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: Pre-radiotherapy
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 (i.e. obese)
Victorian ADIME/IDNT Working Party Version 3: May 2014

4. Oncology: Pre-radiotherapy
68 yo male presents for nutrition assessment in outpatient clinic 2 weeks prior to commencement of radiotherapy
Medical/Clinical:
Diagnosed with T2N0 SCC R) tonsillar fossa
Planned for 6 weeks radiotherapy
Nil difficulties with chewing/swallowing
Nil symptoms at present
Anthropometry:
Wt 80kg, Ht 170cm, BMI 27.5kg/m2
No recent loss of weight. UBW 80kg
PG-SGA A - Well nourished
Victorian ADIME/IDNT Working Party Version 3: May 2014

5. Oncology: Pre-radiotherapy
Social:
Patient lives with wife. Retired 2 years ago. Enjoys gardening.
Diet:
Eats 3 meals per day, minimal snacks
4-6 cans beer x3 per week
Pt demonstrating disinterest in learning/applying nutrition information
Energy Requirements:
Estimated energy intake 8-9MJ
Estimated energy requirements during treatment MJ
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
Inadequate protein-energy intake (NI-5.3)
Predicted suboptimal energy intake (NI-1.4)
Inadequate oral intake (NI-2.1)
Inadequate energy intake (NI-1.2)
Increased nutrient needs (NI-5.1)
Predicted suboptimal nutrient intake (energy and protein)(NI )
Food & Nutrition related knowledge deficit (NB-1.1)
Excessive alcohol intake (NI-4.3)
Not ready for diet/lifestyle change (NB.1.3)
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:
Predicted suboptimal energy intake (NI-1.4)
Food & Nutrition related knowledge deficit (NB-1.1)
Victorian ADIME/IDNT Working Party Version 3: May 2014

9. Other diagnosis’s and reason/s why you might not use them:
Inadequate energy intake (NI-1.2)
Inadequate energy-protein intake (NI-5.3)
Inadequate oral intake (NI-2.1)
Increased nutrient needs (NI-5.1)
The problem/diagnosis we are making is related to future intake that is anticipated to fall short of nutrient requirements for patients undergoing radiotherapy. In comparison, the above diagnoses relate to patients with a current oral intake/energy deficit (not a current issue for this patient prior to commencement of RT).
Predicted suboptimal energy & protein intake (NI )
no quantifiable protein intake data to allow us to use this diagnosis)
Not ready for diet/lifestyle change (NB.1.3)
3rd domain
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
Predicted suboptimal energy intake (NI-1.4) related to commencement of radiotherapy for head and neck cancer and its anticipated side effects as evidenced by patient currently meeting 80% of anticipated requirements during radiotherapy
Victorian ADIME/IDNT Working Party Version 3: May 2014

12. Victorian ADIME/IDNT Working Party Version 3: May 2014
PES statement 2
Food & Nutrition related knowledge deficit (NB-1.1) related to and lack of motivation and lack of knowledge regarding appropriate diet during radiotherapy treatment as evidenced by verbalising disinterest in learning and applying information and new diagnosis of H&N cancer (no previous nutrition education)
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: Pre-radiotherapy
68 yo male presents for nutrition assessment in outpatient clinic 2 weeks prior to commencement of radiotherapy
Medical/Clinical:
Diagnosed with T2N0 SCC R) tonsillar fossa
Planned for 6 weeks radiotherapy
Nil difficulties with chewing/swallowing
Nil symptoms at present
Social:
Patient lives with wife. Retired 2 years ago. Enjoys gardening.
Anthropometry:
Wt 80kg, Ht 170cm, BMI 27.5kg/m2
No recent loss of weight. UBW 80kg
PG-SGA A - Well nourished
Diet:
Eats 3 meals per day, minimal snacks
4-6 cans beer x3 per week
Pt demonstrating disinterest in learning/applying nutrition information
Energy Requirements:
Estimated energy intake 8-9MJ
Estimated energy requirements during treatment MJ
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