Buerger’s Disease Nursing Care Plan Notes


  • Buerger’s diseae or thromboangiitis obliterans is an occlusive disease mostly located in small to medium-sized arteries and less frequently in veins. Commonly found in the upper and lower distal extremities. In prolonged cases, large extremities vessels may be affected. Buerger’s disease is generally bilateral and symmetric with focal lesions.Buerger's Disease
  • It results in thrombus formation and segmental occlusion of the vessels and is differentiated from other vessel diseases by its microscopic appearance.
  • Buerger’s disease occurs most often in men between 20 and 35 years of age, and it has been reported in all races and in many areas of the world. There is considerable evidence that heavy smoking or chewing of tobacco is a causative or an aggravating factor.
  • Inflammation occurs, and the vessels are prone to spasms and constriction. Inflammatory lesions appear in healthy isolated segments of normal vessels walls, which often occlude blood flow. Scarring, fibrosis, and thrombophlebitis occur, which develops into adhering of the vessels and nerves. Soft tissue and skin cells experience hypoxia, which leads to anoxia and tissue necrosis. Nail beds thicken, and peripheral pulses become weak and thread. As Buerger’s disease progresses, pain occurs due to tissue death. Skin sloughs, ulcers form, and the extremity is at risk for gangrene.

patho of Buerger’s Disease

Clinical Manifestations/Signs and Symptoms
  • Extreme sensitivity to heat and cold
  • Pain in the digits due to ischemia
  • Cyanotic and ruddy
  • Nails beds thicken
  • Peripheral pulses become weaken and thread
  • Skin may have blackish ulcerations
  • Intermittent claudication is a hallmark symptom, identified by cramps in the legs after exercise.
Laboratory and diagnostic study findings
  • Doppler ultrasonography findings are diminished or absent compared with those for opposite leg
  • Phlebography (venography) shows an unfilled segment of the vein in an otherwise completely filled vein with its connecting collaterals, this test is generally most indicative in diagnosing venous thrombosis.
Nursing Diagnosis
  • Ineffective peripheral tissue perfusion related to impaired circulation.
  • Pain related to diminished oxygen flow to the affected extremity.
  • Fear and anxiety related to actual or potential serious complications.
Medical Management

Main objectives are to improve circulation to the extremities, prevent the progression of the disease, and protect the extremities from trauma and infection.

Treatment measures include the following:
  • Completely stopping use of tobacco.
  • Regional sympathetic block or ganglionectomy produces vasodilation and increases blood flow.
  • Conservative debridement of necrotic tissue is used in treatment of ulceration and gangrene.
  • If gangrene of a toe develops, usually a below-knee amputation, or occasionally an above-knee amputation, is necessary. Indications for amputation are worsening gangrene (especially if moist), severe rest pain, or severe sepsis.
  • Vasodilators are rarely prescribed (cause dilation of healthy vessels only).
Nursing Management
  • Patient teaching, instruct the patient to do the following several times a day:
    • Lie flat on a bed with both legs elevated above the level of the heart for two to three minutes.
    • Next sit on the edge of the bed with the legs dependent for three minutes
    • Then exercise the feet and toes by moving them up, down, inward, then outward.
    • Lastly, return to the first position and hold for five minutes.
  • Provide for ulcer debridement and healing
    • Remove dead or damaged material from the wound, using wet-to-dry dressing with saline solution and coarse-mesh gauze filled with cotton.
    • Use whirlpool therapy to debride the ulcer bed.
    • Consider using an enzymatic debrider to aid removal of debris.
  • Provide additional intervention to promote venous return and healing, maximize comfort and provide client education for measures to prevent venous stasis ulcer.
  • Administer medications which may include antibiotics.
  • The patient is encouraged to make the lifestyle changes necessitated by the onset of a chronic disease, including pain management and modifications in diet, activity, and hygiene (skin care).
  • The nurse assists the patient in developing and implementing a plan to stop using tobacco.