Nailbed assessment
Encyclopedia
Nail bed Nursing Assessment
Fingernails and Toenails provide important information about a patient's health. A visual inspection of an individuals' nail bedsshould 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
Nail disease
Nail diseases are distinct from diseases of the skin. Although nails are a skin appendage, they have their own signs and symptoms which may relate to other medical conditions. Nail conditions that show signs of infection or inflammation require medical assistance...
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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
Capillary refill
Capillary refill is the rate at which blood refills empty capillaries. It can be measured by holding a hand higher than heart-level , pressing the soft pad of a finger or toe until it turns white, and taking note of the time needed for the color to return once pressure is released. Normal 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
Diabetic neuropathy
Diabetic neuropathies are neuropathic disorders that are associated with diabetes mellitus. These conditions are thought to result from diabetic microvascular injury involving small blood vessels that supply nerves in addition to macrovascular conditions that can culminate in 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
Congestive heart failure
Heart failure often called congestive heart failure is generally defined as the inability of the heart to supply sufficient blood flow to meet the needs of the body. Heart failure can cause a number of symptoms including shortness of breath, leg swelling, and exercise intolerance. The condition...
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.