Question

A patient comes to the clinic following an incident at work where a brick fell on his fingers. He states that his hand is sore and has noticed dark, discoloration under 50% of his index finger. He states that it is very painful. How should the nurse practitioner proceed?

a. Recommend ice to minimize pain.
b. Reassure the patient that as the nail grows, the discoloration will resolve.
c. Refer to general surgery to have the nail removed.
d. Proceed with trephination to prevent damage to nail matrix

Answer 1

The nurse practitioner should initially recommend ice for swelling and pain, reassure that minor discoloration typically resolves over time, but also assess if trephination is needed or refer to surgery for severe cases.

Step-by-step explanation:

When a patient comes to the clinic after an incident where a brick fell on his fingers, causing dark discoloration under 50% of the index finger and severe pain, the nurse practitioner should carefully assess the extent of the injury. Initially, one may recommend ice to minimize swelling and pain. It is vital to reassure the patient that typically, as the nail grows, minor discoloration resolves over time. However, if the damage is more severe and there is a risk of increased pressure under the nail causing pain or potential damage to the nail matrix, the practitioner might consider a procedure like trephination. This involves making a small hole in the nail to relieve pressure. If the injury is severe or if there is any doubt about the best course of action, the patient should be referred to general surgery for further assessment and potential nail removal to prevent further complications.