1 1. reduce pain prevent potential injury subungual ulceration subungual hematoma cosmesis not...
TRANSCRIPT
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Palliative Care
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Why Do We Reduce Toenails? Reduce pain
Prevent potential injury Subungual
ulceration Subungual
hematoma
Cosmesis
Not everyone is a candidate for definitive treatment
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Reducing a toenail: Step 1—assess the patient
PVD?
Neuropathy?
Other immunocompromise?
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Reducing a toenail: Step 2—collect needed materials
Gloves
Eye Protection
Gauze
Nail nippers
Bandaids
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Reducing a toenail: Step 3—stabilize the toe
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Reducing a toenail: Step 4—Reduce the toenail
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Reducing a toenail: Watch for flying toenail
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Don’t try this technique with thick toenails
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Reducing a toenail: How far back do you cut?
Depends on the condition of the toenail
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Reducing a toenail: Step 5—Smooth the nail surface
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Reducing a toenail: Podospray
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Why reduce corns and calluses?
Pain
Potential ulceration
Difficult definitive treatment
Not all patients are good candidates for surgical treatment
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Corn Synonyms
Heloma durum (HD)
Excrescence
Hyperkeratosis
Hyperkeratotic papule
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Callus Synonyms
Tyloma
Intractable Plantar Keratosis
Hyperkeratotic papule
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Debriding a callus: Step 1—assess the patient
PVD?
Neuropathy?
Other immunocompromise?
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Debriding a callus: Step 2—Gather appropriate materials Gauze
Blade handle
Blade
Kelly Forceps
Gloves
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Debriding a callus: Step 3—Load the blade
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Debriding a callus: Step 4—Hold the Blade
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Debriding a callus: Step 4—Hold the Blade
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Debriding a callus: Step 4—Hold the Blade
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Debriding a callus: Step 5—Don’t forget negative pressure
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Debriding a callus: Step 6—When do you stop?
Blood
Color
Texture
Skin Lines
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Palliative Foot Care: What if you see blood?
Don’t say “oops” Inform the patient Hemostasis Clean with alcohol Dress with antibiotic Cover with a
bandaid Patient instructions Follow up
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Hemostatic solutions
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Palliative Foot Care: Billing Issues
C&C is not covered by Medicare, unless…
Normal toenails are not covered by Medi-Cal
Most private insurance co’s do not cover C&C