Evidence-based nursing practice: A case study on Zadek’s procedure for ingrown toenail”

Deula

Nursing Supervisor, Kauvery Hospital, Alwarpet, Chennai

Abstract

This case presentation discusses the nursing care of a 41-year-old male patient who underwent Zadek’s procedure for an ingrown toenail. The patient presented with complaints of pain and discharge from the affected toe. The nursing interventions and patient education provided during the patient’s hospital stay are highlighted.

Introduction

Ingrown toenails are a common condition that can cause significant discomfort and pain. Zadek’s procedure is a surgical intervention that involves wedge excision of the nail plate and nail bed excision. This case presentation aims to discuss the nursing care of a patient who underwent this procedure.

Case Presentation

Mr. Ankesh.S, a 41-year-old male, was admitted to the hospital with complaints of pain and discharge from his right great toe. He had a history of left leg surgery and was planned for debridement and wedge excision of the nail under ankle block. The patient underwent Zadek’s procedure on 20/03/2025.

Diagnosis and Management

The patient was diagnosed with an ingrown toenail (Right great toe). The surgical procedure involved wedge excision of the nail plate and nail bed excision. The patient was managed with supportive measures, including pain management and wound care.

Right leg X ray Before procedure

Nursing Implications

The patient required close monitoring of his vital signs, wound care, and pain management. The nursing staff also provided education on wound care, pain management, and follow-up appointments.

Pre-operative care

  • Patient education:Explain the procedure, potential benefits and risks, and what to expect during and after the surgery.
  • Assessment:Review the patient’s medical history, medications, and allergies.
  • Preparation:Assist with preparing the patient for surgery, which may include applying a tourniquet, scrubbing the surgical site, and positioning the patient.
  • Medication management:Administer pre-operative medications as ordered.

Nursing Interventions

  • Preoperative preparation: The patient was prepared for surgery, including informed consent, anesthesia clearance, and surgical site marking.
  • Postoperative care: The patient received postoperative care, including vital sign monitoring, wound care, and pain management.
  • Wound care: The nursing staff provided wound care, including dressing changes and wound cleaning.
  • Pain management: The patient was managed with pain medication and non-pharmacological interventions, such as positioning and relaxation techniques.
  • Assisting the surgeon: The nurse may assist with setting up the surgical field, preparing instruments, handling tissues, and managing anesthesia if applicable.
  • Monitoring patient status: Observe the patient’s vital signs, pain levels, and overall condition throughout the procedure.

Post-operative care

  • Wound care: Apply a sterile dressing to the surgical site, ensuring it remains clean and dry.
  • Pain management: Administer pain medications as prescribed and monitor for its effectiveness.
  • Patient education: Provide instructions on wound care, pain management, activity restrictions, and follow-up appointments.
  • Monitoring for complications: Observe the patient for signs of infection, bleeding, or other complications, and report any concerns to the surgeon.
  • Follow-up: Provide instructions for follow-up care and ensure the patient understands when to seek further medical attention.

Key responsibilities

  • Patient safety: Ensuring the patient’s well-being and safety throughout the process.
  • Communication: Communicating effectively with the patient, family, and other healthcare professionals.
  • Documentation: Accurately documenting all aspects of the procedure and the patient\ care.

Patient Education

The patient was educated on:

  • Wound care: The patient was instructed on how to care for his wound, including dressing changes and wound cleaning.
  • Pain management: The patient was educated on pain management, including the use of pain medication and non-pharmacological interventions.
  • Activity restrictions: The patient was advised to avoid strenuous activities and elevate his leg to reduce swelling.

Evaluation

The patient’s condition improved symptomatically and clinically, and he was discharged on stable condition. The patient expressed satisfaction with the care provided and thanked the nursing staff for their support.

Heartfelt Gratitude by Patient

“I am grateful for the care and support provided by the nursing staff during my hospital stay. They were kind, compassionate, and attentive to my needs. I appreciate their hard work and dedication.”

Conclusion

This case presentation highlights the importance of comprehensive nursing care in the management of patients undergoing surgical procedures. The nursing staff played a crucial role in providing wound care, pain management, and patient education, which contributed to the patient’s positive outcome.

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