Activities of Daily Living (ADLs) and Personal Hygiene

Must-know rules

BADLs = Body, IADLs = Beyond. BADLs are the self-care essentials (DEATH: Dressing, Eating, Ambulating, Toileting, Hygiene).
Function is lost in a predictable hierarchy. IADLs first, then bathing → dressing → toileting → transferring → feeding. Recovery reverses this order.
Match the assessment tool to the question. Katz for BADLs, Lawton for IADLs, FIM for rehab progress (7-point scale), Barthel for mobility-focused rehab.
Promote maximum independence. Never do for the patient what they can do themselves. Set up, supervise, partially assist, or provide total care: always reassess.
Affected side first ON, unaffected side first OFF. Dress the weak extremity first. Remove from the strong side first.
Culture: ask, don't assume. Gender preferences, hygiene rituals, hair care, dietary laws: ask before providing care. The NCLEX answer is always "ask the patient."
Coroner cases: do NOT touch. Deaths within 24 hours, suspicious deaths, surgical deaths, unknown cause: leave everything in place until ME clears.
Postmortem care details that matter. Elevate head (prevents lividity). Insert dentures before rigor mortis. ID tags on wrist, ankle, and shroud. The final bow.

ADL FOUNDATIONS & FUNCTIONAL ASSESSMENT

BASIC ADLs (BADLs): Bathing: shower, sponge bath, tub bath Dressing
INSTRUMENTAL ADLs (IADLs): Cooking: meal preparation Cleaning: household maintenance Shopping

DOJO RULE

BADLs = Body. IADLs = Beyond. BADLs are what you do for your body: bathing, dressing, eating, toileting.

NCLEX TIP

Match the tool to the clinical question. Rehab setting measuring progress? → Barthel or FIM. Elderly patient: can they live alone.

ADL ASSISTANCE & PROMOTING INDEPENDENCE

LEVELS OF ADL ASSISTANCE

Independent. Patient performs the activity without help. Nurse documents and monitors.
Setup / Supervision. Nurse arranges supplies, provides verbal cues, or stands by for safety.
Partial Assistance. Nurse helps with part of the task (e.g., patient washes upper body
Total Assistance. Nurse performs the entire activity.

BATHING ASSISTANCE: Priority: safety and warmth. Water temperature: 105–110°F (40.5–43.3°C).

DOJO RULE

The Independence Kata. Think of ADL assistance like martial arts training: the sensei doesn't fight the match for the student.

DIGNITY, AUTONOMY & CULTURAL SENSITIVITY

AVOID INFANTILIZATION

Functional dependence does not equal cognitive incapacity. Never use pet names ("sweetie," "dear") with adult patients. Don't talk about patients as if they aren't in the room.

POSTMORTEM CARE

PRIORITIES AFTER DEATH IS PRONOUNCED

Verify the death. Only an authorized provider (MD, NP, PA) or RN (per state law) can pronounce death.
Notify the family. If not present, contact with sensitivity. Allow time with the body.
Handle legal requirements. Notify attending provider, document time of death
Provide emotional support. Allow family to grieve. Offer chaplain/spiritual care.
Begin postmortem care. After family time and legal clearance, prepare the body.

CORONER CASES: DO NOT DISTURB

Leave ALL tubes, drains, IV lines, and catheters in place. Do not bathe or reposition the body. Do not remove dressings. Evidence preservation is a legal obligation.

Step	Action	Key Details
1	Position the body	Supine, arms at sides or on abdomen.
2	Remove/secure devices	Remove non-essential IV lines, catheters
3	Bathe the body	Gently cleanse. Place absorbent pads...
4	Apply clean dressings	Replace soiled dressings.
5	Place identification	ID tags: wrist, ankle
6	Manage belongings	Inventory all items. Have family sign.
7	Prepare for viewing	Clean face, comb hair, apply clean gown.
8	Transport	Body bag or shroud per policy.

DOJO RULE

The Final Bow. In martial arts, you bow at the end of every match: win or lose. Postmortem care is the nurse's final bow.

FINAL DOJO RULE

ADL care is where nursing lives. It's not glamorous: it's bathing, toileting, feeding, grooming.

Memory hooks

DEATH D Dressing · E Eating · A Ambulating and transferring · T Toileting · H Hygiene and bathing

Weak In, Strong Out On Dress the affected (weak) · Off Undress the unaffected (strong)

IADLs Go First 1 IADLs · 2 Bathing · 3 Dressing · 4 Toileting · 5 Transferring · 6 Feeding