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Form 9.3.

Case Study: 82-year-old woman with Alzheimer’s


MDS: ORAL/NUTRITIONAL STATUS

ORAL Describe ability to chew, swallow, and self-feed [exact coding may vary,
PROBLEMS or depending on your version of the MDS form]:
SWALLOWING. None, case study does not indicate any.
NUTRITIONAL
STATUS

Height and Record (a.) height in inches and (b.) Weight in pounds. Base a. HT (in.)
Weight weight on most recent measure in last 30 days; measure weight 5'4
consistently in accord with standard facility practice, e.g. , in
a.m. After voiding, before meal, with shoes off, and in
nightclothes.

b. WT (lb.)
110 lbs

Weight a. Weight loss of 5% or more in last 30 days; or 10% or more in 0. No


change/loss last 180 days
If YES, was weight loss planned?

1. Yes

b. Weight gain of 5% or more in last 30 days; or 10% or more in 0. No


last 180 days
18.5% 1. Yes

Complains about the taste a. Leaves 25% or c.


of many foods more of food
uneaten at most
meals

Regular or repetitive b. NONE OF THE d.X


complaints of hunger ABOVE

(Check all that apply in last 7 days)

Parenteral/IV a. Dietary supplement f.


between meals

Feeding tube b. Plate guard, g.


stabilized built-up
utensil, etc.

Mechanically altered diet c. On a planned h.


weight change
program

Syringe (oral feeding) d. NONE OF THE I. Regular


ABOVE Diet
Therapeutic diet e.

a. Code the proportion of total calories the resident received


through parenteral or tube feedings in the last 7 days.
0) None
1) 1% to 25% 3) 51% or more
2) 26% to 50%

b. Code the average fluid intake per day by IV or tube in last 7 Informati
days on not
x0) None 3). 1001 to 1500 mL/day
1) 1 to 500 mL/day 4). 1501 to 2000 mL/day included
2) 501 to 1000 mL/day 5) 2001 or more mL/day

Answer these questions:

1. Did any of your responses trigger a RAP? If so, which one(s)?

Weight loss 18.5%


Alzheimer's Disease

2. What steps will you follow to complete the RAP?

A RAP is triggered
Trigger – Weight Loss
Factors – Ability of feed herself is reduced
Guidelines – Due to Alzheimer's
Behavior Problems- Self feeding is slow
A care plan should be developed, she is a new resident with no care plan in
place

3. List the questions you should consider as you develop and evaluate a
care plan.
a. Does the care plan address the needs, strengths and preferences
indentified in the resident assessment including the RAP's? Yes
b. Is the care plan oriented toward preventing a decline in functioning?
Yes
c.How does the care plan try to manage risk factors? By increasing her to eat.
Does the care plan build on the resident's strengths? Yes
Does the care plan reflect standards of current dietetics practice? Yes
Do treatment objectives have measurable goals? Yes, stabilize weight loss.
If the resident refuses treatment does the care plan explain alternatives to
address the problem? Yes
Is the care plan evaluated and revised as the resident's status changes? Yes