Activities of daily living assistance

Assisting in activities of daily living (ADL) are skills required in nursing and other professions such as nursing assistants.

Mobility

Inactive patients must be turned every two hours, which is the minimum time that a bed sore can develop. To move a bedridden patient to the side, the patient is first pulled closer to the opposite side that they are turning to give room to maneuver. When the patient is turned to the side, a pillow is usually placed to the back to support that position.^[1]

A pillow is often placed at the head of the bed to protect the head from any injury when moving a bedridden patient up in bed. To facilitate the move, the bed is often shifted to trendelenburg position. Often the patient is turned to one side at a time to place a friction reducing sheet under the patient. When moving up, the patient is asked to bend knees and push with their legs while their chin is to their chest to prevent neck injury. The patient is pulled up either by the friction reducing sheet or draw sheet.^[2]

Hygiene

Bed bath

A bath blanket is put over the patient and only the area washed is exposed at a time for privacy and warmth. To make a mitt out of a washcloth, the fingers and palm of the dominant hand are placed over the washcloth and the washcloth is folded over the fingers and palm. The remaining part of the washcloth not covering the fingers and palms will be folded over and tucked in and the thumb will be out of the mitt.^[3]

The eyes are cleaned, usually first, without soap to avoid irritation. The eye is cleaned from the inner side near the nose to the outer edge to avoid carrying debris to the tear duct. The cloth is rinsed or turned before going to the other eye to prevent spreading any organisms. Each area is dried at a time before washing the next area. For perineal care, the perineum is washed from least contaminated to most contaminated to reduce the spread of microorganisms. For females, the labia is spread and washed from the pubic area toward the anal area and not the other way around. For males, the tip of the penis is cleaned first and cleaned away from the meatus. In an uncircumcised penis, the foreskin is retracted and immediately put back in place to avoid compromising circulation and the foreskin is not retracted for children in order to prevent injury.^[3]

Toileting

A bedpan.

A fracture bedpan used for those with hip fractures.

A bedpan is used for bed bound patients for bowel elimination as well urinary elimination for females. Powder is often placed along the ring of the bedpan to help reduce friction but is avoided if contraindicated by issues like allergies or if a stool sample is needed. Raising the head of the bead assists in voiding or defecating.^[4]

Bedmaking

A fitted sheet goes over the mattress. Often a draw sheet, also called lift sheet, is used, where it is placed over the fitted sheet and in the center where it will be under the patient’s midsection. By lifting the draw sheet, it is used to help move the patient. The fitted sheet and draw sheet, which are those that go under the patient, are firmly tucked in to prevent wrinkles, which can promote skin breakdown. A top sheet and blanket are often placed over the bed and the corners are mitered.^[5]

Hospital bed with mitered corners

When making an occupied bed, such as for patients who are unable or have difficulty getting out of bed, one side of the bed is made at a time. Usually, the patient rolls to one side and the old linen under the patient from the opposite side, such as the fitted sheet and draw sheet, is untucked and rolled as close to the patient as possible. The new fitted sheet and draw sheet are then tucked in and also rolled close toward the patient. Then the patient rolls back toward the other side. The old linen that was folded under the patient is removed and the new linen that was also folded under the patient is eased out to make the other side of the bed.^[6] For those for whom it is contraindicated to roll to the side, such as those recovering from hip replacement surgery, then the patient sits up in bed while the top half of the bed is made and afterwards the bottom half of the bed is made.

Nutrition

To maintain self-esteem, the person is involved as much as possible. His or her preferences are asked regarding the order of items eaten. Condiments are added and food cut according to patient preferences. Dentures, hearing aids or glasses are put in place before mealtime.^[7]

For visually impaired patients, the placement of food on the plate and tray is explained. Using a clock face analogy to relate the position of items is common. It is recommended to place foods and dishes in similar location at each meal for familiarity. For beverage, straws are used when possible, if not contradicted by dysphagia, in order to prevent spilling.^[7]

For those with dysphagia, a 30-minute rest period prior to mealtime is provided to give less difficulty with swallowing. The patient is placed upright. The rate of feeding and size of bites are adjusted to patient’s tolerance. The diet would be modified according to nutrition consult, such as chopping, mincing and pureeing. Solids and liquids are alternated to help with swallowing. Signs of aspiration include coughing, choking, cyanosis, voice changes and regurgitation.^[7]

See also

• Nursing

References

1. Taylor, C. R., Lillis, C., LeMone, P., Lynn, P. (2011) Fundamentals of nursing: The art and science of nursing care. Philadelphia: Lippincott Williams & Wilkins, page 1056-1057.
2. Taylor, C. R., Lillis, C., LeMone, P., Lynn, P. (2011) Fundamentals of nursing: The art and science of nursing care. Philadelphia: Lippincott Williams & Wilkins, page 1058-1060.
3. Taylor, C. R., Lillis, C., LeMone, P., Lynn, P. (2011) Fundamentals of nursing: The art and science of nursing care. Philadelphia: Lippincott Williams & Wilkins, page 896-899.
4. Taylor, C. R., Lillis, C., LeMone, P., Lynn, P. (2011) Fundamentals of nursing: The art and science of nursing care. Philadelphia: Lippincott Williams & Wilkins, page 1263.
5. Taylor, C. R., Lillis, C., LeMone, P., Lynn, P. (2011) Fundamentals of nursing: The art and science of nursing care. Philadelphia: Lippincott Williams & Wilkins, page 906.
6. Taylor, C. R., Lillis, C., LeMone, P., Lynn, P. (2011) Fundamentals of nursing: The art and science of nursing care. Philadelphia: Lippincott Williams & Wilkins, page 910-911.
7. Taylor, C. R., Lillis, C., LeMone, P., Lynn, P. (2011) Fundamentals of nursing: The art and science of nursing care. Philadelphia: Lippincott Williams & Wilkins, page 1184.