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Nail Care (Fingers and Toes) for CNAs

Written by Amanda R. McDaniel, MS, BSN, RN
Amanda is a BSN/RN with a MS in Physiology and a BA in English. She worked as a medical writer in the pharmaceutical industry for 11 years before pursuing a career in nursing. She now works as a nurse on a NeuroTelemetry unit and continues to write and edit on a freelance basis. Amanda’s LinkedIn

Nail care of both the feet and the hands should be performed as part of the patient’s daily hygiene routine. The status of the patient’s nails can reflect their overall health. Nail issues can also lead to infection that can spread systemically (ex, ingrown nails or fungus). You should never clip a patient’s nails with nail clippers, and always review your institution’s policy about what nail care is allowed.

Performing Nail Care

  1. Collect your supplies.
    • Wash, or emesis basins
    • Towels
    • Soft nail or cuticle brush
    • Nail file or emery board
    • Applicator stick (plastic is preferred to wood to avoid splinters)
    • Gloves
  2. Introduce yourself to the patient, perform hand hygiene, and put on gloves. Explain that you are going to take care of the nails on their hands and feet.
  3. Assist the patient to a chair, or seat them on the side of the bed if doing toenail care.
  4. Move the bedside table to a comfortable height over the patient’s lap if doing fingernail care.
  5. Fill the wash basin (for feet) and emesis basin(s) (for fingers) with warm water. Be sure to test the water temperature. Many patients (especially the elderly), have decreased sensation in their feet and hands and are at high risk for scalding injuries.
  6. Place the wash basin on a towel on the floor and place the patient’s feet in the wash basin.
  7. Lay a towel on the bedside table before placing the emesis basin on it. Have the patient place their fingers in the emesis basin.
  8. Allow hands and feet to soak for at least 10 minutes.
  9. As the hands and feet soak, carefully clean under the nails with the applicator stick.
  10. Using the nail or cuticle brush, clean around the cuticles.
  11. Remove the patient’s hands and feet from the basins and dry them thoroughly.
  12. If allowed by institutional or unit policy, use the emery board or nail file to gently remove any sharp corners from the nails.
  13. Empty the basins and dry any spills. Help the patient back to bed or to a comfortable position.
  14. Remove gloves and perform hand hygiene.
  15. Record the hygiene procedure per institutional or unit policy. Report any patient complaints of pain or tenderness or any signs of nail infections such as redness, unusual warmth, swelling, or misshapen nails to the nurse per policy.

Amanda R. McDaniel, MS, BSN, RN

References

Hygiene. (2014). In A. G. Perry, P. A. Potter, and W. R. Ostendorf (Eds), Clinical nursing skills & techniques (8th ed., pp. 420-424). St. Louis, MO: Mosby Elsevier.

More Resources

Prone Position

Prone position is not used as commonly as other patient positions. This position allows for full extension of the hips and the knees and gives many bony prominences a break from continuous pressure. However, placing patients in prone position does not come without the risks of pressure ulcers.

Oral Temperature Measurement with an Electronic Monitor

Body temperature is one of the vital signs frequently measured in healthcare settings. Changes in a body temperature can indicate improvement or worsening of a patient’s condition, so accurate measurement is important.

Assisting the Resident to Transfer from the Bed to a Chair or Wheelchair

It is important to remember on which side to place the chair when assisting a patient in transferring. Putting the chair on the resident’s unaffected side allows the resident to lead with his or her strong extremity. This eases the procedure for the resident and reduces the risk of falling.

Applying Elastic Support Hose

Elastic stockings are worn to prevent deep vein thrombosis (DVT) and reduce the pooling of blood in vessels. Many hospitals and care facilities use elastic stockings in patients with reduced mobility, such as surgical patients and/or the elderly. There are a few risks in wearing elastic stockings; however, these risks can be prevented with proper application and care.

Rectal Temperature with Electronic Thermometer

A rectal temperature provides the most accurate core body temperature reading compared to other non-invasive methods. This makes a rectal temperature desirable; however, this procedure comes with more patient discomfort and more safety risks (bowel perforation, mucosal damage, and/or vagus nerve stimulation) than the other temperature measurement methods.

Transferring the Resident from a Bed with a Mechanical Lift

A mechanical lift is used to transfer residents who cannot support their own weight. When used properly, mechanical lifts prevent injuries for both residents and health care workers. It is important that a nurse’s assistant be trained to use the mechanical lift before attempting to operate it. Most facilities require at least two health care workers to assist when using a mechanical lift.

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