Monitoring INTAKE & OUTPUT

ALEXA C. ABIDIN, RN

Brent Hospital and Colleges IncorporatedEpiscopal Diocese of Southern Philippines

COLLEGE OF NURSING

I. ADULTS

a. Women: 50-55% body weight is water

b. Men: 60-70% body weight is waterc. Elderly: 47% body weight is water

II. INFANTS75-80% body weight is water

BODY FLUIDS

• 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 INTAKE

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,SUCTION,VOMITUS AND DRAINS)

Ideal Daily fluid Intake and OutputSource/ AMOUNT/ Route/ AMOUNTH2O consumed as fluid/ 1500ml/ urine/ 1400-1500mlH2O present in food/ 750ml / insensible losses/ 350-400mlH2O produced by oxidation/ 350ml / lungs/ 350-400mlskin / 100ml/sweat/ 100-200mlfeces /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/INTAKEORAL- WATER, FLUIDS, JUICES ORAL MEDICINE-LIQUID

SUSPENSION

PARENTERAL- INTRAVENOUS FLUIDSCheck 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

SUCTIONNGT RESIDUALSSECRETIONS (in the suction

bottle)

INTAKEDATE/TIME ORAL PARENTERAL TUBAL WHOLE

BLOODTOTAL

7-3 100 800 200 450 1550

3-11 90 800 200 450 1540

11-7 100 800 200 0 110024HOUR TOTAL 4190

OUTPUTDATE/TIME

URINE EMESIS STOOL SUCTION TOTAL NURSE’S SIGNATURE

7-3 300 20 0 50 370

3-11 200 2X 20 220

11-7 300 10 4X 0 31024HOUR TOTAL 900

PROCEDURE FOR MONITORINGINTAKE AND OUTPUT

ASSESSMENT1. Assess the institution’s policy and procedures for monitoring and recording I & O.2. Check the physician’s orders and/or need for I & O monitoring.3. Weigh client daily ( same time, scale and clothes)4. Assess patient’s and family’s knowledge of and ability to assist with intake and output measurement.

PLANNING5. 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. OUTPUT11. 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 suctionb)Chest tube drainagec)Jackson-Pratt or Hemovac drainsd)Emesis14. Remove gloves and disinfect your hands.

EVALUATION15. Calculate client’s intake and output as per doctor’s 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 client’s response.