onychogryphosis

Affected nail map

Maintain individual nail identity and distinguish examined normal nails from unexamined nails.

1. Which hand or foot, side and digit shows the suspected deformity? measurement
2. Which other nails were examined, and which remain unassessed? boundary

Documented growth pattern

Retain reproducible observations and photographs without imposing an unvalidated severity score.

1. What thickness, length, curvature and growth direction were observed, using which landmarks? measurement
2. Was the observation made before or after trimming, and is a dated image available? provenance

Diagnosis and terminology

Keep diagnostic confidence, criteria provenance and terminology mappings explicit.

1. Who assessed onychogryphosis, when, and which observations supported that assessment? provenance
2. If formal criteria are claimed, what issuing body and version support them; otherwise, is clinical judgement identified? definition
3. For any ICD or SNOMED mapping, what code, edition, jurisdiction and exact or broader relationship were verified? boundary

Differential evidence

Record the reasoning distinguishing fungal disease, isolated thickening, ingrowing edges and congenital malalignment.

1. Which alternative explanation remains plausible, and what observation or investigation would distinguish it? boundary
2. If fungal testing was performed, what specimen, method, date and result support its interpretation? provenance
3. Is another nail condition considered an alternative, a contributor or a separate coexisting condition? boundary

Onset sequence

Separate reported early-life abnormalities from later acquired changes.

1. When were thickening, elongation and abnormal curvature first noticed, and by whom? provenance
2. Were abnormal nail direction or similar family nail changes present from early life? boundary

Contributor assessment

Request evidence for pressure, injury and care-access explanations rather than assigning blame.

1. What documented injury, footwear contact or other repeated pressure preceded the affected nail's change? provenance
2. What limits safe nail maintenance, such as reach, vision, dexterity, equipment or access to assistance? action
3. Which proposed contributors are supported by temporal evidence, and which remain hypotheses? boundary

Activity-specific burden

Separate pain, footwear difficulty, activity restriction and cosmetic concern.

1. What pain occurs at rest, with footwear or during use, and on what named scale? measurement
2. Which activities are limited, and what improvement matters most to the person? action

Local complication assessment

Distinguish observed inflammation or skin damage from a separately diagnosed complication.

1. Does the nail contact an adjacent digit, penetrate a fold or overlie a skin breach, and where? measurement
2. What new pain, redness, drainage or tissue change requires review under the applicable clinical pathway? action

Care option rationale

Options discussed in the literature include pressure reduction, mechanical debridement and nail removal with or without matrix treatment; selection depends on clinical context. [Management review](https://pmc.ncbi.nlm.nih.gov/articles/PMC6219229/).

1. What goal supports the proposed option: comfort, tissue protection, appearance or prevention of regrowth? action
2. What current circulation, sensation, skin and relevant health assessments support its suitability? provenance
3. What clinician recommendation and patient preference support the choice, including any intended permanent nail loss? action

Response and recurrence

Track symptom relief, plate regrowth and tissue recovery independently of whether a care episode has ended.

1. How have plate dimensions, pain, function and surrounding tissue changed since the dated intervention? measurement
2. Does the record show persistent deformity, new abnormal regrowth or insufficient observation to distinguish them? boundary
3. Who will reassess the nail, when, and which changes should trigger earlier review? action

Check these first

Recalled without web access and unsourced; every item is a lead to verify.

1. Which of these check these first hold for the sense of onychogryphosis this model covers, and on what evidence? provenance

Kinds and varieties

Recalled without web access and unsourced; every item is a lead to verify.

1. Which of these kinds and varieties hold for the sense of onychogryphosis this model covers, and on what evidence? provenance

Identifiers and schemes

Recalled without web access and unsourced; every item is a lead to verify.

1. Which of these identifiers and schemes hold for the sense of onychogryphosis this model covers, and on what evidence? provenance

Standards and regulation

Recalled without web access and unsourced; every item is a lead to verify.

1. Which of these standards and regulation hold for the sense of onychogryphosis this model covers, and on what evidence? provenance

Real-world use

Recalled without web access and unsourced; every item is a lead to verify.

1. Which of these real-world use hold for the sense of onychogryphosis this model covers, and on what evidence? provenance

Typical measurements

Recalled without web access and unsourced; every item is a lead to verify.

1. Which of these typical measurements hold for the sense of onychogryphosis this model covers, and on what evidence? provenance

Failure modes and hazards

Recalled without web access and unsourced; every item is a lead to verify.

1. Which of these failure modes and hazards hold for the sense of onychogryphosis this model covers, and on what evidence? provenance

Neighbouring kinds and how to tell them apart

Recalled without web access and unsourced; every item is a lead to verify.

1. Which of these neighbouring kinds and how to tell them apart hold for the sense of onychogryphosis this model covers, and on what evidence? provenance