RAI-MDS 2.0 Nutritional Care Resource Guide April 2011 - CCIM

RAP Process Step 1Type ofRAPLeaves 25% ormore fooduneaten at mostmealsChewingproblemsMouth PainJuly 26/08Step 2Nature of theproblemAdjusted and combined RAP(nutritional status and dental careRAPs).Dentures were not used duringmeals until they are properlyfitted. Her next denture fittingappointment is Aug. 25. Residenthas chewing difficulties. She isleaving 25% or more fooduneaten at each meal. Son isvery worried.Weight has declined this quarterfrom 49.8kg to 47 kg because ofinsufficient caloric intake.Step 3Key issues andanalysisStep 4Need forreferralStep 5Rational forcare planningNursing note stated that analgesic was orderedon June 30 to help with Mrs. K’s mouth pain withsome relief.Resident is chewing very slowly, recent mincedtexture was ordered with improvement in herchewing ability.High calorie supplement will be added to hermeals. Son continues to do menu selections butthe resident is still not eating well. Son wouldlike staff to order take out from local Koreanrestaurant. Listing of favourite orders left inresident's top drawer.Referral for denture fitting appointment on Aug25.Care plan will be modified to improve nutritionalintake and monitor mouth pain.Care Plan Interventions• Continue to monitor Mrs.K food intake for the next2 weeks and thenreassess• Have menu available forson to select on his visits• Instruct son to recordintake of homemadefoods• Remind cooking staff tomince take out food• Offer analgesic if residentappears to beuncomfortable chewingProgress Note ChartingAug 31, 2008Mrs. K likes her take outfood. She is morecomfortable chewing duringmealtime when givenanalgesic prior to hermealtime as stated innursing note (Aug 2).With the new denture, Mrs.K is eating slowly, adjustingto the new denture - is stillleaving 25% or more foodat most meals and takinganalgesic for her mouthpain with moderate effect.Son continues tosupplement Mrs. K’s dietwith homemade food.For Information: 416.327.7625 26ltchrai@ontario.ca2626