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. Weight Management Case Example
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 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. Weight Management Case Study
41 y.o. female referred for weight reduction
Medical/Clinical:
Borderline T2DM, HT, cholesteroleamia
Anthropometry:
Wt 110 kg, Ht 170 cm, BMI 38kg.m2
Stable until 1 year ago, weight gain of 1 kg
every month = 12kg
Biochemistry:
All within range
Victorian ADIME/IDNT Working Party Version 3: May 2014

5. Weight Management Case study
Social:
Lives with husband and four children
Bus driver, full time
feels she has no time at all for exercise and dieting
Patient reports poor knowledge of foods
Diet:
BF: toasted muesli with two toast, full cream milk
MT: 2 biscuits with tea
L: 1-2 sandwiches with salami and cheese
AT: yoghurt, biscuits, cake, a few chips if around
Dinner: pasta (lg serve), stirfrys, 300g steak on average with 3 vegies.
Takeaway 1/week, usually pizza, Wine occasionally, softdrink 2-3/7
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
1. Excessive oral intake (NI_2.2) 2. Excessive Energy Intake (NI_1.3) 3. Physical Inactivity (NB_2.1) 4. Overweight/obesity (NC_3.3) 5. Food and Nutrition-Related Knowledge Deficit (NB_1.1) 6. Excessive fat intake (NI_5.6.2) 7. Unintended weight gain (NC_3.4) 8. Undesirable food choices (NB_1.7)
May also get:
Excessive fat intake
Unintended weight gain
Predicted energy intake
Undesirable food choices
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 oral intake (NI_2.2)
Physical Inactivity (NB_2.1)
Food and Nutrition-Related knowledge Deficit (NB_1.1)
Victorian ADIME/IDNT Working Party Version 3: May 2014

9. Other diagnoses and reason/s why you might not use them:
1. Excessive Energy Intake (NI_1.3) Can only use this diagnosis if you can calculate kJ from diet history & compare the standard 2. Overweight/obesity (NC_3.3) This is the least preferable option as “intake” statements are preferred over “behavioural” statements where possible. If your assessment includes the “perfect” diet history and a desirable level of physical activity, you still have the option of “Overweight/obesity” as a nutritional diagnosis. 3. Excessive fat intake (NI_5.6.2) The consult is primarily for weight loss, therefore energy intake is more important 4. Unintended weight gain (NC_3.4) This is related to weight due to medical issues, i.e. fluid retention 5. Undesirable food choices (NB_1.7) This statement may be used, however there are more appropriate statements to use
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 oral intake (NI_2.2) as related to nutrition related knowledge deficit and competing priorities as evidenced by excessive serving sizes and frequent consumption of high fat, high energy meals and drinks.
Victorian ADIME/IDNT Working Party Version 3: May 2014

13. Victorian ADIME/IDNT Working Party Version 3: May 2014
PES statement 2
Physical inactivity (NB_2.1) as related to competing priorities as evidenced by nil exercise
Victorian ADIME/IDNT Working Party Version 3: May 2014

14. Victorian ADIME/IDNT Working Party Version 3: May 2014
PES statement 3
Food and nutrition-related knowledge deficit (NB_1.1) as related to lack of prior exposure to nutrition-related information and competing priorities as evidenced by reported intake of high fat, high energy meals and drinks, with weight gain of 12kg in the last 12/12 and current BMI of 38
Now based on the information provided and your PES statements what might you suggest are some interventions you might use to fix your diagnosis?
-education
-meal plan
-suggest exercise, recommend if you know that patient is allowed to exercise
How would you evaluate?
Monitor weight, BMI, review knowledge, check exercise levels
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. 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

17. Weight Management Case Study
41 y.o female referred for wt reduction
Medical/Clinical:
Borderline T2DM, HT, cholesteroleamia
Biochemistry:
All within range
Social:
Lives with husband and four children
Bus driver, full time
feels she has no time at all for exercise and dieting
Patient reports poor knowledge of foods
feels she
Anthropometry:
Wt 110 kg, Ht 170 cm, BMI 38kg.m2
Stable until 1 year ago, weight gain of 1 kg every month = 12kg
Diet:
BF: toasted muesli with two toast, full cream milk
MT: 2 biscuits with tea
L: 1-2 sandwiches with salami and cheese
AT: yoghurt, biscuits, cake, a few chips if around
Dinner: pasta (large serve), stir fries, 300g steak on average with 3 vegies.
Takeaway 1/week, usually pizza, Wine occasionally, soft drink 2-3/7
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: