September 20, 2021 (Monday) – 4th Year- 1st sem –2-DIFFERENT MACHINE IN ICU-CCU x ETHICO-LEGAL DILEMMAS IN CRITICAL CARE
DIFFERENT MACHINE IN ICU-CCU
 Equipment used in the ICU varies from the
general, such as instruments to measure blood
pressure, to very specialized devices, such as
bedside monitors or ventilators. ICU equipment
may be used to monitor the patient and/or help
treat their illness. NET brand ICU Equipment have
set new standards in intensive care.
  Back then, there was only one set up of
ventilator or one mode – called “Assist Control”.
 If the patient is admitted in the ICU, automatic
that the patient needs to have NGT, connect in
the cardiac monitor, connect to the ventilator if
suffering from severe DOB or Decrease
consciousness.
1) Mechanical Ventilators
 A mechanical ventilator is a machine that helps
a patient breathe (ventilate) when they are
having surgery or cannot breathe on their
own due to a critical illness. The patient is
connected to the ventilator with a hollow tube
(artificial airway) [ET tube] that goes in their
mouth and down into their main airway or
trachea. They remain on the ventilator until they
improve enough to breathe on their own.
 How many weeks that a patient will be on the ET
tube? 1 week – because prolonged use of ET
tube the patient will depend on the ET tube and
also there’s high tendency that the pt. could
have more complication on his/her lungs.
 If the pt. cannot tolerate to remove the mech
vent support after 1 week [hindi kayanin na
walang support], the doctor will remove the
ongoing ET tube and replaced it again a new ET
tube. If the pt. cannot wean off again to the
ventilator, this is the time that that tracheostomy
tube insertion will enter. [automatic na gagawin
kapag hindi na wean off nang pt. and ventilator]
 Tracheostomy tube insertion – the surgeon will
make a hole make through the front of the neck
and into the windpipe (trachea). Can lasts longer
for months or years.
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MAIN BENEFITS OF MECHANICAL VENTILATION
 The patient does not have to work as hard to
breathe – their respiratory muscles rest.
 The patient's as allowed time to recover in
hopes that breathing becomes normal again.
 Helps the patient get adequate oxygen and
clears carbon dioxide.
 Severe DOB – the pt. cannot remove the
carbon dioxide and there’s limited oxygen
that can suffer from cardiac arrest.
 Preserves a stable airway and preventing injury
from aspiration.
1. Support arm- support the tubings or mech
vent circuit
 neck vein circuit has two ways:
expiratory port with filter and
inspiratory port.
2. Inspiratory port with filter – the air
needed by the patient is already clean; it
cleans the air to be inhaled
3. Active Humidifier – will clean the air
breathe out by the patient so that if the
patient will breathe in again, the air is clean;
lilinisin yung air na papasok
4. Inspiratory line with watertrap – active
humidifier has water; this line will trap the
moist coming from the active humidifier so
that it will not come directly to the patient
itself; for moist
5. Y-piece- separated to mech vent circuit. Y-
piece connect the ET tube and connect also
to the neck vein circuit.
 Function: connect the pt. to mech vent
circuit to the mechanical ventilator.
6. Expiratory line with watertrap – if the
patient breathe out, there were some
mucus or saliva. This line will trap those
obstructions or secretions so that it will not
come to the machine; for secretions such as
mucous, saliva
7. Expiratory port – if the patient breathes
out the air, the machine will clean it using
Active Humidifier.
8. Flexible connected – if the pt. is restless,
the nurse can flex this so that even if the pt.
will move – it will prevent the ET tube of the
pt to be remove
September 20, 2021 (Monday) – 4th Year- 1st sem –2-DIFFERENT MACHINE IN ICU-CCU x ETHICO-LEGAL DILEMMAS IN CRITICAL CARE

9. Proximal flow-pressure sensor – this  Oxygen Saturation – 95-100

can detect any problems to the pt.’s ET tube  Respiratory Rate – 12-20
and machine.  Temperature -36 degree Celsius to 37
[ex.] Proximal flow-pressure sensor detect degree Celsius
that were so many saliva in the watertrap
and the machine will alarm and will tell that o Main Function of Cardiac Monitor: For ECG tracing
there’s high pressure or clogged. – to identify what ECG rhythm does the patient
10. Nebulizer – it is connected to the have.
o In the ICU there were always two ECG tracing that
Inspiratory Port w/ Filter always monitor; Ventricular Tachycardia and
because the patient will inhale the Atrial Fibrillation.
medications. o If the pt. is suffering from Ventricular
Tachycardia and Atrial Fibrillation – the pt.
3 MODES OF MECHANICAL VENTILATORS ANYTIME can suffer from cardiac arrest. Prepare
i. Assist Control (AC) Mode the defibrillator ASAP.
− 100 % the machine will give enough o *Common ECG changes in ICU: (1) Ventricular
oxygen to the patients. All of the Tachycardia; (2) Atrial Fibrilization
functions will be coming to the machine.
− 100% machine will give enoughO2 to the 3) Suction machine
patient; 100% oxygen will be coming  A suction machine, also known as an aspirator,
from the machine is a type of medical device that is primarily used
for removing obstructions — like
ii. Synchronized Intermittent Mandatory mucus, saliva, blood, or
Ventilation (SIMV) Mode secretions — from a
− 50% coming from the patient and 50% person’s airway. When
coming from the machine. an individual is unable
iii. Continuous Positive Airway to clear secretions
Pressure (CPAP) Mode due to a lack of
− 100% coming from the patient but if the consciousness or an
machine will detect that the pt. doesn’t ongoing medical
have enough oxygen, the machine will procedure, suction
give a support to the patient. machines help them
− 100% of O2 will be coming from the breathe by maintaining a
patient clear airway.

2) Cardiac Monitor 4) Infusion Pump

 A cardiac event monitor is a device that you  An infusion pump is a medical device that
control to record the electrical activity of delivers fluids, such as nutrients and
your heart (ECG). This device is about the size of medications, into a patient's body in
a pager. It records your heart rate and rhythm. controlled amounts. Infusion pumps are in
 Cardiac event monitors are used when you need widespread use in clinical settings such as
long-term monitoring of symptoms that occur less hospitals, nursing homes, and in the home.
than daily.  Why we need infusion pump? To give exact
amounts of fluids and or medications.
 In general, an infusion pump is operated by a
trained user, who programs the rate and
duration of fluid delivery through a built-in
software interface.
 Infusion pumps offer significant
advantages over manual
administration of fluids,
including the ability to deliver
fluids in very small volumes,
and the ability to deliver fluids
at precisely programmed rates
or automated intervals.   They
can deliver nutrients or
medications, such as insulin or
other hormones, antibiotics,
chemotherapy drugs, and pain
relievers. 

 Cardiac Rate – 60-100 bpm 5) Syringe pump

 Blood Pressure -120/80

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September 20, 2021 (Monday) – 4th Year- 1st sem –2-DIFFERENT MACHINE IN ICU-CCU x ETHICO-LEGAL DILEMMAS IN CRITICAL CARE

 A syringe driver, also known as a syringe pump,  The principles of standards that govern proper
is a small infusion pump, used to gradually conduct.
administer small amounts of fluid (with or  The discipline dealing with what is good or bad or
without medication) to a patient or for use in and right or wrong duty and obligation.
chemical and biomedical research. Some syringe  Ethics refers to a set of rules that describe
drivers can both infuse and withdraw solutions. acceptable conduct in society.
 [ex] fast infusion of potassium chloride or  Ethics serve as a guide to moral daily living
sodium bicarbonate, patient can suffer to and helps us judge whether our behavior can
cardiac arrest. be justified.
 Function: To give exact amount of  Ethics refers to society's sense of the right way of
medications in a proper time. Set how many living our daily lives. It does this by establishing
hours/minute, cc, running etc. rules, principles, and values on which we can base
o [ex. Potassium Chloride – 50 ml for 1 our conduct. The concepts/principles most directly
hr. Rate – 5 drops] associated with ethics are truth, honesty, fairness,
and equity.
6) Defibrillators  Need to be honest on whatever the pt.’s
 Defibrillators are devices that restore a normal condition
heartbeat by sending an electric pulse or  The patient’s relatives are well
shock to the informed. [Every procedure what we are
heart. They are going to do/procedure to the pt. – get
used to prevent or consent. ex. NGT- get consent; IF fluids
correct an – get consent]
arrhythmia, a  Pt. suffered from motor -vehicle
heartbeat that is accident without relatives and need to
uneven or that is intubate. [hindi sa lahat nang bagay, we
too slow or too can comply to the ethics that we have in
fast. our profession-need din baliin.]
 Defibrillators can  Anything happened to the pt. without
also restore the relatives, we need to do our job. But if
heart’s beating if the relative is there, can get the
the heart suddenly consent.
stops.
 Mostly used when the patient is suffering from LAW
cardiac arrest.  Are demonstration of societal values of
formal organization that are passed and
ETHICO-LEGAL DILEMMAS IN implemented.

CRITICAL CARE Types of Law:

1. Common Law – are rules and principles derived
DILEMMA from past legal decisions.
 A situation with two possible solution which both 2. Criminal Law – concerned offences against the
lead to negative consequences. general public and responses is directed and
 A problem in making a decision because there is deterrence, punishment and rehabilitation of a
no clearly correct or right choice. person who committed the crime.
 May occur when different values conflict. 3. Civil Law – concerned the rights of individual and
remedies particularly involved payment of money
Ex. or some type of compensation.
Patient in coma.  Nursing profession – negligence, malpractice
4. Administrative Law – is legal rules and
Doctors order to Watcher or pt. relative
principles of this court act in controlling the
intubate the pt. refuse to intubate the
exercise of statuary powers and adjustment of the
pt. rule-making by the public authority.

 Get the SIGNED CONSENT of the watcher or pt. NEGLIGENCE

relative who refuse to intubate the pt.
 Make a consent letter that the watcher or relative
will refuse and understand everything that if the
pt. will not intubate, it will harm the patient.
 DOCUMENTATION IS IMPORTANT.
ETHICS
 Focuses on what ought to be done in relation what
is done.
 Is general term that denoted conduct lacking in
due care. Thus, negligence equates with
carelessness.
 Negligence is the failure to act an ordinary prudent
would under similar circumstances.
Elements of negligence:
1. There was duty owed to the patient.
2. There was a breach of duty or standard by the
health care professional.

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September 20, 2021 (Monday) – 4th Year- 1st sem –2-DIFFERENT MACHINE IN ICU-CCU x ETHICO-LEGAL DILEMMAS IN CRITICAL CARE

3. There was harm caused by the breach of duty or  “If isn’t document, it is not happened”
standard. • Dilemma: [ex.] you give the medication
4. The person experience a damages or injuries. at exact 8pm but you didn’t counter sign
it, the court will not accept it by saying it
only.
2. Blood Transfusion
 Wrong blood type; wrong infusion.
 Need to know the serial number, name
of the pt., compability, cross-match,
blood type, expiration date. – need to
verify with other colleagues [nurse].
• Dilemma: There are some religion that
they are not allowed to have a blood
transfusion. Get them signed consent
that anything happened to the pt., the
hospital is not liable.
3. Euthanasia
 If the pt. consent that he wanted to
have potassium chloride without the
hospital liability. [they have will]
4. Do not resuscitate [DNR]
 If the pt.’s relative cannot decide, DO
YOUR JOB.
 If there’s DNR, respect the pt. and the
relative’s decision.
5. Whistle blowing
Ex. 6. Withholding and withdrawing treatment
 Wrong patient, wrong medication.  If they stop the medications or withhold
Types of Medical Negligence: it, ALWAYS GET A CONSENT.
1. Wrong diagnosis 7. Restraints
2. Delay in Diagnosis  If the patient can harm other pt., get a
3. Error and Surgery consent that the pt. need to restraints.
4. Unnecessary Surgery
5. Error and Administration of Anesthesia [or FOUR PRIMARY PRINCIPLE [in ICU-CCU]
medication] 1. AUTONOMY
6. Childbirth and Navel Malpractice − Refers to the right to determine their own
7. Long term negligence treatment rights.
− Right to receive any treatment, the right
MALPRACTICE to discontinue any medications that they
 Is more specific term and looks at a professional want.
standard of care as well as the professional status 2. BENEFICENCE
of the caregiver, the failure of a professional − Doing something good, nurses are
person to act in accordance with prevailing pledged no harm to safeguard the
professional standards or failure to foresee patients.
consequences that a professional person. − Do not harm the patient, give 100% of
 Doing any procedure without your responsibilities care needed by the patient.
or didn’t cope your duties and responsibilities in 3. JUSTICE
your profession. − Patient should be treated fairly.
4. VERACITY
Ex. − Veracity or truth telling is critical for
 1 Mayo scissor left inside the body of the pt.- effective patient communication
negligence developing trust with patient.
 You are a nurse, you CS a pregnant woman – − Whatever the conditions of the patient,
malpractice. we must tell to the pt. and to the
family/relatives.

ETHICO-LEGAL DILEMMAS IN
“Nurses have responsibilities related to ethics, including
CRITICAL CARE SETTING maintaining knowledge of professional code of nursing.”

1. Documentation -Thank you -

 All of the procedure that we done to the
pt., we must document it.