Intake and Output Monitoring

Intake

Is any measurable fluid that goes into the patient's body. Intake includes fluids (such as water,
soup, and fruit juice) and "solids" composed primarily of liquids (such as ice cream and gelatin)
that are taken by mouth (orally), fluids that are introduced by IV, and fluids that are introduced by
irrigation (through a tube)

Output

Is any measurable fluid that comes from the body. Water given off in the form of perspiration and
water vapor (exhaled breath) is also output, but it is not recorded on the DD Form 792, since it
cannot be accurately measured. (An adult usually looses about 500 milliliters (ml) a day through
perspiration and moisture exhaled in breathing.) The major forms of output recorded on the
worksheet are urine, drainage, vomitus (matter vomited), and stools (fecal discharge from the
bowels).

You should monitor client who have fluid imbalances or are at high risk of dehydration by
calculating intake and output (I&O) each shift. Take I&O monitoring seriously. Set a realistic
intake goal for each shift. Most fluid is consumed on the day shift, with the least consumed on
nights. Thus, set a specific goal for each shift. Setting a goal will tell the nurse at a glance
whether the client has consumed enough fluid on his or her shift. If not, the CNA should
encourage fluids before leaving for the day. When establishing goals for fluid intake, fluid is
usually divided as follows:

* Day shift: 1/2 of total 24-hour fluid goal

* Second shift: 1/3 of total 24-hour fluid goal
* Third shift: 1/6 of total 24-hour fluid goal

For client with a fluid restriction, total fluid allowance for each shift can be distributed in the
same quantity listed above. Modify the amounts listed as necessary to personalize fluid intake to
the client’s individual needs.

I&O monitoring is a simple procedure that does not require a physician’s order. Sadly, nurses
sometimes do not take this important intervention seriously. Write the need for I&O monitoring,
as well as any special approaches or resident preferences, on the care plan. If the clients is known
to be at high risk of dehydration upon admission, begin a temporary care plan to address this risk.

Facility personnel should routinely monitor fluid balance (I&O) for the following:

 All clients receiving tube feedings

 Clients with catheters
 Clients with urinary tract infections
 Clients with physician orders for fluid restrictions or orders to force (encourage) fluids
 Clients with specific physician orders for additional liquid (fluid)
 Clients who are known to be dehydrated or who are at risk for dehydration
 Clients with certain heart and kidney conditions that are at high risk for fluid imbalance
 Clients receiving intravenous fluids or parenteral nutrition therapy
  Any clients who develops a fever, vomiting, diarrhea or a nonfebrile infection,
unexplained weight loss or gain, pedal edema, neck vein distension, or shortness of
breath.

CLINICAL DO'S & DON'TS

INTAKE AND OUTPUT gauge fluid balance and give valuable information about your patient's
condition.

DO

 Identify whether your patient has undergone surgery or if he has a medical condition or
takes medications 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.

 Record ice chips as fluid at approximately half their volume.

 Record the type and amount of all fluids the patient has lost and the route. Describe them
as urine, liquid stool, vomitus, tube drainage (including from chest, closed wound
drainage, and nasogastric tubes), and any fluid aspirated from a body cavity.

 If irrigating a nasogastric or another tube or the bladder, measure the amount instilled and
subtract it from total output.

 For an accurate measurement, keep toilet paper out of your patient's urine.

 Measure drainage in a calibrated container. Observe it at eye level and take the reading at
the bottom of the meniscus.

 Evaluate patterns and values outside the normal range, keeping in mind the typical 24-
hour intake and output. (See Fluid Gains and Losses.)

 When looking at 8-hour urine output, ask how many times the patient voided, to identify
problems. For example, was a total of 300 and from 2 voids of 150 ml, or from 10 voids
of 30 ml each?

 Regard intake and output holistically because age, diagnosis, medical problem, and type
of surgical procedure can affect the amounts. Evaluate trends over 24 to 48 hours.

DON'T

 Don't delegate the task of recording intake and output until you're sure the person who's
going to do it understands its importance.
  Don't assess output by amount only. Consider color, color changes, and odor too.

 Don't use the same graduated container for more than one patient.0

Fluid gains and losses

The following are typical 24-hour values for an adult.

Intake 2,600 ml

1,300 ml oral fluids

1,000 ml in food

300 ml in oxidation of food

Output 2,400 to 2,700 ml

1,500 ml urine

200 ml in stool

400 to 600 ml through the skin

300 to 400 ml through respiration

Measure ............................................................................…... Approximate equivalent

Cubic centimeter...................................................................... 1 ml
Teaspoon ................................................................................. 5 ml
Tablespoon............................................................................... 15 ml
Ounce ...................................................................................... 30 ml
Medicine Glass (1 oz.) ............................................................ 30 ml
Small Fruit Cup ....................................................................... 120 ml
Coffee Cup .............................................................................. 160 ml
Large Coffee Mug ................................................................... 180 ml
Plastic or Paper Juice Container .............................................. 180 ml
Half-pint Milk ......................................................................... 240 ml
Large Soup Bowl ..................................................................... 240 ml
Large Water Glass.................................................................... 240 ml
Pint ........................................................................................... 480 ml
1/2 Liter ................................................................................... 500 ml