S: , The patient presents for evaluation at the request of his primary physician for treatment for nails.  He has last seen the primary physician in December 2006.,PRIMARY MEDICAL HISTORY:,  Femoral embolectomy, GI bleed, hypertension, PVD, hypothyroid, GERD, osteoarthritis, diabetes, CAD, renal artery stenosis, COPD, and atrial fibrillation.,MEDICATIONS:,  Refer to chart.,O: , The patient presents in wheelchair, verbal and alert.  Vascular:  He has absent pedal pulses bilaterally.  Trophic changes include absent hair growth and dystrophic nails.  Skin texture is dry and shiny.  Skin color is rubor.  Classic findings include temperature change and edema +2.  Nails:  Thickened and hypertrophic, #1, #2, #3, #4, and #5 right and #1, #2, #3, #4, and #5 left.,A:,1.  Dystrophic nails.,2.  Peripheral vascular disease as per classic findings.,3.  Pain on palpation.,4.  Diabetes.,P:  ,Nails #1, #2, #3, #4, and #5 right and #1, #2, #3, #4, and #5 left were debrided.  The patient will be seen at the request of the nursing staff for therapeutic treatment of dystrophic nails.podiatry, debrided, nails, dystrophic nails, dystrophic