Fingertip ulceration, blackened tissue, or non-resolving cyanosis signals critical ischemia — report promptly.
Before you read
Test yourself first: 3 questions
Question 1 of 3
A client with diabetes reports waking with high morning glucose values. The nurse explains the dawn phenomenon. Which statement best describes it?
Answer: A. The dawn phenomenon is an early-morning rise in blood glucose caused by the normal overnight release of counterregulatory hormones such as growth hormone and cortisol, which increase hepatic glucose output. It is not caused by rebound from nocturnal hypoglycemia, which describes the Somogyi effect.
Question 2 of 3
A client with a below-the-knee amputation reports feeling pain in the foot that has been removed. Which response by the nurse is BEST?
Answer: B. Phantom limb pain is a real neurologic phenomenon in which the client perceives sensation or pain in the missing limb. The nurse should acknowledge that the pain is real, provide prescribed analgesia, and use adjunct measures. Dismissing the pain as imaginary is non-therapeutic.
Question 3 of 3
A client recovering from a myocardial infarction frequently develops premature ventricular contractions. Which finding associated with the PVCs would most concern the nurse and require prompt provider notification?
Answer: B. Isolated occasional PVCs are common, but PVCs become dangerous when they are frequent (more than 6 per minute), occur in runs or pairs, are multifocal, or fall on the T wave (R-on-T phenomenon), because these patterns can deteriorate into ventricular tachycardia or fibrillation. A single PVC once an hour, a normal potassium, and relief of chest pain are reassuring rather than concerning.
Keep the streak going with more questions like these, each with a full rationale.
What is raynaud phenomenon?
It is more common in young women and may be primary or secondary to autoimmune disease such as scleroderma or lupus. Classic triphasic color change is white (pallor), then blue (cyanosis), then red (rubor) on rewarming.
Key points to remember
- Triggered by cold exposure and emotional stress, causing vasospasm of digits.
- Classic color sequence: pallor (white) to cyanosis (blue) to rubor (red) with numbness and pain.
- Primary Raynaud is benign; secondary Raynaud is linked to connective tissue diseases like scleroderma and SLE.
- Calcium channel blockers (e.g., nifedipine) are the first-line drug therapy to relax vessels.
- Smoking and caffeine worsen vasospasm and should be avoided.
- Severe, prolonged attacks can lead to skin ulceration or tissue necrosis of the fingertips.
Signs & symptoms
- Cold → digit vasospasm
- Pallor → cyanosis → rubor
- Numbness, tingling, pain
Nursing priorities
- Teach the patient to keep hands and body warm and to avoid sudden cold exposure.
- Administer calcium channel blockers as prescribed and monitor for hypotension.
- Assess digits for ulceration, skin breakdown, or signs of ischemia.
- Encourage stress-reduction techniques and smoking cessation.
- Teach immediate rewarming of affected digits during an attack.
Patient teaching
- Wear gloves and warm layers; avoid cold environments and rapid temperature changes.
- Stop smoking and avoid caffeine and vasoconstricting drugs.
- Run warm (not hot) water over hands to abort an attack and reduce stress triggers.
- Inspect fingers and toes daily for sores or skin breakdown.
Red flags: report now
- Fingertip ulceration, blackened tissue, or non-resolving cyanosis signals critical ischemia — report promptly.
- New systemic symptoms (joint pain, skin tightening, rash) may indicate underlying autoimmune disease and need evaluation.
References
Clinical references for this topic
