Personal Hygiene and Grooming
Performing Nail and Foot Care
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Take the Review Test:
Safety
- Most agencies require a health care provider’s order for a nurse to trim a patient’s nails. Be aware of your agency’s policy regarding the filing and trimming of nails.
- Check your agency’s policy regarding the appropriate process for cleaning beneath the nails. Do not use an orange stick or the end of a cotton swab; these items can splinter and injure the patient.
- Observe Standard Precautions when providing care, which include wearing clean gloves. Additional precautions requiring other personal protective equipment (PPE) may be necessary, depending on the patient’s condition.
- If trimming is indicated, all nail clippers and files should be for single-patient use only.
- Monitor patients who have a decrease in sensory perception, such as peripheral neuropathy.
- The hands and feet of patients who have diabetes mellitus, peripheral neuropathy, or peripheral vascular disease (PVD) should not be soaked because of an inability to sense temperature and an increased risk for trauma and infection.
- If the patient has diabetes mellitus or circulatory problems, do not trim his or her nails. Check your agency’s policy; initiate the process to obtain an order for a podiatry consult.
Equipment
(Roll cursor over items to see labels)
Clean gloves
Washbasin
Emesis basin
Towel
Washcloth
Waterproof pad
Nail clippers
Soft nail or cuticle brush
Plastic applicator stick
Emery board or nail file
Body lotion
PrintableDelegation
The skill of nail and foot care for patients without diabetes or circulatory compromise can be delegated to nursing assistive personnel (NAP). Be sure to inform NAP of the following:
- Instruct NAP not to trim the patient’s nails.
- Explain any special considerations for patient positioning.
- Report any breaks in skin, redness, numbness, swelling or pain to the nurse.
Preparation
- Inspect all surfaces of the patient’s fingers, toes, feet, and nails. Pay particular attention to any areas of dryness, inflammation, or cracking. Also, inspect the heels, the soles of the feet, and between the toes.
- Assess the color and temperature of the patient’s toes, feet, and fingers. Assess the capillary refill time of the fingernail and toenail beds. Palpate the radial and ulnar pulse of each of the patient’s wrists and the dorsalis pedis pulse of the patient’s feet; note the character and symmetry of the patient’s pulses.
- Identify the patient’s risk for foot or nail problems. Those at risk include older adults and those with diabetes mellitus, heart failure, renal disease, or stroke.
- Assess for the types of home remedies that the patient uses for existing foot problems, such as those used to treat or remove warts, corns, and calluses.
- Explain the nail care procedure, including proper soaking of the nails (except when medically contraindicated), which requires placing the hands or feet in warm water for several minutes.
- Obtain the health care provider’s order for trimming the patient’s nails (required by most agencies).
Follow-up
- Inspect the nails, the areas between the fingers and toes, and the surrounding skin surfaces.
- Ask the patient to explain or demonstrate nail care.
- Observe the patient’s walking after foot and nail care.
- Instruct the patient not to walk barefoot or use corn or callus products.
- Initiate the process to obtain an order for a podiatry consult if the patient has diabetes, peripheral arterial disease (PAD), or peripheral vascular disease (PVD). Instruct such patients to do the following:
- Inspect all surfaces of each foot, using a mirror if necessary to view the bottom of the foot.
- Bathe the feet daily, cleaning around the nails with a soft brush.
- Dry the feet, paying special attention to the skin between the toes.
- Use lambswool between the toes if the skin stays moist or becomes macerated.
- Wear socks made of natural fibers that breathe and absorb perspiration, such as cotton.
- Wear nonconstricting shoes with soft leather and an adequate toe box.
Documentation
- Record the procedure and any observations, such as breaks in the patient’s skin and any areas of inflammation or evidence of ulcerations.
- Document patient teaching about nail or foot care.
- Report any ulcerations or other breaks in the patient’s skin to the nurse in charge or to the health care provider.
Review Questions
1. For which patient would the nurse most likely ask for a podiatrist consult for nail care?
A middle-aged man with type 2 diabetes mellitus who feels tingling in his right foot
A middle-aged man with mobility impairment that has lasted several weeks after a fall from a ladder- An older adult woman with dementia who has broken her pelvis after falling on the kitchen floor
- A 12-year-old girl with a broken foot
CORRECT. A podiatrist should assess and develop a regular schedule of nail care for any patient with diabetes and peripheral neuropathy or vascular insufficiency. This patient is known to have diabetes, and the tingling in his foot may indicate peripheral neuropathy.
INCORRECT. An otherwise healthy patient with temporarily limited mobility will probably not need to see a podiatrist.
INCORRECT. A patient with dementia will require help with nail care, particularly during the lengthy recovery from a broken pelvis, but it is unlikely that the expertise of a podiatrist will be required.
INCORRECT. An otherwise healthy child with a broken foot will probably not need to see a podiatrist.
2. Why would the nurse plan to perform foot care for a patient with peripheral vascular disease (PVD), rather than delegate this activity to nursing assistive personnel (NAP)?
- The patient prefers that the nurse provide the care.
- NAP are not trained to perform foot care.
- The patient’s elevated risk of infection makes it unsafe for NAP to perform the care.
- The patient’s condition requires that he remain on bed rest.
INCORRECT. For patients with circulatory compromise, nail and foot care cannot be delegated to NAP. The patient’s wishes have no bearing on whether this care can be delegated.
INCORRECT. NAP are trained to perform nail and foot care; however, such care cannot be delegated for patients with circulatory compromise.
CORRECT. For patients with circulatory compromise, nail and foot care cannot be delegated to NAP.
INCORRECT. For patients with circulatory compromise, nail and foot care cannot be delegated to NAP. Even if a patient with PVD were placed on bed rest, such an order would have no bearing on whether the skill of foot care could be delegated.
3. Which action would the nurse encourage an older adult with foot problems to take at home?
- Apply oval pads to treat corns.
- Wear socks made of natural fibers.
- Carefully shave off calluses with a razor blade.
- If a bandage is needed, apply gauze squares with adhesive tape.
INCORRECT. Use of oval pads for corns can exert pressure on toes, thereby decreasing circulation to surrounding tissues. Patients should seek professional treatment for corns.
CORRECT. Natural fibers, such as cotton, absorb perspiration and “breathe.”
INCORRECT. A patient should never trim corns or calluses with a razor blade or scissors. Doing so puts the patient at risk of cutting the skin, which can lead to infection.
INCORRECT. The thin, delicate skin of an older adult is prone to tearing when adhesive tape is removed.
4. In providing foot care, the nurse would soak the feet and hands of which patient?
- A 30-year-old man with type 1 diabetes
- An 86-year-old woman with generalized weakness
- A 56-year-old patient with vascular insufficiency who was bathed the day before
- A 56-year-old patient with vascular insufficiency who was not bathed the day before
INCORRECT. Hand and foot soaking is contraindicated in any patient with diabetes, vascular insufficiency, or peripheral neuropathy because of the inability to sense temperature and the increased risk of trauma and infection.
CORRECT. Hand and foot soaking is contraindicated in any patient with diabetes, vascular insufficiency, or peripheral neuropathy because of the inability to sense temperature and the increased risk of trauma and infection. This patient, however, has none of these conditions, and the nurse would soak her hands and feet.
INCORRECT. Hand and foot soaking is contraindicated in any patient with diabetes, vascular insufficiency, or peripheral neuropathy because of the inability to sense temperature and the increased risk of trauma and infection.
INCORRECT. Hand and foot soaking is contraindicated in any patient with diabetes, vascular insufficiency, or peripheral neuropathy because of the inability to sense temperature and the increased risk of trauma and infection.
5. A patient with diabetes remarks during foot care that she has been letting her skin air-dry after bathing at home because her doctor told her to use plenty of moisturizer on her hands and feet. What should the nurse teach the patient?
- To apply moisturizer after air-drying thoroughly
- To apply moisturizer while the skin is still wet
- To skip the moisturizer
- To towel-dry thoroughly before applying moisturizer
INCORRECT. The nurse would encourage this patient to towel-dry thoroughly; allowing the skin to air-dry promotes fungal growth and maceration of tissues.
INCORRECT. The nurse would encourage this patient to towel dry thoroughly before applying moisturizer; allowing the skin to air dry promotes fungal growth and maceration of tissues.
INCORRECT. The nurse would encourage this patient to towel-dry thoroughly to impede fungal growth and prevent maceration of tissues, and then to apply moisturizer to lubricate dry skin.
CORRECT. The nurse would encourage this patient to towel-dry thoroughly to impede fungal growth and prevent maceration of tissues.
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