It is mainly a measure of the urine output. The order for I&Os is one way to monitor if we ar… After receiving orders from the doctor on the regimen to be followed, the nurse obtains the first IV Fluid pack/bottle of the specified type from the pharmacy or floor stock. The regime is then reviewed taking into consideration the change in the patient’s condition. In the example below, the doctor provides a total of 3000 ml of IV fluid consisting of 2000 ml of Total Parenteral Nutrition Solution (in one bag) via the Central venous line and 1000 ml (in two 500 ml bags) of Normal saline with 2 gm of potassium added in each bag to offset for dehydration, hyponatraemia and hypokalaemia in the patient. Order and Plan if IV Infusion is to be Given at More than One IV Site. In clinical practice, this amount is not measurable and is called the insensible loss (actually it is the loss not measured). Tip: Aldosterone can also be stimulated by postsurgical … TPN therapy is indicated to a client with a weight loss of 10% the ideal weight, an inability to take oral food or fluids within 7 days post surgery, and hypercatabolic situations such as major infection with fever.TPN solutions requires water (30 … The remainder or amount left-over of any IV fluid or enteral fluid in the container is noted to be carried forward to the next shift in the “remainder” column. The trade-off is that the supply may be delayed. Intake Output Chart Guidelines 1. If you continue browsing the site, you agree to the use of cookies on this website. Feeds via gastrostomy and nasogastric tubes are usually given by intermittent bolus method. If the rest of the gastrointestinal tract is healthy, blended or homogenized food of any type can be given. Accurately measuring and recording fluid intake and output are important aspects of resident care. The water intake of a 50-90 kg adult person is about 2500 to 3000 ml per day or 2 ml/kg/hour. Besides the I-O chart, other clinical factors should be considered when fluid therapy is planned. A) 300 mL. There should be an order, a plan besides the recording of fluid intake and output. This arrangement is subject to policies of the hospital concerned. Normally the empty chart is pre-printed and the data is entered in ink. Ask this question during i… (See IUC criteria from the CDC.) At the beginning, the nurse records the following data in the Intake Chart: The nurse needs to ensure that the type of fluid being insfused is the same as the one ordered. Shift Total When More than One Route is Used. After reading the loss for the current period, she may use an ink marker or tape to indicate on the bag or bottle the level when it was last read. Nurses measure the intake and output using the metric system in units of milliliters (mL). However to avoid confusion, for recording of the Output only on one of the charts should be used (preferably the second one). Find PowerPoint Presentations and Slides using the power of XPowerPoint.com, find free presentations research about Intake And Output In Nursing PPT Instructions on Extra Label on the Pack/bottle. As they are with the patients in the hospital, it is essential to monitor the amount of fluid being taken in so that any risks to health can be dealt with promptly. The plan is often attached to the I-O chart both of which are placed together with the nursing observation chart usually clipped on to a clip-board or a file separate from the medical record. C) 1,300 mL. When an infusion pump is used, the volume is calculated by the machine based on the flow rate set by the nurse. Stool/faeces (only the occurrence of passage of stool is recorded. Fluid may be given also via an arterial line to keep it patent. It is only in situations where there is clear indication that the patient’s oral intake needs to be monitored and controlled that an I-O chart is indicated. The nature of the stool (consistency, colour) may also be indicated. Now customize the name of a clipboard to store your clips. The amount can be read from these markings or by emptying the entire content of the bag into a measuring jug when it is full or at the end of the shift or day. Thanks. I served as a doctor in primary, secondary and tertiary care with the Ministry of Health Malaysia from 1977 to 2011. Often, the right amount is not given if the line is obstructed or the rate becomes too fast. Nurses, wherever they work, have a vital role to play in the prevention, detection and treatment of AKI. the kitchen). This is not a deficit because it is not an abnormal loss. placed on a clip board. Other forms of fluid or semi-fluid may be discharged by the body. In the second method, reading is done and then the whole bag or bottle is emptied. Measurements of volume are in ml. The nurse, may write a plan that extends to the next working day but it is probably better to write a separate plan for the shifts of current nursing work day and another for the shifts that follows. Enteral feed formulas used for continuous infusion usually comes as sterile solutions in 1000 ml bottles. Strictly, doctors should order IV fluids for the duration that they are required. Intake and output nursing calculation practice problems for CNAs, LPNs, and RNs. Measure absolutely everything. 24 hours, the nurse must ensure that the rate of flow is set so that the intended amount will be infused. There are instances when fluid is given via more than one mode i.e. Another normal means of output of water is through evaporation of water from the skin and mucous membranes (mouth, throat, respiratory tract) and also through sweating. When the pack/bottle is finished in the middle of the shift, Night shift: 9.00 p.m. to 7.00 a.m. next day, to infuse fluids into two separate veins, or. Sometimes it is best to combine the order with the plan, Orders and plans must be for a defined period. ), Patients where intake needs to be limited (e.g. Nursing2002: July 2002 - Volume 32 - Issue 7 - p 17. Monitoring of Intake help care givers ensure that the patient has proper intake of fluid and other nutrients. The form used to record I/O is not user-friendly — i.e., they feature miniscule boxes, ‘total’ lines that do not correspond with shift changes and lack of instructions. Monitoring of output helps determine whether there is adequate output of urine as well as normal defecation. KCl is a dangerous drug and should be ordered with care. Complaints often received from Specialists & Doctors regarding calculation errors or no totalling of I/O. The shift total is made up by adding the total for each line. Allied Health & Medicine*Begin Class by reading . This includes anything that is liquid at room temperature like: 1. Enteral tube feeds may be given in two ways: For patients taking well orally and on a normal diet, an Intake-Output Chart is quite unnecessary. It is also good practice to clear the tubes with water or saline from time to time. When plasma potassium concentrations are high the adrenal cortex releases aldosterone which will increase excretion of potassium. Gravity driven drips via closed administration sets, A fistula originating from the jejunum or ileum, A draining tube inserted into a body cavity containing fluid. Nurses have an important role to play in discontinuing an IUC when it’s no longer needed. the fluid output including urine, discharges or drainage. All relevant particulars of the input and output data are charted in the appropriate time-interval (period) on the chart under the relevant the chart headings (column and row titles). There, the maintenance of hydration is hindered by complications arising from the patient's clinical condition, the poor assessment and documentation of hydration and a lack of staff time to monitor fluid intake (National Institute for Health and Clinical Excellence (NICE), 2007; National Patient Safety Agency (NPSA), 2007; Richards & Borglin, 2011). Monitoring a resident's fluid balance with an intake and output record (I & O) allows nursing staff to prevent dehydration, fluid retention, and other problems related to fluid imbalance. 21:5 in Red Book. The rate of infusion may be decided in the fluid intake / infusion plan. For this purpose, the type of chart chart used has separate sections for different sites so that the specific site (vein) the fluid is to be infused is specified. Part 1 focused on the two formulas used to calculate fluid resuscitation. Then, she/he needs to calculate the rate of infusion in ml/min and the equivalent drops per minute if a gravity driven drip set is used rather than an IV infusion pump. The remainder will be recorded again by the nurse in charge at the next shift as the starting amount. I was (but has since ceased to be) a fellow by examination of RCS Edinburgh and RCPS Glasgow. In effect the doctor writes the plan. Many hospitals pay intake nurses slightly more than a normal bedside nurse, because of the mix of skills the role requires and the experience level of the average intake nurse. In the clinical setting, the normal output can be measured only partially. Takeaways: 1. The intake output chart is a vital in patient care. The amount contributed by these two mechanisms is about 800-1200 ml (dependent on climate and environment). is not from 12 Midnight to 12 Midnight of the next day). 1. Patient can demonstrated the knowledge about intake and output … I&Os are ordered to measure a patient’s fluid balance. Nursing Diagnosis Goal Nursing Intervention Evaluation Deficit Knowledge about intake and output chart. Few studies are available about self‐reported water intake and urine output. I served as invited lecturer and taught undergraduate and postgraduate students at various medical faculties (UITM, UKM and USM) in Malaysia. Equipment . Therefore, he /she has ordered 1000 ml of 0.9% Sodium Chloride in 5% Dextrose. If an infusion pump is used, the amount given as indicated on the machine is read from it. She/he then records the amount that the patient actually takes. Periods In Intake Output Planning and Charting. 3. If a syringe is used with a pump, then the amount set up would be the amount drawn into the syringe (usually 50 or 100 ml). • Monitor clients receiving sodium bicarbonate for fluid vol-ume excess. 30 ml/hour while the rest of the fluid is given by the intravenous route. There are instances when more than one IV infusion site is used  i.e. 5. Clipping is a handy way to collect important slides you want to go back to later. Clients should be educated and instructed about the purpose of TPN, their need for TPN, the procedure that will be used to insert the TPN catheter, how the total parenteral nutrition feedings will be delivered, how the nurse will care for and maintain these feedings, the necessity to use sterile technique, and the risks, including the complications, of total parenteral nutrition, as discussed immediately above .Total parenteral nutrition, or hyperalimentation, is delivered throu… is not from 12 Midnight to 12 Midnight of the next day). He/she has also indicated that 1 gm of KCl is to be added to 3 of the solutions ordered. Drinks (coffee, soft drinks, tea etc.) When IV fluid is to be given, the recommended fluid intake is usually ordered by doctors. The order itself is often written in the continuation sheet of the Medical Record as part of the treatment plan. This amounts to 1000-1500 ml per day in a normal adult. Some 300 ml of water is also excreted together with faeces and is also not usually measured. To enable her to make the next reading, she may indicate the level at which last measurement was made – on the bag with a marker or tape. Gelatin (Jell-O ®) 7. F. Remember to use basic conversions from … The aim of this study was to assess the quantity of water intake and urine output in 24‐h period in healthy young individuals. Charting is then started on a new form. In cases of diarrhoea, significant amount of fluid may be lost with the stool. At the end of the patient’s stay, the charts should be reincorporated as part of the Medical record. I am a life member of the Malaysian Society for Quality in Health, Malaysia; a society I helped establish and served as a Hospital Accreditation surveyor for many years. If urine output is to be measured hourly, then the use of the standard I-O chart may not be suitable (too many rows required). In a closed drainage system changing the whole drainage bag/bottle at every shift is not done. When providing and monitoring fluid intake and output, clinical care providers use two types of forms/charts, one for purposes of planning and the other for recording findings. • Maintain accurate intake and output records. A gastrostomy is done to bypass the mouth and esophagus in cases of inability to swallow, obstruction or injury to the aesophagus. In this example, the doctor intends to give the patient 2500 ml of fluid (the normal daily requirement) in 24 hours. Juice 2. The same form for ordering and planning as shown above may be used. Workflow Chart for Starting and Recording IV Infusion by Nurse Using Ward Stock. A proper IV fluid order would indicate the type of fluid to be given, the starting time, the period it is to be administered. The content of the formulations depends on the types of disease. Elemental Formula these are usually proprietary formulas where food substances supplied are those that are broken down into simple elements which are easily absorbed (protein in the form of amino acids, , sugar as glucose or dextrose and fat as fatty acids). The urinary drainage bag denotes a total of 1,000 mL for the past 24 hours. I am a retired surgeon, currently offering consultancy services in Information Management in Health Care Services. - A detailed account of the patient’s fluid intake and output should be taken. It is important to document the Name of the Patient, the Registration number / Medical record number and the (starting) date for which the chart is used. Two approaches can be taken in this siuation (just as for when fluid is given via two IV sites). This is recorded at a supplementary section at the bottom of the chart. 2. The nurses are trained on how to ensure that the right concentration is given and the aseptic technique is followed. They would also prefer to determine the periods of feeding rest and clearance of the tubes. Where IV infusion has been started on a previous shift, the nurse would record the amount of fluid left in the pack/bottle as the amount carried over. Note if the edema is pitting or nonpitting and grade pitting edema. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Report an im-balance of 24-hour totals and/or urine output less than 30 mL/hour. In the monitoring of Intake and output the following need to be taken into consideration: Enter your email address to follow this blog and receive notifications of new posts by email. In this chart, the width of the column is compromised and abbreviations may be used. The Intake-Output chart is so named because on one side is the Intake and the other the Output. For enteral feeds, because of the methods involved, it is easier for the doctor or dietitian to just order and for the nurse to plan the route, intervals, frequency and rate. The charting of  intake of fluid given by continuous enteral feeding (i.e. Orders Jejunostomy Feeds by Doctor or Dietitian. However, the finish time need not be recorded; assuming that, in a continuous infusion, after the last pack/bottle finishes.the next  one is put up immediately. When two main sections are used, the total for each section is added to give the shift total. The assumption is also made that the nurse knows she should add only 1 gm of KCL per 500 ml of fluid. In this way the remainder in the bottle/container is used for the next shift and not wasted. B) 1,000 mL. The chart used for this purpose is as shown below: Urine output in an adult is between 1000 to 1500 ml per day. The amount at the end of a shift is calculated by subtracting the amount of the previous reading from the accumulated amount. . In the example below, instruction is given at rate of 100 ml/hr to finish the 500 ml bottle at 12 noon. These include: The time of measurement for each output is written on a separate row unless it coincides with the time when the input was recorded. In between feeds, the tube is closed with a spigot and patients can move about if they are able to. The nurse checked with Nita, the nursing assistant, regarding the … How the data is transferred from the order to the plan and then onto the chart will be discussed later. Milk 6. In normal circumstances, if too much urine is produced the commonest reason is that more fluid than what is required has been given to the patient. However, most hospitals make it a rule that only pharmacists are allowed to mix items such as parenteral nutrition and cytotoxic drugs. D. It may be necessary to convert intake from household measures of containers to mL to calculate Intake and Output (I & O) E. Remember: intake includes ANY food item which is liquid at room temperature (example: popsicles or ice cream.) Body fluid is located in two fluid compartments: the intracellular space and the extracellular space. In order to avoid physiological complications, Nasoduodenal, Nasojejunal and Jejunostomy feeds are best given via continuous infusion using infusion pumps. If a patient becomes fluid overloaded, heart failure may result. Teach the patient to report any sign of dehydration or edema. However, it must be remembered that most of the accumulation is in the small intestine. Sometimes, especially in children the amount of loss due to diarrhoea is estimated. If the fluid flow is by gravity and the flow rate is controlled by a flow regulator (in drops/min), then the amount infused is calculated as amount set up minus the amount left in the pack. Special formulas that are elemental formulas with some elements increased or added or reduced or removed. Ice cream 9. For providing the normal requirements for water, it is common practice to order 1/5 Normal saline in Dextrose 5 % at a rate that will provide the volume and sodium required (in both adults and children). Normal saline, Dextrose 5%, Normal Saline in Dextrose 5% or parenteral nutrition solution) is then recorded. The frequency, periods of delivery and rest are usually planned by nurses. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Normally, nurses copy the orders into another sheet and converts it into a plan used as a guide to administer the infusion. In children this amount is significant enough to be recorded. To meet the daily fluid and calorie requirements of adults 2500 ml (two and a half bottles may be required). Indications include: For oral feeds, depending on circumstances, the doctor or nurse may decides on how much fluid to be given and how frequently. Assessment . I graduated with MBBS from University of Malaya in 1977. After surgical operations, drains may be inserted into abdominal or thoracic cavity and abscess or cyst cavities to facilitate drainage of secretions or discharges such as blood, serum or pus. The nurse provides the desired amount to the patient in a container (e.g. Measurement of the output is made by transferring the content into a measuring–container or aspirated with a syringe. A nurse monitoring the intake and output of fluids for a patient with severe diarrhea knows that normally how many mL of body fluids is lost via the gastrointestinal tract? The instances when the nurse needs to enter (write down) data into the chart include: The nurse enters the actual time that she starts the infusion rather than the time planned. In practice, KCl may be supplied by the pharmacy in gm per vial (usually 1 gm per vial equivalent to 13 mEq) or in meq per vial (usually 10 mEq per vial). A nurse explains the homeostatic mechanisms involved in fluid homeostasis to a student nurse. Charting Intake when Fluid Is Given by Both IV and also Enteral Route. This part discusses the nurse’s role in managing patients with burns. Elevate the head of bed at 35 to 45 degrees, unless contraindicated. When a certain amount is planned for a period, e.g. Otherwise, she can also subtract the reading of the previous level from the level at the time of the current reading. Chart with Sections for Two Sites of Administration (for one shift). If all or most of the feed is not passed on or retained, this will indicate that there is problem with gut motility or absorption. Liquid formulations of protein, sugar and fat usually milk-based. The above form may be used for ordering and planning for infusion via a different set piggy-backed to the first set. However, issues arise when additions like electrolyte such as Potassium or drugs such as inotropes (dopamine, dobutamine), heparin and antibiotics need to be added. Urine output may need to be measured at the end of a shift or more often (e.g.
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