SEMINAR ON RAYNAUDS DISEASE

AND BUERGERS DISEASE

PRESENTED BY,UMADEVI.K

IIN YEAR MSC NURSINGEVALUATOR

PROF.R.BABUHOD MSN

INTRODUCTION

Adequate perfusion oxygenates and nourishes body

tissues and depends in part on a properly functioning

cardiovascular system. Adequate blood flow depends on

the efficient pumping action of the heart, patent and

responsive blood vessels, and adequate cir culating

blood volume. Nervous system activity, blood viscosity,

and the metabolic needs of tissues influence the rate

and adequacy of blood flow.

Raynauds disease and Thrombo angitis obliterens are

the diseases caused mainly by poor bloodsupply

RAYNAUDS DISEASE

Raynauds disease is the intermittent arteriolar vasoconstriction that results in coldness,pain and pallor of finger tips or toes.

The term Raynauds phenomenon is used to refer to localized intermittent episodes of vasoconstriction of small arteries of the feet and hands that cause color and temperature changes.Generally unilateral.

INCIDENCE

Most common among patients between 16 and 40 years of age and it occurs more frequently in cold climates and during the winter.

TYPES

Primary : without any underlying disease or medical problem

Secondary : caused by underlying problem

ETIOLOGY Immunologic disorders Scleroderma Systemic lupus erythematosus Rheumatoid arthritis Obstructive arterial disease Trauma Certain medicines (BETA BLOCKERS) Sjogrens syndrome Carpel tunnel syndrome Diseases of arteries Chemical exposure Thyroid gland disorders (HYPOTHYROIDISM) Stress

RISK FACTORS

PRIMARY Age Gender Family history Climate SECONDARY Associated diseases Certain occupations Exposure to certain substances

PATHOPHYSIOLOGY Due to etiological factors

Vasospasm and spastic constriction of

arteries and arterioles

Retarted blood flow to capillaries and

venules

Cyanosis

After a period of minutes and hours local

ruber occurs

Throbbing pain accompanies with recovery

CLINICAL MANIFESTATIONS

Pallor Skin becomes bluish(cyanotic)

due pooling of deoxygenated blood during vasospasm.

Hyperemia Rubor(red color) Numbness,tingling and burning

pain occur as cold changes.

MEDICAL MANAGEMENT Avoiding trigerring factors like

cold and tobacco etc is a primary in controlling raynauds disease

Calcium channel blockers (Nifedipine)

SYMPATHECTOMY Interrupting the sympathetic

nerves by removing sympathetic ganglia or dividing their branches may help some patients.

NURSING MANAGEMENT The nurse teaches patients to avoid

situations that may be stressful or unsafe. Stress management classes may be helpful.

Exposure to cold must be minimized, and in areas where the fall and winter months are cold, the patient should remain indoors as much as possible and wear layers of clothing when outdoors.

Hats and mittens or gloves should be worn at all times when outside. Fabrics specially designed for cold climates (eg, Thinsulate) are recommended.

Patients should warm up their vehicles before getting in so that they can avoid touching a cold steering wheel or door handle, which could elicit an attack. During summer, a sweater should be available when entering air-conditioned rooms.

Concerns about serious complications, such as gangrene and amputation, are common among patients that should be informed

Patients should avoid all forms of nicotine; the nicotine gum or patches used to help people quit smoking may induce attacks.

Patients should be careful about safety. Sharp objects should be handled carefully to

avoid injuring the fingers. Patients should be informed about the

postural hypotension that may result from medications, such as calcium channel blockers, used to treat Raynaud’s disease.

The nurse also discusses safety precautions related to alcohol, exercise, and hot weather

THROMBOANGITIS OBLITERENS Buerger’s disease is characterized by

recurring inflammation of the intermediate

and small arteries and veins of the lower and

(in rare cases) upper extremities. It results in

thrombus formation and occlusion of the

vessels.In buergers disease blood vessels

becomes inflamed ,swelled and blocked with

blood clots.this eventually damages or

destroys the skin tissues and may lead to

infection and gangrene.It is differentiated

from other vessel diseases by its microscopic

appearance. In contrast to atherosclerosis,

Buerger’s disease is believed to be an

autoimmune disease that results in occlusion

of distal vessels.

ALSO CALLED AS “PRESENILE GANGRENE”

INCIDENCE

It occurs most often in men between the ages of 20 and 35 years, and it has been reported in all races and in many areas of the world

ETIOLOGY The cause of Buerger’s disease is

unknown, but it is believed to be an autoimmune vasculitis.

Genetic predisposition There is considerable evidence that

heavy smoking or chewing of tobacco is a causative or an aggravating factor.

Generally, the lower extremities are affected, but arteries in the upper extremities or viscera can also be involved.

Buerger’s disease is generally bilateral and symmetric with focal lesions.

RISK FACTORS

Tobacco use Chronic gum disease

PATHOPHYSIOLOGY

Due to etiological factors

Acute inflammation and thrombosis

of the viens of hands and feet

Vasculitis

Decreased blood supply to skin

Gangrene formation

CLINICAL MANIFESTATIONS

Pain (pain is relieved by rest)

The patient complains of foot cramps,

especially of the arch ( instep claudication),

after exercise.

A burning pain is aggravated by emotional

disturbances, nicotine, or chilling.

Cold sensitivity of the Raynaud type is

found in one half the patients.

Digital rest pain is constant, and the

characteristics of the pain do not change

between activity and rest.

Physical signs Includes; Intense rubor (reddish blue discoloration) of the

foot Absence of the pedal pulse but with normal

femoral and popliteal pulses. Radial and ulnar artery pulses are absent or

diminished. Various types of paresthesia may develop. As the disease progresses, definite redness or

cyanosis of the part appears when the extremity is in a dependent position.

Involvement is generally bilateral, but color changes may affect only

one extremity or only certain digits. Color changes may progress to ulceration, and

ulceration with gangrene eventually occurs

ASSESSMENT AND DIAGNOSTIC FINDINGS

History taking (current or rescent history of tobacco taking)

Physical examination (presence of extremity ischemia.claudication,pain at rest)

Segmental limb blood pressures ( to demonstrate the distal location of the lesions or occlusions)

Duplex ultrasonography (to document patency of the proximal vessels and to visualize the extent of distal disease)

Contrast angiography (to demonstrate the diseased portion of the anatomy)

Distal plesthysmography

MAIN OBJECTIVES OF MANAGEMENT

To improve circulation to the extremities

To prevent the progression of the disease

To protect the extremities from trauma and infection.

MANAGEMENT Treatment of ulceration and gangrene

is directed toward minimizing infection and conservative débridement of necrotic tissue.

Tobacco use is highly detrimental, and patients are strongly advised to stop using tobacco completely.

Vasodilators are rarely prescribed because these medications blood away from the partially occluded vessels, making the situation worse.

Prostaglandins like limaprost are vasodialators which gives relief in pain.

A regional sympathetic block or ganglionectomy may be useful in some instances to produce vasodilation and increase blood flow of limb

Debridment is done for necrotic ulcers. In chronic cases lumbar sympathectomy

is done to reduce vasoconstriction and increases blood flow to limb.

Above knee and below knee amputation is done in rare cases

Anti inflammatory drugs like corticosteroids are used for inflammation and pain

Bypass can sometimes be helpful

NURSING MANAGEMENT If amputation is performed elevating the stump

for the first 24 hours to promote venous return and minimize edema and the incision is monitored for the signs of hematoma.

The patient may experience grief, fear, or anxiety related to loss of the limb. The patient is encouraged to discuss his or her feelings. Spiritual advisors and other health care team members are consulted as appropriate. Recovery and rehabilitation require consultation among health care providers (eg, physicians, physical and occupational therapists, prosthetists, dietitians, nurses)

The patient is assisted in developing a plan to stop using tobacco and to manage pain.

The patient may need to be encouraged to make the lifestyle changes necessary with a chronic disease, including modifications in diet, activity, and hygiene (skin care).

The nurse determines whether the patient has a network of family and friends to assist with activities of daily living.

The nurse ensures that the patient has the knowl edge and ability to assess for any postoperative complications such as infection and decreased blood flow.

CONCLUSION The prognosis for Raynaud’s disease varies; some

patients slowly improve, some become progressively worse, and others show no change. Ulceration and gangrene are rare; however, chronic disease may cause atrophy of the skin and muscles. With appropriate patient teaching and lifestyle modifications, the disorder is generally benign and self-limiting.

Although this condition is different from atherosclerosis, Buerger’s disease in older patients may also be followed by atherosclerosis of the larger vessels after involvement of the smaller vessels. The patient’s ability to walk may be severely limited. Patients are at higher risk for nonhealing wounds because of impaired circulation

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