Intake and OutputIntake and Output

Maintaining fluid balanceMaintaining fluid balance

Fluid BalanceFluid Balance

Fluid intake should equal fluid Fluid intake should equal fluid output. output.

Intake = what you take inIntake = what you take in Output = what you excreteOutput = what you excrete

IntakeIntake

70% of adult body consists of 70% of adult body consists of waterwater

1% short = thirsty1% short = thirsty 5% short = slight shortage5% short = slight shortage 12% short = possible death12% short = possible death Daily: ½ of body weight in Daily: ½ of body weight in

ouncesounces

OutputOutput

Average urine output = 1500 Average urine output = 1500 cc’scc’s

Water is also lost from:Water is also lost from: Skin: 200-500 ccs / daySkin: 200-500 ccs / day Lungs: 400 cc’sLungs: 400 cc’s Gastrointestinal tract: 100 cc’sGastrointestinal tract: 100 cc’s

Fluid Imbalance:Fluid Imbalance:DehydrationDehydration

Definition: Definition: output exceeds intakeoutput exceeds intake.. Causes:Causes: DiarrheaDiarrhea VomitingVomiting BleedingBleeding Excessive perspiration (diaphoresis)Excessive perspiration (diaphoresis) Poor fluid intakePoor fluid intake

Symptoms of DehydrationSymptoms of Dehydration

Fever is present.Fever is present. There is a decrease in urine.There is a decrease in urine. Urine is concentrated.Urine is concentrated. Weight loss occurs.Weight loss occurs. Membranes are dry and it is Membranes are dry and it is

difficult to swallow.difficult to swallow.

Tongue is coated and Tongue is coated and thickened.thickened.

Skin becomes hard and Skin becomes hard and cracks and is dry and warm.cracks and is dry and warm.

““Tenting” of skin.Tenting” of skin.

Edema: Causes:Edema: Causes: Fluid intake exceeds outputFluid intake exceeds output.. High salt intakeHigh salt intake InfectionsInfections Injuries or burnsInjuries or burns Certain kidney diseasesCertain kidney diseases Certain heart diseases or Certain heart diseases or

heart inefficienciesheart inefficiencies

Sitting too long in one Sitting too long in one positionposition

Infiltration of an IVInfiltration of an IV

Symptoms of EdemaSymptoms of Edema

Decrease in urine outputDecrease in urine output Gain in weightGain in weight Puffiness or swellingPuffiness or swelling Shortness of breathShortness of breath

Intake and OutputIntake and Output

Chart any fluid taken in and any Chart any fluid taken in and any fluid that is eliminated. Record fluid that is eliminated. Record in cubic centimeters (cc).in cubic centimeters (cc).

To convert ounces to cc’s:To convert ounces to cc’s: 1 oz. = 30 cc’s1 oz. = 30 cc’s 30X (number of ounces) = 30X (number of ounces) =

number of cc’snumber of cc’s

IntakeIntake

All liquid taken by mouth: All liquid taken by mouth: water, coffee, tea, milk, water, coffee, tea, milk, juices, and other beverages.juices, and other beverages.

Any food item that turns to Any food item that turns to liquid at room temperature liquid at room temperature (ex: gelatin, ice cream, ice, (ex: gelatin, ice cream, ice, etc.)etc.)

All fluid taken by IV or tube All fluid taken by IV or tube feeding.feeding.

Tube feedings, or enteral Tube feedings, or enteral feedings, are recorded as oral feedings, are recorded as oral intake or in a special column.intake or in a special column.

They are used for patients They are used for patients who are unable to swallow; who are unable to swallow; examples: nasogastric tube, examples: nasogastric tube, gastrostomy tubegastrostomy tube

Intravenous (IV) refers to fluids Intravenous (IV) refers to fluids given into a vein.given into a vein.

Blood units, plasma and other Blood units, plasma and other intravenous solutions are intravenous solutions are measured.measured.

This measurement is the This measurement is the responsibility of the nurse or responsibility of the nurse or other authorized team member.other authorized team member.

OutputOutput

UrineUrine Emesis (vomit)Emesis (vomit) Suctioned secretionSuctioned secretion DrainageDrainage Excessive perspirationExcessive perspiration Bowel movementBowel movement

Bowel movement (BM)Bowel movement (BM) – – Liquid bowel movements are Liquid bowel movements are usually measured and recorded.usually measured and recorded.

A solid or formed BM is usually A solid or formed BM is usually noted in the remarks column.noted in the remarks column.

Emesis – Emesis – anything that is anything that is vomited is measured and vomited is measured and recorded.recorded.

Color, type, and other facts are Color, type, and other facts are noted in the remarks column.noted in the remarks column.

Urine – Urine – All urine voided or drained All urine voided or drained via a catheter is measured and via a catheter is measured and recorded. recorded.

IrrigationIrrigation – Any irrigation or – Any irrigation or suction drainage, including drainage suction drainage, including drainage from NG tubes, hemo-vacs, chest from NG tubes, hemo-vacs, chest tubes, and other drainage tubes, is tubes, and other drainage tubes, is measured.measured.

The type, amount, color and other The type, amount, color and other facts are noted in the remarks facts are noted in the remarks columncolumn

Urine hat / specimen collectorUrine hat / specimen collector

If an irrigating solution is injected If an irrigating solution is injected into a tube and more solution into a tube and more solution returns, the excess is considered returns, the excess is considered output.output.

All amounts must be measured All amounts must be measured in graduates.in graduates.

A A graduategraduate is a container that is is a container that is made of plastic and has made of plastic and has calibrations for milliliters / cc’s or calibrations for milliliters / cc’s or ounces on the side. (1 ml = 1 cc)ounces on the side. (1 ml = 1 cc)

In addition, the graduate must In addition, the graduate must be held at eye level to accurately be held at eye level to accurately record amounts.record amounts.

Care must be taken when adding Care must be taken when adding or totaling the columns on the or totaling the columns on the I&O record.I&O record.

Most records contain totals for 8-Most records contain totals for 8-hour and 24-hour periods.hour and 24-hour periods.

Measuring I&OMeasuring I&O

Patients should be given careful Patients should be given careful instructions when an I&O record instructions when an I&O record is being kept.is being kept.

The patient must inform health The patient must inform health care providers when he or she care providers when he or she drinks fluids not provided by the drinks fluids not provided by the health care team.health care team.

Standard precautions must be Standard precautions must be followed at all times when body followed at all times when body fluids are measured for I&O fluids are measured for I&O records.records.

Gloves must be worn while the Gloves must be worn while the fluids are being measured and fluids are being measured and discarded.discarded.

If splashing or spraying of fluids is If splashing or spraying of fluids is possible, a mask, eye protection, possible, a mask, eye protection, and gown must be worn.and gown must be worn.

Converting Common Converting Common MeasurementsMeasurements

1 Tbs = 15 ml1 Tbs = 15 ml 2 Tbs = 30 ml or 1 ounce (oz)2 Tbs = 30 ml or 1 ounce (oz) 1 cup = 8 oz = 240 ml1 cup = 8 oz = 240 ml 1 pint = 2 cups = 16 oz = 480 ml1 pint = 2 cups = 16 oz = 480 ml 1 quart (qt) = 2 pints = 4 cups = 1 quart (qt) = 2 pints = 4 cups =

32 oz = 960 ml32 oz = 960 ml