Explain why NAs must be careful while giving nail care to residents who have diabetes

Patients who are unable to care for their own finger or toe nails will require your assistance in keeping nails clean and trimmed.  If your patient is unconcious or medicated, they can easily scratch their own skin, which can lead to infection.  Nail beds host a variety of microorganisms that can cause infection in your patient, and proper care will preven the spread of infection.  If your patient is undergoing anticoagulation therapy, do not perfom nail care as the medication can cause increased bleeding.  Patients who are diabetic should have nail care performed by a doctor because diabetes causes a decrease in the ability of tissue to repair itself.  Even a very tiny cut on the foot can lead to an ulcer.  Before you care for any patient’s nails, check with your facility to be sure that cutting nails is within the scope of duties for a nurse’s aide.  You will need training to properly cut nails, but the following guidelines will always need to be followed:

1. Before you begin nail care, wash your hands and put gloves on.  Ensure equipment such as scissors or trimmers are clean and sterile to prevent passing on infection.
2. As you cut each nail, ensure there are no sharp or jagged edges.  Sharp edges can cause cuts to the patient’s skin, increasing the risk of infection transmission through breakage in the skin.
3. Inspect the patient’s nail beds as you work to look for signs of inflamation or fungal growth.  If you observe discoloration or signs of infection, report it to the nurse.

Proper nail care can reduce the transmission of disease because the hands and feet are often exposed to many microorganisms which can grow quickly in the nail beds.  This procedure will also help the patient to remain comfortable and allow you to look for signs of infection that can lead to complications.

Examiners Checklist For This Skill:

1) Performed beginning tasks.
2) Washed, soaked and dried the resident’s hands.
3) Cleaned the nails.
4) Clipped one nail at a time, so that edges are smooth according to
resident preference.
5) Filed nails, as needed, smoothing rough areas.
6) Applied lotion as needed.
7) Performed completion tasks.

Expert Tip by Tanya Glover, CNA

If you get assigned the skill of nail care for your exam, the only thing I can say is LUCKY YOU! If you are nervous about this one, let me set your fears to rest. Doing patients nails is not any different than giving your BFF a manicure. The only thing is that you have to remember that you are holding older and more fragile hands. When you are working on patients nails and the patient is a woman, this is a really great time for some girl bonding, even if they cannot respond, or in some cases, understand what you are doing or saying. Remember to treat their nails the way you would want yours treated when you go to a saloon. Be gentle and take care not to cut too low or nick their skin. Now, if you are working on their feet, take the same precautions. Feet are so important and you want them to feel and look good! Keep in mind though that if your patient is diabetic, you NEVER want to provide nail care for the feet. To keep things extra special, when you are done with the toes, rub on some good smelling and soft lotion. This is a treat for a patient who does not experience much pampering and “me” time.

When doing this skill on your partner, allow them to help you. They will if you let them! The instructor really just wants to see that you have the idea down. They get that you are nervous having someone stare at you and if you just talk yourself thorough the skill aloud it will all be fine. This is the easiest skill to perform for the exam in my opinion.