INTAKE AND OUTPUT MONITORING

INTAKE

A. B.

C. D. E.

Is any measurable fluid that goes into the patient's body. Intake includes: Fluids (such as water, soup, and fruit juice) "solids" composed primarily of liquids (such as ice cream and gelatin) Are taken by mouth (orally) Fluids that are introduced by IV, Fluids that are introduced by irrigation (through a tube)

OUTPUT
Is any measurable fluid that comes from the body. The major forms of output recorded on the worksheet are: A. Urine B. Drainage C. vomitus (matter vomited) D. stools (fecal discharge from the bowels). Other forms: Water given off in the form of perspiration and water vapor (exhaled breath)

I and O Monitoring

Measurement and recording of all fluid intake and output during a 24-hour period. does not require a physicians order Unit of measurement of I and O is in mL (milliliter) To masure fluid intake, nurses must convert household measures such as glass, cup or soup bowl to metric units. Purpose: provides important data about the clients fluid and electrolyte balance.

INDICATIONS
Facility personnel should routinely monitor fluid balance (I&O) for the following: All clients receiving tube feedings Clients with catheters Clients with urinary tract infections Clients with physician orders for fluid restrictions or orders to force (encourage) fluids Clients with specific physician orders for additional liquid (fluid) Clients who are known to be dehydrated or who are at risk for dehydration Clients with certain heart and kidney conditions that are at high risk for fluid imbalance Clients receiving intravenous fluids or parenteral nutrition therapy Any clients who develops a fever, vomiting, diarrhea or a nonfebrile infection, unexplained weight loss or gain, pedal edema, neck vein distension, or shortness of breath.

CLINICAL DOs and DONTs

DOs Identify whether your patient has undergone surgery or if he has a medical condition or takes medications that can affect fluid intake or loss. Measure and record all intake and output. If you delegate this task, make sure you know the totals and the fluid sources. At least every 8 hours, record the type and amount of all fluids he's received and describe the route as oral, parenteral, rectal, or by enteric tube. Record ice chips as fluid at approximately half their volume.

Record the type and amount of all fluids the patient has lost and the route. Describe them as urine, liquid stool, vomitus, tube drainage (including from chest, closed wound drainage, and nasogastric tubes), and any fluid aspirated from a body cavity. If irrigating a nasogastric or another tube or the bladder, measure the amount instilled and subtract it from total output. For an accurate measurement, keep toilet paper out of your patient's urine. Measure drainage in a calibrated container. Observe it at eye level and take the reading at the bottom of the meniscus.

When looking at 8-hour urine output, ask how many times the patient voided, to identify problems. For example, was a total of 300 and from 2 voids of 150 ml, or from 10 voids of 30 ml each? Regard intake and output holistically because age, diagnosis, medical problem, and type of surgical procedure can affect the amounts. Evaluate trends over 24 to 48 hours.

DONTs Don't delegate the task of recording intake and output until you're sure the person who's going to do it understands its importance. Don't assess output by amount only. Consider color, color changes, and odor too. Don't use the same graduated container for more than one patient.

Fluid gains and losses

The following are typical 24-hour values for an adult. Intake 2,600 ml 1,300 ml oral fluids 1,000 ml in food 300 ml in oxidation of food Output 2,400 to 2,700 ml 1,500 ml urine 200 ml in stool 400 to 600 ml through the skin 300 to 400 ml through respiration

MEASUREMENT OF VOLUME

Measure ............................................................................... Approximate equivalent Cubic centimeter...................................................................... 1 ml Teaspoon ................................................................................. 5 ml Tablespoon............................................................................... 15 ml Ounce ...................................................................................... 30 ml Medicine Glass (1 oz.) ............................................................ 30 ml Small Fruit Cup ....................................................................... 120 ml Coffee Cup .............................................................................. 160 ml Large Coffee Mug ................................................................... 180 ml Plastic or Paper Juice Container .............................................. 180 ml Half-pint Milk ......................................................................... 240 ml Large Soup Bowl ..................................................................... 240 ml Large Water Glass.................................................................... 240 ml