Skill 42
Nail and Foot Care
Feet and nails often require special care to prevent infection, odors, pain, and injury to soft tissues. Often people are unaware of foot or nail problems until discomfort or pain occurs. For proper foot and nail care, instruct patients to protect the feet from injury, to keep the feet clean and dry, and to wear appropriate footwear.
Patients most at risk for developing serious foot problems are those with peripheral neuropathy and peripheral vascular disease. These two disorders, commonly found in patients with diabetes mellitus, cause a reduction in blood flow to the extremities and a loss of sensory, motor, and autonomic nerve function. As a result, the patient is unable to feel heat and cold, pain, pressure, and positioning of the foot or feet. The reduction in blood flow impairs healing and promotes risk for infection.
Delegation Considerations
The skill of nail and foot care of patients without diabetes or circulatory compromise can be delegated to nursing assistive personnel (NAP). The nurse instructs the NAP about:
▪ Refraining from trimming patient’s nails.
▪ Implementing special considerations for patient positioning.
▪ Reporting any breaks in skin, redness, numbness, swelling, or pain.
