2. 
Adequate perfusion oxygenates and nourishes body tissues and
depends in part on a properly functioning cardiovascular
system. Adequate blood flow depends on the efficient pumping
action of the heart, patent and responsive blood vessels, and
adequate cir culating blood volume. Nervous system activity,
blood viscosity, and the metabolic needs of tissues influence the
rate and adequacy of blood flow.

Raynauds disease and Thrombo angitis obliterens are the
diseases caused mainly by poor bloodsupply

3.  Raynauds
disease is the intermittent
arteriolar vasoconstriction that results in
coldness,pain and pallor of finger tips or
toes.
 The term Raynauds phenomenon is used
to refer to localized intermittent episodes
of vasoconstriction of small arteries of the
feet and hands that cause color and
temperature
changes.Generally
unilateral.

5. 
Most common among patients between 16 and
40 years of age and it occurs more frequently
in cold climates and during the winter.

6. Primary : without any underlying disease or
medical problem
 Secondary : caused by underlying problem


7. 












Immunologic disorders
Scleroderma
Systemic lupus erythematosus
Rheumatoid arthritis
Obstructive arterial disease
Trauma
Certain medicines (BETA BLOCKERS)
Sjogrens syndrome
Carpel tunnel syndrome
Diseases of arteries
Chemical exposure
Thyroid gland disorders (HYPOTHYROIDISM)
Stress

8. 








PRIMARY
Age
Gender
Family history
Climate
SECONDARY
Associated diseases
Certain occupations
Exposure to certain substances

9. 
Due to etiological factors
Vasospasm and spastic constriction of arteries

and arterioles

Retarted blood flow to capillaries and venules


Cyanosis
After a period of minutes and hours local ruber
occurs

Throbbing pain accompanies with recovery

10.  Pallor
 Skin
becomes bluish(cyanotic) due
pooling of deoxygenated blood during
vasospasm.
 Hyperemia
 Rubor(red color)
 Numbness,tingling and burning pain
occur as cold changes.

11.  Avoiding
trigerring factors like cold
and tobacco etc is a primary in
controlling raynauds disease
 Calcium channel blockers (Nifedipine)
 SYMPATHECTOMY
 Interrupting the sympathetic nerves
by removing sympathetic ganglia or
dividing their branches may help some
patients.

12. 



The nurse teaches patients to avoid situations that may be
stressful or unsafe. Stress management classes may be
helpful.
Exposure to cold must be minimized, and in areas where
the fall and winter months are cold, the patient should
remain indoors as much as possible and wear layers of
clothing when outdoors.
Hats and mittens or gloves should be worn at all times
when outside. Fabrics specially designed for cold climates
(eg, Thinsulate) are recommended.
Patients should warm up their vehicles before getting in so
that they can avoid touching a cold steering wheel or door
handle, which could elicit an attack. During summer, a
sweater should be available when entering air-conditioned
rooms.

13. 





Concerns about serious complications, such as
gangrene and amputation, are common among
patients that should be informed
Patients should avoid all forms of nicotine; the
nicotine gum or patches used to help people quit
smoking may induce attacks.
Patients should be careful about safety.
Sharp objects should be handled carefully to
avoid injuring the fingers.
Patients should be informed about the postural
hypotension that may result from medications,
such as calcium channel blockers, used to treat
Raynaud’s disease.
The nurse also discusses safety precautions
related to alcohol, exercise, and hot weather

14. 
Buerger’s disease is characterized by recurring inflammation
of the intermediate and small arteries and veins of the lower
and (in rare cases) upper extremities. It results in thrombus
formation and occlusion of the vessels.In buergers disease
blood vessels becomes inflamed ,swelled and blocked with
blood clots.this eventually damages or destroys the skin
tissues and may lead to infection and gangrene.It is
differentiated from other vessel diseases by its microscopic
appearance. In contrast to atherosclerosis, Buerger’s disease
is believed to be an autoimmune disease that results in

15. ALSO CALLED AS
“PRESENILE
GANGRENE”

17. 
It occurs most often in men between the ages
of 20 and 35 years, and it has been reported in
all races and in many areas of the world

18. The cause of Buerger’s disease is unknown,
but it is believed to be an autoimmune
vasculitis.
 Genetic predisposition
 There is considerable evidence that heavy
smoking or chewing of tobacco is a causative
or an aggravating factor.
 Generally, the lower extremities are affected,
but arteries in the upper extremities or viscera
can also be involved.
 Buerger’s disease is generally bilateral and
symmetric with focal lesions.


19. Tobacco use
 Chronic gum disease


20. 

Due to etiological factors
Acute inflammation and thrombosis of the
viens of hands and feet


Vasculitis
Decreased blood supply to skin

Gangrene formation

21. 
Pain (pain is relieved by rest)

The patient complains of foot cramps, especially of the
arch ( instep claudication), after exercise.

A burning pain is aggravated by emotional disturbances,
nicotine, or chilling.

Cold sensitivity of the Raynaud type is found in one half
the patients.

Digital rest pain is constant, and the characteristics of the
pain do not change between activity and rest.

22.  Physical
signs
Includes;
 Intense rubor (reddish blue discoloration) of the foot
 Absence of the pedal pulse but with normal femoral
and popliteal pulses.
 Radial and ulnar artery pulses are absent or
diminished.
 Various types of paresthesia may develop.
 As the disease progresses, definite redness or cyanosis
of the part appears when the extremity is in a
dependent position.
 Involvement is generally bilateral, but color changes
may affect only
 one extremity or only certain digits.
 Color changes may progress to ulceration, and
ulceration with gangrene eventually occurs

23. 





History taking (current or rescent history of tobacco
taking)
Physical examination (presence of extremity
ischemia.claudication,pain at rest)
Segmental limb blood pressures ( to demonstrate the
distal location of the lesions or occlusions)
Duplex ultrasonography (to document patency of the
proximal vessels and to visualize the extent of distal
disease)
Contrast angiography (to demonstrate the diseased
portion of the anatomy)
Distal plesthysmography

24. To improve circulation to the extremities
 To prevent the progression of the disease
 To protect the extremities from trauma and
infection.


25. Treatment of ulceration and gangrene is
directed toward minimizing infection and
conservative débridement of necrotic tissue.
 Tobacco use is highly detrimental, and
patients are strongly advised to stop using
tobacco completely.
 Vasodilators are rarely prescribed because
these medications blood away from the
partially occluded vessels, making the
situation worse.
 Prostaglandins
like
limaprost
are


26. A
regional
sympathetic
block
or
ganglionectomy may be useful in some
instances to produce vasodilation and increase
blood flow of limb
 Debridment is done for necrotic ulcers.
 In chronic cases lumbar sympathectomy is
done to reduce vasoconstriction and increases
blood flow to limb.
 Above knee and below knee amputation is
done in rare cases
 Anti inflammatory drugs like corticosteroids
are used for inflammation and pain
 Bypass can sometimes be helpful


27. If amputation is performed elevating the stump
for the first 24 hours to promote venous return
and minimize edema and the incision is
monitored for the signs of hematoma.
 The patient may experience grief, fear, or anxiety
related to loss of the limb. The patient is
encouraged to discuss his or her feelings. Spiritual
advisors and other health care team members are
consulted as appropriate. Recovery and
rehabilitation require consultation among health
care providers (eg, physicians, physical and
occupational therapists, prosthetists, dietitians,
nurses)
 The patient is assisted in developing a plan to stop


28. The patient may need to be encouraged to
make the lifestyle changes necessary with a
chronic disease, including modifications in
diet, activity, and hygiene (skin care).
 The nurse determines whether the patient has
a network of family and friends to assist with
activities of daily living.
 The nurse ensures that the patient has the
knowl edge and ability to assess for any
postoperative complications such as infection
and decreased blood flow.


29. The prognosis for Raynaud’s disease varies; some patients
slowly improve, some become progressively worse, and
others show no change. Ulceration and gangrene are rare;
however, chronic disease may cause atrophy of the skin
and muscles. With appropriate patient teaching and
lifestyle modifications, the disorder is generally benign
and self-limiting.
 Although
this
condition
is
different
from
atherosclerosis, Buerger’s disease in older patients may
also be followed by atherosclerosis of the larger vessels
after involvement of the smaller vessels. The patient’s
ability to walk may be severely limited. Patients are at
higher risk for nonhealing wounds because of impaired
circulation


30. THANK
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