- Grades of respiratory distress.

Grades of respiratory distress

1. Grade I (mild distress):- tachypnea ,working ala nasi and tachycardia .
2. Grade II (moderate distress):- Chest retraction "in-drawing" (e.g subcostal and intercostal) due to moderate hypoxemia.
3. Grade III (severe distress):- Grunting which is due to severe hypoxemia and indicate alveolar lesion (i.e parenchymatous lung disease).Here O2 supply is needed and patient must be hospitalized.Grunting is the last compensatory mechanism.
4. Grade IV:- Cyanosis and disturbed consciousness and endotracheal tube is needed here.

Dr Ibrahim

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- Grades of Dyspnea.

Grades of Dyspnea

Two scoring systems can be adopted to evaluate the dysnea changing it from subjective complaint to objective complaint.

1-American Thoracic society score (ATS):
Grade 0:- No breathlessness except with strenuous exercise.
Grade 1:- Breathlessness when hurrying on the level or walking up a slight hill.
Grade 2:- Walks slower than people of the same age on the level because of breathlessness or has to stop for breath when walking at own pace on level.
Grade 3:- stop for breath after walking about 100 yards (96 meter) or a few minutes on the level.
Grade 4:- Too breathless to heave the house or breathless when dressing or underdressing.

2-New york heart association score (NYHA)

There are four functional  grades of  Dyspnea as follows:-

1. Grade I (minimal Dyspnea):  Dyspnea on running or on doing more than ordinary effort .

2. Grade II : on doing ordinary effort .

3. Grade III (considerable Dyspnea) : on doing less than  ordinary effort .
4. Grade IV : Dyspnea at rest.

*Ordinary effort is that of the person himself as regard his previous effort tolerance and usual life style.

*Reference:-
- Basics of respiratory medicine,Staff members,Thoracic medicine department,mansourauniversity,3ed,2009,symptoms of chest disease P.g 57.

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- Human Skin Histology.

-Human skin is considered the largest organ of the body and form  about 16% of the body weight (1) with a surface area somewhat less than 1.5 m² (2).
-The skin form the external surface of the human body.At the orifices of the mouth,nose and the anal canal, the skin join the mucous membrane at the muco-cutaneous junction (3).

-Types of human skin (1):-

1. Thick skin (Non-Hairy) which has thick epidermis and found only in the palms and soles as they are the most sites subjected to abrasions and trauma and thick skin shows characteristic parallel ridges and grooves which are called "Finger prints".
2. Thin skin (Hairy) which has thin epidermis and covers the rest of the body.
   

-Histological structure of the skin :-

skin is composed of 3 layers

1. Epidermis
2. Dermis
3. Hypodermis (Subcutaneous fatty layer) 

1- Epidermis:-

• It is the outer superficial epithelial layer of skin.
• It is composed of Stratified squamous keratinized epithelium.
• The thickness of the epidermis varies in different types of skin. It is the thinnest on the eyelids and the thickest on the palms(0.8mm) and soles(1.4mm).
• The epidermis is ectodermal in origin.
  
• The epidermis is devoid of blood vessels and gets its nutrition through diffusion.
  
  
  

- What are the symptoms of pleural mesothelioma?

What are the symptoms of pleural mesothelioma?

Mary Hesdorffer, MS, APRN, nurse practitioner with the Mesothelioma Applied Research Foundation discusses symptoms of pleural mesothelioma.

- What does a pleural mesothelioma diagnosis mean?

What does a pleural mesothelioma diagnosis mean?

Mary Hesdorffer, MS, APRN, nurse practitioner at the Mesothelioma Applied Research Foundation talks about the importance of consulting with a pleural mesothelioma expert when discussing a diagnosis.