RAYNAUDS DISEASE and Buergers Disease

Definition: Buergers disease (thromboangiitis obliterans) is a recurring inammation of the intermediate and small arteries and veins of the lower and upper extremities
Rare,occurs most often in men between 20 and ! "ears of age, and it has been reported in

all races and in man" areas of the world# $here is considerable evidence that heav" smo%ing or chewing of tobacco is a causative or an aggravating factor#

Raynauds disease & is one of several primar" arteriospastic disorders characteri'ed b" episodic vasospasm in the small peripheral arteries and arterioles, precipitated b" exposure to cold or stress#
$his condition occurs bilaterall" and usuall" affects the hands or, less commonl", the feet# (ost prevalent in females, particularl" between pubert" and age )0# The Term Raynauds phenomenon is used to refer to locali'ed intermittent episodes of

vasoconstriction of small arteries of the feet and hands that cause color and temperature changes# *enerall" unilateral# Reference+ ,ippincott (anual of -ursing .ractice

CLASSIFICATION/TY !S

RI"ARY+ cause is not %nown (idiopathic) S!CONDARY: caused b" underl"ing problem

 Repetitive actions Hand and foot injuries Exposure to certain chemicals Medicines Smoking

CLINICAL "ANIF!STATIONS of Raynauds

/old fingers and toes 0e1uence of color changes in "our s%in in response to cold or stress -umb, pric%l" feeling or stinging pain upon warming or relief of stress

CLINICAL "ANIF!STATIONS of #uer$ers

.ain is the outstanding s"mptom (generall" bilateral and s"mmetric with focal lesions)# .atients

complain of cramps in the feet, particularl" the arches, after exercise (instep claudication)# .ain is relieved b" rest#

Burning pain aggravated b" emotional disturbances, nicotine, or chilling2 digital rest pain (3ngers /olor changes (rubor) of the feet progress to c"anosis (in onl" one extremit" or certain digits) that

or toes)2 and a feeling of coldness or sensitivit" to cold ma" be earl" s"mptoms#

appears when the extremit" is in a dependent position#

OSSI%L! CO" LICATIONS:

Comp&ete &ost of #&ood to the di$its 'i&& (ause: Deformities of fin$ers and toes )an$rene u&(er

DIA)NOSTIC T!ST:
1. Co&d Stimu&ation Test $he cold stimulation test for Ra"naud4s phenomenon is a test that measures the temperature

of each finger after the" are placed in an ice5water bath. Nursin$ Responsi#i&ities:

6xplain the procedure and purpose of the test

2. -ailfold /apillaroscop"

a noninvasive method to evaluate vascular d"sfunction

-ursing Responsibilities2

6xplain the procedure and purpose of the test

3. Antinu(&ear anti#odies test 7 positive test for the presence of these antibodies 8 produced b" "our immune s"stem 8

indicates a stimulated immune s"stem and is common in people who have connective tissue diseases or other autoimmune disorders.

. 6r"throc"te sedimentation rate. $est determines the rate at which red blood cells settle to the bottom of a tube in the space of

an hour# 7 faster than normal rate ma" signal an underl"ing inflammator" or autoimmune disease# 7utoimmune diseases are commonl" associated with secondar" Ra"naud4s# N*RSIN) ROC!SS ro#&em+, Su#-e(ted (ues: O#-e(ti.e (ues: Ineffe(ti.e periphera& tissue perfusion r/t to &a(/ of #&ood supp&y to e0tremities )oa&: In(reased arteria& #&ood supp&y to e0tremities Nursin$ Inter.entions:
1. Assess the patient for the #&ood (ir(u&ation1 (o&or and sensation at the e0tremities( For further

investigation and treatment

2. App&y 'arm (ompress at the affe(ted area 2 To promote good blood circulation)

3. Administer the medi(ation as pres(ri#ed #y do(tor su(h as (a&(ium (hanne& #&o(/ers and

a&pha #&o(/ers 2To vasodilate the blood vessel and increase blood supply to the extremities3

4. "onitor the #&ood (ir(u&ation to the e0tremities e.ery t'o hours2 circulation chart) ( To

observe for any further complication)

5. !n(oura$e patient to perform e0tremities e0er(ises 'hi&e sittin$ or durin$ 'or/ ( Muscular

excersises promotes blood flow and the development of collateral circulation) .roblem92 0ub:ective cues+ ;b:ective cues+ Nursin$ Dia$nosis: An0iety re&ated to disease pro(ess

)oa&: To redu(e the an0iety &e.e& of patient Nursin$ inter.entions:

1. 7sess the patients anxiet" level b" observing clients behaviour e#g cr"ing facial expression 2. Reinforce doctors explainations to patient b" using the non medical term( to increase the

understanding of patient about the disease#

3. .rovide moral and emotional support to patient ( to provide patient ps"chological comfort) . 6ncourage diversional activit" e#g watching tv, listening to music( to deviate clients mind awa"

from the

"!DICAL "ANA)!"!NT
1. Ca&(ium Channe& %&o(/ers4 such as nefidipine# /alcium5 cahnnel bloc%ers are used in Ra"nauds

disease to produce vasodilation to produce vasodilation in the affected blood vessels# /alcium channel bloc%ers act b" causing relaxation of the smooth muscle of the arterial wall#

Nursin$ Responsi#i&ities:

$a%e B., renal and hepatic tests before giving the drug /ontraindicated in+ clients with
rd

degree bloc% of sic% sinus s"ndrome

/aution in clients concurrentl" ta%ing digoxin and beta5bloc%er <=+ monitor for tach"cardia and h"potension 7void grapefruit

2.

An$iotensin4re(eptor anta$onist4 losartan at !0 mg>d has been found effective in patients with primar" Re"naud phenomenon and scleroderma# -ursing Responsibilities

(onitor blood pressure and pulse (onitor B?-, creatinine and electrol"tes $ell the client to report edema in feet and legs dail"

(onitor h"dration status

Sur$i(a& "ana$ement
1. Ner.e Sur$ery4 Sympathe(tomy4 is a surgical procedure that destro"s nerves in the s"mpathetic

nervous s"stem# $he procedure is done to increase blood flow and decrease long5term pain in certain diseases that cause narrowed blood vessels.

0"mpathectom" is performed to relieve intermittent constricting of blood vessels (ischemia)

when the fingers, toes, ears, or nose are exposed to cold (Ra"naud4s phenomenon) Nursin$ Responsi#i&ities:

/onfirm that all re1uired consent forms are full" completed @eep patient -.; as ordered (onitor vital signs

2. Amputation & necessar" if ischemia causes ulceration and gangrene

5!ALT5 !D*CATION

0top 0mo%ing 6xercise /ontrol 0tress 7void /affeine $a%e care of feet and hand Aress warml" outdoors

Referen(es 6ohn and %ar&ett7 athophysio&o$y A ra(ti(a& Approa(h789,, Ro#ert e&#er$1 :o-(ie(h "a;ur# <as(u&ar CT An$io$raphy "anua&789,9 Le"one1 %ur/e7"edi(a&4Sur$i(a& Nursin$: Criti(a& Thin/in$ in atient Care7899=

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