Complaints of Cold Fingers with Associated Discoloration - Essay Example

A 22-year-old patient presents with complaints of cold fingers with associated discoloration. Give an overview of your evaluation of this patient including a problem-specific history and physical (brief H&P) as well as diagnosis (Raynaud's Syndrome) and initial plan of care.

The complaint of cold fingers along with discoloration may be associated with an underlying vascular disorder of the digital blood vessels. History should take into account the disorders that can potentially cause vasoocclusion and therefore result in cold fingers and discoloration. Queries should be directed at revealing the presence of atherosclerotic disease, neurovascular compression syndromes, and vibration injury resulting from occupational exposure to vibratory devices.  Any history of reactive erythema secondary to emotional stress or cold exposure should be given due consideration. The possibility of hyperviscosity states resulting secondary to hematologic conditions like multiple myeloma should be ruled out since any delay in the detection of such conditions can prove fatal. History of other associated features like weakness, headache, hematuria, and confusion should also be taken. The presence of cryoglobulinemia should be considered in patients with a history of hepatitis C infection (Wigley et al, 2014).  Physical Examination will be aimed at observing the blanching of the affected digits bilaterally. The level of discomfort and the change in color of the skin which may range from bluish to purplish should be noted. These changes are mostly symmetric and present bilaterally. The patient may be allowed a chance to dip his hands in ice water for confirmation of diagnosis. To differentiate between the primary and secondary forms, attention should be paid to gender, age at onset of the condition, presence of signs and symptoms of connective tissue disorders, frequency of attacks, and presence of vasomotor conditions like livedo reticularis or migraine. Disease onset during teenage, frequent mild attacks on a daily basis, female sex, attack precipitation by stress, symmetric involvement, history of migraines, and the presence of livedo reticularis are all associated with the primary form of the disease. Findings that are inconsistent with these are suggestive of secondary Raynaud’s (Goroll & Mulley, 2009).

Physical examination should also include a search for signs like acrocyanosis of ears, fingertips, and nose tips following exposure to cold; cold agglutinin syndrome.

Based on the clinical presentation, a diagnosis of Raynaud’s Syndrome can be made. However, due to limited information, the differentiation between primary or secondary forms of disease is not a possibility.

There is a need to differentiate between primary and secondary forms of Raynaud’s phenomenon. In cases of primary Raynaud’s, the treatment plan should be aimed at conservative management. The patient should be informed about the nature of the problem and advised to keep their bodies and extremities warm during colder periods of the year. Other associated factors that can precipitate an attack should be avoided. These include smoking, static lifestyle, and medication that causes vasoconstriction, etc. In cases where these measures fail to deliver optimum results, pharmacological intervention may be sought. Vasodilators such as nifedipine or prazosin can be utilized; however, their results may vary from one patient to another. In cases of secondary Raynaud’s, the plan should take into consideration the underlying disorder that is contributes to signs and symptoms of Raynaud’s. Cases that fail to respond to pharmacological intervention are candidates for interventional management which may include procedures like sympathectomy or injections of Botulinum toxin etc. (Zundert, 2011).