1. Maintaining fluid balance
Intake and Output
Maintaining fluid balance

2. Fluid Balance Fluid intake should equal fluid output.
Intake = what you take in
Output = what you excrete

3. Intake 70% of adult body consists of water 1% short = thirsty
5% short = slight shortage
12% short = possible death
Daily: ½ of body weight in ounces

4. Output Average urine output = 1500 cc’s Water is also lost from:
Skin: ccs / day
Lungs: 400 cc’s
Gastrointestinal tract: 100 cc’s

5. Fluid Imbalance: Dehydration
Definition: output exceeds intake.
Causes:
Diarrhea
Vomiting
Bleeding
Excessive perspiration (diaphoresis)
Poor fluid intake

6. Symptoms of Dehydration
Fever is present.
There is a decrease in urine.
Urine is concentrated.
Weight loss occurs.
Membranes are dry and it is difficult to swallow.

7. Tongue is coated and thickened.
Skin becomes hard and cracks and is dry and warm.
“Tenting” of skin.

8. Edema: Causes: Fluid intake exceeds output. High salt intake
Infections
Injuries or burns
Certain kidney diseases
Certain heart diseases or heart inefficiencies

9. Sitting too long in one position
Infiltration of an IV

10. Symptoms of Edema Decrease in urine output Gain in weight
Puffiness or swelling
Shortness of breath

11. Intake and Output
Chart any fluid taken in and any fluid that is eliminated. Record in cubic centimeters (cc).
To convert ounces to cc’s:
1 oz. = 30 cc’s
30X (number of ounces) = number of cc’s

12. Intake
All liquid taken by mouth: water, coffee, tea, milk, juices, and other beverages.
Any food item that turns to liquid at room temperature (ex: gelatin, ice cream, ice, etc.)

13. All fluid taken by IV or tube feeding.
Tube feedings, or enteral feedings, are recorded as oral intake or in a special column.
They are used for patients who are unable to swallow; examples: nasogastric tube, gastrostomy tube

16. Intravenous (IV) refers to fluids given into a vein.
Blood units, plasma and other intravenous solutions are measured.
This measurement is the responsibility of the nurse or other authorized team member.

18. Output Urine Emesis (vomit) Suctioned secretion Drainage
Excessive perspiration
Bowel movement

19. Bowel movement (BM) – Liquid bowel movements are usually measured and recorded.
A solid or formed BM is usually noted in the remarks column.
Emesis – anything that is vomited is measured and recorded.
Color, type, and other facts are noted in the remarks column.

20. Urine – All urine voided or drained via a catheter is measured and recorded.
Irrigation – Any irrigation or suction drainage, including drainage from NG tubes, hemo-vacs, chest tubes, and other drainage tubes, is measured.
The type, amount, color and other facts are noted in the remarks column

21. Urine hat / specimen collector

22. If an irrigating solution is injected into a tube and more solution returns, the excess is considered output.
All amounts must be measured in graduates.
A graduate is a container that is made of plastic and has calibrations for milliliters / cc’s or ounces on the side. (1 ml = 1 cc)

24. In addition, the graduate must be held at eye level to accurately record amounts.
Care must be taken when adding or totaling the columns on the I&O record.
Most records contain totals for 8-hour and 24-hour periods.

25. Measuring I&O
Patients should be given careful instructions when an I&O record is being kept.
The patient must inform health care providers when he or she drinks fluids not provided by the health care team.

26. Standard precautions must be followed at all times when body fluids are measured for I&O records.
Gloves must be worn while the fluids are being measured and discarded.
If splashing or spraying of fluids is possible, a mask, eye protection, and gown must be worn.

27. Converting Common Measurements
1 Tbs = 15 ml
2 Tbs = 30 ml or 1 ounce (oz)
1 cup = 8 oz = 240 ml
1 pint = 2 cups = 16 oz = 480 ml
1 quart (qt) = 2 pints = 4 cups = 32 oz = 960 ml