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RELIANCE INSTITUTE OF
NURSING LIMTARA
DHAMTARI (C.G)
TOPIC - RAYNAUD’S
DISEASE
• PRESENTED BY-
• OM VERMA
• ASSISTANT PROFESSOR
Raynaud’s disease
Raynaud’s phenomenon is
a form of intermittent
arteriolar vasoconstriction
that results in coldness,
pain & pallor of the
fingertips or toes.
There are 2 forms of this
disorders :-
1. Primary or idiopathic
Raynaud’s disease
2. Secondary Raynaud’s
syndrome
Definition
“Raynaud's phenomenon (RP) is a
condition resulting in a particular series of
discolorations of the fingers and/or the
toes after exposure to changes in
temp.(cold or hot) or emotional events.
Skin discoloration occurs b’coz an
abnormal spasm of the blood vessels
causes a diminished blood supply
to the local tissues.”
according to luck man.s
According to joyce M black
The Raynaud’s 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
According to lippin cott
• It is a recurrent vasospasm of the
fingers and toes and usually occurs
in response to stress or cold
exposure
Incidence
Raynaud’s disease is
most common in women between 16
& 40 yrs. Of age & it occurs more
frequently in cold climates & during
the winter.
• CLASSIFICATION
• • Primary
• occurrence of the vasospasm alone,
with no association with another illness
• • Secondary
• secondary to other conditions, most
commonly an autoimmune disease
• eg- SLE, rhematoid arthrits
Etiology
1) Primary Raynaud’s disease :-(symptoms
are idiopathic)
Hereditary
Smoking worsens frequency and intensity of
attacks & there is a hormonal component.
Caffeine
2) Secondary Raynaud’s (Syndrome) :-
Connective tissue disorders
Eating disorders
Obstructive disorders
Drugs
Occupation
Others
• Working with vibrating machinery - the
fingers may go into spasm. This is due
to an intermittent lack of blood supply
to the fingers.
• o Emotional distress
• o Exposure to the cold
• • Exposure to chemicals such as PVC,
Silica.
• • Smoking
• • Autoimmune disease
Risk factors
1) The risk factors for primary Raynaud's include :-
Gender,Age,Family history & Living in a cold climate
2) The risk factors for secondary Raynaud's include
:-
 Age
 Certain diseases and conditions
 Injuries to the hands or feet
 Exposure to certain workplace chemicals
 Repetitive actions with the hands
 Certain medicines
 Smoking
 Living in a cold climate
Clinical manifestation
1. Intermittent arteriolar vasoconstriction resulting in
coldness, pain, pallor.
2. Involvement of the fingers appears to be asymmetric;
thumbs are less often involved.
3. Characteristic color changes: white-blue-red.
a) White- blanching, dead-white appearance if spasm is
severe
b) Blue - cyanotic,because of pooling of deoxygenated
blood during vasospasm.
c) Red – because of oxygenated blood
returns to the digits after the
vasospasm stops.
4. Occasionally,ulceration of the fingertips.
5. Numb, prickly feeling or stinging pain
upon warming or relief of stress.
• Signs and Symptoms
• • The attacks can affect the fingers and toes,
and rarely the nose, ears,or lips.
• • The affected body parts will usually have two
or more of the following changes:
• • Look pale due to lack of blood flow
• • Look bluish due to a lack of oxygen
• • Feel numb, cold, or painful
• • Redden as blood returns to the affected area
• Patients often describe 3 phases
of change –
• • initial white (vasoconstriction),
• • followed by blue (cyanosis),
• • then red (rapid blood reflow
Diagnostic evaluation
1. History taking
2. Physical examination
3. Cold Stimulation Test
4. Nail-fold Capillaroscopy
5. Digital artery pressure
6. Doppler ultrasound
7. Complete blood count
8. Blood test for urea & electrolytes
9. Thyroid function tests
10.An auto-antibody screen tests
• Diagnosis
• • History collection
• Obtain a history of injury or frostbite
• occupational history eg- jackhammers
• Industrial exposure to polyvinyl chloride
• Autoimmune disorders
• • Physical examination
• observe the colur of digits, ulcers
• Examine nailfold capillaries under magnification help
• diagnose underlying autoimmune disorders
• Laboratory investigation
• Complete blood count
• ESR
• Antinuclear antibody - May be positive
in autoimmune disorders and should be
obtained in patients with features of these
disorders.
• Rheumatoid factor - May be elevated in
• rheumatoid arthritis, other autoimmune
disorders
• History taking :-Clinical symptoms must
last atleast 2 yrs. To confirm the
diagnosis.& Ask about the risk factors of
the disease.
• Physical examination :- Check the finger &
toes for blood circulation.
• Cold Stimulation Test :-A cold stimulation
test can be used to trigger Raynaud's
symptoms.For this test,a small device that
measures temperature is taped to
fingers.hands are then exposed to cold—
they're usually briefly put into ice
water.hands are then removed from the
cold & the device measures how quickly
fingers return to their normal
temperature.If you have Raynaud's,it may
take more than 20 minutes for fingers to
return to their normal temperature.
• Nail-fold Capillaroscopy :-For this
test,doctor puts a drop of oil at the base of
fingernail.He or she then looks at
fingernail under a microscope.If doctor
sees abnormal arteries,it may mean you
have a disease linked to Raynaud's.
• Digital artery pressure :- 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).
• Doppler ultrasound :-to assess blood flow.
• Complete blood count :- this can
reveal a
normocytic anemia suggesting
the anemia or renal failure
• Blood test for urea and electrolytes:-
this can reveal renal impairment.
• Thyroid function tests :- this can
reveal hypothyroidism.
• An auto-antibody screentests:-
for rheumatoid factor,Erythrocyte
sedimentation rate and C-reactive
protein,which may reveal specific
causative illnesses or a generalised
inflammatory process.
• Medical Management
• • Avoiding the particular stimuli (eg, cold,
tobacco)
• that provoke vasoconstriction
• • Calcium channel blockers
• eg- Nifidipine
• 30-120 mg of the extended-release
• formulation taken once daily
• • Topical nitroglycerin (1% or 2%)
• Medical management :-
• Avoiding the particular stimuli such as cold
&tobacco,that provoke vasoconstriction is a primary
factor in controlling Raynaud's phenomenon.
• Longer acting calcium channel blocker such as
Nifedipine, Amlodipine may be used to prevent
vasospasm.
• Antiplatelet agents such as Aspirin or Dipyridamole
(persantine) may be given to prevent total occlusion.
• Sympathectomy (interrupting the sympathetic nerves
by removing the sympathetic ganglia or dividing their
branches) such as Reserpine (serpasil),Guanethidine
or Prazosin may be helpful.
•
• Nursing Management
• • The client is encouraged to avoid exposure
to cold.
• • Avoid repetitive hand movements and
stressful situations.
• • Quit smoking and avoids secondary smoke
as nicotine is potent vasoconstrictor.
• • Stress management techniques ex.
biofeedback
• • Assist in alleviating some distress from the
condition
• Complication :-
• Atrophy of skin & muscles
• Ulceration
• Gangrene
Medical management
1. Avoiding particular stimuli
i.e. cold & tobacco
2. Calcium channel blocker
such as Nifedipine,
Amlodipine may be used
3. Antiplatelet agents such as
Aspirin may be used.
4. Sympathectomy may be
helpful.
Alternative & experimental approaches
1. The Ayurvedic oil preparation Mahanarayan
Oil has been used very successfully in many
cases as a vasodilater when applied daily to
affected areas.
2. Two separate gels combined on the fingertip
increased blood flow in the fingertips by
about three times.One gel contained 5%
sodium nitrite and the other contained 5%
ascorbic acid.The milliliter of combined gel
covered an area of 3 cm².The gel was wiped
off after a few seconds.
3. Fish oil supplements which contain long-
chain omega-3 fatty acids may help to
control symptoms of primary Raynaud's.
Nursing management
1. Minimizing Sensory Alteration
2. Relieving Pain
3. Patient Education and
Health Maintenance
Raynaud's Disease: Causes, Symptoms, Diagnosis and Treatment

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Raynaud's Disease: Causes, Symptoms, Diagnosis and Treatment

  • 1. RELIANCE INSTITUTE OF NURSING LIMTARA DHAMTARI (C.G) TOPIC - RAYNAUD’S DISEASE • PRESENTED BY- • OM VERMA • ASSISTANT PROFESSOR
  • 2.
  • 3. Raynaud’s disease Raynaud’s phenomenon is a form of intermittent arteriolar vasoconstriction that results in coldness, pain & pallor of the fingertips or toes. There are 2 forms of this disorders :- 1. Primary or idiopathic Raynaud’s disease 2. Secondary Raynaud’s syndrome
  • 4. Definition “Raynaud's phenomenon (RP) is a condition resulting in a particular series of discolorations of the fingers and/or the toes after exposure to changes in temp.(cold or hot) or emotional events. Skin discoloration occurs b’coz an abnormal spasm of the blood vessels causes a diminished blood supply to the local tissues.” according to luck man.s
  • 5. According to joyce M black The Raynaud’s 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
  • 6. According to lippin cott • It is a recurrent vasospasm of the fingers and toes and usually occurs in response to stress or cold exposure
  • 7. Incidence Raynaud’s disease is most common in women between 16 & 40 yrs. Of age & it occurs more frequently in cold climates & during the winter.
  • 8. • CLASSIFICATION • • Primary • occurrence of the vasospasm alone, with no association with another illness • • Secondary • secondary to other conditions, most commonly an autoimmune disease • eg- SLE, rhematoid arthrits
  • 9. Etiology 1) Primary Raynaud’s disease :-(symptoms are idiopathic) Hereditary Smoking worsens frequency and intensity of attacks & there is a hormonal component. Caffeine 2) Secondary Raynaud’s (Syndrome) :- Connective tissue disorders Eating disorders Obstructive disorders Drugs Occupation Others
  • 10. • Working with vibrating machinery - the fingers may go into spasm. This is due to an intermittent lack of blood supply to the fingers. • o Emotional distress • o Exposure to the cold • • Exposure to chemicals such as PVC, Silica. • • Smoking • • Autoimmune disease
  • 11. Risk factors 1) The risk factors for primary Raynaud's include :- Gender,Age,Family history & Living in a cold climate 2) The risk factors for secondary Raynaud's include :-  Age  Certain diseases and conditions  Injuries to the hands or feet  Exposure to certain workplace chemicals  Repetitive actions with the hands  Certain medicines  Smoking  Living in a cold climate
  • 12.
  • 13. Clinical manifestation 1. Intermittent arteriolar vasoconstriction resulting in coldness, pain, pallor. 2. Involvement of the fingers appears to be asymmetric; thumbs are less often involved. 3. Characteristic color changes: white-blue-red. a) White- blanching, dead-white appearance if spasm is severe b) Blue - cyanotic,because of pooling of deoxygenated blood during vasospasm. c) Red – because of oxygenated blood returns to the digits after the vasospasm stops. 4. Occasionally,ulceration of the fingertips. 5. Numb, prickly feeling or stinging pain upon warming or relief of stress.
  • 14. • Signs and Symptoms • • The attacks can affect the fingers and toes, and rarely the nose, ears,or lips. • • The affected body parts will usually have two or more of the following changes: • • Look pale due to lack of blood flow • • Look bluish due to a lack of oxygen • • Feel numb, cold, or painful • • Redden as blood returns to the affected area
  • 15. • Patients often describe 3 phases of change – • • initial white (vasoconstriction), • • followed by blue (cyanosis), • • then red (rapid blood reflow
  • 16. Diagnostic evaluation 1. History taking 2. Physical examination 3. Cold Stimulation Test 4. Nail-fold Capillaroscopy 5. Digital artery pressure 6. Doppler ultrasound 7. Complete blood count 8. Blood test for urea & electrolytes 9. Thyroid function tests 10.An auto-antibody screen tests
  • 17. • Diagnosis • • History collection • Obtain a history of injury or frostbite • occupational history eg- jackhammers • Industrial exposure to polyvinyl chloride • Autoimmune disorders • • Physical examination • observe the colur of digits, ulcers • Examine nailfold capillaries under magnification help • diagnose underlying autoimmune disorders
  • 18. • Laboratory investigation • Complete blood count • ESR • Antinuclear antibody - May be positive in autoimmune disorders and should be obtained in patients with features of these disorders. • Rheumatoid factor - May be elevated in • rheumatoid arthritis, other autoimmune disorders
  • 19. • History taking :-Clinical symptoms must last atleast 2 yrs. To confirm the diagnosis.& Ask about the risk factors of the disease. • Physical examination :- Check the finger & toes for blood circulation.
  • 20. • Cold Stimulation Test :-A cold stimulation test can be used to trigger Raynaud's symptoms.For this test,a small device that measures temperature is taped to fingers.hands are then exposed to cold— they're usually briefly put into ice water.hands are then removed from the cold & the device measures how quickly fingers return to their normal temperature.If you have Raynaud's,it may take more than 20 minutes for fingers to return to their normal temperature.
  • 21. • Nail-fold Capillaroscopy :-For this test,doctor puts a drop of oil at the base of fingernail.He or she then looks at fingernail under a microscope.If doctor sees abnormal arteries,it may mean you have a disease linked to Raynaud's. • Digital artery pressure :- 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). • Doppler ultrasound :-to assess blood flow.
  • 22. • Complete blood count :- this can reveal a normocytic anemia suggesting the anemia or renal failure
  • 23. • Blood test for urea and electrolytes:- this can reveal renal impairment. • Thyroid function tests :- this can reveal hypothyroidism. • An auto-antibody screentests:- for rheumatoid factor,Erythrocyte sedimentation rate and C-reactive protein,which may reveal specific causative illnesses or a generalised inflammatory process.
  • 24. • Medical Management • • Avoiding the particular stimuli (eg, cold, tobacco) • that provoke vasoconstriction • • Calcium channel blockers • eg- Nifidipine • 30-120 mg of the extended-release • formulation taken once daily • • Topical nitroglycerin (1% or 2%)
  • 25. • Medical management :- • Avoiding the particular stimuli such as cold &tobacco,that provoke vasoconstriction is a primary factor in controlling Raynaud's phenomenon. • Longer acting calcium channel blocker such as Nifedipine, Amlodipine may be used to prevent vasospasm. • Antiplatelet agents such as Aspirin or Dipyridamole (persantine) may be given to prevent total occlusion. • Sympathectomy (interrupting the sympathetic nerves by removing the sympathetic ganglia or dividing their branches) such as Reserpine (serpasil),Guanethidine or Prazosin may be helpful. •
  • 26. • Nursing Management • • The client is encouraged to avoid exposure to cold. • • Avoid repetitive hand movements and stressful situations. • • Quit smoking and avoids secondary smoke as nicotine is potent vasoconstrictor. • • Stress management techniques ex. biofeedback • • Assist in alleviating some distress from the condition
  • 27. • Complication :- • Atrophy of skin & muscles • Ulceration • Gangrene
  • 28. Medical management 1. Avoiding particular stimuli i.e. cold & tobacco 2. Calcium channel blocker such as Nifedipine, Amlodipine may be used 3. Antiplatelet agents such as Aspirin may be used. 4. Sympathectomy may be helpful.
  • 29. Alternative & experimental approaches 1. The Ayurvedic oil preparation Mahanarayan Oil has been used very successfully in many cases as a vasodilater when applied daily to affected areas. 2. Two separate gels combined on the fingertip increased blood flow in the fingertips by about three times.One gel contained 5% sodium nitrite and the other contained 5% ascorbic acid.The milliliter of combined gel covered an area of 3 cm².The gel was wiped off after a few seconds. 3. Fish oil supplements which contain long- chain omega-3 fatty acids may help to control symptoms of primary Raynaud's.
  • 30. Nursing management 1. Minimizing Sensory Alteration 2. Relieving Pain 3. Patient Education and Health Maintenance