Questions and Answers
What is intake and output?
Measurement of all fluids that go in the body (intake) and all fluids that come out of the body (output).
What is the purpose of measuring intake and output?
To assess fluid balance and evaluate nursing care.
What is considered part of intake?
What is output?
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What variables affect intake and output?
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What are indications for monitoring intake and output?
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How should intake and output be measured?
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What sources contribute to intake?
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Where should recording of intake and output take place?
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What should be done when measuring urine for continent patients?
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How do you measure intake per tube?
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What is a key method to be more accurate in measuring I&O?
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What do we do with the results of intake and output measurements?
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Study Notes
Definition of Intake and Output
- Intake refers to all fluids entering the body, while output includes all fluids leaving the body.
- Important for assessing fluid balance and evaluating nursing care.
Intake Details
- Includes water, fluid beverages, and solid foods.
- Normal intake ranges from 2,000 to 3,000 ml/day.
Output Details
- Comprises urine, feces, and insensible water loss (approximately 900 ml/24 hours).
- Total normal output also falls between 2,000 to 3,000 ml/day.
Factors Affecting Intake and Output
- Environmental temperature, body temperature, level of sweating, respiratory rate, vomiting, diarrhea, and issues with fluid regulation due to renal, cardiac, or endocrine dysfunctions.
Clinical Indications for Monitoring
- Standard practice in settings like ICU and telemetry units.
- Essential for patients with heart disease, kidney disease, endocrine disorders, edema, or those on IV fluids, drains, or with gastrointestinal suction.
- Includes patients experiencing vomiting, diarrhea, or those under NPO status, as well as those with fluid restrictions or on diuretics.
Measurement and Documentation
- I&O must be documented in milliliters.
- Conversions: 1 oz = 30 ml; 1 cup = 240 ml.
- Sources of intake include oral fluids, IV fluids, medications, and tube feedings; output sources encompass diarrhea, vomiting, and drainage from catheters and tubes.
Recording Process
- Utilize a worksheet in the patient's room for ongoing documentation.
- Record oral intake continuously; document IV and tube feedings at the end of the shift.
- Ensure Foley catheters and drains are emptied at end-of-shift and accurately recorded.
Measuring Urine Output
- For continent patients: use toilet, bedside commode, or calibrated measuring containers for bedpans.
- Incontinent patients require checks every 2 hours; catheter bags need to be drained into a calibrated container when recording.
Measuring Oral Intake
- Provide patients with calibrated drinking cups.
- Include all liquids at room temperature in intake calculations, such as gelatins and broth soups, but exclude thick soups.
Measuring from Tubes
- For tube feedings, record bolus feeding volumes immediately.
- Continuous feedings require total infusion volumes to be documented at the end of the shift.
Drainage Measurement
- For drains (like NGT), mark canisters at each shift's end to accurately measure and document changes.
- Employ appropriate measuring tools for wound or surgical drains.
Accuracy Recommendations
- Prioritize precise measurement; avoid estimation.
- Educate the patient, family, and staff to ensure compliance and accuracy in reporting.
Analyzing Results
- Calculate total intake and output; compare the differences.
- Allow a +/- 500 ml variance as acceptable, utilizing critical thinking to communicate findings effectively with the healthcare team.
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Description
This quiz focuses on the concepts of intake and output in nursing care. It covers definitions, purposes, and specific measurements related to fluid intake and output. Perfect for nursing students or healthcare professionals seeking to reinforce their knowledge.
