MDS Alert

How would you code this case example in Section B5?

Mrs. K is a 92-year-old widow of 30 years who has severe functional dependency secondary to heart disease. Her primary nurse assistant has reported during the last two days Mrs. K has "not been herself." She has been napping more frequently and for longer periods during the day. She is difficult to arouse and has mumbling speech upon awakening. She also has difficulty paying attention to what
she is doing. For example, at meals instead of eating as she usually does, she picks at her food as if she doesn't know what to do with a fork. Then she stops and closes her eyes after a few minutes. Alternatively, Mrs. K has been waking up at night believing it to be daytime. She has been calling out to staff demanding to be taken to see her husband (although he is deceased). On three occasions, Mrs. K was observed attempting to climb out of bed over the foot of the bed.

Indicators

Easily distracted
Periods of altered perception or awareness of surroundings
Episodes of disorganized speech
Periods of restlessness
Periods of lethargy
Mental function varies over the course of the day

Coding options:

0 = Behavior not present
1 = Behavior present, not of recent onset
2 = Behavior present, over last 7 days appears different from resident's usual functioning (e.g., new onset or worsening)

Indicators                                      Coding

a. Easily distracted: 2 (present, new)

b. Periods of altered perception or awareness of surroundings: 2 (present, new)

c. Episodes of disorganized speech: 2 (present, new)

d. Periods of restlessness: 2 (present, new)

e. Periods of lethargy: 2 (present, new)

f. Mental function varies over the course of the day: 2 (present, new)

Source: RAI user's manual, page 3-49.