Seminar on buergers disease and raynauds disease

1. SEMINAR ON RAYNAUDS DISEASE AND BUERGERS DISEASE PRESENTED BY , UMADEVI.K IIN YEAR MSC NURSING EVALUATOR PROF.R.BABU HOD MSN

2. INTRODUCTION Adequate perfusion oxygenates and nourishes body tissues and depends in part on a properly functioning cardiovascular system. Adequate blood flow depends on the efficient pumping action of the heart, patent and responsive blood vessels, and adequate cir culating blood volume. Nervous system activity, blood viscosity, and the metabolic needs of tissues influence the rate and adequacy of blood flow . Raynauds disease and Thrombo angitis obliterens are the diseases caused mainly by poor bloodsupply

3. RAYNAUDS DISEASE Raynauds disease is the intermittent arteriolar vasoconstriction that results in coldness,pain and pallor of finger tips or toes. The term Raynauds 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.Generally unilateral.

4. INCIDENCE Most common among patients between 16 and 40 years of age and it occurs more frequently in cold climates and during the winter.

5. TYPES Primary : without any underlying disease or medical problem S econdary : caused by underlying problem

6. ETIOLOGY Immunologic disorders Scleroderma Systemic lupus erythematosus Rheumatoid arthritis Obstructive arterial disease Trauma Certain medicines (BETA BLOCKERS) Sjogrens syndrome Carpel tunnel syndrome Diseases of arteries Chemical exposure Thyroid gland disorders (HYPOTHYROIDISM) Stress

7. RISK FACTORS PRIMARY Age Gender Family history Climate SECONDARY Associated diseases Certain occupations Exposure to certain substances

8. PATHOPHYSIOLOGY Due to etiological factors Vasospasm and spastic constriction of arteries and arterioles Retarted blood flow to capillaries and venules Cyanosis After a period of minutes and hours local ruber occurs Throbbing pain accompanies with recovery

9. CLINICAL MANIFESTATIONS Pallor Skin becomes bluish(cyanotic) due pooling of deoxygenated blood during vasospasm. Hyperemia Rubor (red color) Numbness,tingling and burning pain occur as cold changes.

10. MEDICAL MANAGEMENT Avoiding trigerring factors like cold and tobacco etc is a primary in controlling raynauds disease Calcium channel blockers ( Nifedipine ) SYMPATHECTOMY Interrupting the sympathetic nerves by removing sympathetic ganglia or dividing their branches may help some patients.

11. NURSING MANAGEMENT The nurse teaches patients to avoid situations that may be stressful or unsafe. Stress management classes may be helpful. Exposure to cold must be minimized, and in areas where the fall and winter months are cold, the patient should remain indoors as much as possible and wear layers of clothing when outdoors. Hats and mittens or gloves should be worn at all times when outside. Fabrics specially designed for cold climates ( eg , Thinsulate ) are recommended. Patients should warm up their vehicles before getting in so that they can avoid touching a cold steering wheel or door handle, which could elicit an attack. During summer, a sweater should be available when entering air-conditioned rooms.

12. Concerns about serious complications, such as gangrene and amputation, are common among patients that should be informed Patients should avoid all forms of nicotine; the nicotine gum or patches used to help people quit smoking may induce attacks. Patients should be careful about safety. Sharp objects should be handled carefully to avoid injuring the fingers . Patients should be informed about the postural hypotension that may result from medications, such as calcium channel blockers, used to treat Raynaud’s disease. The nurse also discusses safety precautions related to alcohol, exercise, and hot weather

13. THROMBOANGITIS OBLITERENS Buerger’s disease is characterized by recurring inflammation of the intermediate and small arteries and veins of the lower and (in rare cases) upper extremities. It results in thrombus formation and occlusion of the vessels.In buergers disease blood vessels becomes inflamed ,swelled and blocked with blood clots.this eventually damages or destroys the skin tissues and may lead to infection and gangrene.It is differentiated from other vessel diseases by its microscopic appearance. In contrast to atherosclerosis, Buerger’s disease is believed to be an autoimmune disease that results in occlusion of distal vessels.

14. ALSO CALLED AS “ PRESENILE GANGRENE ”

15. INCIDENCE It occurs most often in men between the ages of 20 and 35 years, and it has been reported in all races and in many areas of the world

16. ETIOLOGY The cause of Buerger’s disease is unknown, but it is believed to be an autoimmune vasculitis . Genetic predisposition There is considerable evidence that heavy smoking or chewing of tobacco is a causative or an aggravating factor. Generally, the lower extremities are affected, but arteries in the upper extremities or viscera can also be involved. Buerger’s disease is generally bilateral and symmetric with focal lesions.

17. RISK FACTORS Tobacco use Chronic gum disease

18. PATHOPHYSIOLOGY Due to etiological factors Acute inflammation and thrombosis of the viens of hands and feet Vasculitis Decreased blood supply to skin Gangrene formation

19. CLINICAL MANIFESTATIONS Pain (pain is relieved by rest) The patient complains of foot cramps, especially of the arch ( instep claudication ), after exercise. A burning pain is aggravated by emotional disturbances, nicotine, or chilling. Cold sensitivity of the Raynaud type is found in one half the patients. Digital rest pain is constant, and the characteristics of the pain do not change between activity and rest.

20. Physical signs Includes; Intense rubor (reddish blue discoloration) of the foot Absence of the pedal pulse but with normal femoral and popliteal pulses. Radial and ulnar artery pulses are absent or diminished. Various types of paresthesia may develop. As the disease progresses, definite redness or cyanosis of the part appears when the extremity is in a dependent position. Involvement is generally bilateral, but color changes may affect only one extremity or only certain digits. Color changes may progress to ulceration, and ulceration with gangrene eventually occurs

21. ASSESSMENT AND DIAGNOSTIC FINDINGS History taking (current or rescent history of tobacco taking) Physical examination (presence of extremity ischemia.claudication,pain at rest) Segmental limb blood pressures ( to demonstrate the distal location of the lesions or occlusions) Duplex ultrasonography (to document patency of the proximal vessels and to visualize the extent of distal disease) Contrast angiography (to demonstrate the diseased portion of the anatomy) Distal plesthysmography

22. MAIN OBJECTIVES OF MANAGEMENT To improve circulation to the extremities To prevent the progression of the disease To protect the extremities from trauma and infection.

23. MANAGEMENT Treatment of ulceration and gangrene is directed toward minimizing infection and conservative débridement of necrotic tissue. Tobacco use is highly detrimental, and patients are strongly advised to stop using tobacco completely. Vasodilators are rarely prescribed because these medications blood away from the partially occluded vessels, making the situation worse. Prostaglandins like limaprost are vasodialators which gives relief in pain.

24. A regional sympathetic block or ganglionectomy may be useful in some instances to produce vasodilation and increase blood flow of limb Debridment is done for necrotic ulcers. In chronic cases lumbar sympathectomy is done to reduce vasoconstriction and increases blood flow to limb. Above knee and below knee amputation is done in rare cases Anti inflammatory drugs like corticosteroids are used for inflammation and pain Bypass can sometimes be helpful

25. NURSING MANAGEMENT If amputation is performed elevating the stump for the first 24 hours to promote venous return and minimize edema and the incision is monitored for the signs of hematoma. The patient may experience grief, fear, or anxiety related to loss of the limb. The patient is encouraged to discuss his or her feelings. Spiritual advisors and other health care team members are consulted as appropriate. Recovery and rehabilitation require consultation among health care providers ( eg , physicians, physical and occupational therapists, prosthetists , dietitians, nurses) The patient is assisted in developing a plan to stop using tobacco and to manage pain.

26. The patient may need to be encouraged to make the lifestyle changes necessary with a chronic disease, including modifications in diet, activity, and hygiene (skin care). The nurse determines whether the patient has a network of family and friends to assist with activities of daily living. The nurse ensures that the patient has the knowl edge and ability to assess for any postoperative complications such as infection and decreased blood flow .

27. CONCLUSION The prognosis for Raynaud’s disease varies; some patients slowly improve, some become progressively worse, and others show no change. Ulceration and gangrene are rare; however, chronic disease may cause atrophy of the skin and muscles. With appropriate patient teaching and lifestyle modifications , the disorder is generally benign and self-limiting. Although this condition is different from atherosclerosis, Buerger’s disease in older patients may also be followed by atherosclerosis of the larger vessels after involvement of the smaller vessels. The patient’s ability to walk may be severely limited. Patients are at higher risk for nonhealing wounds because of impaired circulation

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