Raynauds phenomenon- nursing

1. COLLEGE OF NURSING
MADRAS MEDICAL COLLEGE
CHENNAI
MEDICAL SURGICAL NURSING
BY
EDWIN JOSE .L

2. definition
 Raynaud’s phenomenon is a form of intermittent arteriolar
vasoconstriction characterized by episodic digital ischemia,
manifested by the sequential development of digital blanching,
cyanosis, and rubor of the fingers or toes after cold exposure and
subsequent rewarming.
 Emotional stress may also precipitate Raynaud’s phenomenon
 It occurs more often in women, especially those between 15 and
40 years of age.

3. classification
 Primary or idiopathic Raynaud’s phenomenon
 Secondary Raynaud’s phenomenon
 Collagen vascular diseases- scleroderma, systemic lupus
erythematosus, rheumatoid arthritis, dermatomyositis,
polymyositis, mixed connective tissue disease, Sjögren’s
syndrome
 Arterial occlusive diseases: atherosclerosis of the extremities,
thrombo angiitis obliterans, acute arterial occlusion, thoracic
outlet syndrome ,Pulmonary hypertension

4. cont
 Neurologic disorders: intervertebral disk disease, syringomyelia,
spinal cord tumors, stroke, poliomyelitis, carpal tunnel
syndrome, complex regional pain syndrome
 Blood dyscrasias: cold agglutinins, cryoglobulinemia,
cryofibrinogenemia, myeloproliferative disorders,
lymphoplasmacytic lymphoma
 Trauma: vibration injury, hammer hand syndrome, electric
shock, cold injury, typing, piano playing
 Drugs and toxins: ergot derivatives, methysergide, β-adrenergic
receptor blockers, bleomycin, vinblastine, cisplatin,
gemcitabine, vinyl chloride ,Tobacco products, nicotine

5. Cont….
Other contributing factors include the use of vibrating machinery
or work in cold environments, exposure to heavy metals (e.g.,
lead), and high homocysteine levels

7. Clinical manifestation
 Raynaud’s phenomenon is characterized by vasospasm-induced color
changes of fingers, toes, ears, and nose (white, blue, and red).
 Decreased perfusion results in pallor (white).
 The digits then appear cyanotic (bluish purple)
 These changes are followed by rubor (red), a hyperemic response when
blood flow is restored.
 The patient usually describes coldness and numbness in the vasoconstrictive
phase.

8. Cont…..
 Followed by throbbing, pain, tingling, and swelling in the hyperemic phase.
 An episode usually lasts only minutes but may last for several hours.
 Exposure to cold, emotional upsets, tobacco use, and caffeine often bring on
symptoms
 Frequent and prolonged attacks, the skin may become thickened and the
nails brittle.
 Complications include punctate (small hole) lesions of the fingertips and
superficial gangrenous ulcers.

10. Diagnostic evaluation
Diagnosis is based on persistent symptoms for at least 2 years.
 Patients with Raynaud’s phenomenon should have routine follow-
up to monitor for development of connective tissue or
autoimmune diseases

11. treatment
Hand warmers
Oral vasodilators
 Calcium channel blockers- Sustained-release calcium channel blockers
(e.g., nifedipine) are the first-line drug therapy. They relax smooth
muscles of the arterioles by blocking the influx of calcium into the cells.
This reduces the frequency and severity of vasospastic attacks.
 Calcium channel blockers can be taken with nitroglycerin topical
ointment.
 If symptoms persist, other vasodilators (e.g., phosphodiesterase-5
inhibitors [sildenafil]) or topical nitroglycerin 2% ointment may be used.
Phosphodiesterase-5 inhibitors are not used with topical nitroglycerin
due to risk for hypotension
 ACE inhibitors,
 angiotensin receptor blockers

12. Cont….
 In severe cases, parenteral vasodilators (prostacyclin analogues and calcitonin gene-
related peptide) are used.
Surgical management:
 Lumbar sympathectomy can help foot symptoms.
 Radical micro-arteriolysis (digital sympathectomy) can be used where individual fingers or
toes are severely ischaemic, and thoracic sympathectomy under video-assisted thoracic
surgery is now performed.

13. CONT….
Prompt intervention is needed for patients with digital ulceration
or critical ischemia.
Treatment options include prostacyclin infusion therapy (e.g.,
iloprost), antibiotics, analgesics, and surgical debridement of
necrotic tissue.
Botulinum toxin A and statins may lessen the severity of Raynaud’s
phenomenon.
Sympathectomy is done only in severe cases refractory to medical
treatment where digit survival is threatened

14. prognosis
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 , 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.

15. Nursing management
 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.

16. cont
 Sweater should used entering air-conditioned rooms.
Concerns about serious complications, such as gangrene and
amputation, are common among patients.
 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 .

17. Patients education
 Focus on preventing episodes.
Tell patients to avoid temperature extremes and wear loose, warm
clothing as protection from the cold, including gloves when
handling cold objects.
The patient should stop using all tobacco products and avoid
caffeine and other drugs that have vasoconstrictive effects (e.g.,
cocaine, amphetamines, ergotamine, pseudoephedrine).
 Provide patients with appropriate stress management strategies.
 Immersing hands in warm water often decreases the vasospasm.

18. THANKYOU