Intake and Output

1
Intake and Output
Height and Weight
2
Question re Critical Thinking

• List three problems that could make a patient At
  Risk for Fluid and Electrolyte Imbalances ?
• _________________________________________
• _________________________________________
• _________________________________________

3
Question re Critical Thinking

• List three problems that could make a patient At
  Risk for Fluid and Electrolyte Imbalances ?
• Dependent on others to meet their nutritional
  needs
• Preoperative patients
• Postoperative patients
• NPO for diagnostic test, nausea/ vomiting/
  chronic diseases/ aspiration risk
• Severe trauma, burns,
• Patients taking diuretics
• Special drainages or nasogastric suction

4
Question

• True or False
• ___ A HCP order is needed to measure I O?

5
Question

• True or False
• _F_ A HCP order is needed to measure I O?
• The HCP usually orders strict I O on the
  critical patient where fluid overload is a high
  risk.
• On most med-surg units, everyone is on IO.
• A nurse can initiate I O as a nursing order if
  the need is indicated.

6
Measuring Intake and Output

• Unit to measure I O is milliliter (ml)
• Must convert household measures to metric units
• 1 8 oz 240 ml.

7
Equipment to Measure I O

• Worksheet place to record amount and time as it
  actually happens. Kept at the bedside.
• Graphic Record chart
• Graduated glass or cup
• Bedpan or Urinal
• Urine collection devices (graduated)
• Non-sterile gloves
• Sign at the bedside indicating patient is on I
  O

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INTAKE items that are Measurable

• Oral fluids
• water, milk, juice, soft drinks, coffee, tea,
  etc. Include water taken with medications.
• Ice chips
• recorded as ½ the original total amount
• (i.e.) 100ml. of ice 50ml. of intake
• Foods that become liquid at room temperature
• ice cream, sherbet, Popsicle, gelatin. Pureed
  food is not considered fluid intake.

9
INTAKE items that are Measurable

• Tube feedings
• the actual bag or bottle of tube feeding product
  and be sure to include water used to flush the
  tube.
• Parenteral fluids
• IVs, piggybacks, and blood transfusions. Be
  sure to record left to counts, and the amounts
  from pumps.
• GU irrigant
• irrigation fluids amounts must be documented to
  ensure that the actual urinary output is
  determined.

10
OUTPUT items that are measurable

• Urinary output
• Voiding pour urine in measuring container,
  observe amount and time.
• Catheter Empty total content at the end of
• the shift and document amount.
• For ICU patients. a Urimeter measures hourly
  output and is used with foley catheter bags.
• Incontinence If a patient is incontinent
  estimate and record these outputs as small,
  moderate, or large and the number of times pads
  changed.
• Weighed Infant or pedi population the diapers or
  pads are weighed. Each gram of weight is equal
  to 1 ml. of urine.

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OUTPUT items that are measurable

• Vomit and liquid feces
• colostomy bag contents included.
• Tube drainage
• gastric or intestinal
• Wound drainage Called a Wound Vac
• Amount of drainage collected in a vacuum drainage
  or gravity drainage system.

12
Question re Safety

• Fill in the Blank
• What is the most important equipment needed when
  measuring a patients output? _________________

13
Question re Safety

• Fill in the Blank
• What is the most important equipment needed when
  measuring a patients output?
• GLOVES

14
Documentation

• Totaled at the end of the shift from worksheet
  and transferred to the graphic record
• Some patients have hourly measurements ordered
• Shift totals are then added at the end of 24
  hours

Intake and Output Record
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Top Eight Causes for Error in Measuring I0

• 8. Failure to designate the specific volume of
  glasses, cups, and bowls utilized.
• 7. Failure to estimate losses from perspiration,
  incontinence, and wound drainage
• 6. Failure to measure fluids used in irrigations
• 5. Failure to record volumes at the time they are
  observed
• 4. Guessing of the measurements instead of
  actually measuring
• 3. Failure to explain to the patient the
  importance of measurement
• 2. Failure to explain to the family the
  importance of measurement
• The Number ONE Cause for Error in Measuring I0
  is
• 1. Poor communication among staff

16

• H
• E
• I and
• G WEIGHT
• H
• T

17
What is the single most important Indicator of a
patients fluid status?
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Answer The patients weight

• Each kilogram (2.2lbs) of weight gained or lost
  is equal to 1 liter of fluid retained or lost.
• These fluid gains and losses indicate changes in
  total body fluid volume.

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GUIDELINES

• 1. The patient should be weighed the same time
  each day using the same equipment and with same
  clothing on.
• 2. If daily weights are ordered, the patient is
  weighed in the early AM.
• 3. Many times the doctor may order a daily weight
  to assess fluid loss or gain and not for
  nutritional purposes.
• 4. The patients height is usually obtained only
  on admission to the hospital. Shoes should be
  removed.

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What are you going to do if the
patient is too ill to get out of bed to
a scale?
21

• USE A SLING SCALE
• OR
• A BED SCALE

22
Other forms of Scales to use when the patient is
unable to stand
Chair Scales
23
Questions

• If food turns into a liquid at room temperature
  does this count in IO?
• What would 60 ml ice cream count as?
• What would 4 oz. of Jell-O count as?
• If a clear solid liquid turns into a liquid at
  room temperature, does this count as intake?
• What would 20ml of ice count as?

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Answers

• If food turns into a liquid at room temperature
  does this count this item in IO? Yes
• What would 60 ml ice cream count as? 60ml
• What would 4 oz. of Jell-O count as? 120ml
• If a clear solid liquid turns into a liquid at
  room temperature, does this count as intake? Yes
• What would 20ml of ice count as? 10ml

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In Summary This information helps maintain an
ongoing evaluation of the patients HYDRATION
status to prevent severe imbalances.