Nail Care and Delegation

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Questions and Answers

What is a primary reason for cleaning transfer aids between patient uses?

To maintain the aesthetic appearance of the equipment

To save time during patient care

To comply with the facility dress code

To prevent the spread of microorganisms (correct)

Which of the following must be documented after repositioning a patient?

Frequency of repositioning all patients in the ward

Other nurses' observations during the shift

Time taken to change the patient's position (correct)

Patient's tolerance of the position change (correct)

What are potential consequences of poor toenail care?

Enhanced aesthetic appeal of the feet

Improved mobility due to better foot alignment

Reduced risk of nail infections

Increased occurrence of painful nail injuries (correct)

Which type of changes should be reported to a primary care provider regarding a patient's nails?

Nail color alterations and swelling around nails Signup and view all the answers

Delegation of nail care can be executed under which circumstance?

Following an initial assessment by a registered nurse Signup and view all the answers

What should be the nurse’s first action following the removal of gloves and other PPE?

Performing hand hygiene Signup and view all the answers

Which condition requires immediate documentation regarding a patient's nails?

Thinning or thickening of nails Signup and view all the answers

What aspect is crucial when moving a patient up in bed?

Maintaining the patient’s proper body alignment Signup and view all the answers

What is the primary purpose of performing hand hygiene before a procedure?

To prevent the spread of microorganisms Signup and view all the answers

Why is it important to identify the patient before beginning a procedure?

To ensure the right patient receives the intervention Signup and view all the answers

Why should the bed be raised to a comfortable working position for the caregiver?

To reduce back strain during the procedure Signup and view all the answers

What is the reason for placing a waterproof pad under the patient's hand or foot?

To protect bed linens and surrounding surfaces Signup and view all the answers

In what way do gloves enhance the hand hygiene process during patient care?

They prevent the spread of microorganisms Signup and view all the answers

What factors should be considered before delegating nail care tasks?

The qualifications of the person to whom the task is being delegated Signup and view all the answers

What is the correct method for trimming nails to prevent injury?

Clip nails straight across in small cuts Signup and view all the answers

Which action is taken to remove debris from under the nails?

Cleaning under the nails with a cuticle or orange-wood stick Signup and view all the answers

What is a primary assessment finding that indicates potential risk for nail problems?

Diabetes and peripheral vascular disease Signup and view all the answers

What is included in the proper equipment for nail care?

Nail file, emollient, and disposable gloves Signup and view all the answers

What factor should be considered when assembling equipment for a procedure?

The organization of the equipment for easy access Signup and view all the answers

What nursing diagnosis might be associated with a patient needing assistance with nail care?

Risk for injury Signup and view all the answers

Which of the following outcomes would indicate successful implementation of nail care?

Nails are trimmed, clean, and without trauma Signup and view all the answers

How should a nurse assess the nails before providing care?

By assessing the color, shape, and presence of trauma Signup and view all the answers

Why is it important to review the health record before providing nail care?

To identify limitations and confirm medical orders Signup and view all the answers

What should be assessed regarding a patient's ability for self-care of nails?

The patient's overall ability to perform self-care tasks Signup and view all the answers

What is the recommended method for shaping nails to prevent injuries?

File straight across, then gently round the tips Signup and view all the answers

Why should nails of patients with diabetes or circulatory problems only be filed and not cut?

Cutting increases the risk of skin and cuticle injury Signup and view all the answers

What is the purpose of removing hangnails?

To reduce hangnail formation and avoid injury Signup and view all the answers

How should cuticles be treated to maintain nail health?

Gently push back using an orange-wood stick or towel Signup and view all the answers

What step should be taken after washing hands or feet to ensure skin health?

Thoroughly dry the hand or foot, especially between fingers or toes Signup and view all the answers

Why should moisturizing between the toes of patients with peripheral artery disease be avoided?

It can encourage fungal growth and infections Signup and view all the answers

What is the consequence of maceration caused by overly wet skin?

It increases the risk of friction and injury Signup and view all the answers

What should be done after performing nail care on one extremity?

Immediately repeat the same steps for another extremity Signup and view all the answers

Study Notes

Nail Care

Nail care is important to prevent pain and infection.
Untrimmed nails increase the risk of nail injury.
Poor toenail care can impact mobility
Report changes in nail color, shape, or texture to a primary care provider.
Common nail changes to report might include:
- Discoloration of the entire nail
- Dark streaks under the nail
- Curled nails
- Thinning or thickening of the nails
- Separation of the nail from the surrounding skin
- Bleeding around the nails
- Redness, swelling or pain around the nails
- Nails should appear intact, smooth, firmly attached to the nail bed, pink in color, with a white crescent visible at the base.
- Dark streaks running lengthwise in nails are normal for patients with darker skin tones.

Delegation

The care of a patient's nails may be delegated to nursing assistive personnel (NAP) or unlicensed assistive personnel (UAP) after assessment by the registered nurse.
The care of a patient’s nails may be delegated to licensed practical/vocational nurses (LPN/LVNs).
The decision to delegate must be based on careful analysis of the patient’s needs and circumstances, as well as the qualifications of the person to whom the task is being delegated.

Equipment

Nail file
Nail clipper
Cuticle scissors
Orangewood stick or cuticle stick
Emollient
Disposable waterproof pad
Towel
Wash basin and skin cleanser, or commercially prepared bathing system
Disposable gloves
Additional PPE, if indicated

Assessment

Assess the patient’s nail care preferences: frequency, time of day, and type of products.
Assess for any physical activity limitations.
Assess for conditions that may put the patient at high risk for nail problems, such as diabetes and peripheral vascular disease.
Assess the color and temperature of fingers and toes.
Assess adequacy of pulses and capillary refill.
Assess the skin of fingers and toes for dryness, cracking, or inflammation.
Assess the nails and surrounding skin for changes in nail color, changes in nail shape, thinning or thickening of the nails, separation of the nail from the surrounding skin, bleeding around the nails, and redness, swelling, or pain around the nails.
Assess the patient’s ability for self-care of nails or assist with the procedure.

Nursing Diagnosis

Risk for Injury
Bathing Self-Care Deficit
Impaired Physical Mobility

Outcome identification and planning

Nails are trimmed and clean with smooth edges and intact cuticles, without evidence of trauma to nails or surrounding skin.
Patient verbalizes feelings of improved self-esteem

### Implementation

Review health record for any limitations in physical activity, or contraindications to the procedure.
Confirm presence of medical order for nail care, if required by facility policy.
Perform hand hygiene. Put on PPE, as indicated.
Identify patient. Explain procedure to the patient.
Assemble equipment on overbed table within reach.
Close the curtains around the bed and close the door to the room, if possible.
Raise bed to a comfortable working position, usually elbow height of the caregiver. Lower side rail. Place a towel or waterproof pad under the patient’s hand or foot.
Put on gloves. Wash patient’s hands or feet, depending on care to be given.
Gently clean under the nails using the cuticle or orangewood stick. Wash hand or foot.
Clip nail, if necessary. Avoid cutting the whole nail in one attempt. Use the tip of the nail clipper and take small cuts. Cut the nail straight across. Do not trim so far down on the sides that the skin and cuticle are injured. Only file, do not cut, the nails of patients with diabetes or circulatory problems.
File the nail straight across, then round the tips in a gentle curve, to shape the nail. Do not trim so far down on the sides that the skin and cuticle are injured. Only file, do not cut, the nails of patients with diabetes or circulatory problems.
Remove hangnails, which are broken pieces of cuticle, by carefully trimming them off with cuticle scissors. Avoid injury to tissue with the cuticle scissors.
Gently push cuticles back off the nail using the orangewood stick, or towel.
Dry hand or foot thoroughly, taking care to be sure to dry between fingers or toes. Apply an emollient to the hand or foot, rubbing it into the nails and cuticles. Do not moisturize between the toes of patients with peripheral artery disease.
Repeat Steps 7–13 for other extremity or extremities.

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Description

This quiz covers essential aspects of nail care and the delegation of nail care responsibilities to nursing assistive personnel. Learn about proper nail maintenance, common nail changes that should be reported, and the importance of hygiene in preventing infection. Test your knowledge on when and how to delegate nail care tasks effectively.