Essay The Knight and the Cart - 1454 Words

The Knight of the Cart By the end of eleventh century, Western Europe had experienced a powerful cultural revival. The flourish of New towns provided a place for exchange of commerce and flow of knowledge and ideas. Universities, which replaced monasteries as centers of learning, poured urbanized knowledge into society. New technological advances and economics transformations provided the means for building magnificent architectures. These developments were representative of the mental and behavioral transformations that the medieval world underwent and the new relationships that were brought about between men, women and society in the twelfth century. As in technology, science, and scholasticism, Literature was also reborn with a new†¦show more content†¦He is tested at various stages in his voyage, such as by the damsel who requires him to sleep with her if he wants hospitality. Lancelot agrees only after pleading with her not to make him sleep with her. He did this not because the girl was unat tractive for he states, quot;Many men would have thanked her five hundred times for such an offer.quot; He agrees to this act only because he believes that he needs the lodging to rest himself so he can dutifully continue his quest for Guinevere. Yet, Lancelot does not even look at her when she is naked; his lack of interest causes the damsel to relinquish him from his promise. He stays perfectly loyal and faithful to his queen. Obedience is another factor that constitutes courtly behavior in the story. Lancelot battles arduous combats and suffers severe wounds for the love of Guinevere. However, once throughout his voyage he falters in his obedience to her love, when he comes across a dwarf, driver of a cart, the dwarf tells Lancelot to ride in the cart in exchange for information on Guinevere’s whereabouts; Lancelot hesitates momentarily before leaping into the cart. Lancelot regrets this moment of hesitation and scolds himself, he argues â€Å"†¦Reason, who does not follow love’s command, told him to beware of getting in and admonished him†¦Love ordered and wished [he would ride in the cart]†¦; since love ruled his action, the disgrace should not have mattered.† 2 Lancelot is deeply ashamed and never faltersShow MoreRelatedEssay about Courtly Love as an Ennobler in Romantic Literature1380 Words   |  6 Pages Lancelot, the knight of the cart, is in love with Queen Gui nevere, who constantly compromises his reputation by embarrassing him . Chretien de Troyes writes Lancelot in The Knight of the Cart to be deeply in love, so much so that he constantly sacrifices his reputation for the queen. Classically, â€Å"the romantic hero developed from an extravagant to an ideal character† (Williams 275) in typical Romance literature. 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The first indication of his love for Guinevere is when he requests to leave because she would no longer be near, and he wants King Arthur to entrust her to him in order for him to stay. On foot and without his lance, Lancelot sought after a cart that was made for criminals to continueRead MoreChristian Elements in the King Arthur1295 Words   |  6 Pagesto the Age of Discovery, is seen through Medieval literature. Ten centuries of history are noticed, involving individual products of heroic periods and their unique era of culture. Acknowledging Medieval literature illustrates a society of heroic knights, led by a luxurious king, charging into battle, romantic connections between royalty and a common person, and new discoveries being found. 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Mechanical Ventilation

Questions: 1. You are making the initial attempt to wean a patient from mechanical ventilation in the CMV mode using a T-piece. After 30 minutes on the T-piece you observe the following Pulse 90 Stable blood pressure 125/80 Respiratory rate 18/minPhysical appearance-no signs of distress Discuss what would your next action include?2. List 4 things that would keep a patient from being able to wean on the ventilator.3. Your patient has the following parameters collected to determine if the patient is ready to wean from mechanical ventilation. This patients IBW is 80 kg. The patient has been on the SIMV with pressure support of 10 with a rate of 4 and VT of 700 with an Fio2 of 40%. You put him on CPAP for 2 minutes and obtain the following data:HR 110 RR 14 BP 130/90 VC 900 mL MIP 40 cm H2O VT 500 ml4. A 44-year-old male with severe COPD is intubated and ventilated with pressure support ventilation. You note that he is making inspiratory efforts that do not trigger the ventilator. What is the most likely cause and what can you do to improve the patient-ventilator interaction? Answers: 1. The patient who is continuous mandatory ventilation (CMV) is weaned for the ventilator. The vital parameters after 30 min are 90 per min, 125/80 mm of Hg and 18 per min respectively for pulse, blood pressure and breathing rate. The parameters are in the range of normal values for pulse, blood pressure and respiratory rate (George, Nicole Andrew, 2013). In addition, there are no signs of distress. The results indicate that the patient is able to have normal respiration; therefore the mechanical ventilation may be not required. The mechanical ventilators support is required in the instances where the vital parameters are adversely affected. 2. The following are the few parameters to be considered to keep a patient from being able to wean on the ventilator (Laura, 2012) Check ventilator settings and modes: Breathing rate, setting of ventilations etc Educating the patient and attends about the implications Managing the air passage (way) Check the suction for appropriateness 3. The SIMV (Synchronized Intermittent Mandatory Ventilation) is mode of intermittent mandatory ventilation to provide partial ventilation in order to support the patient for mechanical ventilation. During SIMV, the patient can be provided with mandatory, synchronized and spontaneous breath. In the current case, the patient is supported of 10 with a rate of 4, VT of 700 with 40% FiO2. Then the patient was switchover to continuous positive airway pressure (CPAP) for 2 minutes. The observations as follows Heart Rate : 110 Respiratory Rate (RR) : 14 Blood Pressure : 130/90mm of Hg Vital Capacity : 900 mL Maximal inspiratory pressure: 40 cm H2O Tidal Volume (Vt): 500 ml 3.1. What is RSBI? The term, Rapid Shallow Breathing Index (RSBI) is a ratio used as an indicator for the assessment of respiration and decides the patient for weaning of ventilator. It can be measured by calculating the ratio of respiratory rate (f) and tidal volume (Vt) and a value below 105 of RSBI is considered as the accepted value for weaning of extubation (Crawford, Otero, Donnino, Garcia, Khazal Lenoir, 2007). In the current case, the value is 0.028. 3.2. Would we be able to wean this patient and why? Yes the patient can be weaned off for the ventilation based on the RSBI. It is below 105 therefore can be weaned off using suitable method 3.3. Which method of weaning would you use and why? The methods that are used for weaning of ventilation include T-piece trials, SIMV and pressure support ventilation. Among the methods, SIMV can be sued for weaning. The method comprises of gradual decreasing the mandatory rate by 2 to 4 bpm (Jeremy Mark, 2005). The gradual reduction prevent sudden onset of side effects and facilitate the patient for normal respiration. 4. Pressure Support Ventilation (PSV) is operated at preset pressure and it supports the patient in initiation of breath and regulation of certain parameters (breathing rate and tidal volume). Ideally, the ventilator should respond to a patients inspiratory effort. The factors that influence the sensitivity trigger include pressure, flow, and/or time. In the current case, the set parameters are not helping to trigger the ventilation and lead to increase in load on the respiratory muscles. Else, the time for of trigger stint may be prolonged due to the pressure transducer from the ventilator (Mellott, Grap, Munro, Sessler Wetzel, 2009). Therefore the patient and ventilator interaction can be improved manipulating the pressure; flow and/or time E.g. Setting a shortest time for trigger will minimize the efforts of patient in terms of inspiration. References Crawford, J., Otero, R., Donnino, M., Garcia, J., Khazal, R Lenoir, T (2007) Rapid shallow breathing index- a key predictor for noninvasive ventilation. Critical Care 11(Suppl 2) P169 George, Y., Nicole, AD Andrew, MR (2013) Respiratory rate and breathing pattern MUMJ 10(1) 23-25 Jeremy, L Mark, JG (2005) Weaning from mechanical ventilation Contin Educ Anaesth Crit Care Pain 5 (4): 113-117. Laura, CPM (2012) Top 10 care essentials for ventilator patients American Nurse Today 7(3)13-16 Mellott, KG., Grap, MJ., Munro, CL., Sessler, CN Wetzel, PA. (2009). Patient-ventilator dyssynchrony: Clinical significance and implications for practice. Critical Care Nurse, 29(6), 4155.