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Slide for raynaud's disease
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.
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Presented by Om Verma, introducing Raynaud's disease at the Reliance Institute of Nursing.
Raynaud's phenomenon involves arteriolar vasoconstriction leading to coldness and color changes in extremities.
Most common in women aged 16-40, classified into primary and secondary forms.
Etiology includes genetic factors, environmental triggers like cold and smoking effects.
Risk factors differ for primary and secondary Raynaud's, including age, gender, and certain diseases.
Symptoms include color changes (white-blue-red), pain, coldness, and possible ulceration.
Diagnosis includes physical examination, specialized tests like Cold Stimulation, and history.
Tests include CBC, antibody screens, and assessments for potential autoimmune disorders.
Management involves avoiding triggers, use of calcium channel blockers, and alternative treatments. Focus on nursing management strategies and potential complications such as ulcers and gangrene.
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Slide for raynaud's disease
- 1. RELIANCE INSTITUTE OF NURSINGLIMTARA DHAMTARI (C.G) TOPIC - RAYNAUD’S DISEASE • PRESENTED BY- • OM VERMA • ASSISTANT PROFESSOR
- 3. Raynaud’s disease Raynaud’s phenomenonis 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 joyceM 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 lippincott • 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 mostcommon 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’sdisease :-(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 withvibrating 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) Therisk 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. Intermittentarteriolar 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 andSymptoms • • 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 oftendescribe 3 phases of change – • • initial white (vasoconstriction), • • followed by blue (cyanosis), • • then red (rapid blood reflow
- 16. Diagnostic evaluation 1. Historytaking 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 StimulationTest :-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 bloodcount :- this can reveal a normocytic anemia suggesting the anemia or renal failure
- 23. • Blood testfor 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. Avoidingparticular 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 & experimentalapproaches 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. MinimizingSensory Alteration 2. Relieving Pain 3. Patient Education and Health Maintenance