RAYNAUDS

DISEASE

Raynauds disease is a form of intermittent

arteriolar vasoconstriction.
is excessively reduced blood flow in response
to cold or emotional stress, causing
discolouration of the fingers, toes, and
occasionally other areas. This condition may
also cause nails to become brittle with
longitudinal ridges.

CAUSES
Primary
Raynaud's disease, or "Primary Raynaud's", is
diagnosed if the symptoms areidiopathic
Secondary
Raynaud's syndrome, or "Secondary
Raynaud's," occurssecondary toa wide
variety of other conditions. Secondary
Raynaud's has a number of associations:

Connective tissue disorders:

Scleroderma
systemic

lupus erythematosus rheumatoid arthritis

Sjgren's syndrome
dermatomyositis
polymyositis
mixed connective tissue disease
cold agglutinin disease
Ehlers-Danlos syndrome

Obstructive disorders:
atherosclerosis
Buerger's

disease
Takayasu's arteritis
subclaviananeurysms
thoracic outlet syndrome

Others:
physical

trauma, such as that sustained inauto

accidentsor other traumatic events
Lyme disease
hypothyroidism
cryoglobulinemia
malignancy
chronic fatigue syndrome
reflex sympathetic dystrophy
carpal tunnel syndrome
magnesium deficiency
multiple sclerosis
erythromelalgia(the opposite of Raynaud's, with
hot and warm extremities) often co-exists in
patients with Raynaud's

DIAGNOSIS

Digital artery pressure: pressures are measured in the arteries

of the fingers before and after the hands have been cooled. A
decrease of at least 15mmHgis diagnostic (positive).
Doppler ultrasound: to assess blood flow.
Full blood count: this may reveal a
normocyticanaemiasuggesting theanemia of chronic
diseaseorrenal failure.
Blood testforureaandelectrolytes: this may reveal renal
impairment.
Thyroid function tests: this may revealhypothyroidism.
Anautoantibodyscreen, tests forrheumatoid
factor,Erythrocyte sedimentation rate, andC-reactive
protein, which may reveal specific causative illnesses or a
generalised inflammatory process.
Nail fold vasculature:this can be examined under
themicroscope.

SIGNS AND SYMPTOMS

Intermittent pain
Cyanosis
Redness and swelling
Numb and cold extremities
Ulceration
Gangrene

When exposed to cold temperatures, the

blood supply to the fingers or toes, and in
some cases the nose or earlobes, is markedly
reduced; the skin turns pale or white
(calledpallor), and becomes cold and numb.
When theoxygensupply is depleted, the skin
color turns blue (calledcyanosis).
These events are episodic, and when the
episode subsides or the area is warmed, the
blood flow returns and the skin color first
turns red (rubor), and then back to normal,
often accompanied byswelling, tingling, and
a painful "pins and needles" sensation.

MEDICAL MANAGEMENT

Calcium channel blockers.These drugs relax

and open small blood vessels in your hands and
feet, decreasing the frequency and severity of
attacks in most people with Raynaud's.
help heal skin ulcers on fingers or toes. Examples
include nifedipine (Afeditab CR, Procardia),
amlodipine (Norvasc) and felodipine (Plendil).
Alpha blockers.Some people find relief with
drugs called alpha blockers, which counteract
the actions of norepinephrine, a hormone that
constricts blood vessels. Examples include
prazosin (Minipress) and doxazosin (Cardura).

Vasodilators.such as nitroglycerin cream

applied to the base of your fingers to help
heal skin ulcers. Some vasodilators commonly
used to treat other conditions, including the
high blood pressure drug losartan (Cozaar),
the erectile dysfunction medication sildenafil
(Viagra, Revatio), the antidepressant
medication fluoxetine (Prozac, Sarafem,
others), and a class of medications called
prostaglandins, may relieve the symptoms of
Raynaud's.

Nerve surgery.Nerves called sympathetic

nerves in your hands and feet control the
opening and narrowing of blood vessels in
your skin. Cutting these nerves interrupts
their exaggerated response
Chemical injection.Doctors can inject
chemicals such as local anesthetics or
onabotulinumtoxin type A (Botox) to block
sympathetic nerves in affected hands or
feet.

Don't smoke.Smoking causes skin

temperature to drop by constricting blood
vessels, which may lead to an attack. Inhaling
secondhand smoke also can aggravate
Raynaud's.
Exercise.Exercise can increase circulation,
among other health benefits. If you have
secondary Raynaud's, talk to your doctor
before exercising outdoors in the cold.
Control stress.Learning to recognize and
avoid stressful situations may help control the
number of attacks.
Avoid rapidly changing temperatures.Try
not to move from a hot environment to an
air-conditioned room.

Biofeedback.Using mind to control body

temperature (biofeedback) may help
decrease the severity and frequency of
attacks. Biofeedback includes guided
imagery to increase the temperature of
hands and feet, deep breathing, and other
relaxation exercises
Acupuncture.This practice appears to
improve blood flow, so it may be helpful in
relieving Raynaud's attacks.

NURSING MANAGEMENT

Management of risk-management
Smoking cessation
Safety with sharp objects
Maintain extremity warmth
Stress management
Monitor for symptoms of gangrene
Medication compliance and monitor for drug
interactions
Monitor vital signs, particularly blood pressure, due
to risk for postural hypotension
Avoidance of situations that aggravate condition,
such as extremely cold temperatures and prolonged
ambulation
Assessed for home health and community-based
support to promote the highest level of function and
quality of life.

Emphasize the importance of avoiding

nicotine (smoking cessation without the use
of nicotine patches); assist in finding support
group.
Advise patient to minimize exposure to cold,
remain indoors as much as possible, and
wear protective clothing when outdoors
during cold weather.
Advise patient to handle sharp objects
carefully to avoid injuring the fingers.
Caution about postural hypotension (results
from drugs and is increased by alcohol,
exercise, and hot weather).