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 1

2. High Fibre & Diverticulosis 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. High Fibre and Diverticulosis Case Study
45 y.o. male referred for diet advice to assist with a new diagnosis for management of Diverticulosis
Anthropometry:
Wt: 90kg
Ht: 155cm
BMI: 37.5kg/m2
Pt is weight stable
Social Hx
Married
Mother lives with them and mother is usual cook
Clincial
Occasional diarrhoea and abdominal pains, bloating, constipation s/t
Exercise
Some planned exercise
Victorian ADIME/IDNT Working Party Version 3: May 2014

5. High Fibre and Diverticulosis Case Study
Intake:
Diet history reveals regular meals, 10-15g of fibre per day and 3 coffees a day (~200mL each). He rarely drinks water as dislikes taste (= 200mL/day).
Usually buys lunch and dinner from work canteen for convenience.
BF: Muesli, Juice, Coffee
MT: Biscuit and coffee
L: white meat/egg/cheese sandwich +/-salad
AT: Apple and Coffee
D: Meat/chicken 1 cup vegies, 1 cup rice/pasta (asian stirfry)
S: Yoghurt
No prior counselling received
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 6.
Victorian ADIME/IDNT Working Party Version 3: May 2014 6

7. All Possible Diagnoses
1. Inadequate fibre intake (NI-5.8.5) 2. Food and nutrition-related knowledge deficit (NB-1.1) 3. Less than optimal intake of types of carbohydrate (fibre) (NI-5.8.3) 4. Inadequate fluid intake (NI-3.1) 5. Increased nutrient needs (fibre) (NI-5.1) 6. Suboptimal bioactive substance intake (fibre) (NI-4.1) 7. Physical Inactivity (NB-2.1) 8. Obesity (NC-3.3)
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:
Inadequate fibre intake (NI-5.8.5)
Inadequate fluid intake (NI-3.1)
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. Less than optimal intake of types of carbohydrate (fibre) (NI-5.8.3)
You could use this diagnosis, but the diagnosis already chosen are more specific
Increased nutrient needs (fibre) (NI-5.1)
Patient requires a high fibre diet, but not increased from the general population recommendations
Suboptimal bioactive substance intake (NI-4.1)
You could use this diagnosis in place of the low fibre diagnosis, however considering there is a diagnosis specific to fibre, it is better to use the specific diagnosis.
Physical Inactivity (NB-2.1)
This diagnosis is appropriate to use. It was not used as there would have been too man diagnoses.
Obesity (NC-3.3)
This diagnosis was not chosen as it is not the main reason for consultation. It is also better to choose from the intake domain first
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 fibre intake (NI-5.8.5)
related to
new diagnosis of diverticular disease, no previous
Counselling/education and the desire for quick and
easy meals
as evidenced by
low-moderate fibre intake (10-15g).
Victorian ADIME/IDNT Working Party Version 3: May 2014

13. Victorian ADIME/IDNT Working Party Version 3: May 2014
PES statement 2
Inadequate fluid intake (NI-3.1)
as related to
new diagnosis of diverticular disease, no previous
counselling and the desire for quick and easy meals
as evidenced by
~800mL of fluid
Victorian ADIME/IDNT Working Party Version 3: May 2014

14. Alternative to PES statement 1 and 2
Inadequate fluid intake (NI_3.1) and Inadequate fibre intake (NI_5.8.5) as related to new diagnosis of diverticular disease, no previous counselling and the desire for quick and easy meals as evidenced by ~800mL of fluid and low-moderate fibre intake (10-15g). Or
Inadequate fluid intake (NI_3.1)
Inadequate fibre intake (NI_5.8.5)
as related to new diagnosis of diverticular disease, no previous counselling and the desire for quick and easy meals as evidenced by
~800mL of fluid
low-moderate fibre intake (10-15g).
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15. Victorian ADIME/IDNT Working Party Version 3: May 2014
PES statement 3
Food and nutrition-related knowledge deficit (NB_1.1)
as related to
new diagnosis of diverticular disease
as evidenced by
Reported nil previous counselling
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16. 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

17. 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

18. High Fibre and Diverticulosis Case Study
45 y.o. male referred for diet advice to assist with a new diagnosis for management of Diverticulosis
Anthropometry:
90kg, 155cm, BMI: 37.5kg.m2. Pt is weight stable
Clincial:
Occasional diarrhoea and abdominal pains, bloating, occasional
constipation
Exercise
some planned exercise
Social Hx:
Married, mother lives with them and mother is usual cook
Intake:
Regular meals, 10-15g of fibre per day and 3 coffees a day
(~200mL each). He rarely drinks water as dislikes taste (equalling
200mL/day). Usually buys
lunch and dinner from work canteen for convenience.
Bf: Muesli, Juice, Coffee
Mt: Biscuit and coffee
L: white meat/egg/cheese sandwich +/-salad
AT: Apple and Coffee
D: Meat/chicken 1 cup vegies, 1 cup rice/pasta (Asian stir-fry)
S: Yoghurt
No prior counselling received
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
Victorian ADIME/IDNT Working Party Version 3: May 2014