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Nursing Guide to Paronychia: Nursing Diagnosis, Interventions, & Care Plans

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Paronychia is a common inflammatory disorder affecting the periungual tissues (the area around the fingernails or toenails), characterized by redness, swelling, tenderness, and sometimes purulent drainage. It can be classified as acute or chronic based on the duration and underlying etiology.  

Acute paronychia typically results from a bacterial infection and develops rapidly after minor trauma such as nail biting, hangnail removal, or aggressive manicuring. Chronic paronychia, on the other hand, usually results from repeated irritation and secondary fungal colonization and may persist for weeks or months. 

The condition frequently affects the fingernails more than the toenails due to increased exposure of the hands to moisture and trauma. Prompt diagnosis and treatment can prevent progression to abscess formation, cellulitis, or permanent nail deformity.  

Nurses help with identifying early symptoms, supporting wound care and medication administration, educating patients on hand hygiene and preventive strategies, and promoting adherence to follow-up care. Understanding the distinctions between acute and chronic presentations is essential for effective management. 

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Etiology and epidemiology 

Understanding the etiology and epidemiology of paronychia is essential for effective prevention, diagnosis, and management. The condition may arise from bacterial, fungal, or mixed infections and often reflects a disruption in the protective barrier of the nail folds.  

Whether due to trauma, environmental exposure, or underlying medical conditions, the development of paronychia is influenced by numerous risk factors. Epidemiologically, it is a widespread condition that affects individuals across all age groups, with variations in prevalence depending on occupational exposure, hygiene habits, and immune status. 

Causes 

  • Acute paronychia: This is most often caused by bacterial pathogens such as Staphylococcus aureus, Streptococcus pyogenes, or mixed anaerobic flora. It frequently follows local trauma, such as hangnail picking, nail-biting, or minor lacerations around the nail bed. 
  • Chronic paronychia: This is usually caused by fungal organisms, particularly Candida albicans, and results from persistent exposure to irritants or moisture that compromise the nail fold barrier. Chronic inflammation predisposes to secondary colonization and nail dystrophy. 

Risk factors 

  • Frequent handwashing, wet work (e.g., nurses, bartenders, dishwashers) 
  • Nail biting, thumb sucking, or frequent trimming of cuticles 
  • Inappropriate or excessive use of artificial nails or acrylic nail products 
  • Pre-existing skin conditions (e.g., eczema, psoriasis) 
  • Underlying systemic conditions such as diabetes mellitus or immune suppression 
  • Occupational exposures to chemicals or repeated trauma 

Epidemiology 

  • Paronychia affects individuals across all age groups, but chronic forms are more common in adults with occupational exposures. 
  • Women are more frequently affected than men, particularly due to cosmetic nail practices. 
  • Recurrent cases are frequently seen in patients with diabetes, immune disorders, or occupations requiring frequent hand immersion in water or cleaning agents. 

ICD-10 code 

  • L03.031 — Acute paronychia of right finger 
  • L03.032 — Acute paronychia of left finger 
  • L03.033 — Acute paronychia of finger, unspecified 
  • B37.2 — Chronic paronychia due to Candida (for fungal etiology) 

Assessment 

Differentiating between acute and chronic forms enables targeted therapy, whether antibacterial, antifungal, or supportive.  

Diagnosis is largely clinical and based on history and physical findings, though laboratory and microbiological tests may aid in confirming the etiology, especially in recurrent or atypical cases. 

Clinical features 

  • Acute paronychia: There is a sudden onset of pain, erythema, swelling, and tenderness around the nail fold. Pus formation or abscess may develop. Patients may report difficulty using the affected digit. 
  • Chronic paronychia: There is persistent or recurrent swelling, mild erythema, and thickened nail folds. The nail plate may become discolored, ridged, or dystrophic. Less commonly associated with pus formation. 

Evaluation 

  • Perform a physical examination focusing on nail structure, surrounding tissue integrity, and presence of discharge. 
  • Culture and sensitivity testing of any drainage can help identify bacterial pathogens 
  • KOH preparation or fungal culture for suspected chronic paronychia with candida involvement. 
  • Consider blood glucose testing in patients with recurrent or severe paronychia to screen for diabetes. 

Management 

The management of paronychia focuses on reducing inflammation, treating infection, and preventing recurrence through proper hygiene and protective measures. Treatment varies depending on whether the case is acute or chronic and is guided by the underlying etiology, severity of symptoms, and presence of complications such as abscesses or nail dystrophy. Prompt and appropriate interventions help alleviate pain, support healing, and minimize the risk of progression or recurrence. 

Acute paronychia 

  • Warm saline or antiseptic soaks three to four times per day help promote drainage and relieve inflammation. 
  • Use topical antibiotics (e.g., mupirocin or fusidic acid) for mild cases. 
  • Use oral antibiotics such as cephalexin, clindamycin, or amoxicillin-clavulanate for moderate to severe cases or in the presence of cellulitis. 
  • Incision and drainage (I&D) for fluctuant abscesses can be considered, which is typically performed in a sterile clinical setting. 
  • Advise avoidance of trauma or moisture during the healing phase. 

Chronic paronychia 

  • Minimize contact with water and irritants by using protective gloves and skin barrier creams. 
  • Topical antifungal agents such as clotrimazole or ketoconazole are applied twice daily for several weeks. 
  • Topical corticosteroids (e.g., hydrocortisone) help decrease any inflammation and discomfort. 
  • Use emollients to restore skin barrier function and reduce desiccation. 
  • In severe or refractory cases, systemic antifungal treatment or referral to dermatology may be indicated. 

Nursing care plan 

Nursing care for patients with paronychia plays a critical role in promoting healing, preventing complications, and educating patients about long-term prevention strategies.  

Whether managing an acute bacterial infection or a chronic fungal case, nurses can help assess the severity, implement wound care protocols, and ensure that patients understand proper hand and nail hygiene. Interdisciplinary collaboration with dermatology, primary care, or infectious disease specialists may also be necessary in complex or recurrent cases. 

Nursing considerations 

  • Assess for systemic signs of infection, including fever, chills, and lymphadenopathy. 
  • Encourage adherence to hand hygiene protocols that prevent infection without irritating the skin. 
  • Promote the use of appropriate personal protective equipment (PPE) in occupational settings. 
  • Support mental well-being by addressing cosmetic concerns and stigma associated with nail deformities. 

Assessment 

  • Evaluate degree of swelling, redness, and tenderness around nail folds. 
  • Observe for presence of drainage, abscess formation, or spreading cellulitis. 
  • Review occupational history and hand care practices. 
  • Monitor response to treatment and progression of healing. 

Nursing diagnosis/risk for 

  • Risk for impaired skin integrity related to localized infection and inflammation 
  • Acute pain associated with tissue swelling and nerve irritation 
  • Risk for infection transmission due to poor hand hygiene or shared grooming tools 
  • Knowledge deficit regarding prevention of recurrence and appropriate nail care 

Interventions 

  • Administer prescribed topical or systemic antimicrobial therapies. 
  • Instruct the patient on performing warm soaks and wound cleansing at home. 
  • Demonstrate proper nail hygiene, including gentle trimming, avoiding cuticle removal, and moisturizing. 
  • Educate patients to avoid trauma, biting, and prolonged exposure to moisture. 
  • Encourage follow-up care and reinforce when to seek medical attention for worsening symptoms. 

Expected outcomes 

  • Patient experiences reduction in swelling, erythema, and pain within a few days of initiating treatment. 
  • Infection resolves without complications or systemic spread. 
  • Patients adopt improved nail hygiene practices and protective behaviors. 
  • No recurrence is noted during subsequent evaluations or follow-up visits. 

Individual/caregiver education 

  • Recognize early warning signs of infection, such as increased redness, warmth, swelling, and pus. 
  • Understand proper techniques for home wound care, including soaking and medication application. 
  • Implement protective strategies such as wearing gloves and moisturizing hands regularly. 
  • Avoid cosmetic practices that damage the nail folds, such as cuticle cutting or excessive filing. 
  • Educate on how to properly disinfect nail care tools and avoid sharing personal grooming items. 

FAQs

Resources 

References 

Tina Lipscomb, MSN, RN

Tina Lipscomb, MSN, RN, CCM

Tina Lipscomb, MSN, RN, CCM, is a highly experienced RN with a distinguished career spanning 40 years in various nursing roles. For the past 25 years, she has excelled as a case manager and currently serves as the Manager of Case Management at Duke University Hospital. Lipscomb is recognized nationally as an expert in complex case management and has presented at a national conference on care transitions.