Patient: [Patient Name]
MRN: [Medical Record Number]
Date: [Date of Encounter]
Reason for Visit:
Follow-up for diagnosed paronychia (monitoring response to treatment)
Evaluation of worsening pain, swelling, or redness around the fingernail
Evaluation of pus drainage or fever (suggestive of possible infection)
History of Present Illness:
Onset and duration of symptoms (pain,
pen_spark
swelling, redness) around the
fingernail.
Affected finger(s).
Any recent trauma to the fingernail (e.g., hangnail, biting nails).
Current treatment regimen (if applicable).
Presence of any discharge (pus, drainage).
Fever or chills (suggestive of possible infection).
Past Medical History:
Underlying medical conditions (e.g., diabetes, peripheral vascular
disease) that can worsen paronychia.
History of previous paronychia episodes.
Social History:
Occupation (certain jobs increase risk of trauma to fingernails).
Physical Examination:
General examination: Assess for signs of systemic infection
(fever, lymphadenopathy).
Focused examination of the affected finger(s): Evaluate for
erythema (redness), edema (swelling), tenderness, and purulent discharge.
Assess for the extent of involvement (entire nail fold or only one side).
Diagnostic Tests (if indicated):
Culture swab: In cases of suspected bacterial infection, a swab of
any purulent discharge can be sent for culture and sensitivity testing
to identify the causative organism and guide antibiotic selection.
Assessment:
Paronychia: Based on clinical presentation (inflammation around
the fingernail).
Acute vs. chronic paronychia: Consider the duration of symptoms
and clinical findings. Acute paronychia typically has a rapid onset
and more inflammatory features.
Severity of infection (if present): Evaluate for signs of
spreading infection (cellulitis) that may require more aggressive
treatment.
Differential Diagnoses:
Consider other conditions that may mimic paronychia:
Ingrown toenail
Herpetic whitlow (viral infection)
Bacterial felon (deeper abscess formation)
Eczema (may involve the periungual area)
Plan:
Treatment plan: Depends on the severity and stage of paronychia
and presence of infection.
Conservative management: For mild cases, warm soaks, local
antiseptic cleansing, and pain medication may be sufficient.
Antibiotics: If signs of bacterial infection are present,
oral antibiotics will be prescribed based on culture results (if
obtained) or empirically.
Drainage: In some cases, especially with abscess formation,
incision and drainage may be necessary to remove pus and promote
healing.
Nail removal (partial or complete): May be necessary in
severe cases or if the nail is ingrown.
Follow-up:
Schedule a follow-up visit in 2-3 days to monitor response to
treatment and assess for improvement.
Instruct the patient on proper hand hygiene and nail care practices
to prevent future episodes.
Prognosis:
Paronychia is usually a treatable condition. Early diagnosis and
treatment can help prevent complications and promote faster healing.