Nailbed assessment

Nail bed Nursing Assessment

Fingernails and Toenails provide important information about a patient's health. A visual inspection of an individuals' nail beds should be performed by health care nurses as part of the general physical examination. Many diseases and underlying systemic illnesses can be diagnosed from nail bed clues. Nail disease.

Assessment Process

Remove any nailpolish, shoes and socks first.

Inspect all surfaces of the patient's nailbeds. Pay attention to "dryness, inflammation, or cracking" (Perry, Potter, 2002, p. 147). Nails should be smooth, surrounding cuticles and tissues clear and normal in color. Look for ingrown nails that occur in either hands or feet.

Assess capillary refill of finger nailbeds which should be two seconds or less. Circulation problems can change the nail integrity or increase chance of infection.

Observe the patient's gait by having them walk to and from you. Note if the person experiences pain with ambulation. Types of shoes worn may predispose patients to nail problems such as "infection, areas of friction, ulcerations" (Perry, Potter, 2002).

Check if your patient wears nailpolish or artificial nails. Certain chemicals can cause the nailbeds to become dry and brittle. These patients are prone to nail ridges, redness and swelling beneath the polish or artificial nail.

Assess your patient's knowledge and ability to care for their fingernails and toenails. Patients may need health and hygiene teaching, assistance, or a podiatrist to provide service to maintain good healthy nail and foot health. Perry, Potter (2002) state that "Clients with peripheral vascular disease, diabetes mellitus, older adults, and clients whose immune system is suppressed may require nail care from a specialist to reduce the risk for infection" (p. 147).

Risk of Nail Problems

Older patients may have certain conditions that increase their chance of nail and foot problems. Aging itself can result in nailbed changes to fingernails and toenails. Patients may have poor vision, poor coordination, or not be able to bend over to take care of their nails.

Diabetic patients (Perry, Potter, 2002) have vascular changes that reduce blood flow to peripheral tissues. They are prone to breaks in skin integrity which increases their chance for infection. Cuts and scrapes that heal easily for non-diabetics are challenging for a diabetic. Diabetic neuropathy can involve nerves, muscles, bone, and vasculature, which makes assessment and management of foot problems complex (Cooppan and Habershaw, 1995).

Heart or Congestive Heart Failure and Renal patients often have increased tissue edema, especially in dependent areas like hands and feet. Edema will reduce blood flow to fingernails and toenails.

Stroke or Cerebral Vascular Accident patients are at risk for nail problems (Perry, Potter 2002) because of possible residual foot or leg weakness or paralysis resulting in altered walking patterns. This leads to increased friction and pressure on the nailbeds.

References

^Perry, A. Potter, P. (2002). Clinical nursing skills and techniques. St.Louis, MO: Mosby. p. 147.

^Jarvis, C. (2008). ''Physical examination & Health Assessment, Fifth edition. St.Louis, MO: Saunders, Elsevier. p. 268-269.

^Cooppan, R., Habershaw, G. (1995). Preventing leg and foot complication. Patient Care, 29 (3), 35.

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