2.3 ADLs: Bathing, Grooming & Dressing

Activities of Daily Living

Quick Answer: Activities of Daily Living (ADLs) are everyday self-care tasks such as bathing, dressing, grooming, toileting, transferring, and eating. The CNA assists with ADLs while protecting privacy, promoting independence, and treating the resident with dignity.

Assisting with ADLs is the heart of Personal Care Skills and a large portion of the daily CNA role. Two principles apply to every single task. First, provide privacy: knock and get permission to enter, close the door and curtain, drape the resident, and expose only the area you are caring for. Second, promote independence by letting the resident do as much as they safely can; doing a task for a resident who could do it themselves erodes their ability and self-respect.

Before any personal care, gather supplies, explain what you will do in simple terms, wash your hands, and provide for warmth and comfort. Always offer choices, such as the order of care or the clothing to wear, because honoring preferences supports the resident's rights and dignity. Watch for and report changes you notice during care, such as skin breakdown, bruising, pain, or a change in the resident's mood or abilities, since the CNA often sees these first.

Bathing and Perineal Care

A complete bed bath is given to a resident who cannot get out of bed and is a commonly tested skill. Key safety rules:

• Check water temperature; bath water should be about 105 F (40-41 C), comfortably warm, never hot, since older skin burns easily and feels temperature poorly
• Wash from clean to dirty and change the water when it becomes cool, soapy, or soiled
• Wash, rinse, and pat dry one area at a time, keeping the rest of the body covered for warmth and privacy
• Wash the eyes first with plain water, from the inner to the outer corner, using a clean part of the cloth for each eye

Perineal (peri) care cleans the genital and anal area and prevents infection, odor, and skin breakdown. Always clean front to back to avoid carrying bacteria toward the urinary opening, and use a clean part of the cloth for each stroke. For a female resident, separate the labia and wipe front to back. For a male resident, clean the tip of the penis in a circular motion moving outward; if uncircumcised, gently retract the foreskin, clean, and then replace it to prevent constriction. Provide peri care after every episode of incontinence.

Oral and Denture Care

Oral care (mouth care) keeps the mouth clean, moist, and comfortable, prevents infection, and improves appetite. It should be done at least twice a day and after meals.

• For a conscious resident, assist with brushing teeth, gums, and tongue and offer to floss
• For an unconscious resident, turn the head to the side and use only a small amount of moisture on swabs to clean the mouth, which prevents aspiration (fluid entering the airway); never put your fingers in a biting reflex zone

For denture care, line the sink with a towel or fill it with water so the dentures will not break if dropped. Clean dentures over the lined sink with a denture brush and cool or lukewarm water; hot water can warp them. Store them in a labeled cup of clean cool water or denture solution when not worn so they do not dry out and lose their shape. Handle dentures carefully, as they are expensive and personal property, and report any cracks, missing teeth, or mouth sores to the nurse.

Dressing

The key exam rule is simple and high-yield: dress the weak (affected) side first and undress the strong side first. This reduces strain and discomfort on the affected limb and makes the whole task easier. A handy memory aid is "weak first, strong last" when putting clothing on.

More dressing rules:

• For a resident who had a stroke or has a paralyzed arm or leg, gently guide the weak limb into the sleeve or pant leg first while supporting the joint
• Choose clothing the resident prefers and that is easy to put on (front-closing, elastic waists, large buttons or hook-and-loop fasteners)
• Let the resident make choices and do as much as they can to support dignity and independence
• Never rush; dress to keep the resident warm and covered, exposing only the area being dressed

Nail, Hair, and Shaving Care

Grooming supports self-image and comfort, and small details are tested.

• Nail care: soak and clean under and around the nails and file them smooth. Do not cut the nails or trim the cuticles of a resident with diabetes or poor circulation; report long or problem nails to the nurse, because a small cut on such a resident can lead to a serious, slow-healing infection.
• Hair care: brush or comb daily, working out tangles gently from the ends upward, and shampoo on schedule or by request. Style hair the way the resident likes it.
• Shaving: with a safety razor, soften the skin with warm water first and shave in the direction of hair growth to avoid nicks. With an electric razor, never use it near oxygen because a spark can cause a fire. Wear gloves, follow standard precautions, and report any nicks or cuts to the nurse, since broken skin is an infection entry point.

Throughout grooming, maintain privacy, encourage the resident to participate, and observe the skin, mouth, and nails for any changes worth reporting.