Brent Hospital and Colleges Incorporated

Episcopal Diocese of Southern Philippines

COLLEGE OF NURSING

INTAKE & OUTPUT

Monitoring

ALEXA C. ABIDIN, RN

BODY FLUIDS
I. ADULTS
a. Women: 50-55% body weight is water b. Men: 60-70% body weight is water c. Elderly: 47% body weight is water

II. INFANTS 75-80% body weight is water

FLUID INTAKE
Healthy adult ingests fluid as part of the dietary intake. 90% of intake is from the ingested food and water 10% of intake results from the products of cellular metabolism Usual intake of adult is about 2, 500 ml per day The other sources of fluid intake are: IVF, TPN, Blood products, and colloids

FLUID OUTPUT
The average fluid losses amounts to 2, 500 ml per day, counterbalancing the input. The routes of fluid output are the following: SENSIBLE LOSS- Urine, feces or GI losses, sweat INSENSIBLE LOSS- though the skin and lungs as water vapor URINE- is an ultra-filtrate of blood. The normal output is 1400 to 1,500 ml/day or 30-50 ml per hour or 0.5-1 ml per kilogram per hour. FECAL loss- usually amounts to about 200 ml in the stool Insensible loss- occurs in the skin and lungs, which are not noticeable and cannot be accurately measured. Water vapor goes out of the lungs and skin.

 INPUT- INTAKE AND INGESTION OF FLUIDS OUTPUT- END PRODUCT / WASTE OF PATIENT(URINE,SUCTIO N,VOMITUS AND DRAINS)

Ideal Daily fluid Intake and Output Source/ AMOUNT/ Route/ AMOUNT H2O consumed as fluid/ 1500ml/ urine/ 14001500ml H2O present in food/ 750ml / insensible losses/ 350-400ml H2O produced by oxidation/ 350ml / lungs/ 350-400ml skin / 100ml/sweat/ 100-200ml feces / TOTAL/ 2600ml/ TOTAL/ 2300-2600ml

PURPOSE
ASSESSMENT PARAMETERS CHECK AND MONITOR FLUID AND ELECTROLYTE BALANCE ASSESS KIDNEY FUNCTION

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 non febrile infection, unexplained weight loss or gain, pedal edema, neck vein distension, or shortness of breath.

Clinical Signs of Dehydration:

- dry skin and mucous membranes - concentrated urine - poor skin turgor - depressed periorbital space - sunken fontanelle - dry conjunctiva - cracked lips - decreased saliva - weak pulse

 Client's signs of Fluid Excess:

- peripheral edema - puffy eyelids - sudden weight gain - ascites - blurred vision - excessive salivation

INPUT/INTAKE
ORAL- WATER, FLUIDS, JUICES ORAL MEDICINE-LIQUID SUSPENSION

PARENTERAL- INTRAVENOUS FLUIDS Check the label and amount of IV fluids during nursing rounds

 Example: At 7am-Receiving Intravenous fluid is 1000 ml/cc .the remaining IV fluid after 8 hours(3pm) is 200 ml/cc

Total parenteral input is 800cc

 TUBAL Amount of NGT feeding given to patient Utilize the NGT feeding bottle with calibration for measurement

 Whole Blood Before blood transfusion, check the type and amount of blood to be given Amount /volume of blood varies in the type of blood preparation

OUTPUT
URINE Without catheter

Measure the amount of urine by using the calibration container

 WITH FOLEY CATHETER MEASURE THE AMOUNT OF URINE VIA THE URINE BAG DRAIN THE AMOUNT OF URINE IN THE MEASURING BOTTLE

 EMESIS OR VOMITUS MEASURING IS MORE ACCURATE IF THE VOMITUS IS PURELY LIQUID /FLUID TYPE ALSO UITLIZE THE CALIBRATION CONTAINER FOR MEASURING EMESIS

 MIXED EMESIS ( Fluids + solid food particles) and STOOL Assess the frequency of vomiting and defacation Example: Emesis- twice(2x) Stool-3x

SUCTION NGT RESIDUALS SECRETIONS (in the suction bottle)

INTAKE
DATE/TIME ORAL PARENTERAL TUBAL WHOLE BLOOD TOTAL

7-3 3-11 11-7

100 90 100

800 800 800

200 200 200

450 450 0
24HOUR TOTAL

1550 1540 1100 4190

OUTPUT
DATE/TIME URINE EMESIS STOOL SUCTION TOTAL NURSES SIGNATURE

7-3 3-11 11-7

300 20 200 300 10

0 2X 4X

50 20 0
24HOUR TOTAL

370 220 310 900

PROCEDURE FOR MONITORING INTAKE AND OUTPUT ASSESSMENT 1. Assess the institutions policy and procedures for monitoring and recording I & O. 2. Check the physicians orders and/or need for I & O monitoring. 3. Weigh client daily ( same time, scale and clothes) 4. Assess patients and familys knowledge of and ability to assist with intake and output measurement.

PLANNING 5. Determine individualized desired patient outcomes in relation to I & O: a)Intake and/or output are monitored accurately. b)I & O are approximately equal within normal limits for health, or the trend is toward normal expectations. c)The patient cooperates in ensuring accuracy of I & O.

IMPLEMENTATION 6. Use the standard protocol. 7. Select the proper equipment. 8. Wash or disinfect your hands.
9. Explain the procedure you are about to perform.

A. INPUT

10. Measure and record all fluid intake. a)Liquids with meals including gelatin, custards, ice cream, popsicles and sherbet. Ice chips are 50% of measures volume. b)Liquid medication. c)Tube feeding (enteral nutrition) d)IV Fluids

B. OUTPUT 11. Prior to measuring output, put on clean gloves to empty urinary output from foley catheter/urinal or bedpan. 12. Observe the amount and characteristics of urine output. Nurse Alert: Hourly urine output <30 ml/hour should be reported. 13. Measure and record all output, including urine and drainage from all sources. a)Nasogastric suction b)Chest tube drainage c) Jackson-Pratt or Hemovac drains d)Emesis 14. Remove gloves and disinfect your hands.

EVALUATION 15. Calculate clients intake and output as per doctors order. 16. Review the data collected related to the descriptions of the output fluids, comparing them with previously obtain fluids. Assess for differences, and report changes to physician if necessary. 17. Record and report intervention and clients response.