4.1 Activities of Daily Living & Personal Care
Key Takeaways
- Wash from cleanest to dirtiest: eyes first (inner to outer canthus, no soap), perineal area last during a complete bed bath
- Dressing rule: put clothing onto the weak (affected) side first, remove from the strong (unaffected) side first
- Perineal care for females is always front to back (clean to dirty) to prevent urinary tract infection
- For an unconscious resident, give oral care with the head turned to the side and never put fingers in the mouth without a padded tongue blade
- Do not cut a diabetic resident's toenails — this is outside the CNA scope of practice in New Jersey; report and refer to the nurse
Activities of daily living (ADLs) are the routine self-care tasks a person normally performs without help: bathing, dressing, grooming, oral care, toileting, and eating. New Jersey CNAs assist with ADLs while protecting dignity, privacy, and independence. On the NNAAP skills evaluation, several of the five tested skills come directly from this section, so technique and order matter.
Bathing
Bathing cleans skin, improves circulation, and gives the CNA a chance to observe the skin. The two most common methods are the complete bed bath (for fully dependent residents) and the partial bath (face, hands, axillae, and perineal area).
The Clean-to-Dirty Rule
Always wash from the cleanest area to the dirtiest. This prevents spreading microorganisms.
| Order | Body Area | Key Point |
|---|---|---|
| 1 | Eyes | Inner to outer corner, no soap, new section of cloth per eye |
| 2 | Face, neck, ears | Ask about soap on the face |
| 3 | Arms, hands, axillae | Wash farthest body part first; support the joint |
| 4 | Chest and abdomen | Keep the resident covered with a bath blanket |
| 5 | Legs and feet | Check between toes; do not massage the calves |
| 6 | Back and buttocks | Good time to inspect for skin breakdown |
| 7 | Perineal area | Always last — cleanest to dirtiest |
Keep water at about 105°F (40.5°C), change it when cool or soapy, and dry skin thoroughly, especially in skin folds.
Oral Care
Oral hygiene prevents tooth decay, gum disease, and aspiration pneumonia. Provide it at least twice daily and after meals.
- Dentures: Hold over a towel or water-filled basin while cleaning so they do not break if dropped. Store in cool (never hot) water or denture solution in a labeled cup.
- Unconscious resident: Turn the head to the side so fluid drains out, use a small amount of solution, and use a padded tongue blade — never your fingers — to keep the mouth open. Provide oral care every 2 hours because the mouth dries out.
Grooming and Dressing
Grooming includes hair care, shaving, and nail care. Shave in the direction of hair growth with a safety razor; an electric razor is required for residents on blood thinners.
The Affected-Side Rule
For a resident with weakness or paralysis on one side (for example, after a stroke):
- Dressing: put clothing on the weak (affected) side first.
- Undressing: remove clothing from the strong (unaffected) side first.
Memory aid: "weak goes in first, strong comes out first." This reduces strain on the impaired limb and protects the joint.
Perineal Care
Perineal (peri) care cleans the genital and anal area. For females, always wipe front to back (urethra toward anus) using a clean section of cloth with each stroke to prevent a urinary tract infection (UTI). For males, clean in a circular motion from the tip of the penis outward, and retract the foreskin on an uncircumcised resident, then return it.
Nail and Foot Care
Clean under nails and file straight across. A New Jersey CNA does not cut the toenails of a resident with diabetes or poor circulation — a small injury can become a serious wound. Report long nails to the nurse for podiatry referral.
Skin Care and Pressure-Injury Prevention
A pressure injury (pressure ulcer/bedsore) forms over a bony area when prolonged pressure cuts off blood flow. Prevention is a core CNA duty:
- Reposition at least every 2 hours in bed and every 1 hour in a chair.
- Keep skin clean and dry; change wet or soiled linens promptly.
- Reduce friction and shearing — lift, never drag.
- Report the earliest sign: a reddened area that does not fade after pressure is relieved (Stage 1).
AM and PM Care
AM (morning) care prepares the resident for the day: toileting, face/hand washing, oral care, and help with breakfast. PM (evening or HS) care prepares for sleep: oral care, washing, a back rub, fresh linens, and a comfortable, safe position with the call light in reach.
A New Jersey CNA is dressing a resident who had a left-side stroke and has left arm weakness. The resident is putting on a button-up shirt. Which arm should the CNA place into the sleeve first?
During a complete bed bath for a New Jersey nursing home resident, the CNA notices the water has become cool and slightly soapy halfway through. The resident's perineal area has not yet been washed. What is the BEST action?