Medical and surgical nursing -I. Vascular disorder

1. M R S . C . M A R Y L A L I T H A K A L A
A S S O C I A T E P R O F E S S O R
A M E R I C A N N R I C O L L E G E O F N U R S I N G
V I S A K H A P A T N A M
RAYNAUD’S DISEASE

2. DEFINITION
“A disease characterized by spasm of the
arteries in the extremities, especially the fingers
( raynaud's phenomenon ). it is typically brought
on by constant cold or vibration, and leads to
pallor, pain, numbness, and in severe cases,
gangrene.”

4. ETIOLOGY
 Typically, the fingers, and less commonly the toes, are
involved. Rarely, the nose, ears, or lips are affected. The
episodes result in the affected part turning white and
then blue. Often, numbness or pain occurs. As blood flow
returns, the area turns red and burns. The episodes
typically last minutes, but can last several hours.
 Episodes are often triggered by cold or emotional stress

5. 3 COLORS OF RAYNAUD’S PHENOMENA
WHITE
BLUE
RED

7. TYPES
 There are two main types ---
 1. Primary Raynaud's: The cause is unknown.
 2. Secondary Raynaud's: which occurs as a result of
another underlying disorder / condition.
Ex: connective-tissue disorder
scleroderma
systemic lupus erythematous,
injuries to the hands,
prolonged vibration,
smoking,
thyroid disorders, c
certain medications, such as birth control
pills.

8. PATHOPHYSIOLOGY
Hyper activation of the sympathetic nervous
system
Extreme vasoconstriction of the peripheral blood
vessels
Leading to tissue hypoxia.

10. DIAGNOSTIC EVALUATION
1. Distinguishing Raynaud's disease (primary
Raynaud's) from phenomenon (secondary
Raynaud's) is important. Looking for signs
of arthritis or vasculitis, as well as a number of
laboratory tests, may separate them. If
suspected to be secondary to systemic sclerosis.
2. One tool which may help aid in the prediction of
systemic sclerosis is thermography.

11. 3. A careful medical history will often reveal
whether the condition is primary or secondary.
Once this has been established, an examination is
largely to identify or exclude possible secondary
causes.

12. 4) Digital artery pressures are measured in the arteries of the
fingers before and after the hands have been cooled. A decrease
of at least 15 mmHg is diagnostic (positive).
5) Doppler ultrasound to assess blood flow
6) Full blood count may reveal a normocytic anaemia suggesting
the anaemia of chronic disease or kidney failure.
7) Blood test for urea and electrolytes may reveal kidney
impairment.
8) Thyroid function tests may reveal hypothyroidism.
9) An autoantibody screen, tests for rheumatoid factor, erythrocyte
sedimentation rate, and C-reactive protein may reveal specific
causative illnesses or a generalised inflammatory process.
10) Anti-centromere antibodies are common in limited systemic
sclerosis (CREST syndrome).
11) Nail fold vasculature can be examined under the microscope.

13. MEDICAL MANAGEMENT
 Secondary Raynaud's is managed primarily by
treating the underlying cause, and as primary
Raynaud's, avoiding triggers, such as cold,
emotional and environmental stress, vibrations
and repetitive motions, and avoiding smoking
(including passive smoking) and sympathomimetic
drugs.

14. MEDICATION
1. Medications can be helpful for moderate or severe disease.
2. Vasodilators
3. Calcium channel blockers, such as
the dihydropyridines ,nifedipine or amlodipine
4. People with increased severity are prone to ulceration or large artery
thrombotic events and may be prescribed aspirin.
5. Sympatholytic agents, such as the alpha-adrenergic blocker prazosin, may
provide temporary relief to secondary Raynaud's phenomenon.
6. Losartan , and topical nitrates may, reduce the severity and frequency of
attacks, and the phosphodiesterase inhibitors sildenafil and tadalafil may
reduce their severity.[21]

15. 7. Angiotensin receptor blockers or ACE inhibitors may aid blood
flow to the fingers,[21] and some evidence shows that angiotensin
receptor blockers (often losartan) reduce frequency and severity
of attacks,[26] and possibly better than nifedipine.[27][28]
8. The prostaglandin iloprost is used to manage critical ischemia
and pulmonary hypertension in Raynaud's phenomenon, and
the endothelin receptor antagonist bosentan is used to manage
severe pulmonary hypertension and prevent finger ulcers
in scleroderma.[21]
9. Statins have a protective effect on blood vessels,
and SSRIs such as fluoxetine may help symptoms, but the data is
weak.[21]
10. PDE5 inhibitors are used off-label to treat severe ischemia and
ulcers in fingers and toes for people with secondary Raynaud's
phenomenon; as of 2016, their role more generally in Raynaud's
was not clear.[29]

16. NURSING MANAGEMENT