Raynaud’s Phenomenon
Intermittent arteriolar vasoconstriction resulting in coldness, pain, and pallor or the fingertips or toes (Raynaud’s Phenomenon). Most commonly occurs in women from 16 to 40 years old.
- Clinical Manifestations: pallor followed by cyanosis, then followed by rubor when vasodilation occurs. (Pink → White → Blue → Red → Pink); paresthesia; bilateral involvement.
- Medical Management: avoiding causative stimuli; calcium-channel blockers; sympathectomy.
- Nursing Interventions: avoiding situations that cause stress, being cold, nicotine, sharp objects, and postural hypertension that some medications may cause.
Raynaud’s phenomenon may occur unilaterally. If the occurrence is bilateral, it may be called Raynaud’s disease.
Buerger’s Disease
A repeating inflammation of the intermediate and small arteries and veins of the lower and upper extremities. It results in thrombus formation and segmental occlusion of the vessels. Most commonly occurs in men from 20 to 35 years old. Smoking or tobacco is an aggravating or causative factor.
- Clinical Manifestation: pain, changes in color, (if in feet) instep claudication.
- Diagnostics: segmental blood pressure, contrast angiography, duplex ultrasonography.
- Medical Management: stop tobacco use, regional sympathetic block/ganglionectomy to prevent vasodilation, debridement of necrotic tissue, if a toe is gangrenous, BKA/AKA indicated for severe gangrene, severe resting pain or severe sepsis.
- Vasodilators are not prescribed as they only cause vasodilation for healthy vessels.