Onychocryptosis Treatment - Essay Example

Podiatry. An Eleven Year Old Female Patient Is Referred To Your Podiatry Clinic With A Very Painful In Growing Toenail On Her Right Hallux. She Has Been Referred From the GP Who Has Told Her That She Needs a Partial Nail Avulsion Table of Contents Introduction 3 Case Overview 3 Assessment of the Possible Treatment Options for the Patient 4 Reasons for the Treatment 8 Conclusion 9 References 11 Introduction In this present day context, ingrown toenail is viewed to be one of the common health problems of the people. The other name of this common condition is ascertained as ‘Onychocryptosis.’ This is generally considered to be a common nail problem, as it happens due to the pressure of ingrowth nail edge into the side of toe skin. There lay various etiologies that largely influence the infection of ingrown toe nail. These include improper trimmed nail, poor fitting shoe and hyperhidrosis. It is worth mentioning that the fungal infection is the major cause behind raising the condition of ingrown toe nail. Notably, there lay various symptoms of ingrown toe nail. At the initial stage, the ingrown toe nail can be recognised by pain with weight, erythema and slight edema. Subsequently, having infections is the second level of symptoms of ingrown toe nail (Sadhu & Bhat, 2004). With this concern, the essay will elaborate various options that are related with the treatment procedures of ingrown toe nail. There lay numerous complications that might rise with this crucial health condition. Thus, the prime intent of the essay is to assess as well as provide an effective treatment procedure to the eleven year old female patient as stated in the case provide having a very painful ingrown toenail in the portion of her right hallux. It is worth mentioning that the medical histories of the patient will be taken into concern for providing an effective treatment procedure to her. Case Overview The referred case is mainly about a little girl who is eleven years old. The girl has been suffering from a painful trauma due to the infection in her nail. The girl is experiencing painful ingrown toe nail problem in her right hallux. Thus, the girl has been referred by a general physician to undergo partial nail avulsion. The medical history of the small girl denotes that she is an asthmatic patient. Moreover, the doctor did not provided any antibiotic to the patient in opposition to the health condition of ingrown toenail, as she is less than 16 years old. It will be vital to mention in this similar concern that prescribing painkillers and antibiotics to 11 years old patients is unethical in medical aspect. The provided case is quite critical in terms of psychological nature of the patient. Justifiably, it is little difficult to treat the child patient, as she is having asthma. By studying the medical history of the little girl patient having normal weight, the surgical method can be found to be quite positive for her. However, the negative point of the treatment process in this case can be the patients’ suffering with asthma. The patient always carries the salbutamol inhaler with her for having asthma problem. This factor can be duly considered as mentioned earlier to affect the normal surgical process by a certain degree. Assessment of the Possible Treatment Options for the Patient While assessing the probable treatment options for the patient, as referred in the provided case, it can be affirmed that the prime reason of ingrown toenail is inappropriate trimming of the toenail. The hereditary condition is also an important factor of ingrown toe nail. The patients who are diabetic in nature seem to be having this sort of problem or condition at large. There exist numerous processes that can be referred as better treatment mechanisms, which can found suitability for the patient as mentioned in the case provided. These treatment processes entail self-care measures, nail surgery and after nail surgery. As a primary advice for the treatment of the ingrown toe nail, the baby girl can take self-care of her nail in home. This treatment is only suggested at the time of initial stage of infection and after the surgery is conducted. The home remedy or the self-treatment procedure might prove to be quite effective in preventing the critical condition of onychocryptosis. The patients suffering from the above stated adverse health condition may avoid infections by maintaining good foot hygiene in terms of washing foot properly as well as regularly. Apart from this, it can be affirmed that wearing shoes in a comfortable way can avoid having infections in toe nail. Intake of pain killer is better for reducing the pain of such injury by a certain extent. This remedy is not applicable for the little girl patient, as painkillers are always prescribed to the adult patients by the doctors. The other treatment related to onychocryptosis is the nail surgery (Drugs.com, 2014). There lay two sorts of nail surgery related to the crucial health condition of onychocryptosis. One is “partial nail avulsion” and the other is “total nail avulsion.” The partial nail avulsion is an appropriate surgery, which involves the Mohs micrographic process in the treatment. The technique of Mohs micrographic bears high possibility of curing rate. On the other hand, the total nail avulsion is the removal of the entire infected nail and this treatment is only performed at the time of having acute infection in the nail. The entire removal of toenail will be safe for having further infections in the nail. The after nail surgery is an important part of taking care of the infectious nail. It is quite obvious that there lays the probability of having infections in the surgical nail, if it does not get proper care (NHS, n.d.). In this regard, a proper care of the nail will certainly decrease the tendency of the infection level at large. It is mandatory to give rest to the foot after surgery for one or two days. The advice of taking rest and ignoring the placing weight on the affected area will keep the foot more healthy and will increase the chances of recovery (WebMD UK Limited and Boots UK Limited., 2014). Based on the case history of the little girl, the partial nail avulsion, as the treatment procedure, can be suggested for evading the infections in her toe nail. Thus, it is clear that the patient has been suffering from a painful trauma, which is next to unbearable for her. For treating her nail infection, she needs to visit a podiatry clinic. The treatment of partial nail avulsion is next to 98% effective and has been proved successful. This process might prove to be quite secured for the girl despite having varied critical health conditions (British National Formulary, 2004). Discussion on the Treatment Procedure The patient, as referred in the provided case, needs to visit a podiatry clinic for availing better treatment. In the podiatry clinic, she needs to be observed or diagnosed about her ingrown toenail. The infection in the ingrown toe nail must be diagnosed initially and then the treatment procedures would be prescribed. Based on the above discussion, the partial nail avulsion will be the widespread surgical treatment practice for the 11 year-old patient. Through the treatment procedure of partial nail avulsion, the patient can be treated quite well after considering all her medical complexities like having asthma. It can be affirmed that the psychological conditions of the patient are not matured enough to accept the process of treatment in a very casual perspective. It can be apparently observed that the partial nail avulsion treatment is mainly performed after identifying a lingering fungal infection in the nail. Initially, the treatment procedure needs to be revealed in front of the guardians of the patients. As the patient, in relation to the case provided, is minor, the last decision of the treatment procedure will be taken by the parents of the patient (Arthur & et. al., 1988). In this modern era, the surgical treatment process with the inclusion of partial nail avulsion has attained greatest success in the medical field. In this present day context, it is becoming easier to get rid of from such a chronic pain or adverse condition of painful ingrowing toenail. The treatment is suggested to provide five appointments including the surgery treatment to the patient for addressing the above stated health condition. It can be affirmed two sittings will be provided to the patient before the surgery and the remaining two sittings after the surgery or post-surgery. At first sitting, the patient will be diagnosed with the infection level of the ingrown toe nail and then the healthcare professionals will identify the reasons of having such infection (Medscape, 2014). In the second sitting, the doctor will make aware the patient about the surgical procedure and analyse the treatment method accordingly. It is the responsibility of the doctor and the guardians of the patient to aware her about the advantage of the treatment and makes her comfortable to undergo with the surgical procedure. This awareness is mandatory for the patient in order to evade any sort of uncertainty or risk, which might arise during surgery. Justifiably, if the patient would come to know at the time of surgery or at the last moment of the procedure, she might get shocked and thus try to ignore the treatment process (Laco, n.d.). Thus, it can be stated that creating alert to the patient about her surgery and making her comfortable about the surgical treatment are the most ethical behaviours to be taken into concern in terms of medical practice. The third and the imperative sitting will be the final day of surgery. From the case provided, it can be found that the little girl is an asthmatic patient. These asthmatic patients often bear little risk at the time of anaesthesia. To avoid this sort of risk further during anaesthesia, the doctor should take the help of non-anaesthesiologists who provide perioperative care and consult with them related to minimising the risk factors of the asthmatic patients (Sisitki & et. al., 2011). The doctor will operate the patient subsequently by taking into concern every precautionary measure. After the surgery, the patient would be discharged from the podiatry clinic. The next two sittings will be given for the observation and the precaution related to post surgery infections. There lay high risk of getting infected after the surgery (Lopalo, 1980). Specially mentioning, it needs to be kept into mind that the treatment or the surgical process will be easy in nature for making the patient to feel more comfortable during the treatment. In relation to the treatment procedure, the responsible healthcare professional may initially treat the patient by providing hear with first aid. Then, a povidone-iodine solution, which acts as a liquid formation, may be incorporated in the procedure. This liquid solution is identified to be prepared with 1% lidocaine excluding epinephrine. Next, a sterilised rubber band will be used during the treatment for the dry operative base. Another usage of the rubber band will be to minimise the flow of bleeding. During the process, the toe will be rewashed by liquid medicinal property. After rewashing the toe, the doctor will identify the affected parts of the nail, which is known as distal edge and removes the same by the usage of nail splitter. It is worth mentioning that the electrocautery ablation process will be used for abolishing the nail forming matrix on the particular area from where the nail has been removed (Zuber, 2002). Reasons for the Treatment There are various reasons involved for having infections in the ingrown toe nail. The ingrown toenail infections can prove to be quite hazardous for the patients. It has been earlier mentioned that the partial nail avulsion is a quite systematic process for the treatment of ingrown toenail. This particular treatment procedure will then attempt to find out the particular areas where the nail infections have taken place. The fungal infection is the major reason of nail injury. The partial nail avulsion procedure has been proven successful up to 98% in treating nail injury (Medscape, 2014). Apart from this, there also exist numerous advanced techniques that have been launched in the treatment procedure of nail avulsion. Identifiably, there lay several advantages of partial nail avulsion treatment procedure. The partial nail avulsion technique is often recognised to be quite advanced including matricectomy electrocautery, radiofrequency and carbon dioxide laser ablation for the ingrown toe nail. This process reduces the tendency of postoperative pain and decrease the risks related to post surgery infection by sterilizing the infected tissue very immediately. The process including the laser treatment by carbon dioxide has protected the adjacent tissue from the thermal damages. The other benefit of using the carbon dioxide laser treatment is that the process removes the necessity or the requirement of anaesthesia (Tuckley, 1994). The process also eliminates the sparing collagen tissue from destruction. The healing property of the treatment process will certainly make the patient active and serviceable at the immediate period of post-surgery. The most important factor of attempting this kind of treatment for the eleven years old girl is only because of giving her the fast pain relief from infections. The little patient is totally unaware about the worse effects of the infections of ingrown toe nail. There is a huge possibility of denying the treatment procedures by the girl due to fear. To minimize the fear of the patient, the micrographic application in the partial toe nail surgery can be taken into concern (Medicine Net, Inc., 2014). The important factor, which needs to be considered while undergoing the partial nail avulsion treatment process, is the medical conditions of the patient. These medical conditions generally included the suffering of the patient from asthma and incapability of handling high doses of anaesthesia. Thus, from the above discussed aspects, it can be affirmed that the technique of treating the patient with lateral nail avulsion and matricectomy will significantly aid in providing effective solution towards the problem of very painful ingrowing toenail. Conclusion Based on the above analysis and discussion, it can be ascertained that medical science has developed in numerous ways. With the advancement of technology, medical science has invented numerous processes for tackling with varied crucial health conditions. After reviewing the case study, it can be affirmed that the patient who is suffering from ingrown toe nail, wanted relief from the pain. The partial nail avulsion will be the perfect treatment process according to her persistent heath conditions. As the patient is asthmatic in nature, the anaesthesia during the treatment process will be the wrong option for her. Application of anaesthesia upon an asthmatic patient who is minor in age is found to quite risky, which might have negative health implications. Specially mentioning, the treatment procedure of the partial nail avulsion via radiofrequency, electrocautery and carbon dioxide laser ablation will be accurate for the eleven years-old patient. In medical terms, it can be ascertained that a patient having asthma is not medically fit to undergo with the procedure of anaesthesia. Thus, prescribing her to local anaesthetic will be an unethical decision of the healthcare professionals. The general physician has taken a right decision of referring her to a podiatry clinic except referring her to local anaesthetics. In conclusion, it can be asserted that the patient referred in the case provided, will be prescribed with two levels of treatment procedure including partial nail avulsion and self-treatment, which will be conducted after the phase of post-surgery. The importance of self-care after the post-surgical period will be helpful in quick recovery of her affected nail and prevent the same from having further infections. References British National Formulary, 2004. Issue Number 48. London, British Medical Association and the Royal Pharmaceutical Society of Great Britain. Drugs.com, 2014. Partial Nail Avulsion for Ingrown Nail. Article. [Online] Available at: http://www.drugs.com/cg/partial-nail-avulsion-for-ingrown-nail-discharge-care.html [Accessed October 17, 2014]. Fairview Health Services, 2014. Nail Injury (Partial Finger/Toe Nail Plate Avulsion). Article. [Online] Available at: http://www.uofmmedicalcenter.org/healthlibrary/Article/116316EN [Accessed October 17, 2014]. Ferrante, F.M. & et. al., 1996. The Analgesic Response to Intravenous Lidocaine in the Treatment of Neuropathic Pain. Regional Anesthesia and Pain Management Ferrante Et Al. pp. 91-97. Lopalo, S., 1980. Implications of Anaesthesia for the Asthmatic Patient. Journal of the American Association of Nurse Anesthetists. pp. 327-333. Lorimer, D. L., 2002. Local Analgesia. Neales Disorders of the Foot. Churchill Livingstone. Liston, D. E., 2010. Childhood Asthma and Anaesthesia. Anaesthesia Tutorial of the Week 187, pp.1-7. Medscape, 2014. Ingrown Nails Treatment & Management. Article. [Online] Available at: http://emedicine.medscape.com/article/909807-treatment [Accessed October 17, 2014]. Medscape, 2014. Nail Avulsion. Article. [Online] Available at: http://emedicine.medscape.com/article/1126725-treatment [Accessed October 17, 2014]. Medscape, 2014. Local Anesthetics. Article. [Online] Available at: http://emedicine.medscape.com/article/873879-overview [Accessed October 17, 2014]. Medicine Net, Inc., 2014. Ingrown Toenail (Onychocryptosis). Article. [Online] Available at: http://www.medicinenet.com/ingrown_toenail/article.htm#what_causes_ingrown_toenails [Accessed October 17, 2014]. NHS, No Date. Ingrown Toenail – Treatment. Article. [Online] Available at: http://www.nhs.uk/Conditions/Ingrown-toenail/Pages/Treatment.aspx [Accessed October 17, 2014]. Sisitki, M. & et. al., 2011. Anaesthesia for Patient with Asthma. Bronchial Asthma: A Guide for Practical understanding and Treatment, pp. 345-346. Tuckley, J. M., 1994.The Pharmacology of Local Anaesthetic Agents. Update in Anaesthesia Vol.4, No.7, pp. 1-3. WebMD UK Limited and Boots UK Limited, 2014. Foot Care Health Centre. Article. [Online] Available at: http://www.webmd.boots.com/foot-care/ingrown-toenails [Accessed October 17, 2014]. Wilson, I., 2005. Asthma and Anaesthesia. Article. [Online] Available at: http://www.aagbi.org/sites/default/files/1-Asthma-and-anaesthesia.pdf [Accessed October 17, 2014]. 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