List three problems that could make a patient “At Risk for Fluid and Electrolyte Imbalances” ?

A._________________________________________B._________________________________________C._________________________________________

2

List three problems that could make a patient “At Risk for Fluid and Electrolyte Imbalances” ?

1.Dependent on others to meet their nutritional needs

2.Preoperative patients

3.Postoperative patients

4.NPO for diagnostic test, nausea/ vomiting/ chronic diseases/ aspiration risk

5.Severe trauma, burns,

6.Patients taking diuretics

7.Special drainages or nasogastric suction3

True or False

A.___ A HCP order is needed to measure I & O?

True or False

A._F_ A HCP order is needed to measure I & O?

The HCP usually orders strict I & O on the critical patient where fluid overload is a high risk.

On most med-surg units, everyone is on I&O.

A nurse can initiate I & O as a nursing order if the need is indicated.

Unit to measure I & O is milliliter (ml)

Must convert household measures to metric units

1 = 8 oz = 240 ml.

Worksheet – place to record amount and time as it actually happens. Kept at the bedside.

Graphic Record – chart

Graduated glass or cup

Bedpan or Urinal

Urine collection devices (graduated)

Non-sterile gloves

Sign at the bedside indicating patient is on I & O

Oral fluids ◦water, milk, juice, soft drinks, coffee, tea, etc.

Include water taken with medications.

Ice chips ◦ recorded as ½ the original total amount (i.e.) 100ml. of ice = 50ml. of intake

Foods that become liquid at room temperature ◦ ice cream, sherbet, Popsicle, gelatin. Pureed

food is not considered fluid intake.

Tube feedings◦ the actual bag or bottle of tube feeding product and

be sure to include water used to flush the tube.

Parenteral fluids◦ IV’s, piggybacks, and blood transfusions. Be sure

to record “left to counts”, and the amounts from pumps.

GU irrigant ◦ irrigation fluids amounts must be documented to

ensure that the actual urinary output is determined.

Urinary output ◦ Voiding: pour urine in measuring container, observe

amount and time.

◦ Catheter: Empty total content at the end of the shift and document amount.

◦ For ICU patients. a Urimeter measures hourly output and is used with foley catheter bags.

◦ Incontinence: If a patient is incontinent estimate and record these outputs as small, moderate, or large and the number of times pads changed.

◦Weighed: Infant or pedi population the diapers or pads are weighed. Each gram of weight is equal to 1 ml. of urine.

Vomit and liquid feces◦ colostomy bag contents included.

Tube drainage◦gastric or intestinal

Wound drainage – Called a Wound Vac◦Amount of drainage collected in a vacuum

drainage or gravity drainage system.

Fill in the Blank

A.What is the most important equipment needed when measuring a patient’s output? _________________

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Fill in the Blank

A.What is the most important equipment needed when measuring a patient’s output?

GLOVES

13

Totaled at the end of the shift from worksheet and transferred to the graphic record

Some patients have hourly measurements ordered

Shift totals are then added at the end of 24 hours

Intake and Output Record

8. Failure to designate the specific volume of glasses, cups, and bowls utilized.7. Failure to estimate losses from perspiration, incontinence, and wound drainage6. Failure to measure fluids used in irrigations5. Failure to record volumes at the time they are observed4. Guessing of the measurements instead of actually

measuring3. Failure to explain to the patient the importance of

measurement2. Failure to explain to the family the importance of

measurementThe Number ONE Cause for Error in Measuring I&0 is:1. Poor communication among staff

HE I and

G WEIGHT

HT

Each kilogram (2.2lbs) of weight gained or lost is equal to 1 liter of fluid retained or lost.

These fluid gains and losses indicate changes in total body fluid volume.

1. The patient should be weighed the same time each day using the same equipment and with same clothing on.

2. If daily weights are ordered, the patient is weighed in the early AM.

3. Many times the doctor may order a daily weight to assess fluid loss or gain and not for nutritional purposes.

4. The patient’s height is usually obtained only on admission to the hospital. Shoes should be removed.

What are you going

to do if the patient is too ill to get out of bed to a scale??

USE A SLING SCALE

OR

A BED SCALE

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22

1. If food turns into a liquid at room temperature does this count in I&O?

2. What would 60 ml ice cream count as?

3. What would 4 oz. of Jell-O count as?

4. If a clear solid liquid turns into a liquid at room temperature, does this count as intake?

5. What would 20ml of ice count as?

1. If food turns into a liquid at room

temperature does this count this item in

I&O? Yes

2. What would 60 ml ice cream count as?

60ml

3. What would 4 oz. of Jell-O count as?

120ml

4. If a clear solid liquid turns into a liquid at

room temperature, does this count as

intake? Yes

5. What would 20ml of ice count as? 10ml 24