1. Intake and Output Calculation
Prepared by :
Miss . Salwa Maghrabi

2. Outline Equipment . Assessment . Implementations . Documentation .
Definition of intake and output calculation .
The purposes of intake and output calculation.
The procedure :
Equipment .
Assessment .
Implementations .
Documentation .
Negative and positive balance .
Situations .

3. Objectives List the purposes of intake and output calculations .
Mentions the parameters of assessments before intake and output calculation .
Discribe the negative and positive balance.
Determine who to calculate the intake and output .

4. Intake and Output Calculations
The process involves recording all the fluid that goes into the patient and the fluid that leaves the body.
Normal conditions the intake should equal output in 24 hours.
Ex of intake :
Liquids taken PO .
Intravenous fluids (IV) .
Feedings via nasograstic or PEG tubes.
Ex of output :
Urine or liquid feces.
Blood.
Drainage from wounds or suction.

5. The purposes of intake and output calculation
Ensure accurate record keeping.
Prevent circulatory overloud.
Prevent dehydration.
Aids in analyzing trends in fluid status.
Contributes to accurate assessment record.

6. The Procedure
The Equipment :
Intake and output chart.

7. Assessments
1. Check the kardex or listen in report to determine if an assigned client is on I&O. 2. Verify during report how much IV fluid has been accounted for from any currently infusing solution.

8. Assessment
3. Review the nursing care plan. 4. Review the client’s medical record and analyze trends in I&O, vital signs measurements, laboratory findings, and weight records.

9. Cont. Assessment
5. Perform a physical assessment . 6. Inspect all tubing’s and drains . 7. Notice if all suction containers or drainage containers were emptied .

10. Cont Assessment Determine how much the client understands.
Look for a calibrated container and bedside I&O record.
Obtain a collection device for inside the toilet
Measure the amount of water in the client’s bedside.

11. Implementations
Explain the purpose and procedures for measuring I&O to the client.
Record the volume for all fluids consumed.
Make sure that all IV fluids or tube feedings are being administered at the prescribed rate.

12. Cont Implementations
Ensure that the nurse who adds additional IV fluid containers also records the volume .
Keep track of fluid volumes used to irrigate drainage tubes or flush feeding tubes.
Wear gloves.
Measure and record the volume of voided urine, urine collected in a catheter drainage bag, liquid stool or other.
Wash hands .
Check the volume remaining in currently infusing IV fluids.

13. Cont Implemenations Record the total amount of all fluid
intake and output volumes.
Compare the data to determine if the intake and output are approximately the same.
Report major differences in I&O to the client’s physician.

14. Review the plan of care and if the goals have not been met.
Report the I&O volumes IV fluid credit amount, and or other data.

15. Documentation Negative and positive balance: Date and time.
Intake and output volumes for the next shift .
Negative and positive balance:
If the total intake for the shift > the total output for the shift negative balance .
If the total intake for the shift  the total output for the shift positive balance .

16. Situation 1
A patient has recorded the following on a sheet of paper at the bedside: Breakfast: eggs, toast, one cup of coffee (180 ml ); small orange juice (120 ml ). Lunch: sandwich, apple, glass of tea (one glass of tea 240 ml ) Dinner: chicken, broccoli, rice, 2 glasses of tea Between meals: 4 glasses of water ( one glass of water 120 ml ). 1000mL of D5 W infusing IV at 30 mL/hour Calculate the intake for 12 hours shift ?

17. The Answer one cup of coffee =180 ml . small orange juice = 120 ml .
3 glass of tea = 3× 240 = 720 ml .
4 glass of water = 4 × 120 = 480 ml.
30 ml IV fluid × 12 hours = 360 ml
Total intake for 12 hours = = 1860 ml .

18. Situation 2
The patient recorded the following amounts voided on the sheet of paper: 400 cc at 7:00 am; 100cc at 10:00 am; 200cc at 12 noon; 150 cc at 2:00 pm; 400cc at 6:00pm. The nurse emptied 300cc from a JP tube. The patient vomited 100cc at 4:00 pm What is the total output for the 12 hour shift. Calculate the output for 12 hours ?

19. The Answer Urine voided = 400 cc +100cc +200cc +150 cc +400cc =1250 ml
300cc from a JP tube.
The patient vomited 100cc.
The total output for 12 hours = = 1650 ml .