(^48) Medical-Surgical Nursing Demystified
HALLMARK SIGNS AND SYMPTOMS
- Discoloration of extremities progressing from pale, to blue, and then red
because of decreased blood flow - Tingling and numbness in the extremities because of poor perfusion
INTERPRETING TEST RESULTS
- Vasospasm is detected in an arteriograph.
- Labwork to look for underlying disease process—CBC may show anemia;
sed rate (ESR), rheumatoid arthritis (RA), antinuclear antibody (ANA) (these
autoimmune tests will be positive).
TREATMENT
Treatment is outpatient and consists of avoidance of aggravating factors and may
need medication for primary, and treatment of underlying disorders and ischemia
in secondary.- Administer calcium channel blockers to ameliorate symptoms:
- diltiazem
- nifedipine
- Administer vasodilators to aid in blood flow.
- Avoid cold and stress because this may causes vasospasms.
- Avoid smoking because it causes vasoconstriction.
- Surgical removal of a part of a sympathetic nerve (sympathectomy) because
it can eliminate symptoms.
NURSING DIAGNOSES
- Risk for injury
- Risk for peripheral neurovascular dysfunction
- Ineffective tissue perfusion
NURSING INTERVENTION
- Teach patient to wear mittens rather than gloves when exposed to the cold
because it allows for air flow around fingers to hold body heat.