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Palliative Care. 1. Why Do We Reduce Toenails?. Reduce pain Prevent potential injury Subungual ulceration Subungual hematoma Cosmesis Not everyone is a candidate for definitive treatment. Reducing a toenail: Step 1—assess the patient. PVD? Neuropathy? Other immunocompromise?.
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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
Reducing a toenail: Step 1—assess the patient • PVD? • Neuropathy? • Other immunocompromise?
Reducing a toenail: Step 2—collect needed materials • Gloves • Eye Protection • Gauze • Nail nippers • Bandaids
Reducing a toenail: How far back do you cut? • Depends on the condition of the toenail
Why reduce corns and calluses? • Pain • Potential ulceration • Difficult definitive treatment • Not all patients are good candidates for surgical treatment
Corn Synonyms • Heloma durum (HD) • Excrescence • Hyperkeratosis • Hyperkeratotic papule
Callus Synonyms • Tyloma • Intractable Plantar Keratosis • Hyperkeratotic papule
Debriding a callus: Step 1—assess the patient • PVD? • Neuropathy? • Other immunocompromise?
Debriding a callus: Step 2—Gather appropriate materials • Gauze • Blade handle • Blade • Kelly Forceps • Gloves
Debriding a callus: Step 6—When do you stop? • Blood • Color • Texture • Skin Lines
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
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