Medication Treatment.
Vasodilators such as phenoxybenzamine. Vasodilators are given in Buerger’s disease to increase the lumen of the arteries and improve the flow of blood to the legs.
Nonsteroidal anti-inflammatory and opioids are given to the client to provide comfort form the pain in the affected part. These medications are particularly useful not only because they help decrease pain, but they also help control swelling and inflammation (www.orthopedics.about.com).
Anti-coagulants such as coumarin, dipyramidole and aspirin, 325 mg PO (by mouth), are used to prevent clot formation in the affected vessels. In addition to relieving pain and reducing inflammation (www.surgeryencyclopedia.com)
Calcium Channel blockers such as nifedipine. Calcium-channel blockers are used to
produce vasodilatation in the affected blood vessels. It also act by relaxation of the smooth muscle of the arterial wall (Katzong, 2007).
Statins lower cholesterol level in the blood resulting in an increased clearance in the bloodstream, which reduce the incidence of intermittent claudication and improve exercise duration until the onset of intermittent claudication in persons with Buerger’s disease (Stump, 2008).
Surgical Management
Surgical Bypass of the larger blood vessel in the affected limb may be carried out in the severe cases of the disease to improve circulation. Lumbar sympathectomy in which the sympathetic nerve supply to the blood vessels of the legs is cut, indicated for relief of intractable rest pain and healing of refractory ulcers, often in conjunction with digital amputation.
Local debridement may be used to remove local areas gangrene. Local care is the other main component. Amputation may be required if gangrene is persistent and for patients with severe rest pain
Nursing Management
Non-pharmacological measures in the treatment for Buerger’s disease are directed towards improving blood flow to the affected area and exacerbating factors (Lippincott Williams & Wilkins, 2006).
Positioning. Let the client lie on the bed and elevate the legs for 1-2 minutes or until they blanch. Then let the patient sit on the side of the bed and hold the feet down until become pink. Let the client do this 5 times each, 3 times a day.
Instruct the client no to sit for long periods of time without getting up and walking. Sleep on the firm mattress. Never cross the legs of the knee (Ferrell, 2004).
Clothing. Items of clothing that constrict the circulation must be avoided and the limbs should be kept warm while avoiding direct exposure to heat, as cold may
precipitate vasoconstriction.
Prevention. Peripheral vascular disease is related to the avoidance of the risk behavior, smoking cessation, elimination of chewing tobacco, and marihuana, and avoidance of nicotine replacement and exposure to second-hand smoking (Levy, et al, 2005).
Weight. Must be controlled. Body Mass Index (BMI) can be used to indicate if you are overweight, obese, underweight or normal. Because of these problems, this body mass index calculator shows extra statistics to help patient to be informed and judge the body compared to others of the same height and age. The patient should have an average range from 18.5 – 24.9 (www.halls.md; www.caloriecontrol.org)
Exercise. A special exercise program can be developed to improve the efficiency of the blood supply to the legs. Regular exercise, especially walking is a good preventive measure because exercise improves the circulation generally (Mogotlane, 2005).
Buerger-Allen exercises consist of elevating them at that angle for 2 to 3 minutes.
The legs are then lowered to a dependent position until they become red and supported at that level for 5 to 10 minutes. The legs then placed flat on the bed with the client in a supine position for 10 minutes. The exercises are repeated as tolerated by the client (White, 2000).
Diet. Must have a food preparation should provide complete nutrient as well as supplies carbohydrates, proteins, fats, vitamins, minerals and fiber in their normal proportions. It is the basis for all diet modifications (Varona, 2003).
B vitamins they help blood circulation and are needed for good metabolism. This family of vitamins aids the body with stress and its effects.
Essential fatty acids helpful in improving blood circulation, good for the heart and cardiovascular health. Fatty acids are found in omega fatty acids from fish oil, flax seed oil, and borage seed oil.
Coenzyme Q10 improves circulation, some supplements will include reishi mushroom which helps boost the immune system as well.
Multi-vitamin and Mineral supplement contains B vitamins, vitamin E , calcium, zinc, and magnesium, which all are helpful in both the treatment and prevention of Buerger's disease as well as promote good circulation health. Nutrients in a daily supplement are required for good general health and well being (www.go-symmetry.com).
Zinc, Calcium, Magnesium, Vitamin A, and Carotenoids helps circulation and to protect arteries from stress caused by sudden blood pressure changes, women often are low in calcium but need the other vitamins and minerals to properly absorb the calcium into their body (www.go-symmetry.com).
Local wound care. Limited debridement, appropriate dressings, and IV antibiotics for cellulites. Moisturation of non ulcerated skin to prevent from drying.
Foot and toe care. Taking care of the toe and foot is very important to the client with Buerger’s disease. It helps prevent wounds or foot ulcers from becoming infected and painful or resulting to gangrene. Foot ulcers require meticulous care. Such care is needed to treat infection, to protect the skin from further damage, and to enable the person to continue to walk (Beers, 2004).
Low blood flow to the extremities means the body cannot resist infection as easily. Small cuts and scraped can easily turn into serious infections. Clean any cuts with water and cover with a clean bandage. Keep an eye on any cuts or scrapes to make sure they are healing well. If it get worse or heal slowly contact the physician promptly (www.mayoclinic.com).
Inspect the feet daily for cracks, sores, corns, calluses, erythema, discoloration, or trauma, using mirrors as necessary for adequate visualization, wash feet daily with mild soap and warm water; check water temperature with water thermometer or elbow, dry the foot gently and thoroughly, use a lubricant, such as lanolin, for dry skin, or use moisturizer to soften it and avoid putting lotion between toes.
Use unmedicated power to keep the feet dry, prevent ingrown toenails. Cut toenails straight across and not too short. (A podiatrist may have to cut the nails; tell the podiatrist that peripheral arterial disease is present). Have a podiatrist treat corns or calluses.
Change socks and stockings daily and shoes often to prevent infection from moisture or dirt, wear loose wool socks to keep the feet warm, do not wear tight garters or stockings with tight elastic tops, wear shoes that fit well and have wide toe spaces and do not wear open shoes or walk barefoot.
Alternate between at least two pairs of properly fitted shoes to avoid potential for pressure points that can occur by wearing one pair only, ask the podiatrist about a prescription for special shoes if the feet are deformed, do not use hot water bottles for heating pads, attend to any foot injury immediately, and seek medical attention to avoid any potential complication and do not go barefoot indoors and outdoors (Swearingen, 2002; Beers 2004).
Emotional Support. Provide an emotional support. If necessary, refer the client for psychological counseling to help cope with restrictions imposed by this chronic disease. If the client undergone amputation, assess rehabilitative need, especially regarding changes in body image. Refer to the physical therapists, occupational therapist, and social service agencies, as needed (Lippincott Williams & Wilkins, 2009).
Spiritual. Care is important in dealing of clients with any kind of disease.
Promoting peace of mind and a sense of wholeness and well-being. Some client adhere to specific beliefs and ideals as a way of life, and these carry over into the most basic aspects of health and illness.(Mauk & Schmidt, 2004).
Encourage the client to allocate time for prayer and meditation each day and give Bile verse such as Jeremiah 33:3 (King James Version) “Call unto me, and I will answer thee, and show thee great and mighty things, which thou knowest not” and James 5:15 (King James Version) “And the prayer of faith shall save the sick, and the Lord shall raise him up; and if he have committed sins, they shall be forgiven him”.
Complication. Without smoking cessation, Buerger’s disease progresses inexorably through an obliterative vascular process, leading to coolness of the digits, hands, and feet; paresthesias; intermittent claudication symptoms; skin ulcerations over the fingers and toes; and gangrenous infarctions of the extremities. Once established, the disease may be maintained by even small exposures to tobacco (even smokeless tobacco or second-hand smoke). Failure to stop smoking is associated with a dramatic increase in the risk of limb loss by amputation. (Papadakis, 2006; Imboden, 2007).
Prognosis. If smoking cessation can be achieved, the outlook fro the disease may be better than in patients with premature peripheral vascular disease. If smoking cessation is not achieved then the prognosis is generally poor, with amputation of the affected part is the eventual outcome. (McPhee, 2008; www.ahealthyme.com). More than 90% of the patients who quit smoking avoid amputation (Papadakis, 2006).
Buerger's is not immediately fatal, but life-shortening. Death rate has not been consistently shown as higher in patients who do not cease smoking but for this and other health concerns quitting is highly recommended. Female patients tend to show much higher longevity rates than men (www.answers.com).
Prevention. Smoking is the only known causative agent for this disease and should be avoided and also nicotine products . Avoid cold temperature and other condition that reduce circulation to the hands and feet. (www.lifesteps.com; Papadakis, 2006).
Quit Smoking. Decide to quit smoking – the power of will is very important, the most hard days after smoking is the first three (3) days, think about some issues like: The future for itself and loved ones, Cost lots of money, shortens man’s life span, health problems (throat cancer, lung cancer, emphysema, hardening of the arteries, slowing of mental activity, cholesterol build up and blood pressure problems).
Learn to depend on prayers, carry some Bible promises like Philippians 4:13 – “I can do all things through Christ which strengtheneth me” and 1 Corinthians 15:57 – “But thanks be to God, which giveth us the victory through our Lord Jesus Christ”.
Believe that these promises were written just for you and your need, just now. Repeat them all.
Get rid of all tobacco products, including ash trays and all the rest, stay away from other smokers as much as possible for the next few weeks. Two or even three times a day, take a warm bath for 15 – 20 minutes at a time. Relax and enjoy it. This will help soak the poisons out quicker.
Do deep breathing exercise every time you crave to smoke. Slowly take in as much air then exhale slowly. Repeat saying “I choose not to smoke”. Go out in an open air and breathe deeply. There is energy in fresh air; and it is helping to clean out
Drink at least 6 – 8 glasses of water daily. Do this between meals. This helps flush out poisons, take no alcoholic beverages, none at all. They will cloud the mind, weaken the power of will, and could lead to smoking again. Eat lots of fresh fruits and vegetables. Especially oranges, the vitamin C in oranges help destroy the poisons in the body, lessening the craving.
Walk outdoors for 15-30 minutes after each meal, breathing deeply going out. Don’t sit after a meal; for this is the time a person wants to smoke. The craving for a smoke only last for 3-5 minutes; then it returns later for another 3-5 minutes. As the time passes, it gets easier to resist the urge. Open up the curtains, raise the windows, and let the purifying sunlight and air. There is tobacco odor all over the house. Get it out. It is very important.
Avoid mustard, spices, pepper, vinegar, ketchup, hot sauce, chili, and hoarseradish. These foods tend to arouse craving, skip all sweets, pastries, cake, ice cream, and chocolate during the first 10 days. Avoid rich, sugar-heavy desert. A lot of sugar in the diet makes a person more jumpy and irritable. This is because it steals B vitamins and minerals, especially calcium. Calcium helps strengthen and calm the nerves.
Heavy smokers often like spiced foods; they frequently eat a heavy meat diet, plus gravies, fried foods, and other rich foods. Avoid them, do not use fish, fowl, meat, tea, coffee, or cola beverages. The uric acid, ammonia, purines, and other wastes in meat is what gives it that special flavor. It stimulates the nerves increases the craving for nicotine and alcohol. The caffeine in tea, coffee, and cola drinks can so trigger the nerves that, in matter of minutes, a person will have an uncontrollable desire to light up.
Carrot sticks or raw celery at the close of a meal will lessen the craving to smoke. Chewing raisins help somewhat. Carry a small package of raisins in the pocket. Hot water with lemon juice is helpful. Go on a fast for a day or two a time, drinking only hot water and lemon juice. That will clean the poisons out the fastest. Remember the quicker they eliminated, the quicker the craving will go. Keep positive. Keep busy doing something. Keep praying. Keep thanking God. Keep thinking of the brighter future of you and your loved ones Ferrel, 2004.
Vasodilators such as phenoxybenzamine. Vasodilators are given in Buerger’s disease to increase the lumen of the arteries and improve the flow of blood to the legs.
Nonsteroidal anti-inflammatory and opioids are given to the client to provide comfort form the pain in the affected part. These medications are particularly useful not only because they help decrease pain, but they also help control swelling and inflammation (www.orthopedics.about.com).
Anti-coagulants such as coumarin, dipyramidole and aspirin, 325 mg PO (by mouth), are used to prevent clot formation in the affected vessels. In addition to relieving pain and reducing inflammation (www.surgeryencyclopedia.com)
Calcium Channel blockers such as nifedipine. Calcium-channel blockers are used to
produce vasodilatation in the affected blood vessels. It also act by relaxation of the smooth muscle of the arterial wall (Katzong, 2007).
Statins lower cholesterol level in the blood resulting in an increased clearance in the bloodstream, which reduce the incidence of intermittent claudication and improve exercise duration until the onset of intermittent claudication in persons with Buerger’s disease (Stump, 2008).
Surgical Management
Surgical Bypass of the larger blood vessel in the affected limb may be carried out in the severe cases of the disease to improve circulation. Lumbar sympathectomy in which the sympathetic nerve supply to the blood vessels of the legs is cut, indicated for relief of intractable rest pain and healing of refractory ulcers, often in conjunction with digital amputation.
Local debridement may be used to remove local areas gangrene. Local care is the other main component. Amputation may be required if gangrene is persistent and for patients with severe rest pain
Nursing Management
Non-pharmacological measures in the treatment for Buerger’s disease are directed towards improving blood flow to the affected area and exacerbating factors (Lippincott Williams & Wilkins, 2006).
Positioning. Let the client lie on the bed and elevate the legs for 1-2 minutes or until they blanch. Then let the patient sit on the side of the bed and hold the feet down until become pink. Let the client do this 5 times each, 3 times a day.
Instruct the client no to sit for long periods of time without getting up and walking. Sleep on the firm mattress. Never cross the legs of the knee (Ferrell, 2004).
Clothing. Items of clothing that constrict the circulation must be avoided and the limbs should be kept warm while avoiding direct exposure to heat, as cold may
precipitate vasoconstriction.
Prevention. Peripheral vascular disease is related to the avoidance of the risk behavior, smoking cessation, elimination of chewing tobacco, and marihuana, and avoidance of nicotine replacement and exposure to second-hand smoking (Levy, et al, 2005).
Weight. Must be controlled. Body Mass Index (BMI) can be used to indicate if you are overweight, obese, underweight or normal. Because of these problems, this body mass index calculator shows extra statistics to help patient to be informed and judge the body compared to others of the same height and age. The patient should have an average range from 18.5 – 24.9 (www.halls.md; www.caloriecontrol.org)
Exercise. A special exercise program can be developed to improve the efficiency of the blood supply to the legs. Regular exercise, especially walking is a good preventive measure because exercise improves the circulation generally (Mogotlane, 2005).
Buerger-Allen exercises consist of elevating them at that angle for 2 to 3 minutes.
The legs are then lowered to a dependent position until they become red and supported at that level for 5 to 10 minutes. The legs then placed flat on the bed with the client in a supine position for 10 minutes. The exercises are repeated as tolerated by the client (White, 2000).
Diet. Must have a food preparation should provide complete nutrient as well as supplies carbohydrates, proteins, fats, vitamins, minerals and fiber in their normal proportions. It is the basis for all diet modifications (Varona, 2003).
B vitamins they help blood circulation and are needed for good metabolism. This family of vitamins aids the body with stress and its effects.
Essential fatty acids helpful in improving blood circulation, good for the heart and cardiovascular health. Fatty acids are found in omega fatty acids from fish oil, flax seed oil, and borage seed oil.
Coenzyme Q10 improves circulation, some supplements will include reishi mushroom which helps boost the immune system as well.
Multi-vitamin and Mineral supplement contains B vitamins, vitamin E , calcium, zinc, and magnesium, which all are helpful in both the treatment and prevention of Buerger's disease as well as promote good circulation health. Nutrients in a daily supplement are required for good general health and well being (www.go-symmetry.com).
Zinc, Calcium, Magnesium, Vitamin A, and Carotenoids helps circulation and to protect arteries from stress caused by sudden blood pressure changes, women often are low in calcium but need the other vitamins and minerals to properly absorb the calcium into their body (www.go-symmetry.com).
Local wound care. Limited debridement, appropriate dressings, and IV antibiotics for cellulites. Moisturation of non ulcerated skin to prevent from drying.
Foot and toe care. Taking care of the toe and foot is very important to the client with Buerger’s disease. It helps prevent wounds or foot ulcers from becoming infected and painful or resulting to gangrene. Foot ulcers require meticulous care. Such care is needed to treat infection, to protect the skin from further damage, and to enable the person to continue to walk (Beers, 2004).
Low blood flow to the extremities means the body cannot resist infection as easily. Small cuts and scraped can easily turn into serious infections. Clean any cuts with water and cover with a clean bandage. Keep an eye on any cuts or scrapes to make sure they are healing well. If it get worse or heal slowly contact the physician promptly (www.mayoclinic.com).
Inspect the feet daily for cracks, sores, corns, calluses, erythema, discoloration, or trauma, using mirrors as necessary for adequate visualization, wash feet daily with mild soap and warm water; check water temperature with water thermometer or elbow, dry the foot gently and thoroughly, use a lubricant, such as lanolin, for dry skin, or use moisturizer to soften it and avoid putting lotion between toes.
Use unmedicated power to keep the feet dry, prevent ingrown toenails. Cut toenails straight across and not too short. (A podiatrist may have to cut the nails; tell the podiatrist that peripheral arterial disease is present). Have a podiatrist treat corns or calluses.
Change socks and stockings daily and shoes often to prevent infection from moisture or dirt, wear loose wool socks to keep the feet warm, do not wear tight garters or stockings with tight elastic tops, wear shoes that fit well and have wide toe spaces and do not wear open shoes or walk barefoot.
Alternate between at least two pairs of properly fitted shoes to avoid potential for pressure points that can occur by wearing one pair only, ask the podiatrist about a prescription for special shoes if the feet are deformed, do not use hot water bottles for heating pads, attend to any foot injury immediately, and seek medical attention to avoid any potential complication and do not go barefoot indoors and outdoors (Swearingen, 2002; Beers 2004).
Emotional Support. Provide an emotional support. If necessary, refer the client for psychological counseling to help cope with restrictions imposed by this chronic disease. If the client undergone amputation, assess rehabilitative need, especially regarding changes in body image. Refer to the physical therapists, occupational therapist, and social service agencies, as needed (Lippincott Williams & Wilkins, 2009).
Spiritual. Care is important in dealing of clients with any kind of disease.
Promoting peace of mind and a sense of wholeness and well-being. Some client adhere to specific beliefs and ideals as a way of life, and these carry over into the most basic aspects of health and illness.(Mauk & Schmidt, 2004).
Encourage the client to allocate time for prayer and meditation each day and give Bile verse such as Jeremiah 33:3 (King James Version) “Call unto me, and I will answer thee, and show thee great and mighty things, which thou knowest not” and James 5:15 (King James Version) “And the prayer of faith shall save the sick, and the Lord shall raise him up; and if he have committed sins, they shall be forgiven him”.
Complication. Without smoking cessation, Buerger’s disease progresses inexorably through an obliterative vascular process, leading to coolness of the digits, hands, and feet; paresthesias; intermittent claudication symptoms; skin ulcerations over the fingers and toes; and gangrenous infarctions of the extremities. Once established, the disease may be maintained by even small exposures to tobacco (even smokeless tobacco or second-hand smoke). Failure to stop smoking is associated with a dramatic increase in the risk of limb loss by amputation. (Papadakis, 2006; Imboden, 2007).
Prognosis. If smoking cessation can be achieved, the outlook fro the disease may be better than in patients with premature peripheral vascular disease. If smoking cessation is not achieved then the prognosis is generally poor, with amputation of the affected part is the eventual outcome. (McPhee, 2008; www.ahealthyme.com). More than 90% of the patients who quit smoking avoid amputation (Papadakis, 2006).
Buerger's is not immediately fatal, but life-shortening. Death rate has not been consistently shown as higher in patients who do not cease smoking but for this and other health concerns quitting is highly recommended. Female patients tend to show much higher longevity rates than men (www.answers.com).
Prevention. Smoking is the only known causative agent for this disease and should be avoided and also nicotine products . Avoid cold temperature and other condition that reduce circulation to the hands and feet. (www.lifesteps.com; Papadakis, 2006).
Quit Smoking. Decide to quit smoking – the power of will is very important, the most hard days after smoking is the first three (3) days, think about some issues like: The future for itself and loved ones, Cost lots of money, shortens man’s life span, health problems (throat cancer, lung cancer, emphysema, hardening of the arteries, slowing of mental activity, cholesterol build up and blood pressure problems).
Learn to depend on prayers, carry some Bible promises like Philippians 4:13 – “I can do all things through Christ which strengtheneth me” and 1 Corinthians 15:57 – “But thanks be to God, which giveth us the victory through our Lord Jesus Christ”.
Believe that these promises were written just for you and your need, just now. Repeat them all.
Get rid of all tobacco products, including ash trays and all the rest, stay away from other smokers as much as possible for the next few weeks. Two or even three times a day, take a warm bath for 15 – 20 minutes at a time. Relax and enjoy it. This will help soak the poisons out quicker.
Do deep breathing exercise every time you crave to smoke. Slowly take in as much air then exhale slowly. Repeat saying “I choose not to smoke”. Go out in an open air and breathe deeply. There is energy in fresh air; and it is helping to clean out
Drink at least 6 – 8 glasses of water daily. Do this between meals. This helps flush out poisons, take no alcoholic beverages, none at all. They will cloud the mind, weaken the power of will, and could lead to smoking again. Eat lots of fresh fruits and vegetables. Especially oranges, the vitamin C in oranges help destroy the poisons in the body, lessening the craving.
Walk outdoors for 15-30 minutes after each meal, breathing deeply going out. Don’t sit after a meal; for this is the time a person wants to smoke. The craving for a smoke only last for 3-5 minutes; then it returns later for another 3-5 minutes. As the time passes, it gets easier to resist the urge. Open up the curtains, raise the windows, and let the purifying sunlight and air. There is tobacco odor all over the house. Get it out. It is very important.
Avoid mustard, spices, pepper, vinegar, ketchup, hot sauce, chili, and hoarseradish. These foods tend to arouse craving, skip all sweets, pastries, cake, ice cream, and chocolate during the first 10 days. Avoid rich, sugar-heavy desert. A lot of sugar in the diet makes a person more jumpy and irritable. This is because it steals B vitamins and minerals, especially calcium. Calcium helps strengthen and calm the nerves.
Heavy smokers often like spiced foods; they frequently eat a heavy meat diet, plus gravies, fried foods, and other rich foods. Avoid them, do not use fish, fowl, meat, tea, coffee, or cola beverages. The uric acid, ammonia, purines, and other wastes in meat is what gives it that special flavor. It stimulates the nerves increases the craving for nicotine and alcohol. The caffeine in tea, coffee, and cola drinks can so trigger the nerves that, in matter of minutes, a person will have an uncontrollable desire to light up.
Carrot sticks or raw celery at the close of a meal will lessen the craving to smoke. Chewing raisins help somewhat. Carry a small package of raisins in the pocket. Hot water with lemon juice is helpful. Go on a fast for a day or two a time, drinking only hot water and lemon juice. That will clean the poisons out the fastest. Remember the quicker they eliminated, the quicker the craving will go. Keep positive. Keep busy doing something. Keep praying. Keep thanking God. Keep thinking of the brighter future of you and your loved ones Ferrel, 2004.
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