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INTAKE A OUTPUT

(NOTE: You will need this information on intake and output for practice in 191 lab only.)
I.

What illnesses or situations suggest a hospitalized adult needs Intake and Output
monitoring? When problems or situations such as the following are present:
Acutely ill.
Fever, vomiting, diarrhea.
Before, duringgggggg, and after surgery
If IV or tubes are present.
Drug administration - chemotherapy, diuretics.
Kidney, urinary tract disease, or genito-urinary problem.
Heart disease (ie, CHF)
After major procedures requiring anesthesia, or IV's as cardiac
catheterization.
Neurological conditions.
Collection tests such as 24 hour urine.

II. Why should a nurse plan to do this?


To assess hydration, determine adequacy of intake, assess intake
and output balance, assess effectiveness of interventions as diuretic
administration, forcing fluids, or fluid restriction.
III.
-

Recording and Reporting.


Communicate significant observations to co-assign nurse, instructor, physician,
and record on chart Measuring Fluid Intake/Output.

Elimination - Recording in our acute care agencies varies somewhat from


your text. Locally enemas are generally not recorded unless a major discrepancy occurs,
i.e. you gave 500-1000cc of fluid and no output occurred for 1-2 hours. Removal of naso
oral secretions are generally not added to I & O. The fluid level in some drainage
devices are marked each shift rather than being emptied (i.e., chest tube drainage,
nasogastric drainage). Heavy perspiration and hyperventilation are generally recorded in
nurses notes not on I & O record.

IV. Recording and Reporting (continued)


d.

Where to record information:


Generally there are two varieties of intake and output recording sheets.
One is used at the bedside for immediate recording, the second is a flow
sheet and generally only 8 and 24 hour totals are recorded on the
permanent record in the person's chart. The bedside sheets may be kept
for the physicians until they make rounds the next day. At times, one sheet

serves both purposes and the bedside sheet is inserted in the chart. (For a
sample of the bedside sheet and information on how to record, please see
sample in module.) Intake and output may be reported at change of shift.
e.

How to use I & O as a means of gathering data:


Look at sheet - see if intake and output are in balance. Generally, you
expect recorded intake to exceed output, unless person is diuresing
(increased urine flow). Fluid loss through sweating, breathing and normal
stool are generally not accounted for on the
I & O sheet. Evaluate
adequacy of person's intake and determine if person needs fluids urged or
limited.
This sheet can be used to check if a person has voided. After surgery,
some tests, and delivery, a person is normally expected to URINATE
WITHIN EIGHT HOURS from time of voiding prior to test or surgery. If
a person has not voided, you may find HNV - the abbreviation for has not
voided - in the urine output column. It is considered a nursing responsibility to assure that urine output occurs. Report little or no output to
team leader or primary nurse. If you observed no output, but an alert
oriented client reports output occurred, record BR x1 (unobserved). If
client is incontinent of stool or urine you can write INCT x1 in the
appropriate column.
You may use intake column to see if person is tolerating oral fluids. If
person is tolerating an ounce or two of liquid every 1-2 hours, then they
may be ready to advance to clear liquid diet provided they are not
nauseated, distended, or on restricted fluid.
Check amounts of urine output and drainage to see if amount has been
excessive or scanty.
Eight hours is usually only a basis for trends, you may not be able to infer
a person's hydration status, without monitoring for 24-48 hours.
Accuracy in recording I & O is very important, otherwise data is of little
value in assessment.

PRACTICE:
1.

There are two situations #1 and #2 to practice I & O in Utility Room 112 - drawer
61, and Utility Room 107 - drawer 82.

2. You will need the following equipment:


- pencil, your own paper and black pen.
- *Foley drainage bag with fluid in it. (Filling drainage bag may be easier in F-112
utility room, use faucet with metal adapter.)

Emesis basin with fluid in it.


Bedpan with fluid in it.
Water pitcher with fluid in it.
Measuring graduates.
I & O sheets: bedside sheet and flow-sheet record with I & O section.

FOR TEST:
1. You will be given a situation card.
2. You need the following equipment set up prior to testing time:
Water pitcher with fluid.
Bedpan with fluid.
Foley bag with fluid.
2 measuring graduates (2 different sizes).
1 emesis basin with fluid.
I & O sheets: bedside sheet
HINTS:

In the lab you are determining some of your client's outputs. If your card says
your client had an emesis and no amount is given, you can measure the
amount in the emesis basin to provide your own number. This is true for other
outputs as well. Therefore, if you are giving your client very high outputs,
you are setting the stage for your client to have a potential fluid deficit.

REVIEW: Household and metric equivalents. Memorize for performance tests.


Equivalents:

Household
1 ounce
pint (4 ounces)
pint (8 ounces)
1 teaspoon
1 Tablespoon
15 cc

Metric
30 cc
120 cc
240 cc
5 cc