Buerger’s Disease, also known as Thrombangitis Obliterans, is the occlusion of small to medium-sized arteries and veins found in the bilateral upper and lower distal extremities. It results in thrombus formation and segmental occlusion of the vessels and when left untreated, the vessels of the large extremities may be affected as well. It usually occurs in men, 20 to 35 years of age, across all races. Heavy smoking or chewing of tobacco has been found to be a contributing factor.
Acute and/or chronic pain related to vasospasm, reperfusion disorders, and ischemic/tissue damage
Goal
Pain is reduced and tissue damage is not widespread.
Nursing interventions
INTERVENTION
RATIONALE
Expect initial shock and disbelief following diagnosis of cancer and traumatizing procedures (disfiguring surgery, colostomy, amputation).
Few patients are fully prepared for the reality of the changes that can occur.
Record the characteristics of pain and paresthesias.
Knowing the pain level.
Check the patient’s vital signs.
To monitor the general state of the client.
Discuss with the patient, how and why the pain inflicted.
That patients understand how to process pain.
Help the patient identify trigger factor or situation example: smoking, exposure to cold and how to handle.
That patients understand the factors that influence pain.
Encourage the use of stress management techniques, entertainment activities.
Used to divert the attention of the client.
Soak the affected area in warm water.
Warm water will make the blood vessels dilate and blood flow.
Give the room a warm, draft-free air, for example ventilation, air-conditioning, keep doors closed as indicated.
Avoid infection and keep the air hot.
Monitor drug effects and action.
Determine the level of effectiveness of the drug.
Collaboration: the medications as indicated, prepare surgical intervention when necessary.
Administration of drugs to relieve pain.
Ineffective tissue perfusion is related to the cessation of arterial blood flow
Nursing interventions
INTERVENTION
RATIONALE
Observation of skin color on the sick.
To see cyanosis or redness of the skin.
Note the decrease in pulse.
Identify the severity of the cessation of arterial blood flow.
Evaluation of pain sensation parts, for example: sharp / shallow, hot / cold.
Knowing levels, flavors, and forms of pain.
View and examine the skin for ulceration, lesions, gangrene area.
Seeing how big a part that had gangrene.
Recommended for proper nutrition and vitamins.
Proper nutrition and vitamin requirements are complete will increase the body’s immune system.
Collaboration: the medications as indicated (vasodilator), example: drainage lesions for culture or sensitivity.
Giving obta vasodilator makes the arteries dilate and blood flow.
Knowledge deficit
Nursing interventions
INTERVENTION
RATIONALE
Provide information to patients about the disease.
Increase patients’ knowledge about the disease.
Encourage clients to ask questions about the disease.
Knowing the client’s level of curiosity about the disease.
Instruct to avoid exposure to cold.
Cold temperatures make the constriction of the blood vessels and will aggravate the blockage of blood flow.
Preserve the environment at a temperature above 20.9 C eliminate cold flow.
Hot temperature makes blood vessels to maintain a state of dilatation.
Discuss the possibility of moving to a warmer climate.
Avoid the severity of which will happen.
Emphasize the importance of stopping smoking, and provide information on local clinics / support groups.
That patients know and understand that smoking is a major contributing factor to the occurrence of tromboangitis.
Help the patient to create a method to avoid stress throughrelaxation techniques.
Distraction and relaxation techniques to make the patient more calm in responding.
Emphasize the importance of viewing each day and doing the right skin care.
Avoid skin injury.
Anxiety related to the action procedure to be performed
Nursing interventions
INTERVENTION
RATIONALE
Describe the action procedure to be performed.
Increase patients’ knowledge about action procedures.
Explain the importance of actions to be taken.
In order for patients to understand why the need for that action.
Observation of vital signs.
Knowing the general state of the client.
Give comfort to the patient.
Patients will feel calm and not worry with action procedures to be performed.
Reassure the patient that the action to be performed is the best course of action.
Reduce the level of anxiety on the client.
Reassure the patient that the procedure acts to be performed safely.
Reduce negative thinking about procedures.
Collaboration with physicians for the provision of drugs.
To create a calm and reduce anxiety levels.
Emphasize the importance of viewing each day and doing the right skin care.
Avoid skin injury.
Nursing Notes
Pathophysiology
Inflammation occurs, and the vessels are prone to spasms and constriction. Inflammatory lesions appear in healthy isolated segments of normal vessels walls, which often occlude blood flow. Scarring, fibrosis, and thrombophlebitis occur, which develops into adhering of the vessels and nerves. Soft tissue and skin cells experience hypoxia, which leads to anoxia and tissue necrosis. Nail beds thicken, and peripheral pulses become weak and thread. As Buerger’s disease progresses, pain occurs due to tissue death. Skin sloughs, ulcers form, and the extremity is at risk for gangrene.
Clinical manifestations/signs and symptoms
Extreme sensitivity to heat and cold
Pain in the digits due to ischemia
Cyanotic and ruddy
Nails beds thicken
Peripheral pulses become weaken and thread
Skin may have blackish ulcerations
Intermittent claudication is a hallmark symptom, identified by cramps in the legs after exercise.
Laboratory and diagnostic study findings
Doppler ultrasonography findings are diminished or absent compared with those for opposite leg
Phlebography (venography) shows an unfilled segment of the vein in an otherwise completely filled vein with its connecting collaterals, this test is generally most indicative in diagnosing venous thrombosis.
Nursing diagnosis
Ineffective peripheral tissue perfusion related to impaired circulation.
Pain related to diminished oxygen flow to the affected extremity.
Fear and anxiety related to actual or potential serious complications.
Medical management
Main objectives are to improve circulation to the extremities, prevent the progression of the disease, and protect the extremities from trauma and infection.
Treatment measures include the following:
Completely stopping use of tobacco.
Regional sympathetic block or ganglionectomy produces vasodilation and increases blood flow.
Conservative debridement of necrotic tissue is used in treatment of ulceration and gangrene.
If gangrene of a toe develops, usually a below-knee amputation, or occasionally an above-knee amputation, is necessary. Indications for amputation are worsening gangrene (especially if moist), severe rest pain, or severe sepsis.
Vasodilators are rarely prescribed (cause dilation of healthy vessels only).
Nursing management
Patient teaching, instruct the patient to do the following several times a day:
Lie flat on a bed with both legs elevated above the level of the heart for two to three minutes.
Next sit on the edge of the bed with the legs dependent for three minutes
Then exercise the feet and toes by moving them up, down, inward, then outward.
Lastly, return to the first position and hold for five minutes.
Provide for ulcer debridement and healing
Remove dead or damaged material from the wound, using wet-to-dry dressing with saline solution and coarse-mesh gauze filled with cotton.
Use whirlpool therapy to debride the ulcer bed.
Consider using an enzymatic debrider to aid removal of debris.
Provide additional intervention to promote venous return and healing, maximize comfort and provide client education for measures to prevent venous stasis ulcer.
Administer medications which may include antibiotics.
The patient is encouraged to make the lifestyle changes necessitated by the onset of a chronic disease, including pain management and modifications in diet, activity, and hygiene (skin care).
The nurse assists the patient in developing and implementing a plan to stop using tobacco.
