Nurse Lilly has been assigned to a client with Raynaud’s disease. Nurse Lilly realizes that the etiology of the disease is unknown but it is characterized by:
A. Episodic vasospastic disorder of capillaries
B. Episodic vasospastic disorder of small veins
C. Episodic vasospastic disorder of the aorta
D. Episodic vasospastic disorder of the small arteries
Correct Answer: D. Episodic vasospastic disorder of the small arteries
Raynaud’s disease is characterized by vasospasms of the small cutaneous arteries that involve fingers and toes. In Raynaud phenomenon, blood-flow restriction occurs during cold temperatures and emotional stress. Specifically, in Raynaud phenomenon, there is vasoconstriction of the digital arteries and cutaneous arterioles.
Option A: Only the arteries are affected in Raynaud’s disease. With cold temperatures, the sympathetic nervous system causes the release of vasoconstricting neuropeptides and norepinephrine leading to vasoconstriction of arteriole smooth muscle and decreased blood flood to the skin. Of note, in secondary Raynaud phenomenon, endothelin-1 is released by endothelial cells which causes vasoconstriction.
Option B: The veins are unaffected by the vasospasm occurring with Raynaud’s disease. In the primary Raynaud phenomenon, an increase in alpha-2 adrenergic sensitivity in the digital and cutaneous vessels results in the vasoconstrictive response to cold temperatures and emotional stress. Alpha-2 adrenergic receptors are present on the distal arterial smooth muscles of the digits and affected by the sympathetic nervous system.
Option C: The aorta is a major blood vessel unaffected by Raynaud’s disease. In the secondary Raynaud phenomenon, the underlying disease is the factor that disrupts normal vessel reactivity to cold temperatures. Usually, the endothelial function of the digital and cutaneous vessels is compromised leading to eventual vasoconstriction with resulting tissue ischemia.