Raynauds Disease

 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.
  • 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
  • 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

Classification

1. Primary -Occurrence of the vasospasm alone, with no association with another illness

2.  Secondary- Secondary to other conditions, most commonly an autoimmune disease eg- SLE, rhematoid arthrits

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

Pathophysiology

Expose to cold/ triggering factor ➡️Small arteries at fingers and toes vasospasm ➡️   Become pale, less blood flow and low O2 supply ➡️Warm up (arteries dilate)➡️ Blood flow increase, high O2 supply➡️Color change to bright red➡️  Affected area is warm and throbbing pain


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

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
  • Cold Stimulation Test
  • Nailfold Capillaroscopy
  • Antinuclear antibody (ANA)
  • Erythrocyte sedimentation rate (ESR or "sed rate")
  • C-reactive protein (CRP) tests

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%)

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.
     

#