Nail bed Assessment Flashcards
3 parts of a normal nail discussed in class
Matrix
Nail bed distal to Lunula
Cuticle
What does the matrix of the nail do?
Forms nail plate at proximal end
Where does the matrix of the nail begin?
Around 3 mm beneath proximal nail fold
How fast do nails grow?
Around 3 mm/month
Where does the matrix of the nail end?
To distal end of the lunula
Characteristics of nail bed distal to lunula
Highly vascularized and provides nail with pink color
What does the cuticle do?
Seals and protects proximal nail fold and nail plate
When blanching the nail bed, when should the color return?
In less than 3 seconds
What can cause the color to not return to the nail bed in less than 3 seconds?
Arterial insufficiency
Vasospasm
Onycholysis
Painless loosening of distal nail plate (fingers and toes can be affected)
Causes of onycholysis
Dermatological conditions
Systemic diseases
Medications
What dermatological conditions can cause onycholysis?
Dermatitis
Fungal disease
Psoriasis
What systemic diseases can cause onycholysis
Myeloma Neoplasm Graves disease Anemia Reactive arthritis
If onycholysis is caused by systemic disease, then…
All nail beds are affected
What medications cause onycholysis?
Tetracycline
NSAIDS
Anti-cancer drugs
Photo-onycholysis
Onycholysis that develops after exposure to the sun
Koilonychia
Thin nails with lateral edges tilted upwards giving a concave appearance
Koilonychia is also known as
Spoon nails
Characteristics of Koilonychia
Can be congenital or acquired
How can Koilonychia be acquired?
Hypochromic anemia (iron deficiency) Poorly controlled diabetes (>15 years) Chemical irritants Thyroid problems Syphilis Rheumatic fever Can be due to local injury
Beau’s lines
Transverse groves or ridges across nail plate due to decreased or interrupted nail production by the matrix
What can cause Beau’s lines?
Acute illness or systemic insult
What kinds of acute illness or systemic insult can cause Beau’s lines?
Chemotherapy Peripheral vascular disease Eating disorders Cirrhosis (chronic alcohol use) Myocardial infarction (recent)
Initial onset of Beau’s lines formula
Distance from cuticle to Beau’s line + 3 = number of weeks since insult
Splinter hemorrhages
Red-brown linear streaks found on nail
What can cause splinter hemorrhages?
Can be sign of silent MI or result of history of MI Systemic disorders (*remember multiple nailbeds) Local trauma (*one or 2 nailbeds)
Systemic disorders that can cause splinter hemorrhages
Endocarditis
Vasculitis
Renal failure
Where are splinter hemorrhages commonly seen?
In Cardiac Care Units (CCUs)
