Nails

Question 1

In conducting a physical examination in Nails, inspect and palpate: (5)

Answer 1

1. Shape and Contour:
2. Nail Consistency:
3. Tissues Surrounding Nails
4. Nail Thickness:
5. Nail Bed:

Question 2

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.

Answer 2

1. Normal Nail Shape and Contour:

Question 3

Jagged nails, bitten to the quick, or traumatized nail folds from chronic nervous picking suggest _____.

Answer 3

nervous habits

Question 4

____ suggest poor self-care or some occupations in which it is impossible to keep them clean.

Answer 4

Chronically dirty nails

Question 5

The surface is smooth and regular, not brittle or splitting.

Answer 5

2. Normal Nail Consistency:

Question 6

Abnormal Findings in Nail consistency

Answer 6

Beau’s Line

Question 7

Deep grooved lines that run from side to side on the fingernail. They may look like indentations or ridges in the nail plate.

Answer 7

Beau’s lines

Question 8

Intact epidermis

Answer 8

3. Normal Tissues Surrounding Nails:

Question 9

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.

Answer 9

Hangnails:

Question 10

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.

Answer 10

Paronychia

Question 11

Nail thickness is uniform.

Answer 11

4. Normal Nail Thickness:

Question 12

Abnormal Findings

Nails are _____ with arterial insufficiency.

Answer 12

thickened and ridged

Question 13

Highly vascular and pink. Dark skinned clients may have brown or black pigmentation in longitudinal streaks.

Answer 13

5. Normal Nail Bed:

Question 14

Bluish or purplish tint (may reflect cyanosis); pallor (may reflect poor arterial circulation)

Answer 14

Abnormal Findings in Nail Bed

Question 15

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.

Answer 15

Capillary Refill Test:

Question 16

A ____ takes longer than 1 or 2 seconds.

Answer 16

sluggish colour return

Question 17

Cyanotic nail beds or sluggish colour return: consider cardiovascular or respiratory dysfunction.

Answer 17

Abnormal Findings on Capillary Refill

Question 18

Abnormal Findings Abnormal Conditions of the Nails (9)

Answer 18

1. Scabies
2. Paronychia
3. Beau’s Line
4. Splinter Hemorrhages
5. Clubbing
6. Onycholysis
7. Habit-tic Dystrophy
8. Pitting
9. Koilonychia (Spoon Nails)

Question 19

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.

Answer 19

Scabies

Question 20

Red, swollen, tender inflammation of the nail folds.

- Acute and Chronic

Answer 20

Paronychia

Question 21

___ paronychia is usually a bacterial infection

Answer 21

Acute

Question 22

____ paronychia is most often a fungal infection from a break in the cuticle in those who perform “wet” work.

Answer 22

Chronic

Question 23

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.

Answer 23

Beau’s Line

Question 24

Red-brown linear streaks, embolic lesions; occur with subacute bacterial endocarditis; also may occur with minor trauma.

Answer 24

Splinter Hemorrhages

Question 25

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).

Answer 25

The Profile SIgn

Question 26

• 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.

Answer 26

Clubbing of nails

Question 27

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.

Answer 27

Late Nail Clubbing

Question 28

• 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.

Answer 28

Habit-tic Dystrophy

Question 29

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.

Answer 29

Onycholysis

Question 30

Sharply defined pitting and crumbling of the nails with distal detachment; often occurs with psoriasis.

Answer 30

Pitting