In preparation for the discharge of a client with arterial insufficiency and Raynaud’s disease, client teaching instructions should include:
A. Walking several times each day as an exercise program.
B. Keeping the heat up so that the environment is warm.
C. Wearing a TED hose during the day.
D. Using hydrotherapy for increasing oxygenation.
Correct Answer: B. Keeping the heat up so that the environment is warm.
The client’s instructions should include keeping the environment warm to prevent vasoconstriction. In response to cold temperatures, the body adapts by restricting blood flow to the skin. This is done as a thermoregulatory mechanism to prevent further loss of body heat and to sustain the core body temperature. In Raynaud’s phenomenon, blood-flow restriction occurs during cold temperatures and emotional stress.
Option A: Walking would most likely increase pain. Conservative medical management to prevent Raynaud phenomenon attacks is a lifestyle change. This includes avoiding exposure to cold, staying warm, avoiding stimulants, avoiding anxiety or emotional stress, and smoking cessation.
Option C: Wearing gloves, warm clothes, and socks will also be useful when preventing vasoconstriction, but TED hose would not be therapeutic. Severe Raynaud phenomenon may result in tissue ischemia, leading to necrosis followed by amputation of the affected area.
Option D: With the primary Raynaud phenomenon, spontaneous remission, whereby the patient has been free of Raynaud phenomenon attacks, may occur. Spontaneous remission is not seen with secondary Raynaud phenomenon. Pregnancy has been shown to improve Raynaud’s phenomenon since there is an improvement in peripheral blood flow and oxygenation due to an increase in red blood cell mass and plasma volume.
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