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Palliative Care 1.

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Presentation on theme: "Palliative Care 1."— Presentation transcript:

1 Palliative Care 1

2 Why Do We Reduce Toenails?
Reduce pain Prevent potential injury Subungual ulceration Subungual hematoma Cosmesis Not everyone is a candidate for definitive treatment

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5 Reducing a toenail: Step 1—assess the patient
PVD? Neuropathy? Other immunocompromise?

6 Reducing a toenail: Step 2—collect needed materials
Gloves Eye Protection Gauze Nail nippers Bandaids

7 Reducing a toenail: Step 3—stabilize the toe

8 Reducing a toenail: Step 4—Reduce the toenail

9 Reducing a toenail: Watch for flying toenail

10 Don’t try this technique with thick toenails

11 Reducing a toenail: How far back do you cut?
Depends on the condition of the toenail

12 Reducing a toenail: Step 5—Smooth the nail surface

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15 Reducing a toenail: Podospray

16 Why reduce corns and calluses?
Pain Potential ulceration Difficult definitive treatment Not all patients are good candidates for surgical treatment

17 Corn Synonyms Heloma durum (HD) Excrescence Hyperkeratosis
Hyperkeratotic papule

18 Callus Synonyms Tyloma Intractable Plantar Keratosis
Hyperkeratotic papule

19 Debriding a callus: Step 1—assess the patient
PVD? Neuropathy? Other immunocompromise?

20 Debriding a callus: Step 2—Gather appropriate materials
Gauze Blade handle Blade Kelly Forceps Gloves

21 Debriding a callus: Step 3—Load the blade

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23 Debriding a callus: Step 4—Hold the Blade

24 Debriding a callus: Step 4—Hold the Blade

25 Debriding a callus: Step 4—Hold the Blade

26 Debriding a callus: Step 5—Don’t forget negative pressure

27 Debriding a callus: Step 6—When do you stop?
Blood Color Texture Skin Lines

28 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

29 Hemostatic solutions

30 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


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