Case Analysis & Practical Application Flashcards

A resident refuses all meals for three days, citing depression. The CMD's most appropriate initial intervention is:

Answer: Initiate a psychiatric evaluation and depression screening while optimizing oral intake strategies

Depression is a reversible and common cause of anorexia in SNF residents; psychiatric evaluation combined with oral intake support addresses root cause before invasive feeding.

The state surveyor cites the facility for deficient physician visit frequency. Under CMS regulations, how often must physicians visit SNF residents during the first 90 days of a Medicare-covered stay?

Answer: Every 30 days

CMS requires physician visits at least every 30 days for the first 90 days of a Medicare-covered SNF stay, then at least every 60 days thereafter.

A 79-year-old resident on warfarin for atrial fibrillation sustains a minor fall without injury. The CMD should:

Answer: Reassess fall risk, review INR, and evaluate anticoagulation benefit-risk balance with the resident

Fall risk management in anticoagulated patients requires individualized benefit-risk analysis rather than automatic discontinuation of stroke-protective therapy.

A family alleges that a resident's wound has worsened due to nursing neglect. As CMD, you should:

Answer: Conduct a clinical wound assessment, review nursing documentation, and convene a care conference

Objective clinical assessment and documentation review are necessary to distinguish disease progression from care failures before any conclusions are drawn.

A facility wants to implement a new pain assessment protocol for non-verbal residents. Which validated tool is MOST appropriate?

Answer: Pain Assessment in Advanced Dementia (PAINAD)

PAINAD is validated specifically for non-verbal residents with advanced dementia, assessing breathing, vocalization, facial expression, body language, and consolability.

During a care conference, a resident's surrogate decision-maker requests CPR despite the resident's documented DNR. The CMD should:

Answer: Explain that the resident's own advance directive takes precedence over surrogate preferences

A competently executed advance directive reflecting the resident's own wishes legally and ethically supersedes surrogate preferences under U.S. law.

The MDS Coordinator reports that a resident's Section GG functional scores declined significantly without a documented clinical rationale. As CMD, this finding MOST likely signals:

Answer: A potential quality indicator gap requiring clinical investigation and documentation improvement

Unexplained functional decline in Section GG warrants clinical investigation to identify reversible causes and ensure accurate documentation of care delivered.