1.2 Nutrition Screening & Care Process

Knowing Your Scope

Knowing exactly who does what in nutrition care is one of the most frequently tested concepts on the CDM exam. The board wants to confirm you can act within your scope — screening and supporting — without crossing into the dietitian's clinical territory.

Screening vs. Assessment

These two terms are constantly confused, so anchor the distinction now.

Think of screening as the smoke detector and assessment as the fire investigation. The CDM screens every resident on admission and on a set schedule, then refers anyone flagged to the dietitian. A screen is valid only if it is completed quickly, uses simple criteria, and reliably identifies risk — it is never the place to make a diagnosis.

CDM Role vs. RDN Role

• The CDM screens residents, gathers food preferences and intake data, monitors meal acceptance and weights, implements diet orders, and documents observations.
• The Registered Dietitian Nutritionist (RDN) performs the comprehensive assessment, establishes the nutrition diagnosis, and designs the medical nutrition therapy (MNT) plan.

The CDM works under and alongside the RDN — collecting data and carrying out the plan, but never making the clinical diagnosis or prescribing therapy.

The Nutrition Care Process (NCP)

The Academy of Nutrition and Dietetics standardized care into four ordered steps:

1. Nutrition Assessment — collect and analyze data
2. Nutrition Diagnosis — name the specific nutrition problem in PES format (Problem related to Etiology as evidenced by Signs/symptoms)
3. Nutrition Intervention — act (diet change, supplement, fortified foods, education)
4. Nutrition Monitoring and Evaluation — measure outcomes and adjust

Order matters: each step builds on the previous, and you cannot intervene before a diagnosis exists.

ABCD: The Assessment Data Categories

Assessment data fall into four buckets the CDM helps gather:

• Anthropometric — height, weight, BMI, weight history
• Biochemical — labs such as albumin, prealbumin, hemoglobin
• Clinical — diagnoses, skin condition, dentition, swallowing
• Dietary — intake records, preferences, allergies, appetite

Identifying At-Risk Residents

Flags that should trigger a referral to the RDN include:

• Unintended weight loss or low body weight (see CMS thresholds in 1.4)
• Poor oral intake — eating under 75% of meals over several days
• Pressure injuries or poor wound healing
• Dysphagia (difficulty swallowing) or chewing problems
• Abnormal labs, such as low albumin (<3.5 g/dL) or low prealbumin
• Chewing/denture problems, dehydration, or new tube feeding

Regulatory Timelines and the MDS

In nursing facilities, federal regulations require an RDN nutrition assessment to be completed within about 14 days of admission, and the Minimum Data Set (MDS) is completed on admission, quarterly, annually, and on any significant change in status — including significant weight loss or a new feeding tube. The CDM's accurate intake and weight records feed directly into the MDS, so sloppy data has compliance and reimbursement consequences.

Documentation and the Interdisciplinary Team

Document observations that are objective, factual, and timely — record what you observe ("ate 25% of lunch"), not opinions or blame. The CDM contributes nutrition findings to the interdisciplinary team (IDT) — nursing, the RDN, therapy, social work — which builds and updates each resident's care plan. Clear, continuous documentation is exactly what state surveyors review for compliance with the federal Requirements of Participation.

How the CDM Gathers Reliable Data

The quality of the RDN's assessment depends on the data the CDM collects, so accuracy matters:

• Intake records — record actual percentage consumed (0%, 25%, 50%, 75%, 100%) per meal, not a guess; three days of intakes give a usable pattern
• Calorie counts — a multi-day tally ordered when intake is questioned, summing actual food and fluid consumed
• Weights — taken on the same scale, same time of day, similar clothing; re-weigh and confirm before reporting any large change rather than charting a likely error
• Preferences and allergies — interview the resident and family; honoring likes is one of the strongest tools to raise intake
• Meal observation — note coughing, pocketing food, fatigue, or trouble using utensils, which may signal dysphagia or a need for adaptive equipment

Resident Rights and the Care Plan

Nutrition care must respect resident rights: a resident may refuse a therapeutic diet or supplement, and the team then documents the refusal, offers alternatives, and may pursue a liberalized diet — easing restrictions to improve intake and quality of life when the tight diet is causing more harm (weight loss, poor eating) than benefit. The CDM brings food-acceptance data to these care-plan discussions but does not change a medical diet order alone.

A liberalized diet for a stable diabetic resident, for instance, may improve appetite far more than it harms blood glucose, and current guidance generally favors quality of life over rigid restriction in elders.