Transcript Diabetes Case Study - Dietitians Association of Australia

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
Diabetes
Case Study
Presented by
Victorian ADIME/IDNT Working Party
Version 3: May 2014
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
Diabetes Case Study
Newly Diagnosed Female Type 2 Diabetic referred for diabetes education
Medical/Clinical:
• Mother and father both have history of DM
• OA, asthma, sleep apnoea
Anthropometry:
• Wt 90 kg, Ht 177 cm, BMI 28.7kg.m2, IWR (63-78)
• Pt weight increased by 5 kg in past year
Biochemistry:
• HbA1C: 10 mmol/L
• Random BGL last 24/24 are 6 mmol-23mmol/L
Victorian ADIME/IDNT Working Party
Version 3: May 2014
Diabetes Case study
Social:
• Lives with husband and Son
• Full time office worker
• Nil education prior
Exercise:
Nil planned exercise
Diet:
•Bf: nil
•Mt: nil
•L: takeaway: pasta or 4 x sushi takeaway and 1 fruit (140g CHO)
•AT: 1 x sandwich, white bread and 1 fruit (45g CHO)
•D: stir fry with at least 1.5 cups calrose rice, sweet and sour sauce
and corn. Straight after consumed an icy pole. (115g CHO)
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. ___________________________________________________________
Victorian ADIME/IDNT Working Party
Version 3: May 2014
All Possible Diagnoses
1. Inconsistent carbohydrate intake (NI-5.8.4)
2. Excessive energy intake (NI_1.3)
3. Excessive oral Intake (NI_2.2)
4. Food and nutrition-related knowledge deficit (NB_1.1)
5. Less than optimal intake of types of carbohydrate (low GI foods) (NI_5.8.3)
6. Excessive Carbohydrate Intake (NI_5.8.3)
7. Inadequate Fiber Intake (NI_5.8.5)
8. Unintended Weight Gain (NC_3.4)
9. Physical inactivity (NB_2.1)
10. Obesity (NC_3.3)
Victorian ADIME/IDNT Working Party
Version 3: May 2014
Key Diagnoses
Most appropriate diagnoses for this case study:
1. Inconsistent carbohydrate intake (NI-5.8.4)
2. Food and Nutrition-related knowledge deficit (NB_1.1)
3. Less than optimal intake of types of carbohydrate (low GI
foods) (NI_5.8.3)
Victorian ADIME/IDNT Working Party
Version 3: May 2014
Other diagnoses and reason/s why
you might not use them:
1. Excessive oral Intake (NI_2.2)
This diagnosis is fine to use, but the patient has primarily arrived for diabetes
education and therefore the above 3 diagnoses are more appropriate.
2. Excessive energy intake (NI_1.3)
Can only use this diagnosis if you can calculate kJ from diet history & compare the
standard
3. Excessive Carbohydrate Intake (NI_5.8.3)
Can only use this diagnosis if you can calculate percentage of carbohydrates in diet.
There is not enough information in this case study to do this.
4. Inadequate Fibre Intake (NI_5.8.5)
Can only use this diagnosis if you can calculate fibre from available diet history.
Also this consultation is in regards to diabetes primarily, you could complete this at
the next visit.
5. Unintended Weight Gain (NC_3.4)
This diagnosis is used for weight gains associated with a medical condition (i.e.:
oedema, medications, paralysis)
6. Physical inactivity (NB_2.1)
This diagnosis could potentially be used, but there are already 3 more appropriate
diagnoses to use.
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?
Victorian ADIME/IDNT Working Party
Version 3: May 2014
PES statement 1
Inconsistent carbohydrate intake (NI-5.8.4)
related to
food and nutrition related knowledge deficit concerning appropriate
timing and amounts of carbohydrate
as evidenced by
wide variations in blood glucose levels (6mmols - 23mmols) and
estimated carbohydrate intake different from recommended
amounts (nil carbohydrates at breakfast)
Victorian ADIME/IDNT Working Party
Version 3: May 2014
PES statement 2
Food and nutrition-related knowledge deficit (NB_1.1)
related to
lack of education post diagnosis regarding
carbohydrate containing foods
as evidenced by
reported estimated carbohydrate intake different
from recommended amounts (especially as no
carbohydrate consumption at breakfast)
Victorian ADIME/IDNT Working Party
Version 3: May 2014
PES statement 3
Less than optimal intake of types of carbohydrate (low GI
foods) (NI_5.8.3)
related to
food and nutrition related knowledge deficit
as evidenced by
wide variations in blood glucose levels (6mmols - 23mmols) and
sources of high GI foods such as calrose rice.
Victorian ADIME/IDNT Working Party
Version 3: May 2014
References
PowerPoint Presentations
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Ferguson M, et al. Webinar 3: Implementation, DAA IDNT Working Party, www.daa.asn.au
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Vivanti A, Micallef N. Webinar 2: Diagnoses, PES statements and Case Study, DAA IDNT Working Party,
www.daa.asn.au
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Capra S, Ferguson M, et al. Standardised Language: A powerful tool for dietetic professionals, 2009
www.daa.asn.au
Manuals
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ADA, (2013) International Dietetics and Nutrition Terminology (IDNT) Reference Manual: Standardized
Language for the Nutrition Care Process, Fourth Edition, American Dietetic Association, 2013
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ADA, (2010) International Dietetics and Nutrition Terminology (IDNT) Reference Manual: Standardized
Language for the Nutrition Care Process, American Dietetic Association, 2010
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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
Contacts
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Alison Qvist
Ai Vee Lim
Anna Cardamis
Anna Whitley
Annika Dorey
Caitlyn Green
Lina Breik
Loretta Bufalino
Kate Furness
Rubina Raja
Sonia Brockington
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
Diabetes Case Study
Newly Diagnosed Type 2 Diabetic Female referred for edu
Medical/Clinical:
• Mother and father both have history of DM
• OA, asthma, sleep apnoea
Anthropometry:
• Wt 90 kg, Ht 177 cm, BMI 28.7kg.m2, IWR (63-78)
• Pt weight increased by 5 kg in past year
Biochemistry:
• HbA1C: 10 mmol/L
• Random BGL last 24/24 are 6 mmol-23mmol/L
Exercise:
• Nil planned exercise
Social:
• Lives with husband and Son
• Full time office worker
• Nil education prior
Diet:
• Bf: nil
• Mt: nil
• L: takeaway: pasta or 4 x sushi takeaway and 1 fruit (140g CHO)
• AT: 1 x sandwich, white bread and 1 fruit (45g CHO)
• D: stir fry with at least 1.5 cups calrose rice, sweet and sour
sauce and corn. Straight after consumed a icy pole. (115g CHO)
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:___________________________________________________________________________________________________