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. Excessive GIT losses 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. Excessive GIT losses case study
63 year old female admitted via ED with dehydration and electrolyte disturbances due to a high output ileostomy, referred for dietary assessment.
Medical/Clinical:
PHx: Rectal cancer – ultra low anterior resection & loop ileostomy 12 weeks ago
Stoma output ~2.5L/d past 10 days, now ~1.8L/d
Appetite low post surgery 12 weeks ago but has since improved to normal.
Commenced on Loperamide and Codeine Phosphate 3 days ago
Anthropometry:
Current weight = 56kg
Height = 167cm
BMI= 20kg/m² (RR )
Weight Hx: UBW= 58kg, 2kg weight loss in 10 days (fluid), well nourished
Victorian ADIME/IDNT Working Party Version 3: May 2014

5. Excessive GIT losses case study
Biochemistry:
K+ 3.5mmol/L (RR ) on IV normal saline + KCl
Mg+ 0.54mmol/L (RR ), commenced on IV MgS04
Social:
Lives with husband, retired. Patient prepares the meals
Diet:
Eating reasonable amounts, trying to eat foods that can help to thicken output (white bread/cereals, rice, pasta, bananas)
Trying to drink plenty of fluids, mainly fruit juices/cordials/soft drinks/powerade /water ~1.5-2L/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 fluid intake (NI-3.1)
Increased nutrient needs (K+, Mg+) (NI-5.1)
Imbalance of nutrients (NI-5.5)
Less than optimal intake of types of carbohydrates (sugars) (NI-5.8.3)
Altered gastrointestinal (GI) function (NC-1.4)
Impaired nutrient utilisation (NC-2.1)
Altered nutrition-related laboratory values (K+, Mg+) (NC-2.2)
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:
Increased nutrient needs (K+, Mg+) (NI-5.1)
Inappropriate intake of types of carbohydrates (sugars) (NI-5.8.3)
Victorian ADIME/IDNT Working Party Version 3: May 2014

9. Other diagnosis’s and reason/s why you might not use them:
Inadequate fluid intake (NI-3.1)
The fluid intake at 2-2.5L/day is not actually inadequate
Imbalance of nutrients (NI-5.5)
This diagnosis is more suitable for refeeding syndrome or side effects associated with vitamin/mineral supplements.
Altered gastrointestinal (GI) function (NC-1.4)
This diagnosis could potentially be used but it is not a nutrition related diagnosis
Impaired nutrient utilisation (NC-2.1)
The definition does not fit this case study. It is also more appropriate to choose a diagnosis
from the intake domain
Altered nutrition-related laboratory values (K+, Mg+) (NC-2.2)
This diagnosis could potentially be used but it is more appropriate to choose a diagnosis
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
Increased nutrient needs (K+, Mg+, Na2+) (NI-5.1) related to excessive GIT losses via ileostomy as evidenced by low K+ & Mg+ levels requiring supplementation and known increased salt requirements
Victorian ADIME/IDNT Working Party Version 3: May 2014

13. Victorian ADIME/IDNT Working Party Version 3: May 2014
PES statement 2
Inappropriate intake of types of carbohydrates (sugars) (NI-5.8.3)
related to lack of knowledge regarding dietary management of high output stoma
as evidenced by regular consumption of sweetened beverages >750ml/day with stoma output 1.8L/day.
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. Excessive GIT losses Case Study
63 year old female admitted via ED with dehydration and for dietary assessment.
Medical/Clinical:
PHx: Rectal cancer – ultra low anterior resection & loop ileostomy 12 weeks ago
Stoma output ~2.5L/d past 10 days, now ~1.8L/d
Appetite low post surgery 12 weeks ago but has since improved to normal.
Commenced on Loperamide and Codeine Phosphate 3 days ago
Anthropometry:
Current weight = 56kg , Height = 167cm
BMI= 20kg/m² (RR )
electrolyte disturbances due to a high output ileostomy, referred
Weight Hx: UBW= 58kg, 2kg weight loss in 10 days (fluid)
Biochemistry:
K+ 3.5mmol/L (RR ) on IV normal saline + KCl
Mg+ 0.54mmol/L (RR ), commenced on IV MgS04
Social:
Lives with husband, retired. Patient prepares the meals
Diet:
Eating reasonable amounts, trying to eat foods that can help to thicken output (white bread/cereals, rice, pasta, bananas)
Trying to drink plenty of fluids, mainly fruit juices/cordials/soft drinks/powerade /water ~1.5-2L/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 16