INTAKE AND OUTPUT

One of the most basic methods of monitoring a client's health is measuring intake and output , commonly called I and O. By monitoring the amount of fluids a client takes in and comparing this to the amount of fluid a client puts out. The health care team can gain valuable insights into the client's general health as well as monitor specific disease conditions.

INTAKE
- all those fluids entering the client's body such as water, ice chips, juice, milk, coffee and ice cream. Artificial fluids include: parenteral, central lines, feeding tubes, irrigation and blood transfusion.

OUTPUT
- all fluid that leaves the client's body such as: urine, perspiration, exhalation, diarrhea, vomiting, drainage from all tubes and bleeding.

An accurate record of a client's fluid balance is an important nursing function.

Equipments:

- I & O form at bedside
- I & O graphic record in chart
- Pencil and paper
- Calibrated drinking glass
- Bedside pan, commode or urinal
- Calibrated container to measure outputs
- Weighing scale
- Non-sterile gloves
- Sign at bedside stating patient is for I & O monitoring

Ideal Daily fluid Intake and Output

Source/ AMOUNT/ Route/ AMOUNT
H2O consumed as fluid/ 1500ml/ urine/ 1400-1500ml
H2O present in food/ 750ml / insensible losses/ 350-400ml
H2O produced by oxidation/ 350ml / lungs/ 350-400ml
skin / 100ml
sweat/ 100-200ml
feces /
TOTAL/ 2600ml/ TOTAL/ 2300-2600ml

Purpose:
- helps evaluate client's fluid and electrolyte balance
- suggests various diagnosis
- influence the choice of fluid therapy
- document the client's ability to tolerate oral fluids
- recognize significant fluid losses

Mandatory for clients with burns, electrolyte imbalance, recent surgical procedure, severe vomiting or diarrhea, taking diuretics or corticosteroids, renal failure, congestive heart failure, NGT, drainage collection device and IV therapy.

Deviations:
Other sources of fluid loss and excessive losses from normal routes:
- drainage from catheter or tubes
- vomitus
- diarrhea
- diaphoresis
- hemorrhage
- ileostomy/ colostomy drainage
- excessive urine output

Average daily water requirement by age and weight:
AGE/ ml/ BODY WEIGHT ml/kg
3 days/ 250-350ml/80-100
1 year/ 1150-1300ml/ 120-135
2 years/ 1350-1500ml/ 115-125
4 years/ 1600-1800ml/100-110
10 years/ 2000-2500ml/70-85
14 years/ 2200-2700ml/ 50-60
18 years/ 2200-2700ml/40-60
adult /2400-2600ml/ 20-30

Nursing Intervention:
Intervention/ Rationale

1. Ideally intake and output should be monitored/ To obtain an accurate record
2. In critical situations, intake and output should be monitored on an hourly basis/ Urine output less than 500ml in 24 hours or less than 30cc/hour indicates renal failure
3. Daily weights are often done/ Indicate fluid retention or loss
4. Identify if patient undergone surgery or with medical problem / May affect fluid loss
5. Make sure you know the total amount and fluid sources once you delegate this task/ To get an accurate measurement
6. Record the type and amount of all fluids and describe the route at least every 8 hours
7. If irrigating a nasogastric or another tube or bladder, measure the amount instilled and subtract it from the total output/ To get exact amount
8. Keep toilet paper out of client urine output/ For an accurate measurement
9. Measure drainage in a calibrated container and observe it at eye level.

A significant change in a client's weight or a significant difference in a client's total intake and output should be reported immediately to the physician.

WEIGHT CHANGES
- mild dehydration- 2 to 5% loss
- moderate dehydration- 6 to 9% loss
- severe dehydration - 10 to 14% loss
- death- 20% loss

- mild volume overload- 2% gain
- moderate volume overload - 5% gain
- severe volume overload - 8% gain

Clinical Signs of Dehydration:
- dry skin and mucous membranes
- concentrated urine
- poor skin turger
- depressed periorbital space
- sunken fontanel
- dry conjunctiva
- cracked lips
- decreased saliva
- weak pulse

Client's signs of fluid excess:
- peripheral edema
- puffy eyelids
- sudden weight gain
- ascites
- rales in lungs
- blurred vision
- excessive salivation
- distended neck vein


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