Rita
1. Specify when to refer the patient after therapy and why? Provide rationale.
Given E.D.’s past medical records, her history of obesity and diabetes mellitus further worsens the symptoms of Onychomycosis. After completing her therapy, E.D. needs to receive follow-up treatment and care from different types of specialists in order to better manage her health conditions. A podiatrist needs to provide E.D. with assistance in maintaining hygiene and self-care practices for her infected feet (Nijenhuis-Rosien et. al, 2019, p. 2145). E.D. also needs to receive treatment from an endocrinologist in order to manage her diabetes mellitus. The endocrinologist needs to help E.D. implement self-care practices to improve her cardiovascular health, which will lead to reducing the severity of her Onychomycosis symptoms (Nijenhuis-Rosien et. al, 2019, p. 2145). E.D. should also receive guidance from a nutritionist in order to make important changes to her diet and physical health. E.D. should exercise regularly to reduce her obesity levels, and should make changes to her diet to improve her nutrition (Nijenhuis-Rosien et. al, 2019, p. 2145).
2. According to the recommended guidelines, what are the non-pharmacological approaches to Onychomycosis?
There are a number of alternatives that E.D. can implement based on recommended guidelines. One of the common non-pharmacological approaches is for E.D. to receive nail avulsions by removing her nail. This can occur through a number of different processes. Chemical removal is common if E.D. has thick nails, and can be carried out by using urea in order to enable the nail to easily be removed (Polat et. al, 2020, p. 219). The nail plate has to be removed in cases where E.D. has a severe infection. Other alternatives include laser treatment, in which a laser is used to kill cancerous or infected cells. Light energy treatment
called photodynamic therapy can also be used in order to use light to destroy
cancerous or infected cells. Nail avulsion can also occur through surgical or
mechanical removal processes (Polat et. al, 2020, p. 218).
3. Provide patient education. Keep in mind the past medical history of this patient.
Patient education would begin by informing E.D. about the way to keep her infected feet clean and dry. E.D. should be instructed to maintain hygiene practices in order to ensure that her nails are dry and clean at all times (Polat et. al, 2020, p. 218). This includes instructing E.D. about the correct way to rinse her infected feet, which includes cleaning in between the toes. E.D. should also be informed about the correct way to dry her feet area, and to use dry powders if she feels that she is sweating in her feet area during the day. Another aspect of E.D.’s self-care is to conduct a self-check of her nails to identify any signs and symptoms of deterioration (Polat et. al, 2020, p. 218). In the event that her feet worsen, E.D. needs to visit a physician to provide timely intervention. E.D. should also use barriers to protect her feet, such as flip-flops or shoes that prevent her infected from being exposed to contaminants. This is important in public spaces where infectious agents are found, such as the floors of public swimming pools. When clipping her nails, E.D. should disinfect the nail clippers with isopropyl alcohol to eliminate any infectious agents. E.D. also needs to regularly monitor her blood glucose levels, exercise regularly, and improve her nutrition to manage her diabetes mellitus and obesity (Polat et. al, 2020, p. 218).
Nijenhuis-Rosien, L., Kleefstra, N., van Djik, P.R., Wolfhagen, M.J.H.M., Groenier, K.H. (2019, Mar. 28). Laser therapy for onychomycosis in patients with diabetes at risk for foot ulcers: a randomized, quadruple-blind, sham-controlled trial. Journal of European Academy of Dermatology and Venereology, 33(11); 2143-2150.
Polat, A.K., Belli, A.A., Karaali, M.G., Aksu, A.E.K. (2020, Jul. 21). The attitudes, behaviors, and opinions about non-pharmacological agents in patients with tinea pedis. Journal of European Academy of Dermatology and Venereology, 21(7); 214-221.
Jennifer
1. Specify when to refer the patient after therapy and why? Provide rationale.
E.D. has a medical history that includes diabetes and obesity, which further worsens the onset of Onychomycosis. As a result, it is important for E.D. to immediately be referred to a specialized care clinic. E.D. needs to receive medical attention from a podiatrist that will provide directed care based on her health conditions and nail (Romero-Cerecero et. al, 2020, p. 1678). Additionally, an endocrinologist tis needed to conduct an evaluation of E.D. to provide follow-up care. This includes ongoing treatment for type 2 diabetes mellitus, which provides predisposition to dermatological diabetes. Since E.D. has diabetes metillus and onychomycosis, there can be worrisome symptoms in her feet if E.D. does not receive timely treatment. One of the recommended interventions is to make dietary changes by working closely with a nutritionist in order to reduce her body mass index and improve her diet (Romero-Cerecero et. al, 2020, p. 1678).
2. According to the recommended guidelines, what are the non-pharmacological approaches to Onychomycosis?
The CDC recommends a number of nonpharmacological treatments for
onychomycosis. One of the recommended approaches is laser treatment, in which the
fungal infection is surgically removed. Another recommended intervention is
photodynamic therapy, which occurs through a two-step process (Hassan et. al,
2020, p. 237). The first step features light energy treatment that destroys cancerous
cells along the nail. However, the second step is a form of pharmacological treatment,
in which photosensitizer drugs are used to treat the nail disorder. A third
approach is to conduct nail avulsion through mechanical, surgical, or chemical
processes (Hassan et. al, 2020, p. 236). If E.D. has thick nails, chemical
removal can be used with a compound of 40 to 50% urea in order to improve the
nail avulsion process (Hassan et. al, 2020, p. 236). In some cases where there
is severe infection, the nail plate can be removed, but E.D. would have to take
oral therapy to treat her symptoms.
3. Provide patient education. Keep in mind the past medical history of this patient.
There are a number of important aspects of the patient education process that are important to improve self-care practices. First, E.D. must maintain good hygiene to keep her nails clean and dry. E.D. needs to thoroughly wash her hands and clean in between her toes. E.D. needs to continue to monitor the progress of her nails and visit a physician immediately if any issues arise. Drying powders can be used to keep her feet dry. E.D. needs to avoid exposure to public spaces that can harbor bacteria, such as changing rooms, swimming pools, and gym lockers. It is important to use barrier methods in these areas by wearing flip flops or socks to avoid direct exposure to bacteria (Hassan et. al, 2020, p. 236). E.D. should also take measures to clean and disinfect her nail clippers with rubbing alcohol. E.D. should also avoid sources that could harbor bacteria, such as old shoes or footwear that is shared with family members. E.D. should work with a nutritionist to manage her weight through dietary interventions and regular physical exercise. E.D. should also monitor her blood sugar levels daily to reduce the impact that obesity and diabetes mellitus has on her onychomycosis symptoms (Hassan et. al, 2020, p. 236).
Hassan, N., Dhamija, P., Bharti, V., Vishwakarma, S., Mansoor, S., Iqbal, Z. (2020, Mar. 31). Clinical tools for successful treatment of onychomycosis: a narrative review. Journal of Drugs &
Therapy Perspectives, 36(21): 236-242.
Romero-Cerecero, O., Islas-Garduno, A.L., Zamilpa, A., Tortoriello, J. (2020, Feb. 22). Effectiveness of an enecalin standardized extract of Ageratina pichinchensis on the treatment of onychomycosis in patients with diabetes mellitus. Journal of Psychotherapy Research, 34(7); 1678-1686
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