Self-Care & Activities of Daily Living (ADLs) Nursing Care Plan and Management

Access this comprehensive nursing care plan and management guide to deliver optimal care for patients facing challenges in performing self-care and activities of daily living. This valuable resource provides a wealth of information on nursing assessments, interventions, goals, and nursing diagnoses specifically designed to address self-care deficits. By utilizing this guide, you can enhance your understanding and competence in providing effective care, promoting independence, and improving the overall quality of life for individuals with deficiencies in self-care.

What are activities of daily living?

Activities of daily living (ADLs) encompass the routine tasks an individual regularly perform, such as eating, bathing, dressing, grooming, working, homemaking, and leisure activities. These self-care tasks are essential actions that individuals autonomously undertake to preserve and improve their overall well-being. However, there are instances when individuals experience a deficit in self-care due to various factors. This deficit can arise from temporary limitations, such as post-surgical recovery, or from a gradual decline that hampers a person’s capacity or inclination to attend to their self-care needs. Additionally, individuals grappling with depression may lack the motivation or energy to engage in self-care activities, further exacerbating the deficit.

It is important for nurses to recognize and address these deficits to support individuals in regaining their independence and promoting their physical and mental health. By implementing appropriate interventions and providing necessary support, nurses can empower individuals to resume and maintain their self-care and activities of daily living.

Goals and outcomes

1. The patient will demonstrate an improvement in performing activities of daily living (ADLs), as evidenced by independently completing self-care tasks such as bathing, dressing, and grooming without assistance within [time] days.
2. The patient will verbalize understanding of self-care management techniques and demonstrate the ability to implement them effectively, as evidenced by correctly following prescribed medication regimen, dietary restrictions, and therapeutic exercises within [time] days.
3. The patient will actively participate in self-care education and training sessions, as evidenced by attending and engaging in educational sessions on self-care techniques, asking relevant questions, and actively seeking resources and information to enhance their self-care abilities within [time] days.

Nursing assessment and rationales

Assessment is crucial in identifying self-care deficits and potential nursing care episodes. Through comprehensive evaluation of the individual’s health, function, environment, and support systems, nurses can develop tailored care plans, prevent complications, and promote healing. Collaborative discussions and regular reassessment support a holistic approach to self-care.

1. Assess the patient’s strength to accomplish activities of daily living (ADLs) efficiently and cautiously on a daily basis using a proper assessment tool, such as the Functional Independence Measures (FIM).
The patient may only need help with some self-care measures. FIM measures 18 self-care items related to eating, bathing, grooming, dressing, toileting, bladder and bowel management, transfer, ambulation, and stair climbing.

2. Determine the specific cause of each deficit (e.g., visual problems, weakness, cognitive impairment).
Various etiological factors may need more explicit interventions to enable self-care.

3. Consider the patient’s need for assistive devices.
Assistive devices improve confidence in the performance of ADLs.

4. Recognize choice for food, personal care items, and other things.
The patient will be eager to submit himself or herself to the treatment regimen that supports his or her individual preferences.

5. Evaluate gag reflex or the need for swallowing assessment by a speech therapist prior to initial oral feeding.
The absence of gag reflex or inability to chew or swallow properly may lead to choking or aspiration.

6. Verify the need for home health care after discharge.
Shortened hospital stays have resulted in patients being more debilitated on discharge and therefore requiring more assistance at home. Occupational therapists have access to a wide range of self-help devices.

7. Monitor impulsive behavior or actions indicative of altered judgment.
This may imply the demand for supplementary interventions and management to guarantee safety or security.

Nursing Interventions and Rationales

Nursing interventions for self-care deficit include assessing the patient’s current abilities, setting realistic goals, providing education and training, developing personalized care plans, supporting and monitoring the patient’s progress, involving family or caregivers, collaborating with other healthcare professionals, evaluating effectiveness, and offering emotional support. The following are the therapeutic nursing interventions for self-care deficit:

1. Establish short-term goals with the patient.
Helping the patient with setting realistic goals will reduce frustration.

2. Guide the patient in accepting the needed amount of dependence.
The patient may require help in determining the safe limits of trying to be independent versus asking for assistance when necessary.

3. Present positive reinforcement for all activities attempted; note partial achievements.
External resources of positive reinforcement may promote ongoing efforts. Patients often have difficulty seeing progress.

4. Render supervision for each activity until the patient exhibits the skill effectively and is secured in independent care; reevaluate regularly to be certain that the patient is keeping the skill level and remains safe in the environment.
The patient’s ability to perform self-care measures may change often over time and will need to be assessed regularly.

5. Implement measures to promote independence, but intervene when the patient cannot function.
An appropriate level of assistive care can prevent injury from activities without causing frustration. Nurses can be key in helping patients accept both temporary and permanent dependence.

6. Boost maximum independence.
The goal of rehabilitation is achieving the highest level of independence possible.

7. Apply regular routines, and allow adequate time for the patient to complete task.
An established routine becomes rote and requires less effort. This helps the patient organize and carry out self-care skills.

Feeding

1. Allow the patient to feed themself as soon as possible (using the unaffected hand, if appropriate). Assist with the setup as needed.
It is possible that the dominant hand will also be the affected hand if there is upper extremity involvement.

2. Ensure the patient wears dentures and eyeglasses if required.
Deficits may be exaggerated if other senses or strengths are not functioning optimally.

3. Place the patient in a comfortable position for feeding.
Proper positioning can make the task easier while also reducing the risk for aspiration.

4. Provide patient with proper utensils (e.g., wide-grip utensils, rocking knife, plate guard, drinking straw) to aid in self-feeding.
These things expand the possibilities of success.

5. Assure that the consistency of diet is suitable for the patient’s ability to chew and swallow, as assessed by the speech therapist.
Thickened semisolid foods such as pudding and hot cereal are most easily swallowed and less likely to be aspirated.

6. If vision is affected, guide the patient about the placement of food on the plate.
After a CVA, patients may have unilateral neglect and may ignore half of the plate.

7. Provide an appropriate setting for feeding where the patient has supportive assistance yet is not embarrassed.
Embarrassment or fear of spilling food on self may prevent the patient’s effort to feed self.

Dressing/grooming

1. Provide privacy during dressing.
The need for privacy is fundamental for most patients. Patients may take longer to dress and may be fearful of breaches of privacy.

2. Use appropriate assistive devices for dressing as assessed by the nurse and occupational therapist.
The use of buttonhook or loop-and-pile closures on clothes may make it possible for a patient to continue independence in this self-care activity.

3. Suggest elastic shoelaces or Velcro closures on shoes.
The closures eliminate tying, which can add to the frustration.

4. Give frequent encouragement and aid with dressing as needed.
Assistance can reduce energy expenditure and frustration. However, care needs to be taken so the care provider does not rush through tasks, negating the patient’s attempts.

5. Utilize wheelchair or stationary chair.
Dressing requires energy. A chair that provides more support for the body than sitting on the side of the bed saves energy when dressing.

6. Establish regular activities so the patient is rested before the activity.
A plan that balances periods of activity with periods of rest can help the patient complete the desired activity without undue fatigue and frustration.

7. Consider the use of clothing one size larger.
A large size guarantees easier dressing and comfort.

8. Recommend a front-opening brassiere and half-slips.
Clothing that is easier to put on and remove enhances self-care with dressing.

Oral hygiene

1. Assess the patient’s oral hygiene practices.
Oral hygiene information provides direction on possible etiological factors and guidance for subsequent education.

2. Assess the teeth, gums, mucous membranes, and tongue for color, moisture, texture, irritation, and infection. Use a moist, padded tongue blade to gently pull back the cheeks, lips, and gums.
A tongue blade should be used to expose areas of the oral cavity for inspection.

3. Assess the patient’s nutritional status.
Poor food choices contribute to dentition problems. Poor dentition can affect food consumption with people with loss of teeth consuming fewer foods rich in fiber such as fruits and vegetables.

4. Assess the fit of dental appliances.
An evaluation may suggest possible causes and guide patient education.

5. Assess the mouth for dryness and breath for odor.
A typical flow of saliva is vital in keeping the teeth clean. Halitosis can be due to dryness of the mouth, dentition, or any medical condition.

6. Assess the patient’s ability to complete regular oral care.
Patients may need assistance in completing oral care.

7. Assess for financial problems to maintain improved dental hygiene.
Patients may be too proud to ask for assistance or may be unaware of the community services available to them.

8. Assess for any complaints of toothache.
Dental caries and abscess development are common and painful, requiring dental assessment and evaluation.

9. Assess to what extent “fear of dentists” plays a role in the avoidance of dental care.
Patients may have unwanted experiences in the past regarding dental checkups and may be expecting the dental appointment to be uncomfortable. Providing accurate information may help reduce fear.

1. Provide a mouth care routine including toothbrushing at regular intervals with a soft-bristle toothbrush and fluoride toothpaste.

• Brushing teeth in an up-and-down manner
• Brushing of teeth at least twice a day
• Including the gums and tongue in oral care
• Replacing the toothbrush as bristles wear down
• Advise an ultrasonic toothbrush as an alternative for patients with dexterity problems

Cleaning of teeth with a toothbrush and fluoride-containing toothpaste prevents the build-up of plaque.

2. Teach gentle flossing teeth with unwaxed dental floss.
Flossing promotes gum health and prevents the build-up of plaque.

3. Instruct the patient to rinse the mouth with warm saline or an antiplaque mouth rinse.
These measures help promote oral hygiene.

4. Teach that dentures should be removed and cleaned every night.
Regular cleaning of dentures will prevent mucosal irritation.

5. Assist the patient in performing oral hygiene every after a meal and as often as needed.
Regular brushing of teeth especially after meals is vital to prevent the build-up of bacteria.

6. Advise avoiding high-sugar foods.
High-sugar foods may cause tooth decay and promote good oral health and healing.

7. Apply lubricant to lips and oral mucosa as necessary.
Lubrication promotes comfort and prevents dryness and cracking.

8. Instruct patients to obtain regular dental checkups and follow-ups.
Regular dental checkups identify dental problems early.

9. Educate the patient about the importance of oral hygiene.
Right knowledge helps prevent possible dental problems.

10. Educate the patient about the importance of maintaining a healthy diet despite dentition problems.
Adequate nutrition is vital to healthy teeth and the body.

11. Educate the patient regarding the importance of dental checku

Transferring/Ambulation

1. For moderate assistance, the caregiver places arms beneath both patient’s armpits with the caregiver’s hands on the patient’s back.
This method forces the patient to maintain his or her weight forward.

2. For patients needing maximal assistance, use a gait belt.
This method maximizes patient support while protecting the care provider from injury.

• Raise the bed to the tallest height that still allows the patient’s feet to be flat on the floor.
• Grasp the gait belt with both arms, and pull the patient forward.
• Place a knee against the patient’s weak knee (if applicable), and encourage the patient to put weight on the strong side during the transfer.
• Encourage the patient to use his or her arms to assist, as able, and to place them on the caregiver’s forearms.

3. Aid with ambulation; direct the use of ambulation devices such as canes, walkers, and crutches.
These methods promote patient safety and aid with balance and support.

• Stand on the patient’s weak side.
• If using a cane, place the cane in the patient’s strong hand and ensure proper foot-cane sequence.

Miscellaneous Skills

Telephone

1. Evaluate the need for adaptive equipment through the therapy department (e.g., increased volume, larger numbers, push button phones).
Patients will need a useful tool for communicating their needs from home.

Writing

1. Provide the patient with felt-tip pens. Assess the demand for support or splint on the writing hand.
Felt-tip pens mark with little pressure and are easier to use. Splints assist in holding the writing device.

Toileting

1. Assess and note prior and present patterns for toileting; introduce a toileting routine that factors these habits into the program.
The efficacy of the bowel or bladder program will be improved if the natural and personal patterns of the patient are taken into consideration.

2. Assess patient’s ability to verbalize necessitate to void and/or capacity to use the urinal and bedpan. Bring patient to the bathroom at regular or intermittent intervals for voiding if suitable.
The patient may have neurogenic bladder, is lacking concentration, or be able to verbalize needs in the acute recovery phase, but often is able to recover independent control of this function as recovery develops.

3. Provide privacy while patient is toileting.
Lack of privacy may reduce the patient’s ability to empty the bowel and bladder.

4. Give bedpan or put patient on the toilet every 1 to 1½ hours throughout the day and three times throughout the night.
This eradicates incontinence. Time intervals can be prolonged as the patient starts to verbalize the need to toilet on demand.

5. Give suppositories and stool softeners.
May be essential at first to help in instituting normal bowel function.

6. Observe closely patient for loss of balance or fall. Maintain commode and toilet tissue close to the bedside for nighttime utilization.
Patients may hurry readiness to ambulate to the toilet or commode throughout the night due to fear of soiling themselves and may fall during the procedure.

7. Keep the call light within reach and teach patient to call as promptly as possible.
This facilitates staff members to have ample time to help with the transfer to the commode or toilet.

8. Aid patient in eliminating or changing unnecessary clothing.
Clothing that is not easy to get in and out of may compromise a patient’s capability to be continent.

9. Consider utilization of commode or toilet as early as possible.
Patients are more successful in emptying bowel and bladder when sitting on a commode. A number of patients find it unfeasible to the toilet on a bedpan.

10. Recognize prior bowel habits and restore a normal regimen. Increase bulk in diet, fluid intake, and activity.
Supports the progression of the retraining program and helps in avoiding constipation and impaction.

More Interventions

1. Educate family and significant others to promote autonomy and to intervene if the patient becomes tired, not capable of carrying out the task, or becomes extremely aggravated.
This displays caring and concern but does not hinder with patient’s efforts to attain autonomy.

2. Inform family members to allow the patient to perform self-care measures as much as possible.
Institutes feeling of independence and promotes self-esteem and improves the rehabilitation process. Note: This may be very hard and discouraging for the significant other or caregiver, depending on the extent of the disability and the time needed for the patient to accomplish the activity.

3. Promote independence, but intervene when the patient is not able to carry out self-care activitiesA suitable level of assistive care can avoid harm with activities without causing disappointment.

4. Entertain the patient’s input in the planning schedule.
A patient’s worth in life is improved when wishes or likes are taken into consideration in daily activities.

5. Consider or use energy-conservation techniques.
This saves energy, decreases fatigue, and improves the patient’s capability to execute tasks.

Recommended Resources

Recommended nursing diagnosis and nursing care plan books and resources.

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See also

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