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Areas of Differentiation

1. Definition / Characterization

BUERGERS DISEASE
It is a rare disease of the arteries and veins in the extremities. In Buerger's disease, blood vessels become inflamed, swell and can become blocked with blood clots. Tobacco use; chronic gum disease Inflammation occurs, and the vessels are prone to spasms and constriction. Inflammatory lesions appear in healthy isolated segments of normal vessels walls, which often occlude blood flow. Scarring, fibrosis, and thrombophlebitis occur, which develops into adhering of the vessels and nerves. Soft tissue and skin cells experience hypoxia, which leads to anoxia and tissue necrosis. Nail beds thicken, and peripheral pulses become weak and thread. As Buergers disease progresses, pain occurs due to tissue death. Skin sloughs, ulcers form, and the extremity is at risk for gangrene. Pain (claudication type pain); cold sensitivity with color changes; various types of lower extremity paresthesias; pulsations in the posterior tibial and dorsalis pedis arteries are weak or absent; in advanced cases,extremeties may be abnormally red or cyanotic. Blood tests; Allens Test; Angiogram; X-ray NURSING CARE: Smoking cessation must be clearly and unequivocally conveyed to the client and family. Information about programs to promote abstinence from tobacco should be provided. Teach client to avoid exposure to cold MEDICAL CARE: Calcium-channel blocker Amputation, if infection or gangrene occurs

RAYNAUDS SYNDROME
Condition in which the small arteries and arterioles constrict in response to various stimuli. This can be induced by cold, nicotine, caffeine, and stress. Age, gender, environment, family history, associated diseases (e.g., scleroderma and lupus), exposure to certain substances Generally unilateral and affecting only one or two digits. Symptoms may result from a defect in basal heat production that eventually decreases the ability of cutaneous vessels to dilate.

2. Risk Factors

3. Pathophysiology

4. Manifestations

Classic color changes in the hands in response to cold or stress; cold fingers and toes; numb, prickly feeling or stinging pain upon warming or relief of stress

5. Diagnostic Test/s 6. Collaborative Care

Antinuclear antibodies test; erythrocyte sedimentation rate; NURSING CARE: Advise the client to stay warm; Teach the client to warm up a cold car before driving Encourage client to limit caffeine or chocolate intake Inform to stop smoking to control the disease Teach client about stress management programs; Educate client about any prescribed medications MEDICAL CARE: Muscle relaxants Calcium antagonists (e.g, Nifedipine)

Source: http://www.mayoclinic.com/health/raynauds-disease/DS00433 th Medical-Surgical Nursing by Joyce M. Black and Jane Hokanson Hawks, Volume 2, 8 Edistion, p.1331