This document provides an overview of assessing nails presented by Ms. Similia Pervez. The objectives are to discuss nail anatomy, assessment methods, normality, and abnormalities. Normal nails are described as having a 160-degree angle at the base, smooth texture, and normal capillary refill. Common abnormalities include clubbing, hangnails, ingrown toenails, splitting/peeling, psoriasis, discoloration, Beau's lines, fungus, onycholysis, and blue nails. Various causes and characteristics of 10 abnormal nail conditions are outlined.

1. Unit : IV
Assessment Of Skin, Hair And
Nails.
Topic : Assessment Of The Nail:
Presented by :
Ms. Similia Pervez
Clinical instructor
Facilitator : Principal, SON
SIMS-SIUT
Date : 12-June-2023
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2. Objectives :
By the end of the presentation student 1st semester BScN will be
able to:
 Discuss anatomy of nail.
 Discuss methods of nail assessment.
 Discuss normality of nail.
 Identify nail changes/ abnormality.
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4. Normal nail measurement :
 Here is normally a 160-degree angle between the nail base and the skin.
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5. Normality Of Nails:
Method : Inspect and palpate
Assessment : (Inspect )
 Inspect the fingernails and toenails.
 Note their color and shape.
 Nail plate is attached to nail bed.
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6. Assessment : (Palpate )
 Palpate the fingernails and toenails.
 Longitudinal bands of pigment seen.
 Assess texture of nails.
 Nails are smooth.
 Check capillary refill in nail .
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7. How To Assess Capillary Refill :
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8. Abnormality Of Nails :
Local redness.
Dirty, broken, or jagged fingernails .
Pale or cyanotic nails.
Splinter hemorrhages.
Yellow discoloration .
Thickened nails (especially toenails).
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9. 1. Nail Clubbing
Nail clubbing occurs as the
end portion of the
nail raises up and rounds out.
Early clubbing (180-degree angle ,late clubbing
(greater than 180-degree angle) can
occur from hypoxia. Spoon nails (concave) may be
present with iron deficiency anemia
Nail clubbing can be a sign of:
-Pulmonary disease
-cardiac disease
-systemic disorder
2. Hangnails
The skin along the edge
of the nail tears or is
otherwise damaged.
Causes:
-Habitual nail-biting.
-Injury or trauma .
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10. 3. Ingrown Toenail
This leaves a spike on the side of the nail which
then ingrown into the soft tissue causing infection
and pain.
-An ingrown nail can occur for many
reasons the most common being
picking or tearing the nail or poor cutting technique.
4.Splitting or Peeling nails
Split or peeling nails occur when
the nails are too dry and brittle.
Causes :
-Immersing and then drying hands frequently
-Nail Polish and acetone-based removers
-Vitamin deficiencies
-Medications
-Medical conditions
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11. 5. Nail Psoriasis
Psoriasis can affect your nails and create
changes in the color, thickness, and surface
of your nails. You may notice pitting or depressions
in your nails.
Caused by an overactive immune system,
6. Yellow Discolored Nails
Yellow nails can be caused by:
-Leaving nail polish on too long
-Fungal infections
-Diabetes
-Medications
-Weakened Immune System
-Circulation Problems
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12. 7. Beau’s Lines
Beau’s lines are linear depressions in the nails that
run horizontally and move up from the base of the
nail as it grows outward.
Common underlying disorders for Beau’s lines include:
-Malnutrition
-Liver Disease
-Heart Attack
-Poorly Managed Metabolic Process (like Diabetes)
8. Nail Fungus
It begins as a white or yellow-brown spot under the tip of
your fingernail or toenail , caused fungi present in our body
because of unhygienic conditions .
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13. 9. Onycholysis
Onycholysis is when the nail separates from the
nail bed, raising itself up away from the toe or finger.
This can occur for a variety of reasons:
-Trauma
-Nail polish
-Fungal infection
-Psoriasis
-Medications
-Chemotherapy
10. Nails beds with a blue tinge
Any discoloration of the nail is a hint that something
isn’t quite right.
Cause:
Nails begin to appear bluish when
there are issues in the blood or in the circulatory
system.
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14. References:
 Medically reviewed by Alana Biggers, M.D., MPH — By Jenna Fletcher — Updated
on February 10, 2023
 Bickley, L., & Szilagyi, . Bates' guide to physical examination and history-taking.
Lippincott Williams & Wilkin.
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