1. Allied Health & Medicine **Begin Class by reading Ch. 21:5 in Red Book
Intake and Output
Allied Health & Medicine
**Begin Class by reading
Ch. 21:5 in Red Book

2. To maintain health, the body must take in a certain amount of fluid each day Generally, a healthy person needs to take in from 64 to 96 ounces of fluid per day

3. Fluid Balance
Fluid balance is maintaining equal input and output taking in and eliminating equal amounts of fluids

4. Fluid volume excess
a surplus, an amount greater than that which is normal or that which is required

5. Fluid volume deficit
a reduction in body fluids – “dehydration”

6. Intake (Input) Liquids a person drinks Semi-liquid foods Gelatin Soup
Ice cream
Pudding
Yogurt
(Nurses also figure IV solutions, medications, blood, etc.)

7. Output Urine Feces (including diarrhea) Vomitus
(Nurses also figure blood loss, chest tube output, drainage tubes, etc.)

8. Input -Measurement Know the sizes of the containers your facility uses
Convert all measurements to milliliters (ml)

9. Output - Measurement
Always remember to protect yourself with the proper PPE
Keep container level on a flat surface while measuring
Prevent splashing or spilling
If splashing is a risk: mask,goggles,& gown
After emptying contents into the toilet, rinse container and put it away
Remove gloves and wash hands

10. The diaper/adult brief trick
Weight of 1 US Gallon of water = approx lb (about 3.79 kg)
One ounce of water weighs approx. one ounce.

12. Common Conversions 15 drops = 1 ml = 1 cc 1 teaspoon = 5ml = 5 cc
1 tablespoon = 15 ml = 15 cc
2 tablespoons = 1 oz = 30 ml = 30 cc
1 cup = 8 oz = 240 ml = 240 cc
1 pint = 16 oz = 500 ml = 500 cc
1 quart = 32 oz = 1000 ml = 1000 cc

13. Specimen Hat
Urinal
Graduate
Traditional bed pan
Fracture bed pan

14. Intake By Mouth: all fluids and foods that are liquid at room temp.
Tube Feeding:
Recorded as oral intake or a special column.
Used for patients who are unable to swallow, the unconscious or comatose.
Solution contains all nutrients required by the body and I s more nourishing than IV feedings
Given through NG (nasogastric) or G (gastrostomy) tube

15. Patient will be in a mid fowlers position during feeding and for 30-60 min following.
Make sure there are no kinks in tubing, caution is used when turning or positioning a patient, give frequent oral hygiene, notify nurse if alarm sounds…solution is not flowing…solution is low or empty
IV (Intravenous)
Fluids given into a vein
Includes blood units, plasma, and other solutions

16. Irrigation
-fluids placed into tubes tat have been inserted into the body.
Any fluid removed after irrigation is not intake
If nasogastric tube is irrigated with 80 mL of solution and exact amount is drawn back out, this is not recorded as intake.
However, if 60 mL is drawn back out, 20 mL is recorded as irrigation intake
Measurement Is Responsibility of Nurse or other legally authorized team member. (IV, Irrigation, tube feeding)

17. Output -refers to all fluids eliminated by patient Bowel Movement (BM)
Liquid BM measured and recorded
Solid or formed BM is usually noted in remarks column or described under feces.
Nurse assistant may measure/record
Emesis
Material vomited is measured and recorded
Color, type, and other facts are noted in remarks

18. Urine Irrigation All urine voided is measured and recorded
Urine drained by catheter is measured and recorded
Nurse assistant may measure/record
Urine output of less than 30 mL per hour must be reported
Irrigation
Irrigation or suction drainage is measured and recorded
Drainage included from NG tube, chest tube, other tubes
Type, color, and other facts are noted in remarks column
Excess is recorded as output.

19. Records must be accurate
All amounts are measured in graduates
Container made of plastic or stainless steel
Has calibrations for milliliters/cubic centimeters and/or ounces on the side
Similar to a measuring cup
Graduate should be held at eye level or placed on solid surface and viewed at eye level to accurately record amounts
Be careful adding or totaling
Totals are for 8-hr and 24-hr

20. Recording I’s & O’s Some agencies keep record at bedside
Team members not I and O of patient
Record measurements on I and O record
At times, patients are taught to record I and O
Other agencies keep record in patient chart
Measurements are noted on a sheet of paper and reported.
Nurse, unit sec., or authorized team member records info on Is and Os.

21. Give careful instructions for I’s and O’s
Patient must inform healthcare worker when they drink fluids
Can recorded glasses of water or quantity remaining in a filled pitcher.
Assistants must think about fluid intake every time a glass, cup , or water pitcher is removed from the room.
Amounts must be recorded if a guest brings in fluids.

22. Females: used a bed pan or specimen hat
Males: use a urinal
Patients must not place toilet tissue or expel BMs into bedpan or urine collector
If patients are given correct instructions, they can cooperate so accurate records can be maintained.

23. Standard Precautions
Includes Urine, emesis, liquid bowel movements, and drainage.
Gloves must be worn when fluids are measured and discarded.
Hands must be washed frequently and immediately after removal of gloves
If splashing or spraying of fluids is possible, a mask, eye protection, and a gown must be worn
Graduate must be used for one patient only, and discarded or sterilized when output is no longer measured.
Areas contaminated by body fluids must be wiped with a disinfectant

24. Basic principles for completing I and O records
Use a blue or black ink pen
Find correct time
Find correct column (oral intake, urine output)
Record correct amount
Recheck all entries
Enter observations: color, types
All information for an 8-hr time period is recorded, total each column separately to calculate the 8 hr total

25. Error: draw one red line through error, initial in red Final check:
When all 8-hr time periods have been totaled, add the 3 8-hr totals for each separate column
This gives a 24 hr total
Some charts are 24-hr without 8-hr increments
Recheck all addition
Error: draw one red line through error, initial in red
Final check:
All entries correct, comments are noted in remarks column, addition is accurate, entries are neat and legible.