Intake and Output Monitoring

Intake
Is any measurable fluid that goes into the patient's body. Intake includes fluids
(such as water,soup, and fruit juice) and "solids" composed primarily of liquids (such
as ice cream and gelatin)that are taken by mouth (orally), fluids that are introduced
by IV, and fluids that are introduced byirrigation (through a tube)
Output
Is any measurable fluid that comes from the body. Water given off in the form of
perspiration andwater vapor (exhaled breath) is also output, but it is not recorded
on the DD Form 792, since itcannot be accurately measured. (An adult usually
looses about 500 milliliters (ml) a day through perspiration and moisture exhaled in
breathing.) The major forms of output recorded on theworksheet are urine,
drainage, vomitus (matter vomited), and stools (fecal discharge from the
bowels).You should monitor client who have fluid imbalances or are at high risk of
dehydration bycalculating intake and output (I&O) each shift. Take I&O monitoring
seriously. Set a realisticintake goal for each shift. Most fluid is consumed on the day
shift, with the least consumed onnights. Thus, set a specific goal for each shift.
Setting a goal will tell the nurse at a glancewhether the client has consumed
enough fluid on his or her shift. If not, the CNA shouldencourage fluids before
leaving for the day. When establishing goals for fluid intake, fluid isusually divided
as follows:* Day shift: 1/2 of total 24-hour fluid goal* Second shift: 1/3 of total 24hour fluid goal* Third shift: 1/6 of total 24-hour fluid goalFor client with a fluid
restriction, total fluid allowance for each shift can be distributed in thesame
quantity listed above. Modify the amounts listed as necessary to personalize fluid
intake tothe clients individual needs.I&O monitoring is a simple procedure that does
not require a physicians order. Sadly, nursessometimes do not take this important
intervention seriously. Write the need for I&O monitoring,as well as any special
approaches or resident preferences, on the care plan. If the clients is knownto be at
high risk of dehydration upon admission, begin a temporary care plan to address
this risk.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 DO'S & DON'TS
INTAKE AND OUTPUT gauge fluid balance and give valuable information about your
patient'scondition.
DO

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
knowthe totals and the fluid sources.

At least every 8 hours, record the type and amount of all fluids he's received and
describethe 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
themas urine, liquid stool, vomitus, tube drainage (including from chest, closed
wounddrainage, 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 andsubtract 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 atthe bottom of the meniscus.

Evaluate patterns and values outside the normal range, keeping in mind the typical
24-hour intake and output. (See Fluid Gains and Losses.)

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 voidsof 30 ml each?

Regard intake and output holistically because age, diagnosis, medical problem, and
typeof surgical procedure can affect the amounts. Evaluate trends over 24 to 48
hours.
DON'T

Don't delegate the task of recording intake and output until you're sure the person
who'sgoing 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.0
Fluid gains and losses
The following are typical 24-hour values for an adult.Intake 2,600 ml1,300 ml oral
fluids1,000 ml in food300 ml in oxidation of foodOutput 2,400 to 2,700 ml1,500 ml
urine200 ml in stool400 to 600 ml through the skin300 to 400 ml through
respirationMeasure ...............................................................................
Approximate equivalentCubic
centimeter...................................................................... 1
mlTeaspoon ................................................................................. 5
mlTablespoon............................................................................... 15
mlOunce ...................................................................................... 30 mlMedicine
Glass (1 oz.) ............................................................ 30 mlSmall Fruit
Cup ....................................................................... 120 mlCoffee
Cup .............................................................................. 160 mlLarge Coffee
Mug ................................................................... 180 mlPlastic or Paper Juice
Container .............................................. 180 mlHalf-pint
Milk ......................................................................... 240 mlLarge Soup
Bowl ..................................................................... 240 mlLarge Water
Glass.................................................................... 240
mlPint ........................................................................................... 480 ml1/2
Liter ................................................................................... 500 m