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8/9/2019 New Raynaud

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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
http://www.answers.com/topic/pain-1http://www.answers.com/topic/pain-1


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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

New Raynaud

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