Raynaud’s disease is a form of intermittent arteriolar vasoconstriction. The cause is unknown, but episodes may be associated with immunologic disorders (scleroderma, systemic lupus erythematosus, rheumatoid arthritis, obstructive arterial disease). Episodes may be triggered by emotional factors or by unusual sensitivity to cold. Raynaud’s disease is most common in women between the ages of 16 and 40 years and is seen much more frequently in cold climates and during the winter months. The term “Raynaud’s phenomenon”, as opposed to Raynaud’s disease, is currently used to refer to localized, intermittent episodes of vasoconstriction of small arteries of the feet and hands, causing color and temperature changes. It is generally unilateral and affects only one or two digits. It is always associated with an underlying systemic disease. The prognosis for Raynaud’s disease varies: some patients slowly improve, some grow slowly worse, and others show no change.
CLINICAL MANIFESTATIONS
• Coldness, pain, and pallor brought on by sudden vasoconstriction followed by cyanosis followed by vasodilation and hyperemia (exaggerated reflow) withi a resultant color (rubor); the progression follows the characteristic color change white, blue, red.
• Numbness, tingling, and burning pain occur as color changes.
• Involvement tends to be bilateral and symmetric.
MEDICAL MANAGEMENT
The prime objective in controlling Raynaud’s disease is avoiding the stimuli that provoke vasoconstriction. Calcium-channel blockers may be effective in relieving symptoms. Sympathectomy (interruption of sympathetic nerves by removal of sympathetic ganglia or division of their branches) may be helpful.
NURSING MANAGEMENT
• Instruct patient to avoid situations that may be upsetting, stressful, or unsafe.
• Reassure patient that serious complications (gangrene and amputation) are not usual.
• 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.