BASIC FOOT CARE AND MANAGING CPOMMON NAIL PATHOLOGIES

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BASIC FOOT CARE AND MANAGING CPOMMON NAIL
PATHOLOGIES
Chapter 14
Matthew Cole
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Introduction

• This presentation provides basic information on
  caring for a patients feet. You should use it in
  conjunction with the more detailed written
  chapter in the printed book.
• Part 1 Basic Foot Hygiene and Infection Control
• Part 2 Basic Nail Care and Nail Care Tools
• Part 3 Cutting Toenails and Diabetic Nail Care

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• PART 1 Basic Foot Hygiene and Infection Control

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Basic Foot Hygiene

• Feet should be washed daily
• Avoid harsh soaps on fragile or dry skin.
• Pay attention to the area between the toes - try
  a cotton bud when dealing with deformed or
  recently fixed toes.
• Dry the feet thoroughly after washing, especially
  between the toes.
• Use a suitable emollient daily for anhydrotic
  skin, but avoid putting between the toes.
• Ensure clean hosiery is used each day, as well
  as footwear which is clean and dry. This is very
  important when wounds are present or the
  individual has continence issues, when it must be
  changed as required.

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Infection Control

• Always follow standard hand hygiene protocols.
• Make sure the feet are clean before starting.
• You do not need to use antiseptics or skin
  cleansers to prepare the nails and skin.
• The use of gloves when cutting toe nails is
  preferable but not always mandatory. Check local
  infection control policies.
• Instruments used for cutting toenails should be
  either
• - Disposable single use (i.e. used only once).
• - Pre-packed sterile, to be returned to
  centralised sterilisation service after use on a
  single person.
• - Single-patient use not to be used on other
  patients (not preferable in multi-occupancy
  settings such as wards and care homes).
• Sterilisation consists of washer-disinfector
  cleaning followed by autoclaving.
• Again, check and follow your local infection
  control policy.

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Basic Nail Anatomy

• Free edge
• Sulcus
• Nail plate
• Lunula
• Eponychium

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• PART 2 Basic Nail Care and Nail Care Tools

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Basic Instruments for Nail Care

• Nail nipper and foot file
• Foot file can also be used on callous (hard
  skin) avoiding excessive use, or use on callous
  that does not cause discomfort.

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Using Instruments

• 1. NIPPERS
• Grip handles with top arm against your fingers
  and the bottom arm in your palm.
• Use to nip not cut, as you would with scissors.
• Nippers safer than scissors and superior to
  clippers.

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• 2. FILE
• Place file between your little and fourth
  fingers.
• Grip with 2nd, 3rd and 4th fingers.
• Use thumb to put pressure against the nail.
• Use in a downwards direction only.

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• PART 3 Cutting Toenails and Diabetic Nail Care

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Cutting Toenails

• Make sure the patient is accessible - think of
  your back! Have patient on a couch or bed.
• Simple nails
• May be filed or cut.
• Cut nails straight across the top.
• Do not cut the nails down into the corners.
• The corners of the nail should be up, clear past
  the ends of the sulci at the end of the nail. Can
  you see a small, white free edge remaining?
• File any rough edges or sharp corners

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Cutting Toenails
1. Cut the nail one part at a time

• 2 Grip the toes and forefoot with your opposite
  hand to stabilise it.

3 Cover the nippers with a finger from the
opposite hand once in position, but without
touching the blades.
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4 Gradually nip along the nail, cutting off one
piece at a time.

• 5 File the nail, using a back and forth motion,
  with pressure only on the downward stroke.
• Do not file side to side.

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Before and After
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Cutting Thick or Hard Nails

• Use the nipper to take small pieces at a time,
  using the point of the nipper to break into the
  nail.
• Cut using the side of the nipper.
• Gradually reduce the nail down.
• File the nail - caution with the dust from
  mycotic nails.

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Patients with Diabetes

• Nurses are not allowed to cut the toenails of
  patients with diabetes
• This is an Urban Myth there is no reason why
  simple nail care cannot be carried out by nurses
  and other health professionals for patients with
  diabetes.
• Caution should be taken with those patients
  assessed as being at increased and high risk
  (neuropathy and ischaemia present in the feet
  see NICE guidelines).