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RAYNAUD’S
 DISEASE
WHAT IS RAYNAUD’S DISEASE??
 Raynaud's is a rare disorder that affects the
  arteries.
 Raynaud's is also called a
  disease, syndrome, or phenomenon.
 Vasospasm, which is a narrowing of the
  blood vessels.
 Vasospasm of the arteries reduces blood
  flow to the fingers and toes.
 Also may occur at the tip of ears and nose.
RAYNAUD’S DISEASE
RAYNAUD’S DISEASE
CLASSIFICATION
   Primary Raynaud’s / Raynaud’s disease the
    causes is not known.(idiopathic)

   Secondary Raynaud’s / Raynaud’s
    phenomenon where the causes are known.
ETIOLOGY OF PRIMARY RAYNAUD’S

 Cold temperature
 Stress

 Blood vessels in spasm
ETIOLOGY OF SECONDARY RAYNAUD’S

  Scleroderma
  Lupus.
  Rheumatoid arthritis
  Sjogren's syndrome
  Diseases of the arteries.
  Carpal tunnel syndrome
 Repetitive actions
 Hand and foot injuries
 Exposure to certain chemicals
 Medicines
 Smoking
RISK FACTORS….

   PRIMARY RAYNAUD’S
       Gender
       Age
       Family history
       Living area climate
   SECONDARY RAYNAUDS’S
      Age
      Certain disease and condition
      Work place
      Injury of hand and leg
      Repetitive action
      Living climate
      Smoking
      Medicines
PATHOPHYSIOLOGY
                                            Become
                    Small arteries at
Expose to cold /                        pale, less blood
                    fingers and toes
triggering factor                       flow and low O2
                       vasospasm
                                             supply



                        Blood flow
   Warm up
                    increase, high O2
(arteries dilate)
                          supply




                    Affected area is
Color change to
                       warm and
   bright red
                    throbbing pain
CLINICAL MANIFESTATION
$ During the Raynaud’s attack, arteries
 become narrow and no blood supply to the
 area, this will cause :
   # Turn pale or white and then blue
   # Feel numb, cold, or painful
   # Turn red, throb, tingle, burn, or feel numb
 as
      blood flows back to the affected area
INVESTIGATION
 Cold Stimulation Test
 Nailfold Capillaroscopy

 Antinuclear antibody (ANA)

 Erythrocyte sedimentation rate (ESR or "sed
  rate")
 C-reactive protein (CRP) tests
TREATMENT

   Medical treatment
     @ Calcium channel blockers -- Norvasc
     @ Alpha blockers -- Prazosin
     @ Vasodilators -- Losartan (Cozaar)
   Surgical treatment
      @ Nerve surgery--- sympathectomy
      @ Chemical injection
      @ Amputation.
COMPLICATION
Complete lost of blood to the digits will cause:
        deformities of fingers and toes
        gangrene
        ulcer
HEALTH EDUCATION

 Stop smoking
 Exercise

 Control stress

 Avoid caffeine

 Take care of feet and hand

 Dress warmly outdoors
NURSING CARE PLAN
NURSING CARE PLAN 1
NURSING DIAGNOSIS: Ineffective peripheral
                     tissue perfusion
 related to               lack of blood
 supply to
 extremities.

GOAL: Increased arterial blood supply to
          extremities.
NURSING                                              RATIONALE
INTERVENTION
Assess the patient for the blood            For further investigation and treatment.
circulation,colour and sensation at the
extremities.
Apply warm compress at the affected         To promote good blood circulation
area


Administer the medication as prescribed     To vasodilate the blood vessel and
by doctor such as vasodilator, calcium      increase blood supply to the extremities
channel blockers and alpha blockers


Monitor the blood circulation to the        To observe for any further complication
extremities every two hourly (circulation
chart)
Encourage patient to perform extremities Muscular exercises promotes blood flow
exercises while sitting or during work   and the development of collateral
                                         circulation
EVALUATION : Patients extremities are warm
 to            touch, improve in colour
 and no              complain of numbness
 .
NURSING CARE PLAN 2

NURSING DIAGNOSIS : Anxiety related to
 disease                   process.

GOAL : To reduce the anxiety level of patient
NURSING                                             RATIONALE
INTERVENTION
Asses the patient’s anxiety level by     For further investigation
observing clients behavior e.g crying
facial expression and anxious.



Reinforce doctor’s explainations to      To increase the understanding of patient
patient by using the non medical term    about the disease.



Provide moral and emotional support to   To provide patient psychological comfort
patient



Encourage diversional theraphy e.g       To deviate client’s mind away from the
watching tv, listening songs             disease and to avoid patient get mentally
                                         stress
EVALUATION : Patient’s anxiety level
 decrease                 and client is more
 clear about the          disease.
NURSING CARE PLAN 3

NURSING DIAGNOSIS : Deficient knowledge
                     regarding self-care
                           activities.

GOAL : The patient will able to carry out daily
           activity by understanding the
 health          education given by nurse
 based on the               disease.
NURSING                                                RATIONALE
INTERVENTION
Assess client knowledge level                For the nurses to give adequate health
                                             education to the client


Encourage patient to perform extremities     To promote the blood flow to the affected
exercises.                                   area


Advise patient to place the fingers or toe   The warm water will vasodilate and
under the warm water during the attack.      encourage the blood flow.



Advise patient to stop smoking               Reducing the risk factor may reduce
                                             symptoms or slow the disease
                                             progression

Advise patient not to wear tight wrist       Constrictive clothing and accessories
band or watch and clothings                  impede circulation.
EVALUATION : Client is able to carry out the
 daily          activities by implementing
 the                  health education
 given.
CONCLUSION
 Raynaud's sometimes is called a disease,
  syndrome, or phenomenon.
 Is a narrowing of the blood vessels.

 Vasospasm of the arteries reduces blood flow to
  the fingers and toes.
 In people who have Raynaud's, the disorder
  usually affects the fingers.
 In about 40 percent of people who have
  Raynaud's, it affects the toes. Rarely, the
  disorder affects the nose, ears, nipples, and lips.
 Has two type of raynaud that is primary and
  secondary raynaud disease
 In both types of Raynaud's, even mild or brief
  changes in temperature can cause
  Raynaud's attacks.
 People with severe Raynaud's can develop
  skin sores or gangrene from prolonged or
  repeated Raynaud's attacks.
 It can be treated e.g. by placing the hand
  under warm water to vasodilate
REFERRENCES

 http://www.mayoclinic.com/health/raynauds-
  disease/DS00433/DSECTION
 http://www.nlm.nih.gov/medlineplus/ency/arti
  cle/000412.htm
 http://www.faqs.org/health/topics/77/Raynaud
  -s-disease.html
 http://www.medic8.com/healthguide/articles/r
  aynauds.html
   http://www.nhlbi.nih.gov/health/dci/Diseases/ray
    naud/ray_diagnosis.html

   http://www.medicalnewstoday.com/articles/1767
    13.php -raynaud disease

   http://agedcareact.wordpress.com/2007/11/13/w
    hat-is-raynauds-disease/ - raynaud disease

   http://bodyandhealth.canada.com/channel_cond
    ition_info_details.asp?disease_id=110&channel
    _id=2022&relation_id=16665 –raynaud disease

   http://edition.cnn.com/HEALTH/library/raynauds-
    disease/DS00433.html -raynaud disease
   Brunner & Suddarth’s textbook of medical –
    surgical nursing, 12th edition.

   Pearson International edition medical –
    surgical nursing, 4th edition.

   Joyce.M & Jane Hokanson Hawks medical –
    surgical nursing, 8th edition.
THANK YOU

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Raynaud’s

  • 2. WHAT IS RAYNAUD’S DISEASE??  Raynaud's is a rare disorder that affects the arteries.  Raynaud's is also called a disease, syndrome, or phenomenon.  Vasospasm, which is a narrowing of the blood vessels.  Vasospasm of the arteries reduces blood flow to the fingers and toes.  Also may occur at the tip of ears and nose.
  • 5. CLASSIFICATION  Primary Raynaud’s / Raynaud’s disease the causes is not known.(idiopathic)  Secondary Raynaud’s / Raynaud’s phenomenon where the causes are known.
  • 6. ETIOLOGY OF PRIMARY RAYNAUD’S  Cold temperature  Stress  Blood vessels in spasm
  • 7. ETIOLOGY OF SECONDARY RAYNAUD’S  Scleroderma  Lupus.  Rheumatoid arthritis  Sjogren's syndrome  Diseases of the arteries.  Carpal tunnel syndrome
  • 8.  Repetitive actions  Hand and foot injuries  Exposure to certain chemicals  Medicines  Smoking
  • 9. RISK FACTORS….  PRIMARY RAYNAUD’S  Gender  Age  Family history  Living area climate
  • 10. SECONDARY RAYNAUDS’S  Age  Certain disease and condition  Work place  Injury of hand and leg  Repetitive action  Living climate  Smoking  Medicines
  • 11. PATHOPHYSIOLOGY Become Small arteries at Expose to cold / pale, less blood fingers and toes triggering factor flow and low O2 vasospasm supply Blood flow Warm up increase, high O2 (arteries dilate) supply Affected area is Color change to warm and bright red throbbing pain
  • 12. CLINICAL MANIFESTATION $ During the Raynaud’s attack, arteries become narrow and no blood supply to the area, this will cause : # Turn pale or white and then blue # Feel numb, cold, or painful # Turn red, throb, tingle, burn, or feel numb as blood flows back to the affected area
  • 13. INVESTIGATION  Cold Stimulation Test  Nailfold Capillaroscopy  Antinuclear antibody (ANA)  Erythrocyte sedimentation rate (ESR or "sed rate")  C-reactive protein (CRP) tests
  • 14. TREATMENT  Medical treatment @ Calcium channel blockers -- Norvasc @ Alpha blockers -- Prazosin @ Vasodilators -- Losartan (Cozaar)
  • 15. Surgical treatment @ Nerve surgery--- sympathectomy @ Chemical injection @ Amputation.
  • 16. COMPLICATION Complete lost of blood to the digits will cause:  deformities of fingers and toes  gangrene  ulcer
  • 17. HEALTH EDUCATION  Stop smoking  Exercise  Control stress  Avoid caffeine  Take care of feet and hand  Dress warmly outdoors
  • 19. NURSING CARE PLAN 1 NURSING DIAGNOSIS: Ineffective peripheral tissue perfusion related to lack of blood supply to extremities. GOAL: Increased arterial blood supply to extremities.
  • 20. NURSING RATIONALE INTERVENTION Assess the patient for the blood For further investigation and treatment. circulation,colour and sensation at the extremities. Apply warm compress at the affected To promote good blood circulation area Administer the medication as prescribed To vasodilate the blood vessel and by doctor such as vasodilator, calcium increase blood supply to the extremities channel blockers and alpha blockers Monitor the blood circulation to the To observe for any further complication extremities every two hourly (circulation chart) Encourage patient to perform extremities Muscular exercises promotes blood flow exercises while sitting or during work and the development of collateral circulation
  • 21. EVALUATION : Patients extremities are warm to touch, improve in colour and no complain of numbness .
  • 22. NURSING CARE PLAN 2 NURSING DIAGNOSIS : Anxiety related to disease process. GOAL : To reduce the anxiety level of patient
  • 23. NURSING RATIONALE INTERVENTION Asses the patient’s anxiety level by For further investigation observing clients behavior e.g crying facial expression and anxious. Reinforce doctor’s explainations to To increase the understanding of patient patient by using the non medical term about the disease. Provide moral and emotional support to To provide patient psychological comfort patient Encourage diversional theraphy e.g To deviate client’s mind away from the watching tv, listening songs disease and to avoid patient get mentally stress
  • 24. EVALUATION : Patient’s anxiety level decrease and client is more clear about the disease.
  • 25. NURSING CARE PLAN 3 NURSING DIAGNOSIS : Deficient knowledge regarding self-care activities. GOAL : The patient will able to carry out daily activity by understanding the health education given by nurse based on the disease.
  • 26. NURSING RATIONALE INTERVENTION Assess client knowledge level For the nurses to give adequate health education to the client Encourage patient to perform extremities To promote the blood flow to the affected exercises. area Advise patient to place the fingers or toe The warm water will vasodilate and under the warm water during the attack. encourage the blood flow. Advise patient to stop smoking Reducing the risk factor may reduce symptoms or slow the disease progression Advise patient not to wear tight wrist Constrictive clothing and accessories band or watch and clothings impede circulation.
  • 27. EVALUATION : Client is able to carry out the daily activities by implementing the health education given.
  • 28. CONCLUSION  Raynaud's sometimes is called a disease, syndrome, or phenomenon.  Is a narrowing of the blood vessels.  Vasospasm of the arteries reduces blood flow to the fingers and toes.  In people who have Raynaud's, the disorder usually affects the fingers.  In about 40 percent of people who have Raynaud's, it affects the toes. Rarely, the disorder affects the nose, ears, nipples, and lips.
  • 29.  Has two type of raynaud that is primary and secondary raynaud disease  In both types of Raynaud's, even mild or brief changes in temperature can cause Raynaud's attacks.  People with severe Raynaud's can develop skin sores or gangrene from prolonged or repeated Raynaud's attacks.  It can be treated e.g. by placing the hand under warm water to vasodilate
  • 30. REFERRENCES  http://www.mayoclinic.com/health/raynauds- disease/DS00433/DSECTION  http://www.nlm.nih.gov/medlineplus/ency/arti cle/000412.htm  http://www.faqs.org/health/topics/77/Raynaud -s-disease.html  http://www.medic8.com/healthguide/articles/r aynauds.html
  • 31. http://www.nhlbi.nih.gov/health/dci/Diseases/ray naud/ray_diagnosis.html  http://www.medicalnewstoday.com/articles/1767 13.php -raynaud disease  http://agedcareact.wordpress.com/2007/11/13/w hat-is-raynauds-disease/ - raynaud disease  http://bodyandhealth.canada.com/channel_cond ition_info_details.asp?disease_id=110&channel _id=2022&relation_id=16665 –raynaud disease  http://edition.cnn.com/HEALTH/library/raynauds- disease/DS00433.html -raynaud disease
  • 32. Brunner & Suddarth’s textbook of medical – surgical nursing, 12th edition.  Pearson International edition medical – surgical nursing, 4th edition.  Joyce.M & Jane Hokanson Hawks medical – surgical nursing, 8th edition.