CHAPTER 2

DESIGN INPUT
2.1 Client Requirements
The Hospital have discussed that due to their lack of nurses. The Hospital cannot monitor all the
patients manually at the desired time that the nurses are must to employ. Furthermore, the Dextrose of each
patient using those should be carefully monitored as these chemicals may overdose or underdoes patients.
The dextrose injected of an ICU patient should be carefully monitored especially with those whom are
diabetic.

With the development of the project, below are their requirements,

● Monitoring of drop rate should be real-time.
● The Nurse duty on the station can monitor the content of the dextrose.
● The System should costs below Php 5000.
● The System should be accurate and reliable.

2.2 Design Criteria

The table below specifies the design criteria and its corresponding design constraint. The right
column defines the design criteria. These are the attributes that are desired in the proposed project. The left
column describes each criterion according (whichever is applicable) to the following constraints: Reliability,
Accuracy and Economic Cost. These constraints are necessary in determining which design option is best
suited for the development of the project.

DESIGN
DESIGN CRITERIA
CONSTRAINT

Failure Rate
Expressed in failures per unit of time which an engineered system. It is used to
Reliability
determine the how reliable is the system.

Total Time Cost

The time interval that the sensors give information to the microcontroller is
Accuracy
important to have an accurate drop rate. The algorithm is used to determine the total
time cost.

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 Installation and maintenance cost
The project should only cost around 5000 php. Which installation does not cause any
Economical
amount and the maintenance would be handled by the institution whom are using the
said device.
Table 2.0 Design Criterion for the System

2.3 Review Related of Literature

Medical Schools produce nurses, but we have a shortage crisis of nurses for our hospitals. Tiburcio
Macias, president of the Philippine Hospital Association, said the situation is such that our hospitals find it
hard to operate because of the lack of nurses. There is even a hospital in Cebu that cannot function because
of the dearth of nurses. Health Secretary Manuel Dayrit added this is the reality that we have to face. "We
cannot," he said, "stop our nurses from going abroad. There is a high demand for them among hospitals in
Europe and the United States." Actually, this problem is not even as bad as the problem that we have with
our teachers. Many of them prefer to work as housemaids in Hong Kong because they earn more than as
teacher in our government schools. Filipinos make very good nurses because they really show sympathy
and concern for their individual patients. But like our teachers, they are not properly compensated. This is
not the fault of our hospitals. It is the general economic condition of the whole country. In year 2000, the
country had 5,784 newly-registered nurses. The number of nurses that went abroad that year was 7,683.
This meant that 899 of the old-registered nurses also opted to go abroad. The following year, 13,536 left to
work abroad, we only had 4,780 new nurses. More nurses would leave if they had the money to go abroad.
And the bottom line is that we cannot induce our nurses to stay at home and service our hospitals. [1]

The Local Government Code of 1991 resulted in the devolution of health services to local government
units (LGUs) that included among others the provision, management and maintenance of government health
facilities (district hospitals, provincial hospitals, RHUs, BHS) at different levels of LGUs. Though most of
health facilities are devolved, 70 hospitals scattered all over the country are retained by the central
government (DOH retained hospitals). Private sector plays a crucial role in the Philippine hospital system. As
noted in the earlier chapter, they account for more than 50 percent of the total number of hospitals. Almost
half of the population goes to private facilities for their health care needs. However, private hospitals cater
more to the upper socioeconomic quintiles and those covered by health insurance. In 2009, the country
licensed a total of 721 public and 1,075 private hospitals. In 2010, the total hospital beds are 98,155
(Department of Health, 2009). Of these, around half (50 percent or 49,372 beds) are in government hospitals
(National Statistics Office, 2010). To ensure provision of quality services, 10,530 facilities have been

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accredited (n=1835) and issued with licenses (n= 8,695) to start their operations in 2008 (Philippine Health
Insurance Corporation, Various years). Issuing documents and accreditation are vital processes in quality
assurance and monitoring compliance to standards. [2]

Perhaps the most severe side effects of dextrose are reserved for individuals with underlying disease
processes. Type 1 and type 2 diabetics have an inability to either produce or respond to insulin, a pancreatic
hormone that is released in response to high levels of blood sugar. If a diabetic eats foods containing large
amounts of dextrose, their blood sugar levels will rise very high very quickly, explains Dr. Lauralee Sherwood
in her book "Human Physiology." This leads to a number of symptoms, all of which are linked to
hyperglycemia, or high blood sugar. Diabetic hyperglycemia is very serious and, if untreated, can lead to
tissue damage, coma and death.

Interestingly enough, too much dextrose can actually lead to a paradoxical effect in individuals
without diabetes. If blood sugar rises very high very quickly, the pancreas secretes very large quantities of
insulin. This signals the cells to take up blood sugar quickly, since hyperglycemia is damaging to the tissues.
As a result of the pancreatic overreaction to very high blood sugar, however, the cells can take up too much
blood sugar, leading to low blood sugar levels, or hypoglycemia. This, notes Dr. Sherwood, leads to feelings
of nausea, hunger and dizziness--side effects that are quite uncomfortable [3].

2.3. A Monitoring of Speed and Amount

Web Applications are usually broken into logical chunks called "tiers", where every tier is assigned a
role. Traditional applications consist only of 1 tier, which resides on the client machine, but web applications
lend themselves to an n-tiered approach by nature. Though many variations are possible, the most common
structure is the three-tiered application. In its most common form, the three tiers are called presentation,
application and storage, in this order. A web browser is the first tier (presentation), an engine using some
dynamic Web content technology (such as ASP, CGI, ColdFusion, Dart, JSP/Java, Node.js, PHP, Python or
Ruby on Rails) is the middle tier (application logic), and a database is the third tier (storage). The web browser
sends requests to the middle tier, which services them by making queries and updates against the database
and generates a user interface.

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 For more complex applications, a 3-tier solution may fall short, and it may be beneficial to use an n-
tiered approach, where the greatest benefit is breaking the business logic, which resides on the application
tier, into a more fine-grained model. Another benefit may be adding an integration tier that separates the data
tier from the rest of tiers by providing an easy-to-use interface to access the data. For example, the client
data would be accessed by calling a "list clients ()" function instead of making an SQL query directly against
the client table on the database. This allows the underlying database to be replaced without making any
change to the other tiers.

There are some who view a web application as a two-tier architecture. This can be a "smart" client
that performs all the work and queries a "dumb" server, or a "dumb" client that relies on a "smart" server. The
client would handle the presentation tier, the server would have the database (storage tier), and the business
logic (application tier) would be on one of them or on both. While this increases the scalability of the
applications and separates the display and the database, it still doesn't allow for true specialization of layers,
so most applications will outgrow this model [4].

2.3. B Network

WAN is a computer network spanning regions, countries, or even the world. However, in terms of
the application of computer networking protocols and concepts, it may be best to view WANs as computer
networking technologies used to transmit data over long distances, and between different LANs, MANs and
other localized computer networking architectures. This distinction stems from the fact that common LAN
technologies operating at lower layers of the OSI model (such as the forms of Ethernet Or Wi-Fi) are often
designed for physically proximal networks, and thus cannot transmit data over tens, hundreds or even
thousands of miles or kilometers.

WANs are used to connect LANs and other types of networks together so that users and computers
in one location can communicate with users and computers in other locations. Many WANs are built for one
particular organization and are private. Others, built by Internet service providers, provide connections from
an organization's LAN to the Internet. WANs are often built using leased lines. At each end of the leased line,
a router connects the LAN on one side with a second router within the LAN on the other. Leased lines can
be very expensive. Instead of using leased lines, WANs can also be built using less costly circuit switching
or packet switching methods. Network protocols including TCP/IP deliver transport and addressing functions.
Protocols including Packet over SONET/SDH, Multiprotocol Label Switching (MPLS), Asynchronous Transfer
Mode (ATM) and Frame Relay are often used by service providers to deliver the links that are used in WANs.

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X.25 was an important early WAN protocol, and is often considered to be the "grandfather" of Frame Relay
as many of the underlying protocols and functions of X.25 are still in use today (with upgrades) by Frame
Relay.[5]

A local area network (LAN) is a group of computers and associated devices that share a common
communications line or wireless link to a server. Typically, a LAN encompasses computers and peripherals
connected to a server within a distinct geographic area such as an office or a commercial establishment.
Computers and other mobile devices use a LAN connection to share resources such as a printer or network
storage.

A local area network may serve as few as two or three users (for example, in a small-office network)
or several hundred users in a larger office. LAN networking comprises cables, switches, routers and other
components that let users connect to internal servers, websites and other LANs via wide area networks [6].

2.4 Standards of Medical Devices

2.4.a Standards on Medical Devices

IEEE 802.11b “Standard uses the more typical 2.4 GHz band”
IEEE 802.11a “Wi-Fi works on the 5 GHz band “
IEEE 802.11g “Retaining usage of the reliable 2.4 GHz band”
IEEE 802.11n “802.11n can operate at both 2.4GHz and 5 GHz and it supports multi-channel usage.”
ISO/EC 27001 “Implement the standard in order to benefit from the best practice it contains”
ISO 10993-1, “Biological evaluation of medical devices.”

BS EN 20594-1:1994, “Standardized connector types.”

DB2003 (02) v2.0, “MHRA Infusion System Device Bulletin”

NPSA Handbooks, “Design for patient safety”

EN ISO 14971:2012, E “Risk Management”

EN 60601-2-24:1998, “Safety Infusion Devices”

EN 60601-1:2006/AC: 2010, “Basic Safety and Essential Performance”

2.4b Standards on Dextrose

USP revised General Notices: Section 5.60.30, “Elemental Impurities in USP Drug Products and
Dietary Supplements

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 INS: 2016, “Infusion therapy standards are applicable to any patient care setting in which vascular
access devices”

Calculating maintenance fluid:

Patients Weight Full Maintenance Mls/day Mls/hr.

3 to 10 kg 100 x wt. 4 x wt.
10 to 20 kg 1000 plus 50 x (wt-10) 40 plus 2 x (wt-10)
> 20 kg 1500 plus 20 x (wt-20) 60 plus 1 x (wt-20)

Table 1.1 Calculating maintenance fluid

 100mls/hour (2400mls/day) is the normal maximum amount.

 Based on the Clinical Practical Guidelines in Intravenous Fluids at Hospital.

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