Intake &output, insulin PDF

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intake/ output...

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Intake What is intake? These are fluids taken IN the body. It can be via various routes like the mouth, a tube, or intravenous (IV). What do you include for the liquids that are consumed? This includes anything that is liquid at room temperature like: 

Juice

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Water

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Ice chips (NOTE: this melts to half its volume….if you give the patient 8 oz of ice chips RECORD 4 oz)

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Drinks (coffee, soft drinks, tea etc.)

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Milk

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Gelatin (Jell-O ®)

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Broths

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Ice cream

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Frozen treats: popsicles, sorbet

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Nutrition supplements like Ensure® or Boost ® o

How about pudding or items similar to it? NO…most NCLEX review guides (example: Kaplan) specify NOT to include pudding etc. in the calculation since it is a semi-liquid (Irwin, Yock & Burckhardt, 2015). However, some sources say to include it (Carter, 2007), but with that being said, ask your professor what they want you to do. However, for this review we will NOT include pudding or products similar to it.

Many times test questions will give you the amount in ounces (oz), but we record intake and output in milliliters (mL). To convert oz to mL, simply multiply the amount of oz by 30. Example: 67 oz = 2010 mL Miscellaneous: 

Tube feedings (include free water)

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IV and central line fluids (TPN, lipids, blood products, medication infusion)

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IV and central line flushes

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Irrigants (example: irrigating a catheter….calculate the amount of irrigate delivered and subtract it from the total urine output…which will equal the urine output)

Output What is output? These are fluids that LEAVE the body. It can be via various routes as well.

What’s included: 

Urine output (most of the output calculation)

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Emesis

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Liquid stool (ostomy or diarrhea)

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Wound draining (drains, tubes…example: chest tubes etc.)

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Suction (gastric, respiratory)

Not included but needs to be considered is: insensible loss This is from the skin and respiratory system. It can’t be measured. According the Mosby’s Medical Dictionary, insensible loss is estimated to be 600 mL/day (“insensible water loss”, 2018). This varies depending on the patient’s activity level, temperature etc. Therefore, you want to take that in account when assessing if the patient is at risk for fluid volume deficient OR fluid volume overload. Interpreting Intake and Output 

If the intake is less than output or if the output is MORE than the intake….think DEHYRDATION! The patient is losing too much fluids compared to what they are taking in.

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If the intake is more than output or if the output is LESS than the intake….think that the patient may be retaining fluid and is in FLUID OVERLOAD!

Example: Intake 4250 mL and Output 1210 mL…..patient is at risk for fluid volume overload.

Intake and Output Practice Questions Intake and Output Practice Questions 1. During your 12-hour shift from 7p – 7a what is your patient’s INTAKE and OUTPUT? 2000-0600 Jevity 50 mL/hr 0615: 50 cc free water flush 2100-0215: Two 250 mL of red blood cells 0115: 20 cc saline flush IV 0300: Zosyn IV 50 mL 0400: 10 cc saline flush IV Continuous fluids: Heparin 10 mL/hr & Normal Saline 100 mL/hr

Ileostomy: 300 mL NG suction: 50 cc Urine: 1850 mL Wound vac: 100 cc A. Intake: 2200 mL & Output 1850 mL B. Intake: 2450 mL & Output: 2300 mL C. Intake: 1950 mL & Output: 2400 mL D. Intake: 540 mL & Output: 2450 mL The answer is B: Intake: 2450 mL & Output: 2300 mL 2. Calculate the patients INTAKE during your 12-hour shift: 0800: Two pieces of toast, 2 cups of oatmeal, 8 oz yogurt, 12 oz orange juice, 2 oz grits— 1000: Two 8 oz of coffee w/ 2 oz of cream in each— 1100: 24 oz of ice chips— 1200: IV infusion of Zosyn 50 mL, 2 mL IV push Zofran and 10 cc saline IV flush— 1230: house salad, 12 oz soda, three 12 oz popsicles— 1400: One pack of red blood cells (250 mL)— 1500: 2 mL Morphine and 10 cc saline flush IV— 1715: 10 cc saline flush IV— 1600-1900: Normal Saline IV 100 cc/hr A. 2390 mL B. 2124 mL C. 3394 mL D. 3294 mL The answer is C: 3394 mL

3. The patient’s output is 2025 mL during your 12-hour shift. Based on the patient’s intake in problem 2, what should you monitor the patient for as the nurse? A. Fluid volume overload B. Dehydration C. These findings are within normal limits…continue to monitor The answer is A. The patient’s intake in problem 2 was 3394 mL and if the patient’s output is 2025 mL, the nurse should monitor the patient for fluid volume overload. 4. Calculate the patient’s total urinary output for the shift. The patient has continuous bladder irrigation and a Foley catheter: 0800-1000: 3 Liters of bladder irrigation— 1000: emptied Foley catheter 3600 mL— 1100: 1 Liter of bladder irrigation— 1200: 2 Liters of bladder irrigation and emptied 3250 mL from Foley catheter— 1300: 1 Liter of bladder irrigation— 1400: 1 Liter of bladder irrigation— 1500: 1 Liter of bladder irrigation and emptied 3120 mL from Foley Catheter— 1600-1900: 3 Liters of bladder irrigation — 1900: emptied 4200 mL from Foley catheter A. 2170 mL B. 3280 mL C. 2350 mL D. 1200 mL The answer is A. 5. Your shift is from 7a-7p. The patient had the following intake and output during your shift. Based on your calculation, the patient is at risk for? 0800: 8 oz orange juice, 6 oz yogurt, slice of bread, 10 cc flush— 1000: 8 oz coffee w/ 1 oz of cream—

1200: 12 oz soda, Two 12 oz cherry popsicles, 3 oz chocolate pudding, 4 oz chicken broth— 1300: 6 oz soda, 12 oz custard— 1600: 8 oz ice chips — 1400-1900: 50 cc/hr IV infusion — ————————————————0700: 500 cc urine— 1100: emesis 100 cc, ileostomy stool 350 cc— 1200: wound vac drainage 200 cc— 1300: 250 cc urine— 1500: JP drain 400 cc— 1700: 350 cc urine— 1730: 400 cc urine— 1800: 350 cc urine— 1830: ileostomy stool 400 cc— 1845: 500 cc urine— A. Intake: 2080 mL & Output: 3520 mL; monitor the patient for dehydration B. Intake: 2270 mL & Output: 3800 mL; monitor the patient for dehydration C. Intake: 3890 mL & Output: 2200; monitor the patient for fluid volume overload D. Intake: 4005 mL & Output: 2270 mL; monitor the patient for fluid volume overload The answer is B. INSULIN

The different types of insulin and what insulin falls into each category. They are (remember them in order because the first one is the fastest and the last one is the longest): 

Rapid-acting (fastest)

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Short-acting

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Intermediate (medium acting)

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Long (longest)

Remember the phrase to help you remember which ones are the fastest and longest: Ready (rapid), Set (short), Inject (intermediate), Love (long)! Now how do you remember if Novolog is short or rapid or if Levemir is long or short? Remember the word INSULIN and play off of the word. Watch the video below on how to set-up the word.

Insulin Onset, Peak, and Duration Times Rapid-Acting Insulin: Onset: 15 minutes Peak: 1 hour Duration: 3 hours “15 minutes feels like an hour during 3 rapid responses.” Short-Acting Insulin:

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Onset: 30 minutes

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Peak: 2 hours

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Duration: 8 hours

“Short-staffed nurses went from 30 patient to (2) 8 patients.” Intermediate-Acting Insulin: 

Onset: 2 hours

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Peak: 8 hours

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Duration: 16 hours

“Nurses Play Hero to (2) eight 16 year olds.” Long-Acting Insulin: 

Onset: 2 hours

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Peak: NONE

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Duration: 24 hours

“The two long nursing shifts never peaked but lasted 24 hours.”...