Intake and OutputUnit 20.5

pages 728-733

LEQ: What does a patients I/O record tell you about

their overall health?

Why are they so Important??• It helps us determine the patient’s fluid

status:

• 1. Are they Hydrated?

• 2. Are they Dehydrated?

• 3. Are they in Fluid Overload?

• 4. Is there an obstruction?

Intake1. Oral Fluids: Water, Ice, Beverages

2. Semi-Liquid Foods: Pudding, Jell-O, Custards, Yogurt

3. Parenteral Fluids: IV Fluid, Medications, Blood Products

4. Any Food Liquid at Room Temperature: Popsicles, ice cream, and frozen yogurt

Measuring Output

• Emesis Basin

• Foley Catheter

• Graduated Cylinder

• Urinal

• Fractured Bedpan

• Estimates ( Unless Strict I/O is Ordered)

Urine Identificationpage 603

• Straw Colored (WNL)

• Dark Orange or Yellow (Concentrated)

• Foul Smell (UTI)

• Sediment (UTI or Kidney Failure)

• Blood (Severe UTI, STD, Hemorrhage)

Output1. Urine: Normal Voiding, Diapers,

Ostomies, Ileal Conduits

2. Stool: Liquid Stools from Diarrhea

3. GI Suctioning

4. Wound Drainage

5. Vomiting

6. Sweating

7. Respirations

Items to Keep in Mind

• Measure Fluids instead of guessing• Estimate and Record Fluid Loss from

Incontinence (1oz = 30cc)• Record and Report the Intensity of

Diaphoresis• Record Ice Chips Appropriately ( It is

usually ½ the Volume of Fluid)• Use the Code Key Provided for You

What To Look Out For

• 1. Is the patient drinking at least 1500cc a day (Unless they are on Fluid Restrictions)

• 2. Urinates at least once in an 8 hour shift or urinate less than 30 cc an hour (240cc/8hrs)

• 3. Has concentrated or foul-smelling urine

• 4. Has Dry Skin

• 5. Has a temperature above 99 degrees

• 6. Is perspiring excessively

• 7. Has excessive wound Drainage

Possible Causes of Fluid Excess• Kidney Disease• Liver Disease• Certain Medications : Steroids or a Sodium

Based Medication• Abnormal Fluid Accumulation in Body

Cavities• Overinfusion of IV Fluids• Pregnancy

Signs and Symptoms of Fluid Excess

• Edema or Ascites: Abnormal accumulation of fluid in the spaces between the cells (interstitial)

• Rapid Weight Gain: Fluid Accumulation will increase overall weight

• Increased Blood Pressure: May indicate accumulation of fluid within the circulatory system

• Taut Skin: Shinny Skin may indicate Edema

• Shortness Of Breath: Excess fluid pools in the lungs

Possible Causes of Fluid Loss

• 1. Hypovolemic Shock

• 2. Excess Body Drainage

• 3. Diarrhea

• 4. Medications (diuretics)

• 5. Difficulty Swallowing

• 6. Impaired Physical Mobility

• 7. Postoperative Factors

• 8. Fever

Other Causes and Signs and Symptoms of Fluid Loss1. Concentrated Urine: The body excreting more solutes

and less water2. Rapid Weight Loss: A large percentage of weight is

fluid (as seen with High Protein Diets)3. Increased Pulse: Low Fluid Volumes cause an

increase in Heart Rate4. Decreased Skin Turgor: Loss of elasticity of the skin

due to a lack of proper hydration5. Dry Skin: Reflects fluid loss from cells6. Sticky Mucus Membranes: Reflects fluid loss in

normally moist tissue7. Weakness and Confusion: Lack of fluids can interfere

with normal nerve conduction and decreases circulation to the brain

Things to Remember Taking I&O’s• Collect and record all I/O as it occurs and do not

rely on memory recall at the end of a shift• Measure contents in the appropriate containers and

read at eye level. • Remind patients to let you know if they have taken

in anything or voided• Usually totals are taken at the end of a shift, but

keep in mind that frequent checks can increase the accuracy of I&O’s

• Document in the appropriate area and remember to Be Accurate

• Report any questionable output or drastic changes in the patients condition

•LEQ: What does a patients I/O record tell you about their overall health?

Clinical PrepCharacteristics of Urine page 603

Copy Table 18.1 down in your notes and be prepared to use it to identify various characteristics of Urine Specimens tomorrow along with being able to document the output.

• Identify: Urinal, Hemovac, Emesis Basin, Graduated Cylinder, Foley Catheter, Fractured Bedpan, and Bedpan

20.5 Clinical PrepCharacteristics of Urine page 603• On a blank sheet of paper, number 1-15.

Using your chart, analyze the URINE Specimens by writing down the:

– a Amount in cc’s (ALL SAMPLES)

– b Characteristic of the Sample

– c Hydrated vs Dehydrated (5-15)

– d Possible Diagnosis

• Transfer the Intake and Output from Assignment Sheet #2 for 20.5 B Recording Intake and Output onto the I/O Record at the end of your packet. Bring this with you to class Friday