Personal Care, Hygiene, and Activities of Daily Living
Order of care and the perineal rule
A bed bath moves from cleanest to dirtiest: eyes (inner corner outward, no soap), face, neck, ears, arms, hands, chest, abdomen, legs, feet, back, and perineum last. Perineal care always goes front to back to prevent urinary tract infections, using a fresh area of the washcloth each stroke. Water should be about 105°F - test it with the inner wrist or a thermometer.
Oral care includes teeth, gums, tongue, and dentures. Dentures go in cool water in a labeled cup; hot water warps them, and a denture wrapped in a tissue gets thrown away. For an unconscious resident, use swabs, no fluids, and turn the head to the side.
Skin and dressing
Look at the skin every time you turn the resident. Report reddened areas that do not blanch, and reposition at least every 2 hours. Keep skin clean and dry, and float heels off the mattress. When dressing, put clothing on the weak or affected side first; when undressing, remove from the unaffected side first.
Nail and shaving care: soak and file nails, but do not cut the toenails of a diabetic resident - report that to the nurse. Use an electric razor, especially for residents on blood thinners.
Traps
- Never leave a resident alone in the tub or on the toilet.
- Soap never goes in the eyes or mouth.
- CNAs do not stage pressure injuries; they report them.
- Rushing a resident who can feed or groom themselves undermines independence.
Rule of thumb
Cleanest area to dirtiest area, and always front to back.