This document provides information on Raynaud's disease, including its definition, causes, risk factors, clinical manifestations, diagnosis, and treatment. Raynaud's is a condition characterized by reduced blood flow to the extremities (fingers and toes) in response to cold or stress. It involves painful color changes from white to blue to red as vessels constrict and dilate. The document outlines diagnostic tests like cold stimulation and nailfold capillaroscopy. Medical management focuses on lifestyle changes and medications like calcium channel blockers to prevent vasospasm. Nursing management aims to minimize sensory changes, relieve pain, and provide patient education.

1. RELIANCE INSTITUTE OF
NURSING LIMTARA
DHAMTARI (C.G)
TOPIC - RAYNAUD’S
DISEASE
• PRESENTED BY-
• OM VERMA
• ASSISTANT PROFESSOR

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

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