Intake and Output & Enteral Nutrition PDF

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I&O nutrition...

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Intake and Output & Enteral Nutrition Part A: Intake and Output Rationale: Measuring and reflection of all liquid intake and output (I & 0) during a 24 hr. period is an important part of assessing a client’s fluid and electrolyte balance. You will acquire the knowledge to accurately measure and record a client’s intake and output. Learning Objectives: By the end of this topic, you will: 1. Describe the following terms: Intake - the amount of food or fluid ingested or infused in a given period.

Fluid balance the state of the body in relation to ingestion and excretion of water and electrolyte

Liquid - a state of matter, intermediate between solid and gas, in which the molecules move freely among themselves and the substance flows freely with little application of force. Liquids have a fixed volume but assume the shape of the vessel in which they are contained.

caloric intake: measure of amount of food energy as calories eaten

dehydration: Excessiv e loss of water from the body or from an organ or a body part

output : The amount produced, ejected, or excreted by an entity during a specified time

Fluid volume deficit: A deficit of fluid volume occurs when there is either an excessive loss of body water or an inadequate compensatory intake. Etiologic factors include active loss through vomiting, diarrhea, gastric suctioning, drainage through operative wounds and tubes, burns, fistulas, hypermetabolic states, and drug-induced diuresis. Insufficient intake of water can be caused by nausea, immobility with inaccessibility of water, and lack of knowledge about the necessity of adequate fluid intake.

fluid volume excess: ↑ isotonic fluid retention; Factors contributing to this include (1) arterial dilatation, as occurs in the inflammatory process; (2) reduced oncotic pressure, as in hypoproteinuria (particularly a deficit of albumin, which is responsible for 80 per cent of oncotic pressure), lymphatic obstruction, and increased capillary permeability, which allows water to escape into the tissues and produce swelling; (3) renal retention of sodium and consequently of water, as seen in renal failure; (4) inadequate

Intake and Output & Enteral Nutrition circulation of blood through the general circulation, as in congestive heart failure, or through the portal circulation, as in liver failure; and (5) overproduction or administration of adrenocortical hormones.

2. State the importance of monitoring fluid and nutritional intake and fluid output of a client who is dysphagic, anorexic or receiving an enteral feeding. Nutritional monitoring and evaluation identifies the progress made on the plan of care and measures outcomes. Patients need to be monitored for fluid and nutritional intake and output for any nutritional deficiencies, or for signs of inadequate fluid intake 3. Explain methods used to monitor adequacy of food intake and fluid intake and output. Food intake    

Food diary  A detailed record of portion sizes of all food and fluids a client consumes in 3-7 days 24-hour recall  Client recalls all the food and fluids consumed in 24 hours Food-frequency record  A checklist that indicates the food groups or specific foods eaten Diet history  Involves an comprehensive, time-consuming assessment of a client's food intake in an interview by a dietician

Fluid intake and output  Measure a patient’s fluid intake by mouth, feeding tubes, or intravenous catheters and then the output from the kidneys (urine collection bag, urine hat, and bedpans), gastrointestinal tract (emesis, tube feeding aspirations), drainage tubes, and wounds and record it in a 24 hour period. 4. Describe information and observations to document and report about food intake and fluid intake and output. It is important to record the specifics of an IV fluid, such as the type of solution, additives, time started and amount absorbed. Fluid intake – oral fluids, ice chips, foods that tend to become liquid at room temperature (ice cream, jell-o), tube feedings (including water instilled), parental fluids, IV medications, catheter or tube irrigants. Fluid output – urinary output (the amount and

Intake and Output & Enteral Nutrition time of voiding), vomitus and liquid feces (the amount and type and time), tube drainage, wound drainage. Food intake – a daily caloric count to determine the exact quantity of food and fluid ingested. The patients weight, age and level of activity are recorded to determine whether nutritional intake is adequate. 5. Describe how to document fluid intake and output for an 8 hr. and 24 hr. period of time (include positive or negative balance). Fluid intake and output measurements are totalled at the end of the shift (every 8 to 12 hours), and the torals are recorded in the client’s permanent record. In intensive care areas, the nurse may record intake and output more frequently. Usually, the nurses on night shift total the amounts of I&O recorded for each shift and record the 24-hour total. To determine whether the fluid output is proportional to fluid intake or whether there are many changes in the client’s fluid status, the nurse (1) compares the total 24-hour fluid output measurement with the total fluid intake measurement, and (2) compares both with previous measurements. Urinary output is normally equivalent to the amount of fluids ingested; the usual range is 1500 mL to 2000 mL in 24 hours, or 40 mL to 80 mL in 1 hour(.5...