Nails Flashcards
Test I Review
In conducting a physical examination in Nails, inspect and palpate: (5)
- Shape and Contour:
- Nail Consistency:
- Tissues Surrounding Nails
- Nail Thickness:
- Nail Bed:
The nail surface is normally slightly curved or flat, and the posterior and lateral nail folds are smooth and rounded. Nail edges are smooth, rounded, and clean, suggesting adequate self-care.
- Normal Nail Shape and Contour:
Jagged nails, bitten to the quick, or traumatized nail folds from chronic nervous picking suggest _____.
nervous habits
____ suggest poor self-care or some occupations in which it is impossible to keep them clean.
Chronically dirty nails
The surface is smooth and regular, not brittle or splitting.
- Normal Nail Consistency:
Abnormal Findings in Nail consistency
Beau’s Line
Deep grooved lines that run from side to side on the fingernail. They may look like indentations or ridges in the nail plate.
Beau’s lines
Intact epidermis
- Normal Tissues Surrounding Nails:
Abnormal Findings
Small, torn piece of skin near a fingernail or toenail. These are usually caused by dry skin or (in the case of fingernails) nail biting, and may be prevented with proper moisturization of the skin.
Hangnails:
A nail disease that is an often-tender bacterial or fungal infection of the hand or foot where the nail and skin meet at the side or the base of a finger or toenail.
Paronychia
Nail thickness is uniform.
- Normal Nail Thickness:
Abnormal Findings
Nails are _____ with arterial insufficiency.
thickened and ridged
Highly vascular and pink. Dark skinned clients may have brown or black pigmentation in longitudinal streaks.
- Normal Nail Bed:
Bluish or purplish tint (may reflect cyanosis); pallor (may reflect poor arterial circulation)
Abnormal Findings in Nail Bed
Depress the nail edge to blanch and then release, noting the return of colour. Normally, colour return is instant, or at least within a few seconds in a cold environment. This indicates the status of the peripheral circulation.
Capillary Refill Test:
A ____ takes longer than 1 or 2 seconds.
sluggish colour return
Cyanotic nail beds or sluggish colour return: consider cardiovascular or respiratory dysfunction.
Abnormal Findings on Capillary Refill
Abnormal Findings Abnormal Conditions of the Nails (9)
- Scabies
- Paronychia
- Beau’s Line
- Splinter Hemorrhages
- Clubbing
- Onycholysis
- Habit-tic Dystrophy
- Pitting
- Koilonychia (Spoon Nails)
An intensely pruritic condition caused by the scabies mite. Mites form a linear or curved elevated burrow on the fingers, web spaces of hands, and wrists. Other family members are usually infected. The client cannot stop scratching.
Scabies
Red, swollen, tender inflammation of the nail folds.
- Acute and Chronic
Paronychia
___ paronychia is usually a bacterial infection
Acute
____ paronychia is most often a fungal infection from a break in the cuticle in those who perform “wet” work.
Chronic
Transverse furrow or groove; a depression across the nail that extends down to the nail bed.
Occurs with any trauma that temporarily impairs nail formation, such as acute illness, toxic reaction, or local trauma.
Dent appears first at the cuticle and moves forward as nail grows.
Beau’s Line
Red-brown linear streaks, embolic lesions; occur with subacute bacterial endocarditis; also may occur with minor trauma.
Splinter Hemorrhages
View the index finger at its profile and note the angle of the nail base; it should be about 160 degrees. The nail base is firm to palpation. Curved nails are a variation of normal with a convex profile. They may look like clubbed nails, but notice that the angle between nail base and nail is normal (i.e., 160 degrees or less).
The Profile SIgn
- occurs with congenital chronic cyanotic heart disease and with emphysema and chronic bronchitis.
In early ___, the angle straightens out to 180 degrees and the nail base feels spongy to palpation.
Clubbing of nails
As clubbing progresses, this angle widens and the base of the nail becomes visibly swollen. In late clubbing, the angle where the nail meets the now-convex nail base extends more than halfway up the nail.
Late Nail Clubbing
- Depression down middle of nail or multiple horizontal ridges, caused by continuous picking of cuticle by another finger of same hand, which causes injury to nail base and matrix.
- Common nail condition caused by a conscious or unconscious rubbing or picking of the proximal nail folds.
- This deformity is more common during periods of stress.
Habit-tic Dystrophy
This is a slow, persistent fungal infection of fingernails and, more often, toenails, common in older adults. Fungus causes change in colour (green where nail plate separates from bed), texture, and thickness, with nail crumbling or breaking and loosening of the nail plate, usually beginning at the distal edge and progressing proximally.
Onycholysis
Sharply defined pitting and crumbling of the nails with distal detachment; often occurs with psoriasis.
Pitting
