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. Parenteral Nutrition case study
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. Parenteral Nutrition Case Study
75 year old male admitted via ED with a small bowel obstruction (SBO) referred on day 5 admission for TPN requirements
Medical/Clinical:
PHx: Bowel cancer and anterior resection in 2005, IHD, AF, COPD, cholecystectomy, prior SBO and emergency laparotomy, adhesiolysis and sml bowel resection 2011
SBO not resolving, not wanting to operate at this stage
TPN has been running for the past 3 days without dietetic involvement and is 50ml/hr providing 5.9MJ & 64g protein
Anthropometry:
Current weight = 76kg, Height = 175cm, BMI= 25kg/m² (RR 22-27)
Weight Hx: Stable. Well nourished
Biochemistry:
Electrolytes all within normal range
Albumin 25 (low), CRP 125 (high)
Victorian ADIME/IDNT Working Party Version 3: May 2014

5. Parenteral Nutrition Case Study
Social:
Lives at home with his wife
Wife prepares the meals
Diet:
NBM 5 days
Good appetite and oral intake prior to bowel obstruction
Estimated Requirements: (if appropriate for energy, protein, fluid)
Estimated energy requirements: MJ ( kJ/kg/day)
Estimated protein requirements: g ( g/kg/day)
Victorian ADIME/IDNT Working Party Version 3: May 2014

6. 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 6

7. All Possible Diagnoses
Inadequate energy intake (NI-1.4)
Inadequate oral intake (NI-2.1)
Inadequate parenteral nutrition infusion (NI-2.6)
Less than optimal parenteral nutrition composition or modality (NI-2.8)
Inadequate protein-energy intake (NI-5.3)
Inadequate protein intake (NI-5.7.1)
Altered gastrointestinal (GI) function (NC-1.4)
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:
Inadequate parenteral nutrition infusion (NI-2.6)
Defined as parenteral infusion that provides fewer calories or nutrients compared to established reference standards or recommendations based on physiological needs
Inadequate protein-energy intake (NI-5.3)
Defined as Inadequate intake of protein and/or energy compared to established reference standards or recommendations based on physiological needs of short or recent duration
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-1.4)
This diagnosis could potentially be used, but it is more appropriate to use the inadequate parenteral nutrition infusion or inadequate protein-energy intake.
2. Less than optimal parenteral nutrition infusion (NI-2.8)
This is defined as parenteral nutrition composition or modality that is inconsistent with evidence-based practice, which does not necessarily fit with this case study.
3. Inadequate oral intake (NI-2.1)
This diagnosis could potentially be used, but we can be more specific by using the inadequate parenteral nutrition infusion or inadequate protein-energy intake.
4. Inadequate protein intake (NI-5.7.1)
5. Altered gastrointestinal (GI) function (NC-1.4)
This diagnosis could potentially be used, but there are already more appropriate diagnoses to use from the intake 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. 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

12. Victorian ADIME/IDNT Working Party Version 3: May 2014
PES statement 1
Inadequate parenteral nutrition infusion (NI-2.6) related to no early dietetic referral for calculation of requirements as evidenced by current TPN providing 75% EER & 85% EPR
Victorian ADIME/IDNT Working Party Version 3: May 2014

13. Victorian ADIME/IDNT Working Party Version 3: May 2014
PES statement 2
Inadequate protein-energy intake related to no early dietetic referral for calculation of requirements for TPN as evidenced by current TPN providing 75% EER & 85% EPR
Victorian ADIME/IDNT Working Party Version 3: May 2014

14. 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,
Voevodin M. IDNT – International Dietetics and Nutrition Terminology, Monash University, 2010
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

15. 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

16. Parenteral Nutrition Case Study
75 year old male admitted via ED with a small bowel obstruction (SBO) referred on day 5 admission for TPN requirements
Medical/Clinical:
PHx: Bowel cancer and anterior resection in 2005, IHD, AF, COPD, cholecystectomy, prior SBO and emergency laparotomy, adhesiolysis and sml bowel resection 2011
SBO not resolving, not wanting to operate at this stage
TPN has been running for the past 3 days without dietetic involvement and is 50ml/hr providing 5.9MJ & 64g pro
Anthropometry:
Current weight = 76kg, Height = 175cm, BMI= 25kg/m² (RR 22-27)
Weight Hx: Stable. Well nourished
Biochemistry:
Electrolytes all within normal range
Albumin 25 (low), CRP 125 (high)
Social:
Lives at home with his wife
Wife prepares the meals
Diet:
NBM 5 days
Good appetite and oral intake prior to bowel obstruction
Estimated Requirements:
Estimated energy requirements: MJ ( kJ/kg/day) Estimated protein requirements: g ( g/kg/day)
Using the nutrition diagnosis reference sheet, identify possible nutrition diagnoses that could fit this case study
1. _______________________________________________ ____________________________________________________
2. _______________________________________________ ____________________________________________________
3. _______________________________________________ ____________________________________________________
4. _______________________________________________ ____________________________________________________
Based on the above case study write two-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 16