1. Intake and Output Unit 20.5 pages 728-733 LEQ: What does a patients I/O record tell you about their overall health?

2. Why are they so Important?? It helps us determine the patient’s fluid status: 1. Are they Hydrated? 2. Are they Dehydrated? 3. Are they in Fluid Overload? 4. Is there an obstruction?

3. Intake 1.Oral Fluids: Water, Ice, Beverages 2.Semi-Liquid Foods: Pudding, Jell-O, Custards, Yogurt 3.Parenteral Fluids: IV Fluid, Medications, Blood Products 4.Any Food Liquid at Room Temperature: Popsicles, ice cream, and frozen yogurt

4. Measuring Output Emesis Basin Foley Catheter Graduated Cylinder Urinal Fractured Bedpan Estimates ( Unless Strict I/O is Ordered)

5. Urine Identification page 603 Straw Colored (WNL) Dark Orange or Yellow (Concentrated) Foul Smell (UTI) Sediment (UTI or Kidney Failure) Blood (Severe UTI, STD, Hemorrhage)

6. Output 1.Urine: Normal Voiding, Diapers, Ostomies, Ileal Conduits 2.Stool: Liquid Stools from Diarrhea 3.GI Suctioning 4.Wound Drainage 5.Vomiting 6.Sweating 7.Respirations

7. Items to Keep in Mind Measure Fluids instead of guessing Estimate and Record Fluid Loss from Incontinence (1oz = 30cc) Record and Report the Intensity of Diaphoresis Record Ice Chips Appropriately ( It is usually ½ the Volume of Fluid) Use the Code Key Provided for You

8. What To Look Out For 1. Is the patient drinking at least 1500cc a day (Unless they are on Fluid Restrictions) 2. Urinates at least once in an 8 hour shift or urinate less than 30 cc an hour (240cc/8hrs) 3. Has concentrated or foul-smelling urine 4. Has Dry Skin 5. Has a temperature above 99 degrees 6. Is perspiring excessively 7. Has excessive wound Drainage

9. Possible Causes of Fluid Excess Kidney Disease Liver Disease Certain Medications : Steroids or a Sodium Based Medication Abnormal Fluid Accumulation in Body Cavities Overinfusion of IV Fluids Pregnancy

10. Signs and Symptoms of Fluid Excess Edema or Ascites: Abnormal accumulation of fluid in the spaces between the cells (interstitial) Rapid Weight Gain: Fluid Accumulation will increase overall weight Increased Blood Pressure: May indicate accumulation of fluid within the circulatory system Taut Skin: Shinny Skin may indicate Edema Shortness Of Breath: Excess fluid pools in the lungs

11. Possible Causes of Fluid Loss 1. Hypovolemic Shock 2. Excess Body Drainage 3. Diarrhea 4. Medications (diuretics) 5. Difficulty Swallowing 6. Impaired Physical Mobility 7. Postoperative Factors 8. Fever

12. Other Causes and Signs and Symptoms of Fluid Loss 1.Concentrated Urine: The body excreting more solutes and less water 2.Rapid Weight Loss: A large percentage of weight is fluid (as seen with High Protein Diets) 3.Increased Pulse: Low Fluid Volumes cause an increase in Heart Rate 4.Decreased Skin Turgor: Loss of elasticity of the skin due to a lack of proper hydration 5.Dry Skin: Reflects fluid loss from cells 6.Sticky Mucus Membranes: Reflects fluid loss in normally moist tissue 7.Weakness and Confusion: Lack of fluids can interfere with normal nerve conduction and decreases circulation to the brain

13. Things to Remember Taking I&O’s Collect and record all I/O as it occurs and do not rely on memory recall at the end of a shift Measure contents in the appropriate containers and read at eye level. Remind patients to let you know if they have taken in anything or voided Usually totals are taken at the end of a shift, but keep in mind that frequent checks can increase the accuracy of I&O’s Document in the appropriate area and remember to Be Accurate Report any questionable output or drastic changes in the patients condition

14. LEQ: What does a patients I/O record tell you about their overall health?

15. Clinical Prep Characteristics of Urine page 603 Copy Table 18.1 down in your notes and be prepared to use it to identify various characteristics of Urine Specimens tomorrow along with being able to document the output. Identify: Urinal, Hemovac, Emesis Basin, Graduated Cylinder, Foley Catheter, Fractured Bedpan, and Bedpan

16. 20.5 Clinical Prep Characteristics of Urine page 603 On a blank sheet of paper, number 1-15. Using your chart, analyze the URINE Specimens by writing down the: –a Amount in cc’s (ALL SAMPLES) –b Characteristic of the Sample –c Hydrated vs Dehydrated (5-15) –d Possible Diagnosis

17. Transfer the Intake and Output from Assignment Sheet #2 for 20.5 B Recording Intake and Output onto the I/O Record at the end of your packet. Bring this with you to class Friday