Buerger’s Disease

Buerger’s Disease Nursing Care Plans Diagnosis and Interventions

Buerger’s Disease NCLEX Review Care Plans

Nursing Study Guide on Buerger’s Disease

Buerger’s disease is a rare disorder characterized by obstruction or narrowing of the blood vessels in the extremities. The narrowing and occlusion of arteries and veins cause reduced blood flow, leading to peripheral vascular diseases.

Buerger’s disease is also known as thromboangiitis obliterans and it commonly affects young to middle-aged men.

This disease has a strong association to smoking, although the mechanism of the relationship is still unknown.

Buerger’s disease can affect people of all ages. However, higher incidence rates are seen in people in Middle Eastern and Far Eastern countries.

Signs and Symptoms of Buerger’s Disease

Buerger’s disease runs a recurrent course commonly happening as sudden episodes lasting for one to four weeks.

The signs and symptoms may include the following:

  • Extreme pain in lower arms and legs while at rest
  • Tingling or numbness in hands and feet
  • Pale, reddish, or bluish hands or feet
  •  Inflammation along a vein secondary to blood clot formation
  • Raynaud’s phenomenon – fingers and toes may turn pale when exposed to cold
  • Painful open sores on fingers and toes

Causes of Buerger’s Disease

The exact etiology of buerger’s disease is still unknown. Studies suggest that genetic factor plays a role in the development and severity of the disease.

Other researchers claim that buerger’s disease is an autoimmune disease. However, more studies are still needed to support this claim.

Tobacco use, whether by smoking or by chewing, is strongly related to buerger’s disease. The relationship is still not completely understood.

The identified risk factors for the development of Buerger’s disease are as follows:

  • Tobacco use – a history of cigarette smoking or any other form of tobacco use is strongly related to buerger’s disease. Scientists believe it is the chemicals in tobacco that irritates the lining of blood vessels, but more research is needed to prove this.
  • Chronic gum disease – buerger’s disease is also related to long-term gum infections although the relationship is not fully understood as well.
  • Sex – the disease is more common in men than in women. It can be accounted to the higher incidence of tobacco use in men than in women.
  • Age. Buerger’s disease commonly affect people aged 45 years and less.

Complications of Buerger’s Disease

Buerger’s disease is characterized by narrowing or blockage of the arteries and veins.

This mechanism causes reduction in blood flow to the distal parts of the extremities causing deprivation of oxygen and nutrients to the tissues leading to tissue death or gangrene.

Gangrene is a serious condition often requiring surgical treatment by amputation. Buerger’s disease can also lead to:

Diagnosis of Buerger’s Disease

  • Medical History – Many physicians will require tobacco use in the patient’s history to diagnose buerger’s disease. As there is no single diagnostic test to identify Buerger’s disease, the physician will make the diagnosis depending on the history and presence of signs and symptoms.
  • Physical Examination – Allen’s test involves the patient making a fist. The medical staff will put pressure on the arteries on the wrists. The patient will then release the fist while the medical staff releases the pressure on the arteries one after the other. The amount of time it takes for the blood to return to the hand will indicate possible vascular problems.
  • Ruling out of other vascular diseases – since there is no definitive diagnostic test for buerger’s disease, it is important that other vascular diseases be ruled out to aid proper treatment. The vascular diseases that need to be ruled out are arteriosclerosis obliterans, traumatic arterial thrombosis, popliteal arterial entrapping syndrome, occlusive vasculopathy due to systemic lupus erythematosus, and Behcet’s disease.
  • Angiogram. An angiogram is an imaging study which can be performed in two different ways. One way is a non-invasive procedure involving the administration of a contrast medium intravenously and then subjecting the patient to a CT or MRI scan. Another way is the insertion of a catheter into an artery and then injecting dye while taking X-ray images. This test identifies blood vessel damage and possible occlusion and narrowing.

Treatment of Buerger’s Disease

  1. Smoking cessation – Although the relationship between tobacco use and buerger’s disease is unknown, smoking cessation still proves to be the main intervention to manage the disease.
  2. Other treatments are available to help manage the signs and symptoms of Buerger’s disease; however, they are not as effective as smoking cessation.
    1. Medications to help dilate blood vessels and improve flow.
    1. Intermittent compression of arms and legs to improve blood flow.
    1. Spinal cord stimulation
    1. Amputation of gangrenous areas
  3. Potential future treatments
    1. Nerve surgery – this may be required to cut the nerves and control pain and increase blood flow to the affected extremities.
    1. Growing new blood vessels – medication may be given to stimulate the formation of new blood vessels. However, this intervention is still experimental.
    1. Endovascular procedure – this treatment option involves the insertion of a catheter into an artery to try to open up blood vessels and restore blood flow.

Nursing Care Plans for Buerger’s Disease

Nursing Care Plan 1

Nursing Diagnosis: Acute Pain related to the inflammatory process of Buerger’s disease as evidenced by pain score of 10 out of 10, verbalization of joint pain, guarding sign on the painful areas, irritability, and restlessness

Desired Outcome: The patient will demonstrate relief of pain as evidenced by a pain score of 0 out of 10, stable vital signs, and absence of restlessness.

InterventionsRationale
Administer prescribed medications that alleviate the symptoms of joint pain.Aspirin helps alleviate fever and reduces joint pain due to its anti-inflammatory property. Caution is recommended in the use of aspirin as it is known to cause Reye’s syndrome.
Assess the patient’s vital signs and characteristics of pain at least 30 minutes after administration of medication.  To monitor effectiveness of medical treatment for the relief of pain. The time of monitoring of vital signs may depend on the peak time of the drug administered.  
Elevate the head of the bed if the patient is short of breath. Administer supplemental oxygen, as prescribed. Discontinue if SpO2 level is above the target range, or as ordered by the physician.To increase the oxygen level and achieve an SpO2 value within the target range.
Place the patient in complete bed rest during pain attacks. Educate patient on stress management, deep breathing exercises, and relaxation techniques.Stress causes a persistent increase in cortisol levels, which has been linked to people with circulatory issues.

Nursing Care Plan 2

Nursing Diagnosis: Ineffective Tissue Perfusion (Peripheral) related to decreased peripheral blood flow secondary to Buerger’s disease, as evidenced by pale, reddish, or bluish hands or feet, pain on the affected area, Raynaud’s phenomenon (fingers and toes turn pale when exposed to cold), leg numbness and weakness

  Desired Outcome: The patient will be able to achieve optimal tissue perfusion in the affected areas as evidenced by having strong and palpable pulses, regained leg strength, and reduced pain.

InterventionsRationales
Assess the patient’s vital signs at least every 4 hours, or more frequently if there is a change in them.To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment for Buerger’s disease.
Encourage the patient to cooperate in the smoking cessation program. Administer nicotine patch as prescribed. Manage tobacco withdrawal symptoms as they appear.Although the relationship between tobacco use and buerger’s disease is unknown, smoking cessation still proves to be the main intervention to manage the disease.  
Prepare the patient for the surgical procedure as indicated. Preparation involves educating the patient, gaining their consent, and accomplishing a pre-operative checklist.Regional sympathetic block or ganglionectomy can be done surgically to promote vasodilation and improve blood flow. In cases of gangrene and/or ulceration, conservative debridement of necrotic tissue is highly recommended.
Administer analgesics as prescribed.To provide pain relief especially in the affected area.
Ensure adequate hydration.Increased blood viscosity is a contributory factor to clotting. Adequate hydration helps reduce blood viscosity.

Nursing Care Plan 3

Nursing Diagnosis: Ineffective coping related to amputation of gangrenous digits/limbs as evidenced by verbalization of helplessness and/or hopelessness, ritualistic behavior, anxiety, inability to meet basic needs and role expectations

Desired Outcome: The patient will demonstrate effective coping skills during and after recovery phase.

InterventionRationale
Assess the anxiety level of the patient, anxiety triggers and symptoms by asking open-ended questions.To establish a baseline observation of the anxiety level of the patient. Open-ended questions can help explore the thoughts and feelings of the patient regarding the situational crisis.
Initially, support the patient by meeting dependency needs if deemed necessary.The patient can become more anxious if the avenues for dependency are suddenly and/or complete eliminated.
Encourage the patient to be independent and provide positive reinforcement for being able to do self-care and other independent behaviors.To enhance the patient’s self-esteem and encourage him/her to repeat desired behaviors.  
Discuss with the patient and significant other/s the available treatments for anxiety.Anxiety is treatable. Psychotherapy involves speaking with a licensed therapist and going through how to gradually cope with the symptoms. Medications such as anxiolytics and antidepressants can help the patient cope with anxiety.  
Support the patient’s efforts to verbalize and explore the meaning behind each ritualistic behavior or obsessive thought.The patient should first recognize and accept the presence of obsessive thoughts and ritualistic behavior before change can happen.
Provide a supportive approach when gradually limiting the time given for ritualistic behavior.To encourage the patient to replace his/her ritualistic behaviors with adaptive behaviors.
Teach the patient to perform relaxation techniques such as deep breathing exercises, guided imagery, meditation, and progressive muscle relaxation.To promote relaxation and reduce stress levels.

Other nursing diagnoses:

  • Activity Intolerance
  • Risk for Infection Post-Surgery
  • Powerlessness

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines and policies and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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