Monitoring Intake & Output

Ms. Salome A. Rahim, RN, SN, MN, MPH Teaching Nursing Consultant TMSS Health Sector, TMSS

Ms. Salome A. Rahim, Nursing Consultant, THS, TMS

Pretest

What is major output that is measured? Write the examples of output items. Write the intake and output monitoring.

Ms. Salome A. Rahim, Nursing Consultant, THS, TMS

Pretest

Major item of output measurement is a. vomitus b. stool c. urine d. diaphoresis Choose the items of intake measure measurements; coffee, pepsi, mango shake, dhal, lemon juice, milk, ice cream, soup, tomato puree Write the equipments in monitoring I & O. What are the indications of monitoring I & O. Calculate the total I & O from 7:00 am to 3:00pm.

D5NSS 350ML, vomitus 15 ml, metronidazole inj. 50 ml, water 200 ml, bhudta 25ml, urine 50 ml, tea 100ml, orange juice 50 ml. Mango puree 30 ml

Ms. Salome A. Rahim, Nursing Consultant, THS, TMS

Objectives:

To maintain fluid balance. To assess whether a patient is receiving adequate fluids or to verify that the output is sufficient for optimum kidney function. To maintain record for the use of all health team members.

Ms. Salome A. Rahim, Nursing Consultant, THS, TMS

Indication for I & O measurement

Postoperative patients Those who have intravenous fluids, indwelling catheters or feeding tubes. Patients, who are diabetic, have burns, draining wounds or are on diuretics and steroid therapy. Patients who has cancer or a debilitating disease. Infants, children, and the elderly to ensure effective hydration and elimination.

Ms. Salome A. Rahim, Nursing Consultant, THS, TMS

Equipments

I & O form at bedside I & O graphic record in chart Glass or cup Bedpan or urinal bedside commode Clean gloves

Ms. Salome A. Rahim, Nursing Consultant, THS, TMS

Guiding Principles

The intake should approximate the output. Any ratio that is quite unequal should be reported. Intake should be monitored for several days to get an accurate measurement of the patients fluid status. If the total intake is substantially below the total output, the patient is in danger of fluid volume deficit. If the patient total fluid intake is substantially above the total output, the patient is at risk for fluid volume excess (Matheny, 1987, page 13).

Ms. Salome A. Rahim, Nursing Consultant, THS, TMS

A urine output of less than 30ml/hr may indicate renal disease or dehydration, and should be reported. Some patients for whom fluid balance is important but not critical will have daily weights performed but intake and output measurement. For others whose water balance is crucial, intake and output will be ordered along with daily weights.
Ms. Salome A. Rahim, Nursing Consultant, THS, TMS

Items Measured

Intake

Measure all fluid items that are naturally fluid at room temperature. These include water, milk, juice, and all other beverages, ice cream, gelatin and soups. Tube feedings. Do not measure pureed foods; they are simply solids that are prepared in a different form. Any solution that is infused intravenously, including blood products and irrigating solutions that are not returned, are included in intake.

Ms. Salome A. Rahim, Nursing Consultant, THS, TMS

Output Urine is the major output item that is measured. Stool or losses of water through the skin if the patient has diarrhea or profuse diaphoresis. Vomitus, drainage from the suction devices, wound drainage, and bleeding.
Ms. Salome A. Rahim, Nursing Consultant, THS, TMS

Devices Used For Measurement Collection hat To measure the urine output of infant: subtracting the weight of the dry diaper from the wet one and infant urine collection bag.

Ms. Salome A. Rahim, Nursing Consultant, THS, TMS

Units of Measurement Intake and output are measured in either cubic centimeters (cc) or metric liquid units called milliliter (ml).

Ms. Salome A. Rahim, Nursing Consultant, THS, TMS

Patient Participation First, make sure the patient knows which fluids of intake and output are to be measured and the units of measurements. The use of any devices other than the toilet should be explained so that the patient is familiar with them. If the patient is on restricted or increased fluid intake, develop a plan that is the most acceptable and comfortable for that person.
Ms. Salome A. Rahim, Nursing Consultant, THS, TMS

Record Keeping Bedside record Permanent records

Ms. Salome A. Rahim, Nursing Consultant, THS, TMS

Post test

Major item of output measurement is a. vomitus b. stool c. urine d. diaphoresis Choose the items of intake measure measurements; coffee, pepsi, mango shake, dhal, lemon juice, milk, ice cream, soup, tomato puree Write the equipments in monitoring I & O. What are the indications of monitoring I & O. Calculate the total I & O from 7:00 am to 3:00pm.

D5NSS 350ML, vomitus 15 ml, metronidazole inj. 50 ml, water 200 ml, bhudta 25ml, urine 50 ml, tea 50ml, orange juice 50 ml. Mango puree 30 ml

Ms. Salome A. Rahim, Nursing Consultant, THS, TMS

Post Test on IV Infusion

Write the 3 items in calculating the flow rate. Doctor order: D5LR 1 L at 130 ml/hr. Calculate the number of hours and gtts/min. Drop factor is 15gtts/ml. The needle size for blood transfusion for adult is a. 18 b. 20 c. 23 d. 25 The nurse will stay with the patient having blood transfusion during first a. 25ml b. 30ml c. 50ml d. 100ml The only appropriate IVF solution for blood transfusion is? How many hours the IVF solution should change? a. 24 b. 36 c. 48 d. 78 Hives is the complication of? What do you record after Intravenous infusion and blood transfusion? What is KVO and KSS

Ms. Salome A. Rahim, Nursing Consultant, THS, TMS