College of Nursing
The Nails
Season 2, Episode 4
ANATOMY AND PHYSIOLOGY OF
THE NAILS
Nails
• Assist in grasping objects
• Protect the distal ends of
fingers and toes (from
trauma)
• Fingernails grow 0.1
mm/day
– toenails are slower
Nails
• Complete replacement
of nail plate:
– Finger (4-6 months)
– Toe (12-18 months)
Nails
• Parts:
– Lunula (whitish moon)
– Nail plate (firm,
rectangular, and curving;
site of attachment of nail
bed)
– Cuticle (extends from nail
fold, functions as a seal,
protects space between
fold and plate from
external moisture)
Nails
• Parts:
– Lateral nail fold (covers
sides of nail plate)
– Proximal nail fold (covers
¼ of the nail plate [nail
root])
– Free edge (0.1 mm/day
or slower if toenails)
Season 2, Episode 4
ASSESSMENT OF THE NAILS
Nail Assessment
• Equipment needed:
– Acetone
– Cotton ball
Nail Assessment
1. Inspect fingernail plate shape
– Determine its curvature and angle
2. Inspect fingernail and toenail textures
3. Inspect fingernail and toenail color, lesions,
and obvious deformities
Season 2, Episode 4
NAIL GROOMING, COLOR,
MARKINGS, AND SHAPE
Nail Grooming
• Normal
– Clean, manicured
Nail Grooming
• Abnormal
– Dirty, jagged, or broken
(poor hygiene or related
to client’s occupation)
Nail Grooming
Nail Color
• Normal
– Pink with some
longitudinal ridging
– May have
freckles/pigments (darkskinned)
Nail Color
• Abnormal
– Pale or cyanotic (hypoxia
or anemia)
Nail Color
• Abnormal
– Splinter hemorrhages
(trauma)
Nail Color
• Abnormal
– Yellow discoloration
(fungal infection or
psoriasis)
Nail Shape
• Schamroth’s technique
– Put ring fingernails together
– Locate diamond-shaped space in between the
fingernails (normal finding)
Nail Shape
• Schamroth’s technique
– No diamond shape
(clubbing of the fingers)
Nail Shape
Nail Shape
• Angles formed between
the nail base and skin:
– 160⁰ (normal)
– 180⁰ (early clubbing +
spongy sensation)
– >180⁰ (late clubbing)
Nail Texture
• Present and smooth (normal)
• May be thickened and yellowish due to
decreased circulation (elderly)
• Excessive thickness due to hypoxia (clubbing)
Nail Texture
• Beau’s lines
– Transverse linear
depression (associated
with an acute, severe
illness)
– Bilateral (usually)
Nail Texture
• Beau’s lines
– Due to temporary
disruption of proximal
nail growth (systemic
illness)
– Timing of illness may be
estimated by measuring
distance from line to the
nailbed
Nail Texture
• Koilonychia
– Spoon-shaped nails
– Loss of convexity
– Consider iron-deficiency
anemia
Nail Texture
• Mees’ lines
– Transverse lines similar to
the lunula (crosses the
nail)
– Occur following an acute or
severe illness
– Vary in width
– Moves distally as nail
grows out
Nail Texture
• Mees’ lines
– Arsenic poisoning
– Heart failure
– Hodgkin’s disease
Nail Texture
• Mees’ lines
– Chemotherapy
– Carbon monoxide
poisoning
– Leprosy
Nail Texture
• Onycholysis
– Painless separation of
the nail plate from the
pinker nailbed
– Starts distally, progresses
proximally (enlarges free
edge of the nail)
Nail Texture
• Onycholysis
– Local (trauma from
excess manicuring,
psoriasis, fungal
infection, and allergy to
cosmetics)
Nail Texture
• Onycholysis
– Systemic (diabetes,
anemia, photosensitive
drug reactions,
hyperthyroidism,
peripheral ischemia,
bronchiectasis, and
syphilis)
Nail Texture
• Paronychia
– Indicates local
inflammation of
proximal and lateral nail
folds (superficial
infection)
– Nail folds are red,
swollen, and tender
Nail Texture
• Paronychia
– Most common infection
of the hand (Staph and
Strep spp)
– May spread until
completely surrounds
nail plate
Nail Texture
• Paronychia
– Local trauma (nail biting,
manicuring, or frequent
hand immersion in
water)
Nail Texture
• Paronychia
– May create a felon
(painful abscess on
fingertip) if extends into
pulp space of finger
Felon
Remember
• Also inspect the
surrounding tissue:
– Intact epidermis
(normal)
– Presence of hangnails
(abnormal)
Remember
• Perform blanch or
capillary refill test
– 2-3 seconds (normal)
SLOW CRT
Remember
• Always document your
findings
Season 2, Episode 4
LIFESPAN CONSIDERATIONS
Lifespan Considerations
• Neonate/Newborn
• Children
• Elders
Lifespan Considerations
• Neonate/Newborn
– Nails grow quickly,
extremely thin, and tear
easily
Lifespan Considerations
• Children
– Bent, bruised, or
ingrown nails (shoes too
tight)
– Nail-biting should be
discussed with family
member
Lifespan Considerations
• Elderly
– Nails grow slower and
thicker
– Nails tend to split
Lifespan Considerations
• Elderly
– Toenail fungus is more
common and difficult to
eliminate (not
necessarily dangerous to
health)
Lifespan Considerations
• Elderly
– Longitudinal bands commonly develop
• Bands across nails → protein deficiency
• White spots → zinc deficiency
• Spoon-shaped nails → iron-deficiency
THANK YOU.