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Weekly Fluid Intake Record Amount of water per day (check one): 1000 mL per day 1500 mL per day Other: __________ mL per day Preferred Fluid (check all that apply): Water ( ice no ice warm thickened Other: ______________) Juice: _________________________________________ ( ice no ice) Other: __________________________________________ Quick Reference of Sample Volumes (volumes may vary) 150 mL water glass (used to pass meds) 175 mL water glass 225 mL glass cup (coffee/tea) 200 mL plastic cup (coffee/tea) 225 mL soup/cereal bowl 70 mL small bowl (pudding etc.) For more directions and guidance: Week of: __________________________________________________ Mon Tues Wed Thurs Fri Sat Sun 1 2 3 4 5 6 7 8 Total Volume = 100 mL (approximately 1/2 cup) = 200 mL (approximately 1 cup) Tips to Promote / Encourage Fluid Intake • Offer fluid with each hourly check-in. Offer fluid with each interaction with the patient (like the med pass). Provide a full glass of fluid with each med pass. Encourage increased fluid intake with meals. • Family members to offer fluid each hour on the hour while awake. Hydration Information Increase fluid intake when patient is feeling unwell or has illness. Increase fluid intake during warm weather. Adequate fluid intake promotes regular bowel patterns. • Beverages that contain caffeine (tea/coffee/ soda) are poor sources for providing hydration as they have diuretic properties and contribute to fluid loss (makes the patient void more). www.ammi.ca #SymptomFreeLetItBe

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Page 1: Amount of water per day (check one): Preferred Fluid ... · Weekly Fluid Intake Record Amount of water per day (check one): 1000 mL per day 1500 mL per day Other: _____ mL per day

Weekly Fluid Intake Record

Amount of water per day (check one):

1000 mL per day 1500 mL per day Other: __________ mL per day

Preferred Fluid (check all that apply):

Water ( ice no ice warm thickened Other: ______________)

Juice: _________________________________________ ( ice no ice)

Other: __________________________________________

Quick Reference of Sample Volumes (volumes may vary)

150 mLwater glass

(used to pass meds)

175 mLwater glass

225 mLglass cup (coffee/tea)

200 mLplastic cup

(coffee/tea)

225 mL soup/cereal

bowl

70 mLsmall bowl (pudding etc.)

For more directions and guidance:

Week of: __________________________________________________

Mon Tues Wed Thurs Fri Sat Sun

1

2

3

4

5

6

7

8

Total Volume

= 100 mL (approximately 1/2 cup)

= 200 mL (approximately 1 cup)

Tips to Promote / Encourage Fluid Intake

• Offer fluid with each hourly check-in.

• Offer fluid with each interaction with the patient (like the med pass).

• Provide a full glass of fluid with each med pass.

• Encourage increased fluid intake with meals.

• Family members to offer fluid each hour on the hour while awake.

Hydration Information

• Increase fluid intake when patient is feeling unwell or has illness.

• Increase fluid intake during warm weather.

• Adequate fluid intake promotes regular bowel patterns.

• Beverages that contain caffeine (tea/coffee/soda) are poor sources for providing hydration as they have diuretic properties and contribute to fluid loss (makes the patient void more).

www.ammi.ca #SymptomFreeLetItBe

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