THROMBOANGIiTIS OBLITERANS (BUERGERS DISEASE)

Presented by: Vencer, Diane May P. Sinoy, Gem Alexis B. Esguerra, Janine Elizabeth L. Presented to: Joel Penaflorida, RN, MAN

INTRODUCTION

GOALS AND OBJECTIVES

General Objectives:
The ultimate goal of this study is to increase the students awareness and have a thorough understanding about the disease; its nature, causes, clinical

manifestations, management, and prognosis in order to increase competency in promoting health, preventing disease and rehabilitating patients through a case presentation. With this, we hope this will lead to insights on

appropriate nursing care and management that a patient

with the same ailment will have in the future.

Specific Objectives:
Within 2 hours of case presentation, the student nurses will be able to: Present the introduction of the studied disease; State the general and specific objectives of the study;

Enumerate the obtained initial database written in the

patients chart; Present the nursing history including the past and present illness of the patient; Relate the activities of daily living of the patient; Present the patients cephalocaudal assessment;

Identify the anatomy and physiology of the system involved system;the circulatory and integumentary systems. Trace the Pathophysiology of the disease process through schematic diagrams; Compare the clinical manifestations of the disease based on the theories and actual observations; Explain the assessment and diagnostic findings; Interpret the laboratory results and the nurses responsibilities; Discuss the medical and nursing management for the

said condition.

State the discharge planning of the patient; List the health teachings given to the patient; State the prognosis of the disease; Enumerate the problem list;

Present the Gordons Functional Health Pattern of the patient; and

Present the Nursing Care Plan made for the patient. Outline the drug study from the patients medication; State the discharge planning of the patient;

Initial Data Base

This chapter presents the general information of the patient having thromboangiitis obliterans or buergers disease.

Biographical Information: Patients name: Mr. I

Age: 43 years old

Gender: Male Civil Status: Separated Nationality: Filipino Permanent Address: Yusabel, Sinawal General Santos City Birthday: January 20, 1968

Birthplace: Cebu city

Religion: Roman Catholic Language: Cebuano Occupation: Housekeeper Place of Confinement: General Santos City Hospital Room #: Surgical ward: Hallway - Up Date of Admission: December 17, 2011 Time: 13:20 pm

Attending Physician: Dr. Solamo

Chief complaint: Infected wound Admitting Diagnosis: Infected wound Right foot T/C Diabetic Necrosis Final Diagnosis: Buergers Disease

Nursing History
In this chapter we are presenting the past and current condition of our patient. This includes the patients lifestyles, beliefs and practices, behavior regarding health that may aggravate the condition of

the patient. This will help us formulate diagnosis for the patients care
plan and implement nursing interventions that will promote the health status of our patient.

A. Brief History
Mr. I has no family history of neither Diabetes Mellitus nor Buergers Disease. He started smoking cigarettes during his Grade 6 with 1-3 sticks per day until it progresses to 2 packs a day. He was a

former fisherman that works in a local fishing company stationed at the

General Santos City. Smoking was his way of enduring the coldness of the sea, verbalized by the patient.

B. Reasons for Seeking Health Care

Mr. I went to the hospital last December 17, 2011 because he

wants the doctor to check his wound on his right foot. He said, at first the wound was still small, he is cleaning the wound and changing the dressing at first but he stopped because sometimes he forget to do so and there were times that he has no betadine to put onto his wound. Until one day he just noticed that the wound has gone bigger and with more drainage this time.

C. History of Present Illness

Mr. I has no family history of neither Diabetes Mellitus nor Buergers Disease; he was not hospitalized before. Eight months prior to admission, he has accidentally stepped on a nail causing a puncture in his right sole. From a punctured wound on his sole, lesions started to appear to the ankle and pedal area of his right foot.

D. Past Health History

According to the patient, he did not experienced being hospitalized during his childhood. He also added that he was not diagnosed with any diseases. When he is experiencing fever, cough and or colds before, he would take paracetamol, bioflu, and neozep as for the treatment of these illnesses respectively. He relieves felt pain by self medication of mefenamic acid. He doesnt have any allergies in foods, medicine and animal meats.

PHYSICAL ASSESSMENT

IDEAL PATHOPHYSIOLOGY

IDEAL SCHEMATIC DIAGRAM OF THROMBOANGIITIS OBLITERANS

PREDISPOSING FACTOR Age 20 to 40 years old Gender Men Diabetes Mellitus Hypertension Family history of Buergers disease Autoimmune vasculitis Genetics PRECIPITATING FACTOR History of tobacco exposure of any kind, including smoking, chewing, or snuff. Sedentary lifestyle High cholesterol level High glucose level

Infiltration of Polymorphonuclear Leukocytes (Granulocytes or PMN/ PML) in the small and medium-sized arteries and veins

Accumulation of THROMBUS in the vascular lumen

Occluding and obliterating some portions of the blood vessels

Decreased blood flow to the feet and legs

Ulceration and gangrene

PATHOPHYSIOLOGICAL CHANGES Intermittent claudications of the instep Impaired peripheral pulses Initially: coldness, cyanosis and numbness Later: redness, heat and tingling sensation.

COMPLICATIONS Diminished pulses in distal extremities Sensitivity to cold in the extremities Possible muscle atrophy Pain in the digits Ulceration and gangrene ( fingertip ulceration if the hands are affected)