Chapter 21 Federal Regulations

TABLE 21.2 cont. Item-by-Item Minimum Data Set Guide for the Registered Dietitian Nutritionist MDS Section

Section I. Disease Diagnoses (cont.)

Issues RDNs Should Keep in Mind ●

Neurological disease ➤

Cerebral palsy

➤ Cerebrovascular accident ➤ Dementia

➤ Parkinson’s disease ● Depression

● Chronic obstructive pulmonary disease ● Macular degeneration Infections

● Section J. Health Conditions

● Weight changes ●

● ● Section K. Oral/Nutritional Status

Dehydration: intake is less than recommended; resident has clinical signs of dehydration

Insufficient fluid in last 3 days

● Edema, fever, internal bleeding, shortness of breath, vomiting Pain

● End-stage disease

● Why are there chewing/swallowing problems? ● Why is there mouth pain?

● What caused weight/height changes?

● What are the resident’s calculated nutrition needs vs intake? ● Are the approaches appropriate?

Section L. Oral/Dental Status

● What is the rationale for the diet order, portion size? ● What is the condition of teeth, fit of dentures/partials?

● Can the resident suck through a straw? ● Can the resident swallow when asked?

Section M. Skin Condition

Is there a difference in ability to swallow thin or thick liquid? ● Does the resident have a stasis or pressure ulcer?

●

Is there a resolved/closed pressure ulcer? ● Are there other skin problems/lesions?

● ●

Does the resident’s nutritional status/intake increase the risk for impaired skin?

Section N. Activity Pursuit Patterns Section O. Medications

● What are the nutritional interventions for wound care? ● Does the resident actively participate in the dining committee?

●

Does the resident take medications that may contribute to nutritional conditions (antacids, antibiotics, antihypertensives, anticonvulsants, antiulcer drugs, cardiac glycosides, diuretics, insulin, oral diabetic medications, laxatives, psychotropics, vitamins/minerals)?

● Are there possible food-drug interactions from routine medications? ●

Have there been changes in medications and/or doses in the last 90 days?

Section P. Special Treatments/Procedures Section Q. Discharge Potential

● Have there been recent hospitalizations? Is the resident receiving special treatments? ● Are there abnormal laboratory test results? ●

●

Is resident capable of providing his or her own meals (eg, procuring, preparing)

●

Is diet instruction needed? (should be completed with competency demonstrated)

Source: Centers for Medicare & Medicaid Services. MDS 3.0 RAI Manual v1.13. www.cms.gov/Medicare/Quality-Initiatives-Patient- Assessment-Instruments/NursingHomeQualityInits/MDS30RAIManual.html.

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