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 I&O. • 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

8. INTAKEitems 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. INTAKEitems 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 • IV’s, 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. OUTPUTitems 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.

11. 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 patient’s output? _________________

13. Question re: Safety Fill in the Blank • What is the most important equipment needed when measuring a patient’s output? GLOVES

14. Documentation Intake and Output Record • 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

15. Top Eight Causes for Error in Measuring I&0 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 I&0 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 patient’s fluid status?

18. Answer: The patient’s 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.

19. 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 patient’s height is usually obtained only on admission to the hospital. Shoes should be removed.

20. 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 I&O? • 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?

24. Answers • If food turns into a liquid at room temperature does this count this item in I&O? 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

25. In Summary This information helps maintain an ongoing evaluation of the patient’s HYDRATION status to prevent severe imbalances.