Chapter 48: Nail Disorders Buttaro: Primary Care: A Collaborative Practice, 6th Edition

Multiple Choice

1. A patient is diagnosed with herpetic whitlow and in a 2 weeks follow-up evaluation, is noted to have paronychial inflammation of the tendon sheath in one finger that has responded to treatment. What is a priority treatment for this patient?

a. Begin therapy with an oral antiviral medication.

b. Obtain a consult for incision and drainage of the lesion.

c. Order a creatinine clearance test to evaluate renal function.

d. Refer the patient to the emergency department.

ANS: D

When paronychial infection of the tendon sheath is suspected in patients with herpetic whitlow, they should be immediately referred to the emergency department for a surgical referral. Oral antiviral medications are given for severe cases and recurrences, but the emergent situation is a priority. Incision and drainage may lead to superinfection of longer healing. Creatinine clearance is ordered when beginning oral antiviral therapy.

Multiple Response

1. A patient diagnosed with recurrent herpetic whitlow is counseled about management of symptoms and prevention of complications. What will be included in this teaching? (Select all that apply.)

NURSINGTB.COM a. Begin antiviral medications within 3 days of onset of symptoms. b. Contact the provider if symptoms persist longer than 3 weeks. c. Cool compresses may help with comfort and decrease erythema. d. Keep hands away from the mouth and eyes to prevent inoculation. e. Wear gloves when preparing foods to prevent spread to others.

ANS: B, C, D a. Analgesics may be necessary for comfort. b. Apply clear nail polish to protect her nails. c. Avoid trimming the nails until the infection clears. d. Use protective gloves while working. e. Wear waterproof gloves when washing dishes.

Patients with herpetic whitlow should be seen by a physician if symptoms are recalcitrant to treatment after 3 weeks. Cool compresses may help with symptomatic relief. Patients should avoid touching the mouth and eyes to prevent spread of lesions to these tissues. Antiviral medications should be given within 48 hours of onset of symptoms to be effective. Wearing gloves during food preparation is not necessary.

2. A female patient who works with caustic chemicals has developed acute paronychia. What will he provider include when teaching this patient about her condition? (Select all that apply.)

ANS: A, D, E

Patients with paronychia may require analgesics for comfort. They should be instructed to wear protective gloves while working, if the condition is work-related and to wear waterproof gloves while washing dishes. Nail polish should be avoided, and nails should be kept trimmed and clean.