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Raynauds phenomenon

By Master StudentHaider Mohammed

Raynauds phenomenonRaynauds phenomenon is a form of intermittent arteriolar vasoconstriction that results in coldness, pain, and pallor of the fingertips or toes. There are two forms of this disorder:

1- Primary or idiopathic Raynauds (Raynauds disease) occurs inthe absence of an underlying disease.2- Secondary Raynauds(Raynauds syndrome) occurs in association with an underlying disease, usually a connective tissue disorder, such as systemiclupus erythematosus, rheumatoid arthritis, or scleroderma; trauma; or obstructive arterial lesions.

EpidemiologyRaynauds phenomenon is most common in women between 16 and 40 years of age, and it occurs more frequentlyin cold climates and during the winter.Male : female = 1:5

Etiology- Immunologic disorders- Scleroderma- Systemic lupus erythematosus- Rheumatoid arthritis- Obstructive arterial disease - Diseases of arteries- Some Drugs

Clinical Manifestations1- pallor brought on by sudden vasoconstriction.2- become bluish (cyanotic) because of pooling of deoxygenated blood during vasospasm.3- a red color (rubor) is produced when oxygenated blood returns to the digits after the vasospasm stops.4- Numbness, tingling

5- burning pain occur as the colorchanges. The manifestations tend to be bilateral and symmetric and may involve toes and fingers.

Risk Factors1- Primary- Age - Gender- Family history- Climate2- Secondary- Associated diseases- Certain occupations - Exposure to certain substances

complicationsserious complications such as gangrene and amputation, but these complicationsare uncommon unless the patient has another underlying disease causing arterial occlusions.

Diagnostic Finding1- Physical exam for Fingers & toes2- Imaging studies, including thermography (IRT) and arteriography3- CBC (FBC)4- RFT/BUN/ S.Creatinine - To evaluate for possible renal impairment or dehydration5- ANA (ANF) - May be positive in autoimmune disorders and should be obtained in patients with features of these disorders6- Serum CPK- Elevated in muscle damage

Medical Management1- Calcium channel blockers (nifedipine[Procardia], amlodipine [Norvasc]) may be effective in relieving symptoms.2- Sympathectomy (interrupting the sympathetic nerves by removing the sympathetic ganglia) may help some patients.3- Avoid some medications cause narrowing blood vessels (amphetamines, drugs of cancer)

Nursing Diagnosis1- Acute pain related to tissue ischemia secondary to vasospasm.2- Ineffective peripheral tissueperfusion related to lack ofsupplies to extremities secondary to vasospasm3- Anxiety related todisease process

Nursing Management1- The nurse teach patient Avoiding the particular stimuli (cold, tobacco) that provoke vasoconstriction is a primary factor in controlling Raynauds phenomenon.2- Instruct the patient about the should wear layers of clothing or gloves when going outside.3- Patients should be cautioned to handle sharp objects carefully to avoid injuring their fingers.

4-Assess vital signs, noting tachycardia, hypertension, and increased respiration5- Given medications for painsuch as analgesics as prescribe to relieve pain.6- Asses the patient for the blood circulation, color and sensation at the extremities every 2hrs7- apply warm compress at the affected area8- provide moral and emotional support to patient to relief the anxiety level