Personal Care, Skin and Medication Assistance
18% of the exam 4 min
Eighteen percent of the exam across two domains: bathing, perineal and catheter care, mouth and denture care, dressing, toileting, plus pressure injuries, skin tears and the limits of assisting with medication.
Bathing: clean to dirty, warm and private
A bath moves from the cleanest areas to the dirtiest. The eyes come first, washed with water only, no soap, from the inner corner to the outer, with a different part of the washcloth for each eye. Then the face, neck, arms, chest, abdomen, legs, feet and back, and the perineal area last, with fresh water. Change the water whenever it becomes cool, soapy or dirty, and always before perineal care. Keep the client covered with a bath blanket and expose only the part being washed. Check the water with a bath thermometer or the inside of your wrist (comfortably warm, around 105°F) and let the client test it, because older skin burns easily and sensation may be reduced. Pat fragile skin dry, especially between the toes and in folds. After a tub bath, drain the water and wrap the client in a towel before helping them out. Encourage the client to do as much as they safely can.
Perineal care, toileting and catheters
For a female client, wipe front to back, from the urethra toward the anus, with a clean part of the cloth for each stroke. For an uncircumcised male client, retract the foreskin, clean the tip in a circle from the opening outward, then return the foreskin to its natural position; left retracted, it can cut off circulation. A client with a hip fracture uses a fracture pan, flat end under the buttocks. Offer the toilet at regular times and respond quickly to requests. Clean and dry the skin promptly after incontinence, and apply barrier cream only if the plan calls for it. With a urinary catheter, keep the bag below the bladder and off the floor, keep the tubing free of kinks, and clean the tubing from the body outward about four inches. Never disconnect, pull or reinsert a catheter. If output drops, check the tubing for kinks, then measure, record and report. Empty an ostomy pouch when it is one-third to one-half full; a healthy stoma is pink to red and moist.
Mouth care, grooming and dressing
Teeth are brushed at least twice a day, including gums and tongue. Poor oral care in older adults is linked to pneumonia. For an unconscious client, turn them on their side with the head turned, use swabs with only a little liquid, and place a towel and basin, so nothing is aspirated. Clean dentures over a sink lined with a towel or partly filled with water, rinse them in cool or lukewarm water (hot water warps them), and store them in a labeled cup, never wrapped in a napkin. Use an electric razor for a client on blood thinners. Comb tangles from the ends up toward the scalp. File fingernails after soaking, but never cut or file the toenails of a client with diabetes or poor circulation; report the need. Remove hearing aids before bathing. Dress the weak side first and undress the strong side first. Put elastic stockings on in the morning before the client gets up, smooth and without wrinkles. Let the client choose their own clothes.
Skin: pressure injuries and skin tears
Recognizing and reporting changes in skin is its own subject in the federal training rule. A stage 1 pressure injury is intact skin with redness that does not fade when gently pressed; on darker skin it may look purple, bluish or shiny, or feel warm, firm or painful. Injuries form over weight-bearing bony areas: tailbone, heels, shoulder blades, elbows and the back of the head when lying on the back; hips, knees, ankles and ears when lying on the side. Prevention: reposition at least every 2 hours in bed unless the plan says otherwise, float the heels with a pillow under the calves, keep sheets smooth and dry, lift with a draw sheet instead of dragging, and clean incontinence promptly. Never massage a red area that does not fade, and never use heat or alcohol on fragile skin. Prevent skin tears with padding, short nails, moisturizer and no tape on fragile skin. Report new redness, open areas, drainage or odor.
Assisting with medications
DC's outline lists assisting with self-administration of medication, and state law sets the exact limits. In general, the aide reminds the client it is time, brings the labeled container, opens it if the client cannot and the law allows, and observes. The client takes the medicine. The aide does not choose or change doses, give injections, crush pills or hide them in food, give unlabeled pills, share their own or anyone else's medication, or remove a client's medication from the home. A refused dose is respected, documented and reported; a missed dose is reported, never doubled. New side effects such as a rash, itching, dizziness, nausea or confusion after a new drug are reported promptly. Swelling of the face, lips or throat, or trouble breathing, is an emergency: call 911. When a client wants to stop a medicine, the aide reports it and the prescriber decides.
Where people lose points
✗ "Use mild soap on the eyes so they are really clean."
✓ Water only on the eyes. Soap irritates them.
✗ "Dress the strong side first so the client can help."
✓ Dress the weak side first; undress the strong side first.
✗ "Massage a red area over a bone to bring back circulation."
✓ Massage damages tissue that is already injured. Relieve pressure and report.
✗ "Rinse dentures in hot water to kill germs."
✓ Hot water warps dentures. Use cool or lukewarm water over a padded sink.
✗ "A catheter bag can rest on the floor if it is out of the way."
✓ Never on the floor, and always below the bladder.
✗ "Crushing a pill into applesauce helps a reluctant client take it."
✓ Hiding medicine violates the right to refuse, and some pills must not be crushed. Respect, document, report.
Numbers to memorize
| Bath order | Eyes (water only) first, perineal area last |
| Bath water | Comfortably warm, around 105°F; client tests it too |
| Female perineal care | Front to back, clean area of cloth each stroke |
| Catheter bag | Below the bladder, off the floor, tubing not kinked |
| Ostomy pouch | Empty at 1/3 to 1/2 full |
| Brushing | At least twice a day |
| Dressing | Weak side first; undress strong side first |
| Elastic stockings | Morning, before getting up, no wrinkles |
| Stage 1 pressure injury | Intact skin, redness that does not fade |
| Repositioning in bed | At least every 2 hours unless the plan says otherwise |
| Medication role | Remind, bring labeled container, observe; client takes it |
| Allergic reaction signs | Face, lip or throat swelling or trouble breathing = call 911 |
Test yourself
No answers here on purpose — retrieving them is the practice. Drill this domain if any of these stall you.
- Walk through a complete bed bath from the first body part to the last.
- Explain perineal care for a female and for an uncircumcised male client.
- Give four rules for caring for a client with a urinary catheter.
- Where do pressure injuries form in a client lying on their back, and what is stage 1?
- What may an aide do to assist with medications, and what may they never do?
- How do you clean and store dentures, and why?
Go deeper on these
- Assisting with medications: an HHA's role and limits
- Perineal and catheter care: the steps HHAs get tested on
- Pressure injuries and skin tears: what HHAs check and report