1
Q
General Guidelines for Cutting Normal Toenails
People who do not have normal toenails include those with?
A
poor circulation
peripheral neuropathy with loss of protective sensation
lack of self-care knowledge
history of foot ulcers
immunosupression from chronic disease or medication.
2
Q
People with complications can still be treated, but?
A
may need additional care and vigilance
3
Q
How should nails should be cut?
A
Following the natural curve of the nail.
4
Q
Nails should be cut following the natural curve of the nail.
Avoid…?
A
sharp 90 degree corners
5
Q
When trimming along the natural curve, the foot care nurse must not?
A
cut along the lateral or medial nail edges.
6
Q
When trimming along the natural curve, the foot care nurse must not cut along the lateral or medial nail edges.
This could lead to?
A
tissue trauma
7
Q
When trimming along the natural curve, the foot care nurse must not cut along the lateral or medial nail edges.
This could lead to?
A
tissue trauma
8
Q
Cutting the nails straight across is acceptable but?
A
care must be taken to avoid leaving sharp corners.
9
Q
Cutting the nails straight across is acceptable but care must be taken to avoid leaving sharp corners.
Why?
A
Sharp nail edges can rub against other toes and cause trauma to the skin.
10
Q
Nails should be cut just short enough to?
A
prevent the distal aspect of the nail from protruding past the distal aspect of the toe
11
Q
Clients who trim their own nails often present with?
A
spicules at the nail edges
12
Q
Clients who trim their own nails often present with spicules at the nail edges.
The foot care nurse should do what?
A
trim these spicules provided they are accessible and the procedure does not cause excessive pain to the client
13
Q
Note: prior to implementing nail care, what must be done?
A
a thorough assessment
14
Q
Steps for cutting NORMAL toenails
(19) - Eeep.
A
- Provide privacy
- Explain procedure (ensure written consent)
- Wash hands
- Assemble equipment on clean, convenient surface that is within easy reach
- Assist client into a comfortable sitting position
- Sit opposite or to the side of the client
- Don personal protective equipment
- Swab the toes & toenails with cleansing agent (ie: alcohol)
- Using a curette or a Black’s file, define the nail edge by gently running the instrument along the hyponychium of the nail
- Begin cutting the toenails by using the ingrow scissor, mustache scissor or nail nipper as appropriate for the client’s nails
- File rough nail edges with the Black’s file or Diamond Deb file
- Remove remaining detritus with the curette or Black’s file
- Check between all the toes for debris, remove carefully
- Cleanse toes & toenails
- Apply lotion if appropriate for client
- Assist client into a comfortable position
- Remove & store used equipment
- Wash hands
- Document
15
Q
- Assemble necessary equipment on clean, convenient surface that is within easy reach
(1)
A
cover surface with a clean towel or drape
16
Q
- Assist client into a comfortable sitting position
2
A
a. a reclining chair with an elevated foot rest is ideal for client with limited hip mobility
b. remember to reassess client comfort throughout the procedure
17
Q
- Sit opposite or to the side of the client
2
A
a. a chair slightly lower than the client’s will allow for more comfortable positioning
b. if available, a chair with wheels will allow the nurse to easily move around the client’s feet during the procedure
18
Q
- Don personal protective equipment
3
A
a. disposable gloves
b. safety glasses or goggles
c. mask
19
Q
- Using a curette or a Black’s file, define the nail edge by gently running the instrument along the hyponychium of the nail
(2)
A
a. defining the nail edge allows the nurse to “get a feel” for how much space is between the nail plate and the nail bed
b. defining the nail edge allows the nurse to remove detritus from under the nail
20
Q
- Begin cutting the toenails by using the ingrow scissor, mustache scissor or nail nipper as appropriate for the client’s nails
(3)
A
a. cut at one corner of the nail and “nibble” across
b. follow natural curve of nail
c. cut just short enough so the nail does not extend past the tip of the toe
21
Q
- File rough nail edges with the Black’s file or Diamond Deb file
(2)
A
a. the Black’s file small surface makes it an ideal instrument to file away spicules
b. file in one direction only (dorsal→plantar or medial→lateral)
22
Q
- Apply lotion if appropriate for client
1
A
a. never apply lotion between toes or leave lotion on toenails
23
Q
- Assist client into a comfortable position
1
A
a. client may require assistance to put foot wear back on
24
Q
- Document
3
A
a. nail care performed
b. observations
c. client response
25
If the integrity of the skin is accidentally breached during foot care, DO WHAT?
DO NOT do WHAT?
Finally?
wipe area clean with skin antiseptic
cover with loosely applied sterile gauze or a Band-Aid®.
Do not apply constrictive adhesive dressings to toes.
A protocol should be developed for the daily monitoring and documenting of the wound healing process.
26
After demonstrated safe use, the nurse may use the Dremel to:
(2)
effectively reduce thick, callused skin on the feet, in addition to or in place of a foot file
effectively reduce, smooth and trim thick, overgrown nails
27
The nurse must ensure safe and prudent DREMEL practice, including the following guidelines:
(4)
read and follow safety rules noted in the owner’s manual
wear PPE (goggles, face mask etc.)
follow established infection control guidelines following use
use only podiatric burrs for foot care
28
WHAT IS MOTHER FUCKING very important WHEN USING THE DREMEL???
WHY?????
Using the appropriate amount of downward pressure
There is a fine line between too much and not enough. If you use too little pressure, the nail will not be affected, but if you use too much pressure, the nail can be damaged.
29
What are the 3 accessories to use with the Dremel?
3/32" collet (2.4 mm) specific for podiatry burr
Collet nut
Podiatry burr
30
What do you need to explain to the client re. Dremel use in foot care?
the dermal will vibrate but not cause pain
31
How do you hold a Dremel?
balance the Dremel in your hand using the pencil/pen grip
32
When balancing the Dremel in your hand using the pencil/pen grip, what must you take care to do?
Why?
keep fingers off the shaft lock pin during operation
this may loosen and dislodge the burr
33
Speed you should use?
Why?
low speed (5,000 RPM)
for safety and control
34
Describe what each hand should be doing while using the Dremel.
Firmly anchor the Dremel in one hand while anchored to the client's toe or foot.
The other hand should be used to stabilize the clients toe/foot, to keep the drill from 'slipping' onto surrounding fragile skin.
35
Describe technique for using Dremel on nails.
start at the proximal edge of the nail plate and move to the distal edge
36
Describe technique for using Dremel on calluses (hyperkeratoses).
(3)
start near the centre and move out towards the edges of the callus
allow the podiatry burr to contact the surface of the callus using minimal pressure and constant movement
avoiding contact with thinner, non-callused skin
37
Describe Dremel contact with the nail plate.
gently touch the nail plate with the burr for 2 to 3 seconds at a time (no more than 5 seconds at a time)
38
Gently touch the nail plate with the burr for 2 to 3 seconds at a time (no more than 5 seconds at a time).
Repeat this series of short touches with the burr, frequently...?
checking the working area with finger of free hand
39
Gently touch the nail plate with the burr for 2 to 3 seconds at a time (no more than 5 seconds at a time).
Repeat this series of short touches with the burr, frequently checking the working area with finger of free hand to feel that...?
(3)
the burr is not penetrating too deeply
causing any build up of "heat'
accidentally touching surrounding fragile tissue
40
When reducing onychogryphotic nails with the Dremel...?
allow the podiatry burr to contact the surface of the nail using minimal pressure avoiding contact with the sulci
41
D/C Dremel use if...?
| 2
skin / nail becomes warm
client reports any discomfort
42
How to not Dremel a toe off?
TAKE YOUR TIME AND DO NOT RUSH!
Take the time to work gently and carefully, especially when beginning.
43
Steps for cutting THICKENED toenails
19 points, but in this case,
steps 8-10 are specific to THICK
1. Provide privacy
2. Explain procedure (ensure written consent)
3. Wash hands
4. Assemble equipment on clean, convenient surface that is within easy reach
5. Assist client into a comfortable sitting position
6. Sit opposite or to the side of the client
7. Don personal protective equipment
*******************
8. Cut the toenails as detailed in the Guidelines for Cutting Normal Toenails
9. For toe nails that are onychogryphotic, the Dremel with podiatric burr should be turned on according to the manufacturers instructions
10. Pass the podiatric burr over the thickened nail for 2-3 seconds
*******************
11. File rough nail edges with the Black’s file or Diamond Deb file
12. Remove remaining detritus with the curette or Black’s file
13. Check between all the toes for debris, remove carefully
14. Cleanse toes & toenails
15. Apply lotion if appropriate for client
16. Assist client into a comfortable position
17. Remove & store used equipment
18. Wash hands
19. Document
44
9. For toe nails that are onychogryphotic, the Dremel with podiatric burr should be turned on according to the manufacturers instructions
(2)
a. allow the burr to contact the nail surface with moderate pressure
b. avoid touching the surrounding skin with the podiatric burr
45
10. Pass the podiatric burr over the thickened nail for 2-3 seconds
(5)
a. palpate the nail for excessive heat
b. ask for client feedback related to discomfort
c. do not hold the podiatric burr on the nail for greater than 5 seconds
d. stop the Dremel if the nail becomes hot or client reports discomfort
e. the nails should be reduced to an appropriate level to ensure nails are smooth and trimmed to effectively remove pressure from the nail beds
46
Onychocryptosis
When should nursing intervx be implemented and why?
immediately
to prevent skin integrity breakdown and potential infection
47
Onychocryptosis
If infection IS NOT present, what should the nurse do?
(5)
use a curette to define the spicule
cut with a slight angular cut to remove the spicule
leave the nail long enough to cover and protect the soft tissue of the nail
swab the area well with alcohol
ensure that all the nail has been removed
48
Onychocryptosis
If infection IS present, what should the nurse do?
If infection is present or the condition of the nail is beyond the scope of nursing practice or practitioner comfort level, refer to a physician.
49
Onychocryptosis
Client teaching
(6)
proper fitting footwear
proper nail care to prevent ingrown nails
review particulars with client and try to identify what may have contributed to ingrown nail (e.g. tight shoes or injury) and how to prevent reoccurance
consider the use of simple toe spacers (e.g. 'tubifoam') to temporarily reduce pressure to affected nail
a client that is NOT immunocomprimised has good circulation can use a warm saline soak
consider referral for partial nail avulsion in the case of prolonged or repeated problems and if client is in agreement
50
Onychocryptosis
Client teaching
consider the use of simple toe spacers (e.g. 'tubifoam') to temporarily reduce pressure to affected nail
IF AND ONLY IF:
client has no signs of poor circulation
client can adequately manage the device independently
client can monitor for skin breakdown
client has footwear that will accommodate the padding
51
Onychocryptosis
Instructions for a WARM SALINE soak?
What will this do?
1 t of table salt to 500 ml of warm water
5 - 10 minutes
1 - 2/day
for 2 - 3 days
promote healing and reduce discomfort
52
Onychogryphosis
| ```
Nursing intervx
5
```
trim by slowly “nibbling” across nail
do not remove too much of nail as this can cause further trauma to the nail bed
reduce the thickness of the nail by using a metal file or Dremel
ensure all nail surfaces are smooth and not likely to 'catch' on socks
NARC
consider referral to doctor or Social Services agency if you suspect that very long nails may be related to general poor health, neglect or other chronic illness and if client does not exhibit signs of a social support system
53
Onychogryphosis
| Nursing teaching
5
proper fitting footwear (adequate toe box)
regular foot care
refer to appropriate health professional as necessary
advocate for support with family and current services for client to obtain proper footwear and regular foot care if needed
54
Onychomycosis
Nursing intervx are dependent on what?
dependant on the severity of the fungal infection and the client’s ability to participate in treatment regime
55
Onychomycosis
Nursing intervx
(4)
reducing thickness by filing with metal file or Dremel to reduce pressure on the nail in footwear
*** must wear a mask when filing fungal nails to prevent nail dust inhalation
refer to a physician for nail cultures and prescription if necessary
be supportive of your client’s choices
regular foot care follow up at an interval that will maintain nails in comfort
56
Onychomycosis
Nursing teaching
encourage adequate footwear and good hygiene
be knowledgeable and prepared to discuss current and evidenced-based types of treatment for fungal nails including various products, length of treatment and possible side effects
seek medical attention if any signs and symptoms of infection under nail or in surrounding tissue develop
57
Heloma Durum -- hard corns
Nursing intervx
(4)
examine footwear - causing pressure at site of corn
unmedicated corn pads or padding for temporary relief if client can adequately monitor for skin breakdown and footwear can accommodate the extra space
reduce the pressure by gently filing with Diamond Deb or Dremel
refer if non-invasive procedures ineffective
58
Heloma Durum -- hard corns
Nursing Intervx
reduce the pressure by gently filing with Diamond Deb or Dremel.........BUT?!
Do not remove all of the hyperkeratotic tissue.
Leave enough for protection especially until cause of corn is resolved.
59
Heloma Durum -- hard corns
Nursing Intervx
refer if non-invasive procedures ineffective.........WTF can a podiatrist do?! (2)
provide debridement and enucleation of hyperkeratotic lesions to relieve pain
create custom device to reduce pressure to area longer term if needed
60
Heloma Durum -- hard corns
What should never be used?
Why?
acid-base preparations
viable tissue may be damaged
61
Heloma Durum -- hard corns
Nursing teaching
ensure understanding that corns will continue to reoccur until the offending footwear or cause of pressure is permanently removed
padding should only be used as a temporary measure
seek medical attention if any signs and symptoms of infection under corn or in surrounding tissue develop
62
Heloma Molle -- soft corns
Nursing intervx
check footwear to see if it is wide enough to accommodate toes without causing interdigital pressure
encourage client to keep area dry (use of astringent) such as alcohol
may try using padding (felt or foam) to relieve the pressure
may require referral if non-invasive procedures are ineffective
63
Heloma Molle -- soft corns
Nursing intervx
may try using padding (felt or foam) to relieve the pressure, be certain that...?
the wedge is not touching the corn and the shoe can accommodate the foot along with the padding and client can monitor for skin breakdown
64
Heloma Molle -- soft corns
Nursing intervx
may require referral if non-invasive procedures are ineffective.........WTF can a podiatrist do?! (2)
may provide debridement and enucleation of hyperkeratotic lesions to relieve pain
create custom device to reduce pressure to area longer term if needed
ENUCLEATION
to deprive of a nucleus
to remove without cutting into
65
Heloma Molle -- soft corns
Nursing Teaching (3)
ensure that client understands that corns will continue to reoccur until the offending footwear or cause of pressure is permanently removed
padding should only be used as a temporary measure
seek medical attention if any signs and symptoms of infection under corn or in surrounding tissue develop
66
Heloma Milliare -- seed corns
Nursing intervx (1)
file flat with file or Dremel
67
Tyloma -- callus
What should the nurse examine and why?
Nursing intervx
footwear and gait and to see if cause of callus build up can be determined
68
Tyloma -- callus
What should the nurse examine and why?
Nursing intervx
When should the nurse treat a tyloma and how? (3)
if callus is color of surrounding skin, can reduce (some) of the thickened area using a file or Dremel (on dry skin)
be sure not to remove the entire callus, leave some to protect the area. The callus should be reduced to the point that the consistency of the callus to palpation is similar to the surrounding skin
moisturize with emollients
69
Tyloma -- callus
What should the nurse examine and why?
Nursing intervx
When should the nurse NOT treat a tyloma?
If you cannot treat, what should you do?
if callus is severely thickened or any discoloration, subkeratotic hematoma or hemorrhagic tissue visible underneath, referral to physician or podiatrist is indicated
70
Tyloma -- callus
What should the nurse examine and why?
Nursing intervx
What if callus build-up continues to be a problem between treatments?
if callus build-up continues to be a problem between treatments and in the presence of adequate footwear then an off-loading strategy is indicated with referral to appropriate care-giver.
71
Tyloma -- callus
What should the nurse examine and why?
Nursing teaching
self-care to manage callus regularly using
foot file
pumice stone
moisturizer
discuss how improper or inadequate footwear contributes to callus build-up (e.g. open backed shoes allow heels to dry out)
reinforce that adequate or therapeutic footwear must be maintained and worn continuously in order to be effective
teach client to seek medical attention if any signs and symptoms of infection under callus or in surrounding tissue develop
72
Steps for reducing a tyloma
16 points
1-7
and
13-16
are the same as cutting toenails
1. Provide privacy
2. Explain procedure (ensure written consent)
3. Wash hands
4. Assemble equipment on clean, convenient surface that is within easy reach
5. Assist client into a comfortable sitting position
6. Sit opposite or to the side of the client
7. Don personal protective equipment
8. A small or moderate sized callus can be removed using a Diamond Deb file. Pass the file over the callus in one direction only for no longer than 30 seconds at a time.
9. The Dremel with podiatric burr can be used to reduce a callus. It should be turned on according to the manufacturers instructions
10. Pass the podiatric burr over the callus for 2-3 seconds
11. If a corn or callus is severely thickened or should a subkeratotic hemotoma be suspected, refer to a podiatrist or nurse clinician
12. Apply an emollient or lotion if appropriate for client
a. never apply lotion between toes or leave on the toe nails
13. Assist client into a comfortable position
14. Remove & store used equipment
15. Wash hands
16. Document
73
Steps for reducing a tyloma
9. The Dremel with podiatric burr can be used to reduce a callus. It should be turned on according to the manufacturers instructions
(2)
a. allow the burr to contact the callus surface with moderate pressure
b. avoid touching the surrounding skin with the podiatric burr
74
Steps for reducing a tyloma
10. Pass the podiatric burr over the callus for 2-3 seconds
(4)
a. palpate the skin for excessive heat
b. ask for client feedback related to discomfort
c. do not hold the podiatric burr on the skin for greater than 5 seconds
d. stop the Dremel if the skin becomes hot or client reports discomfort
75
Verruca Plantaris -- plantar wart
Nursing intervx (2)
if evidence of callus buildup around the wart, reduce the callus using file or Dremel
```
if wart painful and bothersome, refer to physician or podiatrist for treatment and removal by
cryotherapy
salicylic acid preparations
or
laser treatment
```
76
Verruca Plantaris -- plantar wart
Nursing teaching
provide information about the spread and control of virus and general hygiene.
many plantar warts resolve without treatment within 1 to 2 years through the body’s own immune system producing the appropriate antibodies
protect bare feet in public places
teach client to seek medical attention if any signs and symptoms of infection in surrounding tissue develop
77
Tinea Pedis -- Athlete’s Foot
Nursing intervx
Taking care of @ home. (4)
keep feet clean and dry (preventative), dry well between toes
simple maceration will resolve with better drying
if symptoms appear, use of isopropyl rubbing alcohol 70% between toes to help dry the skin
tersaseptic foot soaks
(one capful diluted in 6-8 litres of warm water)
78
Tinea Pedis -- Athlete’s Foot
Nursing intervx
WHO to refer to MD? (3)
clients with diabetes or other serious chronic illness to
anyone with signs of secondary infection or cellulitis
anyone whose symptoms do not resolve in 2 weeks with OTC treatment or reoccurrence
79
Tinea Pedis -- Athlete’s Foot
Nursing intervx
An otherwise healthy client can consult who
For what Sx?
For what Tx
A pharmacist
if symptoms of blisters, "burning", intense itchiness or foul odor are present,
an OTC cream, powder or spray
80
Tinea Pedis -- Athlete’s Foot
Nursing teaching
General (1)
Footwear (4)
OTCs (1)
provide information on control and spreading of infection
encourage regular changes of clean socks, and stocking with little nylon content
alternate shoes regularly, sandals in the summer
advise to use footwear in public places such as locker rooms and swimming pools.
it may be helpful to treat footwear with powder or spray
follow product instructions, but it is often advisable to treat for a week beyond resolutions of symptoms to prevent reoccurrence
81
Hyperhydrosis
This condition may indicate?
Management? (2)
PRN?
excessive sweating may indicate a medical disorder, (ie: hypothyroidism)
sweat-absorbing insoles
changing and airing out footwear regularly
refer to appropriate health professional as necessary
82
Bromhydrosis
Treatment? (2)
Advise client? (2)
PRN?
good foot hygiene
germicidal foot soaks followed by careful drying
advise client to change socks daily
choose shoes that will allow the feet to breathe (sandals in the summer)
refer to the appropriate health professional as necessary
83
Anhidrosis
Treatment?
Education?
PRN?
application of emollients (urea based) and barrier creams daily
educate client NOT to soak feet, as this will worsen the condition
refer to the appropriate health professional as necessary
84
Dry Fissures
Interventions (2)
can reduce any callus build up with foot file or Dremel
moisturize
85
Dry Fissures
Teaching (4)
wear shoes with closed heels to prevent drying out
moisturize+++
as often and as much as it takes to maintain skin hydration
use foot file or pumice stone after bath
for 30 to 60 seconds at a time
then moisturize
seek medical attention if any signs and symptoms of infection in surrounding tissues develop.
86
Moist Fissures
Teaching (5)
dry well and use skin astringent like alcohol to promote dryness
use creative methods to dry between toes, e.g. hair dryer, Q-tips, reaching device
open footwear if possible
socks that will wick moisture away from skin
seek medical attention if any signs and symptoms of infection in surrounding tissues develop
87
Hallux Valgus (Bunion)
Nursing Interventions
Symptomatic treatment of hallux valgus is aimed at?
ensuring that friction over the medial bump does not cause tissue breakdown and necrosis
88
Hallux Valgus (Bunion)
Nursing Interventions
Symptomatic treatment of hallux valgus is aimed at ensuring that friction over the
medial bump does not cause tissue breakdown and necrosis.
What will help?
Proper footwear that is sufficiently soft and provides adequate width and depth of toe box
89
Hallux Valgus (Bunion)
Nursing Interventions
What should be avoided?
Slip on shoes
90
Hallux Valgus (Bunion)
Nursing Interventions
What may reduce pain and inflammation?
Cool compresses may reduce pain and inflammation.
91
Hallux Valgus (Bunion)
Nursing Interventions
What may provide temporary relief?
Who can use them?
bunion pads
Effective padding techniques require a trained and experienced practitioner.
92
Hallux Valgus (Bunion)
Nursing Interventions
What must be performed and why?
Routine foot care
to avoid corn and callus formation
93
Hallux Rigidus
```
Nursing intervx (1)
Nursing teaching (1)
PRN (1)
```
Padding to protect and relieve the pain.
use of proper footwear (rocker sole).
Refer to appropriate health professional as necessary
94
Hammertoe, Claw Toe & Mallet Toe
Nursing intervx
What is the main aim of intervx?
What are THREE ways to do this?
The main aim of intervention is to prevent secondary lesions.
Padding to protect from minor pressure points and friction.
Extra depth in the toebox of shoes is recommended to accommodate the deformity.
Routine foot care to assess for, treat and prevent corn and callus formation.
95
Hammertoe, Claw Toe & Mallet Toe
Nursing teaching
Promote what? (2)
When to refer to health care provider?
When might surgical intervx be necessary?
Promotion of proper footwear and orthotics as appropriate.
if recurring pain or ulceration is present.
Surgical intervention may be necessary if recurring pain or ulceration occurs.
96
Overlapping toes
Nursing intervx
Routine foot care to assess and treat callus and corn formation.
Proper fitting footwear to accommodate the overlapping toes is essential.
Padding can be used to cushion the affected toe.
97
Overlapping toes
Nursing teaching
proper footwear and orthotics as appropriate
Refer to health care provider if recurring pain or ulceration is present.
Refer to appropriate health professional as necessary.
98
Pes Planus (Flat Foot)
Intervx (1)
Education (2)
Use cushioning or moleskin to reduce pressure over the unnatural weight bearing areas.
proper footwear.
Refer to appropriate health professional as necessary.
99
Pes Cavus (High Arch)
Intervx (1)
Education (2)
Padding to protect areas of unnatural weight bearing areas.
proper footwear (plenty of cushioning)
Refer to the appropriate health professional as necessary.
100
Metatarsalgia
Treatment is?
When to refer to physician for diagnosis?
Who else to refer to? For what?
What can be accomplished with a variety of OTC products?
What OTC is suggested?
What should these be combined with and why?
specific to the cause
any persistent pain accompanied by redness/swelling
podiatrist, orthotist or pedorthist
or orthotics designed to relieve pressure and redistribute weight from the painful areas to more tolerant areas
off-loading pressure to the ball-of-the-foot
gel metatarsal cushion pads
gel metatarsal cushion pads worn with proper footwear for significant relief of pain
101
Plantar Fasciitis
Nursing intervx
Refer to who? For what?
What does Tx include?
What is important?
What do advise against? Why?
physician, podiatrist or physiotherapist
for proper diagnosis of heel pain
rest
ice
proper stretching exercises
possibly anti-inflammatory med
exercise and proper footwear (arch support/heel cushioning) is important
advise against walking barefoot
plantar surface will be unsupported
102
Haglund’s Deformity (Pump Bump)
Nursing Intervention (5)
appropriate footwear (avoid high heels or slip-on shoes)
ice
stretching exercises to relieve tension of
Achilles Tendon
heel pads
referral to a pedorthist if shoe modification is needed
103
Client Education
Client education is an important nursing intervention.
What can it achieve? (4)
empower the client by increasing their knowledge of basic foot health
encourage responsibility for own feet
provide necessary knowledge of specific pathological conditions (as appropriate)
ensure an understanding of nursing recommendations in order to maximize foot care effectiveness
104
Client Education
What must the nurse assess?
the individual’s ability to learn or perform proper foot care
105
Client Education
What must the nurse emphasize?
the importance of proper nail cutting and foot health
106
Client Education
Individuals with compromised feet?
Educate individuals with compromised feet to the importance of proper footwear and care of the feet.
107
Client Education
general principles of client education for good foot health
Do NOT (5)
use commercial (acid-based) preparations to remove corns/calluses
use razor blades or knives to cut toe nails or reduce calluses
wear tight or inappropriate footwear
cross feet or legs or wear constrictive stockings or garter belts
attempt long walks when lower extremities are painful or swollen
108
Client Education
general principles of client education for good foot health
AVOID (6)
walking barefoot
soaking feet unless as part of regular hygiene (no more than 10 minutes)
heating pads or hot water bottles
wearing socks that are darned, torn or rough to prevent skin breakdown
wearing new shoes for more than 2 hours at one time
lotions with high concentration of alcohol or perfume
109
Client Education
general principles of client education for good foot health
encourage (5)
regular exercise
regular foot care if client unable to care for feet
mild soap for washing
purchasing of new shoes late in the day, as feet tend to swell
appropriate footwear and have both feet measured each time footwear is purchased
