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. Victorian ADIME/IDNT Working Party Version 3: May 2014
Coeliac Disease
Presented by
Victorian ADIME/IDNT Working Party Version 3: May 2014

3. 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

4. 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

5. 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

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. ____________________________________________________________
Learners should find at least 9.
Victorian ADIME/IDNT Working Party Version 3: May 2014

7. 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

8. 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

9. 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

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?
Version 3: May 2014

12. Victorian ADIME/IDNT Working Party 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

13. 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

14. 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

15. Victorian ADIME/IDNT Working Party Version 3: May 2014
References
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. 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. _______________________________________________ ____________________________________________________
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