14559879 Raynauds Disease

8/12/2019 14559879 Raynauds Disease

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Raynauds Disease

(Raynauds Phenomenon)


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Definition

Raynaud's diseaseis a condition of the

circulation that affects blood supply to the

skin and causes the extremities of the body

to lose feeling and become numb.

Paroxysmal pallor and coldness of the

extremities.


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Synonyms

Raynaud's phenomenon

vasoconstriction

scleroderma lupus

microcirculation


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Two lassification

Primary Raynaud's phenomenonor idiopathic isconsidered the more common! milder condition.There is no underlying disease associated with

the primary classification. "bout #$% of all casesdiagnosed occur in women between &$ and (years old.

Secondary Raynaud's phenomenonis less

common! but is considered the more serious ofthe two classifications. )t is associated with anunderlying disease! most commonly! one of theconnective tissue diseases


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Predisposing *actors

The risk factors include+ Smoking

,orking with vibrating machinery - the fingersmay go into spasm. This is due to an

intermittent lack of blood supply to the fingers.

motional distress-

xposure to the cold

,omen affected more often than men


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Signs and Symptoms

People with Raynaud's /primary or secondary0have attacks in response to cold or emotional

stress. The attacks can affect the fingers and

toes! and rarely the nose, ears, nipples, or lips.

The affected body parts will usually have two ormore of the following changes+

1ook paledue to lack of blood flow

1ook bluishdue to a lack of oxygen *eel numb, cold, or painful

Redden and throb or tingle as blood returns to the

affected area


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Pathophysiology

Precipitating FactorsSmokingWorking withvibrating machineryEmotional distressExposure to the cold

Women affectedmore often thanmen

Stress

Digital artery contraction spasm

Occlusion of arteries

Predisposing Factors

Age- between 15and 40 years

old.Gender- Women

are mostlyaffectedlimate! winter

oldexposure


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"issue ischemia#s$s% &lanching of the digits' burning' throbbing pain' swelling

of the area(

"issue hypoxia

"issue necrosis

"issue ulceration

Gangrene


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Diagnostic Test

Diagnostic tests which doctors use to assessRaynaud's phenomenon include the+

Antinuclear Antibody (ANA) lab testare

unusual antibodies! detectable in the blood! thathave the capability of binding to certain structureswithin the nucleus of the cells.

!rythrocyte Sedimentation Rate (!SR) blood

test- "his blood test determines the rate at#hich red blood cells settle to the bottom of atube$ A fasterthannormal rate may signal aninflammatory or autoimmune disease$


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Diagnostic Test

Nailfold %apillaroscopy "est2" drop of oil is put onthe nailfolds and then looked at under amagnifying glass to see whether there are

changes in the capillaries which are indicative ofconnective tissue disease. %old Stimulation "est- " heat sensor is taped to your

fingers and the temperature is recorded. 3our hand is thenimmersed in ice water for & seconds. Then it is removed

from the bath and the temperature recorded every $minutes until your finger temperature is the same as it wasbefore the bath. This test should notbe performed if youhave a finger infection or problems #ith the bloodsupply to your fingers$


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Diagnostic riteria

The diagnostic criteria used to diagnose primaryRaynaud's phenomenoninclude+

Periodic vasospastic attacks ofpallor/whiteness0or cyanosis/blueness0 /note+ some doctors

include the additional criterion of the presence ofthese attacks for at least 4 years0

Normal nailfold capillary pattern Negatieantinuclear antibody test /"5"0 Normal erythrocyte sedimentation rate /SR0 Absence of pitting scars or ulcers of the sin!

or gangrene /tissue death0 in the fingers or toes


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Diagnostic riteria

The diagnostic criteria used to diagnose Secondary

Raynaud's phenomenoninclude+

Periodic vasospastic attacks of pallor/whiteness0

and cyanosis/blueness0

Abnormalnailfold capillary pattern

Positieantinuclear antibody test /"5"0

Abnormalerythrocyte sedimentation rate /SR0 Presence of pitting scars or ulcers of the sin!

or gangrene in the fingers or toes


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5ursing 6anagement

The client is encouraged to avoid exposure to

cold$

"void repetitive hand movements and stressful

situations. 7uit smoking and avoids secondary smoke as

nicotineis potent asoconstrictor.

Stress management techni8ues ex. biofeedbac "ssist in alleviating some distress from the

condition.


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6edical 6anagement

"ssessed regularly for symptoms of autoimmunediseases.

6edication is administered if the symptoms are due tovasospastic disease.

*iofeedbacallows clients to oluntarily control thetemperature of their hands. "voiding particular stimuli (cold, tobacco)that provoke

asoconstriction. %alcium channel blocers The first choice drugs for

Raynaud's in Scleroderma patients. +asodilators Some doctors prescribe a vasodilator /a

drug that relaxes blood vessels0! such as nitroglycerinecream. 3ou put the cream on your fingers to help healskin ulcers.


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Pharmacological 6anagement Nifedipine (Procardia, Adalat)calcium channel blockers

5ifedipine was found to reduce the+ *re8uency of ischemicepisodes

Nursing considerations Don't give immediate-release formwithin & week of acute 6) or in acute coronary syndrome.6onitor blood pressure regularly! especially in patients whotake beta blockers or antihypertensive. ,atch for symptoms of

heart failure.

%aptopril (%apoten)- " inhibitors

-ndications9ypertension!Diabetic nephropathy

Nursing considerations+ 6onitor patient's blood pressure and pulse rate fre8uently. "lert+ lderly patients may be more sensitive to drug's

hypotensive effects. "ssess patient for signs of angioedema. Drug causes the most fre8uent occurrence of cough! compared

with other " inhibitors.
http://en.wikipedia.org/wiki/Calcium_channel_blockerhttp://en.wikipedia.org/wiki/Calcium_channel_blocker


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Pharmacological 6anagement Diltia.em hydrochloride (%ardi.em)slow channel

blocker or calcium antagonist

-ndicationsindicated for the treatment of hypertension. )tmay be used alone or in combination with otherantihypertensive medications.

Nursing considerations Patients controlled on drug alone or with other drugs may

be switched to ardi:em 1" tablets once a day at thenearest e8uivalent total daily dose. 6onitor blood pressure and heart rate when starting

therapy and during dosage ad;ustments. 6aximum antihypertensive effect may not be seen for &

days.


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Pharmacological 6anagement

6edication that aids in healing finger ulcers

are iloprost a prostaglandinwhich is given

)< and %iproflo/acin (%ipro),an antibiotic. hemotherapy drugs such as *leomycin

Sulfate (*leno/ane)and %isplatin! also

cause secondary Raynaud>s disease.


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Surgical 6anagement

Nere surgery$Through small incisions in the affectedhands or feet! a doctor strips away these tiny nervesaround the blood vessels. The surgery! calledsympathectomy! may reduce the fre8uency and duration ofattacks! but it's not always successful.

%hemical in0ection$Doctors can in;ect chemicals to blocksympathetic nerves in affected hands or feet. 3ou mayneed to have the procedure repeated if symptoms return orpersist.

Amputation$Sometimes! doctors need to remove tissuedamaged from a lack of blood supply. This may includeamputating a finger or toe affected by Raynaud's in whichthe blood supply has been completely blocked and thetissue has developed gangrene.

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14559879 Raynauds Disease