Due by Saturday, 11:59 p.m. (MT) end of Week 1 (120 pts)
Learning Objectives Covered
1. Explain Negative pressure ventilation
2. Describe how the ventilator functions and how input power is converted to ventilator breaths, how breaths are controlled by the ventilator and the variables that describe the modes of ventilation
3. List and describe the three phase variables for a mechanical breath to be delivered: Trigger, Limit, and Cycle
Background
 
Negative pressure ventilators were inspired in the early 1900’s, before the polio epidemic, to provide artificial respiration. The use of negative pressure ventilators today is rare but understanding their use helps provide a greater understanding of ventilators. Negative pressure ventilators were intended to mimic natural spontaneous breathing by creating pressure gradients around the patient’s chest. They provided noninvasive ventilation, which was accomplished by using either a shell that surrounded the chest or a cylinder that enclosed the entire body. The principle of these devices is that a vacuum pump created subatmospheric pressure (negative pressure) intermittently in a chamber surrounding the thorax (chest wall) which resulted in the expansion,of the patient’s chest initiating inspiration. When the vacuum was terminated, the negative pressure outside the chest wall returned to zero and the elastic recoil of the chest and lungs permitted passive exhalation allowing air to flow out of the lungs into the atmosphere. When negative pressure is being applied to the thorax air flows into the lungs from the atmosphere.
There are two primary types of negative pressure ventilators: Iron lung and chest cuirass. An iron lung is a device where the entire body, except for the head, is placed in a chamber with an airtight seal around the neck. A chest cuirass is a jacket with seals around the neck, arms, and thighs. The chest cuirass was suitable for home use and provided much more versatility than the iron lung.
Modern mechanical ventilators use positive pressure to provide ventilatory support. Positive-pressure ventilation is an invasive technique that uses an endotracheal or tracheostomy tube to push gas directly into a patient’s lungs until the machine terminates the breath. The pushing of gas into the patient’s lungs creates positive pressure as opposed to negative pressure, which is created by the downward pull of the diaphragm and the outward expansion of the chest wall creating pressure gradients and therefore causing air to flow into the lungs.
Input power is simply the power source that enables a device to function. The power source provides a ventilator with the energy to perform the work required to ventilate a patient. A power source may be an electric or gas source. Ventilators that are electrically powered are most commonly used in homes. Ventilators that use a 50psi gas source are referred to as pneumatically-powered and are most commonly used for transporting ventilator dependent patients throughout the hospital or during an MRI. Patients that use both electrical and pneumatic power are referred to as combined powered ventilators and are most commonly used in the Intensive Care Units (ICU).
It is important to note that when reference is made to a ventilator breath it implies that the  inspiratory phase of a breath is delivered and exhalation is always passive. In order to understand mechanical ventilation one must understand the phases of inspiration during ventilation. There are three phases of inspiration. The beginning (how and when inspiration starts), the middle (how much air enters the lungs and how much the lungs expand), and the end (how and when inspiration ends). Mechanical ventilation uses ventilators to deliver gas to the lungs using positive pressure at a certain rate (respiratory rate). The amount of gas delivered can be limited by time, pressure, volume, or flow. The duration of inspiration can be cycled(terminated) by time or volume. There are three phase variables that define the parameters of a ventilator breath. The three parameters are set by the clinician on the machine and include: how the breath begins (trigger), how the breath is delivered (limit), and how the breath ends (cycle). Another equally important parameter that is also set by the clinician determines how often a breath is delivered (respiratory rate).
How a mechanical breath begins is defined by the trigger variable. The breath trigger variable is known as the sensitivity control. The limit variable places a maximum value or limit on a control variable during delivery of a breath. During mechanical ventilation of an adult the limit or control variable can be pressure limited or volume limited. A limit variable is a parameter that rises to a certain value but does not exceed it. For example, a patient with ARDS has extremely non-compliant lungs (stiff lungs). When ventilating these patients, care must be taken during mechanical ventilation to not over distend the lungs, which can result in a pneumothorax and further damage to the lungs. These patients are placed on pressure control also known as pressure limited ventilation and a pressure level is set. Once the breath is triggered (begins) then the machine will deliver pressure and the pressure will rise until it reaches the preset level. Once the preset pressure level is reached then it is maintained at that level until inspiration ends. The cycle variable is the parameter that ends the inspiratory phase and allows passive exhalation to begin. During pressure control ventilation the cycle variable is time. An inspiratory time (I time) is set and once the set time elapses then inspiration ends. During volume control ventilation the amount of air to be delivered during inspiration (tidal volume) is set and when the set volume is reached inspiration ends. Therefore, it is important to remember that pressure control/pressure limited ventilation is time cycled and volume control/volume limited ventilation is volume cycled.
There are three primary types of breaths delivered by a ventilator: mandatory, assisted, and spontaneous. A mandatory breath indicates that the ventilator does all the work of breathing and the patient does none of the work required to breathe. This type of breath allows the patient to fully rest their inspiratory muscles. During a mandatory breath all three phases of inspiration are controlled. The ventilator starts the breath, controls inspiratory gas delivery and determines when inspiration ends. An assisted breath is a breath in which the patient does some of the work, however, the patient is only allowed to start or initiate a breath. Once inspiration begins the ventilator then takes over and controls the inspiratory phase and determines when inspiration ends. Therefore, during an assisted breath only 2 of the 3 phases of inspiration is controlled. A spontaneous breath is a breath in which the patient controls all phases of inspiration which means that the patient does all the work required to breathe. The ventilator monitors the patient parameters, notifies clinicians of issues through set alarms and serves as a backup if the need arises.
Prompt
For this assignment, you will provide detailed responses to the following questions
1. Discuss the effects of positive pressure ventilation on oxygenation and ventilation
2. Define the following terms and explain their significance
· Peak inspiratory Pressure (PIP)
· Plateau pressure (Pplat)
· Airway resistance (Raw)
· Dynamic Compliance (Cdyn)
· Static Compliance (Cstat)
3. Define each of the ventilator modes listed below:(use your own words)
· Continuous Mandatory Ventilation
· Synchronized Intermittent Mandatory Ventilation
· Pressure Support Ventilation
· Continuous Positive Airway Pressure
Submit your answers in at least 500 words on a Word document. You must cite at least three references in APA format to defend and support your position.

NURSING

This assignment is due on Saturday March 23,2013 at 10 AM EST , One of the assignment is a continuas assignment that you completed part one last week , and the secound is a ppt . For the one which is a continuation assignment , you have to refere to my act and see the solutions to the last paper you send to me with ID ending in 82. But also i have giving you all the details you need in the attached file . if you have aany dought contact me and i will be happy to give you more imformation . In the other file , it is require that you construct a PPT, it is important that you follow the instructions and do just the right thing as require. The have to be at least 9 slides and 100 words of speaker notes for each of the slides . The slides itself need to have at least 4 bullets points of sgort sentences , and 100 words of speaker notes for each to elaborate on the bullets points . In text citations is require in the speker notes , and also you must use APA format . you must also address all the requirement for the PPT stated in the file , and a reference slides must be included at the end ( title and reference slides not counting to the 9 slides). Please let me know if you dont understand anytrhing rather than do the wrong stuff.

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Part 2
This is the continuation of part 1 of the assignment with the transtutor ID TTs130313_11261_82 , so it will be important for the writer to refer to the solutions of that assignment as that is part one to be able to complete this section .This is due on Saturday March 23, 2013 At 10 AM EST . APA and in text citation must be used for the entire assignment , and must also include a reference list all in APA format . The similarity scores cannot be more than 15% for this assignment.
To recommend your solution to the problem, add a section of 4 pages that includes answers to the following questions:
•What is the importance of implementing a quality improvement process to reduce the incidence of the safety issue? (the transfer of secondary infections to patients while they are in treatment facilities)
•What would be a method of application of the quality process to the safety issue?
•What Quality & Safety Education for Nurses (QSEN) standards are met by the implementation of this method?
•Present your work in a scholarly manner, using APA format.

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EVALUATION AS A KEY TOOL IN HEALTH AND HUMAN SERVICES.

Heroin Epidemic in the United States Essay Assignment Paper
I need 1 page research paper and 1 page opinion paper. i also need 2-3 references in MLA you can use any website they have to be up to date.
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-Heroin epidemic and the United States. Changes in the way we treat chronic pain with medication in the early 1990’s. 1995 FDA approved OxyCotin (1.2 billion in sales in 2002) More than 10,500 heroin deaths reported in 2014, that is triple in four years. 2014 -75% started using heroin from prescription drugs. 2014, 21.5 million American had substance abuse problem. Is the fault with pharmaceutical companies and making billions of dollars? Pain management doctors and prescription drugs. Do hospitals and clinics that push for patient satisfaction cause addiction to prescription drugs? Did recent restrictions from the States (ex. Florida) on physician painkillers act as a cause of heroin addiction? Heroin Epidemic in the United States Essay Assignment Paper.
Many now mixing heroin with fentanyl (25 -40% more powerful than heroin) and oxycodone. Are drugs like OxyCotin and Vicodin “bridge/gateway drugs”? Heroin is readily available, very pure and cheaper than prescription pills. Heroin is more pure than in the past, meaning it can be snorted instead of only injected, opens up to a wider range of people willing to try the drug.
Is the problem than more young, white, middle class kids are heroin addicts? Pain management doctors in the 1990’s, title didn’t exist before the 90’s. Heroin Epidemic in the United States Essay Assignment Paper.
Generation “H”, is this entitled generation at fault or their parents? Has the thought of their parents protecting them form everything caused them to lose the fear of Heroin? Heroin Epidemic in the United States Essay Assignment Paper.
New York City began enforcing a state statute that requires a minor’s family to qualify for public assistance to be treated for addiction, many can not afford the treatment. Is the answer more money for more treatment.
Silver lining to a tragedy. Estimates are 1 out of 11 organ donors died because of a drug overdose. One concern is the danger of HIV, Hep. B & C etc. Testing shows most are young and disease free. Organ recipients are required to give consent when offered a high-risk organ. Heroin Epidemic in the United States Essay Assignment Paper.
Police and firemen being trained to administer (naloxone) Narcan to overdose patients.
New drugs developed to treat constipation by chronic narcotic users. Have younger Americans lost the fear of Heroin? Demographic shift of users, middle class Americans majority of cases. In upstate New York Ithaca proposed the nations first drug injection center to help prevent overdose deaths (2016), Sweden model. Computer program called iStop, it helps prevent doctor shopping for pain killers. Shows opioid prescriptions written for a patient. Heroin Epidemic in the United States Essay Assignment Paper
here is 1 reference
Suffolk County has most heroin-related deaths in New York State, report finds
Cigarette Smoking
Discussions are not just opinion to obtain full points, postings must be based on supported fact, not simply opinion. Posting should be a minimum of one short paragraph and a maximum of two paragraphs.  Word totals for each post should be in the 100-200 words range.  Whether you agree or disagree explain why with supporting evidence and concepts from the readings or a related experience.  Include a reference, link, or citation when appropriate. APA 6th edition format for references as well as in-text citations is expected.The U.S. Department of Health & Human Services released a comprehensive Clinical Practice Guideline for Treating Tobacco Use and Dependence–2008 Updatehttps://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/tobacco/clinicians/update/index.html The goal of these recommendations is that clinicians strongly recommend the use of effective tobacco dependence counseling and medication treatments to their patients who use tobacco, and that health systems, insurers, and purchasers assist clinicians in making such effective treatments available. After reading these recommendations answer the following questions.
1. what are the clinical interventions for patients unwilling to quit cigarette smoking?2. According to the best practices what are the best strategies to help your clients quit smoking?3. are there any specific smoking cessation recommendations for especial populations such as teenagers or the elderly? Heroin Epidemic in the United States Essay Assignment Paper.