Respiratory Failure

Respiratory Failure

                                          Respiratory failure occurs when the respiratory system fails in either one or both of its gas exchange functions: oxygenation and the elimination of carbon dioxide. A reduction in the oxygen carried in the bloodstream is referred to as hypoxaemia, and a rise in the carbon dioxide levels within the bloodstream is referred to as hypercapnia.

Respiratory failure is classified into two groups

•  Type I respiratory failure
•  Type II respiratory failure

 Type I respiratory failure

                                                              Type I respiratory failure occurs when there is a problem with oxygenation resulting in hypoxaemia. This is most commonly caused by ventilation/perfusion mismatch resulting in reduced diffusion of oxygen from the alveoli into the pulmonary circulation. Type I respiratory failure is characterized by

      

      

Type II respiratory failure 

                                                              Type II respiratory failure occurs when there occurs when there is inadequate alveolar ventilation resulting in hypoxaemia and hypercapnia. Type II respiratory failure is characterized by

       

 

                                                                          Type II respiratory failure can be further sub-classified depending on the pre-existing condition of the patient and the speed of onset

Acute type II respiratory failure

                                                                        The patient will have no, or minor, evidence of pre-existing respiratory disease and patients typically have a high PaCO2, low pH, and normal bicarbonate.

Chronic type II respiratory failure

                                                                        Evidence of chronic respiratory disease, high PaCO2, normal pH, and high bicarbonate (>26 mmol/l).

Acute-on-chronic type II respiratory failure

                                                                            An acute deterioration in an individual with significant pre-existing type II respiratory failure, high PaCO2, low pH, and high bicarbonate (>26 mmol/l).

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Apgar Score

Apgar score

The Apgar score is a simple assessment of how a baby is doing at birth, which helps determine whether your newborn is ready to meet the world without additional medical assistance. Your practitioner will do this quick evaluation one minute and five minutes after your baby is born.

The 1-minute score determines how well the baby tolerated the birthing process. The 5-minute score tells the health care provider how well the baby is doing outside the mother's womb.

In rare cases, the test will be done 10 minutes after birth.

This score – developed in 1952 by anesthesiologist Virginia Apgar and now used in modern hospitals worldwide.

What Does the Apgar Score Mean?

Apgar is an acronym, standing for the following criteria:

• Appearance
• Pulse (heart rate)
• Grimace (reflexes)
• Activity (muscle tone)
• Respiration (breathing effort)

A pediatrician, ob-gyn, midwife or nurse will assign your newborn an Apgar score from 0 to 2 on each of the five criteria, with a total of 10 possible points. The higher the Apgar score, the better your baby is doing.

Appearance / (Skin color)

• If the skin color is pale blue, the infant scores 0 for color.
• If the body is pink and the extremities are blue, the infant scores 1 for color.
• If the entire body is pink, the infant scores 2 for color.

Pulse / (Heart Rate)

Heart rate is evaluated by stethoscope. This is the most important assessment:

• If there is no heartbeat, the infant scores 0 for heart rate.
• If heart rate is less than 100 beats per minute, the infant scores 1 for heart rate.
• If heart rate is greater than 100 beats per minute, the infant scores 2 for heart rate.

Grimace (reflexes)

Grimace response or reflex irritability is a term describing response to stimulation, such as a mild pinch:

• If there is no reaction, the infant scores 0 for reflex irritability.
• If there is grimacing, the infant scores 1 for reflex irritability.
• If there is grimacing and a cough, sneeze, or vigorous cry, the infant scores 2 for reflex irritability.

Activity (muscle tone)

• If muscles are loose and floppy, the infant scores 0 for muscle tone.
• If there is some muscle tone, the infant scores 1.
• If there is active motion, the infant scores 2 for muscle tone.

Respiration (breathing effort)

• If the infant is not breathing, the respiratory score is 0.
• If the respirations are slow or irregular, the infant scores 1 for respiratory effort.
• If the infant cries well, the respiratory score is 2.

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Caring for life...

Can you wake up a Section officer at mid night to sign a document?

Can you wake up a clerk at mid night to prepare a bill?

Can you wake up a lecturer at mid night to teach you?

Can you wake up a shopkeeper to buy a match box from his shop?

Everybody will answer No

But you can wake up a NURSE from a deep sleep at mid night for a patient who suffering in pain,

We the Nurse stand at the bedside of patients to save them because we feel the pain inside us.

                          PROUD 2 B A NURSE

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Nurses are the Real Life Heroes

          Critical-care nursing, or intensive-care-unit (ICU) nursing, is a specialty that requires focus and stamina. ICU nurses need a solid foundation of experience to actively monitor and treat acutely ill patients with life-threatening conditions. Critical-care Nurses are the real life heroes, always ready to fight against Pathogenic organisms and of course also against Angel of Death even lots of stressful environment.   

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