Topic 3.

Intake and Output (I&O) • Congestive heart failure

Water is essential for life and • In case of dehydration
maintaining the correct balance of fluid • Decreased or little urine output
in the body is crucial to health. • Dry mucous membrane
Measuring intake and output chart is • Any bleeding
one of the most basic methods of • Excessive perspiration
monitoring a client’s health. Accurate 24 • Dark concentrated urine
hours measurement and recording is an
essential part of patient assessment. In Importance of measuring fluid I&O
critically ill patient, it becomes very
important to accurately record fluid
intake and output for proper evaluation
and control of fluid balance. Accuracy in
recording fluid intake and output is vital
to the overall management of certain
patient groups and facilitate correct
prescribing of intervention and
subcutaneous fluids.

• It is defined as the measurement

and recording of all fluid intake and
output during a 24-hour period. It
provides important data about the • Physician diagnosis and treatment
client’s fluid and electrolyte balance. may depend on accurate
• Unit of measurement of intake and measurement of I&O.
output is mL (milliliter) • Measurement of I&O can monitor
• To measure fluid intake, nurses progress of treatment or of a
convert household measures such disorder
as glass, cup, or soup bowl to metric • This provides information about
units. retention or loss of sodium and
• Gauge fluid balance and give ability of the kidneys to concentrate
valuable information about your or dilute urine in response to fluid
patient’s condition. change
• It helps determine the patient’s fluid
Purpose of I&O calculation status:
• Ensure accurate record keeping o Are they hydrated?
• Prevent circulatory overload o Are they dehydrated?
o Is there fluid overload?
• Prevent dehydration
o Is there an obstruction?
• Aids in analyzing trends in fluid
status
What to consider for patient’s intake?
• Contributes to accurate assessment
• Oral fluids
record
• Yogurt
Indication of I&O chart • Jelly (JELL-O)
• Fluid and electrolyte imbalance • Ice chips (melts to half its volume)
• Kidney impairment • Foods that tend to become liquid at
room temperature
• In case of dialysis patient
• Tube feedings
• Client’s with burns
• Parenteral fluids
• Recent surgical procedure
• Intravenous medications
• Severe vomiting or diarrhea
• Intravenous and tube feeding
• Taking diuretics or corticosteroids
• Catheter or tube irrigants
What to consider for patient’s o Regard intake and output
output? holistically because age,
• Urine diagnosis, medical, problem, and
• Vomitus and liquid feces type of surgical procedure can
• Tube drainage affect the amounts. Evaluate
• Wound drainage and draining trends over 24 to 48 hours.
fistulas
• DONT'S
Clinical Do’s and Dont's o Don’t delegate the task of
• DO’S recording intake and output until
o Identify whether your patient has you’re sure the person who’s going
undergone surgery or if he has a to do it understands its
medical condition or takes importance.
medication that can affect fluid o Don’t assess output by amount
intake or loss. only. Consider color, color
o Measure and record all intake and changes, and odor too.
output. If you delegate this task, o Don’t use the same graduated
make sure you know the totals and container for more than one
the fluid sources. patient.
o At least every 8 hours, record the
type and amount of all fluids the
patient received and describe the
route as oral, parenteral, rectal, or
by enteric tube.
o Record ice chips as fluid at
approximately half their volume.
o Record the type and amount of all
fluids the patient has lost and the
route. Describe them as urine,
liquid stool, vomitus, tube drainage
and any fluid aspirated from a
body cavity.
o If irrigating a nasogastric or
another tube or the bladder,
measure the amount instilled and
subtract it from total output.
o For an accurate measurement,
keep toilet paper out of your
patient’s urine.
o Measure drainage in a calibrated
container. Observe it at eye level
and take the reading at the bottom
of the meniscus.
o Evaluate patterns and values
outside the normal range, keeping
in mind the typical 24h-hour intake
and output
o When looking at 8-hour urine
output, ask how many times the
patient voided, to identify
problems.
Intake and Output Sheet of San Pedro Hospital

Note: You can place emesis or other discharges on the “others” column. 3/11 nurse on duty is
the one who closes the computation in San Pedro Hospital.

Learning Activity: Compute for the total Intake and Output

You are assigned to a 9-year-old female patient. Upon receiving her at 7am, you observed that
she has a foley catheter attached to a urobag. You asked her when was the last time her urine
bag was emptied. She replied that it was around 3am this morning. So, you drained it and noted
that the urine level was approximately 300cc. You also observe that she has an IVF line of
D5LR iL at 80cc/hr (microset) at 700mL level. At 8:30am, she reported to drink 100cc of orange
juice. After 3 hours, she vomited approx. 87mL of coffee ground emesis. At the end of your shift
(3pm), her urine bag was noted to have 90 cc of urine and her IVF is at 50 cc level.