Discussion of Concepts both Primary and Interrelated Concepts

Many premises have been suggested to explain and dissect the fundamental mechanisms involved in Raynaud’s Disease pathogenesis. Contemporary research data strongly back the mosaic theory of the disease. The mosaic theory of Raynaud’s disease combines the multi-etiology of the condition, encompassing neuronal, hormonal, and local mediators (Fardoun et al., 2016). The compromised function of any three mediators has been shown to lead to an embellish constriction or narrowing of the cutaneous arteries to respond to noradrenaline.

The noradrenaline (NE) is an organic chemical belonging to the catecholamine family, functioning in the body and brain, both neurotransmitter and hormone. The NE stimulates its impacts by binding to adrenergic receptors on vascular smooth muscle cells (VSMCs). The VSMCs have both α1, α2, and β2 adrenergic receptors (ARs). The β2 adrenoceptors have been shown to enhance vasodilation. However, α1 and α2 adrenoceptors promote vasoconstriction, causing Raynaud’s disease (Fardoun et al., 2016). Understanding such pathogenesis of RP promotes nursing care, helping nurses build a strong sense of their tasks such as ordering diagnostic tests, managing medications, and treating chronic illness.


Sickle Cell Disease

            Similarly, like in the RP condition, researchers have also proposed several hypotheses to understand the pathogenesis of SCD. SCD is a disorder mostly linked to recessive Mendelian genetic inheritance. In this case, both parents donate a single mutant allele to the affected offspring. However, scholars have discovered an exception to the rule. Research has shown that the late-onset SCD exhibits mosaicism characterized by segmental uniparental isodisomy of genetic material (chromosome 11p15), resulting in mosaicism for SS and AS erythrocytes (Vichinsky & Mahoney 2019). An in-depth analysis of DNA in some studies has revealed an occurrence of post-zygotic mitotic recombination, causing mosaic segmental isodisomy. In both cases, the persons exhibited twofold HbAS and HbSS erythroid antecedents and peripheral RBCs, with HbSS erythrocytes contributing to an acute hemolytic phenotype of sickle cell condition (Traeger-Synodinos et al. 2019).

Nursing Care Of the Client Using Conceptual Evidence

Raynaud’s Disease

To offer apposite patient education, the nurses must familiarize themselves with precipitating factors, evaluation approaches, signs and symptoms, and treatment and medication for Raynaud’s disease. Raynaud’s disease’s patients’ main complaint of the numbness and pain in their fingers. In this case, the primary role of a nurse is to educate the patient on the onset of symptoms linked to RP so that they can be minimized on time. Advanced practice nurse (APN) must conduct extensive history and physical examination to diagnose Raynaud’s disease and differentiate between primary and secondary Raynaud’s disease. The patient’s history should capture the age of the onset, impacted area, severity, and frequency of attacks.

The APN should ask the following three questions: a) Are your fingers and toes sensitive to cold? b) Do you experience a change in fingers’ color when exposed to extremely cold temperatures? c) Do you often experience a change in your fingers’ colors to white or blue or both? (Pereira & Thable, 2021). The APN should make a diagnosis for RP if the answer is yes for both questions. Once the diagnosis is made and the APN has established the severity of the disease, the nurse directs care to prevent complications and improve quality of life. APN helps the patient develop self-care management and encourages the patient to observe the following: avoid exposure to cold, avoid cigarettes, manage stress, exercise, and learn strategies to prevent attacks (Pereira & Thable, 2021).

Sickle Cell Disease

Nursing care for SCD patients primarily emphasizes assessing and establishing complications, encouraging nonpharmacologic and pharmacologic treatment methods, and personalizing care to meet the patient’s needs. Besides, nurses are also key to family and patient education, including SCD management, signs and symptoms recognition, and when to see the doctor (DeBaun et al. 2020). Nurses understand that SCD patients are more likely to present pain, and failure to recognize pain leads to more patient suffering. They monitor for severe and deadly problems, including stroke and acute chest syndromes, and educate the patient and family on practicing self-management (Brandow et al., 2020). By promoting self-management, the nurse can influence positive health care outcomes for chronic conditions and impact positive patient and clinician satisfaction.


This study examined Raynaud’s Disease and Sickle Cell Disease, focusing on the pathophysiology of the diseases, signs and symptoms, diagnostic tests and treatment modalities, key theories or concepts concerning the conditions, and nursing care implications in both care. Both RP and SCD are diseases the impact the blood supply in target parts of the body. In RP, the digital arteries that supply blood to the skin become narrow, restricting blood flow to fingers and toes. In SCD, RBC deformability is decreased with the deoxygenation of polymerized sickle hemoglobin, reducing the supply of red blood cells to some parts of the body. Nursing care has a significant implication in both conditions in prescribing medication and educating on self-management strategies.


Putting the concepts together for this task was not a walk in the pack as it required extensive literature review concerning the two diseases and grappling with terminologies, which involves much understanding of medical and pathophysiological terms. Putting together the concepts in the pathophysiology of Raynaud’s Disease and Sickle Cell disease process presented the toughest challenges but relying on literature search helped me understand the different concepts.


Brandow, A. M., Carroll, C. P., Creary, S., Edwards-Elliott, R., Glassberg, J., Hurley, R. W., … & Lang, E. (2020). American Society of Hematology 2020 guidelines for sickle cell disease: management of acute and chronic pain. Blood advances4(12), 2656-2701.

Connes, P., Alexy, T., Detterich, J., Romana, M., Hardy-Dessources, M. D., & Ballas, S. K. (2016). The role of blood rheology in sickle cell disease. Blood reviews30(2), 111-118.

DeBaun, M. R., Jordan, L. C., King, A. A., Schatz, J., Vichinsky, E., Fox, C. K., … & Murad, M. H. (2020). American Society of Hematology 2020 guidelines for sickle cell disease: prevention, diagnosis, and treatment of cerebrovascular disease in children and adults. Blood advances4(8), 1554-1588.

Fardoun, M. M., Nassif, J., Issa, K., Baydoun, E., & Eid, A. H. (2016). Raynaud’s phenomenon: a brief review of the underlying mechanisms. Frontiers in pharmacology7, 438.

Fernández‐Codina, A., Walker, K. M., Pope, J. E., & Scleroderma Algorithm Group. (2018). Treatment algorithms for systemic sclerosis according to experts. Arthritis & Rheumatology70(11), 1820-1828.

Górska, K., Szczerkowska-Dobosz, A., Purzycka-Bohdan, D., Stawczyk-Macieja, M., Wierzba, K., & Nowicki, R. J. (2017). Raynaud’s phenomenon as an interdisciplinary problem. Przeglad Dermatologiczny104(5), 499.

Llamas-Velasco, M., Alegría, V., Santos-Briz, Á., Cerroni, L., Kutzner, H., & Requena, L. (2017). Occlusive nonvasculitic vasculopathy. The American Journal of Dermatopathology39(9), 637-662. Mavrogeni, S., Bratis, K., Koutsogeorgopoulou, L., Karabela, G., Savropoulos, E., Katsifis, G., & Kolovou, G. (2017). Myocardial perfusion in peripheral Raynaud’s phenomenon.