a peripheral vascular disease

DEFINITION
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is a recurring inflammation and thrombosis (clotting) of small and medium arteries and veins of the hands and feet. also known as thromboangiitis obliterans This disease was first reported by Leo Buerger in 1908, who described a disease in which the characteristic pathologic findings ² acute inflammation and thrombosis (clotting) of arteries and veins ² affected the hands and feet. Believed to be an autoimmune vasculitis that result s in occlusion of distal vessels.

RISK FACTORS
Men between 20 and 35 years of age Heavy smoking or chewing of tobacco is a causative or an aggravating factor

CLINICAL MANIFESTATIONS
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Pain- it is the most outstanding symptom- due to intermittent claudication. Rest pain with persistent ischemia of 1 or more digits - due to occlusion of decreases blood flow. Paresthesia ± due to diminished nerve sensation. Finger¶s and toes turn pale when exposed to cold(Raynaud¶s phenomenon) ± due to decreased blood flow as affected by cold temperature. Absent or weak tibial pulse Cyanosis - ( cyanosis bluish discoloration of the skin and mucous membrane due to lack of oxygen in the blood) a later manifestation. Ulcerations and gangrene ± if there is prolonged insufficient blood supply

ASSESSMENT AND DIAGNOSTIC FINDINGS
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Segmental limb blood pressure Duplex Ultrasonography May indicate presence of distal extremity ischemia (indicated by claudication, pain at rest, ischemic ulcers or gangrene) Contrast Angiography May indicate a proximal source of emboli. It is the most conclusive diagnostic procedure for peripheral vascular diseases.

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May be accompanied by Atherosclerosis of the large vessels Patient¶s ability to walk is severely limited Higher risk for non-healing wounds because of impaired circulation

MEDICAL MANAGEMENT
Main Objectives are: To improve circulation to extremeties Prevent progression of the disease Protect the extremeties from trauma and infection
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Smoking cessation has shown to slow the progression of the disease and decrease the severity of amputation in most patients, but does not halt the progression.

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Regional sympathetic block/Ganglionectomy produces vasodilation and increases blood flow Ganglion ± Is a biological tissue mass, most commonly a mass of nerve cell bodies

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Vascular surgery can sometimes be helpful in treating limbs with poor perfusion secondary to this disease. Use of vascular growth factor and stem cell injections have been showing promise in clinical studies. Amputation Occasional below knee is necessary Indications: Gangrene especially if there is moist, severe rest pain or severe sepsis

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Streptokinase Has been proposed as adjuvant therapy in some cases a protein secreted by several species of streptococci can bind and activate human plasminogen. SK is used as an effective and inexpensive clot-dissolving medication in some cases.

NURSING MANAGEMENT
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Assess pain ± monitor if it is being tolerated or needs medication to relieve pain. Obtain blood pressure ± serves as a baseline data for peripheral pulse Assess signs of ulcer formation Assess for signs of gangrene Quit smoking ± to prevent further occlusion of the blood vessels Foot care ± to decrease the occurrence of infection and gangrene. Protect from trauma to avoid source of infection Enough rest Increase fluid intake Socks or stocking must always clean Slight massage of the food with moisturizer Avoid circular or rolled stocking

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