Personal Hygiene and Activities of Daily Living (ADLs)

Assisting with personal hygiene and activities of daily living (ADLs) is a fundamental nursing responsibility. These tasks affect patient dignity, self-esteem, and physical health. LPN/VNs must provide or assist with hygiene care while promoting maximum independence.

Activities of Daily Living (ADLs)

ADLs are basic self-care tasks essential for daily living:

Instrumental ADLs (IADLs) are higher-level skills:

• Managing finances
• Medication management
• Meal preparation
• Housekeeping
• Transportation
• Shopping

Assessment of Self-Care Ability

Before providing hygiene care, assess the patient's:

• Physical ability (strength, coordination, ROM)
• Cognitive status (understanding, memory)
• Sensory deficits (vision, hearing)
• Level of fatigue
• Cultural and personal preferences
• Previous self-care routines

Levels of Assistance:

Types of Baths

Bathing Guidelines

General Principles:

1. Water Temperature: 105-110°F (40-43°C) for adults
2. Sequence: Face → neck → ears → arms → hands → chest → abdomen → legs → feet → back → perineum
3. Direction: Wash from cleanest to dirtiest areas
4. Skin Assessment: Observe for breakdown, rashes, lesions during bath
5. Privacy and Dignity: Expose only the area being washed

Special Considerations:

• Use mild, pH-balanced soap to prevent skin dryness
• Rinse thoroughly to remove all soap residue
• Pat skin dry rather than rubbing
• Apply lotion to prevent dry skin (avoid between toes)
• Change water when it becomes cool or soapy

Oral Care

Importance of Oral Hygiene:

• Prevents dental caries and periodontal disease
• Reduces risk of aspiration pneumonia (especially in ventilated patients)
• Promotes comfort and appetite
• Allows assessment of oral mucosa

Oral Care for Unconscious Patients:

1. Position in side-lying position with HOB elevated
2. Use suction to prevent aspiration
3. Use foam swabs or soft toothbrush
4. Apply moisturizer to lips
5. Perform at least every 2 hours

Denture Care:

• Handle carefully over a basin of water
• Use denture brush and denture cleaner (not regular toothpaste)
• Store in labeled container with water or denture solution
• Assess oral mucosa and gums when dentures are removed
• Check for proper fit when reinserting

Hair Care

• Shampoo as needed and patient condition allows
• Use dry shampoo for bed-bound patients if wet shampooing is not possible
• Brush hair daily to stimulate scalp and prevent tangles
• Braid long hair to prevent matting
• Assess scalp for lesions, dryness, or infestations

Foot and Nail Care

Foot Care Guidelines:

• Wash and dry feet daily, especially between toes
• Inspect for calluses, corns, ulcers, infections
• Apply lotion to dry skin (not between toes)
• Wear properly fitting shoes and clean socks

Nail Care:

• Trim nails straight across after bathing (when softer)
• Use nail file to smooth edges
• Diabetic patients: Do NOT cut nails; refer to podiatrist

Perineal Care

Importance:

• Prevents infection
• Maintains skin integrity
• Promotes comfort
• Reduces odor

Technique:

• Use warm water and mild soap
• Female: Wash from front to back (urethral meatus to anus)
• Male: Retract foreskin if uncircumcised, clean glans, replace foreskin
• Rinse and dry thoroughly
• Report abnormalities (discharge, odor, skin breakdown)