phosphate
1010mg mg
Fluid
1.5L
500ml
Pt has high reliance on convenience foods due to the inability to cook for himself
Victorian ADIME/IDNT Working Party Version 3: May 2014

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

8. All Possible Diagnoses
Excessive mineral intake (sodium) NI
Altered nutrient related lab value (phosphate)NC-2.2.6
Food and nutrition related knowledge deficit NB-1.1
Excessive phosphate intake NI
Excessive potassium intake NI
Altered nutrient related lab value (potassium) NC-2.2.5
Excessive fluid intake NI-3.2
Inadequate Fiber intake NI-5.8.6
Excessive potassium and phosphate intake incorrect as they have been compared to a reference standard and were not excessive.
Correct diagnosis for both of these is altered nutriend related lab value as they have been caused by something else (constipation and incorrect binder use)
Inadequate fiber intake may be assumed due to bowel issue however, this has not been calculated and compared to a reference standard
Food and nutrition knowledge deficit is correct however is in the behavioural domain and there are concise and correct diagnoses in the intake domain. This could potentially be an aetiology e.g. not understanding the benefits of binders or preventing constipation.
Victorian ADIME/IDNT Working Party Version 3: May 2014

9. Victorian ADIME/IDNT Working Party Version 3: May 2014
Key Diagnoses
Most appropriate diagnoses for this case study:
Excessive mineral intake (sodium) NI
Altered nutrient related lab value (phosphate) NC-2.2.6
Altered nutrient related lab value (potassium) NC-2.2.5
Excessive fluid intake NI-3.2
Victorian ADIME/IDNT Working Party Version 3: May 2014

10. Victorian ADIME/IDNT Working Party Version 3: May 2014
Key Diagnoses
Other diagnosis’s and reason/s why you might not use them:
Food and nutrition related knowledge deficit NB-1.1- have been compared to a reference standard and were not excessive.
Excessive phosphate intake NI have been compared to a reference standard and were not excessive.
Excessive potassium intake NI have been compared to a reference standard and were not excessive.
Inadequate Fiber intake NI may be assumed due to bowel issue however, this has not been calculated and compared to a reference standard
From Loretta: 1st statement doesn’t make sense to me.
Fibre (not fiber)
Victorian ADIME/IDNT Working Party Version 3: May 2014

11. Based on the above case study write two possible PESS statements
___________________ as related to
E:______________________________
_________________as evidenced by
S/S:_____________________________
______________________________
Victorian ADIME/IDNT Working Party Version 3: May 2014

12. Suggested PES statement 1
Altered nutrient related lab value (phosphate) (NC-2.2.6) related to inconsistent use of phosphate binders and food and nutrient knowledge deficit as evidenced by increased phosphate levels, pt not being able to describe effect of binders on phosphate levels, pt not currently taking binders
Victorian ADIME/IDNT Working Party Version 3: May 2014

13. Suggested PES statement 2
Excessive sodium intake and excessive fluid intake (NI ) (NI-3.2)
related to
Lack of cooking skills leading to high sodium convenience meals, excessive thirst
as evidenced by
Reported intake of sodium and fluid above reference standards, signs of fluid overload e.g. large fluid gains, pitting oedema
Victorian ADIME/IDNT Working Party Version 3: May 2014

14. Suggested PES statement 3
Altered nutrient related lab value (potassium) (NC-2.2.5)
Related to constipation
As evidenced by K+5.6mmol/L with intake within recommended standard and BNO 4/7 and
Loretta: and ….
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,
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

16. Renal Nutrient Intake Energy 9.0MJ Protein 85g Sodium 170mmol
Potassium
65mmol
Phosphate
1010mg
Fluid
1.5L
Medical/Clinical:
3 year old Male referred for “review of diet”
ESRF –HDX 3/7, T2DM, HTN,
Pitting oedema to ankles
Meds include Caltrate 1TDS, pt admits to skipping this due to not wanting to take too many pills
Pt is anuric. Bowels not opened for 4/7
BGL’s range stable between 4-8mmol/L
Anthropometry:
Ht = 165cm Wt =71kg (dry wt) BMI = 26kg/m2
Interdialytic weight gain 3.2-4L
Biochemistry:
Na 138
K 5.6*
Urea 21.7*
Creatinine 450*
Ca 2.35
PO4 1.9*
Social:
From home with wife
Diet:
Analysed and compared to
Reference standards (right)
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 PESS statements
A4 working sheet, write in font 12, when printing print to A4 size
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:________________________________________________________________________________________