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Raynauds Disease
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Definition
Is avasospastic disorder causing discoloration of the fingers, toes, and
occasionally other areas. This condition can also cause nails to become brittle
with longitudinal ridges. Named for French physician Maurice Raynaud (1834
1881), the phenomenon is believed to be the result of vasospasms that decrease
blood supply to the respective regions. Emotional stress and cold are classic
triggers of the phenomenon.
It comprises both Raynaud's disease (also known as "Primary Raynaud's
phenomenon" where the phenomenon is idiopathic, and Raynaud's
syndrome (secondary Raynaud's), where it is caused by some other instigating
factor. Measurement of hand-temperature gradients is one tool used to
distinguish between the primary and secondary forms.
It is possible for the primary form to progress to the secondary form.
In extreme cases, the secondary form can progress to necrosis organgrene of
the fingertips.
Raynaud's phenomenon is an exaggeration ofvasomotorresponses to cold or
emotional stress. More specifically, it is a hyperactivation of the sympathetic
system causing extreme vasoconstriction of the peripheral blood vessels, leading
to tissue hypoxia. Chronic, recurrent cases of Raynaud phenomenon can result
in atrophy of the skin, subcutaneous tissues, and muscle. In rare cases it can
cause ulceration and ischemic gangrene.
Prevalence:
The phenomenon is more common in women than men, with the Framingham
Study finding that 5% of men and 8% of women suffer from it.
http://en.wikipedia.org/wiki/Vasospasmhttp://en.wikipedia.org/wiki/Maurice_Raynaudhttp://en.wikipedia.org/wiki/Idiopathichttp://en.wikipedia.org/wiki/Necrosishttp://en.wikipedia.org/wiki/Gangrenehttp://en.wikipedia.org/wiki/Vasomotorhttp://en.wikipedia.org/wiki/Sympathetic_systemhttp://en.wikipedia.org/wiki/Sympathetic_systemhttp://en.wikipedia.org/wiki/Hypoxia_(medical)http://en.wikipedia.org/wiki/Subcutaneous_tissuehttp://en.wikipedia.org/wiki/Ulcer_(dermatology)http://en.wikipedia.org/wiki/Ischemic_gangrenehttp://en.wikipedia.org/wiki/Framingham_Heart_Studyhttp://en.wikipedia.org/wiki/Framingham_Heart_Studyhttp://en.wikipedia.org/wiki/Vasospasmhttp://en.wikipedia.org/wiki/Maurice_Raynaudhttp://en.wikipedia.org/wiki/Idiopathichttp://en.wikipedia.org/wiki/Necrosishttp://en.wikipedia.org/wiki/Gangrenehttp://en.wikipedia.org/wiki/Vasomotorhttp://en.wikipedia.org/wiki/Sympathetic_systemhttp://en.wikipedia.org/wiki/Sympathetic_systemhttp://en.wikipedia.org/wiki/Hypoxia_(medical)http://en.wikipedia.org/wiki/Subcutaneous_tissuehttp://en.wikipedia.org/wiki/Ulcer_(dermatology)http://en.wikipedia.org/wiki/Ischemic_gangrenehttp://en.wikipedia.org/wiki/Framingham_Heart_Studyhttp://en.wikipedia.org/wiki/Framingham_Heart_Study -
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Epidemiology:
It is important to distinguish Raynaud's disease from syndrome. In order
to diagnose these two forms of Raynaud's, a doctor may look for signsofarthritis orvasculitis, and may conduct a number of laboratory tests.
Primary Raynaud's (disease)
Raynaud's disease, or "Primary Raynaud's", is diagnosed if the symptoms
are idiopathic, that is, they occur by themselves and not in association with other
diseases. Some refer to Primary Raynaud's disease as "being allergic to coldness".
It often develops in young women in their teens and early adulthood. Primary
Raynaud's is thought to be at least partly hereditary, although specific genes have
not yet been identified.
Smoking worsens frequency and intensity of attacks, and there is a hormonal
component. Caffeine also worsens the attacks. Sufferers are more likely to
have migraine and angina than controls.
B. Secondary Raynaud's (syndrome)
Raynaud's syndrome, or "Secondary Raynaud's", occurs secondary to a wide
variety of other conditions. Secondary Raynaud's has a number of associations:
Connective tissue disorders:
scleroderma [8]
systemic lupus erythematosus
rheumatoid arthritis
Sjgren's syndrome dermatomyositis
polymyositis
mixed connective tissue disease
cold agglutinin disease
Ehlers-Danlos Syndrome
http://en.wikipedia.org/wiki/Diagnosis_(medical)http://en.wikipedia.org/wiki/Arthritishttp://en.wikipedia.org/wiki/Vasculitishttp://en.wikipedia.org/wiki/Heredityhttp://en.wikipedia.org/wiki/Tobacco_smokinghttp://en.wikipedia.org/wiki/Migrainehttp://en.wikipedia.org/wiki/Angina_pectorishttp://en.wikipedia.org/wiki/Sclerodermahttp://en.wikipedia.org/wiki/Sclerodermahttp://en.wikipedia.org/wiki/Raynaud's_phenomenon#cite_note-pmid17218139-7%23cite_note-pmid17218139-7http://en.wikipedia.org/wiki/Raynaud's_phenomenon#cite_note-pmid17218139-7%23cite_note-pmid17218139-7http://en.wikipedia.org/wiki/Systemic_lupus_erythematosushttp://en.wikipedia.org/wiki/Rheumatoid_arthritishttp://en.wikipedia.org/wiki/Sj%C3%B6gren's_syndromehttp://en.wikipedia.org/wiki/Dermatomyositishttp://en.wikipedia.org/wiki/Polymyositishttp://en.wikipedia.org/wiki/Mixed_connective_tissue_diseasehttp://en.wikipedia.org/wiki/Cold_agglutinin_diseasehttp://en.wikipedia.org/wiki/Ehlers-Danlos_Syndromehttp://en.wikipedia.org/wiki/Diagnosis_(medical)http://en.wikipedia.org/wiki/Arthritishttp://en.wikipedia.org/wiki/Vasculitishttp://en.wikipedia.org/wiki/Heredityhttp://en.wikipedia.org/wiki/Tobacco_smokinghttp://en.wikipedia.org/wiki/Migrainehttp://en.wikipedia.org/wiki/Angina_pectorishttp://en.wikipedia.org/wiki/Sclerodermahttp://en.wikipedia.org/wiki/Raynaud's_phenomenon#cite_note-pmid17218139-7%23cite_note-pmid17218139-7http://en.wikipedia.org/wiki/Systemic_lupus_erythematosushttp://en.wikipedia.org/wiki/Rheumatoid_arthritishttp://en.wikipedia.org/wiki/Sj%C3%B6gren's_syndromehttp://en.wikipedia.org/wiki/Dermatomyositishttp://en.wikipedia.org/wiki/Polymyositishttp://en.wikipedia.org/wiki/Mixed_connective_tissue_diseasehttp://en.wikipedia.org/wiki/Cold_agglutinin_diseasehttp://en.wikipedia.org/wiki/Ehlers-Danlos_Syndrome -
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Eating disorders
anorexia nervosa
Obstructive disorders
atherosclerosis
Buerger's disease
Takayasu's arteritis
subclavian aneurysms
thoracic outlet syndrome
Drugs
Beta-blockers
cytotoxic drugs - particularly chemotherapeutics and most
especially bleomycin
ciclosporin
ergotamine
sulfasalazine
anthrax vaccines whose primary ingredient is the Anthrax Protective
Antigen
Occupation
jobs involving vibration, particularly drilling suffer from Vibration white
finger
exposure to vinyl chloride,mercury
exposure to the cold (e.g. by working packing frozen food)
Others
hypothyroidism
cryoglobulinemia
malignancy
reflex sympathetic dystrophy
carpal tunnel syndrome
Magnesium Deficiency
Erythromelalgia, (the opposite of Raynaud's, with hot and warm
extremities) often co-exists in patients with Raynaud's) [9]
http://en.wikipedia.org/wiki/Anorexia_nervosahttp://en.wikipedia.org/wiki/Atherosclerosishttp://en.wikipedia.org/wiki/Buerger's_diseasehttp://en.wikipedia.org/wiki/Takayasu's_arteritishttp://en.wikipedia.org/wiki/Aneurysmhttp://en.wikipedia.org/wiki/Thoracic_outlet_syndromehttp://en.wikipedia.org/wiki/Beta-blockerhttp://en.wikipedia.org/wiki/Chemotherapyhttp://en.wikipedia.org/wiki/Bleomycinhttp://en.wikipedia.org/wiki/Ciclosporinhttp://en.wikipedia.org/wiki/Ergotaminehttp://en.wikipedia.org/wiki/Sulfasalazinehttp://en.wikipedia.org/wiki/Anthrax_vaccineshttp://en.wikipedia.org/wiki/Vibration_white_fingerhttp://en.wikipedia.org/wiki/Vibration_white_fingerhttp://en.wikipedia.org/wiki/Vinyl_chloridehttp://en.wikipedia.org/wiki/Mercury_(element)http://en.wikipedia.org/wiki/Hypothyroidismhttp://en.wikipedia.org/wiki/Cryoglobulinemiahttp://en.wikipedia.org/wiki/Cancerhttp://en.wikipedia.org/wiki/Complex_regional_pain_syndromehttp://en.wikipedia.org/wiki/Carpal_tunnel_syndromehttp://en.wikipedia.org/wiki/Erythromelalgiahttp://en.wikipedia.org/wiki/Raynaud's_phenomenon#cite_note-8%23cite_note-8http://en.wikipedia.org/wiki/Anorexia_nervosahttp://en.wikipedia.org/wiki/Atherosclerosishttp://en.wikipedia.org/wiki/Buerger's_diseasehttp://en.wikipedia.org/wiki/Takayasu's_arteritishttp://en.wikipedia.org/wiki/Aneurysmhttp://en.wikipedia.org/wiki/Thoracic_outlet_syndromehttp://en.wikipedia.org/wiki/Beta-blockerhttp://en.wikipedia.org/wiki/Chemotherapyhttp://en.wikipedia.org/wiki/Bleomycinhttp://en.wikipedia.org/wiki/Ciclosporinhttp://en.wikipedia.org/wiki/Ergotaminehttp://en.wikipedia.org/wiki/Sulfasalazinehttp://en.wikipedia.org/wiki/Anthrax_vaccineshttp://en.wikipedia.org/wiki/Vibration_white_fingerhttp://en.wikipedia.org/wiki/Vibration_white_fingerhttp://en.wikipedia.org/wiki/Vinyl_chloridehttp://en.wikipedia.org/wiki/Mercury_(element)http://en.wikipedia.org/wiki/Hypothyroidismhttp://en.wikipedia.org/wiki/Cryoglobulinemiahttp://en.wikipedia.org/wiki/Cancerhttp://en.wikipedia.org/wiki/Complex_regional_pain_syndromehttp://en.wikipedia.org/wiki/Carpal_tunnel_syndromehttp://en.wikipedia.org/wiki/Erythromelalgiahttp://en.wikipedia.org/wiki/Raynaud's_phenomenon#cite_note-8%23cite_note-8 -
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Nail Fold capillaroscopy
- Nailfold capillaroscopy (study of capillaries under a microscope) can help
the doctor distinguish between primary and secondary Raynaud's phenomenon.
During this test, the doctor puts a drop of oil on the patient's nailfolds, the skin at the
base of the fingernail. The doctor then examines the nailfolds under a microscope to
look for abnormalities of the tiny blood vessels called capillaries. If the capillaries are
enlarged or deformed, the patient may have a connective
ANA
- The antinuclear antibody test (ANA) test determines whether the body is
producing special proteins (antibodies) often found in people who have connective
tissue diseases or other autoimmune disorders. Patients with these connective tissue
diseases or other autoimmune disorders, make antibodies to the nucleus, or
command center, of the body's cells. These antibodies are called antinuclear
antibodies and are tested for by placing a patient's blood serum on a microscope
slide containing cells with visible nuclei. A substance containing fluorescent dye is
added which binds to the antibodies. Under a microscope the abnormal antibodies
can be seen binding to the nuclei.
ESR
- The erythrocyte sedimentation rate (ESR) is a diagnostic test for
inflammation. The erythrocyte sedimentation rate (ESR) test is a measure of
inflammation in the body and tests how fast red blood cells settle out of unclotted
blood by measuring the rate at which the red blood cells fall to the bottom of a tube
over time. An increased sedimentation rate corresponds to increased non-specific
inflammation in the body. It is often called a "sedrate" for short.
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Symptoms:
The condition can cause pain within the affected extremities, discoloration (paleness)
and sensations of cold and/or numbness. This can often be distressing to those who are
not diagnosed, and sometimes it can be obstructive. If someone with Raynaud's is
placed in too cold a climate, it could potentially become dangerous.
The symptoms include several cyclic color changes:
1. When exposed to cold temperatures, the blood supply to the fingers or
toes, and in some cases the nose or earlobes, is markedly reduced; the skin
turns pale or white (called pallor), and becomes cold and numb.
2. When the oxygen supply is depleted, the skin colour turns blue
(called cyanosis).
3. These events are episodic, and when the episode subsides or the area is
warmed, the blood flow returns and the skin colour first turns red (rubor), and
then back to normal, often accompanied by swelling and tingling.
All three colour changes are observed in classic Raynaud's. However, not all patients
see all of the aforementioned colour changes in all episodes, especially in milder cases
of the condition. Symptoms are thought to be due to reactive hyperemias of the areas
deprived of blood flow.
In pregnancy, this sign normally disappears due to increased surface blood flow.
Raynaud's has also occurred in breastfeeding mothers, causing nipples to turn white and
become extremely painful.[5] Nifedipine, a calcium channel blockerand vasodilatorwas
recommended to increase blood flow to the extremities and noticeably relieved pain to
the breast, in an extremely small study group.
http://en.wikipedia.org/wiki/Pallorhttp://en.wikipedia.org/wiki/Oxygenhttp://en.wikipedia.org/wiki/Cyanosishttp://en.wikipedia.org/wiki/Ruborhttp://en.wikipedia.org/wiki/Swelling_(medical)http://en.wikipedia.org/wiki/Hyperemiahttp://en.wikipedia.org/wiki/Pregnancyhttp://en.wikipedia.org/wiki/Raynaud's_phenomenon#cite_note-4%23cite_note-4http://en.wikipedia.org/wiki/Nifedipinehttp://en.wikipedia.org/wiki/Calcium_channel_blockerhttp://en.wikipedia.org/wiki/Vasodilatorhttp://en.wikipedia.org/wiki/Pallorhttp://en.wikipedia.org/wiki/Oxygenhttp://en.wikipedia.org/wiki/Cyanosishttp://en.wikipedia.org/wiki/Ruborhttp://en.wikipedia.org/wiki/Swelling_(medical)http://en.wikipedia.org/wiki/Hyperemiahttp://en.wikipedia.org/wiki/Pregnancyhttp://en.wikipedia.org/wiki/Raynaud's_phenomenon#cite_note-4%23cite_note-4http://en.wikipedia.org/wiki/Nifedipinehttp://en.wikipedia.org/wiki/Calcium_channel_blockerhttp://en.wikipedia.org/wiki/Vasodilator -
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Anatomy and Physiology
In people with Raynaud's, blood flow is more strongly reduced in response to cold
temperatures than in people without the disorder. When Raynaud's is severe (which is
uncommon), exposure to cold for as little as 20 minutes can cause major tissue
damage.
The blood vessels of people with Raynaud's also physically overreact to stressful
emotions. It is normal during times of psychological stress for the body to release
hormones that narrow its blood vessels. But for people with Raynaud's, this squeezing of
blood vessels is stronger. This results in less blood reaching fingers, toes, and
sometimes other extremities.
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Three layers of the arteries and veins
Tunica Intima
Tunica Media
Tunica Adventitia
Lumen-cavity of the blood vessels
Arteries-thicker than veins it is more elastic and can contract than veins
Arterioles-small arteries that delivers blood to the capillaries
Capillaries-connects arterioles with Venules and allows the exchange of gases, wastes,
and nutrients between blood and the tissue cells.
Venules -small vessels that connects the capillaries to veins
Veins-have more fibrous tissues and they have internal valves to ensure blood flow in
one direction
Venous sinuses -veins with thin walls.
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Pathophysiology
Predisposing Factors:Female
15 25 years of age
Precipitating Factors:Cold temperature, pollution
Lifestyle: SmokingOccupational Trauma
Digital ArterySpasm/Constriction
Occlusion in the arteries
Impaired blood circulation
Tissue Hypoxia
Tissue Ischemia
Skin discoloration, cyanosis, pain, tingling with burningpain
Raynauds Disease
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Management
A. Surgical Management:
Symphatectomy
- is a surgical procedure that destroys nerves in the sympathetic nervous
system. The procedure is done to increase blood flow and decrease long-
term pain in certain diseases that cause narrowed blood vessels. It can also be used
to decrease excessive sweating. This surgical procedure cuts or destroys the
sympathetic ganglia, collections of nerve cell bodies in clusters along the thoracic or
lumbar spinal cord.
Untreated: Infection
Septicemia
Treated: Amputation
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Amputation for gangrenous tissue
- An amputation usually refers to the surgical removal of the whole or part of
an arm/hand or a leg/foot. Amputation of a toe or leg is one of the oldest surgical
procedures.
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Nerve surgery
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B.Non Surgical
Calcium channel blockers
Alpha-adrenergic blocking agents
Calcium antagonist to dilate peripheral vessels
Nursing Intervention:
Kept hands warm
Teach effects of nicotine
Teach ways to avoid exposure to cold
Wear adequate clothing
Wear gloves when handling frozen foods
Caution when cleaning refrigerator Wear socks during cold climate
Discuss imporatance of reducing emotional stress
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Discharge Planning
Medication
-As prescribed by the physician
-Vasodilator
Exercise
-Ambulate as tolerated
Treatment
-Avoid triggers
-Gradual cessation of smoking
Health teaching
-Discuss the etiology of the condition
-Ways to avoid exposure to cold
Outpatient Care
-Follow up checkups as indicated by the physician.
Diet
-Diet as tolerated
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Spiritual
-Continue Religious practices
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