Unit 5 - Advanced Nursing Foot Care Interventions

Question 1

Off-loading

Answer 1

reducing pressure by deflecting it away to an adjacent area or redistributing it over a larger area

Question 2

Padding

Answer 2

the material used to deflect or redistribute the pressure

Question 3

The basic mechanical principle of pressure says that…

Answer 3

pressure is equal to the total force per unit area

Question 4

Formula for calculating pressure

Answer 4

Pressure (P)

Force (F) - in kilograms (person’s weight)

DIVIDED BY

Area (A) in sq cm

Question 5

Unit the answer will be in

Answer 5

kg/sq cm

Question 6

If a person weighs 75 kg and the area of their foot that is in contact with the ground is 4 sq cm (2 cm X 2 cm) the pressure equals:

Answer 6

Pressure =

Force 75 kg

DIVIDED BY

Area 4 sq cm

= 18.75 kg/sq cm

Question 7

If the same weight is distributed over an area that is 16 sq cm (4 cm X 4 cm)

Answer 7

Pressure =

Force 75 kg

DIVIDED BY

Area 16 sq cm

= 4.69 kg/sq cm

Question 8

This results in…

Answer 8

a reduction of 18.75 – 4.69 = 14.06 kg/sq cm

Question 9

A warning about padding and footwear!

Answer 9

Warning!
If the footwear is not large enough to accommodate the padding, added padding could actually increase pressure and cause damage.

Question 10

In this foot care course, use of padding will be limited to simple, commercially available, over-the counter products. The padding discussed will be …

Answer 10

products that relieve pressure on the toes, dorsum or sides of the foot.

Question 11

In this foot care course, use of padding will be limited to simple, commercially available, over-the counter products. The padding discussed will be products that relieve pressure on the toes, dorsum or sides of the foot.

What about the plantar aspect of the foot?

Answer 11

Any change to plantar pressure with use of padding has the potential to alter gait, balance and stability drastically and must be managed by a professional trained to do so.

Question 12

Any change to plantar pressure with use of padding has the potential to alter gait, balance and stability drastically and must be managed by a professional trained to do so, WHO?

Answer 12

Either an orthotist or pedorthist

Question 13

Can a nurse make adjustment or modification to insoles?

Answer 13

Nurses doing adjustment or modification of insoles that change plantar pressure need

additional training
and
to be working as part of a team that includes an orthotist and/or pedorthist.

Question 14

Safety Guidelines for the use of over-the-counter (OTC) Padding:

Shoes (3)

Answer 14

many problems of pressure on toes, dorsum or sides of the foot can be alleviated or managed with appropriately fitted shoes alone

properly fitted shoes must precede use of padding

the client must wear shoes that properly accommodate their feet AND have room for the padding

Question 15

Safety Guidelines for the use of over-the-counter (OTC) Padding:

Self-care / Management @ home (2)

Answer 15

clients must be able to examine their feet or have a care-giver who can

clients must be able to apply and remove the device to clean or have someone that can help them

Question 16

Safety Guidelines for the use of over-the-counter (OTC) Padding:

Indications / Contraindications (1)

Answer 16

use only for clients that have good circulation and no peripheral neuropathy

Question 17

Safety Guidelines for the use of over-the-counter (OTC) Padding:

Proper use (2)

Answer 17

clients will usually not feel a padding device if it is properly fitted. Instruct clients to remove padding if it causes any discomfort

stop using a padding device if it does not have the desired effect after a period of trial (e.g. stop using a toe sleeve if it does not reduce the interdigital corn)

Question 18

Safety Guidelines for the use of over-the-counter (OTC) Padding:

5 rules to regurgitate on a test

Answer 18

many problems of pressure on toes, dorsum or sides of the foot can be alleviated or managed with appropriately fitted shoes alone

properly fitted shoes must precede use of padding

clients must be able to examine their feet or have a care-giver who can

clients must be able to apply and remove the device to clean or have someone that can help them

use only for clients that have good circulation and no peripheral neuropathy

Question 19

Where and When Referral is indicated:

Referral can be to ? (2)

Answer 19

a podiatrist
or
a pedorthist /orthotist with a prescription from a doctor

Question 20

Where and When Referral is indicated: (5)

Answer 20

plantar callus build-up that is not managed with regular foot care and suitable, well fitted shoes

plantar callus in a client with peripheral neuropathy and/or poor circulation

callus that is due to a permanent gait abnormality (e.g. leg length discrepancy)

foot deformity that cannot fit properly into a regular shoe

any concern that does not respond to conservative treatment and is disabling in the client’s view

Question 21

Types of Padding Used in Nursing Foot Care

Cotton ball or lamb’s wool - Describe. Used to?

Answer 21

easy to use padding

reduce friction between toes and absorb moisture

Question 22

Types of Padding Used in Nursing Foot Care

Cotton ball or lamb’s wool - How often to change

Answer 22

Daily

Question 23

Types of Padding Used in Nursing Foot Care

Cotton ball or lamb’s wool - Precaution?

Answer 23

if using lamb’s wool ensure that client is not allergic

Question 24

Types of Padding Used in Nursing Foot Care

Toe separator - Describe. Used to?

Answer 24

gel or soft foam/plastic in varying sizes

reduce friction and pressure between toes

Question 25

Types of Padding Used in Nursing Foot Care

Toe spreader - Describe. Used to? (3)

Answer 25

gel or soft foam/plastic in varying sizes

1) Spread one toe apart from another, usually the hallux
2) Reduce pressure on an involuted or ingrown toenail
3) With a small bunion can reduce the prominence of the 1st MTPJ

Question 26

Types of Padding Used in Nursing Foot Care

Toe crest or toe prop - Describe. Used to? (2)

Answer 26

gel, foam or soft fabric

lift and straighten claw or hammer toes and reduce callus formation on toe tips

Question 27

Types of Padding Used in Nursing Foot Care

Toe crest or toe prop used to lift and straighten claw or hammer toes and reduce callus formation on toe tip.

Works best with?

Answer 27

flexible toe deformities

Question 28

Types of Padding Used in Nursing Foot Care

Toe crest or toe prop used to lift and straighten claw or hammer toes and reduce callus formation on toe tip.

Works best with flexible toe deformities.

This being said…?

Answer 28

may be of limited benefit or uncomfortable if toes are rigid

Question 29

Types of Padding Used in Nursing Foot Care

Toe sleeves - Describe. Describe use. (1)

Answer 29

gel, fabric or foam in varying sizes

worn around a toe to reduce pressure and friction

Question 30

Types of Padding Used in Nursing Foot Care

Toe sleeves - Indications

Answer 30

used for hard corns or interdigital corns

Question 31

Types of Padding Used in Nursing Foot Care

Toe sleeves - Precaution?

Answer 31

it should be appropriate size and not restrict circulation

Question 32

Types of Padding Used in Nursing Foot Care

Corn pads - Describe. Used to?

Answer 32

gel, foam or felt in varying sizes

cushions and distributes pressure away from a bony prominence

Question 33

Types of Padding Used in Nursing Foot Care

Corn pads - HOLY FUCK.

Teach the client WHAT and WHY???

Answer 33

teach the client to USE UNMEDICATED CORN PADS ONLY

medicated corn pads or corn removers can damage healthy skin

Question 34

Types of Padding Used in Nursing Foot Care

Corn pads - Duration of use? More preferable than using corn pads?

Answer 34

use short term or occasionally

prefer that footwear be fitted to accommodate foot properly

Question 35

Types of Padding Used in Nursing Foot Care

Moleskin - Describe. Used to?

Answer 35

felt or soft flannel fabric with an adhesive backing.
comes pre-cut or in sheets that can be shaped to fit.

reduce friction over the skin

Question 36

Types of Padding Used in Nursing Foot Care

Moleskin - Client teaching

Answer 36

needs to be removed during hygiene

can be used as a small lining on footwear
e.g., a sandal strap

Question 37

Types of Padding Used in Nursing Foot Care

Moleskin - Duration of use?

Answer 37

best used short term or occasionally

Question 38

Types of Padding Used in Nursing Foot Care

Bunion or bunionette covers - Describe. Used to?

Answer 38

gel, foam or soft fabric in varying sizes

reduce pressure and/or friction to protect the skin

Question 39

Types of Padding Used in Nursing Foot Care

Bunion or bunionette covers - Describe fitting?

Answer 39

need to fit snugly but not restrict circulation

Question 40

Nail Splinting (or nail packing)

Indications for use.

Answer 40

Often when a toenail is trimmed too short or torn down the edge of the nail, it begins to grow out and presses into the fleshy pulp of the end of the toe.

This pressure can become painful for the client prompting them to attempt to further trim back the toenail perpetuating the problem or leading to formation of a spicule that can pierce the skin of the sulcus and cause an ingrown toenail.

In this situation, it may be helpful to use nail splinting to reduce discomfort and to protect the sulcus while the nail grows out to the correct length.

Question 41

Nail Splinting (or nail packing)

Contraindications for use. (3)

Answer 41

presence of infection

presence of peripheral neuropathy

client unable to clearly see and reach toe to monitor condition of toe or do not have a care-giver that can do so

Question 42

Nail Splinting (or nail packing)

Procedure for Nail Packing - 6 Steps

Answer 42

cleanse the area well with antiseptic

carefully and gently clean the debris from around the edge and side of the nail using a or black’s file or curette

carefully smooth the edges of the nail to remove any rough spots

prepare a rolled wisp of cotton soaked in alcohol or a thin strip (2 mm wide) cut from an alcohol pad approximately 2 to 3 cm long

use a black’s file or nail probe to gently insert the packing under the free lateral edge of the nail starting from the proximal to the distal free edge

allow the packing to fill the distal end of the sulcus and trim leaving a small “tail” if desired to facilitate removal

Question 43

Nail Splinting (or nail packing)

Procedure for Nail Packing - Client teaching (4)

Answer 43

there should be no discomfort when light pressure is applied to the nail plate and toe

keep the area clean with usual bathing and dry well

monitor daily and to seek medical attention if any pain, redness, swelling or discharge develop in the area

to remove the packing to gently pull the “tail” distally (not sideways)

Question 44

Nail Splinting (or nail packing)

Procedure for Nail Packing - How long to leave in place? (2)

Answer 44

advice differs on how long a nail splint should remain in place, ranging from 3 days to 3 months

if the nail splint does not cause any discomfort it can be left in until the next foot care visit but should be removed and the area assessed and reapplied if still needed at that time

Question 45

Nail Splinting (or nail packing)

Procedure for Nail Packing - Documentation?

Answer 45

document the procedure and outcome at subsequent visits