Transcript Poor Oral Intake Case Study

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
Coeliac Disease
Presented by
Victorian ADIME/IDNT Working Party
Version 3: May 2014
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
Coeliac Disease Nutrition Assessment (A)
18 year old female referred for diet advice and education secondary to
newly diagnosed coeliac disease
Medical/Clinical:
• Normal colonoscopy. Biopsies from duodenum indicative of coeliac
disease.
• Reported symptoms include abdominal pain, bloating and loose bowel
motions ( 1-2 per day)
• Has not altered diet since diagnosis.
• Has not received any nutrition counselling/education
Anthropometry:
• Ht: 168cm
Wt: 57kgs
BMI: 20.2kg/m2
• Loss of ~3 kgs over past 12 months (~5% loss of body weight)
Biochemistry:
• Elevated T-Glutaminase Ab IgA, normal IgA, normal Anti Gliadin
(deamidated) Ab-IgG
• HLA-DQ2 & HLA-DQ8 - positive
Victorian ADIME/IDNT Working Party
Version 3: May 2014
Coeliac Disease
Social:
• Lives with parents and sister
• Studying full time at university
• Trains and plays netball 3 times a week
Diet:
• Consumes wheat based breakfast cereals, bread and pasta. Uses ready made
sauces, stocks.
• Take away 3 times a week – Mc Donalds, Nandos
• 1 x cappuccino per day
• ETOH – socially on weekend, mainly spirits and champagne
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. ____________________________________________________________
Victorian ADIME/IDNT Working Party
Version 3: May 2014
All Possible Diagnoses
•
•
•
•
Excessive bioactive substance intake (specify) (NI-4.2)
Inadequate protein intake (NI-5.7.1)
Less than optimal intake of types of carbohydrates (specify) (NI-5.8.3)
Less than optimal intake of types of proteins or amino acids (specify) (NI –
5.7.3)
• Food and Nutrition knowledge deficit (NB – 1.1)
• Altered Gastrointestinal (GI) function (NC-1.4)
• Undesirable food choices (NB-1.7)
Victorian ADIME/IDNT Working Party
Version 3: May 2014
Key Diagnoses
Most appropriate diagnoses for this case study:
• Less than optimal intake of types of protein or amino
acids (specify) (NI – 5.7.3) ie: gluten
• Altered Gastrointestinal (GI) function (NC-1.4)
• Food and Nutrition knowledge deficit (NB – 1.1)
Victorian ADIME/IDNT Working Party
Version 3: May 2014
Other diagnosis’s and reason/s why you
might not use them:
• Excessive bioactive substance intake (specify) (NI-4.2) – gluten
is not a bioactive substance
• Inadequate protein intake (NI-5.7.1) – this relates to protein
intake related to recommended overall protein intake
• Less than optimal intake of types of carbohydrates (specify)
(NI-5.8.3) – gluten is not a carbohydrate
• Undesirable food choices (NB-1.7) - has to do with
inconsistency in regards to dietary reference intake standards
Victorian ADIME/IDNT Working Party
Version 3: May 2014
Based on the above case study
write 2 to 3 possible PES statements
• P:______________________________
___________________ as related to
• E:______________________________
_________________as evidenced by
• S/S:_____________________________
______________________________
Victorian ADIME/IDNT Working Party
Version 3: May 2014
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?
Version 3: May 2014
PES statement 1
Less than optimal intake of types of protein or amino acids (NI –
5.7.3) ie: gluten
related to new diagnosis of coeliac disease and no previous education
regarding a gluten free diet
as evidenced by GIT symptoms - abdominal pain, bloating and loose bowel
motions ( 1-2 per day) and positive intake of gluten containing foods
Victorian ADIME/IDNT Working Party
Version 3: May 2014
PES statement 2
Food and Nutrition knowledge deficit (NB – 1.1)
related to no previous education or understanding of the details required for
a gluten free diet
as evidenced by patient unable to identify foods containing gluten
Victorian ADIME/IDNT Working Party
Version 3: May 2014
PES statement 3
Altered Gastrointestinal (GI) function (NC-1.4)
related to coeliac disease
as evidenced by small bowel biopsy indicative of villous atrophy, positive
coeliac serology, presence of GIT symptoms - abdominal pain, bloating and
loose bowel motions ( 1-2 per day) and positive intake of gluten containing
foods
Victorian ADIME/IDNT Working Party
Version 3: May 2014
References
o 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
Coeliac Disease - Case Study
18 year old female referred for diet advice and education
secondary to newly diagnosed coeliac disease
Medical/Clinical:
•Normal colonoscopy. Biopsies from duodenum indicative of
coeliac disease.
•Reported symptoms include abdominal pain, bloating and loose
bowel motions ( 1-2 per day)
•Has not altered diet since diagnosis
•Has not received any nutrition counselling/education
Anthropometry:
Ht: 168cm
Wt: 57kgs
BMI: 20.2kg/m2
Loss of ~3 kgs over past 12 months (~5% loss of body weight)
Biochemistry:
•Elevated T-Glutaminase Ab IgA, normal IgA, normal Anti Gliadin
(deamidated) Ab-IgG
•HLA-DQ2 & HLA-DQ8 - positive
Exercise:
•Trains and plays netball 3 times a week
Social:
•Lives with parents and sister
•Studying full time at university
Diet:
•Consumes wheat based breakfast cereals, bread and pasta. Uses
ready made sauces, stocks.
•Take away 3 times a week – Mc Donalds, Nandos
•1 x cappuccino per day
•ETOH – socially on weekend, mainly spirits and champagne
Using the nutrition diagnosis reference sheet, identify possible nutrition diagnoses that could fit this case study
1.
2.
3.
4.
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
5. ____________________________________________________
6. ____________________________________________________
7. ____________________________________________________
8. ____________________________________________________
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:
P:__________________________________________________________________________________________as related to
E:________________________________________________________________________________________as evidenced by
S/S:___________________________________________________________________________________________________
PES Statement 3:
P:__________________________________________________________________________________________as related to
E:________________________________________________________________________________________as evidenced by
S/S:___________________________________________________________________________________________________