1. Unit 2: Activities of Daily Living
Lesson 1: Activities
of Daily Living

2. Lesson 1 – Activities of Daily Living
Activities of daily living (ADLs)
Moving about
Personal hygiene and grooming
Dressing
Eating
Toileting
Activities of Daily Living
Activities of daily living (ADLs) are the activities that are done during a normal day in a person's life. These activities include:   
Moving about   
Bathing  
Oral care   
Hair care   
Nail care   
Shaving   
Dressing and undressing   
Eating   
Toileting
Having patients do ADLs as independently as possible promotes their physical abilities as well as their mental, emotional, and social well-being. As a result, ADLs are an important part of rehabilitation and restorative care. Furthermore, OBRA requires that patients receive the necessary care to be able to attain, maintain, and improve their ADL abilities. Physicians, therapists, and registered nurses evaluate patients to determine if they are able to take part in ADL training

3. Lesson 1 – Activities of Daily Living
Role of a health assistant with ADLs
Health Assistants and ADLs
Health assistants must follow the patient's care plan when helping with activities of daily living (ADLs). Specifically, health assistants need the following information:   
The ADL to do   
Any areas of injury or weakness, such as the right leg, the left hip, or the back   
The use of any assistive, orthotic, and prosthetic devices   
How much assistance the patient needs
While helping a patient, health assistants must immediately report any problems to their supervisor.
After helping a patient, health assistants must report all of the actions taken. They must also report any observations. For example, they should report how well the patient did the ADL and if the patient complained of discomfort.

4. Lesson 1 – Activities of Daily Living
Assistive devices
Devices patients use to do ADLs they otherwise would not be able to do
Assistive Devices for ADLs
In order to do activities of daily living (ADLs) as independently as possible, patients may use assistive devices. Assistive devices are devices that patients use to do ADLs they otherwise would not be able to do.

5. Lesson 1 – Activities of Daily Living
Assistive devices for moving about
Transfer seats
Seat lifts
Crutches
Canes
Walkers
Wheelchairs
Moving About
Moving about includes sitting and lying down, getting up, and walking. For example, when people sit down in a chair and get up, they do the following actions:   
Turning to sit in a chair   
Lowering into the chair   
Maintaining an upright position   
Changing position in the chair   
Rising from the chair   
Coming to a standing position
In order to move about as independently as possible, patients may use these assistive devices:   
Transfer seats   
Seat lifts   
Crutches   
Canes   
Walkers   
Wheelchairs

6. Lesson 1 – Activities of Daily Living
Assistive devices for bathing
Bath transfer seats
Grab bars
Bath mats
Bath seats
Wash mitts
Long-handled brushes and sponges
Hand-held showers
Bathing
Bathing includes the following actions:   
Gathering the supplies   
Undressing   
Regulating the water flow and temperature   
Getting into the tub or shower   
Washing and rinsing the hair   
Washing and rinsing the body   
Drying the hair   
Drying the body   
Getting out of the tub or shower   
Dressing   
Putting away the supplies
In order to bathe as independently as possible, patients may use these assistive devices:   
Bath transfer seats   
Grab bars   
Bath mats   
Bath seats   
Wash mitts   
Brushes and sponges with long handles   
Hand-held showers
Patients may also bathe at the sink or in bed.

7. Lesson 1 – Activities of Daily Living
Assistive devices for oral care
Toothbrushes with built-up handles or cuffs
Electric toothbrushes
Oral Care
Oral care includes the following actions:   
Gathering the supplies   
Placing the toothpaste on the toothbrush   
Brushing the teeth   
Rinsing the mouth  
Flossing the teeth 
Cleaning and putting away the supplies
In order to do oral care as independently as possible, patients may use these assistive devices:   
Toothbrushes with built-up handles or cuffs   
Electric toothbrushes
Oral care may also include caring for dentures.

8. Lesson 1 – Activities of Daily Living
Assistive devices for hair care
Long-handled combs and brushes
Combs and brushes with built-up handles or cuffs
Hair Care
Hair care includes the following actions:   
Gathering the supplies   
Brushing or combing the hair   
Styling the hair   
Cleaning and putting away the supplies
In order to do hair care as independently as possible, patients may use combs and brushes with long handles, built-up handles, or cuffs.

9. Lesson 1 – Activities of Daily Living
Nail Care
Nail Care
Nail care includes the following actions:   
Gathering the supplies   
Cleaning the nails   
Trimming the nails   
Filing the nails   
Cleaning and putting away the supplies

10. Lesson 1 – Activities of Daily Living
Shaving may be more independently done with an electric razor
Shaving
Shaving includes the following actions:   
Gathering the supplies   
Shaving the face   
Cleaning and putting away the supplies
In order to shave as independently as possible, patients may use electric razors.

11. Lesson 1 – Activities of Daily Living
Assistive devices for dressing
Dressing stick
Button hook
Zipper pull
Sock and stocking aids
Shoe grabber
Long-handled shoehorn
Shoe remover
Dressing and Undressing
When people dress, they do the following actions:   
Selecting and getting the clothing   
Putting on the undergarments   
Putting on the shirt and pants or skirt or dress, including managing Velcro closings, snaps, buttons, zippers, and belts   
Putting on the socks   
Putting on and taking off the shoes, including managing shoe laces   
Putting away the supplies
In order to dress and undress as independently as possible, patients may use these assistive devices:   
Dressing sticks   
Button hooks   
Zipper pulls   
Sock and stocking aids   
Shoe grabbers   
Shoehorns with long handles   
Shoe removers

12. Lesson 1 – Activities of Daily Living
Tips for independent dressing
Loose-fitting clothing
Clothing that fastens in front
Avoid snaps, buttons, and zippers
Slip-on or Velcro closing shoes
Dress affected limb first
Undress unaffected limb first
Dressing and Undressing Continued
Furthermore, in order to dress and undress as independently as possible, patients should do the following:   
Use loose-fitting clothing.   
Use clothing that fastens in front rather than the back.   
Use pullover shirts rather than those with snaps and buttons.   
Use shirts and dresses with snaps and Velcro closings rather than those with buttons and zippers. Use pants and skirts with elastic waists rather than those with snaps, buttons, zippers, and belts.   
Use slip-on shoes or shoes with Velcro closings or elastic shoe laces rather than those with regular shoelaces.
Dress affected limbs first.
Undress unaffected limbs first.

13. Lesson 1 – Activities of Daily Living
Assistive devices for eating
Non-slip place mats
Special utensils
Special plates
Special cups
Eating
Eating includes the following actions:   
Opening the containers and packages   
Preparing food, such as putting condiments on food and cutting food   
Using a spoon, fork, and knife   
Using a cup   
Bringing the food to the mouth   
Chewing and swallowing   
Using a napkin
In order to eat as independently as possible, patients may use these assistive devices:   
Non-slip place mats   
Utensils with built-up handles, curved or angled handles, or cuffs   
"Rocking" knives   
Plates with rounded edges or plates guards   
Cups with handles   
Cups with spouted lids   
Cup holders
In addition, health care workers should encourage patients to eat with others in the dining room. This promotes patients' mental, emotional, and social well-being.

14. Lesson 1 – Activities of Daily Living
Toileting assistive devices
Elevated toilet seats
Toilet seat hand rails
Commodes
Cleaning aids
Toileting
Toileting includes the following actions:   
Getting to the toilet   
Pulling down the pants or pulling up the skirt or dress   
Sitting on the toilet   
Eliminating in the toilet   
Cleaning oneself   
Flushing the toilet   
Pulling up the pants or pulling down the skirt or dress   
Washing the hands
In order to toilet as independently as possible, patients may use these assistive devices:   
Elevated toilet seats   
Toilet seat hand rails   
Commodes   
Cleaning aids

15. Lesson 1 – Activities of Daily Living
Assistive devices for other ADLs
Grabbers
Jar openers
Doorknob grips
Pen and pencil grips
Magnifying glasses
Other ADLs
Activities of daily living (ADLs) also include these activities:   
Grabbing objects   
Opening jars   
Opening doors   
Writing   
Reading
In order to do these activities as independently as possible, patients may use these assistive devices:   
Grabbers   
Jar openers   
Doorknob grips   
Pen and pencil grips   
Magnifying glasses

16. Lesson 1 – Activities of Daily Living
Orthotic device
Applied externally to a body part to support or control movement
Prosthetic device
Artificial replacement for a missing body part
Device to make a body part work better
Orthotic and Prosthetic Devices for ADLs
In order to do activities of daily living (ADLs) as independently as possible, patients may also use orthotic and prosthetic devices.
An orthotic device is a device that is applied externally to a body part to support or control movement. Examples of orthotic devices include neck collars, spinal supports, splints, braces, and hand and footwear.
A prosthetic device is often an artificial replacement for a missing body part. Examples of prosthetic devices include artificial hands, feet, arms, legs, eyes, and teeth. Other types of prosthetic devices make a part of the body work better. These include contact lenses, eye glasses, and hearing aids.
Patients use orthotic and prosthetic devices to do ADLs they otherwise would not be able to do.

17. Lesson 1 – Activities of Daily Living
Types of ADL training
Setup
Verbal cues
Demonstration
Hand-over-hand
Types of ADL Training
Health care workers must encourage patients in activities of daily living (ADLs) and provide the least amount of assistance necessary. Physicians, therapists, and registered nurses determine how much assistance patients need. Health assistants help patients according to their care plan. Depending on a patient's ability, there are various types of ADL training:   
Setup   
Verbal cues
Demonstration
Hand-over-hand      

18. Lesson 1 – Activities of Daily Living
Setup
Health care worker prepares ADL for patient
Setup
One type of ADL training is setup. With setup, health care workers need to set up, or prepare, ADLs for patients. For example, for bathing, a health care worker needs to gather the supplies, regulate the water flow and temperature, and help a patient into the bathtub or shower.

19. Lesson 1 – Activities of Daily Living
Verbal cues
Health care worker gives simple directions to prompt patient
Verbal Cues
Verbal cues is also a type of ADL training. With verbal cues, health care workers need to use simple directions to prompt patients. For example, for dressing, a health care worker needs to say, "Please put on your shirt." and "Now put on your pants." Verbal cues is a more assistive type of ADL training than setup.

20. Lesson 1 – Activities of Daily Living
Demonstration
Health care worker shows patient what to do
Demonstration
Demonstration is a third type of ADL training. With demonstration, health care workers need to show patients what to do. For example, for brushing the teeth, a health care worker needs to make the motions of brushing her teeth with a toothbrush. Demonstration is used in conjunction with verbal cues if patients need more assistance. It is also used with patients who cannot hear well

21. Lesson 1 – Activities of Daily Living
Hand-over-hand
Health care worker guides patient’s hands
Hand-over-hand
Another type of ADL training is hand-over-hand. With hand-over-hand, health care workers need to guide patients' hands. For example, for eating, a health care worker needs to place a spoon with food in a patient's hand, place his hand over the patient's hand, and guide the spoon to the patient's mouth. Hand-over-hand is used in conjunction with verbal cues if patients need more assistance. It is a more assistive type of ADL training than demonstration.

22. Lesson 1 – Activities of Daily Living
Guidelines for assisting with ADLs
Seat patient
Give clear, brief instructions
Organize items purposefully
Allow some struggle
Teach safety
Guidelines for ADLs
When assisting patients with activities of daily living (ADLs), health care workers must follow these guidelines:   
When possible, have patients sit down.   
Give clear, brief directions.   
Organize items purposefully.   
Allow patients to struggle a bit before providing more assistance.   
Teach safety.

23. Lesson 1 – Activities of Daily Living
Organizing items purposefully
Arrange items in order of use
Do not put items close together
Make sure patient can reach items
Organizing Items Purposefully
In order for health care workers to organize items purposefully, they must do the following:   
Arrange the items in order of use. For example, if a patient is dressing, health care workers should put the patient's clothes in the order in which they will be used, such as undergarments, shirt, pants, socks, and shoes. This helps the patient know which step of the dressing process to do next.   
Do not put the items close together. For example, if a patient is eating, place the utensils, plate, cup, and napkin in their appropriate positions. This helps the patient more easily pick up the items in order to eat.   
Make sure the patient can reach the items. For example, if a patient is bathing, hang the towel next to the tub within the patient's reach. This helps the patient more easily get the towel in order to dry off. It also prevents the patient from getting hurt while trying to get the towel.

24. Unit 2: Activities of Daily Living
Lesson 2: Incontinence

25. Lesson 2 – Incontinence Incontinence
Inability to control urination or bowel movements
<MM Name>
Incontinence
Some patients have problems with toileting abilities, such as getting to the toilet or managing their clothing. Other patients, though, may not have control over their bladder or bowel. The bladder is the organ that stores urine. The bowel, or large intestine, is the organ that stores feces. Incontinence is the inability to control urination or bowel movements.
As with all activities of daily living (ADLs), having patients use the bathroom as independently as possible promotes their physical abilities as well as their mental, emotional, and social well-being. OBRA requires that patients who experience incontinence receive the necessary care to restore their bladder and bowel function to the highest possible level. Physicians, therapists, and registered nurses evaluate patients to determine if they are able to take part in bladder and bowel training.

26. Lesson 2 – Incontinence Bladder and bowel training
Role of an assistant
Health Assistants and Bladder and Bowel Training
Physicians, therapists, and registered nurses create bladder and bowel training programs for patients. Health assistants help patients according to their care plan. For example, if health assistants are to have patients use the bathroom, they need the following information:   
When to have the patient use the bathroom   
How much assistance the patient needs
While helping a patient, health assistants must immediately report any problems to their supervisor.
After helping a patient, health assistants must report all of the actions taken. They must also report any observations. For example, they should report if the patient voided, or emptied the bladder or bowel.

27. Lesson 2 – Incontinence Bladder training Prompted voiding
Habit training
Kegel exercises
Bladder Training
Bladder training helps patients attain and maintain control over the voiding of urine. Bladder training may involve the following interventions:   
Prompted voiding - Prompted voiding is encouraging a patient to void every two to three hours. Prompted voiding promotes regular voiding.   
Habit training - Habit training is determining a patient's normal voiding routine and establishing a schedule of voiding based on this routine. Habit training promotes regular voiding.   
Kegel exercises - Kegel exercises are exercises that strengthen the bladder and bowel muscles. They help control the leakage of urine.

28. Lesson 2 – Incontinence Bowel training Habit training
Increased fiber and fluid intake
Increased physical activity
Effective stress management
Bowel Training
Bowel training helps patients attain and maintain control over the elimination of feces. Bowel training may involve the following interventions:   
Habit training - Habit training is determining a patient's normal elimination routine and establishing a schedule of elimination based on this routine. Habit training promotes regular elimination.   
Increased fiber and fluid intake - Increased fiber and fluid intake promote regular elimination and soft, bulky stools. High-fiber foods include whole grains, vegetables, fruits, dry beans, and nuts.   
Increased physical activity - Increased physical activity promotes regular elimination. Physical activity includes physical fitness activities, such as aerobics, strength training, and stretching, as well as other recreational activities, such as taking walks, gardening, and dancing.   
Effective stress management - Effective stress management promotes regular elimination.

29. Lesson 2 – Incontinence Other treatment Medication Biofeedback Surgery
Other Treatments
Bladder and bowel training may not help all patients control incontinence. Such patients may benefit from other treatments, such as medication, biofeedback, and surgery.

30. Lesson 2 – Incontinence
Guidelines for assisting with voiding and elimination
Provide privacy
Encourage independence
Show sensitivity, support and patience
Answer call quickly
Help with hygiene
Watch body language
Guidelines for Incontinence
In addition to the physical effects it has on patients, incontinence also has mental, emotional, and social effects on patients. For example, patients may sense a loss of dignity and control. As a result, they may have low self-esteem. They may feel sad, angry, embarrassed, worthless, anxious, and frustrated. And they may withdraw from social activities.
When assisting patients with voiding, health care workers must follow these guidelines:   
Provide patients with privacy.   
Allow patients to do as much of the toileting as possible.   
Show sensitivity, support, and patience.   
Answer call lights as soon as possible.   
Help patients with personal hygiene.   
Do not show reactions to urine or feces or smells in facial expressions or body language.