Cabaron, Carmelle Grace L.

BSN IIIA
Signs and symptoms

Buergers Disease

or Thromboangiitis Obliterans (TAO)

is an occlusive disease mostly located in
small to medium-sized arteries and less
frequently in veins. Commonly found in the
upper and lower distal extremities. In
prolonged cases, large extremities vessels
may be affected. Buergers disease is
generally bilateral and symmetric with focal
lesions. This occurs most often in men
between 20 and 35 years of age, and it has
been reported in all races and in many areas
of the world. There is considerable evidence
that heavy smoking or chewing of tobacco is
a causative or an aggravating factor.

Buergers disease usually starts with pain

in the areas affected, followed by weakness in the
same areas. The symptoms include:

Extreme sensitivity to heat and cold

Pain in the digits due to ischemia
Cyanotic and ruddy
Nails beds thicken
Peripheral pulses become weaken and
thread
Skin may have blackish ulcerations
Intermittent claudication is a
hallmark symptom, identified by
cramps in the legs after exercise.

Tests and Diagnosis

While no tests can confirm whether you have
Buerger's disease, your doctor will likely order
tests to rule out other more common conditions
or confirm suspicion of Buerger's disease brought
on by your signs and symptoms. Tests may
include:
1. Blood tests
Blood tests to look for certain substances can rule
out other conditions that may cause similar signs
and symptoms. For instance, blood tests can help
rule out scleroderma, lupus, blood-clotting
disorders and diabetes, along with other diseases
and conditions.
2. The Allen's test

Cause
Buergers disease begins by causing your
arteries to swell and blood clots to form in your
blood vessels. This restricts normal blood flow
and prevents blood from fully circulating through
your tissues. This results in tissue death because
the tissues are starved of nutrients and oxygen.

Your doctor may perform a simple test called the

Allen's test to check blood flow through the
arteries carrying blood to your hands. In the
Allen's test, you make a tight fist, which forces
the blood out of your hand. Your doctor presses
on the arteries at each side of your wrist to slow
the flow of blood back into your hand, making
your hand lose its normal color.
Next, you open your hand and your doctor
releases the pressure on one artery, then the
other. How quickly the color returns to your hand
may give a general indication about the health of
your arteries. Slow blood flow into your hand may
indicate a problem, such as Buerger's disease.

Your doctor can counsel you and

recommend medications to help you stop
smoking and stop the swelling in your
blood vessels. You'll need to avoid nicotine
replacement products because
they
supply nicotine, which activates Buerger's
disease; there are non-nicotine products
that you can use. If the disease is still
active, your doctor may check your urine
for the presence of nicotine to see if you're
still smoking.
Another option is a residential smoking
cessation program. In these programs, you
stay at a treatment facility, sometimes a
hospital, for a set number of days or
weeks. During that time you participate in
daily counseling sessions and other
activities to help you deal with the
cravings for cigarettes and to help you
learn to live tobacco-free.

Pharmacologic Treatment

3. Angiogram
An angiogram helps to see the condition of your
arteries. An angiogram can be done noninvasively with the use of CT or MRI scans.
Or it may be done by threading a catheter into an
artery. During this procedure, a special dye is
injected into the artery, after which you undergo
a series of rapid X-rays. The dye helps to
delineate any artery blockages that show up on
the images.
Your doctor may order angiograms of both your
arms and your legs even if you don't have
signs and symptoms of Buerger's disease in all of
your limbs. Buerger's disease almost always
affects more than one limb, so even though you
may not have signs and symptoms in your other
limbs, this test may detect early signs of vessel
damage.

Pharmacologic therapy is generally ineffective;

abstinence from tobacco is the only measure
known to prevent disease progression. Given the
arteritis of the small and medium-sized vessels,
surgical or endovascular revascularization may
not be possible, because of the absence of a
distal target for revascularization. As the disease
evolves, amputation may be the only viable
option.
Other treatments
Other treatment approaches exist but are less
effective. Options include:

Treatment
Smoking cessation
Although no treatment can cure Buerger's
disease, the most effective way to halt the
disease's progress is to quit using all tobacco
products. Even a few cigarettes a day can worsen
the disease.

Medications to dilate blood vessels,

improve blood flow or dissolve blood clots
Intermittent compression of the arms and
legs to increase blood flow to your
extremities
Spinal cord stimulation
Surgery to cut the nerves to the affected
area (surgical sympathectomy) to control
pain and increase blood flow, although this
procedure is controversial and long-term
results haven't been well-studied
Medications to stimulate growth of new
blood vessels (therapeutic angiogenesis),
an
approach
that
is
considered
experimental

Amputation,
occurs

if

infection

or

gangrene

Lifestyle and home remedies

Take care of your fingers and toes if you have
Buerger's disease. Check the skin on your
arms and legs daily for cuts and scrapes,
keeping in mind that if you've lost feeling to
a finger or toe you may not feel, for example,
a cut when it happens. Keep your fingers and
toes protected and avoid exposing them to
cold.
Low blood flow to your extremities means
your body can't resist infection as easily.
Small cuts and scrapes can easily turn into
serious infections.
Clean any cut with soap and water, apply
antibiotic ointment, and cover it with a clean
bandage. Keep an eye on any cuts or scrapes
to make sure they're healing. If they get
worse or heal slowly, see your doctor
promptly.
Visit your dentist regularly to keep your
gums and teeth in good health and avoid
gum disease, which in its chronic form is
linked to Buerger's disease.
Prevention
Quit using tobacco in any form
Virtually everyone who has Buerger's disease
has used tobacco in some form, most
prominently cigarettes. To prevent Buerger's
disease, it's important to not use tobacco.
Quitting smoking can be hard. If you're like
most people who smoke, you've probably
tried to quit in the past. It's never too late to
try again. Talk to your doctor about
strategies to help you quit.

After 5 hours of nursing intervention the patient

will be able to verbalize that the pain has reduced
from 9/10 to 5/10.
NURSING INTERVENTION

NURSING CARE PLAN

ASSESSMENT
Subjective:

Nag sakit ang akong mga kamot ug tiil sukad

gaena pa. As verbalized by the patient.
Objective:

Grimace face
Weakness of both hands and feet
Open sores are visible in both hands and
feet
Nail bed thickens
Visible inflammation of a vein below the
skins surface

Vital Signs:

T 36 c
PR 89 bpm
RR 21 bpm
BP - 130/80 mmhg
O2sat 105%

NURSING DIAGNOSIS
Acute pain related to diminished arterial
circulation and oxygenation of tissues with
production of lactic acid in tissues and
inflammatory process
PLANNING

Assess degree and characteristics of

discomfort/pain. Note guarding of
extremity. Palpate leg and upper
extremities with caution.
Assess for referred pain as appropriate.
Anticipate need for pain relief.
Monitor the severity of pain using pain
rating scale. Note location, quality and
associated manifestation of skin,
aggregation factors that increase pain and
factors that alleviate the pain.
Instruct/encourage use of relaxation
technique, such as deep breathing
exercise to distract attention and reduce
tension to prevent furthered
complications.
Elevate affected extremity.
Encourage client to change position
frequently
Monitor vital signs, noting elevated
temperature.
Provide rest periods to facilitate comfort,
sleep, and relaxation.
Help the client use non-pharmacological
methods to control pain such as listening
to music, watching TV and therapeutic
massage.
Plan care activities around periods of
greatest comfort whenever possible.
Note non-verbal cues e.g. restlessness,
reluctance to move, tachycardia,
diaphoresis etc. .

EVALUATION

After 5 hours of nursing intervention the

patient was able to verbalize that the pain
has reduced from 9/10 to 4/10.
Goal met