Raynauds disease and its management

1. RAYNAUDS DISEASE
AND ITS
MANAGEMENT
PRESENTED BY:
MISS.SHWETA SHARMA
M.SC. NURSING
1ST YEAR
AIIMS, JODHPUR

2. INTRODUCTION
• Raynaud’s phenomenon is an episodic vasospastic disorder of small
cutaneous arteries, most often involving the fingers and toes.
(Lewis)
• Raynaud’s syndrome is a condition in which the small arteries and
arterioles constrict in response to various stimuli.
(Joyce M.
Black)
• Raynaud’s phenomenon is a form of intermittent arteriolar vasoconstriction
that results in coldness, pain, and pallor of the fingertips or toes.
(Brunner and

3. • It is named after Maurice Raynaud, who, was a medical
student, defined the first case in 1862.
• There are 2 forms of this disorder-
Primary or idiopathic Raynaud’s disease which occurs in the
absence of an underlying disease.
Secondary Raynaud’s syndrome occurs in association with an
underlying disease, usually a connective tissue disorder, such
as SLE, rheumatoid arthritis or scleroderma, trauma,
obstructive arterial lesions.

4. •It occurs primarily in young women (typically
between 15 and 40 years of age).
•More common in women than men.

5. ETIOLOGY
• It is classified as either vasospastic or
obstructive.
Manifestations of vasospastic Raynaud’s
syndrome can be induced by cold,
nicotine, caffeine and stress.
Obstructive Raynaud’s syndrome is often
found in association with auto-immune
disorders such as systemic lupus
erythematosus, scleroderma or
rheumatoid arthritis.

6. CAUSES
Use of vibrating machinery- The fingers may go into spasm.
This is due to an intermittent lack of blood supply to the fingers.

11. RISK FACTORS
For primary Raynaud's
include: -
• Gender
• Age
• Family history
• Living in a cold climate
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. PATHOPHYSIOLOGY

13. CLINICAL
MANIFESTATIONS

15. •This is followed by throbbing, aching
pain, numbness, tingling and swelling in
the hyperaemic phase.
•An episode usually lasts only minutes but
in severe cases may persist for several
hours.
•Exposure to cold, emotional upsets,
tobacco use, and caffeine often bring on
symptoms.
•After frequent, prolonged attacks the skin
may become thickened and the nails
brittle.

17. DIAGNOSTIC EVALUATION
Criteria for diagnosing primary Raynaud’s disease include-
 Manifestations for at least 2 years.
 Intermittent attacks of pallor or cyanosis of the digits by exposure to
cold or from emotional stimuli.
 Bilateral or symmetrical involvement.
 No evidence of occlusive disease in the digital arteries or of any
systemic disease that might be the cause of the changes.
 Gangrene, which (when it occurs) is limited to the skin of the tips of
the digits.

18. History collection
•Obtain a history of injury or
frostbite
•Occupational history e.g.-
jackhammers
•Industrial exposure to polyvinyl
chloride
•Autoimmune disorders

19. Physical examination-
• Observe the colour of digits
and see for ulcers.
• Examine nailfold capillaries
under magnification which
helps to diagnose underlying
autoimmune disorders.
Cold stimulation test

20. Nail-fold Capillaroscopy-

21. 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.

23. Others-
•Complete blood count- normocytic anaemia suggesting the
anaemia or renal failure.
•Blood test for urea and electrolytes-Renal impairment.
•Thyroid function tests- Hypothyroidism.
•Erythrocyte sedimentation rate and C-reactive protein- specific
causative illnesses or a generalised inflammatory process.
•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 and
other autoimmune disorders.

24. COMPLICATIONS
•Punctate (small hole)
lesions of the fingertips
•Atrophy of skin & muscles
•Superficial gangrenous
ulcers in advanced stages
•Amputation

25. CONSERVATIVE MANAGEMENT
• The primary focus of Raynaud’s phenomenon is
patient teaching.
• Focus instructions on preventing recurrent
episodes.
• Tell patients to wear loose, warm clothing as
protection from the cold, including gloves when
handling cold objects and turtleneck sweater.
• Fabrics specially designed for cold climates (e.g.,
Thinsulate) are recommended.
• At all times, patients should avoid temperature
extremes.

26.  Immersing hands in warm water often decreases
the vasospasm.
 Patient should stop using all tobacco products,
avoid caffeine, chocolate and other drugs that
have vasoconstrictive effects (e.g., cocaine,
amphetamines, ergotamine, pseudoephedrine).
 Advise turning up the thermostat at home if
necessary and staying out of drafts.
 Teach the client to warm up a cold car before
driving so that they can avoid touching a cold
steering wheel or door handle, which could elicit
an attack.

27. • Body core heating is important to prevent
chilling and the shunting of blood from the
extremities to the trunk.
• During summer, a sweater should be available
when entering air-conditioned rooms.
• Patients should be cautioned to handle sharp
objects carefully to avoid injuring their fingers.
• In addition, patients should be informed about
the postural hypotension that may result from
medications, such as calcium channel blockers,
used to treat Raynaud’s phenomenon.

28. • Provide patients with stress
management strategies as
stress can also trigger
vasospasm.
• The manifestations of
Raynaud’s syndrome may
be alarming, so reassure the
client that the condition is
not likely to lead to a serious
disability.

29. MEDICAL MANAGEMENT
Pharmacological therapy-
• Sustained-release calcium channel blockers (e.g., nifedipine) are the first-line drug
therapy. 30-120 mg of the extended-release formulation of nifedipine taken once
daily.
• They relax smooth muscles of the arterioles by blocking the influx of calcium into the
cells. This reduces the frequency, duration and severity of vasospastic attacks.
• Topical nitro-glycerine (1% or 2%)
• Prompt intervention is needed for patients with digital ulceration and/or critical
ischemia.
• It includes IV prostanoid therapy (e.g., iloprost), antibiotics, analgesics and possibly
an endothelin receptor antagonist (e.g., bosentan).

30. ALTERNATIVE MEDICINE
Lifestyle changes and supplements that encourage better
circulation might help manage Raynaud’s.
Fish oil- Help improve tolerance to cold.
Ginkgo- Help decrease the number of Raynaud's attacks.
Acupuncture- Improve blood flow, so it may be helpful in
relieving Raynaud's attacks.
Biofeedback

32. SURGICAL MANAGEMENT
• Surgical debridement of necrotic
tissue.
• Sympathectomy- It is considered
only in advanced cases. It is the
surgical cutting of a sympathetic
nerve or removal of a ganglion
to relieve a condition affected by
its stimulation.

33. NURSING DIAGNOSIS
1.Ineffective peripheral tissue perfusion related
to lack of blood supply to extremities.
2.Anxiety related to disease process.
3.Deficient knowledge regarding self-care
activities.

34. PREVENTION
• Stop smoking
• Exercise
• Control stress
• Avoid caffeine
• Take care of feet and hand
• Dress warmly outdoors

35. PROGNOSIS
• The prognosis for patients with Raynaud’s phenomenon
varies; some slowly improve, some become progressively
worse, and others show no change. Raynaud’s
symptoms may be mild so that treatment is not required.
• However, secondary Raynaud’s is characterized by
vasospasm and fixed blood vessel obstructions that may
lead to ischemia, ulceration and gangrene.

37. •Acrocyanosis is differentiated from Raynaud’s disease
by a relative persistence of skin colour changes,
symmetry and an absence of the paroxysmal pallor
that is found with Raynaud’s. Almost all patients with
acrocyanosis have marked clamminess and
hyperhidrosis of their hands and feet, which tend to
worsen in warmer temperatures while the colour
changes improve. Finger colour normalizes when the
hands are transferred from the dependent to horizontal
position.

38. RESEARCH ARTICLES
The complementary effects of galvanic current electrical stimulation associated with conservative
treatment to increase vasodilation in patients with Raynaud's phenomenon: a randomized trial.
A single-blind randomized controlled trial was conducted by Tapia-Haro RM et al in 2020 to analyse the
effectiveness of an electrotherapy intervention with galvanic current on symptoms associated with
Raynaud's phenomenon. The study was conducted in Spain and 34 participants with Raynaud's
phenomenon, with a mean age of 43.43 years were included. The patients were randomly assigned to
a control group with conservative treatment (anti-inflammatory, vasodilatory and analgesic drugs) or an
intervention group that received conservative treatment and vasodilatory electrical stimulation during
seven weeks, three times/week for a total of 20 sessions. The primary outcome was the number of
attacks. The galvanic current electrotherapy group showed significantly greater improvements in the
number of attacks, radial artery blood flow, ulnar artery blood flow, oxygen saturation, upper limb
disability, central sensitization and temperature recovery than the conservative treatment group. This
study suggests that a complementary treatment with galvanic current in combination to conservative
approach is superior to conservative applied as isolate, in reducing the clinical manifestations and
disability in Raynaud's phenomenon.

39. Alexithymia and emotion regulation in patients with Raynaud's disease.
A study was conducted by Fabian B, Csiki Z and Bugan A in 2020 to explore
alexithymia (the inability to recognize or describe one’s own emotions) and emotion
regulation and their relationship with depression and quality of life among patients
with RD. Total of 110 patients with RD completed self-report measures. Alexithymia
was associated with adverse emotional regulation skills, depression, and quality of
life impairment. Detailed analysis revealed that there are significant differences
between alexithymic and non-alexithymic patients in emotion regulation. Alexithymia
is a significant factor affecting health status in RD since it plays a significant role in
emotion regulation. It concluded that multidisciplinary approach is essential to
improve treatment outcome by identifying patients with high alexithymia, and to
improve their emotional regulation skills.

40. SUMMARY AND CONCLUSION
• As discussed throughout the presentation, learning about
Raynaud’s disease and its management will help nurses to care
for patients of Raynaud’s disease.
• Nurses can do assessment of patients with Raynaud’s disease,
observe the sign and symptoms, provide the necessary nursing
care, prevent complications and support the patient
psychologically.
• Nurses can also counsel the patients and their family for various
options available in treatment for Raynaud’s disease.

41. REFERENCES
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3.Joyce M. Black, Jane Hokanson Hawks. Medical Surgical Nursing Clinical Management of Positive
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conservative treatment to increase vasodilation in patients with Raynaud's phenomenon: a randomized
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