Nails 1
ALLENTOWN COLLEGE OF ST. FRANCIS DE SALES
DEPARTMENT OF NURSING AND HEALTH
Nursing 201
Nursing Skills Laboratory Procedure: Assessment of the Nails
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ACTION
Inspect the curvature of the nail plate of the nails, by observing the curvature of
the nail plate of the client’s nails from all angles
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Inspect the folds around the nail plate of the nails, by observing the folds around
the nail plate of the client’s nails from all angles
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Inspect the edges of the nails, by observing the edges of the client’s nails from all
angles
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Inspect the angle between the nail plate and nail base, by observing the angle
between the nail plate and nail base of the client’s nails from all angles
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Palpate the nails for adhesion, by 1) grasping each of the client’s nails between
the thumb and pad of the index finger of your right hand, 2) squeezing each of the
client’s nails between the thumb and pad of the index finger of your right hand,
and 3) observing the movement of the client’s nail plate between the thumb and
pad of the index finger of your right hand
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Inspect the surface of the nail plate, by observing the surface of the nail plate of
the client’s nails from all angles
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NORMAL FINDINGS
Symmetry
Nail plate is flat or
slightly curved
Symmetry
Nail folds are smooth,
rounded, warm, and
nontender
Color of the nail folds
is consistent with
genetic background
Symmetry
Nail edges are
smooth, rounded, and
clean
Symmetry
Angle between the nail
plate and nail base is
160
Symmetry
Nail plate is firmly
adherent to the nail
bed with only a slight
degree of mobility
Nail base is firm
Symmetry
Surface of the nail
plate is regular, even
ABNORMAL FINDINGS
 Asymmetry
 Koilonychia (Spoon
nail)
 Asymmetry
 Paronychia
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Asymmetry
Nail edges are rough,
jagged, and dirty
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Asymmetry
Clubbing
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Asymmetry
Onycholysis
Nail base is spongy or
floating
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Asymmetry
Surface of the nail
plate is irregular,
uneven
Nails 2
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Inspect the color of the nail plate and the nail bed underneath the nail plate, by
observing the color of the nail plate and the nail bed underneath the nail plate of
the client’s nails from all angles
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Inspect the thickness of the nails, by observing the thickness of the client’s nails
from all angles
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Symmetry
Nail plate is
translucent
Color of the nail bed
underneath the nail
plate is consistent with
genetic background
Nail bed underneath
the nail plate has
brownish-black
pigmented areas or
linear bands or
streaks along the nail
edge (in dark-skinned
people)
Symmetry
Thickness of the nail
plate is even, unridged
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Beau’s line
Longitudinal ridging
Asymmetry
Nail plate is opaque
Color of the nail bed
underneath the nail
plate exhibits
cyanosis, pallor
Nail bed underneath
the nail plate has
brownish-black
pigmented areas or
linear bands or
streaks along the nail
edge (in light-skinned
people)
Splinter hemorrhages
Asymmetry
Thickness of the nail
plate is uneven, ridged
Nails 3
ABNORMALITIES OF THE NAILS
ABNORMALITY
Koilonychia (Spoon nail)
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Paronychia
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Clubbing
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Onycholysis
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Beau’s line
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Longitudinal ridging
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Splinter hemorrhages
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DESCRIPTION
An abnormality of the nails, that commonly occurs as a result of heredity or iron deficiency
anemia, in which the nail plate thins and the lateral edges of the nail plate tilt up forming a
concave profile
An abnormality of the nails, that commonly occurs as a result of a bacterial or fungal
infection, in which the nail folds around the nail plate are swollen, hot, tender, and reddened
An abnormality of the nails, that commonly occurs a result of conditions (e.g., cyanotic
heart disease, cystic fibrosis, and acquired pulmonary disease) that lead to impaired tissue
perfusion for a long period of time, in which the angle between the nail plate and nail base
is  180, the nail plate is more convex, the distal phalanx is rounded and bulbous, and the
proximal nail fold is spongy or floating
An abnormality of the nails in which the nail plate is loosened from the nail bed, usually
starting at the distal edge and progressing proximally
An abnormality of the nails, that commonly occurs as a result of a acute, severe illness
(e.g., hepatic or renal disease), in which the nail plate has a transverse groove on it parallel
to the lunula that extends down to the nail bed
An abnormality of the nails, that commonly occurs as a result of aging, in which the nail
plate has parallel, elevated nail ridges
An abnormality of the nails, that commonly occurs with subacute bacterial endocarditis,
trichinosis, and/or minor trauma, in which there are red-brown, linear streaks in the nail bed