BUERGERS DISEASE An inflammatory arterial disorder that causes thrombus formation.

Autoimmune vasculitis, affects more men ages 20 and 35 years old. Associated with cigarette smoking

PATHOPHYSIOLOGY: Autoimmune disorder

Increase production of antibodies that attacks the small blood vessels of the lower extremities

Inflammation of blood vessels

Decrease blood flow to the blood vessels

pain

Gangrene/ulceration

amputation

SIGNS and SYMPTOMS: - Intermittent claudication most common sign, a pain increase during stressful situation, pain is decreased during rest. - Paresthesia - Cool and red extremities in the dependent position - Decreased or diminished peripheral pulses

DIAGNOSTIC TESTS: 1. Duplex Ultrasound - to document the patency of blood vessel and visualize the extent of distal disease. 2. Contrast Angiography demonstrate the diseased portion of the anatomy.

MANAGEMENT: GOAL: Improve the circulation and to prevent the progression of the disease. - Take a rest, to decrease oxygen demand - Administer vasodilators Pentoxyfylline (Trental), to increase RBC flexibility to increase blood flow. - Amputation - if there is gangrene or ulceration - Omit SMOKING! NURSING INTERVENTIONS: Towards the surgical management (AMPUTATION) - Elevate the stump for the first 24 hours, to promote venous return and decrease edema.

Monitor for hematoma. Ensure integrity of bandage and the continued ability to fit two fingers between the two layers of the wrap, to ensure circulation. Assess and record distal skin color warmth. Encourage patient to verbalize pain.

RAYNAUDS DISEASE Intermittent arterial vasospasm in the fingers and sometimes in the toes which results to pallor, coldness and pain. Focused on upper extremities Common on women between 14-40 years old.

RISK FACTORS: Rheumatoid arthritis Arterial occlusive disease Young women No exact cause/idiopathic Age 14-40 years old Unusual sensitivity to cold Disorder of immunity such as SLE or Scleroderma Stressful women

PATHOPHYSIOLOGY: Risk factors Vasospasm of arteries

Intermittent vasoconstriction of the small blood vessel affecting the upper extremities (fingers) Color changes Temperature changes Decreased oxygen to the distal area

Raynauds phenomenon (hallmark sign) Whitish color- vasoconstriction Bluish color- due to pooling of blood into the area secondary to vasoconstriction Reddish color-exaggerated blood flow

coldness Pain, numbeness, and tingling sensation

gangrene

MANAGEMENT: 1. Precipitating factors should be avoided - stress - cold temperature 2. Calcium channel blockers Side effects and Adverse effects: - cephalgia (headache) - angina (due to REFLEX TACHYCARDIA) - constipation - hypotension - edema -

- arrythmias - lightheadedness - nausea - bradycardia - nervousness

Nursing interventions: (for calcium channel Blockers) Change position slowly Hygiene - dental care Advise patient to use sunscreen to prevent Photophobia No activities that require mental alertness such as driving Notify client that angina attack could occur 30 minutes after administration Educate client to take his own pulse Liver enzyme should be monitored

MANEGEMENT: Remove smoking and nicotine use Removal of Sympathetic Gangria Sympathectomy (surgical excision of a Sympathetic nerve or surgical interruption of Sympathetic nerve backways which results in dilation of blood vessels and increase blood flow to affected area.)

SURGICAL MANAGEMENT: 1. Arteriography reveal vasospasm 2. Plethysmography intermittent vessel occlusion a determination of the variation in the size of a body part by measuring the volume of blood contained in it or passing through it.