I Identify whether your patient has undergone surgery or if he has a medical condition or takes medication that can affect fluid intake or loss. * Measure and record all intake and output. If you delegate this task, make sure you know the totals and the fluid sources. At least every 8 hours, record the type and amount of all fluids he's received and describe the route as oral, parenteral, rectal, or by enteric tube.It helps us determine the patient’s fluid status: Y Are they Hydrated? Y Are they Dehydrated? Y Are they in Fluid Qverload? Y Is there an obstruction?Fluid Balance = Fluid intake should equal fluid output. = Intake = what you take in = Output = what you excreteMeasuring intake/output Intake: * Output: Ice * Emesis Juice * Urine Coffee * Blood/drainage Yogart * Liquid stools Jello * NG drainage |V/Tube feedings Anything liquid at room temperatureNormal bladder function » The normal adult bladder holds between 500 and 600 millilitres (mLs) of urine. » People start feeling the urge td urinate when the bladder is about half full. >» Aperson with normal bladder function can suppress this urge for up to 1 or 2 hours, until the bladder is full. > Most people urinate 3 to 6 times during the day and possibly once or twice during the night.Normal bladder function + Adult bladder has capacity of 400-600 ml + Urge to void on average @ 150 ml + Sense of fullness on average @ 300 ml + Bladder volume > 500 ml increases risk for: - Over-distension — Atony — Incomplete bladder emptying - UTI Baidini ot al (2009) fz of MiccwwSpecial Precautions... ¢ During lactation, COCPs should be withheld until six months after delivery or until the infant is weaned, whichever comes earlierDIAGNOSIS - URINE OUTPUT URINE OUTPUT (ml / day) - IN ADULTS * Normal = 800-2000 b * Decreased = 500 (Oliguria) * Decreased = 100 (Anuria) * Increased = >2500 - 3000Fluid balance/imbalance eRe Tas 5 amt fluid taken in = amt fluid excreted Fluid imbalance- hero eos B em roe ces mito Dehydration- excess fluid lossview MenUHE Hay Sten Possible Causes of Fluid Excess * Kidney Disease * Liver Disease * Certain Medications : Steroids or a Sodium Based Medication * Abnormal Fluid Accumulation in Body Cavities, * Over infusion of IV Fluids * Pregnancyewig menue ray StenRLE ORIENTATION MCN- OB WARD 10 - Baxter, Travenol 15- Hospira, Abbott, Mc Graw 20- Wellcare, Cutter, B. Braun, TerumoRLE ORIENTATION MCN- OB WARD 1. Infusion Rate (long method) — MACRO DROP Total vol. to be infused X factor No. of hours (60min/hour)RLE ORIENTATION MCN- OB WARD 1. Infusion Rate (long method) — micro DROP Total vol. to be infused X 60 gtts/min No. of hours (60min/hour)RLE ORIENTATION MCN- OB WARD 1. Infusion Rate (short method) -micro DROP Total vol. to be infused No. of hoursINTRAVENOUS INFUSIONS.SOAPIE a ISSN ne VS | AN (use NANDA) (SMART criteria) At least 10 Goal met, unmet or interventions (focus partially met Related factor (r/t) Specific on alleviating the is/are the “cause” of Measurable problem) the problem Attainable Realistic Include SKA - Timebound - Include Health - Promotion1. Newborn Care - vital signs - newborn’s (immerse/bedside) bath - cord care - breastfeeding - CBG 2. Postpartum Care - vital signs - breastfeeding - nutrition education RLE ORIENTATION MCN- 08 WARD 0 Meera si aa A8. © ABUAH SEBASTIANEA MA © esas hesBo Maori Fy st marin RLE ORIENTATION 2. Postpartum Care MCN- 0B WARD - wound care (perineal care) - breast massage - BT assist ewer - wound care (post CS) Fe sun - perilight application ae - suppository insertion - urinary catheter insertion and removal Sea - oral meds o - discharge instruction AB © ABUAH SEBASTIAN BAY MA © Aleaneis And0 Maras aa RLE ORIENTATION = con ano! 8 0 ABUAN seBAsTAN Ea 2. Postpartum Care - IV monitoring/ troubleshooting/spiking - | & O monitoring - 24 hours urine collection - bladder training - binder application - CBG - drug incorporation & preparation - skin test MA © Aleaneis AndBo Maori Fy st marin RLE ORIENTATION 2. Postpartum Care MCN- OB WARD - wound care (perineal care) - breast massage - BT assist ewer - wound care (post CS) Fe sun - perilight application ae - suppository insertion - urinary catheter insertion and removal Sea - oral meds o - discharge instruction AB © ABUAH SEBASTIAN BAY MA © Aleaneis AndVital Signs (Newborn) KeyFacts % member ‘Newborn Vital Signs Pulse 120-160 bpm ‘rig slp sow as 80 bo cig, vp to 180 bom pial pb counted for fu inte Respiations A 30-60 respratonsminte Predominant aptrogmatc but sdvonas wth abdoninal movements Aespations are counted for 1 mite ‘Blood Pressure 20-60/45-40 mem Hg ait 10/80 mm gat ay 10 Temperature Norma ange 365-375 97.7-99.4°F) alloy, 36437.2C 07 559°) ‘Sin: 36-36 5C 68.97.79) acta 36537 2C 078957) G0 Ne a tn. aa AB © ABUAH SEBASTIAN BAY AK 0 Acai And!Latching on techniques Ia Signs of Good Attachment a. chin touching breast b. mouth wide open c. lower lip turned outward d. more areola visible above than below the mouth* irrigating solution, usually 200mL of solution warmed to body tempe (or as ordered) *goggles, gown, mask «clean gloves sterile gloves *impervious plastic trash| Cleaning Wounds Preparation: * Assemble the equipment at the patient’s bedside. * Cut tape into strips for securing dressings. * Loosen lids on cleaning solutions and medications for easy removal. * Attach the impervious plastic trash bag to the over bed table to hold used dressings. * Check the irrigating fluid if at the proper temperature.| Cleaning Wounds PROCEDURE: *Patient preparation 1. Assist the client to a position in which the irrigating solution will flow by gravity from the upper end to the lower end then into the basin. 2. Place the waterproof drape over the client and the bed.3. Put on clean gloves and gently roll or lift an edge of the soiled dressing to obtain a starting point. Support adjacent skin while gently releasing the soiled dressing from the skin. When possible, remove the dressing in the direction of hair growth. 4. Discard soiled dressing and your contaminated gloves in the impervious plastic trash bag to avoid contaminating sterile field then wash hands.| Cleaning Wounds 5. Put on clean gloves. 6. Inspect the wound. 7. Clean the wound. Moisten gauze pads either by dipping the pads in wound cleaning solution and wringing excess or by using a spray gun bottle to apply solution to the gauze.FIRST SWAB8. Use a separate swab for each stroke, and discard each swab after use. This prevents the introduction of microorganisms to the wound area. 9. Dry the wound with 4”x4” gauze pads, using the same procedure as for cleaning.| Typesof Dressings Transparent Dressings are often applied to wounds including ulcerated or burned skin areas.[ATTENDING PRCA uring Service Department VITAL SIGNS RECORD