One of the following actions must be taken by the nurse if a patient with diabetes and peripheral neuropathy requires assistance in cutting nails?

Appeared in: IGNOU Post B. SC. Nursing entrance-2019

Explanation

Patients with diabetes and peripheral neuropathy have reduced sensation in their feet, meaning they may not feel an injury from nail cutting.
Diabetes often causes poor circulation, which impairs the healing process. A minor cut can easily become a non-healing ulcer.
The combination of reduced sensation and poor healing places the patient at high risk for infection, gangrene, and amputation.
The safest and most appropriate action is to refer the patient to a podiatrist or chiropodist, who are specialists trained in high-risk foot care.

Option B: Asking the ward sister, who is also a general nurse and not a specialist, does not mitigate the risk. The problem is the lack of specialized skill, not the specific nurse performing the action.
Option C: This approach is dangerous and reactive. The principle of diabetic foot care is to prevent injury, not to act only after a problem occurs. The potential for harm is too great.
Option D: Simply watching does not remove the inherent danger of a non-specialist cutting the nails. The risk lies in the act of cutting itself, which could cause injury.

Clinical Relevance

Nursing practice connection: Use the key finding related to Diabetic Foot Care and Scope of Nursing Practice to guide bedside assessment, documentation, and the next nursing action.
Preventing foot ulcers and amputations is a major nursing priority in diabetic care. Knowing when to refer to a specialist is a critical safety competency.
Failure to follow this standard of care can be considered negligence and lead to severe patient harm, including limb loss.
What if the patient had diabetes but no signs of peripheral neuropathy or vascular disease? In some settings, a nurse with specific training might be permitted to trim the nails straight across. However, the safest policy, and the one followed by most institutions, is still referral to a podiatrist.

How to Approach the Question

First, identify the key elements in the patient scenario: a patient with both diabetes and peripheral neuropathy.
Recognize that this combination makes the patient extremely high-risk for foot complications.
Recall the principles of diabetic foot care, which prioritize injury prevention above all else.
Evaluate each option based on patient safety. Does the action minimize or increase the risk of a cut or subsequent infection?
Eliminate options that involve a non-specialist performing the procedure (B and C) or passively observing a risky procedure (D).
Select the option that aligns with the established standard of care: assessment, documentation, and referral to a specialist.

Concept Tested & Keywords

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E6 Nursing Fundamentals Potter Perry 12e Part 4 pp. 219-221, 173-175, 191-193

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