Definition
Performing nail and foot care is a vital nursing procedure that promotes hygiene, comfort, circulation, and early detection of issues like infections or pressure injuries especially important for patients who are elderly, diabetic, or immobile.
Purposes
- To keep the feet clean and dry.
- To teach the patient proper way to inspect all surfaces of feet and hands for lesions, dryness, or signs of infection.
- To trim nails and keep them short to prevent injury.
- To prevent accumulation of dirt and microorganisms underneath the nails.
Indications
- Any patient who is unable to perform activities to maintain good hygiene.
- Geriatric patients who are unable to do self-care.
- Diabetic patients.
- Unconscious patient.
- Patients with cardiovascular and renal disease.
Articles
- Wash basin.
- Wash cloth.
- Bath or face towel.
- Nail cutter with a nail file.
- Warm water.
- Soap in soap dish.
- Body lotion.
- Clean disposable gloves.
- Paper bag/kidney try.
- A bowl with cotton swabs.
- Bowl with antiseptic solution.
- Bowl with cotton swabs soaked in antiseptic solution (optional: for diabetic and unconscious patient).
Procedure
| NURSING ACTIONS | RATIONALE | |
| 1. | Before procedure Assess patient’s ability to care for nails or feet, visual alteration, fatigue musculoskeletal weakness, etc. | Determines patient’s ability to perform self-care and degree of assistance required from nurse. |
| 2. | Assess patient’s knowledge of foot and nail care practices. | Determines patient’s need for health teaching. |
| 3. | Explain procedure to patient including the fact that proper soaking requires several minutes. In case of patients who are unconscious, soak nails with wet cotton swabs. In patients with diabetes, soak only for a few minutes. | Soaking softens the nails and enables easy cutting of the nails. In diabetic patients, extended soaking can result in accidental injury at the time of procedure leading to delayed wound healing. |
| 4. | During procedures Wash hands and arrange equipment on the over-bed table. | Easy access to equipment prevents delay. |
| 5. | Pull curtains around bed or close room door. | Maintains patient’s privacy. |
| 6. | Assist ambulatory patient to sit in bedside chair; help bed-bound patient to supine position with head of bed elevated; place towel on mattress. | Sitting position facilitates immersing feet in basin. |
| 7. | Fill washbasin with warm water Test water temperature and have it about 43-44°C. | Warm water softens nails and thickened epidermal cells, reduces inflammation of skin, and promotes local circulation. Proper water temperature prevents burns. |
| 8. | Place basin on towel and help patient place feet in basin for soaking toenails. Place call light within patient’s reach. | Patients with muscular weakness or tremors may have difficulty positioning feet. Patient’s safety is maintained. |
| 9. | Adjust over bed table to low position and place it over patient’s lap (patient may sit in chair or lie in bed). | Easy access prevents accidental spills. |
| 10. | Fill basin with warm water and place basin on towel on over bed table for soaking fingernails. | Warm water softens nails and thickened epidermal cells. |
| 11. | Instruct patient to place fingers in basin and place arms in comfortable position. | Prolonged positioning can cause discomfort unless normal anatomical alignment is maintained. |
| 12. | Allow patient’s feet and fingernails to soak for 10-20 minutes and rewarm the water after 10 minutes, if necessary. | Softening of corns, calluses, and cuticles ensures easy removal of dead cells. |
| 13. | Dry hands with towel. | |
| 14. | Clip fingernails straight across and even with top of fingers using clipper. Shape nails with file. Wipe each fingertip with cotton dipped in antiseptic solution. | Cutting straight prevents splitting of nail margins and formation of sharp nail spikes that can irritate lateral margins. |
| 15. | Move over-bed table away from patient. | Provides easier access to feet. |
| 16. | Put on disposable gloves and scrub callused areas of feet with washcloth. | Gloves prevent transmission of fungal infection and friction removes dried skin layers. |
| 17. | Remove feet from basin and dry thoroughly. | |
| 18. | Clean and trim toenails and do not file corners of toenails. | Shaping corners of toenails may damage tissues. |
| 19. | Apply lotion to feet and hands and assist patient back to bed and into comfortable position. | Lotion lubricates dry skin by helping to retain moisture. |
| 20. | Remove disposable gloves and place in receptacle; clean and replace equipment and supplies to proper place; dispose off soiled linen in hamper; wash hands. | Reduces transmission of infection. |
| 21. | Inspect nails and surrounding skin surfaces after soaking and nail trimming. Place nail cutter in a bowl with antiseptic solution for 20-30 minutes then wash, dry, and replace. | Evaluates condition of skin and nails. Allows nurse to note remaining rough nail edges. |
| 22. | After procedure Record procedure and observations (e.g., breaks in skin, inflammation, ulceration, etc. and patients’ response). | |
| 23. | Report any breaks in skin or ulcerations to nurse in charge or physician. | These abnormalities can seriously increase patient’s risk of infection and must be carefully observed. |
Special Considerations
| HIGH-RISK CATEGORY PATIENTS | ETIOLOGY |
| Older adults. | Poor vision, lack of coordination, or inability to bend may contribute to difficulty in performing foot and nail care. Normal physiological changes and aging also result in nail and foot problems. |
| Diabetic patients. | Vascular changes associated with diabetes mellitus reduce blood flow to peripheral tissues. Break in skin integrity places diabetic patients at high risk for skin infection. |
| Heart failure and renal disease patients. | Both conditions can increase tissue edema, particularly in dependent areas, such as legs and feet Edema reduces blood flow to neighbouring tissues. |
| Cerebrovascular accident or stroke patients. | Presence of residual foot or leg weakness or paralysis results in altered walking patterns. Altered gait pattern causes increased friction and pressure on feet. |
- Enlists the patients who are at risk for foot/nail problems and need special attention.
- Appropriate foot care in patients diagnosed with diabetes ensures the maintenance of skin integrity and prevents risk of infection which otherwise may lead to reduced sensation of foot due to poor circulation and the underlying disease condition
- Alert patients to the implications of neuropathy and ischemia so that regular foot care and inspection is encouraged and maintained.
- Daily cleansing and moisturizing of the feet, using either a pumice stone, foot file or seeing a podiatrist/chiropodist depending on the patients’ risk category.
- Ensure and encourage people with diabetes to attend their annual diabetes review, where feet are inspected for any deformity, callus or signs of ulceration, with sensation and vibration checks and affirmation of pedal pulses to ascertain their risk, and the need for further triage, if necessary.
- People with diabetes should be made aware of the checks they should be receiving on an ongoing basis. Health checks are performed by a healthcare providers (HCP) who is trained in delivering foot checks. The steps are:
- Remove the patient’s socks and shoes in order to perform systematic examination.
- Examine footwear, making sure that they fit the person correctly, and do not cause any rubbing, Socks must also be suitable and preferably seamless.
- Take a history from the patient, so that an assessment can be made on presence/absence of sensation (using 10 g monofilament), color of the feet, any warmth or inflammation, deformity, ischemia (palpating foot pulses), presence of corns or calluses or breaks in the skin. Two or more of the following, previous or present foot ulcer or amputation, neuropathy, peripheral vascular disease or foot deformities result in the classification of an ‘at risk’ foot.
- Patients must be referred to the multidisciplinary foot team as per the risk category. Any limb-threatening or life-threatening diabetic foot problem, such as ulceration, suspected infection, ischemia, gangrene or Charcot arthropathy must be referred immediately to acute care.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
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