A nursing case study
Presented by: Group 26
Charlotte faith Valeroso
Barbie Joy Tumaliuan
Rohmar jones Tingonong
Caroline D. UY
Ms. Divina L. Malana, RN, MSN
Buerger’s disease is thrombotic and inflammatory occlusion of small arteries and veins among smokers. It is also known as ThromboangiitisObliterans. It involves inflammation and fibrosis of nerves. It results in thrombus formation and segmental occlusion of the vessels. It is differentiated from other vessel diseases by its microscopic appearance. In contrast to atherosclerosis, Buerger’sdisease is believed to be an autoimmune vasculitis that results in occlusion of distal vessels. Buerger’s disease occurs most often in men between 20 and 35 of age, and it has been reported in all races and in many areas of the world. There is considerable evidence that heavy smoking or chewing tobacco is a causative or an aggravating factor. The clinical manifestations are pain, foot cramps, especially of the arch (instep claudication), after exercise and cold sensitivity. Physical signs include intense rubor (reddish- blue discoloration) of the foot and absence of pedal pulse, but with normal femoral and popliteal pulses. If the upper extremities are involved, the radial and ulnar artery pulses are absent or diminished. As the disease progresses, definite redness or cyanosis of the part appears when the extremity is in a dependent position. Color changes may progress to ulceration, and ulceration with gangrene eventually occurs. Segmental limb blood pressures are taken to demonstrate the distal location of the lesions or occlusions. Duplex ultrasonography is to document patency of the proximal vessels and to visualize the extent of distal disease. Contrast angiography is used to identify the diseased portion of the anatomy. Treatment focuses on improving circulation to the extremities, prevent the progression of the disease, and to protect the extremities from trauma and infection. Treatment of ulceration and gangrene is directed toward minimizing infection and conservative debridement of necrotic tissue. If gangrene of a toe as a result of arterial occlusive disease in the leg, it is unlikely that toe amputation or even transmetatarsal amputation will be sufficient; often, a below- knee amputation or occasionally an above- knee amputation is necessary. The indications for amputation include gangrene, especially if the infected area is moist; severe rest pain; severe sepsis. The disease is found worldwide, but the highest incidence of thromboangiitisobliterans occurs in the Middle and Far East. Figure 1 shows the worldwide prevalence of this disease. SOURCE: emedicine.medscape.com
Figure 1 shows the prevalence of the disease ranges from values as low as 3.05% in Western Europe to values as high as 54% in India, 41% in Korea and Japan, and 80% among Jews of Ashkenazi ancestry living in Israel.
In the country, a growing number of young Filipinos are picking up smoking despite new restrictions on tobacco advertising, according to a nationwide study. Based on health report in 2005, there are 20 million of Filipinos who are smoking. Four million youth, aged between 11 and 19, are smokers, said the 2007 survey commissioned by the World Health Organization and the health department. The youth group made up 23 percent of all Filipino smokers, compared to about 18 percent in 2005. This 23 percent could further increase in a matter of three years. SOURCE: CVMC Medical records
Fig 2 shows the number of cases admitted with Buerger’s Disease for the 4 years in CVMC. There were a total of 5 patients. In 2008, there is 1 patient admitted (male). By the year 2009, there have been 2 patients (a male and a female). In the year 2011, there were 2 males admitted. This figure indicates that males are more at risk than females. This year, from January-November,...