P2.1: VASCULAR: RAYNAUD'S DISEASE

Question 1

The lining of all blood vessels consists of HOW MAY LAYERS of endothelial cells

Answer 1

Single layer

Question 2

3 LAYERS OF Arteries and veins

Answer 2

1. TUNICA EXTERNA
2. TUNICA MEDIA
3. TUNICA INTIMA

VASCULAR SMOOTH MUSCLE CELLS

Question 3

Elastic fibers have a central core of coiled elastin and an outer covering of microfibrils composed of ________.

Answer 3

Glycoproteins

Question 4

Extensive networks of cross-linked elastic fibers give all vessels except ______ AND ______ the ability to stretch like a rubber hose when blood pressure is raised.

Answer 4

Capillaries and Venules

Question 5

A thin outer layer of connective tissue that maintains vascular integrity and shape.

Answer 5

Tunica Adventitia

Question 6

It’s a functional disorder caused by intense vasospasm of the arteries and arterioles in the fingers and, less often, the toes

Answer 6

RAYNAUD’S DISEASE/ARTERIOSPASTIC DISEASE

Question 7

Nursing management for RAYNAUD’S DISEASE/ARTERIOSPASTIC DISEASE

Answer 7

CONSERVATIVE
* Lifestyle change
* Warm water immersion

PHARMACOLOGIC
* Calcium Channel Blocker

SURGERY
* Sympathectomy

Question 8

EXAMPLES OF THESE GIVEN DRUG TYPES:

• Calcium channel blocker - ???
• a1-andrenoreceptor antagonists - ???
• ACE-inhibitors - ???
• Nitric Oxide - ???
• Prostaglandin Analogs - ???
• Phosphodiesterase inhibitors - ???

Answer 8

• Amlodipine
• Prasozin
• Captopril
• Nitric Oxide
• Iloprost
• Sildenafil

Question 9

A condition primarily characterized by the occurrence of digital vasospasm that is episodic, inappropriate and excessive

Answer 9

RAYNAUD’S DISEASE/ARTERIOSPASTIC DISEASE

Question 10

It interrupts sympathetic nervous stem input to affected vessels, reducing vasoconstriction and spasm

Answer 10

Interventional Therapy: Sympathectomy

Question 11

Periodic vasospastic disease of small, cutaneous arteries involving the fingerhands, and less commonly in feet (even in ears & nose) marked by brief episodes of vasospasm (narrowing of the blood vessels).

Answer 11

RAYNAUD’S DISEASE/ARTERIOSPASTIC DISEASE

Question 12

What kind of Raynaud’s is when the condition occurs along with a likely cause

Answer 12

Raynaud’s Phenomenon or secondary type

The cause is unknown, but linked with immunologic abnormalities

• Primary Raynaud’s – rarely leads to tissue necrosis
• Secondary Raynaud’s – associated with collagen vascular disease

Question 13

Triphasic color changes in the hands:

Pallor to cyanosis (noticed in tips of fingers, later moving into 1 or more of the distal phalanges)

Answer 13

Ischemia

Question 14

Triphasic color changes in the hands:

With intense redness, throbbing and paresthesia

Answer 14

Hyperemia

Question 15

What kind of Raynaud’s is when this disorder occurs without any known cause

Answer 15

Raynaud’s disease, or Primary Raynaud’s

The cause is unknown, but linked with immunologic abnormalities

It is more common and tends to be less severe than secondary Raynaud’s.

Question 16

Triphasic color changes in the hands:

Answer 16

1. Ischemia
2. Hyperemia
3. Return to normal color

Question 17

Triphasic color changes in the hands:

Vasospastic phase –cold, numbness
Hyperaemic phase – throbbing, tingling, swelling

Answer 17

Return to normal color

Question 18

DIAGNOSTIC PROCEDURES: Important to determine possible causes and treatment to be instituted

Answer 18

1. Physical examination
2. Laser Doppler flow velocimetry
3. Serial computed thermography
4. Past health history
5. Functional health patterns

Question 19

NURSING INTERVENTIONS: prevention of recurrent episodes

Answer 19

1. Avoidance of cold, mechanical and chemical injury
   * Use warm clothing, use of protective gadgets when colding cold objects
   * Avoid temperature extremes
   * Immerse hands in warm water to decrease spasm
2. Cessation of smoking
3. Wear gloves and mittens when handling cold items
4. Limit intake of chocolates and caffeine
5. Evaluate the patients occupation and its effect on symptom occurrence.
6. Help the patient identify stress triggers and use effective coping strategies
7. Anxiety reduction – stress management, relaxation techniques
8. Administration of vasodilators – Ca – channel blockers

Question 20

COMPLICATIONS:

Answer 20

• Punctuate lesions – small hole-lesions
• Gangrenous ulcers – advanced stages

Question 21

CONTRIBUTORY FACTORS:

Answer 21

Occupationally related to trauma and pressure to fingertips
* (associated with the use of heavy vibrating tools, exposure to alternating hot and cold temperatures – butchers and food preparers), exposure to heavy metals.

Repetitive actions
* Typing, playing the piano, or another repetitive action done for long periods of time is often linked to secondary Raynaud’s. Using vibrating tools at work also can make you more likely to develop the disorder.

Question 22

MANAGEMENT:

Answer 22

• Use of Calcium Channel blockers
• Sympathectomy, if conservative treatment fails to prevent ischemic ulcers

Sympathectomy: Surgical interruption of sympathetic nerve pathways used for persons with severe symptoms (done only in advanced cases)

Question 23

NURSING DIAGNOSIS:

Answer 23

• Altered peripheral tissue perfusion related to decreased arterial blood flow
• Impaired skin integrity related to: decreased peripheral circulation, altered sensation
• Pain related to ischemia
• Activity intolerance
• Risk for injury related to decreased sensation

Question 24

PRECIPITATING FACTORS:

Answer 24

Exposure to cold, emotional stress, caffeine ingestion, tobacco use.