Activities of Daily Living and Personal Care

What ADLs Are and Why They Dominate the Exam

Activities of Daily Living (ADLs) are the basic self-care tasks every person performs daily: bathing, dressing, eating, ambulating (walking/moving), toileting, and hygiene/grooming. A common memory aid is DEATH (Dressing, Eating, Ambulating, Toileting, Hygiene).

Personal care and ADLs are the single largest block of the Connecticut written exam — about 14% of the 60 questions — and they make up most of the hands-on clinical skills test Prometric administers. Get these right and you pass two parts of the certification at once.

The guiding principle is promoting independence: do with the resident, not for them. A resident who can wash their own face should be handed the washcloth. Doing too much causes deconditioning and erodes dignity.

Bathing: Sequence, Temperature, and Safety

A complete bed bath follows a strict clean-to-dirty order to prevent cross-contamination:

1. Eyes and face (inner to outer corner of the eye, no soap on eyes)
2. Arms, hands, and axillae (underarms)
3. Chest and abdomen
4. Legs and feet
5. Back and buttocks
6. Perineal area LAST (most contaminated)

Key safety numbers and rules:

Perineal care prevents urinary tract infections (UTIs). On a female resident, always wipe front to back (urethra toward anus) and use a clean section of the cloth for each stroke so fecal bacteria never reach the urethra.

Oral Care, Including the Unconscious Resident

Oral hygiene removes plaque, prevents aspiration pneumonia, and keeps the resident comfortable. Brush teeth, tongue, and gums at least twice daily.

For an unconscious resident, follow these steps exactly:

• Position the resident on their side, or turn the head to the side, so fluid drains OUT and is not aspirated into the lungs.
• Use a small amount of fluid and a Yankauer (tonsil-tip) suction if ordered to clear secretions.
• Never place your bare fingers inside the mouth — an involuntary bite reflex can injure you.
• Apply lubricant to the lips to prevent cracking.

For dentures: hold them over a basin of water or a padded surface (they shatter if dropped), clean with cool/tepid water — hot water warps them — and store in a labeled, water-filled cup.

Dressing, Grooming, and Diabetic Foot Care

The exam-critical dressing rule: weak side first. When dressing, put the affected (weaker) limb in FIRST; when undressing, remove the strong side first so the weak limb leaves the sleeve last. This minimizes painful stretching of a paralyzed or arthritic limb (for example, a resident with left-sided weakness after a CVA, or cerebrovascular accident/stroke).

Grooming preserves dignity and self-esteem. Honor the resident's preferences for hairstyle, makeup, and shaving. Use an electric razor for any resident on anticoagulants (blood thinners) to reduce bleeding risk.

Diabetic foot care is a frequent trap:

• The CNA may wash, dry (especially between the toes), and inspect the feet and apply lotion to the tops and soles — but never between the toes (trapped moisture breeds fungus).
• The CNA must NOT cut or trim a diabetic resident's toenails — that is referred to the nurse or podiatrist because poor circulation and peripheral neuropathy (loss of sensation) make a small nick dangerous.
• Report any redness, blister, sore, or break in the skin immediately.

Nail, Hair, and Shaving Details

For non-diabetic residents, nails are trimmed straight across (not curved) to prevent ingrown nails, then filed smooth. When shaving a beard, hold skin taut and shave in the direction of hair growth; switch to an electric razor for any resident on anticoagulants.

Toileting and Promoting Continence

Good toileting practice preserves dignity and prevents incontinence-associated dermatitis. Offer the bedpan, urinal, or a trip to the bathroom on a regular schedule (toileting before and after meals and at bedtime). Provide privacy, keep the call light within reach, and answer it promptly. Position a bedfast resident on a fracture pan (low-profile bedpan) if they cannot lift their hips. After elimination, perform perineal care, wash your hands, and record the result.

Resident Rights, Dignity, and Refusals

Under federal OBRA 1987 (Omnibus Budget Reconciliation Act) and Connecticut DPH regulations, residents have the right to refuse any care. If a resident refuses a shower, the CNA should: offer an alternative (sponge bath), respect the choice, document the refusal, and report to the nurse. Forcing care is considered abuse.

Always protect privacy and dignity: knock, close the door, pull the curtain, drape exposed body parts, and explain each step before doing it.

A Worked Skills-Test Example: The Partial Bed Bath

On the Prometric skills test you may draw a personal-care station. A model sequence: wash hands and put on gloves; greet and identify the resident; explain the task and provide privacy; raise the bed to a safe working height; check water temperature (~105 F); wash the face with a no-soap section of the cloth, inner to outer eye; proceed clean-to-dirty down the body; dry each area to prevent chilling; lower the bed, place the call light within reach, remove gloves, and wash hands again. Hand hygiene at the start and end is scored on every CT station — it is the one mandatory skill.

Common Exam Traps

• Choosing the perineal area FIRST in a bed-bath sequence (it is always LAST).
• Wiping female perineal care back-to-front or reusing the same cloth surface.
• Dressing the strong arm first (it is weak side first).
• Trimming a diabetic resident's toenails (refer to the nurse/podiatrist).
• Forcing care on a resident who refuses instead of documenting and reporting.