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 Version 3: May 2014
Heart Failure
Presented by
Victorian ADIME/IDNT Working Party Version 3: May 2014

3. Refresher Example of PES Statement
Excessive energy intake (NI-1.5) related to frequent consumption of large portions of high-fat meals as evidenced by average daily energy intake exceeding recommended amount by 2000kj & 6kg gain during the past 18 months
Victorian ADIME/IDNT Working Party Version 3: May 2014

4. Heart Failure Case Study
75 y.o male admitted to hospital with SOB, new diagnosis of heart failure. Referred for education prior to discharge given recent fluid overload. Medical hx: Hypertension, GORD, hypercholesterolaemia, osteoarthritis Anthropometry: Weight: 80kg Ht: 175cm Weight hx: usually stable approx 75kg. Increased 5kg over last 2 weeks. Biochemistry: Na 134 K 4.3 TC 6.0mmol/L LDL 4.0mmol/L Clinical: High blood pressure Shortness of breath Good appetite, bowels opening regularly 1.5 L fluid restriction per medical unit The patient has seen a dietitian in the past for advice regarding hypertension. He is reluctant to change his diet and has a preference for salty foods and processed meats. He reports he was not aware that drinking more than 1.5L could worsen his heart failure.
Victorian ADIME/IDNT Working Party Version 3: May 2014

5. Heart Failure Case Study
Social: Lives with wife, shares cooking and shopping with wife Nil formal services Previously independent with mobility and all ADLs Home and Hospital Diet: Enjoys high salt meats, eats sausages or processed meats 5/7 days Eats high salt snacks daily including potato chips and nuts. Currently consuming all presented hospital meals. Usually drinks 1L water day plus 3 cups coffee (~800ml) and 3 cups cordial (~600ml). Drinking a similar amount in hospital. Estimated intake: Energy: ~8.0MJ Fluid: 2.5L Protein: 80g Sodium: 4g/day Estimated Requirements: Energy: 7.9MJ Fluid: 1.5L restriction Protein: 60-75g Sodium: < 2g/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

7. All Possible Diagnoses
Unintended weight gain (NC-3.4)
Excessive fluid intake (NI-3.2)
Excessive mineral intake (sodium) (NI )
Excessive oral intake (NI-2.2)
Undesirable food choices (NB-1.7)
Limited adherence to nutrition-related recommendations (NB-1.6)
Altered nutrition-related laboratory values (sodium and cholesterol) (NC-2.2)
Not ready for diet/lifestyle change (NB-1.3)
Less than optimal intake of types of fats (saturated fats) (NI-5.6.3)
Excessive fat intake (NI-5.6.2)
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:
Excessive fluid intake (NI-3.2)
Excessive mineral intake (sodium) (NI )
Less than optimal intake of types of fats (saturated fats) (NI-5.6.3)
Victorian ADIME/IDNT Working Party Version 3: May 2014

9. Other diagnoses and reason/s why you might not use them:
Excessive oral intake (NI-2.2) – this might apply but there are more specific intake diagnoses available
Excessive fat intake (NI-5.6.2) - unable to make this diagnosis from this case because the total fat intake is not quantified
Undesirable food choices (NB-1.7) – Behavioural-environmental domain, not first choice when there are intake diagnoses available
Limited adherence to nutrition-related recommendations (NB-1.6) - Behavioural-environmental domain, not first choice when there are intake diagnoses available
Not ready for diet/lifestyle change (NB-1.3) – as above, ?could be an etiology
Altered nutrition-related laboratory values (sodium and cholesterol) (NC-2.2) – Clinical domain, not first choice when there are intake diagnoses available
Unintended weight gain (NC-3.4) – as above
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
Excessive mineral intake (sodium) (NI ) and less than optimal intake of types of fats (saturated fats) (NI-5.6.3)
related to
Taste preference for salty foods and high fat meats and reluctance to change dietary habits
as evidenced by
Daily sodium intake ~4g/day, consumption of high fat and high salt meats 5/7 days, and high total blood cholesterol (6.0 mmol/L) and LDL (4.0mmol/L).
Victorian ADIME/IDNT Working Party Version 3: May 2014

13. Victorian ADIME/IDNT Working Party Version 3: May 2014
PES statement 2
Excessive fluid intake (NI-3.2)
related to
Knowledge deficit regarding heart failure management
as evidenced by
Intake of 2.5L fluid/day exceeding 1.5L fluid restriction
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,
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. Case Study
75 y.o male admitted to hospital with SOB, new diagnosis of heart failure. Referred for education prior to discharge given recent fluid overload.
Medical hx:
Hypertension, GORD, hypercholesterolaemia, osteoarthritis
Anthropometry: Weight: 80kg Ht: 175cm
Weight hx: usually stable approx 75kg. Increased 5kg over last 2 weeks.
Biochemistry: Na 134 K 4.3 TC 6.0mmol/L LDL 4.0mmol/L
Clinical: High blood pressure
Shortness of breath
Good appetite, bowels opening regularly
1.5 L fluid restriction per medical unit
The patient has seen a dietitian in the past for advice regarding hypertension. He is reluctant to change his diet and has a preference for salty foods and processed meats. He reports that he was not aware that drinking more than 1.5L could worsen his heart failure.
Social:
Lives with wife, shares cooking and shopping with wife
Nil formal services
Previously independent with mobility and all ADLs
Home and Hospital Diet:
Enjoys high salt meats, eats sausages or processed meats 5/7 days
Eats high salt snacks daily including potato chips and nuts.
Currently consuming all presented hospital meals.
Usually drinks 1L water day plus 3 cups coffee (~800ml) and 3 cups cordial (~600ml). Drinking a similar amount in hospital.
Estimated intake: Energy: ~8.0MJ Fluid: 2.5L
Protein: 80g Sodium: 4g/day
Estimated Requirements: Energy: 7.9MJ Fluid: 1.5L restriction
Protein: 60-75g Sodium: < 2g/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 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