section L and M question

1. Edentulous is lacking natural teeth hence the presence of dentures. The CAA is simply reminding us that being edentulous may pose a problem with nutrition. You will choose not to proceed because you have documentation that it doesn't - resident consumes solids adequately with dentures, diet is mechanically altered, or resident's primary nutrition is via an enteral route, etc. Being edentulous may also affect the resident's positive self-image/appearance but with the presence of dentures, it doesn't.

2. RAI pp M2-3, "A clinical assessment could include a head-to-toe physical examination of the skin and observation or medical record review of pressure ulcer risk factors." This should be checked at all times since MDS data collection always involve reviewing the medical record. Therefore, you would have identified/eliminated the factors that may put the resident at risk which will then support how you will answer M0150 - "Is this resident at risk for pressure ulcers?"

If the Braden is 18 or less, I proceed even if I don't think the person is really at risk, and I do that to cover my clinical decision. However, I care plan almost everybody except ambulatory psych residents if they are even rarely incontinent or need assistance just at night with bed mobility. I definitely over care plan skin, but sure as I don't the surveyor will walk in on someone with a stage II from sitting on the toilet.