MONITORING INTAKE & OUTPUT

- The measurement and recording of all fluid intake and output during 24 hour period
Purpose: 1. To monitor and ensure effective hydration and elimination 2. To obtain an accurate assessment of clients fluid and electrolyte balance

EQUIPMENT
1. 2. 3. 4. 5. 6. Calibrated cup or glass Calibrated water pitcher Bedpan/urinal Calibrated container for urine Intake and output record 24 hour record in chart

Procedure
1. Check the doctors order for measuring intake and output 2. Assess the clients knowledge and ability to participate 3. Wash hands 4. Organize equipment if needed

Intake
5. Place the calibrated cups in the room and instruct the client and relatives to measure all fluids consumed by the client on the cup provided. 6. Measure all oral intakes of water, juice, beverage, soup with calibrated cup 7. Measure all intravenous intake and gastric tube feeding, if any

Intake
8. Record time and amount of all fluid intake and bedside I & O form 9. Transfer 8-hour total fluid intake from bedside I & O record to 24-hour I & O record on clients chart 10. Compute 24-hour intake record by adding all 8-hour total intake

Output
11. Wear non-sterile gloves 12. Measure the amount of urine output accurately a. Empty urinal bedpan into calibrated container b. If the client is with indwelling catheter, measure the contents of the urine bag and discard its contents after each measurement

Output
13. If any, diarrheic stools and vomitous should be measured and added to output tally 14. Remove and discard gloves. Wash hands 15. Record the time and amount of output on bedside I & O record. 16. Transfer 8-hour output to total to 24-hour I & O record on clients chart 17. Compute 24-hour output record by totaling all 8-hour total output

CLINICAL DOS & DONTS

Dos: 1. Identify whether your patient has undergone surgery or if he has a medical condition or takes medications that can affect fluid intake or loss. 2. Measure and record all intake and output. 3. At least every 8 hours, record the type and amount of all fluids he's received and describe the route.

CLINICAL DOS & DONTS

Dos: 4. Record ice chips as fluid at approximately half their volume. 5. Record the type and amount of all fluids the patient has lost and the route. 6. If irrigating a nasogastric or another tube or the bladder, measure the amount instilled and subtract it from total output.

CLINICAL DOS & DONTS

Dos: 7. For an accurate measurement, keep toilet paper out of your patient's urine. 8. Measure drainage in a calibrated container. 9. Evaluate patterns and values outside the normal range, keeping in mind the typical 24hour intake and output 10. When looking at 8-hour urine output, ask how many times the patient voided, to identify problems

CLINICAL DOS & DONTS

Dos: 11. 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

CLINICAL DOS & DONTS

Donts: 1. 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. 2. Don't assess output by amount only. Consider color, color changes, and odor too. 3. Don't use the same graduated container for more than one patient