Intake and Output - Garcia PDF

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Intake and Output Intake (I) – anything that is entering the body • ORAL INTAKE – A record of how much liquid a patient consumes • ENTERAL INTAKE – Nutritional formula feedings are ordered for patients who are unable to take food by mouth. – The formula is administered through a tube that delivers the nutritional feeding into the gastrointestinal tract. • Tube goes up the nose and down the mouth – pts who has esophageal cancer who can’t eat. • Administered either thru Bolus (pour the can into the syringe and little by little, for pts who is up and about) or Continuous (thru a IV, slower rate and all the time) • PARENTERAL INTAKE – Includes any IV fluid that infuses into the patient. • To calculate the parenteral intake, the nurse multiplies the hourly infusion rate by the number of hours the IV fluid infused. – IVPBs (intravenous piggy bag) • Parenteral intake includes IVPBs. The nurse adds the total amount of fluid in the IVPB(s) administered during the shift to the parenteral intake. • Hang the bag higher than the IV bag, go in thru the same IV line • Document it • Requires the nurse to know the measurement of food and liquid containers used in clinical agencies. • Refers to any food that is liquid at room temperature – Soup – Juice – Coffee/Tea – Milk – Ice cream – Popsicle = 3 ounces – Gelatin – Ice Chips (melts to ½ the original volume) Output (O) – anything that comes out of the body • OUTPUT – body fluid that is eliminated during the shift. – i.e., urine, wound drainage (suction that takes drainage into a canister), gastric fluid (vomit), diarrhea • Any liquid produced by the body that can be measured – nurses are interested – Urine – Emesis (vomitus) – N/G tube drainage (drains stomach contents) – Wound drainage – Diarrhea – Colostomy/ileostomy drainage – Fluids removed from special procedures • Does not include: Blood drawn from the vein, tears, or sweat.

Monitoring Intake • When a patient is on intake and output, the nurse monitors the intake and – adds together what the patient drinks, including all foods that turn to liquid as a part of the intake. – includes formula feedings administered through feeding tubes such as nasogastric, gastric, or jejunostomy tubes. – includes parenteral intake. – records and reports the patient’s I & O for the shift. Clinical Example of Recording Intake  For breakfast, the patient drank 180 mL of coffee, a 4 oz glass of juice, and 8 ounces of milk. For lunch the patient drank 120 mL of tea and took 4 tbs of broth.  Use the metric equivalent measurements to convert all household measurements to mL.  Add the total for the shift.  What is the patient’s intake?

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The patient is on I & O. For breakfast, the patient drank 90 mL of coffee and 6 ounces of milk. For lunch the patient ate 4 oz of gelatin and 2 tbs of ice cream. At the end of the shift, the nurse noted that the patient had taken 500 mL of water. What is the patient’s intake for the shift?

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The patient returned from a procedure and was only allowed ice chips. The patient took 12 oz of ice chips. Recall that ice chips melt to ½ the original volume. In this example,12 oz melts down to 6 oz. Actual intake from the ice chips is 180 mL. What is the patient’s intake for the 7 - 3 shift?

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7 - 3 Shift Intake mL Ice chips 180

Measuring Output  The nurse measures the patient’s output by using calibrated devices that assist in measuring the amount of fluid output.

Clinical Example of Recording Output  Throughout the shift the nurse uses a calibrated device to measure the amount of output in mL and records the output.  The patient had 225 mL of emesis during the shift. At the end of the shift, the nurse emptied 350 mL of urine from the urinary catheter and 50 mL of wound drainage. What is the patient’s output?

Bladder Irrigation and Output • There are times when the physician orders the urinary bladder to be irrigated with a specific solution. • In working with a patient who is ordered a bladder irrigation, it is important to remember: • Irrigating solution is instilled into the bladder. • As the solution leaves the bladder it is mixed with urine. • To subtract the total amount of irrigating solution instilled into the bladder from the total amount of fluid measured from the urinary drainage bag to calculate the actual urine output.

The physician may order the urinary bladder irrigation via two methods: – Continuously • A specific amount of irrigating solution is continuously instilled into the bladder every hour through the urinary catheter. • For ex. : Irrigate bladder with 0.9% NaCl at 50 mL / hr. – Manually • A specific amount of irrigating solution is instilled into the urinary catheter at scheduled intervals. • For ex: Irrigate bladder with 0.9% NaCl 100 mL q6h. Practice Problems •...