Blackened, gangrenous, or non-healing digit ulcers indicate advancing ischemia — report immediately.
Before you read
Test yourself first: 3 questions
Question 1 of 3
The nurse is assessing a newborn for Hirschsprung disease. Which finding in the first 48 hours of life is most suggestive of this disorder?
Answer: A. Failure to pass meconium within 24 to 48 hours of birth is a hallmark of Hirschsprung disease, caused by absence of ganglion cells in a segment of the distal colon. Frequent loose stools, projectile vomiting, and excessive meconium passage are not characteristic.
Question 2 of 3
A child is diagnosed with hand-foot-and-mouth disease. The nurse expects to find which characteristic lesions?
Answer: A. Hand-foot-and-mouth disease, caused by coxsackievirus, produces painful vesicular lesions in the mouth and on the palms and soles. It is usually self-limiting, and care focuses on hydration and comfort.
Question 3 of 3
A nurse is assessing a 78-year-old client. Which finding is a normal age-related change rather than a sign of disease?
Answer: A. Decreased skin elasticity and turgor is an expected aging change due to loss of subcutaneous tissue and collagen. Resting tachycardia, productive cough, and a new confusion onset are not normal aging and warrant evaluation.
Keep the streak going with more questions like these, each with a full rationale.
What is thromboangiitis obliterans (buerger disease)?
It causes pain, ischemia, and eventually ulceration or gangrene of the digits. It typically affects young male smokers and is almost always tied directly to tobacco exposure.
Key points to remember
- Almost exclusively occurs in tobacco users, especially young men who smoke.
- Affects small and medium arteries AND veins of the distal extremities (hands and feet).
- Causes intermittent claudication, cold sensitivity, digit pain at rest, and diminished pulses.
- Complete tobacco cessation is the ONLY treatment proven to halt disease progression.
- Untreated disease progresses to ulceration, gangrene, and possible amputation of digits.
- Often accompanied by superficial thrombophlebitis and color changes in the digits.
Common causes
- Strongly linked to smoking
- Inflamm + clots, small vessels
- Young male smokers
Signs & symptoms
- Intermittent claudication
- Cold, cyanotic digits
- Ulcers, gangrene → amputation
Nursing priorities
- Emphasize and support complete, permanent tobacco and nicotine cessation — the cornerstone of care.
- Assess distal pulses, skin color, temperature, and integrity of fingers and toes.
- Teach extremity protection: avoid cold, trauma, and tight footwear.
- Promote warmth and gentle exercise to enhance collateral circulation.
- Manage pain and monitor wounds for infection or progression to gangrene.
Patient teaching
- Stopping ALL tobacco and nicotine products is essential and is the only way to stop progression.
- Avoid cold exposure, injury, and constrictive clothing on extremities.
- Inspect hands and feet daily and report any sores, color changes, or pain.
- Avoid vasoconstrictors such as caffeine and decongestants.
Red flags: report now
- Blackened, gangrenous, or non-healing digit ulcers indicate advancing ischemia — report immediately.
- Rest pain and a cold, pulseless extremity signal critical limb ischemia.
- Any continued tobacco use will progress the disease and risk limb loss.
References
Clinical references for this topic
