Raynaud’s disease

Raynaud’s disease

1. Raynaud’s Disease (Raynaud’s Phenomenon )

2.   It is a recurrent vasospasm of the fingers and toes and usually occurs in response to stress or cold exposure It  is named after Maurice Raynaud , who, was a medical student, defined the first case in 1862 

3. 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

4. The disease is most common in women between 16 and 40 years of age, it occurs more frequently in cold climates and during the winter

5. 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

6. Predisposing and precipitating Factors The risk factors include: Working with vibrating machinery - the fingers may go into spasm. This is due to an intermittent lack of blood supply to the fingers. Emotional distress Exposure to the cold Womens affected more often than men

7. Exposure to chemicals such as PVC, Silica. Smoking Autoimmune disease

8. Pathophysiology Precipitating Factors Smoking Working with vibrating machinery Emotional distress Exposure to the cold Women affected more often than men Stress Digital artery contraction spasm Occlusion of arteries Predisposing Factors Age - between 15 and 40 years old. Gender - Women are mostly affected Climate- winter Cold exposure Tissue ischemia

9. 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

10. Patients often describe 3 phases of change initial white (vasoconstriction), followed by blue (cyanosis), then red (rapid blood reflow).  

11. 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

12. Normal nail fold capillaries

13. Dilated capillaries in systemic sclerosis

14. 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

15. 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%)

16. 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.