See it and Catch it! Recognizing the Thought Traps that Negatively Impact How...
Raynauds phenomenon
1.
2. GENERAL OBJECTIVES
At the end of the class the students will be
able to acquire in depth knowledge regarding
raynaud’s phenomenon, will develop a
positive attitude and apply it in the clinical
practice.
3. SPECIFIC OBJECTIVES
At the end of seminar student will be able to-
• define raynaud’s phenomenon
• understand anatomy and physiology of artery
• enlist the types of raynaud’s phenomenon
• explain the epidemiology of raynaud’s phenomenon
• listdown the risk factors and etiology of raynaud’s
phenomenon
• explain pathophysiology of raynaud’s phenomenon
• enumerate the sign and symptoms of raynaud’s phenomenon
• enlist the diagnostic evaluations of raynaud’s phenomenon
• discuss the management of raynaud’s phenomenon
• describe surgical management of raynaud’s phenomenon
• list down the complications of raynaud’s phenomenon
• discuss nursing management of raynaud’s phenomenon
4. Introduction
Raynaud's is a rare disorder that affects the
arteries, it is an excessively reduced blood flow
to the fingers, toes and occasionally other areas.
Raynaud's phenomenon by itself is just a sign
(hypoperfusion) accompanied by a symptom
(discomfort).
It is a hyperactivation of the sympathetic
nervous system causing extreme
vasoconstriction of the peripheral blood vessels,
leading to tissue hypoxia.
5.
6. Anatomy and physiology of blood
vessels
•ARTERIES
•ARTERIOLES
•CAPILLARIES
•VENULES
•VEINS
7.
8. RAYNAUD’S PHENOMENON
French physician Maurice Raynaud (1834–1881)
In medicine, Raynaud phenomenon is an excessively
reduced blood flow in response to cold or emotional
stress, causing discoloration of the fingers, toes, and
occasionally other areas. This condition may also
cause nails to become brittle with longitudinal
ridges.
The phenomenon is believed to be the result
of vasospasms that decrease blood supply to the
respective regions.
11. Types
There are two main types of Raynaud’s—
primary and secondary.
In primary Raynaud’s (also called Raynaud’s
disease), the cause isn't known. Primary Raynaud's
is more common and tends to be less severe than
secondary Raynaud's.
Secondary Raynaud’s is caused by an underlying
disease, condition, or other factor. This type of
Raynaud's is often called Raynaud's phenomenon.
As a result, the skin may turn white and then blue
for a short time. As blood flow returns, the affected
areas may turn red and throb, tingle, burn, or feel
numb.
12. Epidemiology
Frequency
United States
A 7-year study of Raynaud phenomenon in whites
in the United States showed baseline prevalence
rates of 11% in women and 8% in men and yearly
incidence rates of 2.2% in women and 1.5% in
men.
International
The prevalence of primary Raynaud phenomenon
varies among different populations, from 4.9%-
20.1% in women to 3.8%-13.5% in men.
13. Mortality/Morbidity
Primary Raynaud phenomenon does not usually
cause death or serious morbidity. However, in
very rare cases, ischemia of the affected body
part can result in necrosis.
Secondary Raynaud phenomenon is important
as a possible marker for other diseases that may
lead to morbidity and mortality. Examples of
this include scleroderma (progressive systemic
sclerosis), systemic lupus erythematosus,
and hyperviscosity syndromes.
14. Risk factors
The risk factors for primary Raynaud's include:
o Gender. Women are more likely to have
primary Raynaud's than men.
o Age. Primary Raynaud's usually develops
before the age of 30.
o Family history. Primary Raynaud's may occur
in members of the same family.
o Living in a cold climate. Cold temperatures
can trigger Raynaud's attacks.
15. Cont….
The risk factors for secondary Raynaud's include:
o Age. Secondary Raynaud's usually develops after
the age of 30.
o Certain diseases and conditions.
o Injuries to the hands or feet.
o Exposure to certain workplace chemicals
o Repetitive actions with the hands
o Certain medicines
o Smoking.
o Living in a cold climate.
16. Etiology
In primary Raynaud’s (also called Raynaud’s
disease), the cause isn't known.
Secondary Raynaud’s is caused by an
underlying disease, condition, or other factor.
This type of Raynaud's is often called Raynaud's
phenomenon.
17. Causes of Secondary Raynaud's
who have Diseases and Conditions like:
Scleroderma, Lupus, Rheumatoid arthritis
Atherosclerosis
Blood disorders such as cryoglobulinemia and polycythemia
Autoimmune disorders
dermatomyositis, and polymyositis
Progressive systemic sclerosis
Mixed connective-tissue disease
Vasculitis
Primary pulmonary hypertension
Buerger's disease
Thyroid problems
18. Cont….
Repetitive Actions
Typing, playing the piano, or doing other similar
movements repeatedly over long periods may lead to
secondary Raynaud's. Using vibrating tools, such as
jackhammers and drills, also may raise your risk of
developing Raynaud's.
Hand or Foot Injuries
Injuries to the hands or feet from accidents,
frostbite, surgery
Chemicals
Vinyl chloride, which is used in the plastics industry
can cause scleroderma-like illness
19. Cont….
Medicines
Certain medicines can cause secondary Raynaud's,
including:
Migraine headache medicines that contain ergotamine,
This substance causes the arteries to narrow.
Certain cancer medicines, such as cisplatin and
vinblastine.
Some over-the-counter cold and allergy medicines and
diet aids. Some of these medicines can narrow the
arteries.
Beta blockers. These medicines slow heart rate and
lower blood pressure.
Birth control pills. These medicines can affect blood
flow.
20. Pathophysiology
Due to vasospasm
Decreased perfusion to micro circulation
Pallor
Cynosis
Hyperemic phase when circulation restored
Skin thickened and nails become brittle ( after
prolonged attacks)
21. Clinical manifestations
Coldness and numbness in vasoconstrictive phase
Turn red, throbbing, burn, aching pain and
tingling in hyperemic phase
Turn pale or white and then blue
Severe secondary Raynaud's can cause skin sores
or gangrene.
25. Lifestyle Changes
Lifestyle changes can help to avoid things that
may trigger a Raynaud's attack.
Examples of such triggers include:
Cold temperatures
Emotional stress
Workplace or recreational factors
Contact with certain chemicals or medicines.
26. Other Lifestyle Changes
Physical activity as part of healthy lifestyle. Physical
activity can increase the blood flow and help keep person
warm.
Limit use of caffeine and alcohol.
If you smoke, quit
Move to a warmer sport, such as indoors, during cold
weather.
Warm your hands or feet.
Wiggle or massage your fingers and toes.
Get out of stressful situations and try relaxation
techniques.
Move your arms in circles or shake your arms or feet.
27. Medicines
Examples of medicines used to treat Raynaud's
include:
Calcium channel blockers - nifedipine
Alpha blockers
Prescription skin creams
ACE inhibitors (used less often).
28. Surgery
Cervical sympathectomy - only temporary relief.
Digital sympathectomy has been gaining support for
severe or tissue-threatening disease. It is more
commonly necessary with the secondary forms.
Laser therapy may result in less frequent, less severe
attacks
30. Nursing management
• Teaching to prevent recurrent episodes
• Warm clothing worn to avoid cold
• Temperature extremes avoided
• Avoiding caffeine and tobacco with
vasoconstrictive drugs
• Stress avoided by relaxation training,
biofeedback and stress management
31. Nursing Diagnosis
Decreased oxygenation to the peripheral tissue
related to vasospasm of the blood Vessels
Ineffective tissue perfusion related to interruption of
arterial flow in arms and legs
Acute pain related to decreased peripheral blood
flow to extrimities causing intermittend or
continuous pain
Activity intolerance related to hypoxia
Altered nutrition less than body requirement related
to excessive energy demands required by increased
cardiac workload
Fear and anxiety related to hospitalization and
treatment regimen
Knowledge deficit related to long term problem and
prevention of complication
