Hand and foot care for a patient

Authors: V.Rednenko 

Editor: V.Rednenko 

Equipment for the practical skill:

• Simulated patient (patient manikin)
• Hospital bed with bedding
• Over-bed table
• Washcloth
• Towel
• Bed protector
• Emesis basin (hand care) or wash basin (foot care)
• Bath thermometer
• Nail clippers
• Nail stick
• Emery board (nail file)
• Soap
• Paper towels
• Gloves

Clinical situation:

Patient N. is in the neurological department with acute cerebrovascular accident, he is assigned to the hand and foot care. The patient is bedridden.  Carry out the prescribed procedure.

Order of the skill performance:

Preparatory stage:

• Introduce yourself
• Identify patient
• Obtain informed consent to the procedure (if the patient's condition allows it)
  • Give all the information to the person about what the procedure involves, including the benefits and risks, whether there are reasonable alternative, and what will happen without this procedure
  • Explain what you are going to do.
  • Ask the patient to consent to procedure.
  • Explain to the patient how he can help.
• Make sure you have the necessary equipment and put it on the over-bed table (the chair next to the bed)
• Sanitize your hands, put on gloves
• Prepare the patient bed:
• Raise the bed to a comfortable working height.
• Make sure the wheels on the bed are locked

Main stage:

• Cover the over-bed table with the paper towels and arrange your supplies. Fill the emesis basin or wash basin with warm water. Use the bath thermometer to verify that the water temperature is between 105° F and 115° F (40-45 ° C). Place the wash basin or emesis basin on the over-bed table.
• Help the person to transfer from the bed to a chair, or to sit on the edge of the bed. Alternatively, position the person in high Fowler's position.
• Put on the gloves, if you are using them.
• Help the person to soak her hands or feet.
  • Hand care:
    • Position the emesis basin within the person’s reach.
    • Help the person put her fingertips in the basin. Soak the fingertips in the water for 5 minutes.

• • Foot care:
    • Place the bed protector on the floor or the mattress near the person’s feet.
    • Place the wash basin on the bed protector, and help the person put her feet in the basin.
    • Soak the feet in the water for 5 minutes.
• Wet the washcloth and apply soap. Lift the person’s hand or foot from the water, one at a time.
• Wash the hand or foot, pushing the cuticles back gently with the washcloth.

• Use the nail stick to gently clean underneath the person’s nails. Wipe the stick on the towel after cleaning under each nail.
• Rinse the person’s hands or feet.
• Dry the person’s hands or feet thoroughly, including between the fingers and toes.
• Care for the nails.
  • Hand care:
    • If you are permitted to do so, use nail clippers to trim the person’s fingernails so that the nail extends slightly beyond the tip of the finger.
    • Trim the nails straight across, and then shape and smooth the edges with the emery board.
  • Foot care:
    • Note whether or not the nails need to be trimmed. Also inspect the condition of the skin on the person’s feet, including in between the toes.
• Remove and dispose of your gloves.

Final stage:

• Ensure the person’s comfort and good body alignment.
• Adjust equipment for safety: Lower the bed to the level specified in the person’s care plan. Make sure the wheels on the bed are locked. Place the person’s method of calling for help within reach. Lower or raise the side rails according to the person’s care plan.
• Clean up your work area.
• Wash your hands.